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Going to see consultant this week...

linda321

linda321

Well-Known Member
Messages
118
Location
West Sussex, UK
Type of diabetes
Type 1
Treatment type
Insulin
I was diagnosed with diabetes back in July and treated as type 2 to start with. Despite glycoside, metformin and sitagliptin, my BS stayed high so I've been on insulin for the past 2 months. My insulin is Novomix30 and I am only injecting a small amount twice a day - at the moment 6 units in the morning, 8 at night. I have never been obese (overweight yes!) and exercise a lot (gym 4 times per week) so was very surprised at the type 2 diagnosis. I have an appointment with the consultant on Thursday hopefully to get a diagnosis either way, either LADA or type 2.

MY BS are still all over the place ranging from highs of 17 to lows of 2.7! Perhaps I am still in the honeymoon phase? I am worried that BS is still mostly over 7, and what the implications of that are for the future.

My question is what can I expect from the consultant? I am guessing that I will need another blood test which I don't think they will have done - I did have hb1ac and all the others last week. Are there any questions you would recommend I ask?
 
Hi there, and welcome to the forum, especially this little LADAs section. You'll find lots of help here.

In a way, diagnosis might not make much difference if you're already insulin-dependent, and it sounds as if you are. But of course you want to know. In which case, it's the antibody or GAD test which will show if you are LADA. You might need to push hard for it, as it's expensive and GPs can be reluctant. You certainly sound like a LADA, Linda.

But more important, you don't want to swing between lows and highs like that. Such low lows suggest to me that the basal component is too high. Have you considered coming off pre-mixed and going onto full basal/bolus? If you can get the basal dose right (Jack will advise you) and also get your carbs level down a bit, to say 100 or 70g per day (I and many others are on 30g/day but it doesn't suit everyone), then you'll be able to lower both bolus and basal. Which is much better for you and means fewer spikes and better control.

I would buy Gary Scheiner's book, Think Like a Pancreas.

Good luck, and don't worry, you'll certainly be able to get better control with a little effort and experimentation. Then you'll feel much better too. Highs and lows make you feel awful.

Oh, and the third component to good control is exercise. Really important. Poke around on here and see what people recommend.

Good luck.
 
Good advice from Lucy, a basal/bolus insulin regime would be better and should give you a greater flexibility over your bg control, ask the consultant if you can change over.
 
Think like a pancreas - helped me a lot in my early
insulin using days .
Easy to read and grasp .
I still refer back to it - when hit a blip kind of thing .

Maybe take your BG ranges along to show your consultant.
Read up on basal background insulin and ask your consultant about them .
Explain your concerns to the consultant and ask to reach a
positive way forward for yourself .
 
Hi Linda
Welcome to the forum and especially the lada section. As Lucy says, you will need a GAD test to establish if you are T2 or T1 / LADA (mine took 3 weeks before I had the results back).

You don't say what diet you are on. Many of us find a very low carb (no bread, no potatoes, no rice, no pasta etc) helps a great deal. I was giagnosed a year back and I am on a very low carb diet and because of this I am not on any meds or insulin.... Still in the honeymoon period. There is a lot to learn. Have a read on the previous LADA forum posts here.
Unfortunately I learned very little from the NHS specialists, getting all my knowledge from others on this forum.

Keep reading, then read more.
 
Thank you! I thought that the basal/bolus regime might suit me better and you have all confirmed this. I'll definately ask about that. I will order the book straight away! I have been lurking on the forum for a while and have read quite a bit.

Re diet, I am not sure whether very low carb is for me, I think I'd rather go the low GI route. But I have tried to cut down, and am probably at 100g per day generally.

It's not easy is it?
 
No it isn't, and it's a pain. REALLY feeling that tonight. I'd just say about the low GI plan, that used to sound attractive to me too in the days before I knew I was diabetic (only four months ago, ha!). Since reading Dr Bernstein though - Dr Bernstein's Diabetic Solution, the other book you should probably read - I think it probably just isn't enough. Unfortunately it's certainly true for me that a low-GI carb is just as much a carb as a high-GI one. The only carbs I can eat are those that aren't starches, full stop. Green veggies (which luckily I love), salad. And that's it. Even brown rice is still starch and so just too much carb.

But don't be put off by me feeling sour. Read and read. Bernstein I think while excessively exacting has it absolutely right. Carbs limitation is the way to sanity ...

After a bit, it will all fall into place and then hopefully retreat to being a background thing in your life. And 100g carb is a very good place to start. Measure and note it all down and then look at your results.
 
Hi Linda!

Ian and Lucy are spot on with their advice. You certainly look likely to be a misdiagnosed LADA - many of us were originally misdiagnosed as Type 2. In addition to the GAD test, you could ask for a c-peptide test - this indicates the amount of insulin you are still producing - Type 2s are often producing a lot but unable to use it, while LADAs are usually producing insufficient insulin and need to either require less (low carb diet) or supplement (injected insulin) or a mixture of both. They'll probably refuse this test on grounds of cost, but worth asking.

