Diagnosed Abroad

[broono83]

Hi and apologies if this post rambles a little. I was abroad with work when diagnosed and couldn't contact my GP or talk to anyone about it really, it was very stressful.

I had been having (what I now understand are the usual) symptoms for 3 or 4 months of frequent urination and extreme thirst. In Nov and Dec I was working for 6 weeks in California, I visited home over thanksgiving and had a blood test in the UK. I got the results a few days later that my non fasting BGL was 20. For reference at the time I was 14st 7lbs and 5' 8 so definitely overweight but not really heavy, with a fairly stocky male build too, 35 years old, no family history. My Liver function ALT and AST were slightly raised (66 and 55 U/L where they should be below 50 and 40 respectively).

This seemed to coincide with a worsening of my symptoms to include blurred eyesight (specifically this was using phone or monitor, I could read it for 5-100 secs before it became uncontrollably blurred, I could "reset" by focusing on something far away for 30 secs then back) and a general malaise, extreme tiredness.

I ended up seeing a doctor in America who repeated bloods, converting to UK numbers they were fasting BGL of 20, Hba1c of 110mmol/L, Pancreas function was OK but urine was full of Ketones (>3000mg). Cholesterol was high as well. I was prescribed Metformin at 2000mg per day as well as Atorvastatin. Immediately did research including on here and decided to try and tackle with an immediate change in diet and exercise. Managed to get my fasting BGL down to about 7.7 before Christmas when I returned home.

Had another blood test in the UK (unfortunately after a night out with dinner and drinks) and although my fasting BGL was now 8.2 my liver function ALT and AST had gone up to 128 and 141. HBa1c measured at 98mmol/L. Urine protein and Albumin were high. UK doctor advised Metformin too with a starting dose of 500mg per day.

Thanks for those of you still with me!

I really wanted to try and control with diet so I went quite strict, very low carb and sugar and low calorie diet. Have lost 20lbs since mid Nov and fasting BGL was down to 6.5. I was quite happy as I have an appointment with a Endocrinologist at the end of Jan however my doctor phoned me up and asked me to start taking the Metformin! He knew I hadn't taken it as I had another quick doctors appt with his colleague and he must have been reviewing my file. He said that due to my build (and relative lack of weight to lose compared to most Type 2s) that I probably wouldn't be able to control with diet alone. What do you guys think?? I still think I could lose a stone, maybe more, with exercise and diet.

I have started taking Metformin yesterday so will see what effect it has on my guts and sugar levels. I am also worried about my liver and kidney function as they both seem to be going in the wrong direction, are these worrisome numbers at the moment?

Finally I admit I do like a drink (although not drinking at the mo) and am worried as everywhere says not to drink with Metformin, that's not something I really want to commit to for life. I understand cutting back, moderation etc but if this medication is incompatible is there an alternative that is?

Anything else I should do in the mean time? Also when I measure my glucose levels after food to see what triggers glucose rises, should I do it 2 hours after or sooner?

Thanks again, glad to have found here.

 

[broono83]

Yeh that's what I thought (and have read on here) and was reasonably encouraged with my progress so far but now been told by 3 different doctors (one of them twice) to start Metformin

 

[xfieldok]

Welcome to the forum.

Statins can raise your glucose. Most of us try to avoid unless they have had a cardiac event.

Carbs are the enemy for T2. So far as alcohol is concerned, avoid beer and lager. Red wine or spirits with diet mixers are better.

What do you eat in a typical day?

 

[broono83]

Hi,

Thanks for reply.

My worry with alcohol was more about its interaction or incompatibility with Metformin? I generally have a glass of red or rum and diet coke anyway so it's mostly low carb (the types of rum I drink are low/no sugar)

On a typical day right now I am eating either soup or roast chicken for lunch and a variety of low carb meals for dinner, eg Meatballs with courgetti, roast chicken and med veg, chilli con carne with spinach etc... Breakfast I am currently not eating 4 days a week to increase the fasted part of my day to 18 hours. The other 3 days I have eggs for brekkie.

I have read the "8 Week Blood sugar Diet" book by Claire Bailey and am more or less following that or at least it's principles (its 800 calories per day and <20g carbs)

 

[Metabolism_Boss]

People with less weight to lose do sometimes have a longer journey to reduce their Hba1c. It has taken me three years to get from 108 to 47, I was 10 stone 4 lb when I was diagnosed and now 8st 9lb. I am aiming for the safe lower end of my recommended BMI of 18, as for me even two or three pounds can make all the difference.

