Confused About Treatment

Hi ashvxii and welcome to the forum. First let me tag in @daisy1 for her useful welcome info thread.
I’m puzzled why you should be put straight on insulin with an HbA1c of 65. We’re you given no explaination at all? Are they thinking you may be type 1?
I can only tell you my story. My HbA1c was 70 on diagnosis, I was diagnosed Type 2, I was started on Metformin tablets and tolerate them well now after a bit of stomach upset in the early days. I wasn't advised to eat low carb by my GP or Diabetes education course, but stumbled on this forum by chance and took up a low carb life style with self monitoring. I started by eating less than 100g carbs/day to begin with and then after 6 weeks reduced it to 50-70g/day, nowadays I tend to keep under 60g. Caution needs to be taken on certain drugs going low carb but on just Metformin it’s ok l, you’d certainly need guidance if you do start the insulin. The best way to see what foods suit you is to test right before a meal and then two hours after the first bite, you’re looking for a rise of no more than 2 mmol/l and to be within these recommended ranges http://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html

This has worked for me, to date I've lost nearly 6 stone (still more to go) and got my HbA1c (blood test for 2-3 month average blood sugar) down to a non diabetic level, all due to the fantastic support and advise I got here. Read around the Forum and ask any questions that occur to you.
I think a visit back to the GP to ask some more questions might be useful.

Hi! You're not the only one who's confused... Straight to insulin, but initial appointment not till september?! It's like one is treating you as a T1, the other as a T2. Your weight and gestational diabetes imply T2, your age could indicate T1... Or a bunch of other diabetic "brands" in between! For me, a T2, well, I was quite a bit higher when my HbA1c was done, but only put on pills, and could stop those 3 months into low carb eating. And that was moderate low carb, say about 80 grams a day. I'm trying 20 grams or less now, to lose additional weight (44 pounds down in total, and counting), and get rid of my fatty liver disease. And who knows, PCOS in the process. People can come off insulin, so it isn't a point-of-no-return thing, but be careful if you decide you want to try low carb and injecting, because you might hypo. Check this place's low carb program and dietdoctor.com for ideas. And if you have questions, we're here to answer them. (Just keep in mind we're not doctors). And do yourself a favour; stock up on test strips. Should you want to start eating to your meter, you'll need about 7 a day to begin with.
Good luck!
Jo

ashvxii said:

Hello everyone, I’m so glad I found this forum as I’m sure there is lots of people who can help me. I have been searching for information for a few days now but was unable to post until now.

I got diagnosed with diabetes on the 7th of June after I noticed my blood sugars were raised very high (I’ve had gestational diabetes twice) so I had a blood glucose monitor.

I called my doctor who did my HbA1c and the result was 65 (I’m not sure what that means) but I do know anything over 48 is considered diabetic. Anyway she referred me to the diabetic team, she said it was an emergency referral but they gave me an appointment for late September (which I have since moved to This coming Tuesday) as I think that’s a bit of an excessive wait. Anyway my main problem is all I’ve been told to do is inject myself with insulin until I see the diabetic team.
To be honest I’m confused as to how many units I should be injecting and I’d prefer if I was on medication as I’m only 24 and would like to reverse this diabetes. I’m worried injecting insulin might effect my ability to just manage it with diet. Does anyone know if this is possible?

I’ve been losing weight since my second baby in January . I’ve lost about 20lbs since March. I’m 5ft 10 & 218lbs!! Ideally my goal is 175lbs so hopefully this will help. Has anyone got much experience with being placed on insulin straight away. My blood sugar readings are not this high, my fasting blood sugar though is always high. Between around 7-14.

Thanks to anyone who can help me

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Hi
Ur so young I'd instantly suspect ur type 1, especially being put onto insulin straight away, I'd personally suggest you contact your local diabetes centre if you have one or demand ur gp contacts them to get u there asap, but as you've an appt tues this is fine. Unfortunately I suspect ur weight loss is related to being type 1 too. Sorry. Hope they quash and worries u have when u c them Tuesday. The reason I say type 1 is ur age ur wt loss and treatment, whereas if ur type 2s are usually older and treatment options r different from the start.

ashvxii said:

Yes exactly to be honest I never asked which type I was which obviously I should of, I’m annoyed now I didn’t. Well done on your weight loss, I am now too eating relatively low carb. It definitely takes some adjusting. Thank you for your advice, I haven’t experienced hypo so far just relatively good readings after meals. As I mentioned my fasting blood sugars aren’t so good. I’ll let you know more on Tuesday after I see someone. It’s very confusing, my doctor only prescribes me 50 test strips at a time which don’t last long. I wish I could buy somewhere over the counter

