CONFUSED BY GP !!!

[hazey276]

I've been for my follow up appointment this morning at my GP's and he said that he'd been contacted by the specialist i saw last week whilst in hospital. He said he now thinks i'm a "late onset type 1 diabetic", (A WHAT ?) :shock: , although he explained i must admit i left more confused than i went in and now my mind is totally befuddled . Please help what is a LATE ONSET TYPE 1 DIABETIC in laymens terms as i am now totally confused more than ever ? By the way did BS this morning it was 4.1 is that ok

Here's hoping !!!!!!!!!!!!!!!!!

Hazey

 

[sami]

it's type 1 bt in older people it sometimes comes on slower thats why they say you have type 2 if your not a child or very young hope this helps

 

[Nellie]

Wellcome to the club. Actually its not very select since some researchers feel that there are more of us than juvenile onset type 1s. but we're very often miss diagnosed.
Heres a couple of websites with more information:
http://www.locallada.swan.ac.uk/what.html

http://www.diabetesmonitor.com/lada.htm


I had read your story and was pretty convinced that you would eventually be diagnosed with Type 1. I'm just shocked that it took so long and lead you to such dangerously high BS.
I'm positive that you''ll feel much better now. I know I did very quickly.


As to your morning BS , what was you BS at bedtime?
I like to have a fasting BS in the 70s low 80s (4-5mmol) but I do check from time to time what my BS is in the early hours and I know that my basal keeps my figures fairly steady overnight.
What you dont want to happen is to go to bed with a high BS and wake up with a low one because if you then go to bed with a more normal BS you might drop too low during the night.
( that was difficult to explain so I hope you understand!)

 

[hazey276]

Thanks to you all for your replies. With regards to your question Nellie my reading last night just before goiung to bed was 16.8 and as i said it was 4.1 at 9 this morning. Something else that has confused me is that when i left hospital i was told by the consultant that i was to come off the metformin SR but when i went to my GP he said i must stay on it : ? . Obviously i'm not asking for medical advice but has anyone else had such conflicting advice from different sources. Oh by the way my reading by mid afternoon today was 14.5. I'm back at my GP's this Friday again for my next consultation .

Thanks again for any advice

Hazey

 

[Nellie]

That does seem to be a big drop overnight, I think that I would check my BS at 3am to make sure that I wasn't going too low (I had to do this recently when I started on a pump, its not fun but it is a reassurance) Obviously you need to tell yur doctor your BS readings when you see him.
I can't really advise on your paticular insulin regime I've just realised its not basal/bolus

I'm now on 20 units of Novomix 3 times a day

and I haven't used this regime. There are people with far better knowlege of that method than I have.
As to the metformin, I wonder if you can contact the hospital and ask them to tell your doctor their advice, don't they communicate with each other?

 

[Dennis]

Hi Hazey,
Just remember that your consultant is an expert in diabetes and your GP isn't - very few GPs are. When it comes to whether to follow instructions from your GP or a specialist, I would go with what the specialist recommends every time. If you look back at your situation, wasn't it following your GP's advice that got you hospitalised in the first place?

 

[Tinkerbelly]

Hello Hazey

I was wondering if you are still eating just the 3 meals per day similar to what you described in your previous posts before going into hospital? If so, this might account for why your blood sugar is high mid afternoon and before bedtime. Most of the biphasic insulins take roughly about 2 hours from the time of the injection before they start to show any lowering effect on bg.

May be it would pay to have a chat with your dsn and see what she says about the possibility of "tweaking" your carb intake a bit to suit the action of the dose of Novomix 30 you are taking depending on what your bg levels are



Type 1 - 43 years

 

[LittleSue]

Hello Hazey
Your consultant should be writing to your GP about your hospital admission, including any treatment changes. Maybe your GP hasn't received this yet, or it wasn't clear? Or maybe your GP's just hopeless <sigh>
It would be unusual for a type 1 to be on Metformin, but not impossible.
As suggested, probably best to follow your consultant's advice. How about phoning your consultant's office to check about the Metformin?
Sue

 

[KWCO]

Hi

Never heard about the title of your diabetes - but 4.1 is great! Well done

KIM

 

[hazey276]

Hi again and thanks for the replies. I definitely told my GP what had been said at the hospital but he "insisted" that i stay on the Metformin and to come off it would have a "negative" effect on my health. The other thing the consultant said was that i should have 4 small meals a day instead of 3 normal ones which once again my GP didn't seem to agree with :? . The light at the end of the tunnel is that the consultant said that he wanted to see me in the not too distant future and he would send a letter for an appointment, so hopefully i can twist his arm to let me go to his diabetic clinic at the MRI , and then i'll only have to go and see my GP when i've got a broken finger nail or something like that.

