Consultant visit/high a1c

[Mijas_pueblo_]

Morning all,

I went to see an Endo consultant a while back. The upshot was that she wanted me to go onto Trulicity injections and was going to tell my GP to arrange it. Now, I went to see the GP and said that I'm not interested having looked at the side effects and we agreed to see what my next review showed. Sadly that showed the my a1c was up - I knew it would be as I was getting readings of 12~18 most of the time. Not too sure why, but whatever I did diet wise made no difference. I did wonder if my pancreas is finally giving up....

Anyway, I was told that if I couldn't get the numbers down in 3 months we'd have to look at insulin. In the meantime I went back to the consultant who asked how the Trulicity was going? and she wan't too impressed when I said I wan't on it. The consultant has now written to my GP again and I have been asked to go in to "discuss".

I really don't want to go on it, but I have to accept that it may be the only way. But, before I make the appt I'm going back to low carb/keto basics. I'm going to give it 2 weeks and see if I can get the numbers falling again. If so then I know I can sort it. If not then I may have to reluctantly take the meds offered..... sigh.

I was on Trulicity for 6 months . It did not suit me at all. I injected every Wednesday afternoon, by Thursday night chronic dioreah for several hours. This went on for weeks.
Eventually took myself off of Trulicity.

I use a low carb diet, but not keto. My Consultant said no to Keto as we still need some carbs. Keto too drastic .

Now off of Trulicity a lot healthier and happy.

 

[ianf0ster]

I was on Trulicity for 6 months . It did not suit me at all. I injected every Wednesday afternoon, by Thursday night chronic dioreah for several hours. This went on for weeks.
Eventually took myself off of Trulicity.

I use a low carb diet, but not keto. My Consultant said no to Keto as we still need some carbs. Keto too drastic .

Now off of Trulicity a lot healthier and happy.

Really, Carbs are the only non-essential macro-nutrient, meaning we don't actually need them at all. What does your Consultant think we need them for? We can synthesize Glucose from protein - for the extremely tiny amount that we actually need.
It is unusual for people not to go into Keto at 20gms of carbs per day (or higher) - so you don't need to go zero carb to go Keto - though some people do go zero carb - like traditional Inuit.

 

[seanj67]

I was on Trulicity for 6 months . It did not suit me at all. I injected every Wednesday afternoon, by Thursday night chronic dioreah for several hours. This went on for weeks.
Eventually took myself off of Trulicity.

I'm still refusing it, the consultant has handed me back to my GP and said'd she'll see me once more - I'll cancel that appointment when it arrives as it's a 20 mile drive to the hospital and all I'll get is "You need to take the Trulicity" - I'm getting my numbers down more effectively now anyway so will carry on as I am until my next review at the GP/DN.

 

[KK123]

I'm still refusing it, the consultant has handed me back to my GP and said'd she'll see me once more - I'll cancel that appointment when it arrives as it's a 20 mile drive to the hospital and all I'll get is "You need to take the Trulicity" - I'm getting my numbers down more effectively now anyway so will carry on as I am until my next review at the GP/DN.

I feel for you Sean! When you are under a Consultant and a GP you sometimes feel you are betwixt the devil and the deep blue sea. I was under a Consultant for 'high' cholesterol who said STATINS, no argument then saw the Dr who said please yourself basically. This resulted in a letter from the Consultant pretty much saying 'Go away if you're not going to do what I say'. Fine by me but I do worry about being seen as a rebel sometimes. x

 

[PenguinMum]

A fasting insulin test might be useful to you too - although since it isn't found on the NHS, your doc probably won't have heard of it, or know how to interpret it.
*** education opportunity *** (if they are open to it)

You can get very reasonably priced private Fasting Insulin Tests (or Any Other Time Insulin Tests, depending on when you take the blood sample) from several companies including Medichecks and Thriva.

The result of the test would inform you how much insulin you have circulating at the time of the test - which you can compare with what you had eaten, and give you a rough idea whether you are insulin resistant, or insulin deficient.

No idea if you doc or consultant would be willing to take that info on board, but it might provide you with the info you need to make an informed decision.

Are you able to explain to me, in simple terms, the difference between a fasting insulin test and a c peptide test to discover your natural insulin levels. I have an incomplete pancreas and was told by an Endo that my natural insulin levels will dry up eventually. So far so good on LC. TIA.
Apologies to @seanj67 if derailing your thread.

 

[Brunneria]

Are you able to explain to me, in simple terms, the difference between a fasting insulin test and a c peptide test to discover your natural insulin levels. I have an incomplete pancreas and was told by an Endo that my natural insulin levels will dry up eventually. So far so good on LC. TIA.
Apologies to @seanj67 if derailing your thread.

Nope, sorry. I have never done the reading necessary to know the details of the different tests - except that one measures insulin, and the other measures c peptide.

 

[bulkbiker]

Are you able to explain to me, in simple terms, the difference between a fasting insulin test and a c peptide test to discover your natural insulin levels. I have an incomplete pancreas and was told by an Endo that my natural insulin levels will dry up eventually. So far so good on LC. TIA.
Apologies to @seanj67 if derailing your thread.

https://www.diabetes.co.uk/c-peptide-test.html
Thats what a c-peptide measures.

