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First appt with diabetes nurse, what to ask?

A

Ali2020

Active Member
Messages
26
Type of diabetes
LADA
Treatment type
Insulin
Diagnosed in Feb with Hba1c of 87, age 60, weight 9st 5 lb, Prescribed Metformin and told to check this website. I decided to try changing diet and increasing exercise this led to Hba1c 3 months later of 46.
Stable until 1st October. Got virus cough, achy, headache etc. Not Covid.
Now blood sugars start day at 16 and end up to 23, despite reduced appetite and weight falling off me.
I have managed to organise an appointment with our specialist diabetic nurse tomorrow at 9am, but what do I need to ask? are there tests which could help with accurate diagnosis at this moment in time? any suggestions as want to make the best use of this appointment time. Many thanks
 
Ali2020 said:
Now blood sugars start day at 16 and end up to 23, despite reduced appetite and weight falling off me.
I have managed to organise an appointment with our specialist diabetic nurse tomorrow at 9am, but what do I need to ask? are there tests which could help with accurate diagnosis at this moment in time? any suggestions as want to make the best use of this appointment time. Many thanks
Click to expand...

I suspect that the nurse will tell you that viruses (viri?) put up blood sugars, and they will go down when you recover, but weight loss and high blood sugars are also indicative of T1/LADA diabetes, so I'd ask her if this is a possibility. Many LADA folk get an initial misdiagnosis of T2, and can hold their illness in remission for a while by low carbing, because reducing carbs reduces your need for insulin down to a level your body can cope with.

Tests : she should test for ketones then and there, because DKA (diabetic ketoacidosis) is deadly without insulin, and if you have significant levels of ketones you need insulin now.
Cpeptide and GAD antibody tests will tell you whether your insulin production is low and whether you have antibodies that indicate your body is destroying your insulin producing cells. Ask for them, remind your DN that people can get LADA at any age (eg Theresa May) and you don't want to get DKA as a result of this missed diagnosis.

Good luck.
 
Hi. I agree that I would be suspicious of LADA. I've been down the same route at age 60. The nurse may not agree as many GPs and DNs don't understand Late onset T1. You need to say you suspect you may be late onset T1 and would like the two tests for it (GAD and C-Peptide). If this is refused ask what action they will be taking. I had to suggest to my Diabetes specialist GP that he added Gliclazide which will delay going onto insulin which he agreed to. So, be prepared for a bit of an impasse but make sure you get them to add more meds and do the T1 tests if you can. Make sure you are having a low-carb diet (not low-calorie) so you can show your diet is right. Note that once your BS goes into the 20s they do need to take it seriously and if it goes much higher you need to start checking for ketones.
 
EllieM said:
I suspect that the nurse will tell you that viruses (viri?) put up blood sugars, and they will go down when you recover, but weight loss and high blood sugars are also indicative of T1/LADA diabetes, so I'd ask her if this is a possibility. Many LADA folk get an initial misdiagnosis of T2, and can hold their illness in remission for a while by low carbing, because reducing carbs reduces your need for insulin down to a level your body can cope with.

Tests : she should test for ketones then and there, because DKA (diabetic ketoacidosis) is deadly without insulin, and if you have significant levels of ketones you need insulin now.
Cpeptide and GAD antibody tests will tell you whether your insulin production is low and whether you have antibodies that indicate your body is destroying your insulin producing cells. Ask for them, remind your DN that people can get LADA at any age (eg Theresa May) and you don't want to get DKA as a result of this missed diagnosis.

Good luck.
Click to expand...
Thank you so much. This is just what I needed.
 
Daibell said:
Hi. I agree that I would be suspicious of LADA. I've been down the same route at age 60. The nurse may not agree as many GPs and DNs don't understand Late onset T1. You need to say you suspect you may be late onset T1 and would like the two tests for it (GAD and C-Peptide). If this is refused ask what action they will be taking. I had to suggest to my Diabetes specialist GP that he added Gliclazide which will delay going onto insulin which he agreed to. So, be prepared for a bit of an impasse but make sure you get them to add more meds and do the T1 tests if you can. Make sure you are having a low-carb diet (not low-calorie) so you can show your diet is right. Note that once your BS goes into the 20s they do need to take it seriously and if it goes much higher you need to start checking for ketones.
Click to expand...
Thank you so much this is just what I needed
 
EllieM said:
I suspect that the nurse will tell you that viruses (viri?) put up blood sugars, and they will go down when you recover, but weight loss and high blood sugars are also indicative of T1/LADA diabetes, so I'd ask her if this is a possibility. Many LADA folk get an initial misdiagnosis of T2, and can hold their illness in remission for a while by low carbing, because reducing carbs reduces your need for insulin down to a level your body can cope with.

