New T2, high hba1c and weight loss

[Killi123]

Hello everyone
I've been recently diagnosed with diabetes, to be honest I'm still in shock I've got it. I thought I was a healthy person, very active and ate healthy. My reading is very high of 138 I really don't know what it really means apart from I need to get it down. GP has put me into Metformin and increasing doesage every week until I'm taking 4 tablets daily. I'm up to 3 at the moment.
I've lost nearly 3 stones without trying, is that normal?
Will the medication help sort the weight loss.
Thank you

 

[Antje77]

Hello everyone
I've been recently diagnosed with diabetes, to be honest I'm still in shock I've got it. I thought I was a healthy person, very active and ate healthy. My reading is very high of 138 I really don't know what it really means apart from I need to get it down. GP has put me into Metformin and increasing doesage every week until I'm taking 4 tablets daily. I'm up to 3 at the moment.
I've lost nearly 3 stones without trying, is that normal?
Will the medication help sort the weight loss.
Thank you

Hi @Killi123 , and welcome to the forum!
Have you told your GP about the unintended weight loss? Losing weight without trying isn't generally associated with type 2 diabetes but it is a known flag for type 1. This, in combination with your high hba1c should have made some bells ring with your GP. Do you use a glucose meter to see what's going on? Should you feel ill, nauseous or have a stomach ache, please call 111 for advice.

With luck, you'll be able to tackle this with the metformin and some adjustments to your diet, but should you have type 1 diabetes you might need more very shortly.

Don't postpone calling for help if you're in any doubt if you feel alright.

Wish you all the best, and let us know how you are!

 

[ziggy_w]

Hello everyone
I've been recently diagnosed with diabetes, to be honest I'm still in shock I've got it. I thought I was a healthy person, very active and ate healthy. My reading is very high of 138 I really don't know what it really means apart from I need to get it down. GP has put me into Metformin and increasing doesage every week until I'm taking 4 tablets daily. I'm up to 3 at the moment.
I've lost nearly 3 stones without trying, is that normal?
Will the medication help sort the weight loss.
Thank you

Hi @Killi123,

I really would like to echo @Antje77's advice. With what you're describing (very high HbA1c and unintended weight loss), there is a very good chance that you have Type 1 diabetes (and if this is the case, Metformin won't help.) Have they done any tests (C-Peptide, GAD) to rule Type 1 out? If not, please get this checked out as soon as possible.

 

[Killi123]

Morning,
Thank you for the very useful advice. I'm not sure what tests have been done apart from the usual blood test. I presume the GP should know?? I've haven't been told to use a blood sugar meter yet and to be honest I wouldn't know how to use one. I'm hoping my weight loss will plateau with low carb diet. If I do lose any more weight I'll definitely ringing the docs. It's all a bit scary for me

 

[Andydragon]

To add to what was said though, I am type 2 and I had rapid weight loss and a high hba1c at initial diagnosis So whilst it is common on type 1, it can occur in type 2 also

the metformin didn’t bring my levels down enough so I was immediately given an additional drug (exenetide) and given that worked was the proof I was type 2 and not 1

However I was also sent to specialists at the hospital. So was treated better than a lot seem to be nowadays. But this was also well over a decade ago no global pandemic

 

[Antje77]

I presume the GP should know??

The problem is GP's are so used to seeing T2's, they can sometimes forget adults can develop T1 as well. Many people who developed T1 as an adult start out with a misdiagnosis because the conditions are so much alike, and T2 is way more common than T1.

The trouble with very high blood glucose in T1 is that it can lead to a dangerous condition called diabetic ketoacidosis or DKA quickly. This doesn't happen often, most of us T1's have never experienced DKA thankfully. But if it happens it's a medical emergency needing treatment within hours.

This small chance you can develop DKA is the reason we urge you to get medical help as soon as you feel unwell in any way.

 

[Daibell]

Hi. You are very likely to be T1 and not T2. I'm one of many who have gone down the same route where the GP didn't spot unintended weight loss. Yes, do low-carb. I suspect the Metformin won't do very much and you may need to move on to one of the other tablets such as Gliclazide if your blood sugar doesn't come down. Do ask for the two tests for T1 i.e. GAD and C-Peptide if your BS doesn't come down. If your GP appears ignorant and won't arrange these then you may need to ask for a referral. Do get a glucose meter and some ketone strips. Your weight loss will probably be due to your body burning it's fat as it doesn't have enough insulin to use the carbs. Together with the low-carb diet you can have proteins and fats as well as veg and non-tropical fruit. You should be having another HBA1C test in 3 months; arrange it yourself if the surgery doesn't.

