Elevated HBA1c
Discussion
My wife is being told she has an elevated level, 135 at the last blood test, 2 years ago the level was 51. She is suspicious that the GP (telephone consultation) was looking at the wrong records as he thought she was already on medication for diabetes and is saying that she shouldn't even wait for three months before starting medication. She has asked for a repeat blood test before she does anything.
In the past year she has lost approx 30lbs, we don't eat a high sugar diet - generally home cooked, biscuits are rare, no sugar in tea/coffee, cake is rare, maybe 1-2 units of alcohol per week.
Are there any noticeable symptoms should she be experiencing if she really has these high levels - the GP didn't seem to have a clue as I guess he is working from the NICE crib sheet rather than actually understanding the issue.
In the past year she has lost approx 30lbs, we don't eat a high sugar diet - generally home cooked, biscuits are rare, no sugar in tea/coffee, cake is rare, maybe 1-2 units of alcohol per week.
Are there any noticeable symptoms should she be experiencing if she really has these high levels - the GP didn't seem to have a clue as I guess he is working from the NICE crib sheet rather than actually understanding the issue.
The 51 result 2 years is higher than the diabetes threshold.
The 135 result is alarmingly high. Usually to diagnose diabetes they take 2 blood results separately, if both are above 48m/mols you're told you have type 2 diabetes mellitus.
Would be helpful to fully understand her diet, often people think they dont have sugar but actually have far more than they think. Hydration is very important, especially in the heat.
Does she:
Pee more than normal?
Constantly thirsty?
Lost the weight you mention without trying to?
Extra tired?
If she reports any symptoms if hyperglycaemia she will need medical attention asap so call 111.
The 135 result is alarmingly high. Usually to diagnose diabetes they take 2 blood results separately, if both are above 48m/mols you're told you have type 2 diabetes mellitus.
Would be helpful to fully understand her diet, often people think they dont have sugar but actually have far more than they think. Hydration is very important, especially in the heat.
Does she:
Pee more than normal?
Constantly thirsty?
Lost the weight you mention without trying to?
Extra tired?
If she reports any symptoms if hyperglycaemia she will need medical attention asap so call 111.
I would get another blood test completed as soon as possible. HBA1C of 135 as said above is very high. I believe the threshold is 48 according to www.diabetes.org.uk
Edited by Andy OH on Wednesday 20th July 14:09
I was diagnosed with T2 diabetes with a HbA1c of 116, I would say that I didnt have any of the usual symptoms you listed above. At the time the GP suggested I may only notice the difference when my blood sugars dropped but I didn't, I also ate only home cooked food and dont have a sweet tooth so no sugar in tea, cake, snacks etc, it was purely portion control at meal times and carb servings.
There should be a second blood test to confirm.
There should be a second blood test to confirm.
Which scale is being used? If mmol/mol that sounds so high she'd be quite ill. If its mg/dl (not usual in the uk, then less of a concern.
https://www.hba1cnet.com/hba1c-calculator/
https://www.hba1cnet.com/hba1c-calculator/
We think it is a spurious test, she feels fine and has been losing weight slowly since she stopped work getting away from the unsocial hours, unsocial people and stress (she worked in B&Q for 5-6 years) so she was eating at unsocial and irregular hours. 5 ft 2" and size 12/14 depending on retailer (she was 12/14 when we met 45 years ago) - not dared ask her what she weighs.
She feels normal so a test that indicates she is quite ill puzzles us. Not aware of her peeing a lot, doesn't drink tap water but likes san pellegrino (thank god for Costco) and can live with the filtered water from the fridge dispenser. Was always tired when working (anxiety & depression) but has eased since she stopped work 3-4 years ago. Always full of energy, disappointed yesterday because her exercise class was cancelled due to heat, I struggle to keep up with her when walking and I am a foot taller than her - she says exercise has to be a brisk walk!
