Type 2 In need of some advice slightly confused

AtkinsMo said:

Trust me, in 2010 it was serious stuff, still have my records from then, too! Can see how many weeks it took to get my BP down into acceptable range, have records of all the medications, when they were introduced, how effective they were, what the side effects were, etc etc. So glad that I managed to get it controlled by natural means, eventually, and got weaned off the medications.

And anxiety does have big impacts on my BP, and I’m probably not alone, and because I test it and record it so regularly, I can see the patterns.

Some guidelines just get tighter and tighter under the influence of pharmaceutical companies, in my honest opinion, who are in the business of generating profits, not the wellbeing of people. A patient cured is a customer lost.

Should a 70 year old really have the same BP as a 20 year old, do you think? I think probably not. But we’ll probably have to agree to differ.

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I never doubted that your BP was very high in 2010. I'm interested to hear what side effects you had. Obviously they were a large part of why you were keen to discontinue the drugs.

I've been extremely lucky in that my first line ACE inhibitor drug was effective and side effect free, as far as I know. I often joke about it being the only one of my regular meds that doesn't cause any particular worries. I wish the others were like that. (Almost every other disorder I have has involved a long tortuous stressful journey of finding the least worst treatments, with mixed success.)

I've been on my BP drug for 10 years. Even when my BMI was down to the mid 20s, with an A1c of 32 I found I couldn't go off it. We must just have different bodies with different issues.

As far as I know, BP target ranges are meant to take age and other factors into account. The main guidelines I'm familiar with (NZ) take BP and about 5 other factors into account with a scoring system. It has the effect that if a 70 year old is otherwise low risk for cardiovascular events, he or she wouldn't need to reduce BP at the same threshold as someone who scored much higher. It's all figured out on a case by case basis by the doctor at the time. The guidelines are only a framework for their clinical expertise.

I had high BP for a few years before my BG went over 42 then 48. When it was just high BP the doctors were not too concerned. But adding diabetes increased the risk.

I am afraid I am a ‘Pharmaceutical Skeptic’. If I have to go on a drug I will do everything in my power to (safely) get off it again. I follow the writings of people like Ben Goldacre, and basically believe that the Pharmaceutical Industry has far too much power and influence. They should not be allowed to lobby Governments, they should not be allowed to provide Doctor education and the people that have any financial ties to them should not be allowed to serve on agencies (such as NICE in the UK), where at present, eight of the ten advisors, for instance on the committee that recommends the target patients for a further rolling out of Statin medications, have direct ties to the Pharmaceutical companies that stand to profit hugely by the policy. And any drug that the company refuses to release the raw data of it’s research for examination by independent researchers / government experts should not be funded through the NHS. Through statistical manipulation, minor ‘benefits’ are exaggerated, using the technique of quoting relative risk reduction, whilst significant side effects are minimised, reporting those findings in terms of actual risks.

But yes, I did have significant, life limiting side effects on my BP meds, the worst of which was massively swollen ankles which had a very serious impact on my normally active lifestyle, and I am sure, had I stayed on that particular medication my overall health would have been much the worse. I ended up on Ramipril, which did not adversely effect me, until I finally got my blood pressure to come down on its own, then my BP went too low. We were staying with another son at the time who lives in France, to help out for the birth of another grandson, so I could not readily access my GP, so I decided to halve my tablets. My BP stabilised for a couple of weeks, then started to go down again, so I ended them altogether. I reported back to my GP on our return, in a rather ‘shame faced’ manner (my GP and I often disagree, but I hope we have a respect for one another) and he warmly congratulated me and said “Excellent, you are no longer hypertensive, I’ll strike it from your notes, well done”. I am, however, a ‘lifer’ on blood anticoagulant therapy, but prefer to stick on the old fashioned, tried and tested cheap as chips variety, rather than the new super expensive variants.

And @Stesmithy83 , I’m sorry we’ve hijacked your thread in hypothetical discussion, I hope you are doing a bit better today.

AtkinsMo said:

I am afraid I am a ‘Pharmaceutical Skeptic’. If I have to go on a drug I will do everything in my power to (safely) get off it again...

But yes, I did have significant, life limiting side effects on my BP meds, the worst of which was massively swollen ankles which had a very serious impact on my normally active lifestyle, and I am sure, had I stayed on that particular medication my overall health would have been much the worse. I ended up on Ramipril, which did not adversely effect me...

I am, however, a ‘lifer’ on blood anticoagulant therapy, but prefer to stick on the old fashioned, tried and tested cheap as chips variety, rather than the new super expensive variants.

And @Stesmithy83 , I’m sorry we’ve hijacked your thread in hypothetical discussion, I hope you are doing a bit better today.

