Doubtful type 2 diagnosis help

[lalafil]

Need some advice. I had extreme fatigue in March with brain fog and hungry after eating. I had lost around 7kg in a few months, but Didn’t think it was unusual. After a month a contacted my GP. They did a blood test and showed my hba1c as 97. They repeated and it was at 99.

Diagnosed as type 2, based on my age 41 and blood test only. They said it was very high and surprised I don’t have any other symptoms. On review with the nurse the first thing she said was I was not overweight enough to be type 2, but my age suggests I am. My diet is healthy in the whole, but I did eat lots of carbs before.

Recommended meds, but due to IBS I was not that keen on metformin. Asked for another med and was refused. I am now in a low carb diet. I am for 100-120g daily and only treat myself to chocolate weekly - all in carb allowance.

I asked about LADA, but they said my age fasts no. I bought myself a BG monitor to help learn the foods that would spike my blood and see improvements. My results are not going down. I wake up with 14.4 and after 2 hours spoke to 17. This could be on toast, or days I have yogurt and fruit and avoid high carbs food.

I have even tried to go keto for a week and my waking blood sugar was still 14.4. GP is refusing to test me for LADA as they are saying it’s type 2 due to age. They are also refusing to prescribe anything other than metformin, even though they said it will upset my IBS, which is controlled by avoiding trigger foods.

So what is my next step? Do you think I would for The LADA criteria or in type 2 denial.

 

[Daibell]

Your GP is showing dated knowledge of T1. He is wrong in saying T1 is a young person's condition. Other than seeing another GP you may have to have a private blood test as I did. You need a GAD test and C-Peptide. If you have Metformin, insist on the SR (Slow Release) version. There are other tablets beside Metformin (which never does much). I had to suggest to my GP that I should start Gliclazide which did help a for a few years. Your GP MUST provide a solution following NICE Diabetes Guidelines (Google the flow-chart). Ask to be referred to the clinic if he can't provide a solution that works.

 

[EllieM]

I have even tried to go keto for a week and my waking blood sugar was still 14.4. GP is refusing to test me for LADA as they are saying it’s type 2 due to age.

Ask your GP if he/she remembers the previous UK prime minister, diagnosed T1 at 56? The T1.5/LADA forum here is full of people who were diagnosed much older than you.

 

[Dr Snoddy]

Are you eating toast made with low carbohydrate bread? Are you having full fat plain yoghurt or a low fat one with added sugar? What of fruit are you having for breakfast? It could be that a diet of 100-120g carbohydrate per day is still too high to bring your glucose levels down.
Before breakfast the liver tends to dump glucose into the bloodstream - the so-called dawn phenomenon. What you are then eating for breakfast may just be adding to an already high level. Although you have IBS could you have a high protein breakfast instead e.g. Eggs?

 

[lalafil]

Are you eating toast made with low carbohydrate bread? Are you having full fat plain yoghurt or a low fat one with added sugar? What of fruit are you having for breakfast? It could be that a diet of 100-120g carbohydrate per day is still too high to bring your glucose levels down.
Before breakfast the liver tends to dump glucose into the bloodstream - the so-called dawn phenomenon. What you are then eating for breakfast may just be adding to an already high level. Although you have IBS could you have a high protein breakfast instead e.g. Eggs?

I am eating normal toast twice a week. Rest is plain Greek yogurt which is 6g carbs 100g, with berries.

I feel trying to cut my carbs down more is an unsustainable life choice. I have tried really low carb fur a week of 65g daily and no change. Already cut them in half based on old eating habits.

open to meds as long as they don’t upset my stomach.

 

[becca59]

Sorry @lalafil that you are struggling to get the help you need. Your GP is actually being negligible by not getting you tested properly. The % of people diagnosed type 1 later in life is now very high. 54 myself. There are many older diagnosed Type 1s on this very forum. You must insist.

 

[Dr Snoddy]

I too am sorry that you are not being listened too. And it is very difficult to be assertive when you are already feeling unwell and anxious. Are you able to take someone with you to your next appointment to support you? Or, if telephone consultation, have someone on speaker phone?

