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New diabetic, suspected MELAS

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ME_Valentijn

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I'm an American living in the Netherlands, with my Dutch fiance. I've been diagnosed ME/CFS since January of 2011. I'm moderately affected, and housebound. I can get out of the house with assistance and a wheelchair or my mobility scooter on a good day.

I was diagnosed with diabetes in January. I started having symptoms after in December, after I caught a flu-like virus that was going around. After several weeks of exhaustion, headaches, and nausea (I missed Christmas!), my Type 1 fiance suggested testing my blood sugar on his old meter. It was 22.2. I went into the GP's office the same day, and was diagnosed with Type 2, due to being over 27 and overweight. Testing was ordered for the next morning, and I was prescribed 500mg of metformin to take once per day. She said she'd schedule me for a followup appointment in a month, but the date she gave me was 8 weeks away.

I was tested fasting the follow morning. Blood glucose was 16.8 and A1c was 88. My blood sugar went down a little bit, partially due to restricting my carbs quite a bit. For the first week I was usually over 13.5 for most of the day. I ordered ketone testing strips, and almost always had at least traces of ketones, frequently going up to "moderate" (++) levels, and even "high" (+++) once. And was still feeling awful - crushing exhaustion, headaches, peeing all day and night, and usually too nauseated to want to eat anything.

So we called the GP again a week after diagnosis. My blood sugar managed to do a fanastic spike of 18.5 in her office 90 minutes after lunch, even though the identical meal (27 carbs) had my blood sugar going down a bit to 10.9 at the same time on the previous day. She tested my urine for ketones, and got trace amounts. Then she called an endocrinologist who specializes in complicated Type 2 cases at a nearby hospital, and ordered GAD auto-antibody testing. C-peptide has not been tested. She also added 30mg of Gliclazide at that point.

Blood pressure was tested, which is always fun ... usually my pulse is too weak for a blood pressure monitor to detect every beat, so it can't calculate it and gives an error message. The GP gave up after a couple tries, and did it by hand, finding it to be 130/80. My usual is about 110/90 (narrow pulse pressure). But the 130/80 wasn't too surprising ... I tested a couple times when my headache was bad and blood sugar was high, and was getting 150/100 intermittently between the accustomed "ERROR" messages.

The GP was upset that I was usually testing my blood sugar 4 times per day on the fiance's old meter, and thought I should do it much less (or preferably not at all apparently). She was also was very much not in favor of testing urine with ketone strips. She claimed that everyone produces detectable amounts of ketones in their urine, and that it can never cause problems in Type 2.

Nonetheless, she was taking things more seriously after seeing that glucose spike for herself. Though I think it surprised me more than it did her, since I expected it to be the same as it had been the previous day. First time I've say "holy ****!" in a doctor's office anyhow, when the 18.5 reading came up :p So the next appointment was 4 days later, quite an improvement over the initial two-month blow-off. Values between breakfast and bed time were going down a bit, but going up at bedtime, staying high in the middle of the night when I tested, and always still high in the morning. So more metformin was added.

When I had first started the 500mg metformin a couple weeks earlier, my arms had started burning intermittently. I assumed it was a diabetic neuropathy thing. But when I went up to 1000mg, it became a constant problem, along with my shoulders getting weak, arms aching in addition to burning, a very nasty headache, leg muscles spasming, more exhaustion, and my whole body being cold for several days. I started to suspect meds were causing the problem, and found an English manufacturer's insert for my metformin - they were the symptoms of lactic acidosis. So I stopped the metformin and called the doc to let her know, as instructed in the insert.

I was very sick at that point, and probably should have gone to the hospital. But I'm used to sticking things out with ME/CFS and I was feeling too sick and exhausted to consider going anywhere, including the hospital. I probably wasn't in a good state of mind for making rational decisions :p Anyhow, I couldn't keep awake in the morning so went back to bed, slept a few hours, and felt a little better. Most symptoms wore off over the rest of the day, except for a nasty burning headache that felt like my brain had been dipped in a vat of acid. That slowly improved over the next couple days as well, though trying to think at all brought back the burning. So I had a lot of couch time in front of mindless TV programs. Though my shoulders still haven't recovered fully, after nearly two weeks.

