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Is Diabetes Indicated As Per The Attached Reports?
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Hi, I have provided some attachments. Please review them.
I spoke to you last year regarding fear about low a1c and high normal fbs. 3.8 (up to 4.03 on recheck) and 100 respectively. Well this year I just had blood work done and I'm all freaked out. Now a1c is 4.38 and fbs is 117! Doctor 9s unconcerned because of low a1c. He said I could eat less carb. He believes in low carbs for everyone which I have never really agreed with. He also said maybe less food at night. But he wasn't concerned as he said they go by a1c. However, on the lab sheet it says that an elevated hbF could give false low reading. How do I know if I have that?! All other bills work is good.... Liver, kidneys, good hdl, 64, ldl and triglycerides fine. Cardiac risk 2.9. Below the range. Hemoglobin 15.4. So what should I think. I'm like panicking!
Hi, I have provided some attachments. Please review them.
I spoke to you last year regarding fear about low a1c and high normal fbs. 3.8 (up to 4.03 on recheck) and 100 respectively. Well this year I just had blood work done and I'm all freaked out. Now a1c is 4.38 and fbs is 117! Doctor 9s unconcerned because of low a1c. He said I could eat less carb. He believes in low carbs for everyone which I have never really agreed with. He also said maybe less food at night. But he wasn't concerned as he said they go by a1c. However, on the lab sheet it says that an elevated hbF could give false low reading. How do I know if I have that?! All other bills work is good.... Liver, kidneys, good hdl, 64, ldl and triglycerides fine. Cardiac risk 2.9. Below the range. Hemoglobin 15.4. So what should I think. I'm like panicking!
Brief Answer:
Don't be worried about Fasting Blood Suagar level.
Detailed Answer:
Hi,
Thanks for your question.
Noted your concern.
Once again your HbA1c is absolutely within normal range.
Though Fasting Blood sugar is in Prediabetic range, HbA1c does not correlate with it.
In such a case HbA1c may be more reliable for me if done by NGSP method.
If you really worried I may suggest to do OGTT (Oral Glucose Tolerance Test) to confirm blood sugar status.
Hope this helps you.
Regards,
Dr. Abhay Mali.
Diabetologsit.
Don't be worried about Fasting Blood Suagar level.
Detailed Answer:
Hi,
Thanks for your question.
Noted your concern.
Once again your HbA1c is absolutely within normal range.
Though Fasting Blood sugar is in Prediabetic range, HbA1c does not correlate with it.
In such a case HbA1c may be more reliable for me if done by NGSP method.
If you really worried I may suggest to do OGTT (Oral Glucose Tolerance Test) to confirm blood sugar status.
Hope this helps you.
Regards,
Dr. Abhay Mali.
Diabetologsit.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Would you think I need to do that test? I don't think it's widely available anymore. My doctor says they don't do it anymore because 9f reliance on a1c. However I was wondering if anything could be giving false low a1c such as hbF? I don't know what that is. Also I read that vitamin C, E and Co q 10. I take about 2500 C and 100mg Co q 10 and whatever E is in multi.
Also I spoke to one of your doctors while I was waiting for you, an endocrinologist. She said I must be having hypoglycemic events which are not good and my fbs isn't normal. She scared me. Said to change diet. I'm afraid to eat anything now and didn't sleep all night! Help! You helped me so much before. My doctor is unconcerned. My other labs are similar to last year. Slightly lower hdl, 64 vs 71. Ratios still good though. 2.9 cardiac risk which is below normal range. Hemoglobin 15.4. Thyroid tests all normal. Thankyou... Anxiously waiting.
Also, I've been on bio identical progesterone and triple estrogen cream for about 25 years. Is that a problem? Seems to have helped everything else alot.
Double checked with the lab... They do use the standard you referenced for a1c
You're the expert in diabetes. I'd really like your input on this:
Answer:
As I mentioned before there should be 2 fbs values over 105 mg/dl to be called prediabetes or impaired fasting glucose intolerance. If it still persists high, yes it is impaired fasting glucose intolerance or preDiabetes.
A low HbA1c in a person without anemia is due to hypoglycemia.
