Newly Diagnosed, medicated but BS still wild

[Nilockz]

Hi All,

Was diagnosed as a type 2 diabetic back in early September 2022. A1C result in the initial blood test came back as 85 mmol/mol so definitely something not right with my bodies processing of the glucose in my blood. Following that diagnosis, I installed a Freestyle Libre 2 ("FSL") and have had that in ever since as after a few days of pricking my fingers, it certainly got tiresome.

I was started on Metformin ER 500mg by my GP, upped to 1000mg ER a few weeks later and then taken off the Metformin and switched to Gliclazide 80mg once a day. I've been on the Gliclazide since 24th October so have been taking for a little over a month.

So onto the reason why I'm here looking for some more advice. Went to my diabetic eye screening appointment yesterday and the nurse was adamant that I was not a type 2 as I described having recurrent hypo's (circa 3 a week), following carb heavy meals. For example, had a risotto the other night, about 2 hours later needed to rescue my blood sugars via jelly babies. She suggests that it is perhaps something more to do with my pancreas and not as simple as a diagnosis of diabetes.

Since diagnosis, I've altered my diet a little and try to keep carb intake below 120grams per day. I have not been able to up my physical activity due to another medical issue, completely unrelated. A1C as per the FSL is now showing at estimated 49 mmol/mol with 88 out of 90 days of data.

I've attached screenshots of the past couple of days sugars via the FSL, to me they still seem erratic at best but can identify the peaks as a result of breakfast, lunch & dinner. Sugars seem to start to creep up around 3am most days so that I'm starting the day at 8-9. I can confirm that I do not have a middle of the night snack at 3am!!

So I suppose looking for anyone's advice on this - do my graphs look normal? Other images I've seen of type 2's on meds seems to suggest a much more controlled graph, staying in range for the vast majority of the time.

Once I have my A1C in the next few weeks, going to push GP to refer me to endocrinologist to potentially do some more investigation into my pancreatic function.

 

[catinahat]

Welcome @Nilockz
With a starting HbA1c of 85 mmol it seems fairly clear that you are T2.

Sugars seem to start to creep up around 3am most days so that I'm starting the day at 8-9. I can confirm that I do not have a middle of the night snack at 3am

This is a normal bodily function, our liver releases some of its stored glucose to give us a little shot of energy so we are ready to start the day. It's called the Dawn Phenomenon. It happens to everyone, in a non diabetic person the resulting insulin response would use up that extra glucose and their sugar levels would remain stable. For someone with diabetes who's insulin doesn't work too good, it causes higher levels.

do my graphs look normal?

They look normal for someone eating more carbs than their body can cope with. I know your 120g is technically classed as low carb but I probably don't have that many in 4 days.
Your graphs clearly show spikes of between 9 - 12 around mealtimes, indicating that those meals contained too many carbs for you to deal with.

the nurse was adamant that I was not a type 2 as I described having recurrent hypo's

Does your nurse realise that gliclazide can cause Hypoglycaemia

recurrent hypo's (circa 3 a week), following carb heavy meals. For example, had a risotto the other night, about 2 hours later needed to rescue my blood sugars via jelly babies

How low did you go and did you confirm the low with a finger prick test. The fact that you were ill after a carb heavy meal is interesting. There is a condition called Reactive Hypoglycaemia where in a response to carbs the pancreas releases too much insulin causing a hypo. It is perfectly possible to have both T2 and Reactive Hypoglycaemia and luckily the solution to both conditions is to avoid carbs.
If you do decide to cut your carbs even further please keep a close eye on your levels. Gliclazide works by forcing your pancreas to produce more insulin so as I said it can cause hypos.

 

[Deleted member 475901]

I can't see anything in your graphs that indicate a dangerous hypo. But you are having big spikes, and if you've cut carbs you may be having false hypos as it drops because your body is used to running too high.
Still you need to discuss the diagnosis with a doctor.

I was one of the lucky one as I only needed to drop carbs down to 85g a day to get into remission. I got false hypo symptoms the first few weeks but a finger prick test showed I was still in the normal range. Once my body adjusted they stopped.

 

[Antje77]

With a starting HbA1c of 85 mmol it seems fairly clear that you are T2.

A hba1c of 85 clearly shows diabetes, it doesn't show which type.

