What do my results mean?
All of the results you will receive will fall into the red, amber or green zones as in a traffic light formation; red being of concern, green being satisfactory and amber in between. All of the sections below explain what your results mean and give you some thoughts about the next steps to improve or maintain your results.
Blood Pressure
Blood pressure is a measurement of the force of blood flow inside your arteries. Your blood pressure is stated as two figures, e.g. 130/80mmHg. The first figure is known as the systolic pressure and relates to the pressure as the heart contracts and pushes blood through the arteries. The other figure is the diastolic pressure which is when the heart relaxes to refill with blood.
Having high blood pressure (also known as hypertension) does not always produce symptoms, so you may not know that you have it.
It is necessary to ensure that it is in the target range and not increasing your risk of developing diabetes complications, including cardiovascular disease (CVD). If you have diabetes, your healthcare team will help you aim towards a target level of 130/80mmHg or less.
What is high blood pressure?
High blood pressure – also known as hypertension – is when your blood pressure is constantly higher than the recommended level, if you have high blood pressure, you run a higher risk of having a heart attack or a stroke, and over time it can cause the heart to become abnormally large, or the pumping action of the heart to become less effective. High blood pressure rarely makes people feel ill, so the only way of knowing if you have high blood pressure is to have it measured.
What causes high blood pressure?
In nine out of ten people, there is no definite cause of high blood pressure. However, the following can all play a part.
- Not doing enough physical activity
- Being overweight
- Having too much salt in your diet
- Drinking too much alcohol
- Not eating enough fruit and vegetables
Genes are another factor. So, if one of your parents have (or had) high blood pressure, you are at more risk of developing it too.
What you can do?
If you have high blood pressure, it is essential to control it. Even reducing your blood pressure by a small amount can lower your risk of problems in the future. To reduce your blood pressure, or prevent it from getting high, you can do the following things.
- Do more physical activity
- Keep to a healthy weight
- Cut down on salt
- Cut down on alcohol
- Eat more fruit and vegetables
If you do develop high blood pressure, your doctor may prescribe medicine to help reduce your blood pressure and protect your heart.
Average Blood Glucose
What is HbA1c?
Glucose in the blood sticks to haemoglobin in red blood cells, forming something called HbA1c. The higher the glucose in the blood, the higher the amount of HbA1c. The HbA1c gives a measure of your average blood glucose level in the previous 2-3 months.
What does it tell us?
The better the blood glucose control, the less chance there is of developing diabetes complications such as eye, kidney, nerve and circulation problems. The HbA1c test tells you how well your blood glucose has been controlled over the past few months and whether you are on target to keeping your risk of complications as low as possible.
Why measure it?
We usually measure HbA1c every 3-6 months. The results show how the blood glucose control has improved in response to changes in diet, exercise or medication.
Current HbA1c Results
The HbA1c results are currently given as a percentage. In someone who does not have diabetes, the result would be between 4.0 and 6.0 %
Current Targets
For most people with diabetes, the current HbA1c target is less than 7.0 %. However, you should discuss your own individual target with your own health care team, as sometimes a different target might be more appropriate. For example, very good glucose control is important if you are planning a pregnancy, so that you might aim for an HbA1c target of 6.1 %.
If you have had a lot of problems with low blood glucose levels (hypos), a higher target might be appropriate.
What is Changing?
Laboratories in the UK are about to change to a new reference method for measuring HbA1c. This will make comparing HbA1c results from different labs and from research trials throughout the world much easier.
New HbA1c Results
The way the results from the new method are shown is very different to the old results, but the test will still give you the same basic information about how good your glucose control has been over the last 2-3 months. For someone without diabetes the new HbA1c result will be between 20 and 42 mmol/l.
How Old and New Relate
Here is how the old and new results compare:
| Current HbA1c (%) | New HbA1c(mmol/mol) |
|
4.0 |
20 |
|
6.0 |
42 |
|
7.0 |
53 |
|
8.0 |
64 |
|
9.0 |
75 |
|
10.0 |
86 |
How Targets will Change
The equivalent of the current HbA1c target of less than 7.0 % is a new HbA1c target of less than 53 mmol/mol.
When will this happen?
The new units for HbA1c are obviously very different to those currently in use. Everyone will need time to become familiar with the new units, and how they compare with the current result. So from 1 April 2009, all HbA1c results in the UK will be given in the current HbA1c % and in the new HbA1c mmol/mol. This dual reporting will continue until 31 March 2011.
