Serious why do our sg polyclinics use Blood Glucose instead of HBA1C test?

[kkbutterfly]

went to polyclinic to complain of very bad thirst over the past 8 months.
Doctor suggested a fasting blood glucose test.
after I go home, I research online, a HBA1C is extremely accurate .
best taken concurrently with fasting blood glucose test.
Blood Glucose only show you the level at that point of time which likely to fluctuate constantly
any expert can explain why our clinics do not recommend both since blood is already drawn.

 

[bodycells]

went to polyclinic to complain of very bad thirst over the past 8 months.
Doctor suggested a fasting blood glucose test.
after I go home, I research online, a HBA1C is extremely accurate .
best taken concurrently with fasting blood glucose test.
Blood Glucose only show you the level at that point of time which likely to fluctuate constantly
any expert can explain why our clinics do not recommend both since blood is already drawn.

Why don't you go to the polyclinic and tell them this..? This is a forum, not a polyclinic.

 

[kkbutterfly]

Why don't you go to the polyclinic and tell them this..? This is a forum, not a polyclinic.

I go back , research online and have some doubts.

 

[bushtucker]

SOP for public subsidized clinics. You want HBA1C or advanced tests, go make an appointment with a private clinic or specialist.

 

[nayr69sg]

Why not do both? The answer is cost.

The HBA1c did not start out as a test to diagnose Diabetes. It was used primarily to monitor the glucose control of diabetics over a 3-4 month period. It measures the % of hemoglobin in the body that are glycated (ie have attached glucose molecues). The life span of red blood cells is about 120 days. Hence the variations in HBA1c will not change day to day but over a period of 120 days or so.

Our target for diabetics is a HBA1c of <7% for adequate glucose control.

The way to diagnose diabetes was to do a fasting blood glucose sample. If it was >7.0 we would repeat it again and if was still >7.0 we could diagnose Diabetes in the patient. Another test was the random blood glucose level (non fasting). A reading > 11.0 suggested diabetes. The key is to have 2 separate readings. Eg either 2 abnormal fasting readings or 2 abnormal random readings or 1 abnormal fasting and 1 abnormal random. 2 abnormal = diabetes. To complicate things a bit there is pre-diabetes as a diagnosis now. Fasting blood glucose of 6.1-6.9 is considered possible impaired fasting glycemia and hence pre-diabetes.

We can also send patients for a glucose tolerance test where they fast for 8 hrs , then get a fasting sample taken, then drink a 75g glucose drink, wait 2 hours and have their blood glucose drawn again. The 2hour reading if >11.1 supports a diagnosis of diabetes. (of course their fasting might already be >7.0 but some people have normal fasting but abnormal 2 hour post prandial readings). If the 2 hour reading is between 7.8-11.0 it suggests impaired glucose tolerance which is also part of the pre-diabetes spectrum.

In recent times, the HBA1c has been used to diagnose diabetes as well. A reading of <6.0 is considered normal. If it is >6.5 it suggests diabetes. Between 6.1 to 6.4 might suggest pre-diabetes.

Again you need 2 abnormal results to diagnose diabetes. Eg say someone has HBA1c of >6.5 and fasting glucose >7.0 then you can diagnose DM. The advantage with adding the HBA1c to the fasting glucose is you might not need to repeat another fasting glucose. That's about it.

Cost is the catch. And you know lah, in Singapore cost is the big thing.

The HBA1c used to cost around $25-$35. Fasting glucose is very cheap. I think like $2-$5. Maybe even cheaper. So 2 fasting glucose readings is still cheaper than HBA1c alone. And if you are trying to DIAGNOSE diabetes there is no real case for using HBA1c besides convenience to the patient. It is no more "accurate" than doing 2 fasting glucose readings or a glucose tolerance test.

But HBA1c is essential in determining a diabetic (already diagnosed) patient's long term glucose control.

Hope this clarifies some of the questions.

In canada we do both the HBA1c and Fasting glucose in screening.

 

[kkbutterfly]

Why not do both? The answer is cost.

The HBA1c did not start out as a test to diagnose Diabetes. It was used primarily to monitor the glucose control of diabetics over a 3-4 month period. It measures the % of hemoglobin in the body that are glycated (ie have attached glucose molecues). The life span of red blood cells is about 120 days. Hence the variations in HBA1c will not change day to day but over a period of 120 days or so.

Our target for diabetics is a HBA1c of <7% for adequate glucose control.

The way to diagnose diabetes was to do a fasting blood glucose sample. If it was >7.0 we would repeat it again and if was still >7.0 we could diagnose Diabetes in the patient. Another test was the random blood glucose level (non fasting). A reading > 11.0 suggested diabetes. The key is to have 2 separate readings. Eg either 2 abnormal fasting readings or 2 abnormal random readings or 1 abnormal fasting and 1 abnormal random. 2 abnormal = diabetes. To complicate things a bit there is pre-diabetes as a diagnosis now. Fasting blood glucose of 6.1-6.9 is considered possible impaired fasting glycemia and hence pre-diabetes.