I really appreciate what everyone has done for me on the forum and even though my levels are getting better i still sometimes have days where i feel really low and vulnerable (as you've probably guessed today is a particularly bad one) . I know this must sounds stupid but it's just how it is some days. It''s got to the point that my GP appointments take about 2 minutes because i won't and can't discuss anything other than my diabetes very quickly before making a sharp exit for the door. I'm actually dreading this afternoons appointment :cry: .

Sorry for moaning and i'll keep you posted how i get on !!!

Hazey !!!!!!!!!!!!!!!!!

 

[lionrampant]

Hi again and thanks for the replies. I definitely told my GP what had been said at the hospital but he "insisted" that i stay on the Metformin and to come off it would have a "negative" effect on my health. The other thing the consultant said was that i should have 4 small meals a day instead of 3 normal ones which once again my GP didn't seem to agree with :? . The light at the end of the tunnel is that the consultant said that he wanted to see me in the not too distant future and he would send a letter for an appointment, so hopefully i can twist his arm to let me go to his diabetic clinic at the MRI , and then i'll only have to go and see my GP when i've got a broken finger nail or something like that.

I really appreciate what everyone has done for me on the forum and even though my levels are getting better i still sometimes have days where i feel really low and vulnerable (as you've probably guessed today is a particularly bad one) . I know this must sounds stupid but it's just how it is some days. It''s got to the point that my GP appointments take about 2 minutes because i won't and can't discuss anything other than my diabetes very quickly before making a sharp exit for the door. I'm actually dreading this afternoons appointment :cry: .

Sorry for moaning and i'll keep you posted how i get on !!!

Hazey !!!!!!!!!!!!!!!!!

Put simply, your diabetic consultant wouldn't tell your G.P how to treat hayfever, so your G.P shouldn't be over-riding your consultant on diabetes. End of discussion really. Ask your consultant how to get things moving next time you see him.

We all get those days by the way. I've had this for 15 years and I get that way sometimes. You just have to run with it.

 

[hazey276]

Hi folks, was going to go back to my GP last Friday, (6.00 pm appointment), when at 3.30 pm i received a phone call off him on my mobile. He said i didn't need to go in and see him, he told me to keep on the same medication over the weekend and phone him today :shock: . I explained there were a couple of other things i wanted to talk to him about, without even asking what they were or what my levels were he said he would sort them out on Monday :shock: . At 4.00 pm, on the dot, when the surgery opened this afternoon i rang and left a message for him to ring me back. The surgery shuts at 6.00 pm prompt, (he doesn't do staying behind, i've had a 6.00 pm appointment in the past so i know), and as yet no phone call so i'm now ******** myself because in the evenings it's creeping up to between 15 & 18 and i'm starting to feel really **** again and i don't want another hospital stay, plus, i've still got the other problems i've had from Friday still unresolved. The next time i can contact him is this Friday, that's if he returns my call when i ring him. I really am getting a feeling of de javu, sliding scale pumps and a hospital bed creeping on :cry: Sorry to moan but i'm really ****** OFF again just when i was starting to feel the benefits of my lower levels

No doubt this means i'll have another **** week, i'll let you know how i get on on Friday evening when i've HOPEFULLY spoke to him :cry:

Thanks for all the support again !!!!!!!!!!!!!!!

Hazey

 

[diabetesmum]

Hi Hazey,

You really need to check your ketones. Do you have any Ketostix? If you have more than a trace of ketones you need to get urgent medical advice. I would say that this means A+E tonight. Tell them you are a possible Type 1.5.

Ketones are caused by a relative lack of insulin and you BS readings show that you could well be deficient in insulin. You may not be, as you can have high BS readings without ketones, but you should not just assume this, as diabetic ketoacidosis is a medical emergency and you could become critically ill within hours.

If you have no way of testing your ketones at home, but you still feel ill and are getting worse, then please go to A+E anyway and get them to test you - even better as they can and should test your blood ketone level.

Symtoms of developing DKA include stomach pains, nausea, and headache.

