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And today's appointment with my DN ...

Discussion in 'Type 2 Diabetes' started by briped, Jan 10, 2019.

  1. briped

    briped Type 2 · Well-Known Member

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    2 months after going of jardiance and decreasing my victoza my Hba1C had gone up ever so slightly to 41 (5.9), and my kidney number (whatever units they're measured in) had come down to 91. Just one point above range. I didn't even know they'd been raised a couple of months ago ...
    Anyway, for a moment there I felt sure I was with a DN in the UK, as she reminded me of the many stories I've read on this forum. I know this post is going to be a bit messy, but I hope you'll bear with me.
    DN "How about having some porridge for breakfast. You've really got to eat more carbs. Carbs are essential"
    me "why?"
    DN "Because you need them for fuel"
    Me "I'm in nutritional ketosis and use my fat for fuel"
    DN "But you're stressing your body. Your kidneys won't thank you for it"
    Me "But my kidneys have improved. You just told me so yourself. "
    DN "Well, that could have to do with your fluid balance"

    Later, when I came home and googled around for victoza and her equally dangerous relatives, such as Ozempic, which the DN wants me to switch to, I realised this about victoza, and I quote from bloodsugar101

    "There have been postmarketing reports of acute renal[kidney] failure and worsening of chronic renal failure, which may sometimes require hemodialysis in Victoza®-treated patients [see Adverse Reactions (6.2)]. Some of these events were reported in patients without known underlying renal disease."

    So might it just be that my improved kidney function is due to my lowering the dose by one third? And why oh why didn't I know enough to ask her this question when I had the chance? So typical me.
    Also according to Bloodsugar 101 victoza isn't really all that effective when it comes to blood sugar control, so I'm wondering if I should just ditch it altogether and see what happens. Go for more walks instead ...

    DN "Why did you decide against switching to Ozempic? It'll help you lose weight too".
    Me "How? By reducing my appetite?"
    DN "Yes"
    Me "But I don't need my appetite reduced. I'm not eating enough as it is"
    DN "But you'll only have to inject it once a week"
    Me "I have no problem injecting myself. I hardly feel it".
    Anyway, she gave me a bunch of leaflets or ads, as it were, filled with happiness, and very uninformative too. wrapped in a charming red zip wrapper which I'm sure will be useful for something else, but the leaflets will fill my paper recycling bin.

    I also asked her about SR Metformin, and told her of my fear of going to sleep to wake up in the middle of the night with a tummy upset. She'd never heard of SR Metformin, and wondered if it could be called something else in the UK ...? I wonder too? Being afraid of going to sleep is really no fun at all.

    Then she told me that I was on the waiting list to see the endo doc in about 18 months time, but that I was very welcome to give them a ring and ask to have my blood tested for cholesterol levels, as I hadn't had that done this time around.
    Me "18 months!?!?!"
    DN "Yes, the big wigs (she pointed upwards, clearly thinking of our beloved government), have decided that well controlled T2s such as yourself, are going to be referred to their GPs for future treatment, and you may well be one of them".
    I quipped that I'd go back to my old cake eating ways, but I don't think she heard me.
    So that's me, probably on my way to be discharged from the endo out patients clinic, not knowing when I'll be having my next Hba1C - oh, should I mention that she also told me not to test my bloods very often?
     
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  2. Daibell

    Daibell LADA · Master

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    Hi. Well, what can I say about the nurse other than she needs re-training. You can't blame her but blame sheer ignorance within NHS training. Most T2s don't see an endo but are managed by the surgery. Surgeries vary but my one has an excellent nurse who covers diabetes including insulin dependents like me. To not know about Metformin SR is amazing (note the SR comes after the name). It is also called Metformin MR (Modified Release). If you keep the carbs way down you really should lose weight. If you can avoid ongoing Victoza it will be good as it does have various side effects and is only relevant if you have a lot of excess weight.
     
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  3. briped

    briped Type 2 · Well-Known Member

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    Just goes to show that its not just NHS training, but probably rather global training (I'm in Denmark). Thanks for your lovely reply. No, I don't blame her. On a personal level I like her and get on with her, but the more I learn about T2, the more I realise that she's probably just stuck in her ways, and I'm becoming more difficult to deal with, as in uncooperative in her eyes.
    To me LCHF/keto makes a lot of sense, but it's been 13 years since I was diagnosed, and I can't just expect to turn this supertanker within a matter of months. I'm no good at counting carbs, fat etc, but really I do believe my body is in starvation mode, as I lost only 2 kgs in 3 months. That's why I joined lowcarbmanager.com to help me sort out a healthy balanced keto way of eating. I started actually logging my food today, and can see that I only got 8g. of carbs, which is good, I suppose. My fat intake was too low - and still is, even after eating a handful of pecan nuts I only reached 46g. My proteins are bang on target. I'll get the hang of it eventually, I'm sure.
    My DN actually said that she knew of only one kind of metformin, but that, surprise surprise, you get different dosis. It would seem we're a metforminely underdeveloped nation :) About victoza ... Oh I know. Scary stuff.
     
  4. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Legend

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    The "kidney thing" sounds like it is the eGFR (Glomerular Filtration Rate). In the UK this should be 90 or over. and is a mathematical estimate of how well your kidneys are working. If yours was 91 your kidneys are working perfectly. The top of the range used to be 60 or above. Thuis changed in the last few years to 90 or above.
     
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  5. briped

    briped Type 2 · Well-Known Member

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    Now I'm a little confused ... 3 months ago it was ... I believe the number was 130something, which my DN said was out of range/too high. Anyway, strange how the ideal changes, isn't it. I know that cholesterol levels were lowered, probably to make more people take statins.
     
  6. briped

    briped Type 2 · Well-Known Member

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    Aww, thanks for all your hugs, but really I'm fine. I've got all you lovely people to lean on when/if I'm kicked out of the endo clinic, and certainly when I consult my GP, who's no expert, but lovely and always encouraging and enthusiastic. :)
     
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  7. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Legend

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    Maybe they are different measurement units. Mine are measured in mL/min/1.73m*s and should be over 90.
     
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