High blood sugar

baccus6996 said:

My partner is type 2 diabetic and, with a sensible low carb diet, has the diabetes under control. In October 2021 HbA1c 41 on just metformin and diet. This rose to 52 in Jan 2022, probably with excesses over Christmas. The GP gave her some Glic to bring it down and Feb 2023 it was back to 45. I am getting worried as the average readings on her metre are now: 7 day average 19.6 mmol/l, 14 day average 17.8, 30 day average 15.9. The Glic had been causing problems and so, on 27 July, she was taken off the Glic and given dapagliflozin. Since taking it, she has lost 8 kgs. However, this morning she had a reading of 30mmol/l and, as can be seen above, the 7 day average is almost 20. She has another blood test booked for next week but these readings are really worrying and we can't seem to get an appointment at the surgery before 7th Sept

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First thing's first: What do you call a "sensible low carb diet"? Be as specific as possible, please? Just checking, because sometimes people think they're low carbing when they're decidedly not, so it's something to rule out. With that out of the way, seeing a 30 is, well... Concerning. Did she wash her hands and do a re-check, to make sure it wasn't contamination, and were the test-strips in date? Has she recently had C19, which can influence blood sugars for a good long while after the initial infection? If there something else going on, like different meds (statins, steroids) or an infection of some kind, all of which can up blood sugars?

Because if you can rule every other cause for a steep rise out, there is a chance she was misdiagnosed and is a T1 variant rather than T2. (It happens more often than you'd think). If she hits 20's and up again, try calling 111 for advice, see what they say. And if there is no possible way food, medication or illness could be the culprit, maybe contact the surgery again and ask for a referral to an endo, quoting the high numbers and letting them know you want a C-peptide and GAD test done to check for a different type of diabetes. It happens. And it's something that needs to be addressed sooner rather than later, if it is the case. But for now, let's check the diet and see whether there's tweaking possible there.

Good luck!
Jo

baccus6996 said:

My partner is type 2 diabetic and, with a sensible low carb diet, has the diabetes under control. In October 2021 HbA1c 41 on just metformin and diet. This rose to 52 in Jan 2022, probably with excesses over Christmas. The GP gave her some Glic to bring it down and Feb 2023 it was back to 45. I am getting worried as the average readings on her metre are now: 7 day average 19.6 mmol/l, 14 day average 17.8, 30 day average 15.9. The Glic had been causing problems and so, on 27 July, she was taken off the Glic and given dapagliflozin. Since taking it, she has lost 8 kgs. However, this morning she had a reading of 30mmol/l and, as can be seen above, the 7 day average is almost 20. She has another blood test booked for next week but these readings are really worrying and we can't seem to get an appointment at the surgery before 7th Sept

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Those numbers are too high and if it were me I would ask for emergency appointment with the surgery, failing that ring 111 don’t take no for an answer or just turn up at A&E. There may be a rational reason like illness or infection brewing but your wife needs to be checked by a medical professional asap.

Definitely get medical advice today, and mention your wife is on Dapagliflozin, as this can cause Diabetic Keto acidosis (DKA)

Diabetic ketoacidosis (DKA)
DKA is what happens when your body starts to run low on insulin and harmful substances, called ketones, build up in the body. Signs of DKA can include:

feeling or being sick
feeing very thirsty
feeling confused or unusually tired
having stomach pain
breath that smells fruity (like pear drop sweets, or nail varnish)
breathing more deeply or faster
Symptoms usually develop over 24 hours, but can come on faster. Your doctor will show you how to monitor your ketone and blood sugar levels, and what to do if this happens. You'll learn how to recognise the symptoms of DKA and what to do about it.

baccus6996 said:

Thanks guys. No she has not had covid since last year and only had a very mild infection. She also had a covid booster shot back in April. I control the diet and generally try to keep it between 50 and 100gms of carbs a day. It is usually closer to the 50gms. This has been the same for the last 4 - 5 years which is why I am now worried. I have now managed to get a telephone emergency consult with the local out of hours GP tomorrow morning who may then ask us to go in for a face to face. Incidentally, as a matter of interest, she had been on methotrexate for severe arthritic pain and was on the maximum allowable dosage. Since, 5 years ago, when I took control of the diet and restricted the carbs, she is now off that awful drug altogether and her inflammation markers are now back in the normal range

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I wouldn't be able to get away with 50 to 100grams of carbs a day... Tend to hover between 0 and 40 myself. That does mean there's room for improvement, but still... A more specific list of foods eaten would help, just in case there was a miscalculation somewhere. https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html might help some in bringing the number down further for the moment, as you wait to be seen. But even with 100g of carbs a day, 30 is very, very high. So do get additional testing done, (GAD and c-pep) and do not ever hesitate to call 111 when you see such high numbers. Better to call ten times for naught, than one time too few. Diabetic ketoacidosis is a possibility, as is a T1 variant, so...

...In any case... I wouldn't wait and see until September. Really. Don't.

baccus6996 said:

We have all sorts of salad, mushrooms, chicken, the occasional steak or lamb chop, wholemeal pasta mixed with zucchini noodles, Occasional sour dough brown bread. Occasional basmati mixed with konjac rice. vegetable soups, stews, lentils, beans and chickpeas, occasional bacon. fish, prawns, cheese and low carb meal replacement shakes made with whey protein and either fruit ( strawberries, raspberries, blueberries) or vegetables ( carrots but no other root vegetables) and either flax seeds or chia. We do not buy any processed foods and I make everything fresh. Everything has worked well until the last month but yesterday and today's sky high numbers are very unusual as nothing has changed in the diet

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I would ditch, at least until her high numbers are explained and properly treated, the wholemeal pasta, lentils, chickpeas, basmati, and brown bread. The diet looks pretty good to me in general, but those things would spike me and quite a few others here. Not sure the spike would be THAT high though, but as a precaution, just put those on hold. Find out what's happening. Because if she was misdiagnosed and actually a T1, it could be her honeymoon period is ending. (It's when the pancreas hasn't kicked the bucket yet and still puts out some insulin, but not enough. After a while it quits entirely, which could take months or years, but while honeymooning it often gets mistaken for T2, because it still produces insulin. And since tests for T1 are expensive, a lot of assumptions are made based on age). I'm not saying she's a T1/Mody/LADA, but right now that's the only thing you yourselves can do to get numbers down until someone steps in with proper treatment: cut more of the carbs to keep things as safe as you can.

I really hope you'll get help, because waiting until september for help would not be advisable in the least.