So, reactive hypoglycemia (as it does not happen fasting) should be also present and HbA1c is not reliable in these cases to diagnose prediabetes or Diabetes but only glucose levels.
So, i would say you should have reactive hypoglicemia and impaired fasting glucose intolerance to be confirmed.
This is all what your HbA1c and fbs 117 mg/ dl suggest.
Best wishes,
Dr.Mirjeta
Getting anxious awaiting answer....
Also I spoke to one of your doctors while I was waiting for you, an endocrinologist. She said I must be having hypoglycemic events which are not good and my fbs isn't normal. She scared me. Said to change diet. I'm afraid to eat anything now and didn't sleep all night! Help! You helped me so much before. My doctor is unconcerned. My other labs are similar to last year. Slightly lower hdl, 64 vs 71. Ratios still good though. 2.9 cardiac risk which is below normal range. Hemoglobin 15.4. Thyroid tests all normal. Thankyou... Anxiously waiting.
Also, I've been on bio identical progesterone and triple estrogen cream for about 25 years. Is that a problem? Seems to have helped everything else alot.
Double checked with the lab... They do use the standard you referenced for a1c
You're the expert in diabetes. I'd really like your input on this:
Answer:
As I mentioned before there should be 2 fbs values over 105 mg/dl to be called prediabetes or impaired fasting glucose intolerance. If it still persists high, yes it is impaired fasting glucose intolerance or preDiabetes.
A low HbA1c in a person without anemia is due to hypoglycemia.
So, reactive hypoglycemia (as it does not happen fasting) should be also present and HbA1c is not reliable in these cases to diagnose prediabetes or Diabetes but only glucose levels.
So, i would say you should have reactive hypoglicemia and impaired fasting glucose intolerance to be confirmed.
This is all what your HbA1c and fbs 117 mg/ dl suggest.
Best wishes,
Dr.Mirjeta
Getting anxious awaiting answer....
Brief Answer:
Hypoglycemia without symptoms is extremely rare in normal person.
Detailed Answer:
As you are not on any anti-diabetic treatment possibility of hypoglycemia is near impossible.
To cause hypoglycemia there should be
- No intake of calories for a long period.
- Deranged Liver function.
- Deranged Kidney Function.
- Sepsis - severe infection.
Now come to Fasting blood sugar level in Pre-diabetic range- Irrespective of your pre-diabetic or normal status Fasting blood sugar of 117 won't require any specific treatment.
Hypoglycemia by scientific definition is defined on the basis of 3 factors-
1) Symptoms of hypoglycemia.
2) Documented blood sugar level below 70 during period of symptoms.
3) Symptoms of hypoglycemia relived after having sugar.
so if there are no symptoms of hypoglycemia just fuget about possibility of hypoglycemia.
Reactive hypoglycemia occur after having high calorie intake. And is also present with symptoms of hypoglycemia.
Progesteron and oestrogen may associate with insulin resistance but in with the doses in cream form it is extremely rare to cause impaired blood sugar level.
So better to rely on HbA1c and forget about Fasting blood sugar level and be relaxed.
Hope this make you feel relaxed.
Hypoglycemia without symptoms is extremely rare in normal person.
Detailed Answer:
As you are not on any anti-diabetic treatment possibility of hypoglycemia is near impossible.
To cause hypoglycemia there should be
- No intake of calories for a long period.
- Deranged Liver function.
- Deranged Kidney Function.
- Sepsis - severe infection.
Now come to Fasting blood sugar level in Pre-diabetic range- Irrespective of your pre-diabetic or normal status Fasting blood sugar of 117 won't require any specific treatment.
Hypoglycemia by scientific definition is defined on the basis of 3 factors-
1) Symptoms of hypoglycemia.
2) Documented blood sugar level below 70 during period of symptoms.
3) Symptoms of hypoglycemia relived after having sugar.
so if there are no symptoms of hypoglycemia just fuget about possibility of hypoglycemia.
Reactive hypoglycemia occur after having high calorie intake. And is also present with symptoms of hypoglycemia.