Tests : she should test for ketones then and there, because DKA (diabetic ketoacidosis) is deadly without insulin, and if you have significant levels of ketones you need insulin now.
Cpeptide and GAD antibody tests will tell you whether your insulin production is low and whether you have antibodies that indicate your body is destroying your insulin producing cells. Ask for them, remind your DN that people can get LADA at any age (eg Theresa May) and you don't want to get DKA as a result of this missed diagnosis.

Good luck.
Click to expand...
 
[QUOTE="Ali2020, post: 2318352, member:


Thank you for your helpful comments and suggestions. I had a very helpful visit to the diabetic nurse specialist. She is organising both GAD and C peptide tests And gave helpful advice as well. I am feeling very thankful.

Sent from my iPhone
 
Daibell said:
Hi. I agree that I would be suspicious of LADA. I've been down the same route at age 60. The nurse may not agree as many GPs and DNs don't understand Late onset T1. You need to say you suspect you may be late onset T1 and would like the two tests for it (GAD and C-Peptide). If this is refused ask what action they will be taking. I had to suggest to my Diabetes specialist GP that he added Gliclazide which will delay going onto insulin which he agreed to. So, be prepared for a bit of an impasse but make sure you get them to add more meds and do the T1 tests if you can. Make sure you are having a low
Ali2020 said:
[QUOTE="Ali2020, post: 2318352, member:


Thank you for your helpful comments and suggestions. I had a very helpful visit to the diabetic nurse specialist. She is organising both GAD and C peptide tests And gave helpful advice as well. I am feeling very thankful.

Sent from my iPhone
Click to expand...
ps it was her who suggested the tests!
Click to expand...
 
Daibell said:
Hi. I agree that I would be suspicious of LADA. I've been down the same route at age 60. The nurse may not agree as many GPs and DNs don't understand Late onset T1. You need to say you suspect you may be late onset T1 and would like the two tests for it (GAD and C-Peptide). If this is refused ask what action they will be taking. I had to suggest to my Diabetes specialist GP that he added Gliclazide which will delay going onto insulin which he agreed to. So, be prepared for a bit of an impasse but make sure you get them to add more meds and do the T1 tests if you can. Make sure you are having a low
Ali2020 said:
Ali2020 said:
[QUOTE="Ali2020, post: 2318352, member:


Thank you for your helpful comments and suggestions. I had a very helpful visit to the diabetic nurse specialist. She is organising both GAD and C peptide tests And gave helpful advice as well. I am feeling very thankful.

Sent from my iPhone
Click to expand...
was the nurse who suggested the tests too!
Click to expand...
Click to expand...
 
Hi. I ended up in hospital, referred to A&E by diabetes specialist nurse who told me to let her know if blood sugars over 20 and with ketones. They suspect type 1 diabetes. Various tests done and awaiting results; C peptide, GAD and general stuff too. Now on Lantus 10units daily and Novorapid 2 units 3x pre meal. Blood sugars 4.7 - 13 ( except once 17 after pizza! ) Just been on dog walk. Blood sugar 10.3 before walk. 80 minutes beach walk and 3.7 when back in car! Jelly babies and half oat bar now eaten. It’s all a learning curve! Thanks for your support
 
Ali2020 said:
Hi. I ended up in hospital, referred to A&E by diabetes specialist nurse who told me to let her know if blood sugars over 20 and with ketones. They suspect type 1 diabetes. Various tests done and awaiting results; C peptide, GAD and general stuff too. Now on Lantus 10units daily and Novorapid 2 units 3x pre meal. Blood sugars 4.7 - 13 ( except once 17 after pizza! ) Just been on dog walk. Blood sugar 10.3 before walk. 80 minutes beach walk and 3.7 when back in car! Jelly babies and half oat bar now eaten. It’s all a learning curve! Thanks for your support
Click to expand...
 

SO glad you came onto this site and was able to get some great advice, so many people would have been fobbed off as 'type 2' and then gone onto become dangerously ill. x
 
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