We can also send patients for a glucose tolerance test where they fast for 8 hrs , then get a fasting sample taken, then drink a 75g glucose drink, wait 2 hours and have their blood glucose drawn again. The 2hour reading if >11.1 supports a diagnosis of diabetes. (of course their fasting might already be >7.0 but some people have normal fasting but abnormal 2 hour post prandial readings). If the 2 hour reading is between 7.8-11.0 it suggests impaired glucose tolerance which is also part of the pre-diabetes spectrum.

In recent times, the HBA1c has been used to diagnose diabetes as well. A reading of <6.0 is considered normal. If it is >6.5 it suggests diabetes. Between 6.1 to 6.4 might suggest pre-diabetes.

Again you need 2 abnormal results to diagnose diabetes. Eg say someone has HBA1c of >6.5 and fasting glucose >7.0 then you can diagnose DM. The advantage with adding the HBA1c to the fasting glucose is you might not need to repeat another fasting glucose. That's about it.

Cost is the catch. And you know lah, in Singapore cost is the big thing.

The HBA1c used to cost around $25-$35. Fasting glucose is very cheap. I think like $2-$5. Maybe even cheaper. So 2 fasting glucose readings is still cheaper than HBA1c alone. And if you are trying to DIAGNOSE diabetes there is no real case for using HBA1c besides convenience to the patient. It is no more "accurate" than doing 2 fasting glucose readings or a glucose tolerance test.

But HBA1c is essential in determining a diabetic (already diagnosed) patient's long term glucose control.

Hope this clarifies some of the questions.

In canada we do both the HBA1c and Fasting glucose in screening.

yeah.
I mentioned to the young pretty doctor about why isn't HBA1C is not used concurrently.
she did not explain why, but she told me if I insist to have both test together , she will respect my decision and can proceed on.
the result is as followed:
Hba1c : 5.4%
glucose fasting :5 MMOL/L
she say congratulation but couldn't explain and solve my extreme night thirst
I had expel the suspicious of sleeping with mouth open and eating too much salt.

 

[nayr69sg]

yeah.
I mentioned to the young pretty doctor about why isn't HBA1C is not used concurrently.
she did not explain why, but she told me if I insist to have both test together , she will respect my decision and can proceed on.
the result is as followed:
Hba1c : 5.4%
glucose fasting :5 MMOL/L
she say congratulation but couldn't explain and solve my extreme night thirst
I had expel the suspicious of sleeping with mouth open and eating too much salt.

Aiyah, you don't have diabetes lah. That's why she congratulate you.
What do you mean by "expel" the suspicious of sleeping with mouth open and eating too much salt? Expel?

I gather you were asking whether the cause of your night thirst could be due to Sleep Apnea?

Eating too much salt is something you can work around yourself by.....CUTTING down on your salt intake and see if it helps.

Sleep apnea requires a sleep study to diagnose which is rather costly in Singapore but is free in Canada.

Some of my patients like to ask why why why why. Do test after test all normal. Ask why why why why. I tell them look on the bright side lah. All the tests are normal. You don't have serious illnesses. Just drink more water lah. Or wet your mouth a little before going to sleep. Put lip balm. I mean seriously, you want to have diabetes meh?

 

[kkbutterfly]

Aiyah, you don't have diabetes lah. That's why she congratulate you.
What do you mean by "expel" the suspicious of sleeping with mouth open and eating too much salt? Expel?

I gather you were asking whether the cause of your night thirst could be due to Sleep Apnea?

Eating too much salt is something you can work around yourself by.....CUTTING down on your salt intake and see if it helps.

Sleep apnea requires a sleep study to diagnose which is rather costly in Singapore but is free in Canada.

Some of my patients like to ask why why why why. Do test after test all normal. Ask why why why why. I tell them look on the bright side lah. All the tests are normal. You don't have serious illnesses. Just drink more water lah. Or wet your mouth a little before going to sleep. Put lip balm. I mean seriously, you want to have diabetes meh?

not so simple leh.
I woke up 4 times a time to quench my thirst. doctor knows about this but cannot help.

 

[nayr69sg]

not so simple leh.
I woke up 4 times a time to quench my thirst. doctor knows about this but cannot help.

You are thirsty only at night? Not so simple you say. So what do you fear it might be?

As a doctor we sometimes try to understand what the patient is thinking.
FIFE.
Function – how is it affection their life?
Ideas – what do they think they have?
Fears – is there anything they are particularly afraid of?
Expectations – what do they hope this visit will achieve?