As Lucy says, for most of us with LADA a carb is a carb - brown, white no matter - it shoots BG high. I'm using a new testing system at the moment and am pretty shocked what two ryvitas did to me yesterday even with what should have been sufficient rapid-acting insulin. Anyway, just thought I'd say 'Hi'.

Smidge
 
Guys, This fantastic video was just posted over on the T1 forum. Have you seen it? Linda, this is just the bestest statement of the lo-carb case - Which, of course, is just one option open to you, but IMHO will keep you happy and healthy for years to come.

I'm going to be sending this to people all over the shop ...

Lucy

Oops: clever, forgot the link. Here it is:

https://www.youtube.com/embed/TR8rc_AF6XU?feature=oembed
 
Oh and Linda, have a look at Jenny Ruhl's nutritional calculator. It helped me hugely by giving some ballpark figures of how much fat/protein to aim for if you cut carbs, depending on how far you cut them. And 100g/day is a great start.

http://www.phlaunt.com/lowcarb/DietMakeupCalc.php.

For example, I'm on 30g/day carb, which is about 5% of my total energy/calorie intake. My quotas are 15% protein, and 80% (yes 80%) fat. I have to work quite hard to eat that much fat. Has to be stuff you like.

That's an example.

And as I keep saying, I really recommend Jenny Ruhl's book on lo-carbing. Very balanced, utterly realistic, not proselytising.

http://www.amazon.co.uk/gp/aw/d/0964711656/ref=mp_s_a_1_1?qid=1414495054&sr=8-1&pi=SY200_QL40
 
Linda, I use a Med style diet (lots of fresh produce/ smaller portions of meat/some oily fish/olive oil choosing starchy carbs/fruits from lower GI examples. (legumes, new potatoes, basmati rice, small portions of wholegrain pasta)
I basically use the idea that half my plate is veg, 1/4 'protein', 1/4 starch + some dairy and fruit each day.
My HbA1c hasn't been higher than 6% in 9 years, it is quite usually about 5.8%.
I am lucky enough to have an insulin pump but my glucose levels were in general fine on MDI ( I just was doing a lot of exercise and my doctor considered that being able to reduce basal insulin for those time would prove useful; she was right; but I'm not in the UK so may not have got it there)
I
 
Just getting my stuff together to go to the doctor's appointment this afternoon. I'll let you know how it goes.

Thanks for the links Lucy! Yes that Australian doctor talking about low carbs is brilliant! I've looked at the Jenny Ruhles site too. There's a lot of info there so will take some time to absorb it all!

Phoenix, I like the idea of your med style diet. I read about that in another diabetes book I bought. I do love my fruit and vegetables!
 
OK I am back home now. As expected, some good news, some not so good news!

I am pleased that my Hb1Ac has come down from 13.1 to 9.5. Obviously still some way to go, but it has come down by quite a bit already, which I didn't expect.

I asked the doctor if I could stop taking Metformin, as I think it makes me nauseous. Dr agreed to this and thought it probably wasn't doing much anyway. (Although I have just read the thread 'Type 1 and metformin' and wonder if I should carry on with it?)

They have agreed to do a C-peptide test! I need to wait a couple of weeks as they are retesting liver function.cholesterol etc as well and I have only just had this done.

Doctor was not keen for me to go on basal/bolus as it is more complicated. This was a surprise as I thought they would want me to change regime. In a way I am happy to keep with my mixed 2x per day regime as it is simpler and doesn't involve counting carbs. We are off on a big holiday to New Zealand in the new year and I think this mixed regime might be easier to cope with while I am away. So I didn't push for a change just yet.

My cholesterol is borderline so they will do a full cholesterol check. Possibility of having to take statins! Not so keen about that.

Thanks again for all your help. I shall keep reading this forum and the links you have provided.
 
Hey Linda! Well, you made some progress and that's a start! Great result in getting the c-peptide test sorted - this will give you a baseline as to what your body is doing. If it turns out you're at the bottom end of the range or below, push really hard for a GAD test. The mixed insulin is probably best while you're away, but you'll probably want to change to the more flexible basal/bolus when you have the time to deal with it. Keep pushing them and don't let them sign you off back to your GP - you have a right to know what you're dealing with!

Smidge
 
As above; and test and record, and make sure that when you are ready for a more flexible regime, you don't let your consultant's low expectations stop you doing what you want. Good luck.
 
LucySW said:
Guys, This fantastic video was just posted over on the T1 forum. Have you seen it? Linda, this is just the bestest statement of the lo-carb case - Which, of course, is just one option open to you, but IMHO will keep you happy and healthy for years to come.

I'm going to be sending this to people all over the shop ...

Lucy

Oops: clever, forgot the link. Here it is:

https://www.youtube.com/embed/TR8rc_AF6XU?feature=oembed
Click to expand...
Sorry if i am been dumb but what does IMHO stand for and is LCHF low carb high fat. Think i have been misdianosed as T2 not LADA because have cut carbs down and low starch foods. Also have metabolic based genetic disorder.
Any ideas
Loulou

Sent from the Diabetes Forum App
 
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