Increased Hba[emoji637]c & Blood Pressure

[Calf00]

Hello
I’m a 65 yr old woman with multiple autoimmune issues and Polyglandular Autoimmune Syndrome 2. I was diagnosed with T1D during lockdown aged 60 (after being misdiagnosed as a poorly controlled T2D by my GP). I’ve been stable and v well controlled since starting to inject insulin in 2020. Recently, last 6 months, my Hba1c has increased (from 48 approximately to 53) along side increased BP (usually 120/80 to 130/96 approximately). I missed my last Endo appointment last month. I waited for 2.5hrs past my appointment time in the hospital and I couldn’t wait any longer. I was in dreadful pain sitting and waiting for that length of time (due to other multiple health issues) and i had to return home to rest. Sadly I didn’t know at that time that my numbers had increased. I’m getting a 24hr BP monitor next week. My Novorapid/food insulin numbers are stable. I increased my Lantus insulin a couple of months ago as my morning readings were creeping up. I’m waiting for another replacement Endo appointment at the hospital and my next GP diabetic nurse appointment isn’t until January. Should I increase my lantus insulin myself now?
Could the increased HBa1c be the reason my
BP is increasing please?
Any suggestions gratefully received
Thank you.
PS: I’m awaiting three surgeries over the next 4/6 months, two hand ops and a hernia removal and General Anaesthesia is already causing some concern with the medics for these ops. Thank you.

 

[grantg]

Pain: Have you been given anything that helps to eliviate it? I goto a Pain Management Clinic (requires referal) where they have ability to prescribe something a little better than likes of a gp can. Not sure where your pain is coming from, however with lower back pain and hip pain which i have I found a Tens Machine (which was prescribed via pain management clinic) helped somewhat via distraction method more or less. Alongside was given more targeted pain relief meds which the gp wouldn't of been able to inititally prescribe.

in my area t1/lada dsn assigned in hospital under consultant. was able to phone to query insulin changes. (currently honeymoon period coming down -- as lows) I left a message if they didn't answer, then they would usually phone back in a day or two time and offered further advice. This was in addition to GP surgery nurse with their reviews. I've spaced the reviews out, gp surgery (every 6 months), dsn review (6 months) so review almost every 3 months. Unsure if you've done an education program such as DAFNE if not request a referal that should help you adjust your insulin dosages, i do realise you've stated novarapid/food insulin numbers are stable. forum rules prevent medical advice so none can advise if you should up your long acting insulin or not. best person to speak to is your dsn/consultant. Have a look at this page: https://www.diabetes.co.uk/insulin/adjusting-basal-bolus-insulin-doses.html

Own experience of adjusting dosage of long acting insulin I was told to give 2-3 days inbetween very small (1-2 units at a time) this was followed by single unit changes advised at a time. I was using toujeo changes for that particular long acting insulin could take upto a few days according to the dsn. Hence very slow, gradual changes.

Adjusting your long term, basal insulin dose
Also referred to as background insulin, basal insulin is the insulin which acts over most of the day, typically between 16 and 24 hours depending on which long term insulin you take.

If there is a general trend of higher numbers through the day, it may be advisable to increase your long term insulin instead of adjusting a number of your short term doses.
Conversely, if your numbers are generally going low through the day, you may need to decrease your long term insulin.
If you are unsure about whether your background insulin needs changing, a good way to check is do a fasting test, which involves not eating and not injecting short term insulin for several hours.

Throughout the fast you can test your blood sugar at regular intervals, say once every two hours and observe whether your blood sugars are dropping or increasing

48-53 is only a difference of 5, imo isn't a lot and definately not worth stressing over. Ps Pain etc can increase glucose levels a little alongside stress/anxiety can impact levels. Try not worry .. lot easier said than done

hopefully above is useful.

hope all goes well with your upcoming surgeries.

 

[EllieM]

I've been T1 for 55 years and on bp meds for over 30. The bp meds have varied (up and down) over the decades.

I agree with @grantg that pain/stress can put up blood pressure and I personally am a fan of using bp meds if you need them. (Not obvious to me that your levels are quite high enough to need them.)

Given you are a relatively new T1 I wouldn't be surprised if your insulin needs went up. I strongly suggest you push for advice if you aren't confident to change your own levels. And my insulin needs go up and down with circumstances (eg the seasons) and definitely go up with pain/sickness.

Do you really have no one you can email or phone with your dosage queries? (I'm in New Zealand and don't expect to get a hospital appointment unless I jump up and down and scream, but an reasonably confident that I'd get a reply if I emailed my DN.)

Good luck

 

[searley]

In my case hba1c does not affect my BP.. I’m on 5 bp meds 9 tabletss a day…. My bp is still 172/91 and it remain pretty stable with an hba1c of 68 or 48. But that’s me, you could be different if you finding out hba1c has risen causes you concern that could raise your bp…. I wish mine was as low as yours