Questions about some of the health results your GP or care team might provide you with
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What does the traffic light coding on the health profile in the X-PERT Diabetes Prevention and Management Handbook mean for blood pressure?
The participant handbook is for prevention and management, so the national targets for the general population (less than 140/90) have been used. In the key it states that the green cut-point represents the “National target for good health”, reflecting this. For those with diabetes the criteria for desired blood pressure are slightly more stringent though (less than 140/80), whilst for those with diabetes AND with evidence of damage to the eyes or kidneys they are stricter still (less than 130/80). Both the systolic and diastolic readings are important.
What is a good HbA1c result in a 50 year old, 60 year old, 70 year old, 80 year old? Does it go up with age?
The same cut-offs apply for any age group; i.e. normal glucose tolerance is 20 to 41 mmol/mol, prediabetes is 42 to 47, and diabetes is classified as 48 and above. The only reason why people’s HbA1c increases with age is because people tend to become less glucose tolerant due to weight gain (particularly centrally), lead increasingly sedentary lifestyles, or develop other associated conditions such as fatty liver. If people prevent or treat these conditions as they age by changing their lifestyle (or by maintaining a healthy lifestyle), their glucose tolerance should not deteriorate!
If glucose attaches itself to red blood cells, what happens to it once the red blood cell dies?
Glucose gradually becomes attached to red blood cells during the lifespan of the cell (~120 days). All the time there is red blood cell turnover – some being broken down and some being formed. Once the glucose is attached to the red blood cell, it remains there until the cell is broken down and that is why the HbA1c test informs of average blood glucose levels over the previous 2-3 months. If people make lifestyle changes and reduce their blood glucose levels, they will notice a difference in their HbA1c value within 2-3 months. Once the red blood cells breaks down the glucose will either enter the cells to be used for energy, or will re-attach to another red blood cell, depending on blood glucose control.
Should I be concerned if my total cholesterol is high?
Examining total cholesterol in isolation is not a fair assessment of blood lipid health. The notion that there is good and bad cholesterol is a massive oversimplification.
LDL cholesterol, often referred to as ‘bad cholesterol’ is simply a transporter that carrier the cholesterol from a (the liver) to b (wherever it is needed in the body). It is more important to examine the size and density of the LDL particle to get a fairer assessment of blood lipid health. Large buyout LDL particles are more efficient at transporting cholesterol and are less likely to crash and become oxidised. Small dense LDL particles are more likely to crash, become oxidised, spill the cholesterol on the blood vessel wall, ultimately contributing towards fatty plaque build-up.
In the UK there is no routine blood test that assesses whether one has large or small dense LDL’s but a good way of assessing this is the triglyceride to HDL ratio (triglyceride divided by HDL). If one has a ratio of less than 0.87 they are more likely to have large LDL particles if one has a ratio larger than 2.62 they are likely to have the more harmful small dense particles. For example if a patient has a total cholesterol reading of 7 mmol/l but a triglyceride to HDL ratio of 0.47 this indicates they have good blood lipid health despite having a high total cholesterol.
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