 

[Killi123]

Thank you all for the information, I'm definitely going to ask if my weight doesn't stabilise soon. At the time I did mention to the doctor &. clinic nurse I was concerned about my 3 stone loss because I think it's now muscle mass but they weren't really over concerned about that. My next re test is in October but going off what everyone's been saying maybe I should be pushing for a early test. Thank

 

[KK123]

Thank you all for the information, I'm definitely going to ask if my weight doesn't stabilise soon. At the time I did mention to the doctor &. clinic nurse I was concerned about my 3 stone loss because I think it's now muscle mass but they weren't really over concerned about that. My next re test is in October but going off what everyone's been saying maybe I should be pushing for a early test. Thank

Hi there, what was your weight/BMI to begin with?, a 3 stone weight loss is massive and very significant so I wonder why they have not picked up on that. If your BMI was 'normal' to begin with then you would be looking quite gaunt after losing 3 stone but if your BMI was higher then sometimes they just look and say 'oh, well you look a 'normal' weight' without wondering WHY you have lost weight quickly. That seems to be the overriding problem, they seem to judge solely from appearance and do not listen to what you are saying. x

 

[Daibell]

Hi there, what was your weight/BMI to begin with?, a 3 stone weight loss is massive and very significant so I wonder why they have not picked up on that. If your BMI was 'normal' to begin with then you would be looking quite gaunt after losing 3 stone but if your BMI was higher then sometimes they just look and say 'oh, well you look a 'normal' weight' without wondering WHY you have lost weight quickly. That seems to be the overriding problem, they seem to judge solely from appearance and do not listen to what you are saying. x

I always remember my first, useless, diabetes GP who at my 2nd review weighed me, saw I had lost more weight and said 'good, keep up the good work with the weight loss' and never spotted that I was stick thin. My wife gave him a few choice words!

 

[ert]

To be fair, answering some of the posts above, GP's are type 2 specialists and type 1's are usually diagnosed at hospitals. My GP doesn't even see me for anything diabetes-related as I'm type 1. But there are clear referral pathways that include age of onset < 50 years. / BMI <25 kg/m2/Rapid weight loss/ketosis.

https://www.england.nhs.uk/rightcar...40/2018/07/nhs-rightcare-pathway-diabetes.pdf

If any of those pathways are you @Killi123 ask for a referral.

 

[KK123]

To be fair, answering some of the posts above, GP's are type 2 specialists and type 1's are usually diagnosed at hospitals. My GP doesn't even see me for anything diabetes-related as I'm type 1. But there are clear referral pathways that include age of onset < 50 years. / BMI <25 kg/m2/Rapid weight loss/ketosis.

https://www.england.nhs.uk/rightcar...40/2018/07/nhs-rightcare-pathway-diabetes.pdf

If any of those pathways are you @Killi123 ask for a referral.

I have to be honest, I'm not convinced GPs are specialists in ANY form of diabetes. They do a blood test, make a judgement from your weight & age and off you go with a handful of tablets. I first went to the GP with typical diabetes symptoms on a Friday, sky high levels, very slim, but aged 56. Doc said come back on Monday to see the surgery 'diabetes specialist'. Went back on Monday, 'diabetes specialist' said here are some tablets, then as I was walking out suddenly said hang on, I'll just do a ketone check. She then went into a panic I kid you not and next thing I know I was in hospital with DKA. I do realise GPs have a hard job but any so called expertise in type 2 diabetes only comes AFTER there is no doubt a person is type 2. Before that?, guesswork. The criteria as you have listed needs addressing in my opinion. x

 

[ert]