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I'm a skeptic too, and I certainly agree with what you say about the way the medical industries are run, but that doesn't affect my individual clinical decisions which are made on a case by case basis. You are lucky enough to not need more meds than you take. I am unlucky. That's just life. I don't covet the good health others enjoy because it's pointless and we never know what others are privately going through. I'm grateful I can access treatments, much of the world can't.

Massively swollen ankles are very painful (I had them once) and yes, I'd have come off that drug too. BP meds are a group that has a very long list of drugs to try and it's great your 2nd line choice was OK in terms of side effects.

Like you I tend to prefer the older meds that the medical world has more experience with. In particular I think some of the newer diabetes meds are far too early in their lifecycle for me to want to risk being a guinea pig on them, given that other options like LCHF and insulin exist.

FWIW, I don't think we're discussing hypotheticals, it seems useful so far but I will try harder in future to start a new thread if I'm going off topic.

Stesmithy83 said:

Hi again

Just a little update finally got a call from the doctors I been given a couple of appointments

First up a ‘specialist nurse’ appointment on Friday
After that a appointment dietitian on Friday after the first
Then need to see the regular doctor

Fun times next Friday I guess at least I’ve stopped worrying what will be will bee

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That's great to hear,@Stesmithy83. If the nurse doesn't check your blood pressure, I suggest you ask her to. I am pretty sure she will check it though. Hopefully she will organise for you to take home a device that you wear for 24 hours that will record your BP. Here is some info:
http://www.bloodpressureuk.org/BloodPressureandyou/Medicaltests/24-hourtest

Hi @Stesmithy it's good to hear that your HbA1c has dropped from 86 to 75, that's a significant reduction, in the scheme of things. (Hopefully the GP considered this in light of your iron level test, too).

In my experience, when my blood sugars are well controlled, my blood pressure is also a bit lower, along with my lipid levels (eg cholesterol). A previous GP told me they are interconnected, to a degree. So I hope that provides some reassurance that working to help one of things will usually have a positive effect on the others.

It's a good idea to ask for a printed copy of all your blood tests so you can be sure of the actual values and any changes over time. Your iron might be borderline for anaemia or just a bit above the line, and depending on what is causing that, it could get lower within 3 months between blood tests. Prescription iron tablets are cheap and a good way to help keep the level up until your level is high enough to go off them. Just something to consider.

I remember feeling quite down when I was diagnosed with diabetes too. I gradually adapted to it and before long I was seeing results from the food changes I was making, along with medication.

I won't advise you whether to start with medication or not, as that's up to you. I try to only advise people to set a goal for where they want to be in 3 months, then gather info about how to reach it, and what it would take to get there, before deciding.

I believe you will get your blood sugars under control, and the same with your blood pressure. It's going to be particularly good to see you post about the latter when you've achieved your goal, because it was so very high at the start.

Excellent stuff.

Stesmithy83 said:

a bit of a update

Seen the the diabetic specialist nurse today

Now this is the thing at the moment they said I will be treated as type 2 as most of my symptoms are type 2 but it’s could be possible I am type 1.5

Been put on 1x 500 Metformin daily for 1 week then 2x daily f rom next week

Been given some diet advice(my problem seems I drink a lot of fizzy drinks and crisp) and been sent on a 1 day diabetics information course

They are going to do some more blood tests in 2 weeks they said and should be able to clear up some of the unanswered questions if not I will have to go to a special diabetic clinic in the hospital which didn’t sound good

Also been sent for a ecg on my heart as a precaution in a few weeks and going to be issued with a blood pressure monitor next week

I did ask about blood glucose monitoring and they said I won’t need to do it just just but I might have to if things/medication change they also said if that does happen I will be proscribed one by them

And just to think that all this started because I kept on getting sick lol

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Good to hear that, but IMO there is still one question you need to have answered by a nurse GP or endocrinologist:

Is HbA1c testing always reliable when someone has pernicious anaemia?

If the answer is no, then IMO you need an OGT test, regardless of what type of diabetes you have.

Stesmithy83 said:

I did ask about that today she did say yes my iron is low but my iron stores are fine so she seemed happy with that

So unsure what to do in 2 weeks they are planning another round of blood test so I might get a better idea then I guess

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I suspect she doesn't understand the question and I suggest you ask a GP or endocrinologist. The GP can look up the guidance provided by the pathology lab. I have read the NZ lab guidance and it says the answer is "no" and OGT testing is needed.

Also, if you know what numbers your iron results are, you can find out if you need iron tablets or not. IMO there's not much point letting anemia develop when you can easily prevent it.