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Pre diabetes or not

S

Suedon

Member
Relationship to Diabetes
At risk of diabetes
Have been reading and learning a lot on this board. Appreciate all the information given. My question is this… Hb A1c was 6.0 in Aug last year. Worked on diet which was quite healthy but cut out most treats and it was 5.8 in early Dec.
Thought I was doing well but back to 6.0 in early March this year. I have no family history, swim and walk regularly and BMI low normal.
I have had mild anemia for many years with hemoglobin sub par but Ferritin in normal range. Iron supplements didn’t make much difference. Testing didn’t produce any other blood diagnosis. Also have chronic insomnia . I am 76 years. Possible risk factors.
I asked to be referred to the local Diabetes clinic where I had a one hour visit with Dietitian. I was told there is no diagnosis without an abnormal fasting blood sugar as well as the A1c in prediabetes range. This was then done and was 4.6 same as six years ago .
In all my reading I’ve never heard that you need both tests to be out of normal range for diagnosis. Has anyone else heard this?
According to the clinic I’m not pre diabetic. Not sure how to continue as I don’t have a follow up with them.
Also have been baking with almond flour and cookie and bread recipes on sugarfreelondoner web site. Has anyone found these to raise blood sugar? I don’t overdo it but do enjoy one after dinner.
Since cutting carbs I’ve lost 14 lbs which I didn’t want or need to lose
Thanks for response.
 
6.0 is roughly 42 so only just in the pre-diabetes zone. However, I’m sure the recommended HbA1C for older people is higher. If your BMI is low normal and you’ve already lost 14lbs that you didn’t need to, then in your position my priority would be maintaining a healthy weight for good general health. I wouldn’t worry about that 42.
 
The diagnostic threshold for older people is suggested as being higher unless they have other conditions which put the in an at risk category and a personalised plan should be agreed with your nurse and yourself.
It is important to eat a healthy diet with plenty of protein and healthy fats to maintain your weight. I would think that by cutting your carbs without doing that has likely led to the unneeded weight loss.
Anaemia can make the HbA1C test not quite accurate so I wouldn't worry about a small variation.
Quoting HbA1C in the old units of % makes me think your surgery is a bit behind the times and may not be aware of the NICE guidelines for more mature people and the diagnostic threshold.
 
Welcome to the forum @Suedon

It’s slightly unusual for people to be given HbA1c in ‘old money’ these days (the UK officially switched away from % units to the IFCC standardised mmol/mol units in 2009!). The Diabetes UK website has a converter on their HbA1c overview page here which might help other forum members understand your results?

What is HbA1c?

HbA1c is your average blood glucose (sugar) levels for the last two to three months. If you have diabetes, an ideal HbA1c level is 48mmol/mol (6.5%) or below. If you're at risk of developing type 2 diabetes, your target HbA1c level should be below 42mmol/mol (6%).
www.diabetes.org.uk www.diabetes.org.uk

I wonder whether your anaemia is being interpreted as making your HbA1c difficult to interpret (anaemia can make HbA1c less reliable). The diagnostic criteria outlined here do mention using fasting glucose as an additional piece of the puzzle?

cks.nice.org.uk

Diagnosis in adults | Diagnosis | Diabetes - type 2 | CKS | NICE

Diagnosis in adults, Diagnosis, Diabetes - type 2, CKS
cks.nice.org.uk cks.nice.org.uk
 
I should explain further. I am a born and bred Mancunian living in Canada. The NICE website won’t allow access to those outside UK etc. I would love to know what it says about older adults Hb A1c.
I eat lots of protein and overall a very healthy diet. Probably need more carbs as I often felt hungry on the low carb diet.
 
Ah! Apologies I hadn’t realised you were posting from overseas (we have a few Canadian and US-based members).
 
Suedon said:
I would love to know what it says about older adults Hb A1c.
Click to expand...

There’s a section of the Guidance for T2 Diabete Management in Adults that talks about the importance of individualising the approach, based on the person eg

1.1 Individualised care​

1.1.1 Adopt an individualised approach to diabetes care that is tailored to the needs and circumstances of adults with type 2 diabetes, taking into account their personal preferences, comorbidities and risks from polypharmacy, and their likelihood of benefiting from long-term interventions. Such an approach is especially important in the context of multimorbidity. [2015, amended 2022]​
1.1.2 Reassess the person's needs and circumstances at each review and think about whether to stop any medicines that are not effective. [2015]​
1.1.3 Take into account any disabilities, including visual impairment, when planning and delivering care for adults with type 2 diabetes. [2015]​

And later, regarding HbA1c:

1.6.5 Discuss and agree an individual HbA1c target with adults with type 2 diabetes (see recommendations 1.6.6 to 1.6.10). Encourage them to reach their target and maintain it, unless any resulting adverse effects (including hypoglycaemia), or their efforts to achieve their target impair their quality of life. Think about using the NICE patient decision aid on weighing up HbA1c targets to support these discussions. [2015, amended 2022]​

And

1.6.9 Consider relaxing the target HbA1c level (see recommendations 1.6.7 and 1.6.8 and NICE's patient decision aid) on a case-by-case basis and in discussion with adults with type 2 diabetes, with particular consideration for people who are older or frailer, if:​
  • they are unlikely to achieve longer-term risk-reduction benefits, for example, people with a reduced life expectancy
  • tight blood glucose control would put them at high risk if they developed hypoglycaemia, for example, if they are at risk of falling, they have impaired awareness of hypoglycaemia, or they drive or operate machinery as part of their job
  • intensive management would not be appropriate, for example if they have significant comorbidities. [2015, amended 2022]

Which reflects evidence that HbA1c naturally rises as people get older. There was a discussion on the forum about that a while back, but I can’t quickly find it.
 
