New diagnosis - Not sure what type

[Deleted member 595781]

Hi all,

In early December, I went to see the doctor for something completely unrelated (eczema) and due to my age (51), she said it would be a good idea to get a full test done (blood, urine, faeces). Fortunately, when I got the results, everything (except diabetes stuff) was absolutely fine and within normal ranges.

The abnormal results were:
Fasting glucose: 17.6
HbA1c: 12.6%
Ketones (in urine): 15

To put this into context, I am a normal weight with a BMI of 22.7. I don't smoke and rarely drink. I exercise 5-6 times per week (walking around 10km per day) and normally follow the so-called Mediterranean diet (I've lived in Spain fo the last 20 years, so I guess I should do).

With that diagnosis, the doctor has started me on the following treatment:
Metformin 850: 2 per day
Humalin: 14IU twice per day (immediately after lunch and immediately after dinner)
Humalog: up to three times per day (at breakfast, two hours after lunch, two hours after dinner) with the amount depending on sugar level.

Due to the high sugar levels and not having any risk markers for Type 2, I had another blood test for C-Pepitde levels. The result was 1.5ng/mL compared to a normal range of [0.81-3.85].

I'm not an expert, but have done a lot of reading since all this started (and may be wrong on much).

My understanding is that as the C-Peptide result isn't above the normal range, it shows that I'm not insulin resistant and rules out Type 2, but not being below normal level doesn't mean Type 1/1.5

Unfortunately, I live in a small town and there isn't a diabetes specialist at my health centre to ask. There is actually a bit of a crisis there right now with only 7 doctors available when there should be 16 so you can't get an appointment for love nor money.

Despite being fit, healthy and normal weight, etc. is it really possible that I have Type 2 diabetes (which my current medical notes say), or is something else going on? Throughout this, I've had zero symptoms/signs that anything was wrong.

The only thing I'm 100% certain on right now is that it isn't gestational diabetes.

Congratulations if you made if this far, and any help/advice would be greatly appreciated

 

[Grant_Vicat]

Hi all,

In early December, I went to see the doctor for something completely unrelated (eczema) and due to my age (51), she said it would be a good idea to get a full test done (blood, urine, faeces). Fortunately, when I got the results, everything (except diabetes stuff) was absolutely fine and within normal ranges.

The abnormal results were:
Fasting glucose: 17.6
HbA1c: 12.6%
Ketones (in urine): 15

To put this into context, I am a normal weight with a BMI of 22.7. I don't smoke and rarely drink. I exercise 5-6 times per week (walking around 10km per day) and normally follow the so-called Mediterranean diet (I've lived in Spain fo the last 20 years, so I guess I should do).

With that diagnosis, the doctor has started me on the following treatment:
Metformin 850: 2 per day
Humalin: 14IU twice per day (immediately after lunch and immediately after dinner)
Humalog: up to three times per day (at breakfast, two hours after lunch, two hours after dinner) with the amount depending on sugar level.

Due to the high sugar levels and not having any risk markers for Type 2, I had another blood test for C-Pepitde levels. The result was 1.5ng/mL compared to a normal range of [0.81-3.85].

I'm not an expert, but have done a lot of reading since all this started (and may be wrong on much).

My understanding is that as the C-Peptide result isn't above the normal range, it shows that I'm not insulin resistant and rules out Type 2, but not being below normal level doesn't mean Type 1/1.5

Unfortunately, I live in a small town and there isn't a diabetes specialist at my health centre to ask. There is actually a bit of a crisis there right now with only 7 doctors available when there should be 16 so you can't get an appointment for love nor money.

Despite being fit, healthy and normal weight, etc. is it really possible that I have Type 2 diabetes (which my current medical notes say), or is something else going on? Throughout this, I've had zero symptoms/signs that anything was wrong.

The only thing I'm 100% certain on right now is that it isn't gestational diabetes.

Congratulations if you made if this far, and any help/advice would be greatly appreciated

Hi @pinguwave and welcome to the forum. Unfortunately nobody is allowed to diagnose here. In view of your concerns and difficult situation, do you have any way of contacting your regional hospital? Here we can dial 111 and discuss symptoms, thus enabling us to be put through to a diabetologist/consultant etc. I can quite understand your concern. Wishing you speedy professional assistance.

 

[Deleted member 595781]

I realise that giving diagnoses isn't allowed here and wasn't looking for that. Just trying to understand what my likely situation is, what I should be looking out for, what I should be asking the doctor, etc. I certainly wouldn't act on anything without seeing a doctor first. Unfortunately, there is no equivalent of 111 here.

