Should I investigate these blood test results further?
May 22, 2024 1:43 AM Subscribe
YANMD, but I am confused by my HBA1C blood test results that my doctor (on the NHS) apparently didn't consider worthy of comment.
As an overweight person with two parents who have had diabetes, I know I'm at high risk for developing diabetes. Worth adding that I also have health anxiety.
I get yearly blood tests on the NHS because of another long-term condition I have (high blood pressure, controlled through medications).
With the NHS, they will of course share your blood test and other test results with you, but you have to ask. It's typical for test results to be kept on your record and not shared with you other than to flag where something requires further treatment.
At my last consultation my doctor said my blood test results were fine, and did not suggest any further treatment. We discussed other matters, unrelated to diabetes or prediabetes.
However when I requested my blood test results I saw that my HBA1C result was 41 mmol. According to Diabetes UK, those at risk of prediabetes should have a target result of under 42. So clearly I am under the threshold, but just about. A friend of mine who also sees a doctor on the NHS also had an HBA1C result of 41, and was warned that she could be prediabetic.
I'm confused as to why my doctor didn't flag my results to me. If I hadn't been the nosy type and actually done a bit of research I would have assumed my results were totally fine. Should I investigate further with my doctor? I am asking here because the NHS is overloaded, and the 'worried well' are a major cause of overload, and I don't want to contribute to that. Should I just assume I am prediabetic? My next blood tests are scheduled in 6 months' time. Should I flag it then?
I'm in my 40s.
As an overweight person with two parents who have had diabetes, I know I'm at high risk for developing diabetes. Worth adding that I also have health anxiety.
I get yearly blood tests on the NHS because of another long-term condition I have (high blood pressure, controlled through medications).
With the NHS, they will of course share your blood test and other test results with you, but you have to ask. It's typical for test results to be kept on your record and not shared with you other than to flag where something requires further treatment.
At my last consultation my doctor said my blood test results were fine, and did not suggest any further treatment. We discussed other matters, unrelated to diabetes or prediabetes.
However when I requested my blood test results I saw that my HBA1C result was 41 mmol. According to Diabetes UK, those at risk of prediabetes should have a target result of under 42. So clearly I am under the threshold, but just about. A friend of mine who also sees a doctor on the NHS also had an HBA1C result of 41, and was warned that she could be prediabetic.
I'm confused as to why my doctor didn't flag my results to me. If I hadn't been the nosy type and actually done a bit of research I would have assumed my results were totally fine. Should I investigate further with my doctor? I am asking here because the NHS is overloaded, and the 'worried well' are a major cause of overload, and I don't want to contribute to that. Should I just assume I am prediabetic? My next blood tests are scheduled in 6 months' time. Should I flag it then?
I'm in my 40s.
I get yearly blood tests on the NHS
In your shoes, the only cause for concern I would personally derive from any just-below-threshold result for any disease marker is if I had evidence of that marker creeping upward over time, especially if that upward creep had recently begun to accelerate.
posted by flabdablet at 2:30 AM on May 22 [7 favorites]
In your shoes, the only cause for concern I would personally derive from any just-below-threshold result for any disease marker is if I had evidence of that marker creeping upward over time, especially if that upward creep had recently begun to accelerate.
posted by flabdablet at 2:30 AM on May 22 [7 favorites]
The type of testing that they are reporting on here sounds a little the regular review the NHS do for anybody getting treated for high blood pressure. I was going through a call with my GP to review these tests yesterday and noted that they are looking for indicators of kidney problems, liver function, cholesterol, inflammation markers - as well as blood glucose . The point is that these are top line tests to look for where a problem might exist and flag it if a threshold is reached.
If you are concerned, then I would echo the advice of talking with your GP about where there are any more detailed tests they could do to assess whether you may have metabolic syndrome.
posted by rongorongo at 2:31 AM on May 22
If you are concerned, then I would echo the advice of talking with your GP about where there are any more detailed tests they could do to assess whether you may have metabolic syndrome.
posted by rongorongo at 2:31 AM on May 22
Agreed that you should bring it up with your GP at your next appointment, though I imagine they will only be concerned if they see consistent results at the threshold for 6+ months. What was your result the time before this one? It's worth keeping in mind that your HBA1C score can be impacted by things like stress and other medications you've taken, so the GP will only take action if they see a consistent rise.
Sympathies, though, as a fellow "worried well" with high blood pressure. It's tough to know where the line is sometimes, especially when the GP feels like the only person who can give you that comfort of a definitive answer. But GPs are professionals, they do (most of the time) know what they're doing, so if they're not overly concerned, you probably don't need to be either.
posted by fight or flight at 3:27 AM on May 22
Sympathies, though, as a fellow "worried well" with high blood pressure. It's tough to know where the line is sometimes, especially when the GP feels like the only person who can give you that comfort of a definitive answer. But GPs are professionals, they do (most of the time) know what they're doing, so if they're not overly concerned, you probably don't need to be either.
posted by fight or flight at 3:27 AM on May 22
> I'm confused as to why my doctor didn't flag my results to me.
