Additional anti diabetics or insulin

[Jmennaid]

I am t2 diabetic diagnosed in 2017. Initially diet controlled and then went on to Metformin 1000mg twice daily since 2019 when hba1c increased from 48 to 54. Last year in March hba1c increased again and was prescribed aloglyptin along with metformin. Everything seemed to be going in the right direction until the beginning of this year.

Fasting blood sugars which were normally 5-7 increased to 15+, and has been like this for months. I have experienced recurring thrush and bladder infections being given antibiotics and other treatment for thrush. There has been no change to my diet, my exercise has decreased as a result of the recurring infections as I have to plan what I do based around where I can get a toilet.

Blood tests carried out last week and my hba1c has come back at 81! I have increased liver enzymes and another bladder infection. GP has asked me to consider additional medication which would make me high risk for future infections or to be referred to a specialist diabetic nurse at local hospital.

I am reluctant to try the additional medication as I am so drained physically already with disturbed sleep and all the other issues that come with having thrush and bladder infections.

At 52 I am also going through menopause and on HRT transdermal patches. I feel I am a cycle of sorts that I can’t get out off which is making me down. Perhaps my altered hormone levels are adding to my current issues.

Would appreciate thoughts of anyone who has gone through similar and what treatments you have found that worked.

Apologies for the long post but any advice would be greatly appreciated. TIA

 

[lucylocket61]

Welcome to the forum.

What sort of diet do you have?

 

[Jmennaid]

I ensure that I have 5 portions a day of fruit and veg, I eat oily fish twice a week and prefer chicken to red meat. I am also have a wheat intolerance so I use GF bread and pasta. I only have pasta once a month and GF bread at breakfast time. I use skimmed milk and only in coffee or a small amount at breakfast for porridge or scrambled egg.

I have had issues with weight since my mid twenties and find it difficult to lose weight.

I don’t eat after 6.30 pm where possible but I am a shift worker.

I do try and avoid snacking between meals and will eat a small handful of nuts or veggie sticks if I do get peckish

 

[lucylocket61]

I ensure that I have 5 portions a day of fruit and veg, I eat oily fish twice a week and prefer chicken to red meat. I am also have a wheat intolerance so I use GF bread and pasta. I only have pasta once a month and GF bread at breakfast time. I use skimmed milk and only in coffee or a small amount at breakfast for porridge or scrambled egg.

I have had issues with weight since my mid twenties and find it difficult to lose weight.

I don’t eat after 6.30 pm where possible but I am a shift worker.

I do try and avoid snacking between meals and will eat a small handful of nuts or veggie sticks if I do get peckish

Have you tried lowering your carb intake?

 

[Resurgam]

I was encouraged to eat all those 'healthy' carbs from my early 20s as well - did me no good at all.
I would advise tossing out the diet sheet and all the old ideas - I used my collection to light the barbecue.
Going low carb sorted out my blood glucose in a few weeks - no milk, no grain, no high carb fruit or veges,
I am experimenting with making a low carb bread, but it has not been successful so far.
If you stop all the carbs and you are still not seeing normal numbers then you could be something more interesting than a type two, but it might help to keep things from getting serious until you can get a proper diagnosis.

 

[Jmennaid]

Carb intake is low and hasn’t changed in the last year. My diet has remained steady, perhaps I need to mix it up again.

Having reviewed my HBA1C results over the last 5 years, it would appear that something causes them to spike in the first quarter of the year then level out with changes in medication.

I really can’t go on with this 3 weekly cycle of thrush and bladder infection I am on at the moment. Hopefully will get an appointment quickly for diabetic nurse specialist.

 

[TriciaWs]

Carb intake is low and hasn’t changed in the last year. My diet has remained steady, perhaps I need to mix it up again.

Having reviewed my HBA1C results over the last 5 years, it would appear that something causes them to spike in the first quarter of the year then level out with changes in medication.

I really can’t go on with this 3 weekly cycle of thrush and bladder infection I am on at the moment. Hopefully will get an appointment quickly for diabetic nurse specialist.

Without more detail about a typical day's food it is difficult to understand how many carbs you are eating but most of us do not eat ordinary GF bread, pasta or oats and we swap to full fat milk, yogurt etc. We also strictly limit fruit - to just a few berries if any fruit.
The out-of-date advice about using the Eatwell plate is not helpful for T2s.
When I started low carb I was on 100g a day then dropped to 85g and no more than 30g in a single meal - but I know that some others need to go much lower (I was lucky as I was diagnosed promptly after having annual blood tests and went low carb immediately, so my insulin resistance was not as bad).

 

[searley]

I won't discuss the diet issue, i don't low carb.. or diet as i don't need to... but want to respond the the main question.. more pills or insulin.. as this was a situation i was in 10 years ago

This is only a decision you can make.. pills can come with a lot of side effects.. which in most cases insulin does not BUT insulin is not trouble free either..

Examples:
You WILL have to test you BG multiple times a day
You COULD have hypo's, so will have to also carry stuff to treat that
you MUST tell the DVLA if you drive and will have a 3 year medical license
you should tell your insurance company
if you diet is wrong insulin will make you gain more weight and possible compound the problem further
if you have a HGV license it will be removed from you for minimum 3 months

im sure there is more to add to that list.. so weigh up the pro's and cons.. consider if you diet is right/wrong.. discuss with your care team what they think

Ultimately only you know how you feel on your treatment.. good luck

 

[optimist1]

I wouldn't continue as you are going. Whatever you do, you need to get your BG in range. Diet and a second med may be enough without insulin. Is it worth trying an initial 20-50g of carb a day and a second T2 med? Given your susceptibility to UTI, the SGLT2 type may not be offered. It may not need to be insulin at this stage, to get your BG in range.

 

[Circuspony]

I'm T1 and hormones can send my BG sky high every month so I wonder if that's part of your issue. Personally I'd see the diabetes team and discuss if insulin could help. Can they order a blood test to see how much insulin you are stop producing?

 

[Jmennaid]

Thank you all for taking time to reply. Hopefully appointment comes through for hospital appointment quite quickly. I believe myself that the changes are hormone related but GP not interested in discussing this.

Fasting blood sugar of 13.9 yesterday and then when taken before my evening meal was 8.5 which is the lowest it has been since December. Again no changes in what was eaten yesterday compared to other days.

I have a lot to think about and research/planning to do for my future appointment.

 

[lucylocket61]

Thank you all for taking time to reply. Hopefully appointment comes through for hospital appointment quite quickly. I believe myself that the changes are hormone related but GP not interested in discussing this.

Fasting blood sugar of 13.9 yesterday and then when taken before my evening meal was 8.5 which is the lowest it has been since December. Again no changes in what was eaten yesterday compared to other days.

I have a lot to think about and research/planning to do for my future appointment.

How many carbs a day do you eat? I found my carb intake has a huge impacts on my blood sugar levels, even while going through the menopause.

 

[Jmennaid]

Have counted up carb total for yesterday and it was 45. Fasting blood sugar of 13.9 this morning and then 14.1 prior to lunch

 

[Jmennaid]

Just taken a call from GP, specialist nurse has been in touch with him regarding a 3rd alternative so telephone consultation on Monday.