The above talks about people with type 2 diabetes. I am not in that category. I do know others my age with that diagnosis whose target is below 7.
I have researched rising A1c in older adults and while several studies agree the range could be extended there is no agreement yet on doing it. Too many variables?
I was put in the highest range of fitness for my age group. I believe here they do give a higher A1c for frail elderly but it’s negotiated rather than Set in stone. I anticipate changes as the science progresses.
I was hoping to learn that UK had a higher A1c for fit elderly in my age group with pre diabetes.
 
#10 is an interesting read with significant differences for the elderly with diabetes compared to younger diabetics. Very little of it speaks to pre diabetes. I’m still unsure if I am pre diabetic but the Diabetic clinic said I am not due to normal FBS. I did read one article which said pre diabetes seldom progresses to diabetes in the elderly.
I suppose healthy eating is the way forward until my next bloodwork.
Thanks for all replies.
 
Suedon said:
I was hoping to learn that UK had a higher A1c for fit elderly in my age group with pre diabetes.
Click to expand...

Ah interesting… Prediabetes isn’t a defined condition in the UK. It’s a shorthand for ‘at risk of diabetes’ rather than an official diagnosis with treatment guidance.

In the UK ‘at risk of diabetes’ is usually defined as 42-47mmol/mol (6-6.5%), with 2 or more HbA1c at or above 48mmol (also 6.5%, confusingly) giving rise to a diagnosis with Type 2 Diabetes.

The higher HbA1c suggestions and recommendations in older age groups are really concerning T2D treatment/benefits, rather than risk management of developing diabetes. I’m not aware that the diagnostic threshold is varied by older age in the UK.

Not sure if that helps your thinking?
 
Thanks for that everyday! Our at risk here changes at 6.0 to pre diabetes. I did find a pertinent article if I can figure how to post it here.
 
Hi @Suedon re: your weight loss, when I was first diagnosed last October I went on to a low carb diet and carried on eating my normal levels of protein with a little extra fat. I ended up losing about 14 lbs also. In discussions with my diabetes nurse in the UK, we figured out that my ketones were high and that this was potentially an indicator that I had gone to low in terms of the number of carbs I eat and that I therefore needed to boost my carbs a little (not less than 100g/day and increasing my protein and fats. A friend advised that I should probably work on approx 1.5g of protein/kg (2.2lbs) of body weight. My weight has now stabilised although still lower than it was but still healthy for my size.
 
Hi JimmyBlue,
Thanks! May I ask if you felt hungry when you initially went on low carb before your nurse suggested increasing carbs? If so are you more satisfied now? Which fats did you increase ? I eat avocado, nuts, almond butter,eggs and olive oil on salad and cooking have to be careful with dairy/animal fats at my age and parents history of heart disease. I do use low fat dairy though every day. Maybe like you say i need to increase them. My protein intake is good.
Appreciate your input.
 
Hi @Suedon, when I first started the low card diet, I actually didn't feel that hungry. Breakfast involved full fat Greek yoghurt with fruit and my yoghurt portion was between 150g and 200g. I have reduced that slightly now to around 130g but upped the amount of chopped almond to around 45-50g. I now eat the whole avocado in one hit rather than using a half or quarter. My wife also makes me the Chocolate Mousse from the Freshwell app using cream rather than coconut milk. It makes a for a more solid desert.

Other things I did to improve my sense of being full was to make the Fat Head Dough balls from the Freshwell app and also Lisa65 provided a recipe using Vital Wheat Gluten to make bread rolls. They really fill me up but provide only a small number of carbs. I did not follow the nurse's advice and eat normal bread rolls as I know that they will give me a big spike. Finally, for protein, I eat more lean meat and fish as I find steak and red meat in general can trigger a high BG spike. Fish will often not materially impact me at all but still leaves me feeling full.

I don't use low fat anything and have stopped worrying about my heart. I run at least 2-3 times a week, currently play golf 1-2 times a week and go the gym once a week minimum. At my recent review there was a push to put me on statins claiming my BP was a bit high but when measured it was 136/74 with a resting pulse rate of 45 which for my age (63 1/2) and weight is not abnormal. I do have to work on my total cholestrol which is slightly high at 6.5. I am increasing the distance I run as the primary means to address this issue and trying to reduce the amount of saturated fat I eat and keeping it below 30g/day
 
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