So for example, the report of your HbA1c result might read:
Old HbA1c 6.9 % New HbA1c 51 mmol/mol
The fact that the number is higher does not mean there is more glucose in your blood. It is just a different way of measuring the same thing.
Changeover to New Units
From 1 April 2011, results will be given only as the new HbA1c in mmol HbA1c /mol haemoglobin.
Limitations of HbA1c Measurement
HbA1c results (DCCT or IFCC) will be misleading in certain situations. If this applies to you, your doctor will discuss this with you and monitor your overall glucose control in a different way.
Why not report eAG?
It may be possible to calculate an estimated average glucose (eAG) from an HbA1c result. However, it has been agreed in the UK not to report eAG at the moment.
Blood Fats
What is cholesterol?
Cholesterol is a fatty substance which is found in the blood. It is mainly made in the body. Cholesterol plays an essential role in how every cell in the body works. However, too much cholesterol in the blood can increase your risk of heart problems.
LDL cholesterol and HDL cholesterol
Cholesterol is carried around the body by proteins. These combinations of cholesterol and proteins are called lipoproteins.
There are two main types of lipoproteins:
- LDL (low-density lipoprotein) is the harmful type of cholesterol
- HDL (high-density lipoprotein) is a protective type of cholesterol.
Having too much harmful cholesterol in your blood can increase your risk of getting cardiovascular disease. The risk is particularly high if you have a high level of LDL cholesterol and a low level of HDL cholesterol.
Triglycerides
Triglycerides are another type of fatty substance in the blood. They are found in foods such as dairy products, meat and cooking oils. They can also be produced in the body, either by the body’s fat stores or in the liver. People who are very overweight, eat a lot of fatty and sugary foods, or drink too much alcohol are more likely to have a high triglyceride level. People with high triglyceride levels have a greater risk of developing cardiovascular disease than people with lower levels.
What causes high cholesterol?
One of the causes of high blood cholesterol levels among people in the UK is eating too much saturated fat. It is important that you eat foods that are low in saturated fat. However, some people have high blood cholesterol even though they eat a healthy diet.
What are the dangers associated with high cholesterol?
Coronary heart disease is caused when the coronary arteries (the arteries that supply the heart muscle with oxygen-containing blood) become narrowed by a gradual build-up of fatty material within their walls. This condition is called atherosclerosis, and the fatty substance is called atheroma.
Atheroma develops when the level of the ‘bad’ LDL cholesterol is too high. On the other hand, HDL cholesterol is ‘good’ because it removes excess cholesterol from the circulation, and helps to protect against coronary heart disease.
The aim is to have:
- A low total cholesterol level
- A low level of LDL cholesterol, and
- A high level of HDL cholesterol
Eating a healthy diet can help to improve your cholesterol levels. The most important thing is to reduce the total amount of fat in your diet, especially saturated fat (animal fat).
How can you reduce your cholesterol levels?
To help reduce your cholesterol levels, you need to:
- Cut down on saturated fats and replace them with monounsaturated fats and polyunsaturated fats. You should also reduce the total amount of fat you eat.
- Eat oily fish regularly. Oily fish provides the richest source of a particular type of polyunsaturated fat known as omega-3 fats which can help to lower blood triglyceride levels and also helps prevent the blood from clotting, and help regulate heart rhythm.
- Eat a high-fibre diet. Foods that are high in ‘soluble fibre’ such as porridge, beans, pulses, lentils, nuts, fruits and vegetables, can help lower cholesterol. (Dietary advice)
- Doing regular physical activity can help increase your HDL cholesterol (the ‘protective’ type of cholesterol).
- Keep to a healthy weight for your height.
- Drink alcohol in moderation. Keep within the sensible limits. Men should drink no more than 3-4 units each day and women no more than 2-3 units each day. (Alcohol advice)
- And remember if you smoke – STOP. Smoking is the single biggest risk for developing heart disease. (Stop Smoking support )
People with diabetes, or who already have heart and circulatory disease, should aim for:
- A total cholesterol level under 5 mmol/l
- An LDL cholesterol level under 3 mmol/l
- An HDL cholesterol level above 1 mmol/l
- A triglyceride level under 2 mmol/l.
Shape
What is BMI?
Health professionals use BMI to determine whether a person is overweight or clinically obese. This indicates the risk of developing heart disease, diabetes, stroke and certain cancers.