Went to my diabetic eye screening appointment yesterday and the nurse was adamant that I was not a type 2 as I described having recurrent hypo's (circa 3 a week), following carb heavy meals. For example, had a risotto the other night, about 2 hours later needed to rescue my blood sugars via jelly babies. She suggests that it is perhaps something more to do with my pancreas and not as simple as a diagnosis of diabetes.

How low do you go with those hypos? The attached graphs don't show hypos at all.
It's also worth confirming a hypo on the Libre with a fingerprick, Libre can be a tad off.

Like @catinahat said, gliclazide can cause hypos. But going hypo after a carb heavy meal could also mean you have some reactive hypoglycemia alongside your diabetes.

So I suppose looking for anyone's advice on this - do my graphs look normal? Other images I've seen of type 2's on meds seems to suggest a much more controlled graph, staying in range for the vast majority of the time.

Images seen where?
There's a lot of variation in Time In Range between T2's, some of them look like a mountain range, others look like a flattish line.
The graphs you shared seem to show some dawn phenomenon (early morning rise, very common, very annoying) and clear spikes after food.

The dawn phenomenon is not something you can change easily, but the food spikes are something you could work on. Fewer carbs per meal mean lower spikes. Just be very alert to blood glucose if you want to experiment with lowering carbs, being on gliclazide means you can go too low. Keep some quick acting sugary stuff on you at all times.

 

[sue512]

My graphs look like yours when I’ve eaten too many carbs. If they spike up I’ll often have hypo after, unless my carbs are restricted to about 20-40 per day then my graphs level off a bit and stay within range. I had to reduce to these levels with advice otherwise the gliclizide caused me hypos, but it was rare I needed to eat jelly babies to bring them back up as my dear old liver seems to correct it for me. Since I’m now off the gliclizide blood sugars seem to remain more stable unless I’ve eaten something carb heavy. I find that cgm makes me a little obsessive about my diet and sugars but definitely gives a clearer idea of what’s going on over the 24 hours. Someone posted a link to a gp who wasn’t diabetic so his spikes resolved quickly, but even he reacted to carb heavy meals and posted his graphs from a cgm. It was interesting to compare.

 

[finzi1966]

I think it can be a bit risky to compare graphs with other people because we’re all different but to me I’d say your graphs look like a Type 2 who’s having a tad too many carbs. None of the graphs you’ve posted show hypos, but hypos can happen on gliclazide (I used to get them terribly, down to 2.1 sometimes - came off the gliclazide in the end because I couldn’t cope with the hypos and the weight gain). Maybe what would work would be to gently reduce your carbs (don’t go all out all of a sudden when you’re on gliclazide as you would be risking hypos) but cut down on them (eg no more risotto!) to try to at least limit the amount that you’re going over 9mmol.

But the ups and downs with meals and in the mornings ARE normal, it’s just what would be good would be to try to make them a little less extreme.

When you have a hypo how low do you go?



Here’s a few of mine: some “good” days, some “not so good” days - note that in all of them there’s a spike in the morning between about 9am and 11am.

 

[Daibell]

I think you need to understand a bit more about the drugs and the differences between late onset T1 (LADA). Gliclazide stimulates the pancreas to produce more insulin and the fact that 80mg is causing hypos implies your pancreas is in a reasonable state. I was on 320mg/day before insulin and it no longer had any effect i.e. dead beta cells. Do you have excess weight? If so then you may well have insulin resistance i.e. T2 and the low carb diet will help a lot. If you are slim or losing weight without trying then you may be a LADA with a slowly declining pancreas. Increased Gliclazide would help later but moving to insulin is the normal transition

 

[Teddysgirl]

A hba1c of 85 clearly shows diabetes, it doesn't show which type.

How low do you go with those hypos? The attached graphs don't show hypos at all.
It's also worth confirming a hypo on the Libre with a fingerprick, Libre can be a tad off.

Like @catinahat said, gliclazide can cause hypos. But going hypo after a carb heavy meal could also mean you have some reactive hypoglycemia alongside your diabetes.

Images seen where?
There's a lot of variation in Time In Range between T2's, some of them look like a mountain range, others look like a flattish line.
The graphs you shared seem to show some dawn phenomenon (early morning rise, very common, very annoying) and clear spikes after food.

The dawn phenomenon is not something you can change easily, but the food spikes are something you could work on. Fewer carbs per meal mean lower spikes. Just be very alert to blood glucose if you want to experiment with lowering carbs, being on gliclazide means you can go too low. Keep some quick acting sugary stuff on you at all times.