The GP called me back a few days later, and was in complete denial that metformin can cause symptoms of lactic acidosis. She'd tested my thyroid, liver, and kidney function at diagnosis, to make sure metformin was safe. Which was a bit ironic, since she was running so many tests to see if a drug was safe, without bothering to see if I even had the disease (Type 2) that the drug is helpful for. I flatly rejected her suggestion to try metformin again at the lower dose. So she upped my gliclazide to 60mg, and suggested I watch out for going hypo, a few minutes after reiterating her earlier request to test my blood sugar less, and not test on a daily basis :p A follow-up appointment was scheduled for a week later.

To be continued!
 
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Basically I've questioned my Type 2 diagnosis pretty much since the beginning. Usually Type 2's will get diagnosed after a slow onset, and even be asymptomatic at the time. I never had a pre-diabetes phase, though I suppose it's possible I was milder for a couple months before being hit by a virus and staying hyperglycemic for weeks. And while it's certainly possible for Type 2's to produce moderate of amounts of detectable ketones when hyperglycemic, it's uncommon - which is why Type 2's can have much higher elevations of blood sugar when showing up at the hospital, since Type 1's get hit by serious ketoacidosis symptoms before their blood sugar can get so insanely high.

And with the metformin reaction, well, it was an eye-opener. Partially because I'd been having similar symptoms for the past 6 years, albeit with a different presentation. I get the same muscle burn, aches, twitching, headaches, etc, with ME/CFS - but only in the muscles which I've been over-using. The metformin reaction was hitting parts of the body which I wasn't using. And the metformin headache was a whole magnitude worse than my chronic ME/CFS headache.

Something I'd looked into a bit years ago was MELAS. The E stands for "encephalomyopathy" meaning pretty much the same thing as the E for "encephalomyelitis" in ME/CFS. The "LA" is lactic acidosis. It can cause all of the symptoms we get with ME/CFS - with the notable addition of the "S", which is stroke-like episodes. I don't have seizures, which is why I ruled this out years ago. But I did more reading, and apparently those episodes include days or weeks of hemiplegia, which happened to me about 10 years ago. Also migraines with a lot of vomiting, which happened when I was 11. My migraines are triggered by MSG/E621, which is recommended to be avoided with MELAS, due to potentially triggering episodes. And diabetes is a common symptom as well.

I also have a mitochondrial mutation I found in my 23andMe data years ago, which was found in elevated levels among patients with a mitochondrial disease. I also had (wrongly) that if I had a mitochondrial disease, so would my mother and everyone who shares our mitochondria, namely my aunts and uncles. But due to the way mitochondria are transferred from mother to child, there's often heteroplasmy in patients with mitochondrial diseases, meaning the mutation ends up in some tissue types, but not in others, and with varying degrees of prevalence in that tissue. So it's actually the norm that no one else in the family has the same mitochondrial disease - thought they may present with some aspects of it, like certain eye problems, deafness, diabetes, thyroid issues, etc.

So I think it's very likely that my ME + Diabetes + Other Weird Stuff has one cause, and is really MELAS. It's not good news, since it's progressive and incurable, and I think that's another reason that I dismissed it as a possibility years ago. But since I have it regardless, I'd rather know what it is. I can be more vigilant about avoiding triggers of lactic acidosis, there's supplements which might help, and there's an actual attempt at monitoring and managing problems - unlike the "get lost" approach which most practitioners take toward ME/CFS. And if it turns out to be MELAS, I can let family members know.


I had another GP appointment on Monday. Blood sugar was still staying high so she upped the Gliclazide to 90mg. She didn't tell me to test less this time, so maybe she's coming around to seeing it's useful ... or she's just given up on telling me not to test :D I brought up the possibility of MELAS and she frankly admitted she had no idea what I was talking about, which is something I can respect - unlike her various statements regarding diabetes thus far :rolleyes: But she referred me to the Type 2 endocrinologist at the local hospital to look into diagnosis. Unfortunately his office decided to schedule me an appointment with a diabetes nurse instead, so I cancelled that. Maybe the nurse would be useful in general, especially since my GP knows nothing about diabetes, but it's not going to help with getting a diagnosis for a genetic cause of diabetes!

