Type 2 In need of some advice slightly confused

Stesmithy83 said:

hi everybody I have been reading the forum for the last few weeks but only just finally decided sign up

I think I should add some background info first

So about a 5 weeks I went to a walk in centre in the uk as I had recently had the stomach flu then regular flu then a double ear infection in a space of 3 weeks where a routine blood pressure test found my blood pressure was ‘sky high’ where then I was reffered to my gp for a emergency appointment I seen my go a hour later were I was perscribed ramipril at the time they also did a blood test and urine test

3 days later I get a phone call from my GP asking me to come in straight away as you could imagine I was a bit concerned at which this point they thought I had diabetes I then did a blood glucose but when the result showed it was 6.1 where then the nurse seemed shocked and said ‘I was expecting it to be in double figures with a blood test result like that’ she then went out of the room then came back and said that my iron In my blood was also extremely low they Said they wanted to redo the blood test then took 3 different blood samples and another urine test They then asked about if i had fatigue, if I used the toilet a lot and if I had lost weight which I had I was 117kg in March and I am now 99kg as of last week

I was also told that if I felt dizzy or start being sick I should go straight to AandE

I also had my 2 year eye test last week when they took a picture of the back of my eye where I was told I should tell my gp that there was a lot of small haemorrhages In the blood vessels in my eye

Tomorrow I am due to have a appointment to discuss my results with my go

So there’s the background just want to ask a few questions

Why would my blood test that I had done originally show as being in ‘double figures’ yet the blood glucose test they did on the day only show as 6.1? Could having a low iron in the blood course this problem? And what could have been the 3 blood samples they took for?

Thank you for reading this look forward to reading the reply’s I just needed to write this down to get it off my chest

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I agree with the poster above that your GP will be able to answer the questions you have better than we can at this point. Don't be afraid to ask any question there, it's your time to find out exactly what each diagnosis you have and what your treatment options are.

I have type 2 diabetes, high blood pressure and at times low iron. Low iron can be caused by different things but in my case it was simple anaemia (quite common in women who have not reached menopause). It was corrected with prescription iron tablets.

High blood pressure should be diagnosed and tested used a 24 hour monitoring test that the doctor or nurse gives you to wear and then return to them. There are other ways to test it, too. When it's sky high they can start you on a drug straight away, as they have. I suggest asking for your blood pressure to be tested every time you go in, and then on a regular basis after it is stablised. They will probably do that anyway but it's good to make sure they are monitoring it - say, at least every 3 months.

Your weight loss has been significant and rapid, which can make a doctor/nurse worried but they are doing the right thing by looking into it. 3-4 major infections can cause rapid weight loss. There might have been some other things going on too, which your doctor will be looking into. I know it's easier said than done but try not to worry, since you will soon find out and be on the road to recovery. If you were in immediate danger they would have sent you to hospital, I think.

Welcome to the forum and please let us know how you get on.

Hi. Having low iron can affect the HBA1C as it relies on the state of the blood's haemoglobin. You need to discuss options with the GP as well as resolving what is causing low iron

@Stesmithy83

Hello and welcome to the Forum Here is the Basic Information we give to new members and I hope you will find it useful. Ask as many questions as you want and someone will be able to help.


BASIC INFORMATION FOR NEW MEMBERS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 235,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes.

Over 145,000 people have taken part in the Low Carb Program - a 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic.

Note: This post has been edited from Sue/Ken's post to include up to date information.
Take part in Diabetes.co.uk digital education programs and improve your understanding. Most of these are free.

• Low Carb Program - it's made front-page news of the New Scientist and The Times. Developed with 20,000 people with type 2 diabetes; 96% of people who take part recommend it... find out why
  
  
• Hypo Program - improve your understanding of hypos. There's a version for people with diabetes, parents/guardians of children with type 1, children with type 1 diabetes, teachers and HCPs.
  

Hi and welcome!

When you get that call from the docs, make sure you have a pen and paper with you.
And WRITE DOWN ALL THE NUMBERS THEY QUOTE.
This will come in useful, because our memories are very bad at little details, especially when we are getting news we don't understand or don't want.

Best thing is to write down the name of each test they did, and the actual result numbers.

Please don't let them get away with 'you are fine' or 'that ws a bit high'.

You need the actual numbers so that you (and we) can help you to understand them.

Good luck!

Brunneria said:

Hi and welcome!

When you get that call from the docs, make sure you have a pen and paper with you.
And WRITE DOWN ALL THE NUMBERS THEY QUOTE.
This will come in useful, because our memories are very bad at little details, especially when we are getting news we don't understand or don't want.

Best thing is to write down the name of each test they did, and the actual result numbers.

Please don't let them get away with 'you are fine' or 'that ws a bit high'.

You need the actual numbers so that you (and we) can help you to understand them.

Good luck!

Click to expand...