Progesteron and oestrogen may associate with insulin resistance but in with the doses in cream form it is extremely rare to cause impaired blood sugar level.
So better to rely on HbA1c and forget about Fasting blood sugar level and be relaxed.
Hope this make you feel relaxed.
Above answer was peer-reviewed by :
Dr. Raju A.T
I do get occasional feeling of low blood sugar but I have all my life... Not just now. Usually I'm stressed or need to eat or I'm exercising and haven't eaten something first. It is mild, some weakness feelings and but not truely weak, some shakiness abs some sweating. Always been told to eat something and works quickly...
Also it's never related to having a high carb meal. I can eat alot of carbs, even sugary simple carbs and I don't have that happen.
Which actually doesn't make sense to me with fbs because you'd think it would be low then since I tend to feel that way when I need to eat not after eating.
Also I read that people that have white coat hypertension should always be suspect of having white coat hyperglycemia as they often go together.... In which case a1c is more accurate and fbs may always be up due to stress. I have that... My BP can be in the hypertensive range (140 to 180 /90 to 100)at doctor and as low as 100 to 110 or even lower / 50 to 70 at home... On the same day!
Is that the possible in your opinion?
Just found out that my hs-crp is high but I can't get ahold of the doctor to find out how high so I'm freakin* out about that now too. Last year he only did regular crp which was negative but the nurse said he needed to talk to me about this result. So if that's high along with the fbs but, I low a1c and low risk on other cardiac factors (blood work) what does that tell you?
Also it's never related to having a high carb meal. I can eat alot of carbs, even sugary simple carbs and I don't have that happen.
Which actually doesn't make sense to me with fbs because you'd think it would be low then since I tend to feel that way when I need to eat not after eating.
Also I read that people that have white coat hypertension should always be suspect of having white coat hyperglycemia as they often go together.... In which case a1c is more accurate and fbs may always be up due to stress. I have that... My BP can be in the hypertensive range (140 to 180 /90 to 100)at doctor and as low as 100 to 110 or even lower / 50 to 70 at home... On the same day!
Is that the possible in your opinion?
Just found out that my hs-crp is high but I can't get ahold of the doctor to find out how high so I'm freakin* out about that now too. Last year he only did regular crp which was negative but the nurse said he needed to talk to me about this result. So if that's high along with the fbs but, I low a1c and low risk on other cardiac factors (blood work) what does that tell you?
Brief Answer:
There is no term like White coat hyperglycemia.
Detailed Answer:
- If you feel there are symptoms of hypoglycemia confirm it by doing blood glucose level during symptomatic period.
- Stress can increase blood sugar level but there is no term like white coat hyperglycemia.
- hs CRP is one of cardiac risk factor. Level will determine need for treatment.
- HbA1c level is more reliable indicator than fasting BSL as cardiac risk factor.
Hope this helps.
There is no term like White coat hyperglycemia.
Detailed Answer:
- If you feel there are symptoms of hypoglycemia confirm it by doing blood glucose level during symptomatic period.
- Stress can increase blood sugar level but there is no term like white coat hyperglycemia.
- hs CRP is one of cardiac risk factor. Level will determine need for treatment.
- HbA1c level is more reliable indicator than fasting BSL as cardiac risk factor.
Hope this helps.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
But how much does crp relate to risk if other risk factors are low? Also I just noticed my esinophils are 51 when reference range is 0-50. Is that significant. Wbc is normal and all others are within range.
Is it possible that I could have a hemoglobin variant causing the descrepancy in tests? I'm Caucasian/American of European descent.
Does stress and poor sleep affect fbg even 9f nob diabetics?
Is it possible that I could have a hemoglobin variant causing the descrepancy in tests? I'm Caucasian/American of European descent.
Does stress and poor sleep affect fbg even 9f nob diabetics?
Brief Answer:
hs CRP as cardiac risk factor.
Detailed Answer:
Rather than hs-CRP presence of Diabetes, Blood Pressure (Hypertension), Dyslipidemia (Abnormal cholesterol level), Smoking, Family history of heart disease carries more significance as cardiovascular risk factors.