I have a follow-up appointment with the GP scheduled on Monday, so I'll ask for the direct referral to the hospital which has a unit that specializes in MELAS and other mitochondrial diseases. It's a 90 minute drive, which is hard on me, but it needs to be done. And it sounds like that's where all the muscle biopsy samples get sent to anyhow. The GP had entertained the direct referral there as a possibility at the last appointment, but we'd decided on the local hospital due to being easier to get to. So I'm pretty sure she'll be willing to refer me.

I guess I'm up to the present now. Blood sugar is always high at night (8.5-12.9) and in the morning still (9.7-11.7). Pre-lunch and pre-dinner is lower, but still too high at 5.7-9.0. I'd been eating 100 carbs per day, and lowering that to 65 for a couple days has made no difference. Going off the metaformin and increasing the gliclazide have made no difference.
 
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@ME_Valentijn

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 NEWLY DIAGNOSED DIABETICS

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 147,000 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 free 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. They're all 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.
 
I just had my new all-time low reading since getting diagnosed one month ago ... 4.3 :) I tested because I felt a little shaky after my nap, probably due to my body not being used to my glucose being at such a normal value.

My previous low was 5.7. Usually I'm around 6.4-9.0 before meals. My 4.3 was after lunch, but I went carb free with tuna and mayo. And only 18 carbs in the morning from the milk, maple syrup, and chocolate ball I had with coffee (I also had 2 eggs earlier).

So it seems I can get my glucose down to a normal level during the day, if I literally don't eat any carbs :p I'm curious to try a no-carb dinner, since I'm always high at bed time and stay high all night.

Celebrated the 4.3 with chocolate sprinkles on my afternoon coffee :D
 
I had another doctor appointment this morning. Thankfully they've been weekly, after the initial "come back in 2 months" didn't work out so well :p Basically blood sugar hasn't gone down from 10-11 fasting every morning (high at bedtime and in the middle of the night too), despite Gliclazide being increased from 30mg to 90mg over the past several weeks. So now I'm up to 120mg. No other meds.

The GP wanted to see my booklet with my blood sugar values, but I told her I didn't bring it. She asked why, and I said it was because she wanted me to test less (previously said "not every day"). She laughed at that, so I think she got the message :D I'll bring it again next week.

Getting a referral to the mitochondrial disease clinic is still difficult. The clinic at Radboud isn't included in the usual online site that GPs have access to in the Netherlands, so she thinks it'll have to be an internist which refers me to the clinic. I explained that the internist's office at the local hospital tried to schedule me an appointment with a diabetes nurse, who probably wouldn't have any training in mitochondrial diseases, how to diagnose them, or the power to refer me to someone who could.

The GP thought I should have kept that appointment to then get an appointment the internist from there, but seemed understanding when I explained how hard it is for me to even get out of the house, especially when there's a lot of driving, we have to bring the wheelchair, fiance has to take time off work, etc. So I want a pretty direct path to where I'm going, without a bunch of extra stops on the way that are going to leave me needlessly exhausted for days afterward.

We agreed that my fiance (male, and speaks much better Dutch than me) would call the hospital back to schedule the appointment with an actual internist. It went smoothly ... no one tried to set me up with a nurse this time. So I suspect someone involved in scheduling tried to make an executive decision the first time around and downgrade the referral, without having the faintest clue what the referral was actually for.

I want to try lowering my carbs further to get my blood sugar lowered. But even missing carbs at one meal makes me feel sick and weak, to the point where I'm on the verge of not being able to function at all. I did low carb in college (Atkins), but that was years before I came down with ME/CFS. I did try going low-carb once after getting sick, to lose weight, but just got weaker and felt awful.

My metabolism is already probably pretty shot with ME/CFS, and removing any source of calories (carbs, fats, or proteins) just deprives a system which is already barely functioning. So I'm still aiming for about 15-30 carbs per meal. If I go higher, blood sugar hits the 13s again, ketones come oozing out (not the nice weight-loss kind!), and I get a headache.

