Diagnosed yesterday, first appointment today - they are a little baffled!

Mrs SLD said:

Hi everyone, thanks for my lovely warm welcome on my first post yesterday after being told my hbA1c was 107 when it was checked due to a ulcer on my toe that was taking a while to heal.

It was a massive shock yesterday and the GP herself said over the phone she was a little baffled. I had a 1.5 hour meeting with the diabetic nurse today who was great, but also a little bit surprised. To give some background:


I feel pragmatic but like my entire life has changed in the space of a few days. Now I am checking my blood several times a day and preparing for drugs etc. I have a delicate relationship with food but I love it so much. I hope I can get to a place where I enjoy it again without so much guilt and worry.

Thanks for having me here

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GP's and DN's still often go from the assumption that all Type 2 diabetics are massively overweight. Ten percent of us, off the top of my head, aren't though. They're slim, even. With PCOS in the mix, insulin sensitivity often just happens... Nothing to little to do with your weight or your habits, really. Just lucky genes.

So, now what? Good on your nurse for giving you a meter in anticipation of the Gliclazide. Good on your GP for holding off on the glic for now. Your numbers are high, but like I told you before, you have different ways to tackle this. Now, this is what you're looking at for the moment: Metformin is a drug that most T2's start out with. It doesn't do much of anything about the glucose/carbs you ingest, but it does tell your liver to not dump as much glucose as it might otherwise do. (It does that, in the morning to give us energy, and when we're ill or stressed). And it increases your sensitivity to your own insulin a smidge. It's not going to "solve" your diabetes on its own, usually. And some people get explosive bowel issues on it, so do make sure you eat before you take it: it's worse when taken on a empty stomach. (IF it happens, eh... It doesn't have to, many people tolerate it just fine!). For normal blood glucose, you'd either have to make a change in your diet -lowering carbs being quite effective- or add something like indeed, gliclazide in. Now, for metformin, you don't get a meter off the NHS, because it doesn't cause hypo's. Gliclazide, however, can. It forces your pancreas to excrete more insulin, but it doesn't take what you eat into account. So whether you're high or low, it's excreting it's little heart out. This is something to consider: T2 is a matter of having so much insulin in your system, your body becomes insensitive to it. Ergo, something pushing even more insulin in an already overflooding body, could, in the long rung, make your insensitivity worse. That'd lead to more medication, insulin jabs etc... Doesn't have to, mind you, but it can. It can also wear out the pancreas, so insulin-output drops (after a period of a good solid amount of years, I'd guesstimate). Which is likely why your GP nixed the gliclazide for the time being, until after the second HbA1c. Gliclazide can cause hypo's, and future issues, but it doesn't have to. Really. Maybe the GP is playing it safe? I don't know. I do know you have choices coming up, and they need to be informed ones, when the time comes.

If you can see your way to changing your diet, you could potentially skip the glic entirely, and maybe even ditch the metformin after a while. (I came off both, over 9 years ago). Now, you mentioned your relationship with food being a delicate one... If you're talking EDs, you wouldn't be the first person here to deal with that, so yeah... Tread carefully. You decide whether you think you can handle a low carb diet in the long term. Mind you, it is NOT a starvation diet, you're not supposed to be hungry on it. But it does mean reducing or cutting an entire food group, basically... Carbs turn to glucose once ingested (the bulk of them anyway), so it's not just sugar that's a problem... So are potatoes, corn, cereal, pasta, rice, bread... Most fruit, save for a couple of berries or a tomato, starfruit maybe, would be off the menu as well. Main things to eat would be consisting of fats and protein, nutrient dense foods so you still get all your vitamins and minerals. Full fat dairy, (greek yog, butter, hard cheeses), eggs, meat, poultry, fish... Above ground and green veg, nuts, olives, extra dark chocolate (85% and up, works for me), would be good. When I cook dinner, I do have a portion of potatoes in the airfryer for my husband, but where he has that, I have a bit of salmon with mayo or lemon juice instead. The veg and meat is the same, otherwise. Not entirely different dinners, just one item swapped. I've found cauliflower and broccoli rice to be very versatile. He might have an ice cream after, in this weather. I have coconut yoghurt with some nuts and coconut shavings in (cow dairy doesn't agree with me, alas, so don't think it's all coconut yog all the way across the board, that's just me!), and a low sugar chocolate sprinkle or cocoa powder. We still mostly eat together, it's just a little different. I usually either skip breakfast or have low carb crackers with ham and cheese, for instance. Lunch might be eggs with bacon and ham, some hard goat's cheese, someting meaty, or just another yog because I don't feel like cooking... Just now I pulled open a tin of tuna, squirted some mayo on and sprinkled some dill, Bob's your uncle. Just to name a few examples.

