Annual Check-up - Not happy with progress

[andyrobo]

Hi Guys,

I am after some advice. I have been diagnosed for 3 years and started off with a HbA1c of 6.2 and it has slowly crept up to the latest of 6.9. My weight has crept up by half a stone in the three years, and all my other results, BP etc are fine. I am 40 years old.

I am becoming increasingly frustraited with the diabetic nurse. I seem to be having the same conversation each time specifically about my weight. I have been to see the dietitian and I eat all the correct things, snack on the correct things, etc but I cannot shift more than a pound or so and then put it back on. I exercise two to three times a week at the gym but sit at a desk all day. I drink loads of water so frequent loo trips are the daily exercise! I use the stairs up the three flights to my office.

I really felt disheartened after my check up today - I felt she hears me but does not listen. I know there is no magic answer, but i felt and asked the criteria for the next step of medication - so 7.0 is the cut off - I have to reach that and then stay at that before anything will be done. So that will be at least another year.

I understand that the tablets should lower my levels by 1% which would put me in the well managed category but there seems to be a resistance to this.

What are my options - could I go to see my GP and voice my concerns as I feel the level is steadily rising and is just waiting to reach the magic level before the next step in the process is unleashed. Will medication help me in any way or not? I feel like this would be going behind her back, but I am generally concerned.

I should point out that two of my Auntys are diabetic and are complicated patients, my mum is a complicated patient with her heart, so I suspect that genetically I will have the 'complicated' gene!

Am I blowing this out of all proportion or should I be concerned? If so where should I go next??

THanks for reading!

Andrea

 

[sugarless sue]

The recommended 'Healthy diet' for diabetics is sometimes not the right diet for many diabetics, especially if they want to lose weight. I know you have been diagnosed for three years but some of the information below may be of help to you.

Here is the advice we usually give to newly diagnosed type 2 diabetics.This forum doesn't always follow the recommended dietary advice, you have to work out what works for you as we are all different.

It's not just 'sugars' you need to avoid, diabetes is an inability to process glucose properly. Carbohydrate converts, in the body, to glucose. So it makes sense to reduce the amount of carbohydrate that you eat which includes sugars.

The main carbs to avoid or reduce are the complex or starchy carbohydrates such as bread, potatoes, pasta, rice, starchy root veg and also any flour based products. The starchy carbs all convert 100% to glucose in the body and raise the blood sugar levels significantly.

The way to find out how different foods affect you is to do regular daily testing and keep a food diary for a couple of weeks. If you test just before eating then two hours after eating you will see the effect of certain foods on your blood glucose levels. Some foods, which are slow acting carbohydrates, are absorbed more slowly so you may need to test three or even four hours later to see the affect that these have on your blood glucose levels.

Buy yourself a carb counter book (you can get these on-line) and you will be able to work out how much carbs you are eating, when you test, the reading two hours after should be roughly the same as the before eating reading, if it is then that meal was fine, if it isn’t then you need to check what you have eaten and think about reducing the portion size of carbs.

When you are buying products check the total carbohydrate content, this includes the sugar content. Do not just go by the amount of sugar on the packaging as this is misleading to a diabetic.

As for a tester, try asking the nurse/doctor and explain that you want to be proactive in managing your own diabetes and therefore need to test so that you can see just how foods affect your blood sugar levels. Hopefully this will work ! Sometimes they are not keen to give Type 2’s the strips on prescription, (in the UK) but you can but try !!

As a Type 2 the latest 2010 NICE guidelines for Bg levels are as follows:
Fasting (waking).......between 4 - 7 mmol/l.
2 hrs after meals......no more than 8.5 mmol/l.
If you are able to keep the post meal numbers lower, so much the better.

It also helps if you can do 30 minutes moderate exercise a day. It doesn't have to be strenuous.

Sue/Ken.

 

[Synonym]

Hi Andrea.

If you carefully follow the advice posted by Sue you will not need to go on to medication or advance to complications like your Aunties.

You have to really want to sort it out yourself, for yourself, if you are going to get to grips with your health and ensure a brighter future. Really explore the different threads particularly those on the Food forum and the different diet threads. You sound as if you would not need to change so very much at present, perhaps just cut down on the carbs. :idea: You would need to test to find out what your foods are doing to your BG levels which will help you to sort it all out. It is worth doing this sooner rather than later :!:

It is not rocket science fortunately and many of the members on here have these issues well under control and you could too.

This site is a great enabler with masses of information and helpful people to answer any queries so do ask anything you need to know.

 

[NinaP]

I recently saw my DB nurse and my HBa1c was 6.8 an increase from 6.2, however as I was recovering from major surgery she didn't see this as a problem and that in the next few months as I get fitter it will correct itself. However I test every morning and had noticed that my level were consistently in the high 8's and had even had a couple of 10's (just goes to show you can't rely on the HBa1c). Bearing this in mind she has now prescribed 1 metformin tablet just in the evening to see if that helps. I had slipped with my diet but now I am back on track. Interestingly I normally have 2 slices of wholemeal toast for breakfast and one day decided to see what effect it had. I was shocked. Two hours after the toast my reading was 12.1, now I have cold meat and cheese or fruit for breakfast.

Considering the medical professions resistance to testing (I'm lucky my GP believes in it), just relying on the HBa1c does not tell the whole story. It's time the medical profession realised that information is power and for us diabetics this is vitally important information.

I'm lucky I have a GP and DB nurses who believe in testing and allow patients to be proactive in their health regime.

Good luck Andrea

Nina

 

[sip]

Each person is different and, as diabetics, we have to make adjustments to certain aspects of our lives, such as diet and exercise. Here’s my story:

I was first diagnosed in January 2008, and on the day I was tested by my GP, my reading was 19, and the same blood tested by the hospital lab came up with 25! My HbA1C was 9.9 and by the end of the first year, I managed to get it down to 7.1.

I was on Gliclazide for about six weeks and my BG was dropping to lower 3s at 4:00 and 5:00 in the morning! So my GP put me on 2 x Metformin 500mg daily.

My HbA1C kept coming down and was around 6.5 in the middle of 2009. Two months later, I gave up all medication for six weeks and fasted for 30 days (Ramadhan) — a month later, my blood test came due and my HbA1C was 6.0.

This year has been a roller-coaster and my HbA1C has crept up to 6.9 and the best explanation I can get out of my GP is that there are underlying causes for the increase: kidney stones (pain & bleeding), anxiety, stress, etc. Apparently, even just worrying constantly about your BGs can cause an increase as it introduces anxiety to the equation (similar to white-coat syndrome, where blood pressure results are skewed when tested at the surgery but can be normal when self-testing, when you’re more relaxed). My nurse tells me to stick with slow-release carbs, and she tells me that chapati is one of the best foods for this.

Now, here’s the unusual bit: I don’t take artificial sweeteners and still need sugar with my two-mugs-of-tea each day, my diet is pretty much what it used to be, hot curries with chappati, but I have changed my eating patterns. Instead of eating three full meals a day, I spread my food intake over five smaller meals, and have added fruit and raw vegetables and nuts to my diet.

The biggest help though, has been the ability to test my BGs every day (my GP is very good about this) — it’s not just about being informed (which is important) but also being motivated to do something when I see any unusual changes to my daily readings.

My nurse is reluctant for me to drop my HbA1C below 6.0 but my own target is 5.0 to 5.5 because the one thing I want to do is come off the Metformin (originally invented to help with weight-loss) as it plays havoc with my digestive system: it’s no wonder some people refer to it as Metfartin!

Best wishes and here’s hoping you hit your target.