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Did they get it wrong?

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KarenGG

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In March I was in hospital with DKA and sepsis, I was sent home on Metformin. My waking BS is never under 10 and goes up as high s 18 despite a low carb diet of as close as 20g I can
In March my HBa1c was 7.2% 55.2mmol
Over last few weeks they have tried increasing my Metformin to 2 tablets twice a day which has made no difference to my BS but a repeat HBa1c done yesterday is 5.2% 33.3mmol which was done because I needed another blood test.
The doctor is ringing Thursday but I’m very confused, before going into hospital in March I had no sign of diabetes and they say it’s related to steroids and kidney problems. Could the Metformin be working despite not changing my daily BS’s (they were expecting to discharge me on insulin but decided to try Metformin first)
I am confused!
 
Steroids can actually cause diabetes. I am weaning off steroids, but I still need insulin to control it. It's a real pain. I went keto when I was diagnosed, stayed keto when I had to go on steroids (for another condition). I don't have kidney problems. See Dr Jason Fung Youtube videos, he is a nephrologist. You might find something that helps. We also have a subforum for Diabetes T3c, steroids induced diabetes.
 
KarenGG said:
In March I was in hospital with DKA and sepsis, I was sent home on Metformin. My waking BS is never under 10 and goes up as high s 18 despite a low carb diet of as close as 20g I can
In March my HBa1c was 7.2% 55.2mmol
Over last few weeks they have tried increasing my Metformin to 2 tablets twice a day which has made no difference to my BS but a repeat HBa1c done yesterday is 5.2% 33.3mmol which was done because I needed another blood test.
The doctor is ringing Thursday but I’m very confused, before going into hospital in March I had no sign of diabetes and they say it’s related to steroids and kidney problems. Could the Metformin be working despite not changing my daily BS’s (they were expecting to discharge me on insulin but decided to try Metformin first)
I am confused!
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What the level like the rest of the day? Before and after meals? High morning readings can be due to dawn phenomenon but 18 is pretty significant. Unless it’s amazingly good and the high drops very quickly after testing I’m surprised at the hb1ac being that low alongside those kind of numbers. Any reasons to suspect the hb1ac isn’t accurate, eg anaemia or other red blood cells conditions or a few other issues? Or any reasons to suspect the strips or meter could be faulty?
Metformin isn’t very strong and there’s a lot of options between it and insulin for type 2. Type 3 might well need other approaches such a Insulin if the problem is Increasing.
 
I’d be questioning the accuracy of the hb1ac in that case, taking the daily numbers to the dr, asking if any of my other conditions or medications could be making it inaccurate (there are alternative tests they can use) and asking for c-peptide to see what ability my body still had to produce insulin for itself. Do you have the means to test ketones? I’m sure one dka is enough and if numbers are rapidly rising it would be wise to keep a close eye on both.
 
KarenGG said:
I will be lifelong on steroids sadly, it’s not an option
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How much are you taking and what is it?

I think you will find that is the cause of your high numbers, but still worth knowing what your c-peptide is. Over time steriods can decrease the production of insulin. I'm also on them for life.
 
I’m always on a minimum of 10mg of prednisone but can have to take 60mg, I have a skin condition called pyoderma gangrenosum which is an autoimmune disease causing large ulcer like wounds and is life long, I have only been on 10mg since this ‘diabetes’ started. I am also always anemic and have very low vitamin D levels for which I have vit D Injections (I also have MS)
 
In the end, HbA1c is an indirect measurement that is not much more than an indicator of average blood glucose, but if you already have lots of actual data showing that your blood glucose control is poor, then the HbA1c may as well be discarded as erroneous, irrespective of the reasons for it being so.

Fructosamine may be a better test if HbA1c is suspected to be inaccurate but, again, it's already plain to see that your actual glucose control is wayward.
 
Hi. The NHS puts too much faith in Metformin. It's a very safe drug and helps a bit in various ways but it only ever improves BS by a little. Insulin would almost certainly help if needed but as others have said there are other tablets in between that could help. Yes it would be worth asking for a C-Peptide test to gauge what your own insulin output is
 
HSSS said:
I’d be questioning the accuracy of the hb1ac in that case, taking the daily numbers to the dr, asking if any of my other conditions or medications could be making it inaccurate (there are alternative tests they can use) and asking for c-peptide to see what ability my body still had to produce insulin for itself. Do you have the means to test ketones? I’m sure one dka is enough and if numbers are rapidly rising it would be wise to keep a close eye on both.
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I do, but I’m told only to check if BS over 20mmol, I’m hoping to get some clearer information on Thursday
 
You really don't want your Bg's over 20 mmol, besides how are you to know what your BG levels are without checking? I suggest first thing in the morning, that's your fasting level, before you eat and 3 hours after you eat to see if your BG level is dropping back down.

Not only can steroids cause diabetes, but even if they don't they will cause your BG level to be higher and some people are more affected than others. It doesn't really matter if steroids are causing it, if you have to stay on them damage is being done when you have too high of BG levels all the time.

So make a good chart of your BG levels for at least a week and take them into the doctor to show them.
 
An hba1c of 5.2 would mean an average blood glucose reading of about 5.8.. you could be testing at the wrong times so not seeing lower reading only seeing high ones

Or there could be something wrong with the second hba1c

Ask the gp when he phones
 
KarenGG said:
I will be lifelong on steroids sadly, it’s not an option
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Like many others you have to consider other health problems when deciding on your safest treatments. Many of us juggle other meds for other just as pressing health conditions. I use food as well tablets and Insulin to control my diabetes. It's not a bad as it sounds on good days. Bad days? ... I do my best.
That is all anyone would expect from you. Also what you should allow yourself too. I often dream of just having diabetes or less. I have to exercise acceptance for some of my health status but not something I'm happy to do eternally. Medicine is a science and a very progressive one. :) :) :)
 
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