She hasn't consciously been trying to lose weight but started exercise classes before lockdown and they have recently re-started. Frequently walks to the nearest supermarket (1 1/2 miles each way)
Breakfast is normally a butter croissant, lunch homemade sandwich (two slices of brown bread) with ham/smoked salmon, evening meal is normally meat/fish +potatoes/air fried chips/rice/pasta +vegetables (3 most days) Decaf coffee no milk or sugar. Most weeks one 250ml bottle of lager or a G&T. Only added sugar tends to be tomato sauce on chips (!) and jam maybe once a week in her sandwich.
I am wondering if it has been affected by hydration, she is booked in for another blood test Tuesday.
She will kill me if she sees this but I am trying to understand what could be going on.
She feels normal so a test that indicates she is quite ill puzzles us. Not aware of her peeing a lot, doesn't drink tap water but likes san pellegrino (thank god for Costco) and can live with the filtered water from the fridge dispenser. Was always tired when working (anxiety & depression) but has eased since she stopped work 3-4 years ago. Always full of energy, disappointed yesterday because her exercise class was cancelled due to heat, I struggle to keep up with her when walking and I am a foot taller than her - she says exercise has to be a brisk walk!
She hasn't consciously been trying to lose weight but started exercise classes before lockdown and they have recently re-started. Frequently walks to the nearest supermarket (1 1/2 miles each way)
Breakfast is normally a butter croissant, lunch homemade sandwich (two slices of brown bread) with ham/smoked salmon, evening meal is normally meat/fish +potatoes/air fried chips/rice/pasta +vegetables (3 most days) Decaf coffee no milk or sugar. Most weeks one 250ml bottle of lager or a G&T. Only added sugar tends to be tomato sauce on chips (!) and jam maybe once a week in her sandwich.
I am wondering if it has been affected by hydration, she is booked in for another blood test Tuesday.
She will kill me if she sees this but I am trying to understand what could be going on.
The 135 result seems extraordinarily high and at 51 some action should have been taken, assuming the scale is the 'normal' one.
For a quick ready reckoner, you can buy a finger prick blood test kit over the counter from most pharmacists. Do this test first thing in the morning after a normal prior day eating. This will give you a quick guide. Ideally the result should be around 5.0 but definitely below 7.0.
T2 diabetes is a compound of unhealthy living, so although her health is good now, she may have compounded issues over time. Pure sugars put the pancreas under strain, but carbs also put the pancreas under strain. I note every meal is based around some carbs.... Pizza kills me for example, not an immediately apparent sugary meal......
Losing weight is a symptom of diabetes, along with the others mentioned but as with most illnesses everyone demonstrates different symptoms.
Hopefully the San Pellegrino is the bottled water and not the cans of fizzy fruit juice......
For a quick ready reckoner, you can buy a finger prick blood test kit over the counter from most pharmacists. Do this test first thing in the morning after a normal prior day eating. This will give you a quick guide. Ideally the result should be around 5.0 but definitely below 7.0.
T2 diabetes is a compound of unhealthy living, so although her health is good now, she may have compounded issues over time. Pure sugars put the pancreas under strain, but carbs also put the pancreas under strain. I note every meal is based around some carbs.... Pizza kills me for example, not an immediately apparent sugary meal......
Losing weight is a symptom of diabetes, along with the others mentioned but as with most illnesses everyone demonstrates different symptoms.
Hopefully the San Pellegrino is the bottled water and not the cans of fizzy fruit juice......
I would point out that I don't eat things like jam or sauces like ketchup, I just naturally don't like the sweetness and I exercised fairly regularly/active job yet I had an Hb1Ac of 116 and also felt fine, it was pure luck that it was picked up.
You need to realise bread, pasta, rice, potatoes etc are sugar, it's not just a case of eating refined sugar causing the problem. I'm not saying that this is the case here and it could be an erroneous test but the items you listed as part of a regular meal are where I got caught out and I don't do cake, chocolate, snacks, jam etc as I don't like it.
You need to realise bread, pasta, rice, potatoes etc are sugar, it's not just a case of eating refined sugar causing the problem. I'm not saying that this is the case here and it could be an erroneous test but the items you listed as part of a regular meal are where I got caught out and I don't do cake, chocolate, snacks, jam etc as I don't like it.