If your doctor knows you well, they may have decided that since 41 is within the target range, and you're prone to health anxiety already, the best course of action was to stick to the high-level facts, especially since they know you'll be tested again later this year.
That said, it seems like a big part of the recommendations would be "eating well" and "moving more". Perhaps that would be a good idea either way?
posted by demi-octopus at 4:39 AM on May 22 [5 favorites]
If your doctor knows you well, they may have decided that since 41 is within the target range, and you're prone to health anxiety already, the best course of action was to stick to the high-level facts, especially since they know you'll be tested again later this year.
That said, it seems like a big part of the recommendations would be "eating well" and "moving more". Perhaps that would be a good idea either way?
posted by demi-octopus at 4:39 AM on May 22 [5 favorites]
The only value of a diagnosis is to affect treatment or behavior. If you're below the threshold at which medication or other treatment would be warranted, and you're already aware of and pursuing (or motivated to pursue) appropriate health-promoting diet and exercise approaches, then what benefit would there be from flagging that test result?
posted by Mr.Know-it-some at 6:15 AM on May 22 [10 favorites]
posted by Mr.Know-it-some at 6:15 AM on May 22 [10 favorites]
The thresholds exist because doctors have to have some lower limit. There wouldn’t be some switch that flipped at 42 — it would just become statistically more likely that you were pre-diabetic. Likely enough that it’s worth talking about.
But if 42 is worth your doctor starting the conversation then it’s very reasonable for you to want to start it at 41 instead.
A parent or sibling with diabetes is a risk factor, but both together is a much larger one. You don’t mention siblings, but if one of them develops diabetes then you should really talk to your doctor. And if at some point you end up developing diabetes, you should definitely tell them they’re at risk.
posted by Tell Me No Lies at 6:24 AM on May 22 [1 favorite]
But if 42 is worth your doctor starting the conversation then it’s very reasonable for you to want to start it at 41 instead.
A parent or sibling with diabetes is a risk factor, but both together is a much larger one. You don’t mention siblings, but if one of them develops diabetes then you should really talk to your doctor. And if at some point you end up developing diabetes, you should definitely tell them they’re at risk.
posted by Tell Me No Lies at 6:24 AM on May 22 [1 favorite]
That said, it seems like a big part of the recommendations would be "eating well" and "moving more". Perhaps that would be a good idea either way?
Yeah, since the early interventions for pre-diabetes would overlap significantly with what your GP is probably already recommending for your high blood pressure, they may not have seen a need to flag it for that reason.
posted by mskyle at 6:34 AM on May 22 [5 favorites]
Yeah, since the early interventions for pre-diabetes would overlap significantly with what your GP is probably already recommending for your high blood pressure, they may not have seen a need to flag it for that reason.
posted by mskyle at 6:34 AM on May 22 [5 favorites]
I am not a doctor. I just read a lot. 41 mmol is 5.9 mg/dl which in isolation doesn’t seem concerning. That’s a value that should be interpreted in context of a medical history and other test results. For example, what were your ldl and triglycerides? What were your previous three hba1c readings? What is your waist circumference? That number is just one part of the picture.
posted by bq at 6:42 AM on May 22
posted by bq at 6:42 AM on May 22
I’m sorry to tell you this, but you are already prediabetic according to US guidelines—the lower threshold for prediabetes is 39 (5.7%) according to the American Diabetic Association. It’s kind of a blurry spectrum of a disease, there’s not a magic switch that gets flipped at a certain A1C, and the US and UK guidelines differ on where the border is for calling someone prediabetic vs normal. Regardless of where you are and the label on your chart, the initial recommendations are going to be the same (eat fewer carbs and eat them in a way that minimizes blood sugar spikes, exercise more) so you could talk to your doctor about it, they’re unlikely to immediately medicate you even if you end up passing the lower range for diagnosis in the UK. Tell Me No Lies and mskyle have it right, there’s not really a strong reason to talk to you about it till you’ve passed the diagnosis threshold since you probably already have the diet/exercise advice onboard from your blood pressure condition. If I were you, I’d change up my diet and exercise now, then see if you can get your A1C lower next visit, but it’s still in a pretty good, non-scary range right now, so I don’t think it’s anything to be extremely worried about, just something to try and address via eating better and moving your body more, which will be healthy for you regardless of your metabolic state and any labels on it at a given moment. You’ve got this.
posted by music for skeletons at 6:56 AM on May 22 [4 favorites]
posted by music for skeletons at 6:56 AM on May 22 [4 favorites]
There are many health organizations, researchers, and doctors who question whether or not prediabetes should be a diagnosis at all. A very small percentage of people labeled pre-diabetic will go on to develop diabetes. So perhaps your doctor knows/believes this is a garbage diagnostic tool.
posted by CMcG at 8:33 AM on May 22 [1 favorite]
posted by CMcG at 8:33 AM on May 22 [1 favorite]
That largely depends on the levels you set for pre-diabetes. As noted above the U.S. definition is fairly low and thus includes 1/3 of the population, but that's not the definition that is used everywhere.