Hemoglobin variant at this age of 60+ with normal hemoglobin level is unlikely.
Stress and poor sleep rarely affect Fasting BSL in non-diabetics.
hs CRP as cardiac risk factor.
Detailed Answer:
Rather than hs-CRP presence of Diabetes, Blood Pressure (Hypertension), Dyslipidemia (Abnormal cholesterol level), Smoking, Family history of heart disease carries more significance as cardiovascular risk factors.
Hemoglobin variant at this age of 60+ with normal hemoglobin level is unlikely.
Stress and poor sleep rarely affect Fasting BSL in non-diabetics.
Above answer was peer-reviewed by :
Dr. Raju A.T
So that makes me more worried about my fbs... Both because of the risk factors you mentioned with diabetes and trying to figure out why it's so high relative to a1c. I had thought, and read, that stress can skew fbs results.
So if stress did increase it then that's a bad sign.... Just can't figure out why it would be up like that.
So if stress did increase it then that's a bad sign.... Just can't figure out why it would be up like that.
Brief Answer:
Relation between IFG and cardiovascular disease is uncertain.
Detailed Answer:
You are unnecessary complicating the situations.
There are many factors that you should rely on that keeps you in low risk for cardiovascular disease.
You are concentrating on fasting blood glucose which is in pre-diabetic range called as impaired fasting glucose (IFG).
It is not clear with certainty till date that IFG in the absence of other risk factors (like Impaired postprandial blood glucose level, Hypertension, Dyslipidemia) is associated with increased risk of cardiovascular disease.
So just relax Monitor HbA1c, Blood Pressure, Lipid Profile and keep following healthy life style.
Hope this helps you.
Relation between IFG and cardiovascular disease is uncertain.
Detailed Answer:
You are unnecessary complicating the situations.
There are many factors that you should rely on that keeps you in low risk for cardiovascular disease.
You are concentrating on fasting blood glucose which is in pre-diabetic range called as impaired fasting glucose (IFG).
It is not clear with certainty till date that IFG in the absence of other risk factors (like Impaired postprandial blood glucose level, Hypertension, Dyslipidemia) is associated with increased risk of cardiovascular disease.
So just relax Monitor HbA1c, Blood Pressure, Lipid Profile and keep following healthy life style.
Hope this helps you.
Above answer was peer-reviewed by :
Dr. Kampana
So does that mean I am pre-diabetic? Or is the a1c the important thing? Can fbs be up temporarily but not all the time? Is it ever normal for a normal person to have some readings like that depending on other factors? With low a1c, is it likely that it's high very often throughout the day?
Brief Answer:
HbA1c carries more value.
Detailed Answer:
By definition Pre-diabetes is defined as-
HbA1c 5.7 to 6.4
Impaired Fasting Glucose (IFG) Fasting BSL 100 TO 125
Impaired Glucose Tolerance (IGT) 2 hours post 100gram Glucose BSL 141 to 199.
By definition considering IFG, yes you are prediabetic.
But as already mentioned HbA1c carries much more value.
Complications associated with prediabetes are best correlated with HbA1c level rather than any other value.
Temporary elevation of Fasting BSL is possible.
Yes factors like illness,some medicine intake, high calorie food at night time may cause elevation of Fasting BSL.
It is near immposible to have very high blood sugar levels with such a low level of HbA1c in person not on antidiabetic medicines.
HbA1c carries more value.
Detailed Answer:
By definition Pre-diabetes is defined as-
HbA1c 5.7 to 6.4
Impaired Fasting Glucose (IFG) Fasting BSL 100 TO 125
Impaired Glucose Tolerance (IGT) 2 hours post 100gram Glucose BSL 141 to 199.
By definition considering IFG, yes you are prediabetic.
But as already mentioned HbA1c carries much more value.
Complications associated with prediabetes are best correlated with HbA1c level rather than any other value.
Temporary elevation of Fasting BSL is possible.
Yes factors like illness,some medicine intake, high calorie food at night time may cause elevation of Fasting BSL.
It is near immposible to have very high blood sugar levels with such a low level of HbA1c in person not on antidiabetic medicines.
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Raju A.T
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