As mentioned above its all the other foods that are markets as healthy that are loaded with sugar. Yoghurts, health bars, cereals. White refined flour has all the nutrient density removed so the body processes it and turns it into glucose.
Everyone processes sugar differently, whaf affects me may be different for you.
I listened to a podcast yesterday from Dr Rangan Chaterjee & Tim Spector. Tim runs the Zoe project working on personalised nutrition. I found it very insightful.
Podcast Link
If you have the means (its a bit costly at £259) it will help you understand what impacts your wifes blood sugar, microbiome and blood fats. Not affiliated at all. Takes about 6 weeks for results.
https://joinzoe.com/
Everyone processes sugar differently, whaf affects me may be different for you.
I listened to a podcast yesterday from Dr Rangan Chaterjee & Tim Spector. Tim runs the Zoe project working on personalised nutrition. I found it very insightful.
Podcast Link
If you have the means (its a bit costly at £259) it will help you understand what impacts your wifes blood sugar, microbiome and blood fats. Not affiliated at all. Takes about 6 weeks for results.
https://joinzoe.com/
Get her a freestyle Libre 2 to keep a much better idea of where here blood sugars are at throughout the day. Should be able to get one prescribed by your GP or diabetes specialist. Absolutely brilliant things.
Take it from me the affects of diabetes are terrible. I lost a leg to it 8 years ago, recently lost 2 toes and ball of my foot, I’ve had leg bypasses, angioplasty etc. perhaps the most frightening thing is retinal bleeds which can lead to blindness. I had to have viterctomy (SP) where they strip the retina and you can see little for a few weeks until it recovers. Ensure your wife is referred to your local hospital opthamology department to have her eyes checked regularly. It’s not unpleasant - eye drops to make the pupils expand sting for a few seconds but that’s it. This is really important you don’t know what damage there might already be. When HBA1c was measured on the old scale my ophthalmologist told me for every one point improvement resulted in a 44% benefit to the eyes.
If your wife has willpower look into that 800 calorie a day diet that can reverse diabetes.
I wish her all the best.
Take it from me the affects of diabetes are terrible. I lost a leg to it 8 years ago, recently lost 2 toes and ball of my foot, I’ve had leg bypasses, angioplasty etc. perhaps the most frightening thing is retinal bleeds which can lead to blindness. I had to have viterctomy (SP) where they strip the retina and you can see little for a few weeks until it recovers. Ensure your wife is referred to your local hospital opthamology department to have her eyes checked regularly. It’s not unpleasant - eye drops to make the pupils expand sting for a few seconds but that’s it. This is really important you don’t know what damage there might already be. When HBA1c was measured on the old scale my ophthalmologist told me for every one point improvement resulted in a 44% benefit to the eyes.
If your wife has willpower look into that 800 calorie a day diet that can reverse diabetes.
I wish her all the best.
Thanks for all the comments
She has recently had an eye test (almost £600 for Varifocals) and nothing found (it was at a proper optician, not Specsavers).
Another blood test is booked (make sure she drinks plenty of water over the weekend) and will suggest she asks about the Libre sensor.
She is sensitive to me suggesting what she should do as my father does this and has rubbed her up the wrong way several times over the last 10 years (one of the causes of the anxiety and depression as she is really tense when we see him), she doesn't understand that to be as fit as he is at 93 he must be getting a lot of things right.
She definitely has will power, the art is getting her to think something was her idea and then she is unstoppable!
She has recently had an eye test (almost £600 for Varifocals) and nothing found (it was at a proper optician, not Specsavers).
Another blood test is booked (make sure she drinks plenty of water over the weekend) and will suggest she asks about the Libre sensor.
She is sensitive to me suggesting what she should do as my father does this and has rubbed her up the wrong way several times over the last 10 years (one of the causes of the anxiety and depression as she is really tense when we see him), she doesn't understand that to be as fit as he is at 93 he must be getting a lot of things right.