I wish I knew if I'm producing sufficient insulin :p Maybe I'll ask the internist to test c-peptide when I see her next month.
 
If you are on that high a dose of gliclazide, then you need to be very careful about reducing your carbs too much, otherwise you will risk hypoing - especially if you are in the honeymoon of T1 or T1.5 or anything else with a misfiring pancreas (sorry, I know absolutely nothing about mitochondrial disease).

Like you, I tend to read up and research and often know more about the subject than the doc I am seeing. However, this can often backfire. Doctors often resent this (understatement!) and it can lead to issues. Good ones listen, even if they disagree. The bad ones just stonewall and block any progress and try to prevent referrals. So be careful. :) Mind you, with your medical history, you have probably experienced all this many times already.

Having said all that, it sounds like you are making progress, and that your doc is making the referrals you are requesting, so maybe you are better at the 'negotiation phase' than me. :D Well done! And I look forward to hearing the next installment. :)
 
I had another doctor appointment this morning. Thankfully they've been weekly, after the initial "come back in 2 months" didn't work out so well :p Basically blood sugar hasn't gone down from 10-11 fasting every morning (high at bedtime and in the middle of the night too), despite Gliclazide being increased from 30mg to 90mg over the past several weeks. So now I'm up to 120mg. No other meds.

The GP wanted to see my booklet with my blood sugar values, but I told her I didn't bring it. She asked why, and I said it was because she wanted me to test less (previously said "not every day"). She laughed at that, so I think she got the message :D I'll bring it again next week.

Getting a referral to the mitochondrial disease clinic is still difficult. The clinic at Radboud isn't included in the usual online site that GPs have access to in the Netherlands, so she thinks it'll have to be an internist which refers me to the clinic. I explained that the internist's office at the local hospital tried to schedule me an appointment with a diabetes nurse, who probably wouldn't have any training in mitochondrial diseases, how to diagnose them, or the power to refer me to someone who could.

The GP thought I should have kept that appointment to then get an appointment the internist from there, but seemed understanding when I explained how hard it is for me to even get out of the house, especially when there's a lot of driving, we have to bring the wheelchair, fiance has to take time off work, etc. So I want a pretty direct path to where I'm going, without a bunch of extra stops on the way that are going to leave me needlessly exhausted for days afterward.

We agreed that my fiance (male, and speaks much better Dutch than me) would call the hospital back to schedule the appointment with an actual internist. It went smoothly ... no one tried to set me up with a nurse this time. So I suspect someone involved in scheduling tried to make an executive decision the first time around and downgrade the referral, without having the faintest clue what the referral was actually for.

I want to try lowering my carbs further to get my blood sugar lowered. But even missing carbs at one meal makes me feel sick and weak, to the point where I'm on the verge of not being able to function at all. I did low carb in college (Atkins), but that was years before I came down with ME/CFS. I did try going low-carb once after getting sick, to lose weight, but just got weaker and felt awful.

My metabolism is already probably pretty shot with ME/CFS, and removing any source of calories (carbs, fats, or proteins) just deprives a system which is already barely functioning. So I'm still aiming for about 15-30 carbs per meal. If I go higher, blood sugar hits the 13s again, ketones come oozing out (not the nice weight-loss kind!), and I get a headache.

I wish I knew if I'm producing sufficient insulin :p Maybe I'll ask the internist to test c-peptide when I see her next month.

ME_Valentin, I'm rather confused about your type of diabetes. Your written text says Type 2, but your profile information says 1.5? Are you saying you have been diagnosed T2, but you believe you are T1.5, or have you had further testing which already confirms the overturning of your initial diagnosis?

It could just help members respond most appropriately if we're clear about where you are with your medical team and formal diagnosis.
 
ME_Valentin, I'm rather confused about your type of diabetes. Your written text says Type 2, but your profile information says 1.5? Are you saying you have been diagnosed T2, but you believe you are T1.5, or have you had further testing which already confirms the overturning of your initial diagnosis?
I've been "diagnosed" as Type 2, based solely on not being young and slender. C-peptide hasn't been tested, and isn't routinely in the Netherlands. My onset was sudden, and I produce moderate-high amounts of ketones in my urine with mild-moderate ketoacidosis symptoms when my blood sugar is around 13.5+, which would seem atypical for Type 2.

