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GP appt - need advice please

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Maggie75

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Hi everyone,

I've started a new thread for this (don't know if this is the right thing or not?) as I really need some advice after speaking to GP today. My blood sugars have been high over the last 9 days, highest being around 18 and much higher every day than they've ever been since I was diagnosed 5 years ago even with following a low carb diet. Couple of decent readings with a very low carb meal or just not eating anything for a good few hours.
Anyway, I went to see GP today as there were no DN's available, apparently all the nurses in my Dr's practice are on leave so I headed to see GP with a urine sample and my meter readings to show her, I was put on 3 day course of antibiotics last week for potential urine infection, this made no difference to my blood sugars. Urine was tested, she was confident it didn't show ketones, she wanted to check this with a machine but couldn't find one. She was not overly concerned with my readings apart from the super high ones.
I'm currently taking one Sitagliptin 100mg per day, this was changed a couple of months ago from Alogliptin, that's when all the problems started I think. Anyway, the GP today decided to start me on Glicazide 40mg one per day which I told her I do not want to take, I know this can cause hypo's and my body has already reacted violently to diabetes meds including Metformin so I am terrified to take something like this. She says it would possibly just be short term to reduce my blood sugar and she would speak to DN when she's back next week but I really don't want to take this medication, I was so upset today I just haven't stopped crying, I'm completely freaked out by this. She's also put me on another 3 day course of antibiotics for this potential urine infection.
My last HBA1C was 68 which was last month, she sent me for another one today so I should know the results of this in a day or 2. Is that a level where this medication would usually be prescribed? Surely there has to be something else I could try which doesn't cause hypo's?
I feel as though everything I've been doing in the last 5 years (low carb) when I've been able would need to be turned completely around, and I'll be completely honest, my mental health just couldn't take it. I can already feel it slipping. Why have I not taken my diet more seriously and worked harder at this.
Does this seem to anyone else like a knee-jerk reaction from GP, I just do not believe if I'd seen a DN today they would have put me straight onto Glicazide. Sorry for the long and slightly freaked out post, I'm just struggling with this.

Maggie
 
Sorry that your visit didn't go better for you.

Don't have much in way of advice that i think is relevant for the particular meds you've been prescibed. Advice that I can offer is to keep a detailed food diary record.

I paniced with having to inject insulin multiple times a day (t1/lada) fear of hypos (alongside needlephonic). I was started with a relatively low dosage,which was increased fairly slowly. I find that dr's generally start with very low dosages to see how body reacts to something. have been pretty lucky here with honeymoon period (t1/lada) kicking in and was able to decrease meds. Simular experience with some nsaids i take. Taking the new med does not automatically mean it will cause hypo.

To answer your question on guidance here is Nice Guidlines : https://www.nice.org.uk/guidance/ng28/chapter/Recommendations#reviewing-drug-treatments

Did you discuss the current impact issues have with your current mental health side of things at your appt? Some CBT could assist. I got some help for needlephobia and general anxiety/low mood/depression. felt almost completely hopeless when inititally told, actually surrprised myself at able to do what was needed, albeit was a struggle and did delay (still do delay somethings which i really shouldn't).

Blaming yourself should not be doing. Somethings are with out own control and needing a little extra help at times is sometimes a necessity and there is nothing wrong with that. I posted in your other thread couple of links free trial dexcom/libre. Unsure if you've had both of either or those, perhaps they can at least short term basis may help to give you some needed confidence? https://dexcom.com/en-GB/dexcom-one-plus-sample https://www.freestyle.abbott/uk-en/getting-started/sampling.html

sorry for your struggles, wishing you the best
 
40mg of Gliclazide is a very small starting dose (the max dose is 160g) so whilst it’s good to be aware of the possibility of hypos it’s unlikely given your current levels and the dose that it will happen.

Are you aware of the signs of a hypo? It’s good to understand that even if you start to go hypo you will have time to deal with it. Keep your testing kit with you, and also some simple sugar. I find fruit pastilles good as they are easy to carry, two or three are usually enough to lift me out of a hypo.
 
I stopped taking Sitagliptin after a few weeks because it was making my post-meal readings worse, not better. Don't know why that would happen, but it did.

I'm actually going to ask for Gliclazide or some other sulfonylurea, or even a meglitinide, because a side effect (hypos) that allows me to eat sugar doesn't personally scare me. As long as you've always got sugar on hand, and / or eat enough to stop them coming on in the first place, I don't think they're to be feared, especially if the medication is otherwise helping you.
 
agylli said:
The maximum dose of Gliclazide is 320mg not 160mg.
Click to expand...

above quote from https://www.nhs.uk/medicines/gliclazide/how-and-when-to-take-gliclazide/ has different max dosages depending format prescribed.
 