The reason doctors ask you to take metformin is that in addition to helping control blood glucose, it has protective effects on the heart and vascular system (see reference below).

Luo, F., Das, A., Chen, J.et al.
Metformin in patients with and without diabetes: a paradigm shift in cardiovascular disease management.
Cardiovasc Diabetol18,54 (2019) doi:10.1186/s12933-019-0860-y
Published27 April 2019

I wish you success with your diabetes journey and hope that you continue to progress as you have up to now. If not, I hope that you will continue to look for ways to control your diabetes through diet and exercise - it can be a struggle due to slower progress,but still worth it.

 

[xfieldok]

Your diet looks fine and the amount of alcohol is ok too. Are you using a meter to test before and after eating to check your food tolerances?

 

[broono83]

Your diet looks fine and the amount of alcohol is ok too. Are you using a meter to test before and after eating to check your food tolerances?

Not yet but I do have a meter that I bought in the USA and have about 60 strips left. I have been mostly using it to track fasting levels in the morning.

So to check my food tollerances should I measure immediately before eating and then 2 hours after finishing? Or sooner than that?

 

[LittleGreyCat]

@broono83 I was diagnosed after dropping from 14.5 stone to 14 stone.

I had bad experiences with statins and don't take them any more. Anyway, the ratios are more important than the headline number.
Last test was 6.36 mmol/L (fasting) which was lowest for some time. I would normally expect to be around 7.
My surgery is happy with my numbers.

I now weigh 12 stone, 6 foot tall.
Lowest I have been is a touch below 11 stone 7 lbs which is my current target weight.
This didn't "cure" me.
@Metabolism_Boss puts me to shame with a BMI around 18.
Perhaps I should try harder.

My HbA1c wanders either side of 6.5% and I recently went up from 3 * 500mg to 4 * 500mg Metformin a day.
I don't take any other medication.

In the early days I managed for a time without Metformin but I have gradually upped my dose over the years.

So there is no guarantee of reversal by losing weight but in general it will help with BG control.
Go for it; you may be one of the lucky ones!

 

[sno0opy]

I was in almost the same position, I started the Metformin and found two big benefits for the short to medium term.

For me I think it really helps with appetite, but I also went T total because of risk of side affects.

Both together with diet changes and excersise and u ha e lost loads of weight and got numbers well in control.

My plan is to get my body in the best position to see if I can drop the meds, being back some drink and foods I like.

Good luck any way, but I found no real downsides with Metformin, you can still have a few drinks on it just not get smashed. When I got smashed that's where I had chips on the way home and a baxom sarnie in the morning - one night out destroyed many attempts at diet in the past.

 

[Rose22]

Yeh that's what I thought (and have read on here) and was reasonably encouraged with my progress so far but now been told by 3 different doctors (one of them twice) to start Metformin

If you have a raised hba1c most gps will go with the start line of offering metformin I think. I too was given it, although couldn't tolerate nor the slow release version with gastro side effects. I was also told I might not be able to bring it down enough with diet and exercise alone, and it’s not always that they don’t believe it’s possible I think it’s more in the case when they doubt whether you are a true type 2. When I took metformin I didn’t really drink alcohol on it, perhaps a glass of wine here and there. It isn’t a hypo causing med so there’s not that risk, it might be more the GI effect? Might be worth discussing at your next appointment. Also my liver test results changed whilst I took metformin.
Good luck with the appointment with the Endo end of Jan! Once I saw an Endo consultant my treatment plan has been immeasurably better and finally had an hba1c in range.

 

[xfieldok]

Not yet but I do have a meter that I bought in the USA and have about 60 strips left. I have been mostly using it to track fasting levels in the morning.

So to check my food tollerances should I measure immediately before eating and then 2 hours after finishing? Or sooner than that?

Fasting levels in the morning can be affected by the dawn phenomenon. It is more useful to test before and 2 hours after the first bite. If your rise is 2 or under, 36 in USA , then your golden.

 

[New Haven Neil]

I wasn't as high as you when diagnosed (looking for causes of lethargy and erectile dysfunction), 51/6.8%, but well overweight at 5-10, 14st 6lbs, all in the wrong place, around the middle, skinny frame really. GP wasn't really keen on diet alone, but was agreeable to 'see how it went' for 3 months, diabetic nurse wasn't big at all on low carbs, usual NHS poor story.