I suspect MELAS due to it often causing ME symptoms, diabetes, some weird migraines, hemiplegia, hirsutism, skin problems, and some other issues which I also have. I also have a genetic mitochondrial mutation which has been implicated in causing mitochondrial disease, which includes MELAS. MELAS would also explain my reaction to metformin and apparent predisposition to acidosis in general. I bought a blood lactate home tester (similar to glucose meter, but slower), and frequently have elevated levels while completely rested, and a very weird reaction to exertion.

Testing for MELAS will require a muscle biopsy to be taken at a specialist center, and likely CSF sample to look for elevated lactate and brain scan to look for MELAS-associated oddities there. My GP is working on getting me referred to the Dutch clinic which diagnoses and treats mitochondrial disease. But I'm about 95% sure it's MELAS - the odds of having all of those otherwise unrelated conditions would just be too unlikely otherwise, especially since diabetes and hemiplegia are not at all common among ME patients.
 
I've been "diagnosed" as Type 2, based solely on not being young and slender. C-peptide hasn't been tested, and isn't routinely in the Netherlands. My onset was sudden, and I produce moderate-high amounts of ketones in my urine with mild-moderate ketoacidosis symptoms when my blood sugar is around 13.5+, which would seem atypical for Type 2.

I suspect MELAS due to it often causing ME symptoms, diabetes, some weird migraines, hemiplegia, hirsutism, skin problems, and some other issues which I also have. I also have a genetic mitochondrial mutation which has been implicated in causing mitochondrial disease, which includes MELAS. MELAS would also explain my reaction to metformin and apparent predisposition to acidosis in general. I bought a blood lactate home tester (similar to glucose meter, but slower), and frequently have elevated levels while completely rested, and a very weird reaction to exertion.

Testing for MELAS will require a muscle biopsy to be taken at a specialist center, and likely CSF sample to look for elevated lactate and brain scan to look for MELAS-associated oddities there. My GP is working on getting me referred to the Dutch clinic which diagnoses and treats mitochondrial disease. But I'm about 95% sure it's MELAS - the odds of having all of those otherwise unrelated conditions would just be too unlikely otherwise, especially since diabetes and hemiplegia are not at all common among ME patients.

Lactic acidosis and ketoacidosis are not the same thing.

I honestly would discourage you from self-diagnosing as so many of the symptoms of diabetes, PCOS, thyroid irregularities, fatigue, dehydration; just to name a handful, are so similar.

As someone with several things going on, I'd urge you to work through the various testing processes with your medical team and eat a good, diabetes friendly diet.

I can't, nor can anyone else on this site tell you you are correct or wrong in your self-diagnosis, but sometimes "just knowing x, y or z is going on" can deflect attention from a structured process of investigation to going down a blind alleyway and wasting time.

Sadly, diabetes, and many other conditions are what I call portfolio conditions, in that there are many, many variables in play and the whole picture is what is required.
 
Lactic acidosis and ketoacidosis are not the same thing.
Yes, I know. But I seem to have issues with both. Ketoacidosis symptoms at 13.5+ blood sugar, and lactic acidosis symptoms with 1000mg metformin. But since the problem with both boils down to the "acidosis", there might be one process going on which is making me more susceptible to both.
As someone with several things going on, I'd urge you to work through the various testing processes with your medical team and eat a good, diabetes friendly diet.
Certainly. Do you think that medical team is also the best source for dietary advice? :D

I honestly would discourage you from self-diagnosing as so many of the symptoms of diabetes, PCOS, thyroid irregularities, fatigue, dehydration; just to name a handful, are so similar.
Yes, but this site requires a label. I'm not comfortable calling myself a Type 2 at this point, with none of the appropriate testing having been done to make that diagnosis. And with most signs pointing to MELAS, 1.5 seems the most likely at this point anyhow. I also found it a bit annoying at the first diabetes forum I tried joining right after diagnosis, where labeling myself as Type 2 resulted in misunderstandings and even arguments any time I had an experience which wasn't familiar to the Type 2 members.