Hi everyone, Thank you for your replies, sorry it's taken me a while to get back, this whole situation has really done a number on my mental health which probably isn't helping things.
I decided not to take the Glicazide until I speak to my DN, it just scares me too much. I still don't have the results from my HBA1C, but did receive a text from my DN today asking me to make an appt to see her as she had spoken to the GP I saw on Monday and was aware she had prescribed me Glicazide. By some minor miracle when I called there was a cancellation to see her tomorrow morning so that's ideal.
Again I will make sure to take a urine sample and my readings for her to look at, if she decides that the Glicazide is appropriate then I will have to rethink this whole situation but I really hope there is something else she can prescribe which does not possibly cause hypo's.
My bloods have continued to be quite high, what I can't understand is how I can have 2 eggs with a slice of wholemeal toast in the morning (total of 18g of carbs) and my readings after 2 hours are over 13 then a few hours later have a 40g of carbs meal and my readings after 2 hours are 11. Just don't get it. Anyway my first reading this morning was 13.1, fasting reading, way too high. I honestly wonder how much my stress is factoring into this, or a possible underlying condition.
I have a gastroscopy scheduled for 29 December and I'm very nervous as to what they're going to find. The pelvic pain I've had over the last 2 days has been off the scale, nothing will shift it. Anyways, thanks again for the replies and advice and I'll keep you posted when I speak to the DN.

Maggie
 
Good luck with your DN tomorrow @Maggie75 . I hope it goes well for you.
I’m going to take a stab at your question about why there is a confusing difference with your carb intake and your blood sugars. Bearing in mind it’s just a possibility.
One of the main drivers in T2 diabetes is insulin resistance. Insulin resistance is the term given when your body does not effectively use its own insulin. Insulin acts like a key to cell doors, this insulin key opens the cell doors allowing blood sugar to enter the cells for energy usage. If we are insulin resistant, the insulin (key) doesn’t work as it should, thus blood sugars are left floating in our blood. ( And Eventually stored as fat)

The level of Insulin resistance fluctuates during the day. Some people can be quite insulin resistant in the mornings only to see this resistance ease off in the afternoon. For others it’s the other way around. Higher insulin resistance in the morning means their blood sugars are lower in the afternoon / evenings than in the mornings. This may be why, confusingly, you can eat a slice of whole grain bread in the morning resulting in higher blood sugars, than when you eat two slices of whole brain bread a few hours later. Just a possibility.
It could be, of course, you are simply more active later on in the day.
Just a couple of possibilities that may explain the contradictory nature of food consumption and blood sugars.
 
Hi Maggie,

I can't help with the Glicazide as I've not taken it but I just wanted to send you a virtual hug. It really isn't easy on the mental health when the figures stay high no matter what you do. I have gone through a few months of not eating much at all because I was just so concerned about my BG shooting up so I know what it feels like. I did start to go a bit dizzy when getting up out of a chair and walking so I've started eating a bit more which no doubt means my BG has gone up a bit.

Hopefully it will all calm down again and be just a blip on your journey, and I hope that your meeting with your DN will go ok. My DN told me the NHS guidelines showed that I should be put on Glicazide when I was first diagnosed but persuaded me to give it four months to see if I could get it down (I was 110) and fortunately it did so I didn't need to take it.

All the very best and I hope everything gets better, but the people on this forum are always there to listen and it's really helped me over the months.
 
Nice and lucky with that cancellation fits in well for you. Hope DN appt tomorrow goes well. Hope your able to discuss impact on mental health with them, if not below hopefully useful.

My last nhs psychologist email signature contains a couple of links maybe worth having a look around see if something perhaps can help a bit?

How to lift your mood

Get advice from other people who have found ways to improve their mood.
www.nhsinform.scot

Anxiety self-help guide

Work through a mental health self-help guide for anxiety that uses cognitive behavioural therapy (CBT).
www.nhsinform.scot

Depression self-help guide | NHS inform

Work through a mental health self-help guide for depression that uses cognitive behavioural therapy (CBT).
www.nhsinform.scot

Hope above maybe useful theres english nhs pages with pretty much same info as well.

I have very little experience using the following page, did look through a little bit, some appear to be extremely simular nhsscot . eg https://www.nhs.uk/every-mind-matters/mental-health-issues/low-mood/

I personally would try focus on one thing at a time, less overwhelming that way. Break problems up as much as possible. Thinking about lots of issues at once is so much harder to deal with than one at a time. Seperating them and then tackling one little bit at a time should help makes things so much easier to manage. Lot easier said than done

Best wishes

edit: corrected spelling
 
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@Maggie75 @Melgar is correct with his stab in the dark. Our levels do fluctuate throughout the day. As a Type one on insulin I need a much bigger ratio of insulin to food in the morning than later in the day. It is very common for us to have different ratios for different meals. From your point of view at lunchtime your body is coping better than it does in the morning. Personally I would ditch the toast and enjoy it later in the day. I could no way cope with porridge for breakfast but can easily enjoy a bowlful in the evening with minimum intervention.
 
hope all goes well this morning

If you have any particular questions/points wish to mention to the DSN could write them down bring with you to the appt cross off as go through list leave a wee space inbetween any would allow you to take a couple of notes. Can be difficult to remember lots info at a time, found this makes it a lot easier, short bullet points.
 