So after the 3 months, diet only low but not mega low carbs (no rice paste spuds basically) and cutting our sugar in coffee and bsicuits, a little more exercise (I walk half to a mile most lunchtimes anyway) I lost 2 stone, HbA1c was 41/5.9%. Another 3 months on and I'm 12st 2, 36/5.4%, GP is raising eyebrows but likes what he sees, DN I don't bother with any more as he can't see low carb as a way forward.

So whilst I wasn't as ill as you, I have proved yet again what everyone on here tells us about low carbing for T2's, it works. No meds of any kind taken fordiabetes BTW, although I am on BP meds anyway, have been for years - my BP has reduced to under target levels too for the first time in 20 years - result!

The message is of course to low carb, eat sensibly, use your meter to find out what hits your BG as we're all different (rice and pasta kill me!). Yeah, the ED is much better too - not sure if you're male!

 

[lessci]

Are you covered with decent health insurance in the States? It could be worthwhile having a scan to see if you're one of those unlucky people who are "skinny on the outside, but fat on the inside" ie you have fat deposits around your liver & pancreas which can give you insulin resistance. Knowledge is power and all that, it can help you plan diet attack

 

[broono83]

Hi,

Thanks for all the replies and well wishes!

My doctor has said he thinks its easier to get blood sugar under control using Metformin first then come off it rather than using solely diet, so I don't think he's averse to controlling with diet only in the future.

@Rose22 , you mentioned that maybe they think I'm not a true type 2, is this the hybrid I have read about? My pancreas function tests were normal so does that not mean I am producing enough insulin?

@lessci I'm not back in the UK permanently but I do have private health care with work. My doctor has also advised against a liver ultrasound right now until blood sugar is controlled (unless the Endo reccomends it) as he says there is a possibility of false positives and knock on effect on lifeinsurance.

Speaking of life insurance, I have policies I took out years ago - do I have to inform them that I now may have diabetes? Any experience with taking out more insurance after diagnoses (and at what point are you officially "diagnosed"?

 

[LittleGreyCat]

@Rose22 , you mentioned that maybe they think I'm not a true type 2, is this the hybrid I have read about? My pancreas function tests were normal so does that not mean I am producing enough insulin?

There is an ongoing thing with, if I understand correctly, LADA.
https://www.diabetes.co.uk/diabetes_lada.html
This is where you are T1 (that is, your pancreas is destroyed by your own body through an auto immune reaction) but the onset is very slow.
Many T1s have a "honeymoon" period of up to a year, but there is a view that this "honeymoon" period can last many years in some cases.

Typical T2 is an over-producer of insulin because of insulin resistance (IR) in the tissues. Also typically over weight. In these cases significant weight loss can reduce the IR enough for the insulin to work effectively again and the symptoms of T2 disappear.

A minority of T2s are normal or slightly over weight. Here the issue appears to be under production of insulin, although IR is often also present. This is much harder to reverse. Also sometimes referred to as TOFI (thin outside fat inside) because fat accumulates around the internal organs and causes problems even though the weight falls within the normal BMI range.

If you pancreas is producing "normal" amounts of insulin then it is likely that you also have IR (which suggests that Metformin may be a good idea). It would be sensible to have a figure for the "normal" because normal has a very wide range.
I privately funded an IR test a couple of years ago and the results showed insulin production on the lower part of the normal range, and elevated fasting BG, which was interpreted as some IR.
If your insulin production is at the top end of the normal range you have a potentially better chance of reversing the symptoms than if it is at the bottom of the normal range so it is sensible to get an exact figure.

Whatever, it seems sensible to aim for a weight at or below the mid point of the BMI range as that will improve you general chances of clearing any fat from your liver and pancreas and improving your insulin sensitivity.

 

[broono83]

Also, I’ve started measuring my BG around meals but am finding the meter to be very inaccurate. It’s a true metric manage air.

For example today before dinner I measured 101 (5.5) then 2 hours after eating I measured 192 (10.6), it wasn’t a crazy carb heavy meal so I thought this was way too high - so I measured again immediately with a new strip and it said 160 (8.9).

Obviously I’m looking for less than 36 (2) increase after food but my meters error from one reading to the next is almost equal to that?

 

[xfieldok]

We always say, if you get a reading you don't expect, wash your hands and re-test. You could have contaminated hands or a rougue strip.