 

[Antje77]

My understanding is that as the C-Peptide result isn't above the normal range, it shows that I'm not insulin resistant and rules out Type 2, but not being below normal level doesn't mean Type 1/1.5

There are more types than just 1 and 2. Early in T1 people still produce a fair amount of insulin. Normal level of C-peptide is associated with blood glucose at the same time. Your glucose was sky high but your C-peptide was on the lower side of normal, so you didn't produce the insulin you needed.

Unfortunately, I live in a small town and there isn't a diabetes specialist at my health centre to ask.

Can you get a referral to an endocrinologist?

 

[Chris24Main]

Hi @pinguwave - welcome to the forum.

it's all a bit overwhelming, isn't it.. I'm afraid any direct answers you may get to the question as posed may also be contradictory, because the topic is quite complicated, and we all tend to view through the filter of our own experience.

A couple of things for you though- first - take a breath. The fact that you haven't actually felt any symptoms is a good thing, though obviously not to be complacent about - it should mean you have time to figure this out. I was at my ideal weight when I was diagnosed - do not make the mistake of assuming that because you are normal BMI it cannot be T2 - that's what I thought for a long while, and I was totally wrong.

C-Peptide is simply the bit of protein left over when we make insulin. It's used as a measure, because it's distinct from injected, synthetic insulin. It's only a measure therefore of natural insulin at any given time. It does not necessarily relate to insulin resistance. Being in the normal range is good.

You may be interested to know that the "Mediterranean diet" specifically refers to a study of lower skilled workers in southern Italy in the early fifties - ie, when sugar was still rationed post war. You may find that the pastas and pulses and breads in a modern Mediterranean diet are driving much more demand for insulin than you may be realising, because they turn to sugar very easily.

Given your meds, it's difficult to suggest anything, but can you confirm whether you are using a continuous glucose monitor? You must have some guidance also about matching carbs with insulin?

 

[Deleted member 595781]

Can you get a referral to an endocrinologist?

Unfortunately, I can't even get an appointment to see the doctor right now. The next available appointment is in March.

Given your meds, it's difficult to suggest anything, but can you confirm whether you are using a continuous glucose monitor? You must have some guidance also about matching carbs with insulin?

I don't have a CGM as I don't qualify for it. In Spain, the rules are decided by each region, not at a county level. If I were in Madrid, I would qualify but in Valencia you only qualify (if T2 as my medical record shows) if you need to check your blood sugar levels eight or more times per day.

At the moment, I'm only testing three times per day as that is the maximum that you can get the test strips prescribed for. It was initially two and I had to fight to get it to three so I can test before needing so see if I have to inject the rapid insulin, but I don't test before the basal insulin (14IU immediately after eating lunch and immediately after eating dinner).

Zero guidance on matching carbs to insulin but I guess that doesn't matter too much on the regime I'm on as I inject the rapid one when I get up, two hours after eating lunch and two hours after eating dinner and only if the levels are above 7.2. I assume matching carbs is less important as I'm injecting once I know the effect of what I've eaten, rather than trying to predict it.

Can I ask how you store your insulin? Obviously the pens waiting to be used stay in the fridge, but my doctor said to keep the one I'm using also in the fridge, but this is contradictory to what the pharma company says, who say the one you are using stays at room temperature. I'll have to come up with a new plan for the summer though as it also says to keep it below 30°C and in the hottest months my room temperature can be above that.

 

[Chris24Main]

Ok - understood. In the UK, at least my experience was that if you are injecting insulin, you need a CGM - otherwise how can you possibly know what's going on. The significant danger with additional insulin is that you drive blood sugar too low; that's probably the biggest worry for you, particularly when driving. If there is any route you can argue for a CGM, I would try; failing all possibilities, you may want to consider self-funding.

The bottom line is that we underestimate insulin. It's incredibly powerful as the master hormone for energy regulation throughout the body - and it also causes blood sugar to drop. You have a hugely complex system of checks and balances in your organs for managing this, because too much or too little causes problems both in the short and long term. At the very least you have been told to only inject if your blood levels are above a threshold - ok.

A CGM will give you - in fact it's the only way to find out because it's all very individual - feedback on how different foods cause your blood glucose to rise, and how quickly they fall. One sensor will last 2 weeks, and you can learn a lot - you don't need to be using one for ever.

In a nutshell, the fewer carbs you eat (particularly sugars and starches - and that does mean pasta even in the Med) the less glucose is presented to your liver, and the less insulin you will need to bring down your blood glucose. However, since you are taking the meds you are, it can be difficult to make any sudden change safely.

Storing insulin - I wouldn't worry about that till we get to the summer;

Would you be open to discussing what your Mediterranean diet contains?

 

[Deleted member 595781]

particularly when driving

This isn't an issue for me as I work at home and don't have a car.

