is it time for insulin

[alliebee]

Hi, this is my first post, Im type two, and have been controlled with diet and metformin for 18 months, however in the last month my sugars have gone high, then last week hit an average of 17, and went uo to 25. I felt so very tired, and the usual thirst ect, my gp put me on 80 m of glicazide, but when that hadnt worked , and by fri upped the dose to a tablet at bedtime also.

This hasnt worked at all over the weekend, and im feeling wretched, the clinic are going to ring me tom. Ive hardly eaten, as I feel nausea, but can hardly drag myself around.

I dont mind at all if it is time to go onto insulin, I just want to feel better.

Please can anyone tell me, are they likely to keep trying other meds, as the thought of going weeks
trying meds that may not work and feeling like this dismays me. Thankyou,

 

[AMBrennan]

Sorry to ask this, but how old are you and are you overweight? To me, high BG + ineffective T2 medication + nausea suggests that you may not be T2. I'd get a ketone test at the earliest opportunity (some meters or ketostix) to rule out DKA.

 

[alliebee]

thankyou for the quick reply,
I was doing great on the metformin, just all gone to pieces in the past month or so.
I am 55, and about a stone and a half overweight.

Mt nurse said maybe my body has stopped producing ebough natural insulin, and that it can happen quickly,

Thank god I found this forum as Ive been so low today sugars were 15 on waking and up to 21 after eating, back to 18 now

 

[alliebee]

ps just trace of keytones on ketostix
Think that might be as ive been near starving to get bg down

 

[borofergie]

What does trace mean? 5mg/dl

Keep a careful eye on this... If it gets up to 40mg/dl go straight to A&E

 

[alliebee]

Thankyou so much
I admit I was worried
It showed the second reading yesterday just a trace but has been negative today.

Im just wondering what they are likely to do next. The glicazide dont seem to be doing very much

Will they try a new combination of meds, do you think, or will they put me onto insulin?

All this week ive tried everything, from almost starving, then no carbs, but nothing seems to bring my bg readings down by very much, today the lowest was 15

 

[AMBrennan]

Based on the NICE T2 algorithm, the next step would normally* be to add thiazolidinediones or insulin to your current medication.

I'm a big fan of insulin (which isn't nearly as bad or difficult as many seem to think), so I think you should consider it but this is really something should discuss with you GP.

* I.e. Regular HbA1c > 7.5% (or as agreed) rather than acute high blood glucose.

 

[alliebee]

I so appreciate the replies thankyou,

Im honestly thinking that I wouldnt mind starting on insulin if I need it, the way Ive felt has been truly awful, and the thought of bumbling along on trying different meds and still feeling like this for ages lnder dismays me.
At one point today I was sitting on the loo and drinking from a bottle of water!!!

Not a great image sorry

All Ive wanted today is my bed. I feel just like someone has force fed me 3 big boxes of chocs

So pleased ive found this forum, thank you so much for the advice

 

[grh1904]

I was the same, my meds went up quite quickly in a short space of time, high BG's, weight loss, extreme tiredness & thirst etc.

I was apprehensive about injecting insulin as I thought it would end my career. Best thing I ever did!!!!!!!

 

[Daibell]

Hi

You may want to download the various diabetes papers from the NICE and NHS diabetes websites; they are excellent and some of these show a flow-chart for GPs to follow in deciding what meds to give. Metformin is the typical 1st level med, then comes typically Gliclazide as a 2nd level adder and then there's the 3rd level which can be one of various meds including insulin. I was offered one of the glitazones or sitagliptin at my last appointment as insulin was refused (quote 'it's a last resort'). I went for sitaglitpin which has helped quite a bit. As someone else has said it's always possible you are a very late T1 or have one of the other non-T2 variants so be prepared to ask you GP for further tests.

 

[alliebee]

cant thankyou enough for the messages x

The dnp rang me today and after a royal telling off for ( wait for it) buying and testing my own bg readings said that obviously meds werent working and I must go in on Thurs for an hr appt with the nurse and Please to bring all my readings.....
I did try sitagliptin but made me extremely sick

readings were 11 fasting and 18 after tuna salad at lunch, and 24 after chicken and a minute portion of mixed veg tonight... Just amazing No carbs at all really,

i am so confused and thirsty lol

 

[Beav]

When I got diagnosed I had key tones of 4.2 or something like this (I have to go in if its over 4) . They slowly come down and I was let out of hospital because my sugar levels were ok but they said keep an eye on your key tones. As soon as I got home I had a nice full meal (not hospital muck) and my key tones went completely!

 

[alliebee]

thanks Diabell,

would you know the websites you mentioned, or a link?
have just tried to google for the treatment flowchart with no luck
thanks.

 

[g-man]

I was in a similar position a few years ago when I was on various tablets. Being type 1.5 the tablets lasted about 4 years before the effect finally began to wear off.

I was always apprehensive about insulin but I bought a book called 'Using Insulin' which was so helpful, that it gave me the encouragement to push my diabetes specialist into giving me the option to begin insulin usage.

Although my a1c was only around 7.2 at the time (and there was some reluctance from the DSN to start based on 'such a low a1c'), it only took me a few weeks to get into it and it was so much of a relief when I finally felt things were getting under control.

I kept the book by my side and probably re-read it several times. So much so that when I went back to see my DSN, I was able to explain various things about insulin that even she didn't know! :lol:

Anyway, might be worth investing in the book if you think that insulin is the way forward, however your doc and diabetes specialist are the ones you should ultimately take advice from.

For myself, I noticed that a change of medication didn't take effect immediately, it was always after a few days that I saw changes in my levels.

Hope all works out for you.

 

[alliebee]

thankyou thats amazing advice, Im straight off to amazon to find book

Sadly several days nearly a week on glic, and no change, still in the high teens

 

[alliebee]

Hey G Man,
A huge thankyou, Ive just reviewed and ordered the book with a lunchtime guarantee to have it by onepm tom. them I can read up and argue my case for thursday at three pm

was just what I needed
thankyou so much, will let you know how i get on xx Alison

 

[Daibell]

Hi Alliebee

Ref your request for links etc to guidelines, here are some but you can find others on the NICE and NHS diabetes sites:

Herts NHS July 2010 (my local NHS area): http://www.hertschs.nhs.uk/services/adult/Diabetes/

NICE links to the updated main document CG66 now CG87: http://guidance.nice.org.uk/CG87/NICEGu ... df/English

NICE CG87 Quick Ref Guide (has flow-chart): http://guidance.nice.org.uk/CG87/QuickR ... df/English

 

[alliebee]

oh thanks diabell

thats magic, off to study........ god i love this forum, why didnt i find you before

great guys

 

[ALCHillfoots]

Hi,

Your situation sounds very familiar to what happened to me a few years ago. Metformin at low dose was doing then trick then suddenly it didn't. I also got prescribed Gliclazide, but it took about a fortnight before it really stated to have any poroper effect. Stick with it.

 

[alliebee]

G MAN,
What can I say,

The book arrived today Using insulin, and what a book, informative and easy to read and dip into.

I feel as if I have a tool to work with towards my treatment, im actually pleased my appt today at the clinic cancelled till mon, as I will read and understand even more by then.

fantastic advice, I am so very gratefull Alison x