I empathise with you Magggie75

I’m also a ‘Low Carb’ T2D. I’m on Empagliflozin and now Sitagliptin as well, new med.
My HbA1C has risen and been ‘dire betic’ for around 4yrs 6 months. Like you, seems I can barely eat anything carb, which is ridiculous.
I got told by a DN who was not my usual DN that I was uncontrolled diabetic and that I had to change my diet!! I was so cross and upset, she did not know me at all. So, I made an appointment with the consultant endocrinologist I’d seen when I was first diagnosed, to have a review. She was not impressed with that DN and said that I was controlled about 85% of the time!

What annoys me is, these DNs don’t have nutritional qualifications! It is assumed we can do it ourselves!
In fact, we probably know more, and I’m a trained qualified Complementary Health Care therapist of 25+ years.

I too have issues with my mental health due mainly to the ‘Dire betes’ but over the last 7-8 years a lot of other serious health challenges too No idea how you get any reliable qualified assistance with this without needing to pay. My health care has mainly been funded by myself and healthcare insurance, barely any NHS assistance.

A really good DN who was doing DiabeteUK training Course with said he wanted me off Glicazide when I was first diabetic, I don’t think it’s good with Low Carb, you need to check that and not take my word for it please.
 
I like that, "dire betes", very accurate.
 
Hi everyone, Thank you all so much for your support and advice, it really is very much appreciated.
Just a wee update as to what happened to day with the DN, she was very nice, pretty no-nonsense but that's a good thing sometimes. I explained everything that's been happening with my blood sugars, what the GP had said on Monday and explained I really did not want to take Glicazide because of the potential for hypo's and what this was doing to my mental health.
She was very understanding, said she could see how anxious I was (you're going like a battery I believe were her exact words - lol). We went through some various options and she's prescribed me Dapagliflozin 10mg along with my Sitagliptin, I know it comes along with it's own possible side effects but should not cause hypo's and I will give it a good try along with my low carb diet. She also checked for possible ketones and that was 0.3 so she was very happy with that.
Another bit of good news was that my CT scans have come back ok, nothing ominous showing on them so thank goodness for that. Just the gastroscopy to go now for the upper abdomen. I'm still in a lot of pelvic pain, DN has prescribed pessaries to try and help with this, less said about that the better, but if they help I'll try them.
I've taken my first Dapagliflozin this afternoon, ate a large but very low carb meal for dinner, even had some sugar free jelly with berries and cream for dessert, just tested after 2 hours and bloods are 6.7! Big difference, but that super low carb meal has always given me good results so I'll be watching it closely over the next few days. Thanks again for all your replies.

Maggie
 
sounds like your appt went well @Maggie75 new med will take a little bit of time to build up in system.
nice ketone result glad ct scan results ok that must be a huge relief.

Huge bonus to have dsn that get on well with especially if they are compassionate & understanding. hopefully when next see them will be the same one have appt with. Did they perhaps book review for a few months down the line to see how getting on with the new med?
 
Hi again all and thanks for your replies. I will have my next HBA1C in 3 months and go back to see the DN then unless there's any problems with the new medication. I was a bit lightheaded last night but I know that could be for any number of reasons, including going back onto a low carb diet when my body was used to eating total rubbish! I was also up several times during the night for the bathroom, I know this medication will make me pee more but hopefully that calms down a bit, especially during the night. Fasting blood this morning was 8.8, still not great but better than it has been. Thanks again.

Maggie
 
 
Hi Melgar
I’m aware the post to Maggie 75 was in December. I was just scrolling through and found your posts.
I didn’t know about the insulin resistance as my BGs are highest in the morning fasting 7 -9 and drop to sometimes 4.9 in the afternoon. You are absolutely right I can have whole meal toast or shreddies with raisins (for the iron) as I’m prone to anaemia and it drops my mid afternoon.
Is there any more information I can get to explain more about IR? My Hba1c has been 53 for years.
 
Hi BBGrammy - tagging @Melgar so she'll see your question.

For me, I'd recommend starting with something like Dr David Cavan's book "How to Reverse Prediabetes and Type 2 Diabetes". Review available at link below -

Thread '"How to Reverse Type 2 Diabetes and Prediabetes" (2022) Dr David Cavan'

This is an extensively rewritten version of Dr Cavan's 2014 book "Reverse your diabetes - the step by step plan to take control of type 2 diabetes". I don't mean to imply it's just been updated - it has, in most places, but there are several significant alterations. The original book was written when "low-carb" was being widely described a a "fad diet" and without the benefit of the considerable body of research that's been accumulated on restricted carbohydrate diets since then. That at least has thankfully changed.

In particular, the book now identifies and demolishes seven "myths"...
 
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