She definitely has will power, the art is getting her to think something was her idea and then she is unstoppable!
IJWS15 said:
Thanks for all the comments
She has recently had an eye test (almost £600 for Varifocals) and nothing found (it was at a proper optician, not Specsavers).
Another blood test is booked (make sure she drinks plenty of water over the weekend) and will suggest she asks about the Libre sensor.
She is sensitive to me suggesting what she should do as my father does this and has rubbed her up the wrong way several times over the last 10 years (one of the causes of the anxiety and depression as she is really tense when we see him), she doesn't understand that to be as fit as he is at 93 he must be getting a lot of things right.
She definitely has will power, the art is getting her to think something was her idea and then she is unstoppable!
Pleased eyes are ok. A diabetic retinopathy isn't a sight test, the idea is to photograph one's retina each year and look for deterioration. She has recently had an eye test (almost £600 for Varifocals) and nothing found (it was at a proper optician, not Specsavers).
Another blood test is booked (make sure she drinks plenty of water over the weekend) and will suggest she asks about the Libre sensor.
She is sensitive to me suggesting what she should do as my father does this and has rubbed her up the wrong way several times over the last 10 years (one of the causes of the anxiety and depression as she is really tense when we see him), she doesn't understand that to be as fit as he is at 93 he must be getting a lot of things right.
She definitely has will power, the art is getting her to think something was her idea and then she is unstoppable!
Nothing wrong with specsavers BTW, our local one picked up on something that others missed. Referred me straight away.
Strangely when I joined the call with the GP the other day I asked what symptoms she should be experiencing if the level was that high and he wouldn't answer - I guess because he doesn't know and is just pushing the NICE line that above x you prescribe y - you may a well be speaking to a machine.
Since then she has been doing some research and has come up with dry hair (possible symptom) itchy scalp (possible symptom) occasional blurred vision (Possible symptom but Optician wasn't worried).
Will look into Zoe as we can afford it if it looks helpful - the quiz isn't working on my work PC.
You may sense that I don't have much respect for the current crop of GPs - maybe one day one will be able to explain why my blood pressure dropped dramatically when they increased my medication, especially as I didn't increase what I actually take.
Since then she has been doing some research and has come up with dry hair (possible symptom) itchy scalp (possible symptom) occasional blurred vision (Possible symptom but Optician wasn't worried).
Will look into Zoe as we can afford it if it looks helpful - the quiz isn't working on my work PC.
You may sense that I don't have much respect for the current crop of GPs - maybe one day one will be able to explain why my blood pressure dropped dramatically when they increased my medication, especially as I didn't increase what I actually take.
You might not be prescribed Freestyle Libre, generally for type 1 diabetics only. But you can self fund it, but at about £45 every two weeks it is not cheap.......however the data collected in that two weeks would be really useful. So a one off might be really useful to see what foods, do what to her blood sugar level....
Specsavers have qualified opticians, as such they vary in quality as much as the individual optician. My local Specsavers are really good though. However it is worthwhile (essential) attending the annual diabetic screening to pick up issues - along with the other regular check ups.
I have had diabetes (T1D) for most my life (48yo) and it can be challenging but also controllable. T2D can also be reversed ( my dad managed it a few years ago), so not all doom and gloom....but a major lifestyle change is on the cards (but not necessarily a negative lifestyle change).
As others have stated, the complications can be fairly devastating. My biggest issue has been my sight, with multiple operations, injections, laser treatment, cataracts operations, vitrectomy etc over the last 15 years. Thankfully I can still see and drive.....
But, for the time being, there is not a positive diagnosis, let's see what the latest HBA1C result brings....
Specsavers have qualified opticians, as such they vary in quality as much as the individual optician. My local Specsavers are really good though. However it is worthwhile (essential) attending the annual diabetic screening to pick up issues - along with the other regular check ups.