Please don't hesitate to get medical help, and let us know how you get on. Best wishes.
Sue

 

[Simba]

Hi Hazey,

You really need to check your ketones......diabetic ketoacidosis is a medical emergency and you could become critically ill within hours.

Well worth following this advice. I saw my GP about 3 weeks ago after a period of feeling unwell with all of the symptoms of diabetes. Doctor claimed I was absolutely fine, no risk of diabetes, nothing to worry about etc, offered usual advice, lose some weight, do more execise and cut down on the drink.

Thankfully I had the presence of mind to turn up at A&E 24 hours later where they diagnosed DKA, followed by a weeks stay in hospital. The speed at which I went from feeling unwell to a fully fledged medical emergency was quite frightening.

Every single problem that I've experienced since discharge has been due to GP's, reluctance to issue prescriptions, insistance on doing their own blood tests, insistance that I discuss MY illness with people who know absolutely next to nothing about the problem. I honestly dont think its possible to find a decent GP, sadly they seam to have an adgenda to create "learned helplessness" in their patients. Still working on a plan as to how I managemy GP and get him off my back

Hope things work out OK, if in doubt use A&E

 

[Nellie]

Ditto to the previous 2 posts.

The advice from my consultant is whenever BS is above 250 (quick calculation, 13.8mmol) to check for ketones. I have a protocol to follow but it wouldn't work for you because I'm on a different type of insulin.
PS you can buy them from a chemists if neccessary

 

[hazey276]

Hi folks, just to let you know, phoned doctors this morning to make an appointment for this Friday, was told that i can't have one until next Monday cos he's fully booked :cry: !!

If i buy the ketone test strips can i use them on my optimum exceed monitor or do i have to buy one for ketones ?

 

[Simba]

If i buy the ketone test strips can i use them on my optimum exceed monitor or do i have to buy one for ketones ?

You can certainly buy ketone strips for the optimum exceed, I managed to blag a box from one of the nurses whilst in hospital.

Also if I remember correctly the exceed does sometimes pop up a message suggesting that you test for ketones if the result is greater than 16.7

 

[sofaraway]

Is there no toher GP at the surgery that you can see? I would ring up the hospital and see if you can get to speak to one of the doctors, or get an appointment with one fo the DSN's. i don't think it's acceptable to have to wait until monday to be seen by your GP.

I'd also suggest that when you can get in with the consultant to ask about changing to a basal bolus system, which generally involves 4 injections a day. since you are doing 3 of novomix at the moment it's only 1 extra and you're pretty much guarenteed to get better control.

You can buy urine ketone test strips, or blood ketone test strips that are used with optimum xceed meter, obviously blood is better as it give a current accurate picture, but may be expensive if you can't get them on prescription.

 

[hazey276]

Thanks for all the replies, forgive me for not remembering individual names but i've got a memory like a sieve. Firstly i'm only on 2 novomix a day, i actually received a call from my GP about an hour ago apologising profusely that he'd forgotten to ring me back last night because he was so busy. Anyway, he's increased my novomix from 24 to 30 units in the morning along with the glucophage SR and told me to increase it by 2 units a day until i get readings of between 4 and 7 in the evenings and still keep to the 22 units in the evening because my morning readings are getting there, (plus metformin). He said that i can go to a maximum of 38 units, (didn't say why), and i've got to phone him again on Friday with my weeks readings.

The other thing i wanted to ask is that i know its a little previous but i'm going on holiday in about 5 weeks time. As all you educated people know i've got to keep my Novomix cold and although from leaving home to getting there, (Portugal), it'll be about 6 hours, I wondered whats the best way to keep my pens nice and cold for the journey until i can get them in the fridge at the other end. Any advice would be greatly appreciated.

 

[sofaraway]

"I'm now on 20 units of Novomix 3 times a day which seems to have worked wonders"

Thats why I thought you were still on it three times a day, didn't see where you had reduced it back to 2 times. Anyway my point still sounds basal bolus is better, and something to think about for the near future.

Some type 1's who have insulin resistance take metformin, so maybe that is why your GP wants you to stay on it for the moment.

Thats good that you can adjust your doses until you get your blood sugars into range, i imagine your gp doesn't wnat you to increase too much too quickly and thats why he's put a 38units restriction for the time being.

I have just brought a frio pack, which is designed to keep insulin cool, activated by cold water. havne't tried it out yet, but have heard good reports.