This is so true! I asked my GP if it was possible to print out every HbA1c result on his system the other day. He tapped a few keys on his keyboard and out popped from the printer a list of them all, going back 6 years. I was well chuffed!

Made it so much easier to see what the heck had gone wrong when they forgot to test me, then when they did test me, they forgot to tell me. I am never leaving it up to them again. I now use a notebook with test dates and if they forget me again I will be straight on the phone.

See the carnage in my signature.

Stesmithy83 said:

Absolutely fuming been waiting around all day worried sick for this phone call decided to go around and ask about it only to be told there is staff training and they are shut you would think they would know which days they are shut a day wasted

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Oh that's terrible of them. Sorry to hear you were messed around so much like that. I never like being told to wait for a call because this has happened to me too.

To recap, if I've got it right, you have:
- lost a lot of weight
- your fingerprick blood test was 6.1 (which is good news)
- you have had very high blood pressure and need it checked again asap
- you have got suspected low iron which absolutely would make your HbA1c test result meaningless (nurses and doctors often get alarmed unnecessarily because of this until they figure it out and order the correct type of test instead).

If for some reason you don't get in to see a GP tomorrow, please go to the A & E and claim you are feeling sick and state you were told to go there if you felt sick because your BP was 200/130 (or whatever it was). Sometimes we need to stretch the truth a little so that we get the help we need.

Any A & E should make time to urgently see someone who has had a recent BP with the lower number over 100. If they don't, they are in big trouble. Ideally your GP should have insisted on making a nurse available to you at least every 3 days or so to keep checking your BP until it comes down enough to be safe.

It takes about 3 minutes for a nurse to check your BP. You are at risk of an emergency situation until your BP comes down. You won't know if it has come down if no one is testing it.

Your BG is not a big worry at the moment so it won't matter if it takes a few more days before you get your results and treatment advice.

Your other signs, symptoms and results need further work but again IMO it's ok to wait a few more days for that if necessary.

Based on everything you've said so far the only emergency/urgent issue is your high BP, but the other stuff needs follow up too. Don't let the doctors and nurses let you fall through the cracks. That's what I've learned the hard way.

Stesmithy83 said:

Thank you

Decided to go around to the doctor's first thing this morning

My tests are back and I need to see a nurse which they booked for next week but I have been told that they will phone me today to see the doctor

Back to waiting again

I was told last week if I felt/was sick to go to a and e straight away

Click to expand...

So, you went to the doctor's and no one asked you to sit down for a BP check? That's not a good sign IMO. If I were you I would phone and ask for a BP check today or tomorrow and if they say no, ask to speak to a nurse. Surely a nurse would want to check it? Are you able to remember when it was last checked and what the result was? thanks.

Hi there

Right, back to the beginning, you went to the doctors because you’d had stomach flu, ear infections etc etc. So you were ill. Temporary illness, temperatures, pain etc puts blood pressure up temporarily. You may not have chronically elevated blood pressure at all. The very first thing I would do is get myself a BP meter and test your BP every day and record the results for your doctor. Do it when you are nice and relaxed. Many many people, in addition to having high BP because they are poorly in some other way, also find that their blood pressure goes up in the surgery, It is called ‘white coat syndrome’ and is very common. Be sure to buy an upper arm one, the others are not accurate enough. Lloyd’s had them on offer a while ago, don’t know if they still do.

Next, stop panicking / worrying. Your Hb (iron levels) were low, I know that makes the HbA1c inaccurate. So maybe it was a one-off reading, and when your Hb is back to normal, your HbA1c will be better. If I was you, in the interim I would follow a low carb diet, just to avoid your Blood Glucose spiking anyway, in the meanwhile, and I would incorporate plenty of red meat and green leafy vegetables. When I was pregnant, many years ago, I had awful anaemia and couldn’t tolerate iron tablets, and lightly cooked lambs liver for lunch every day sorted it for me beautifully (no longer advised for pregnant women I know). Of course low Hb levels need to be investigated / treated properly, but in the ‘at least do no harm’ principal, those measures will help a little and make you feel like you are doing something.

That way, you are doing something to ‘hold or improve’ possible T2 diabetes and anaemia, until your appointments for the GP come around. And, by measuring your BP daily you will have some good data for him to judge whether you are on the right dose of Ramipril, whether it needs to be increased, or whether you need to be on it at all.

Was your weight loss spontaneous or were you trying to lose weight / on a diet? If it was spontaneous maybe they are suspecting T1 diabetes, but maybe your finger prick test made them dismiss that. Had they been seriously concerned you would have been given a more urgent appointment I am sure. Try not to be too worried because worry alone will put your BP up.

For the short term, here is what I consider to be the best beginners list for Low Carb.

http://www.thenoakesfoundation.org/wp-content/uploads/2017/02/Green-List.pdf

Jenny15 said:

So, you went to the doctor's and no one asked you to sit down for a BP check? That's not a good sign IMO. If I were you I would phone and ask for a BP check today or tomorrow and if they say no, ask to speak to a nurse. Surely a nurse would want to check it? Are you able to remember when it was last checked and what the result was? thanks.