 

[lalafil]

Your GP is showing dated knowledge of T1. He is wrong in saying T1 is a young person's condition. Other than seeing another GP you may have to have a private blood test as I did. You need a GAD test and C-Peptide. If you have Metformin, insist on the SR (Slow Release) version. There are other tablets beside Metformin (which never does much). I had to suggest to my GP that I should start Gliclazide which did help a for a few years. Your GP MUST provide a solution following NICE Diabetes Guidelines (Google the flow-chart). Ask to be referred to the clinic if he can't provide a solution that works.

I have asked for slow release snd discussed quality of life on normal tablets. Was told I couldn’t until I had side effects with fast release. Then was told as a bribe I would get free prescriptions if I went on medications. Asked to try something else and told no.

it’s frustrating as I am open to treatment but they are not listening to my concerns.

 

[Fenn]

Hi, I don't understand why you won't give metformin a try at least, I believe I had (undiagnosed) IBS or something similar (won't go into details hehe) not everyone gets tummy trouble on them, after diagnosis I went on a very low carb diet as well as metformin and my IBS (or similar) was cured, even after eating more carbs it never returned, and even if you do have trouble, you can then ask for the SR version, I think they have a process they like to follow, right or wrong, they may be thinking you are being awkward by not trying to follow their advice, I'm not saying you are at all, I totally understand why you are relluctant, just trying to understand their reasoning, best of luck.

 

[lalafil]

I too am sorry that you are not being listened too. And it is very difficult to be assertive when you are already feeling unwell and anxious. Are you able to take someone with you to your next appointment to support you? Or, if telephone consultation, have someone on speaker phone?

I feel I am being assertive, just not listened to. I did research and came with a list of questions. It was the nurse response of you are in the typical type 2 category that started my thought about my diagnosis. Then you must of been feeling bad for months, even though I said only a few weeks. She didn’t answer my questiond.

 

[lalafil]

Hi, I don't understand why you won't give metformin a try at least, I believe I had (undiagnosed) IBS or something similar (won't go into details hehe) not everyone gets tummy trouble on them, after diagnosis I went on a very low carb diet as well as metformin and my IBS (or similar) was cured, even after eating more carbs it never returned, and even if you do have trouble, you can then ask for the SR version, I think they have a process they like to follow, right or wrong, they may be thinking you are being awkward by not trying to follow their advice, I'm not saying you are at all, I totally understand why you are relluctant, just trying to understand their reasoning, best of luck.

thanks. I think they think I am awkward but won’t listen to my views. They have a process but can change it depending on need. I did ask for alternatives but got shut down with no justification.

I work in healthcare and asked advice from the diabetes team at the hospital. They said with my IBS history slow release is justified under the pathway.

 

[EllieM]

I work in healthcare and asked advice from the diabetes team at the hospital. They said with my IBS history slow release is justified under the pathway.

Can you ask them about the T1/T2 tests?

 

[ert]

Need some advice. I had extreme fatigue in March with brain fog and hungry after eating. I had lost around 7kg in a few months, but Didn’t think it was unusual. After a month a contacted my GP. They did a blood test and showed my hba1c as 97. They repeated and it was at 99.

Diagnosed as type 2, based on my age 41 and blood test only. They said it was very high and surprised I don’t have any other symptoms. On review with the nurse the first thing she said was I was not overweight enough to be type 2, but my age suggests I am. My diet is healthy in the whole, but I did eat lots of carbs before.

Recommended meds, but due to IBS I was not that keen on metformin. Asked for another med and was refused. I am now in a low carb diet. I am for 100-120g daily and only treat myself to chocolate weekly - all in carb allowance.

I asked about LADA, but they said my age fasts no. I bought myself a BG monitor to help learn the foods that would spike my blood and see improvements. My results are not going down. I wake up with 14.4 and after 2 hours spoke to 17. This could be on toast, or days I have yogurt and fruit and avoid high carbs food.

I have even tried to go keto for a week and my waking blood sugar was still 14.4. GP is refusing to test me for LADA as they are saying it’s type 2 due to age. They are also refusing to prescribe anything other than metformin, even though they said it will upset my IBS, which is controlled by avoiding trigger foods.

So what is my next step? Do you think I would for The LADA criteria or in type 2 denial.

What is your BMI?

 

[lalafil]

What is your BMI?

