Glad I saw a diabetes dietician & she agress my doc is wrong

[Meg2009Arm]

Hi

After struggling with high BG levels after meals which my doc wasn't concerned about because my last three HBA1c's were 7.2 to 6.8 to 6.2 (most recent) I finally made an appointment to see a diabetes dietician at my local hospital (mainly because my husband pushed me to do it after loosing too much weight with a bmi of 17) I'm so glad I went, she basically said I'd been starving myself to try and fit into BG levels that I can't achieve on my medication and for my profile (slim, active type 2 diagnosed in pregnancy with family history of type 2)
She wasn't at all happy with the meds I am on Glucophage and Januvia and said she couldn't understand why I was ever put on januvia and probably should be on Gliclazide. She also said it was fairly inevitable that I'd have to go on insulin at some point. She said I needed to eat more normally (obviously within reason) and demand that my doctor changes my meds because having regular highs of 9 or 10 after pretty small, low carb meals was just not acceptable. Just what I 'd been trying to tell my doc all along and my way of dealing with it has been to keep reducing portion sizes and carbs to try to make it work. She is going to write to my doc to back up what she has said and also told me that if in future I am unhappy with my doctors diabetes care I can get my diabetes care referred to the hospital where they have more specialists.

I didn't feel brave enough to question my doctor but I hope more peole will do so if they feel they need to.

 

[Daibell]

Re: Glad I saw a diabetes dietician & she agress my doc is w

Hi. I'm slightly surprised about the comments on Januvia (Sitagliptin) and Gliclazide. Gliclazide works by stimulating your pancreas to produce more insulin. This can work well if you still have lots of cells left but if not it's a waste of time (my Glic is probably a wate of time). Sitagliptin is a much newer drug and doesn't appear to have many bad effects. It works by increasing the period of time after eating that insulin is produced. Unless you have c-peptide and possibly GAD tests to provide more info it is impossible for any HCP to work out which of the two meds, or both, to prescribe. Sitagliptin removes spikes and doesn't cause hypos. Gliclazide can produce hypos if you pancreas responds to it. I was also told off by my gp for 'starving' myself, but without insulin it's difficult. I guess Gliclazide may be worth a try after discussing with your doc.

 

[Meg2009Arm]

Re: Glad I saw a diabetes dietician & she agress my doc is w

OK Daibell, I'll bare those comments in mind. Thanks.

 

[xyzzy]

Re: Glad I saw a diabetes dietician & she agress my doc is w

Yes it sounds like your GP and the dietician are making conflicting diagnoses. Obviously not a mind reader but I would say your GP seems to maybe think you might be Type 1.5 LADA based on the fact you are not overweight. I think many reasonably informed GP's would do the same thing.

Like Daibell says if you are Type 1.5 or a Type 2 with very little pancreatic function left then Gliclazide will effectively do nothing so you would be throwing away a modern drug that works and helps your levels for one that would do nothing.

The dietician could well be assuming you are a plain Type 2 who has just not eaten enough and has now lost too much weight. This could be a reasonable guess on her part as you've only ever seen her once and she has little experience to make her judgement on. Just because she put her thoughts over forcefully in a hospital environment doesn't necessarily make them correct.

You need to try and persuade your gp to do a c-peptide and / or GAD test to resolve what Type you are as you are at a point where what Type you are will make a lot of difference to your future health. If you get nowhere with your gp I would ask your gp to refer you to the diabetic consultant at the local hospital rather than just a dietician before making any choices.

I think the dieticians comments that regular levels of 9 and 10 will do you no harm are plain wrong and can give you research references and study results to show you why. To me it shows why she is a dietician and not a doctor. I also find it quite strange that a dietician is able to effectively prescribe drugs without a doctors training.

 

[))Denise((]

Re: Glad I saw a diabetes dietician & she agress my doc is w

The only reason I can think that she recommended Gliclazide is that it can cause weight gain and your BMI is low. Just a thought .....

 

[Anonymous]

Re: Glad I saw a diabetes dietician & she agress my doc is w

Hi Meg. I was on all those meds myself for quite some time and I too didn't see any results. I had a GAD and C-peptide test done early 2010 and they discovered why those meds weren't working.... my pancreas doesn't produce enough insulin. So basically these meds are mostly working on your pancreas, your liver, or your neuro signals (januvia).... but if you don't produce enough insulin anyhow they are all useless. I'm not sure whether or not you've been tested recently for state of your pancreas? It was a bit daunting at first being placed on insulin, but the results have been much better.... despite the obstacles I've been dealing with concerning health. Wishing you all the best.

 

[Meg2009Arm]

Re: Glad I saw a diabetes dietician & she agress my doc is w

It's all a bit confusing but I think it is the other way around, that my doc thinks I may just be Type 2 and the dietcian (who has seen me before when i was first diagnosed in pregnancy) wants to allow me to eat a bit more (not without limits) and thinks i may need to adjust my meds to do so. She didn't say she thought I might not be type 2 but she seemed to not agree wth my docs diagnosis. I will ask the doc for a C-Peptide or GAD test. As for the dietician saying it was ok to have highs of 9 or 10 she meant for just a week or two whilst I upped my portion sizes to a better level before I went back to see the doc, I really was eatng far too little before. I told her I had regular highs previously but because my HBa1c was in the 6's my doc thought that was acceptable, I didn't and the dietician agreed with me.
The weird thing is, I've just been eating abit more for 48 hours and none of my levels have gone up in fact seem slightly lower if anything.
Oh yes and the comment about being referred to a dietician at the hospital wasn't quiet right,she meant that I could be reffered to a diabeteic consultant rather then to herself although she is also based at the hospital.
Anyhow I think the overall thing here is I need further investigation to see whether I am type 2 and what meds I need. Thanks everyone for your help, I really do find this forum helpful to bounce ideas off.

 

[xyzzy]

Re: Glad I saw a diabetes dietician & she agress my doc is w

It's all a bit confusing but I think it is the other way around, that my doc thinks I may just be Type 2 and the dietcian (who has seen me before when i was first diagnosed in pregnancy) wants to allow me to eat a bit more (not without limits) and thinks i may need to adjust my meds to do so. She didn't say she thought I might not be type 2 but she seemed to not agree wth my docs diagnosis. I will ask the doc for a C-Peptide or GAD test. As for the dietician saying it was ok to have highs of 9 or 10 she meant for just a week or two whilst I upped my portion sizes to a better level before I went back to see the doc, I really was eatng far too little before. I told her I had regular highs previously but because my HBa1c was in the 6's my doc thought that was acceptable, I didn't and the dietician agreed with me.
The weird thing is, I've just been eating abit more for 48 hours and none of my levels have gone up in fact seem slightly lower if anything.
Oh yes and the comment about being referred to a dietician at the hospital wasn't quiet right,she meant that I could be reffered to a diabeteic consultant rather then to herself although she is also based at the hospital.
Anyhow I think the overall thing here is I need further investigation to see whether I am type 2 and what meds I need. Thanks everyone for your help, I really do find this forum helpful to bounce ideas off.

No problem Meg, take care and let us know how you are getting on.