I have had diabetes (T1D) for most my life (48yo) and it can be challenging but also controllable. T2D can also be reversed ( my dad managed it a few years ago), so not all doom and gloom....but a major lifestyle change is on the cards (but not necessarily a negative lifestyle change).
As others have stated, the complications can be fairly devastating. My biggest issue has been my sight, with multiple operations, injections, laser treatment, cataracts operations, vitrectomy etc over the last 15 years. Thankfully I can still see and drive.....
But, for the time being, there is not a positive diagnosis, let's see what the latest HBA1C result brings....
I am getting confused.
Second blood test yesterday, 10:20 last night she gets a call from the 24 hour doctor that someone will call her - I was expecting the call to be today. 15 minutes later the doctor calls as her glucose level is 27 (why can't they stick to the same measure - HBA1 not mentioned) and she needs to go and see someone. Appointment made for 1:30 this morning so off we go to the hospital.
They wanted to check for ketones in urine which they didn't find but glucose was down to 19.
Turns out the blood tests she has been doing should have been fasting but no-one told her. The doctor she saw last night was puzzled because the recent test results indicate she is seriously ill but she doesn't appear to be . . . he was expecting to be admitting her to hospital last night!
Call with the normal GP shortly after 9 this morning
Second blood test yesterday, 10:20 last night she gets a call from the 24 hour doctor that someone will call her - I was expecting the call to be today. 15 minutes later the doctor calls as her glucose level is 27 (why can't they stick to the same measure - HBA1 not mentioned) and she needs to go and see someone. Appointment made for 1:30 this morning so off we go to the hospital.
They wanted to check for ketones in urine which they didn't find but glucose was down to 19.
Turns out the blood tests she has been doing should have been fasting but no-one told her. The doctor she saw last night was puzzled because the recent test results indicate she is seriously ill but she doesn't appear to be . . . he was expecting to be admitting her to hospital last night!
Call with the normal GP shortly after 9 this morning
Edited by IJWS15 on Thursday 28th July 11:52
She is settling down and is now on 1000mg (why not 1g) of glucophage twice a day and doing self administered blood tests twice a day (normally around 11-14 but some have been 17-18 and not sure why).
She is religiously keeping off added sugar and is exploring how the things we would normally eat are affecting her:
- After a tandoori mixed grill and 1/2 roti last night her level this morning was 11. She said the nan was way sweeter than the roti so I got to eat the nan and she refused the tiny sorbet that was served between courses!
- Scone & butter yesterday morning and still 11-12 yesterday evening
- G&T after dinner mid week and following morning was around 11-12 but there are no more occasional bottles of lager (means I get to drink what is left).
She did throw out all the jam and marmalade and we are now on brown pasta and brown rice - awful stuff.
Some symptoms she didn't know were related have eased (pity the first doctor wasn't prepared to take the time to explain) and we just have to keep an eye on her levels and diet.
Will consider buying a freestyle libre if things don't stay stable, they are only on prescription here if you are on insulin.
She is religiously keeping off added sugar and is exploring how the things we would normally eat are affecting her:
- After a tandoori mixed grill and 1/2 roti last night her level this morning was 11. She said the nan was way sweeter than the roti so I got to eat the nan and she refused the tiny sorbet that was served between courses!
- Scone & butter yesterday morning and still 11-12 yesterday evening
- G&T after dinner mid week and following morning was around 11-12 but there are no more occasional bottles of lager (means I get to drink what is left).
She did throw out all the jam and marmalade and we are now on brown pasta and brown rice - awful stuff.
Some symptoms she didn't know were related have eased (pity the first doctor wasn't prepared to take the time to explain) and we just have to keep an eye on her levels and diet.
Will consider buying a freestyle libre if things don't stay stable, they are only on prescription here if you are on insulin.
IJWS15 said:
She is settling down and is now on 1000mg (why not 1g) of glucophage twice a day and doing self administered blood tests twice a day (normally around 11-14 but some have been 17-18 and not sure why).