27

 

[ert]

27

You don't qualify for the referral pathway for a specialist unless your BMI is under 25 on diagnosis. Here is the link: https://www.england.nhs.uk/rightcar...40/2018/07/nhs-rightcare-pathway-diabetes.pdf
Have you tried a very low carbohydrate to see what effect that has (30 grams)? Everyone has different tolerances to carbohydrates so you will have to keep testing your blood sugars before and two hours after eating to see what doesn't spike your blood sugars. I recommend Jason Fung's Obesity Code for reading.

 

[Torres71]

That's really negligent of your GP not requesting additional tests or advice from an endocrinologist or diabetes consultant given your hba1c results & symptoms. I'd be resolute & request a 2nd opinion or the tests you should have. Many of these symptoms you described are similar to mine over 12 months ago. My hba1c shot up, weight loss, brain fog. My diabetes nurse told me I didn't fit in a box for type 1 or type 2, was offered Metformin, which I declined due to having Chron's disease. I was put on Gliclazide & later had a definite diagnosis of type 1 diabetes & have been on Abasaglar & Novo Rapid insulin ever since. The Gliclazide did nothing other than wring out my pancreas. I do feel much better & genuinely hope you get the tests & definite diagnosis either way. Keep strong.

 

[lalafil]

Yeah

That's really negligent of your GP not requesting additional tests or advice from an endocrinologist or diabetes consultant given your hba1c results & symptoms. I'd be resolute & request a 2nd opinion or the tests you should have. Many of these symptoms you described are similar to mine over 12 months ago. My hba1c shot up, weight loss, brain fog. My diabetes nurse told me I didn't fit in a box for type 1 or type 2, was offered Metformin, which I declined due to having Chron's disease. I was put on Gliclazide & later had a definite diagnosis of type 1 diabetes & have been on Abasaglar & Novo Rapid insulin ever since. The Gliclazide did nothing other than wring out my pancreas. I do feel much better & genuinely hope you get the tests & definite diagnosis either way. Keep strong.

Thanks. I have asked but told to see how life style changes get on. I believe they have diagnosed me as type 2 and not changing their minds. I feel dropping my carbs by half and not going above 110g would of done something. Even if it was a little bit. I now avoid foods that spike my bs. They said it will take time, but 3 months I would of hoped to have had some improvements, even if snall

 

[TriciaWs]

It is worth trying to see a different doctor for additional tests, but up to 10% of adults develop T2 even though they are in the normal weight range.
100g a day is too high for most T2s to get their blood sugars down, and even on far fewer carbs it would take more than a week.
I was lucky in that I managed to get my Blood Sugar down on 85g a day, but my meter showed I could not have more than 30g in a single meal (that includes milk for coffee).
The good news is that there are some excellent substitutions for our favourite foods and plenty of websites dedicated to low carb or keto recipes. If you want help let us know.

 

[lalafil]

It is worth trying to see a different doctor for additional tests, but up to 10% of adults develop T2 even though they are in the normal weight range.
100g a day is too high for most T2s to get their blood sugars down, and even on far fewer carbs it would take more than a week.
I was lucky in that I managed to get my Blood Sugar down on 85g a day, but my meter showed I could not have more than 30g in a single meal (that includes milk for coffee).
The good news is that there are some excellent substitutions for our favourite foods and plenty of website dedicated to low carb or keto recipes If you want help let us know.

Thanks. My bloods are getting done again in 4 weeks. I would of thought essentially halving my carbs would of made some difference. Will try reducing more.

 

[ert]

That's really negligent of your GP not requesting additional tests or advice from an endocrinologist or diabetes consultant given your hba1c results & symptoms. I'd be resolute & request a 2nd opinion or the tests you should have. Many of these symptoms you described are similar to mine over 12 months ago. My hba1c shot up, weight loss, brain fog. My diabetes nurse told me I didn't fit in a box for type 1 or type 2, was offered Metformin, which I declined due to having Chron's disease. I was put on Gliclazide & later had a definite diagnosis of type 1 diabetes & have been on Abasaglar & Novo Rapid insulin ever since. The Gliclazide did nothing other than wring out my pancreas. I do feel much better & genuinely hope you get the tests & definite diagnosis either way. Keep strong.

The GP's have to follow the referral criteria so it's not negligent not to refer if you don't meet them. A low carbohydrate diet is a way forward for blood sugar control.