But when we ask these questions the Singaporean smart aleck patients will say " why you ask me these questions? You the doctor! You tell me"

Well thirst itself for example is not really a sign of major illness in most cases. Especially if it is only present at night and at no other times of the day.

Oh well..... I am just glad I don't have to deal with crappy Sinkie patients anymore.

 

[Charlie99]

went to polyclinic to complain of very bad thirst over the past 8 months.
Doctor suggested a fasting blood glucose test.
after I go home, I research online, a HBA1C is extremely accurate .
best taken concurrently with fasting blood glucose test.
Blood Glucose only show you the level at that point of time which likely to fluctuate constantly
any expert can explain why our clinics do not recommend both since blood is already drawn.

When they draw your blood for a fasting blood glucose test,
they should probably do a HbA1C test.

 

[gongkia]

After seeing one doctor after another and still don't really help, why don't you give Rony Tan a try. Maybe his anointed urine can solve your night thirst problem. You don't want to take chance with your own health, right? Below chart will give you some confidence.

 

[Charlie99]

yeah.
I mentioned to the young pretty doctor about why isn't HBA1C is not used concurrently.
she did not explain why, but she told me if I insist to have both test together , she will respect my decision and can proceed on.
the result is as followed:
Hba1c : 5.4%
glucose fasting :5 MMOL/L
she say congratulation but couldn't explain and solve my extreme night thirst
I had expel the suspicious of sleeping with mouth open and eating too much salt.

Those results do not indicate diabetes.
Perhaps, you may wish to record everything you eat for 3 to 5 days, including the size or portions of all meals and snacks.
Then, we can discuss about it here.

 

[eatshitndie]

check stool for signs of dehydration via too much copulation (and forgetting about drinking water).

 

[nayr69sg]

My guess is sleeping with mouth open. Never drink enough water. Take too much salt. Also likely smoker.

 

[kkbutterfly]

You are thirsty only at night? Not so simple you say. So what do you fear it might be?

As a doctor we sometimes try to understand what the patient is thinking.
FIFE.
Function – how is it affection their life?
Ideas – what do they think they have?
Fears – is there anything they are particularly afraid of?
Expectations – what do they hope this visit will achieve?

But when we ask these questions the Singaporean smart aleck patients will say " why you ask me these questions? You the doctor! You tell me"

Well thirst itself for example is not really a sign of major illness in most cases. Especially if it is only present at night and at no other times of the day.

Oh well..... I am just glad I don't have to deal with crappy Sinkie patients anymore.

yes.thrist itself is not an issue to me.but it cause me sleep deprive.
imagine waking up 4 times cause by thirstiness.
the next day will be a zombie .work affected.driving affected. meeting affected and the list.
If it is not bothering me, I would just drink more water and life move on.

 

[Charlie99]

Try not to add any to salt to all the food that you prepare and cook.

 

[nayr69sg]

yes.thrist itself is not an issue to me.but it cause me sleep deprive.
imagine waking up 4 times cause by thirstiness.
the next day will be a zombie .work affected.driving affected. meeting affected and the list.

Honestly I have never come across people waking up 4 times a night to drink water causing sleep problems.

I have heard people waking up 4 times a night to pee causing sleep problems.

As I said it is possible you have sleep apnea. Sleep wake cycle due to low oxygen to the brain in cycles. So never get into deep sleep. Pretty common.

 

[kkbutterfly]

My guess is sleeping with mouth open. Never drink enough water. Take too much salt. Also likely smoker.

mouth open no. ask my family members to random check on me.
never drink enough water.no. drink so much that I have to keep going toilet.
smoker. quitted 6 years ago

 

[kkbutterfly]

Try not to add any to salt to all the food that you prepare and cook.

I have done that 4 months back.
also cut all sugar 6 months back.
change to brown rice and multi grain bread diet as well.
oh yes.try American ginseng. it temporary kill the thirst.
unfortunately I cant take it at night.
Ginseng will keep me mental alert.

 

[nayr69sg]

mouth open no. ask my family members to random check on me.
never drink enough water.no. drink so much that I have to keep going toilet.
smoker. quitted 6 years ago

So do you wake up to pee in the middle of the night? The term is nocturia.

More likely you are waking up to pee too much thus causing sleepless nights.

Anyway this the problem with chinese patients. They will come with complaints. Say this and that. You suggest it may be X. They will say no lah cannot be X. And give 100s of reasons why it is not X. Then you suggest Y and they will say not Y 100s of reasons why not Y.

End up, what they want is tests. Test everything. All tests normal. They will ask why why why again. *bang head*

If test come back big problem....answer is there. So it is better for some of these patients to have diabetes. Give them the answer and they are happier.