Fasting insulin will (like a finger prick blood sugar measure) let you know what insulin is in your blood at a specific time.

If your Endo believes that over time your endogenous insulin production will diminish then surely it would make sense for you to have these tests so the progression (or not of course) of the reduction in production can be monitored..?

 

[PenguinMum]

https://www.diabetes.co.uk/c-peptide-test.html
Thats what a c-peptide measures.

Fasting insulin will (like a finger prick blood sugar measure) let you know what insulin is in your blood at a specific time.

If your Endo believes that over time your endogenous insulin production will diminish then surely it would make sense for you to have these tests so the progression (or not of course) of the reduction in production can be monitored..?

Thanks so the fasting blood test is basically what I monitor every day. I do LC <30g and up to now my HBA1cs have been outside pre D. I told the Endo I willl continue to follow my plan for as long as I can stay non D.

 

[Brunneria]

Thanks so the fasting blood test is basically what I monitor every day. I do LC <30g and up to now my HBA1cs have been outside pre D. I told the Endo I willl continue to follow my plan for as long as I can stay non D.

fasting bg tests test for glucose levels, not insulin levels.
To get an insulin level test (fasting or not), you send the sample to a lab.

 

[Alexandra100]

You can get very reasonably priced private Fasting Insulin Tests (or Any Other Time Insulin Tests, depending on when you take the blood sample) from several companies including Medichecks and Thriva.

The result of the test would inform you how much insulin you have circulating at the time of the test - which you can compare with what you had eaten, and give you a rough idea whether you are insulin resistant, or insulin deficient.

This sounds very useful, but could you explain how a Fasting Insulin Test is different from a Fasting C-Peptide Test, which can be done on the NHS?

 

[Brunneria]

This sounds very useful, but could you explain how a Fasting Insulin Test is different from a Fasting C-Peptide Test, which can be done on the NHS?

Nope, sorry. I have never done the reading necessary to know the details of the different tests - except that one measures insulin, and the other measures c peptide.

fasting bg tests test for glucose levels, not insulin levels.
To get an insulin level test (fasting or not), you send the sample to a lab.

@Alexandra100 ,
an insulin test tests for insulin, and a c-peptide test tests for c-peptide.
If you wish to delve deeper into the subject I suggest that you track down the labs that offer the various tests and read their literature.

 

[Alexandra100]

I feel for you Sean! When you are under a Consultant and a GP you sometimes feel you are betwixt the devil and the deep blue sea. I was under a Consultant for 'high' cholesterol who said STATINS, no argument then saw the Dr who said please yourself basically. This resulted in a letter from the Consultant pretty much saying 'Go away if you're not going to do what I say'. Fine by me but I do worry about being seen as a rebel sometimes. x

Reading these accounts of would-be tyrannical Consultants and more open-minded GPs brings to mind the advice very frequently given by Dr Bernstein in his monthly phone-ins and elsewhere. He says, when you don't agree with your Consultant (or s/he doesn't agree with you) you should seek out a kindly family doctor who will listen to your point of view and give you what you need. Individualised medicine is more and more recommended everywhere. Any medic who persists in wanting to play God is showing him/herself up as way behind the times.

 

[Alexandra100]

@Alexandra100 ,
an insulin test tests for insulin, and a c-peptide test tests for c-peptide.
If you wish to delve deeper into the subject I suggest that you track down the labs that offer the various tests and read their literature.

I thought c-peptide was a marker for insulin?

 

[KK123]

Reading these accounts of would-be tyrannical Consultants and more open-minded GPs brings to mind the advice very frequently given by Dr Bernstein in his monthly phone-ins and elsewhere. He says, when you don't agree with your Consultant (or s/he doesn't agree with you) you should seek out a kindly family doctor who will listen to your point of view and give you what you need. Individualised medicine is more and more recommended everywhere. Any medic who persists in wanting to play God is showing him/herself up as way behind the times.

Hi Alexandra, well that's good advice and maybe it even works in Countries where you pay directly to see a Doctor/Specialist but in the UK I would be surprised if you could 'choose' a Doctor, friendly or otherwise. In my surgery you see who you get and whilst there is sometimes a choice of who you want to see, diabetes wise it's ONE and only one. x

 

[KK123]

I thought c-peptide was a marker for insulin?

Hi, well yes, a C Peptide test is testing for C Peptide but because C Peptide is produced in more or less equal amounts to insulin, they use it to gauge how much insulin you are producing. x

 

[Alexandra100]

Hi Alexandra, well that's good advice and maybe it even works in Countries where you pay directly to see a Doctor/Specialist but in the UK I would be surprised if you could 'choose' a Doctor, friendly or otherwise. In my surgery you see who you get and whilst there is sometimes a choice of who you want to see, diabetes wise it's ONE and only one. x

I suppose if your GP is really awful, and if there are other practices in the area who accept new patients, you could transfer? But it might be out of the frying pan ... In my case, I go to a large group practice and I make the effort to see the two I consider at least approachable (very kind but clueless about diabetes). It is possible from time to time to book online with the Dr of one's choice, though one may have to stay up late / get up early to grab an appointment as they are posted.