If a low carb diet is of interest, maybe this'll be a help: https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html But, again, you have options. For some people, a very low carb/keto diets just isn't in the cards, but maybe they can do moderately low carb with metformin thrown in... Others can't do low carb at all, for whatever reason, and just go with medication. And then there's people who'll need insulin. Whatever the case, there's no real way to get it wrong, as what works for one, isn't suitable for the other. Try to decide what would work well for you, potentially, and use that meter you've got to see whether you like the results. Log your food -unless that's triggering of course- and test around your meals: before you eat, and 2 hours after the first bite. If you see a rise of 2.0 mmol/l or less, your body could beat down any spike the meal gave you, and that meal was perfect and worth repeating. Also, you're going to be high for a bit, most likely, because you're just starting out, and your liver, bless 'em, thinks being high is normal. When your numbers go lower than it is used to, it might release not-so-helpful-but-well-intended glucose into your system. That'll pass when it gets used to lower numbers, it just takes a little while. Also, since you're starting with a HbA1c of 107, when your blood glucose comes down, your vision is likely to change a bit. Don't panic, that's normal! Your eyesight's been distorted by the glucose in your eyeballs and tears, and your brain has been compensating for that distortion for a good long while... It has to learn not to do that anymore. Takes about a week or two, so don't go running to SpecSavers, because by the time the new glasses come in, your perscription is quite useless. Just get yourself some cheap reading glasses at Boots or something. Those should tide you over until your vision goes back to normal.

I know, it's all a lot to take in, but... Even if this all goes over your head right now because it is all too much, this is the only thing you really need to remember: It can get better, and it can get better in a way that works for you, your life, your needs. Okay? Okay.
Jo

Mrs SLD said:

I keep trying to reply in full Jo but getting an error massive thank you for your time and energy and helpful advice

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Quite alright.

Mrs SLD said:

Thank you. What I wanted to post yesterday is to say a huge thanks, but also to say I have been on Metformin before, as part of a fertility pathway. This was 11 years ago and I definitely had the side effects but I suspect I wasn't as sensible back then, I will make sure to take it with food this time.

In terms of Glicazide, the GP has since explained that there is a risk of retinopathy if my sugars are bought down too quickly, hence why she is re evaluating. I had repeat bloods yesterday so just wanting for those results to see what the next step is.

Picked up all my equipment for the meter and the Metformin yesterday and applied fory medical exemption. We travel to Greece in a couple of weeks so hoping that will be a nice chance to rest and get my head around things. I find it much easier to eat well there, lots of meat/fish and fresh veg.

I am so grateful for the NHS in this. Going from tests, diagnosis to treatment in 4 days

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I like your GP. Quite a few don't seem to know that, though with a small dose to start with, it might be a gradual process of bring glucose down anyway, if you end up going that route. Not dropping it like a stone: our bodies don't like that. And yeah. Metformin for PCOS... I never got to that stage, as I didn't want children. Can't take care of myself due to other issues: I have no business putting someone in the world who needs me to do and be things I know I can't provide. But for you, that does mean you've got a little more experience than the average new T2... Keep in mind that back then, I think slow release metformin was relatively new. It certainly wasn't on the Dutch market anyway, the UK was quicker with it. So if you have issues, you can always ask for the SR version, which seems to be kinder on the gut.

Greece.... Yeah... They do make it easier on one to eat well, there. I hope you'll be able to enjoy the trip. Veg, meat and fish.... All ridiculously fresh and extremely tasty. If the metformin gives run-ish side effects, you might want to rely on a low carb diet temporarily while there, as to not ruin your holiday, but do have enough electrolytes, (Salt, magnesium, potassium), to keep from getting dehydrated. Have the Met with you, just in case you need it, but... Make sure you have a good time, not just a delightfully foreign loo-wall to look at for weeks. Enjoy yourself, breathe a little, and get back to good.
Jo

I was thinking Lada too. That was me (45, from normal to prediabetic to hba1c of 80 in a year, slightly overweight when prediabetic so did fast 800 and lost over a stone and hba1c stopped increasing. When i reintroduced a few carbs from November my Hba1c rocketed and i felt dreadful). Hopefully your DR will do the antibodies test soon for you. Consider paying for a cgm. Having that showed that the metformin and gliclazide were having v little effect and I was very high. I got the antibodies test and the type 1 diagnosis relatively quickly (still felt like an age when waiting for the insulin). Hba1c was down to 46 after 3 months of insulin. Good luck. It is a shock. If it turns out to be type 2 then you do get used to low carb diet. If not then insulin allows more freedom to eat in some ways.

Actually you'll be able to get a free trial of a libre cgm. Google for the link