She is religiously keeping off added sugar and is exploring how the things we would normally eat are affecting her:
- After a tandoori mixed grill and 1/2 roti last night her level this morning was 11. She said the nan was way sweeter than the roti so I got to eat the nan and she refused the tiny sorbet that was served between courses!
- Scone & butter yesterday morning and still 11-12 yesterday evening
- G&T after dinner mid week and following morning was around 11-12 but there are no more occasional bottles of lager (means I get to drink what is left).
She did throw out all the jam and marmalade and we are now on brown pasta and brown rice - awful stuff.
Some symptoms she didn't know were related have eased (pity the first doctor wasn't prepared to take the time to explain) and we just have to keep an eye on her levels and diet.
Will consider buying a freestyle libre if things don't stay stable, they are only on prescription here if you are on insulin.
When is she testing? These numbers seem too high for decent control, really should be below 8mmol/lShe is religiously keeping off added sugar and is exploring how the things we would normally eat are affecting her:
- After a tandoori mixed grill and 1/2 roti last night her level this morning was 11. She said the nan was way sweeter than the roti so I got to eat the nan and she refused the tiny sorbet that was served between courses!
- Scone & butter yesterday morning and still 11-12 yesterday evening
- G&T after dinner mid week and following morning was around 11-12 but there are no more occasional bottles of lager (means I get to drink what is left).
She did throw out all the jam and marmalade and we are now on brown pasta and brown rice - awful stuff.
Some symptoms she didn't know were related have eased (pity the first doctor wasn't prepared to take the time to explain) and we just have to keep an eye on her levels and diet.
Will consider buying a freestyle libre if things don't stay stable, they are only on prescription here if you are on insulin.
Um, it will probably be good to start reading about diabetes. There are plenty of resources on the internet.
You need to be worried about carbohydrate in take now, as well as the more sugary content foods.
Sugary foods simply spike the blood sugar. Starchy carbs (bread, pasta, potatoes, crisps, rice, naan etc) also raise blood sugar but over a longer period of time. This does allow the pancreas to cope, but over loading on carbs is not great either. Make sure you keep some in the diet, as energy levels will drop otherwise. Most foods indicate the level of carbohydrates in them,but it can be surprising how many carbs are in what foods. Brown pasta and rice still have carbs but release slower than their white processed cousins.
Curry - although the sauce might not taste sweet they can be laden with sugar, so just go easy. Naan breads are pure carb.
G and T is good as long as a slimline tonic is used.
I find fresh fruit spikes my blood sugar and fruit juices even more so , so I tend to avoid.
Pizza is the devil.
Loads of other stuff is not great either, but over time you will find the balance.
Take it seriously and it really is quite controllable. Don't take it seriously and be prepared for complications. My dad managed to reverse the diagnosis by diet alone. Unfortunately I am T1, so I cannot reverse it, but I am still reasonably healthy after 40 years of diabetes, despite a few complications over the years.....
Best of luck....
You need to be worried about carbohydrate in take now, as well as the more sugary content foods.
Sugary foods simply spike the blood sugar. Starchy carbs (bread, pasta, potatoes, crisps, rice, naan etc) also raise blood sugar but over a longer period of time. This does allow the pancreas to cope, but over loading on carbs is not great either. Make sure you keep some in the diet, as energy levels will drop otherwise. Most foods indicate the level of carbohydrates in them,but it can be surprising how many carbs are in what foods. Brown pasta and rice still have carbs but release slower than their white processed cousins.
Curry - although the sauce might not taste sweet they can be laden with sugar, so just go easy. Naan breads are pure carb.
G and T is good as long as a slimline tonic is used.
I find fresh fruit spikes my blood sugar and fruit juices even more so , so I tend to avoid.
Pizza is the devil.
Loads of other stuff is not great either, but over time you will find the balance.
Take it seriously and it really is quite controllable. Don't take it seriously and be prepared for complications. My dad managed to reverse the diagnosis by diet alone. Unfortunately I am T1, so I cannot reverse it, but I am still reasonably healthy after 40 years of diabetes, despite a few complications over the years.....
Best of luck....
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