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Hi Jenny15

I have never known any doc surgery that I have attended offer blood pressure tests to people who come in and ask the receptionist for appointments. It just doesn't happen. Nor are receptionists qualified to look at test results and say 'this person needs to have their bp checked NOW.'

Making a phone or doc/nurse appt is about all that we can expect from a receptionist - which is fair enough. They aren't qualified to do more, and on the few occasions where receptionists do step in to make decisions, then people get pretty vocal about how they should leave medical stuff to qualified staff. Expecting them to do blood pressure tests when someone drops in to speak to them over the reception desk isn't really practical.

@Stesmithy83
I totally agree with @AtkinsMo that you need to stop worriting about this, and wait for more information.
And getting your own blood pressure machine is a brilliant idea. I got an OMRON one from Amazon when I was having high blood pressure. Was a great decision. I was able to test myself in the relaxed comfort of my armchair and discovered that the silly-high readings I had got in the surgery were White Coat Syndrome (triggered by my Doc doing his omnipotent 'my decision is FINAL' act 2 mins before taking my bp - which sent my bp through the roof. At home, my blood pressure is perfectly normal.

AtkinsMo said:

Hi there

Right, back to the beginning, you went to the doctors because you’d had stomach flu, ear infections etc etc. So you were ill. Temporary illness, temperatures, pain etc puts blood pressure up temporarily. You may not have chronically elevated blood pressure at all. The very first thing I would do is get myself a BP meter and test your BP every day and record the results for your doctor. Do it when you are nice and relaxed. Many many people, in addition to having high BP because they are poorly in some other way, also find that their blood pressure goes up in the surgery, It is called ‘white coat syndrome’ and is very common. Be sure to buy an upper arm one, the others are not accurate enough. Lloyd’s had them on offer a while ago, don’t know if they still do.

Next, stop panicking / worrying. Your Hb (iron levels) were low, I know that makes the HbA1c inaccurate. So maybe it was a one-off reading, and when your Hb is back to normal, your HbA1c will be better. If I was you, in the interim I would follow a low carb diet, just to avoid your Blood Glucose spiking anyway, in the meanwhile, and I would incorporate plenty of red meat and green leafy vegetables. When I was pregnant, many years ago, I had awful anaemia and couldn’t tolerate iron tablets, and lightly cooked lambs liver for lunch every day sorted it for me beautifully (no longer advised for pregnant women I know). Of course low Hb levels need to be investigated / treated properly, but in the ‘at least do no harm’ principal, those measures will help a little and make you feel like you are doing something.

That way, you are doing something to ‘hold or improve’ possible T2 diabetes and anaemia, until your appointments for the GP come around. And, by measuring your BP daily you will have some good data for him to judge whether you are on the right dose of Ramipril, whether it needs to be increased, or whether you need to be on it at all.

Was your weight loss spontaneous or were you trying to lose weight / on a diet? If it was spontaneous maybe they are suspecting T1 diabetes, but maybe your finger prick test made them dismiss that. Had they been seriously concerned you would have been given a more urgent appointment I am sure. Try not to be too worried because worry alone will put your BP up.

For the short term, here is what I consider to be the best beginners list for Low Carb.

http://www.thenoakesfoundation.org/wp-content/uploads/2017/02/Green-List.pdf

Click to expand...

Stress and being at a clinic can elevate BP but I'm not sure they can elevate it to the very high level the OP was measured at before the Ramipril.

I used a home BP meter for a while when first diagnosed and it was useful. However, I was told and I considered it good advice to only treat professionally provided BP checks as accurate enough to base decisions on.

I was not given BP meds until I'd had the 3-test BP series test done at the clinic. This test minimizes white coat syndrome for most people. Since then, 24 hour monitoring has become more accessible, and is even more accurate.

I suspect the OP's very high BP was the reason for the instant prescribing, and that the HCPs plan to do more testing... but only in their own good time, which doesn't seem fast enough in my over-cautious opinion.

It's possible the BP is not coming down to the threshold of lower risk fast enough and the only way to know is to have BP checks.

The NZ guidelines say:

"In patients with severe hypertension (systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥110 mmHg) initiation of treatment should be considered immediately, before the diagnosis of hypertension is confirmed, e.g. with ambulatory monitoring.1"

"When to initiate antihypertensive medicines
Antihypertensive treatment is indicated for the following patients:1, 4

1. Patients with blood pressure ≥160/100 mmHg, i.e. Stage 2 (moderate) or severe hypertension
2. Any patients with hypertension who have any of the following factors:
   • Evidence of target organ damage
   • Cardiovascular disease
   • Renal disease
   • Diabetes
   • Five-year cardiovascular risk ≥15%"

https://bpac.org.nz/bpj/2013/august/hypertension.aspx#2