Using definitions with a higher limit the results are a bit more grim.
Using definitions with a higher limit the results are a bit more grim.
Prediabetes will progress to overt type 2 diabetes (T2DM) in approximately 25% of subjects within 3–5 years, and as many as 70% of individuals with prediabetes will develop overt diabetes within their lifetime.posted by Tell Me No Lies at 9:34 AM on May 22 [1 favorite]
I can't speak to the diabetes aspect. I can say, though, that I spent the past 5-6 years with an undiagnosed parathyroid issue because two different doctors waved away my (repeated) questions about elevated calcium levels on (repeated) blood tests.
When hyperparathyroidism was finally diagnosed, doctors (who were not the prior ones) said that my calcium level was a dead giveaway for the issue.
Once my overactive parathyroid gland was removed, I felt markedly better - I realized that I had been fatigued and low-level depressed for some time, and/but had no idea that it was because of my parathyroid.
In restrospect, several years of my life were likely altered by doctors not taking my blood test results seriously. If I could go back in time, I'd handle those early calcium-level conversations very differently.
All this is to say: it seems to me that it makes sense to wait for the next blood test, since you're not in the official zone-of-concern yet. Next time though, if doctors continue to wave away results that you find concerning, I encourage you to push for more consideration / make some noise / get another opinion!
posted by marlys at 12:59 PM on May 22 [2 favorites]
When hyperparathyroidism was finally diagnosed, doctors (who were not the prior ones) said that my calcium level was a dead giveaway for the issue.
Once my overactive parathyroid gland was removed, I felt markedly better - I realized that I had been fatigued and low-level depressed for some time, and/but had no idea that it was because of my parathyroid.
In restrospect, several years of my life were likely altered by doctors not taking my blood test results seriously. If I could go back in time, I'd handle those early calcium-level conversations very differently.
All this is to say: it seems to me that it makes sense to wait for the next blood test, since you're not in the official zone-of-concern yet. Next time though, if doctors continue to wave away results that you find concerning, I encourage you to push for more consideration / make some noise / get another opinion!
posted by marlys at 12:59 PM on May 22 [2 favorites]
In your shoes, the only cause for concern I would personally derive from any just-below-threshold result for any disease marker is if I had evidence of that marker creeping upward over time, especially if that upward creep had recently begun to accelerate.
Do you have your numbers from other years? I keep a little excel file of lab values I want to keep track of (for me, A1c, fasting glucose, all the cholesterol and associated fats and liver enzymes) and then it's very easy to see if there are trends (or no trend!). I just pulled it up and while my A1c bounces around +/- 0.3, my cholesterol is slowly trending down as it's been something I've been working on.
posted by lizjohn at 4:08 PM on May 22
Do you have your numbers from other years? I keep a little excel file of lab values I want to keep track of (for me, A1c, fasting glucose, all the cholesterol and associated fats and liver enzymes) and then it's very easy to see if there are trends (or no trend!). I just pulled it up and while my A1c bounces around +/- 0.3, my cholesterol is slowly trending down as it's been something I've been working on.
posted by lizjohn at 4:08 PM on May 22
Lab results jump all over the place - just due to the various factors that go into measuring results. On top of that, the actual values in your body fluctuate day-to-day as well.
For most things, one single reading in the ballpark of the upper of lower limit is no particular cause for alarm or even consideration or mention.
When the doctor is looking at your results, usually they have the history of results for this test as well as the current result. When they make a judgement about what to discuss with you, they are typically taking all that into account.
Point is, let's say your numbers for this lab have been 35, 38, 39, 36, 40, 37, 41.
Is it PANIC time?
No.
Is it jump in and DO SOMETHING time?
No.
Is it time to take another test in 6 months or a year and see how it is going at that time.
Yes.
That is what you are doing and that is what your doctor is doing.
Your doctor is doing with a much lower degree of anxiety, however. Suggest you follow doctor's lead in that particular area.
posted by flug at 4:47 PM on May 22
For most things, one single reading in the ballpark of the upper of lower limit is no particular cause for alarm or even consideration or mention.
When the doctor is looking at your results, usually they have the history of results for this test as well as the current result. When they make a judgement about what to discuss with you, they are typically taking all that into account.
Point is, let's say your numbers for this lab have been 35, 38, 39, 36, 40, 37, 41.
Is it PANIC time?
No.
Is it jump in and DO SOMETHING time?
No.
Is it time to take another test in 6 months or a year and see how it is going at that time.
Yes.
That is what you are doing and that is what your doctor is doing.
Your doctor is doing with a much lower degree of anxiety, however. Suggest you follow doctor's lead in that particular area.
posted by flug at 4:47 PM on May 22
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posted by koahiatamadl at 1:53 AM on May 22 [2 favorites]