Does Diabetes affect INR?

[JaneF]

Hello Everyone,

I apologize in advance as this is a long post, but please bear with me.

I have been on warfarin since my MVR in 2017 and self-testing & regulating doses with my doctor since 2018. I bridged with Lovenox for 2 spinal and a shoulder surgery, but was back in range (2.5 - 3.5) very quickly.

About 8 months ago I started having some huge differences, for example one week it was 1.3 and then the following week back in range, then 4.7 or 5.1 . Nothing significant had changed with my diet, I rarely ever have even a glass of wine, and my doctor and I have been completely baffled.

In November I had my annual blood work done and found out my blood glucose was 178 and my A1c was 6.4. I had no idea, as my glucose had always been fine, however I do have a strong family history of diabetes. Dr. recommended medication immediately, but I asked for a few months to see if I could lower my numbers with some diet modifications. My A1c only dropped to 6.3 so that was not a success. I go back to the doc tomorrow, so I’m sure I will leave with medication.

I said all of the above to ask others, in your experience, could unknowingly being diabetic have caused my erratic INR numbers? Any thoughts are appreciated.

 

[pellicle]

Hi Jane

good question and the answer both surprised me and yet didn't

it appear yes, but it appears its because of blood serum albumin and its affinity to bind with your blood.

https://cardiab.biomedcentral.com/articles/10.1186/s12933-019-0818-0

Compared with control albumin, glycated albumin or albumin purified from diabetic patients had the decreased binding affinity to warfarin with higher free fraction of this anticoagulant [13]. Therefore, variability of glycated albumin, a marker of short-term (2–3 weeks) glycemic control, may affect the pharmacokinetics of warfarin and its anticoagulant activity in diabetic patients. Indeed, when patients were stratified by quartile of international normalized ratio (INR) values out of range, presence of diabetes was independently associated with worst INR control in warfarin-treated AF patients [14].​

it is something that's not commonly discussed although I've brought this up in other contexts.

https://www.valvereplacement.org/threads/had-avr-performed-2-25-21.887924/post-903372
https://www.valvereplacement.org/threads/snakes.888139/post-908720
Its an interesting point. Reach out if you want to work together on this (although I'm not sure our experiments would be successful, but all we can do is try).

Best Wishes

 

[JaneF]

Hi Jane

good question and the answer both surprised me and yet didn't

it appear yes, but it appears its because of blood serum albumin and its affinity to bind with your blood.

https://cardiab.biomedcentral.com/articles/10.1186/s12933-019-0818-0

Compared with control albumin, glycated albumin or albumin purified from diabetic patients had the decreased binding affinity to warfarin with higher free fraction of this anticoagulant [13]. Therefore, variability of glycated albumin, a marker of short-term (2–3 weeks) glycemic control, may affect the pharmacokinetics of warfarin and its anticoagulant activity in diabetic patients. Indeed, when patients were stratified by quartile of international normalized ratio (INR) values out of range, presence of diabetes was independently associated with worst INR control in warfarin-treated AF patients [14].​

it is something that's not commonly discussed although I've brought this up in other contexts.

https://www.valvereplacement.org/threads/had-avr-performed-2-25-21.887924/post-903372
https://www.valvereplacement.org/threads/snakes.888139/post-908720
Its an interesting point. Reach out if you want to work together on this (although I'm not sure our experiments would be successful, but all we can do is try).

Best Wishes

Thanks for the excellent information Pellicle. I go to the doc this afternoon and I’m certain he will put me on diabetes meds of some form. Maybe my INR will stabilize in a few weeks.

I certainly appreciate your offer of help and I might take you up on it in the near future.

All the best,
Jane

 

[carolinemc]

Hello Everyone,

I apologize in advance as this is a long post, but please bear with me.

I have been on warfarin since my MVR in 2017 and self-testing & regulating doses with my doctor since 2018. I bridged with Lovenox for 2 spinal and a shoulder surgery, but was back in range (2.5 - 3.5) very quickly.

About 8 months ago I started having some huge differences, for example one week it was 1.3 and then the following week back in range, then 4.7 or 5.1 . Nothing significant had changed with my diet, I rarely ever have even a glass of wine, and my doctor and I have been completely baffled.

In November I had my annual blood work done and found out my blood glucose was 178 and my A1c was 6.4. I had no idea, as my glucose had always been fine, however I do have a strong family history of diabetes. Dr. recommended medication immediately, but I asked for a few months to see if I could lower my numbers with some diet modifications. My A1c only dropped to 6.3 so that was not a success. I go back to the doc tomorrow, so I’m sure I will leave with medication.

I said all of the above to ask others, in your experience, could unknowingly being diabetic have caused my erratic INR numbers? Any thoughts are appreciated.

Hi, And welcome to the forum. I have been diabetic, type 2 since 2003 and warfarin does not affect my Protime. Only when I have not exercised for a time and when I take antibiotics will that affect the protime. Stress can affect the protime, being sick like from a virus will affect the numbers, or infection from an open wound. Been on warfarin since 2001, when I had my aortic valve replaced with St. Jude's and put on Warfarin.

 

[LondonAndy]

I have been on insulin since 1996 and on warfarin since 2014, and I have to say I haven't noticed a connection between blood glucose and INR.

 

[pellicle]

I have been on insulin since 1996 and on warfarin since 2014, and I have to say I haven't noticed a connection between blood glucose and INR.

apparently its albumin, so its in your eggs ... take good care of them ;-)

 

[LondonAndy]

apparently its albumin, so its in your eggs ... take good care of them ;-)

Ahhhhh!