I have to be honest, I'm not convinced GPs are specialists in ANY form of diabetes. They do a blood test, make a judgement from your weight & age and off you go with a handful of tablets. I first went to the GP with typical diabetes symptoms on a Friday, sky high levels, very slim, but aged 56. Doc said come back on Monday to see the surgery 'diabetes specialist'. Went back on Monday, 'diabetes specialist' said here are some tablets, then as I was walking out suddenly said hang on, I'll just do a ketone check. She then went into a panic I kid you not and next thing I know I was in hospital with DKA. I do realise GPs have a hard job but any so called expertise in type 2 diabetes only comes AFTER there is no doubt a person is type 2. Before that?, guesswork. The criteria as you have listed needs addressing in my opinion. x

I'm sorry you didn't have a great experience. I arrived at my GP surgery with severe stomach cramps, my GP tested my blood sugars, listed me as type 1 and referred me immediately (I had blood sugars of 30 and a BMI 19.) The c-peptide ( 0.17 ng/mL - less than 0.2 ng/mL on diagnosis is type 1) and GAD antibodies hospital tests confirmed the diagnosis. All surgeries should be using the referral pathway listed above from the NHS. My specialist spends time in my surgery with my GP and nurse for training for type 2. They certainly know their stuff.

LADA is not so straight forward. The patient exhibits type 2 symptoms from the outset. The c-peptide can be in the normal range. It's a slow deterioration of beta cells over 5 years. It's not dangerous to be treated as a type 2 to begin with, which is common.

 

[Daibell]

GPs vary a lot but my two diabetes specialist GPs have been useless. The first one hadn't a clue and when my BS wouldn't go down with just Metformin I suggested adding Gliclazide and he said that's a good idea! The second one is a good GP but she had been on the Warwick Diabetes training course which was obviously way out of date as she didn't know about late onset T1 and wouldn't accept I was LADA as I was too old.

 

[EllieM]

My reading is very high of 138

That is an average blood sugar of 21mmol/L. And if you have T1/LADA, your current levels are probably higher because the hba1c is a 3 month average and chances are you will have been increasing over those 3 months.

That, together with the weight loss, makes T1/LADA extremely likely (it could still be T2 but the consequences of untreated T1 are so serious that you should not ignore that possibility). Untreated DKA is fatal fairly quickly (and unpleasant even if you get treated in time because you'll be in intensive care on an insulin drip.)

I'd strongly urge you to
1) ask your doctor if he's done the testing to work out whether you could be T1 (c-peptide and GAD tests)
2) get some ketone testing urine strips from the chemist
3) get a blood testing meter and test

High blood sugars (well, we know you've got those) plus high ketones puts you at risk of DKA. Ring 111 for advice if you get these.

Good luck.

 

[KK123]

LADA is not so straight forward. The patient exhibits type 2 symptoms from the outset. The c-peptide can be in the normal range. It's a slow deterioration of beta cells over 5 years. It's not dangerous to be treated as a type 2 to begin with, which is common.

Hi Ert, my Consultant went straight for type 1 in hospital saying that 'lada' was type 1 and they didn't really use the term lada. I think by definition I am lada because of my age at diagnosis. If that's correct, then I think it would have been dangerous for me to be treated as a type 2 to begin with, what would have stopped my levels staying dangerously high without insulin? My hb1ac was 140 (15%) with ketones of 4. No doubt my beta cells had been deteriorating over the previous years but how would you know in most cases. By the time some of us are diagnosed the time for being treated as a type 2 are long gone. That's half the problem really, the only ones for whom it may not be dangerous to be treated as a type 2 initially are those who are caught very early, ie years before they get symptoms. x

 

[Killi123]

Hi there, what was your weight/BMI to begin with?, a 3 stone weight loss is massive and very significant so I wonder why they have not picked up on that. If your BMI was 'normal' to begin with then you would be looking quite gaunt after losing 3 stone but if your BMI was higher then sometimes they just look and say 'oh, well you look a 'normal' weight' without wondering WHY you have lost weight quickly. That seems to be the overriding problem, they seem to judge solely from appearance and do not listen to what you are saying. x

Hi My BMI was just over the normal it's definitely in the normal range now. Like you have said, maybe the doctors just look at age, weight and make a judgement on that. In fact the doctor hasn't seen me yet it's just consultation over the phone because of covid. I'm not gaunt in fact people keep commenting on well I look. It just come on so quickly probably since June. I will keep a eye on my weight loss and any more loss definitely be asking doc/nurse for another test. Thank you for your advice and it's comforting to know I can chat on this website to others who have had similar experiences.