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Hi again,
Well, considering the discrepancies in treatment, odds are no-one's actually sure yet what type you are. More bloodtests heading your way, I think, to check for insulin resistance and antibodies. Besides T1 and 2, Mody and Lada are a possibility. Among others. As for the fasting bs, that's sugar that's been stored in your liver. (So it's already in your body, you just don't see it until it's releasd into the bloodstream). As you low carb, the stores eventually get depleted. Personally I've found it goes faster if you drop fruit from the menu entirely, as fructose clings to your liver like mad. So could just be a matter of time. Unless you're a T1 or other, then I have no clue. While tests are being done and you're waiting for answers, best not to worry too much about the dumps, as there is, besides low carbing, nothing much you can do about them at the moment. And stress raises bs too. Maybe they'll put you on basal insulin and bolus, but that's in the future right now; a wait-and-see. As for strips, you can self fund. You can get them at the same place you get your scrip filled, no problem. Or online. A lot of people here get a Codefree or another one I can't recall right now because the strips are less expensive though than the meters' you were given. But as a Dutchy, I don't know the British discount codes. Someone else here will though. Or search in the forum's history. Check first thing in the morning, just before you eat, and two hours after first bite. If you go up more than 2 mmol/l, the meal was carbier than your pancreas could handle. But again, that's T2 rules... Don't get pinned down just yet. Hope this helps!
Jo

@ashvxii

Hello Ashvxii and welcome to the Forum Here is the Basic Information we give to new members and I hope you will find it useful. Ask as many questions as you want and someone will help.

BASIC INFORMATION FOR NEWLY DIAGNOSED DIABETICS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 235,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes.

Over 145,000 people have taken part in the Low Carb Program - a 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic.

Note: This post has been edited from Sue/Ken's post to include up to date information.
Take part in Diabetes.co.uk digital education programs and improve your understanding. Most of these are free.

• Low Carb Program - it's made front-page news of the New Scientist and The Times. Developed with 20,000 people with type 2 diabetes; 96% of people who take part recommend it... find out why
  
  
• Hypo Program - improve your understanding of hypos. There's a version for people with diabetes, parents/guardians of children with type 1, children with type 1 diabetes, teachers and HCPs.
  

ashvxii said:

Hello again everyone, thank you so much for the replies. I thought I would wait until I had my appointment with the diabetic team today before updating. Turns out I am Type 2 diabetic, my doctor was baffled as to why I was instructed to initially use insulin but not only this. My GP had told me to use a “once a day insulin” as a pre-meal fast acting insulin so all this time I’ve been injecting a slow release insulin 3 times daily which wasn’t even a fast acting insulin. I really feel like my GP just isn’t paying attention.

I’ve now been instructed to come off insulin and take metformin 500mg twice daily increasing this to 500mg 4 times daily next week. Is this normal? I’m not sure what my blood sugar readings are going to be but I will have to see. Hopefully I can decrease my fasting blood sugar down to normal. although this morning it was 6.2 which is considerably lower than normal for me. As long as I keep losing weight my doctor is confident I should be able to reverse it BUT he did say because I am not massively overweight he doesn’t know if losing weight will be enough to cure it. I will keep browsing this forum for more information. I must say, everybody on here is extremely helpful & providing really great information. Thank you so much, I really appreciate it

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Your GP obviously doesn't know much about diabetes... A GP has to know a lot about everything, which is a tall order, and diabetes care seems to have slipped through the cracks. That happens often, but this is the first time I've heard of someone perscribing a basal insulin as a bolus. That's just... Can't wrap my head around that one.

Metformin is usually the first stop, but don't rely on it to get your bs down completely. It helps the liver to dump less glucose, which is why your fasting levels are better. Spikes will still be down to diet though. You might not have a lot of weight to lose, but sometimes, visceral fat isn't obvious on the outside; the liver and pancreas can be smothered by densely packed fat tissue, and you wouldn't know it when looking in the mirror. (I am overweight, but the fat on my liver was so dense and oddly formed, they needed a month and many different scans to rule out cancer.).

And this may just be semantics, but... There is, as yet, no cure for T2. Reversal(as in, not needing meds anymore) usually means nothing more than tight dietary control. Low carb eating for the duration, because carbs will still give spikes. My HbA1c is 34 now, but the moment I eat something carby, I still spike. Low carb keeps complications at bay, I'm losing weight, foodintolerances are getting better, the rheumatism and PCOS too... But the moment I eat like a non-insulin-resistant person, I'm back where I started. You can go in remission, but it takes work. Best advice I can give you is not to rely on meds only, because then, diabetes type 2 is a nasty, progressive disease. More meds, until ultimately, back on increasing doses of insulin, and complications along the way. It's your choice, obviously, as many people find it is easier to just take meds, but given your age... I'd low carb my b*tt off. Not so much to lose weight, but to stabilise bs and avoid complications. That's just my take on it though...