BMI is calculated by dividing your weight in kilograms by your height in metres squared. Recommended BMI:
- Underweight = less than 18.5
- Ideal = 18.5 – 25
- Overweight = 25 – 30
- Obese = 30 – 40
- Very obese = over 40
Waist Circumference
Most of us store body fat in one of two distinct ways – around our hips and thighs (pear shaped), or around our middle (apple shaped). The shape of your body is directly linked to your risk of poor health. The apple shape (or central obesity) has been demonstrated to carry greatest risk for developing diabetes and heart disease.
This is now believed to be a much more accurate measure of future health risk. Carrying too much fat around your middle is associated with an increased risk of diabetes and heart disease. It is also associated with increased cholesterol.
A waist measurement above 80cm (32in) for women and a 94cm (37in) for men increases the risk. Greatest risk is seen above 88cm (35in) for women and 102cm (40in) in men.
Well-being
Living with and managing diabetes can seem like an overwhelming task. Many people with diabetes struggle to cope with requirements of the disease and its complications. Remaining positive is a major factor in managing diabetes. The WHO 5 questionnaire is a brief patient-friendly measure of positive well-being. The score you achieve in this questionnaire will determine whether or not you require any psychological support.
Diabetic Kidney Disease
Kidney disease can happen to anyone but is much more likely to happen to people with diabetes. This is because diabetes can affect the circulation of blood through the body causing damage inside the kidneys. You are more at risk if your diabetes is not well-controlled, you smoke, have high blood pressure or if you have family history of kidney problems. If you can keep your diabetes and your blood pressure well controlled you can help to reduce the risk of damage to your kidneys.
How the kidneys work
The kidneys act as a sieve helping the body to get rid of any waste products from the blood, they do this by making urine. The kidneys also play an important part in controlling blood pressure and regulate the amount of fluids and salts in the body.
What happens if I have kidney disease?
The very first sign that the kidneys are starting to become affected by diabetes is the leakage of small amounts of protein. This protein can only be detected by sending the urine to the lap for a test called Albumin Creatinine Ratio (ACR). Your blood pressure may start to rise but otherwise you will not be aware that this damage is occurring. If detected at this time there is lots that can be done to help slow down the damage to the kidneys. It is important that you attend for an annual check for diabetes and ensure that you have the kidney tests performed.
Over time the kidneys will become less efficient at filtering out waste products and these build up in the blood. This can be picked up by taking a blood sample and measuring the glomerular filtration rate (eGFR). If you think that your kidneys should be working at 100% if your GFR is only 50 this tells us your kidneys are only working at 50% or half the rate that they should do.
Once your kidneys start to fail you may have problems with nausea, reduced appetite and ankle swelling. In the advanced stages of kidney disease you can become very unwell and will need to have kidney replacement therapy such as transplant or dialysis. Remember diabetic kidney disease develops over many years and there is lots that can be done to reduce the risk.
Foot Care
Diabetes can cause problems in the feet and legs by:
- Damaging nerves
- Restricting the blood supply (circulation)Damaging the sweat glands
This means that:
- You may not be able to feel your feet properly. If your feet are numb, foot problems and injuries may go unnoticed.
- Healing may be much slower than normal.
- Infection can occur easily and can spread very quickly if not treated properly.
The best way to maintain good foot health and avoid such complications is to maintain good control of blood sugars, blood pressure and cholesterol. You should also stop smoking.
The foot score measures pulses, sensation and the appearance of both feet.
- 0 – 5 = low risk score
- 10 – 20 = moderate risk score
- 25+ = high risk score
Eye Screening
Once a year, you will be invited to have your eyes screened for problems associated with diabetes. This is now performed by a specialist service and is no longer delivered by local opticians. How to make an appointment
Most people with diabetes see well and have no major eye problems. Some people develop cataracts which cause ‘misty vision’, which can be removed by a relatively quick operation.
If your diabetes has been a little more severe, you may develop disease of the retina of your eye (retinopathy). Blindness from diabetic retinopathy can be prevented by regular eye checks and good diabetes and blood pressure control.
There are four main categories of retinopathy:
- No retinopathy – healthy retina
- Background change – early change with small haemorrhages from small blood vessels
- Maculopathy – more serious change with protein leaking from the blood vessels causing some vision loss
- Pre-proliferative – the final stage before tiny new blood vessels form which can result in major haemorrhage into the eye.
The key to preventing all of the above is good diabetes control and control of blood pressure.