Seven weeks after blood test I get to see the DN

[Buttons11]

She did apologise a lot that I had not been seen for 7 weeks, but they have a shortage of nurses. She said I should have been put on medication immediately.
She started off by saying she wanted me to have 80mg gliclazide morning and evening, and 1 metformin in the evening for a week, then after that have one in the morning as well. I asked for the slow release.
She GAVE me a meter!! (Contour TS) and said I should test every morning and again before my evening meal - not afterwards, that's it, just 2 tests a day.
She weighed me (lost 1kg), took my blood pressure (fine) and talked about what things I like most to eat, which I thought was rubbing it in a bit, though I did say I hadn't had any biscuits, chocolate etc since I'd seen the Dr four weeks ago. I didn't mention low carb, and neither did she. She had a look at my feet, and said she will refer me to get my eyes checked.
Then she did a blood test and it was 9.8, sadly one of the higher ones I've had, (maybe due to stress?) but she was a bit taken aback and said to drop one of the gliclazide and just take the morning one.
So now I have another appointment with her in two weeks for her to look at my meter readings, a blood test three weeks after that for HbA1c, and cholesterol which wasn't done last time, and another diabetes review at the beginning of May.

 

[AM1874]

Hi @Buttons11
Surprised that she said test every morning and again before evening meal - not afterwards
Surprised that you have only lost 1kg on low carb for 4 weeks (?)
Surprised that she prescribed 2x80mg gliclazide THEN did a blood test THEN cut your meds to 1x80g
---
Not surprised that she apologised for the shortage of nurses and your 7 week delay
Not surprised that she waffled on about the things you like to eat - rather than LC or LCHF
Not surprised that you have had what seems to be a typical appointment with your DN ..
---
For many people it seems to be someting of a 50% OK and 50% frustrating experience and
the mantra that I now apply for dealing with these appointments is ...
# Listen
# Nod
# Smile and say thankyou
# Ignore

 

[NoCrbs4Me]

Hi Buttons,

Consults with HCPs are generally frustrating for type 2 diabetics. I recommend you read the following web page:

http://www.phlaunt.com/diabetes/

You'll likely know more about type 2 diabetes than any HCP you run into after you've read it a couple of times.

Here's the low carb diet advice I followed to reverse my type:

https://www.dietdoctor.com/low-carb

Hope that helps.

 

[Buttons11]

Hi @Buttons11
For many people it seems to be someting of a 50% OK and 50% frustrating experience and
the mantra that I now apply for dealing with these appointments is ...
# Listen
# Nod
# Smile and say thankyou
# Ignore

That's basically what I did.
I was also surprised that I've only lost 1kg, but my BMI is in the normal range and I don't really want to lose much.

 

[Prem51]

It can take time before weight loss kicks in. It was about 4 weeks before I started losing weight and then lost 1-1.5 lbs a week.

 

[Bluetit1802]

What sort of finger prick test levels do you see before and after meals?

Gliclazide works by stimulating the pancreas to produce extra insulin post meal. The less carbs you eat, the less insulin you need. So with Gliclazide you do need to be careful as it may cause your pancreas to produce too much insulin, and this can lead to hypos. So you MUST test after each meal to make sure you are not going too low. This is important.

 

[Nicksu]

What sort of finger prick test levels do you see before and after meals?

Gliclazide works by stimulating the pancreas to produce extra insulin post meal. The less carbs you eat, the less insulin you need. So with Gliclazide you do need to be careful as it may cause your pancreas to produce too much insulin, and this can lead to hypos. So you MUST test after each meal to make sure you are not going too low. This is important.

I'd definitely agree with that - before I finally stopped the gliclizade (and I was only on 40mg twice daily) I was regularly getting high 3's and low 4's. The dietician told me to stop taking it as it was pushing by BS level too low (particularly with the weight loss which increases your insulin sensitivity). My range now are usually in the low to high 5's.

 

[slip]

I think I'm right in saying gliclizade can cause hypos, so that's why she gave you a meter, did she mention about informing the DVLA (if you drive)? and testing before and during driving too?

 

[Buttons11]

What sort of finger prick test levels do you see before and after meals?

So you MUST test after each meal to make sure you are not going too low. This is important.

You know this. I know this (I think I learnt it from you!) but the DN does not....

I've been getting 6 or 7 before my main meal and a couple of 7s but mostly 8 or 9 after. It's usually within 2 points afterwards, or there abouts. I've had one 5 (before).

 

[Buttons11]

I think I'm right in saying gliclizade can cause hypos, so that's why she gave you a meter, did she mention about informing the DVLA (if you drive)? and testing before and during driving too?

No, she asked if I drove for my living, and I said no, but she didn't say anything else about driving and testing or contacting the DVLA...

 

[Bluetit1802]

This is what the DVLA says. It isn't helpful. Lol.

Diabetes treated by tablets or non-insulin injections
Car or motorbike licence
Check with your doctor or nurse to find out if your treatment means you need to tell DVLA.

If you do need to tell DVLA, fill in form DIAB1 and send it to the address on the form.

Bus, coach or lorry licence
You must tell DVLA if your diabetes is treated by tablets or non-insulin injections. You must fill in:

• form VDIAB1SG if your diabetes is treated by sulphonylurea or glinide tablets
• form VDIAB1GEN if your diabetes is treated by any other tablets or non-insulin injections

Send the form to DVLA. The address is on the form.

