Is there any difference between prediabetes and diabetes at all?
On one occasion, while I was waiting for the HbA1c value to be found, a lab technician asked me why I was doing that test, and if I suspected if my little girl has diabetes. I laughed and told her that my little girl has diabetes for several years and that was why we took the test regularly, every three months.
As the value from the findings was within the reference values, the technician confusedly concluded that my child was then certainly still not on insulin. When I told her that she had been on insulin since day one of the diagnosis, she was taken aback and commented that she had not yet noticed such a finding in people with type 1 diabetes and asked how we achieve this.
This post is actually an amateurish review of HbA1c laboratory reference values, which is considered the most important test for diabetes and should be done regularly. It shows how well diabetes is regulated.
According to the laboratory, the level of HbA1c is proportional to the level of glucose in the blood. Because glucose remains bound to red blood cells throughout their lives, the determination of HbA1c indicates an average daily blood glucose level over the past 2 months. Determination of HbA1c is therefore considered a very important diagnostic tool in monitoring dietary control, and therapy in the treatment of diabetes. Reference values for HbA1c, which are between 4 and 6.2%, are also given. These values differ slightly between laboratories, but this difference is not particularly significant (somewhere up to 6%).
In a laboratory finding, all values less than the upper limit will not be marked as high (HI), and you will not be visually alerted that this value is elevated.
The graph above shows the blood sugar movement of my child, a type 1 diabetic, for the past 3 months. The hours of the day are shown horizontally, and the sugar values are shown vertically. The blue line shows the average value of the observed period, and the gray lines show to which level the blood sugar value was moving. The break on the graph is due to the second measuring device we use at night, and Libre can display the measured values backward only for the last 8 hours.
It can be seen on the graph that somewhere around 10 pm, she has a rise of BG according to the values of 10-12 mmol. There are often such periods, and I believe that growth hormone is activated then, which makes it very difficult for us to keep sugar levels normal. Such an evening rise in blood sugar levels occurs, for example, for 1-2 weeks, after which we have 2-3 weeks of stable sugars. What I wonder when I look at the gray area on the graph, is how is it possible that these values are ultimately within the reference values for healthy individuals if we look at the result of the HbA1c lab test?
The online calculator http://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html allows you to convert HbA1c reference values to mmol, which reflects the average blood sugar value. If we put the value HbA1c = 6 in it, which is within the reference interval for healthy people, we will get the following result:
Unfortunately, this means that 7 mmol is the average blood sugar value that does not raise an alarm / warning in a laboratory HbA1c finding!
The vast majority of people who take this finding do not know what exactly the result means and when they get a value of 6%, they think they are healthy, when in reality they have already developed diabetes. Even all technical laboratory staff do not know that diabetes means HbA1c values as low as 5.7%.
Many who have a fasting BG greater than 6.0 mmol will not have a HbA1c test at all that shows glucose saturation in the last 90 days (in diabetics and shorter), but will be instructed to watch out for sweets, and come in for a checkup in a while. As far as I know, it is not possible to order an HbA1c test from a pediatric clinic if there is no diagnosis of diabetes.
HbA1c is indeed an important indicator, but looking at it alone it cannot be concluded whether someone has good or bad regulation of diabetes, nor that a person is healthy, if the HbA1c values are within the laboratory reference values.
A person can certainly have several hours of blood sugar worth 10, 11 or 12 mmol every day, and still have HbA1c of 5.7%.
Prediabetes is diagnosed after the detection of HbA1c between 5.7-6.2% (according to some sources up to 6.4%), which proves impaired glucose metabolism and diabetes.
HbA1c of 5.6%, which is thought to be present in healthy individuals, is actually a sugar average of 6.3 mmol.
Do we have real numbers on diabetes in our population?
According to the CroDiab register of persons with diabetes, in 2014 there were 254,296 adults with diabetes in the Republic of Croatia, 125,506 men (49.35%) and 128,790 (50.65%) women. With estimates that up to 40% of patients have not been detected, the total number of patients is estimated at over 400,000.
It is not good that, despite the fact that we often hear about the prevention of diabetes, measuring blood glucose is not a common test. Everyone agrees that early diagnosis is the most important, that lately both children and adolescents are more and more endangered because they are overweight, that (pre) diabetes passes without symptoms for years. Laboratory reference values and CHIF’s savings on tests further obscure the obvious diagnosis, and thus a much higher number of patients.
If a complete blood count was taken once a year during a visit to the doctor, the basic part of which would be a glucose and HbA1c test, diabetes would be diagnosed faster and changes in diet and treatment would be started sooner. With lowering the reference values for HbA1c, or at least educating relevant staff about their meaning, this would be the right path.
The text was downloaded with permission from the blog typeoneprincess.com