Would you be open to discussing what your Mediterranean diet contains?

No problem. I think I meant to before but forgot.

For me it is essentially grilled meats, fish and veg. This is mainly in winter as it's pretty much salads daily in summer.
As I work at home, I have time to cook daily and very rarely eat processed food. I have a bag of chicken nuggets in the freezer as 'emergency' food if work doesn't allow time to cook any particular day, but they've been in there about two months now. The freezer is mainly used if there is a need to chill wine urgently.

I enjoy pasta, potatoes and rice as much as anyone else but wouldn't have more than a couple of portions a week. I recently read that if you cook pasta or potatoes, let them cool and reheat, they have very little effect on blood sugars, and it seems to work. I'm enjoying jacket potatoes at the moment cooked the day before in the air fryer and then reheated in the microwave. Same with pasta; cook it the day before (for a bit less than usual), cool it and put it in the fridge. Heat it up the next day in a sauce.

Generally each day will be:
Breakfast: Fruit smoothie using berries and coconut milk
Lunch: As above
Dinner: Something light such as nuts or fruit

Another go-to lunch at the moment is this 'fabada' (in the image), which is a white bean stew. Although it looks like processed food, there are now artificial flavours, aromas, preservatives, etc. and is only 2g of sugar for the whole can. It is also so delicious, you could eat it every day.

I've always had an intolerance to caffeine, even the very low levels found in chocolate, so haven't eaten that since I was a child. As a consequence of that, I believe, I don't have a sweet tooth and very rarely have desserts. In terms of fruit, I find most of that too sweet and stick to berries or bananas that are still mainly green.

 

[Chris24Main]

Yeah - so, let me first say that I basically fast-tracked myself into T2DM with grapes. I was pretty shocked; I thought my diet was about as good as it gets; all fresh cooking, all done by me, and lots of veg. Over time, I realise that I knew zilch, and that there is far more sugar and starch around than you think. Also - no such thing as "natural sugar" - it's all sugar.

The cooking the pasta bit - yes - it may slow down the rate of absorption, but all of that starch will end up in your liver as sugar.
Fruit smoothies - I even bought my wife a smoothie maker - it does duty as my bullet proof coffee maker now. Fruit smoothies are like drinking sugar loaded sodas, but without the flavouring. Bit of a shocker. Sorry.

Berries are generally thought of as the best fruit for blood glucose, but you smash them up - it's all sugar.

Fruit is particularly difficult, because the type of sugar, fructose, can only be metabolised by the liver into fat, which drives both fatty liver and insulin resistance at the same time. Fruit is not your friend, at least for now. Even bananas (at least for me, some still have bananas around these parts - and I used to be a big fan of bananas, but a modern banana is bred to have a huge load of sugar)

Beans - also full of starch, unfortunately. I can't manage even a small portion and maintain what I'm aiming for. 2g of sugar, but you need to be paying attention to the entire carbohydrate load - all of it will turn into sugar. You also need to pay attention to the pea starch extract (and protein) that you will find in ultra processed meals - all of that will end up as sugar in your liver as well.

Jacket potato - how can that be anything other than healthy? - well, because it's the plants way of storing sugar. Put a small piece of potato on your tongue, and in a few seconds, it tastes sweet - that's how good we are at turning potato starch into sugar.

As I say - we're all told that the mediterranean diet is the best, therefore lots of pasta, but in fact; at the time the phrase was coined, it really meant that sugar was rationed.

A lot to take in, and I've been blunt - but, you can actually make a huge difference here if you want to.

 

[Chris24Main]

A quick look up of fabada in a can would suggest for 2g of sugar in the can, you are also getting 51g of carbohydrates - so you may want to consider that it's generating 20 times more sugar in your liver than you may be aware of...

 

[Resurgam]

@pinguwave You seem to be under a misconception which could be dangerous - you need to count ALL the carbohydrates you are consuming - maybe consider purchasing another meter and strips to test, or more strips for what you have if that is cost effective - the price of the strips can be very different for different devices.
For any diabetic - for me when I was not yet diagnosed, it is the total of sugar AND starch in the food which is important, as they both contribute to blood glucose levels.

 

[VashtiB]

Hi @pinguwave

Not sure whether you are still reading as your avatar seems to say that you want the account to be deleted.

If you are reading this my suggestion if you can is to self fund a continuous glucose monitor like the Libre. That may help you find out what is happening to your levels depending on what you eat and what exercise you do and when. The thing about a monitor is that it is independent and has no biases. I will admit upfront that my approach to my diagnosis is to have gone really low carb. That's not everyone's approach. For me it doesn't matter what approach you take as long as it keeps your levels in the normal range as much as possible and it's something you can sustain.


Good luck.