However, you really should test before you drive. "Under 5, don't drive" is the saying. Just to be safe.
https://www.gov.uk/diabetes-driving

Be vigilant, @Buttons11 test rigorously to avoid going low. Gliclazide works well and is a strong drug. If you find yourself going low (usually under 4) or feeling ill because you are low you need to eat a sweet biscuit or two, or a couple of jelly babies, and you need to tell your nurse and ask to come off the Glic.

 

[Daibell]

Hi. Sounds like a mixed bag from the DN. Starting Gliclazide unless she suspected Late onset T1 is unusual. It's use is to stimulate the pancreas when your beta cells are failing. With normal T2 you are likely already to have too much due to insulin resistance. It's good she reduced the dose and it's possible you may not need it unless you are fairly slim. Do test 2 hours after typical meals and other times if you feel hypo'ish

 

[lowedb]

Regarding telling DVLA. The information I was given, which is the same as I found on the DVLAs site is for driving a car you don't need to routinely tell them just because you are on a drug like gliclaizide. You do need to test before driving, and every two hours while driving. Then if you have hypos or become unaware of impending hypos, you may have to tell them but check that bit out as I don't remember what it said. I suppose this could have changed since January though.

 

[Buttons11]

I went back for my review today. The average on the meter she gave me is 6.7 but she didn't even look at that. She looked at the book that came with the meter where I had written down my results. She asked if I had changed my diet - I told her I was eating low carb, then she asked if I'd had any chocolate
She remarked that some of my pre evening meal ones were a bit low (4-5) and asked how I felt when they were that low. I told her I felt awful and she said when I feel like that I should have a cup of tea with a banana or A SLICE OF BREAD! Instead of having 80mg Gliclazide in the morning I have to break a tablet in half and have one half in the morning and the other half in the evening.
She said I shouldn't test twice a day anymore, just once every couple of days or so...
And that's it until my HbA1c towards the end of the month.
Thank you NHS

 

[Avocado Sevenfold]

Blimey @Buttons11 Keep up good work and you may be able to drop the glic completely.

Lovely kitty, by the way

 

[Chook]

I went back for my review today. The average on the meter she gave me is 6.7 but she didn't even look at that. She looked at the book that came with the meter where I had written down my results. She asked if I had changed my diet - I told her I was eating low carb, then she asked if I'd had any chocolate
She remarked that some of my pre evening meal ones were a bit low (4-5) and asked how I felt when they were that low. I told her I felt awful and she said when I feel like that I should have a cup of tea with a banana or A SLICE OF BREAD! Instead of having 80mg Gliclazide in the morning I have to break a tablet in half and have one half in the morning and the other half in the evening.
She said I shouldn't test twice a day anymore, just once every couple of days or so...
And that's it until my HbA1c towards the end of the month.
Thank you NHS

God, its scary isn't it? My DN was the same - we had 20 mins talking about my low carbing lifestyle then she told me I need to have 3 meals and 2-3 snacks each day but to stay off of the 'fatty' stuff (as she called walnuts). I think what worries me is that we entrust our health to them and because we've done a bit of research and joined this forum we are aware of what damage their recommended diet does to us. It does make you wonder what other ailments they are giving us poor advice about.

 

[NoCrbs4Me]

It does make you wonder what other ailments they are giving us poor advice about.

Cholesterol levels, if you consider that an ailment.

 

[BarbaraG]

4-5 before evening meal too low? It's perfectly normal, as in, what a healthy young person would have.

That feeling **** may be because your body has got used to high levels, so now normal feels low. If you stick it out, your body will adjust and you'll feel fine.

OTOH, she may be saying it's on the low side because, with gliclazide, there is a risk of you going too low.

Their idea: Eat more carbs to stop you going too low on the med we've prescribed to make your pancreas pump out more insulin to reduce your BG.

My idea: keep the carbs where they are and reduce the med.

[Disclaimer] This is just my opinion, not medical advice - I'm not qualified to give you that. But when I was losing weight (on a low fat diet, actually - but lowER carb than I had been eating because I had cut way back on sweet ****) and started getting mild hypos every morning about 11:30, the nurse stopped my gliclazide.

 

[Buttons11]

That feeling **** may be because your body has got used to high levels, so now normal feels low. If you stick it out, your body will adjust and you'll feel fine.

.

That's what I thought. I read it somewhere, probably on this forum

TBH, when I started low carbing I felt brilliant and I had so much energy. I hadn't realised how tired the high sugar levels were making me. I've been on medication for a week and felt generally "under the weather" the whole time. I think the glic and the low carb are bringing my bs lower too quickly, and like you say, I need time to adjust to this. Does this make any sense?

 

[Chook]

That's what I thought. I read it somewhere, probably on this forum

TBH, when I started low carbing I felt brilliant and I had so much energy. I hadn't realised how tired the high sugar levels were making me. I've been on medication for a week and felt generally "under the weather" the whole time. I think the glic and the low carb are bringing my bs lower too quickly, and like you say, I need time to adjust to this. Does this make any sense?

Yes, you are making lots of sense. It takes our bodies a while to adjust to the lower carb levels. But, like you said, when we do adjust we feel much better both physically and mentally.

I am not medically trained but it seems a shame you weren't given adequate opportunity or support to control your BG by diet as it sounds like you were doing a good job.