And as you'll note from my earlier response, I am clearly seeking a diagnosis through the standard process. Thyroid's fine, by the way, and no PCOS. I drink about 2L of water per day, and I don't have much fatigue despite the rather daft misnomer of "Chronic Fatigue Syndrome" being used for ME patients. What I do have is exercise intolerance, muscle weakness, chronic headaches, and low pulse pressure.
Sadly, diabetes, and many other conditions are what I call portfolio conditions, in that there are many, many variables in play and the whole picture is what is required.
Agreed. I left the previous forum due to increasing hostility, culminating in someone accusing me of being "determined to be atypical" and flat denial that I've had the symptoms I've had. I'd rather have people see "Type 1.5" and shrug than continually insist on shoe-horning me and yelling at me if I refuse. And even if it turns out that I don't have MELAS, I do have a chronic disease which affects most bodily symptoms and is very disabling. At the very least, it seems reasonable to concede that it's going to be capable of interacting with diabetes and medications in unexpected ways.

Sorry if this is a bit defensive, but it's been a rough few weeks.
 
Yes, I know. But I seem to have issues with both. Ketoacidosis symptoms at 13.5+ blood sugar, and lactic acidosis symptoms with 1000mg metformin. But since the problem with both boils down to the "acidosis", there might be one process going on which is making me more susceptible to both.

Certainly. Do you think that medical team is also the best source for dietary advice? :D


Yes, but this site requires a label. I'm not comfortable calling myself a Type 2 at this point, with none of the appropriate testing having been done to make that diagnosis. And with most signs pointing to MELAS, 1.5 seems the most likely at this point anyhow. I also found it a bit annoying at the first diabetes forum I tried joining right after diagnosis, where labeling myself as Type 2 resulted in misunderstandings and even arguments any time I had an experience which wasn't familiar to the Type 2 members.

And as you'll note from my earlier response, I am clearly seeking a diagnosis through the standard process. Thyroid's fine, by the way, and no PCOS. I drink about 2L of water per day, and I don't have much fatigue despite the rather daft misnomer of "Chronic Fatigue Syndrome" being used for ME patients. What I do have is exercise intolerance, muscle weakness, chronic headaches, and low pulse pressure.

Agreed. I left the previous forum due to increasing hostility, culminating in someone accusing me of being "determined to be atypical" and flat denial that I've had the symptoms I've had. I'd rather have people see "Type 1.5" and shrug than continually insist on shoe-horning me and yelling at me if I refuse. And even if it turns out that I don't have MELAS, I do have a chronic disease which affects most bodily symptoms and is very disabling. At the very least, it seems reasonable to concede that it's going to be capable of interacting with diabetes and medications in unexpected ways.

Sorry if this is a bit defensive, but it's been a rough few weeks.

Touche on the dietary guidance, although I am pleased to report that things, in UK at least, are changing, albeit not at a pace many of us would like.

As far as this site and forum is concerned, it is helpful for individuals to declare their type of diabetes, so that other members can interact with them in the most appropriate way, given their condition's characteristics and treatment regimes, however, it is not mandatory and some members use the title "Prefer not to say".

The settings to make such a change can be found under Personal Details on your profile.

I do hope you find a resolution to your issues in the near future as nobody enjoys the uncertainty of the investigation process.
 
Have you had the results of your gad test?

If you don't think you are type 2 the next step would be excluding the other types of diabetes. If you are gad positive you will be type 1 and you won't need a muscle biopsy. If you're gad negative you might want to consider DNA testing to look into mitochondrial diabetes. These are things that would probably have been covered in any decent appointment with a diabetic specialist nurse at diabetic clinic at the hospital. They would also have been able to give you a pot for urine cpeptide test. A diabetic specialist nurse is a specialist nurse, I wouldn't be so dismissive of the offered appointment on the basis they are "just" a nurse.
 
Have you had the results of your gad test?
No, maybe next week.
If you don't think you are type 2 the next step would be excluding the other types of diabetes. If you are gad positive you will be type 1 and you won't need a muscle biopsy. If you're gad negative you might want to consider DNA testing to look into mitochondrial diabetes.
I'm not sure that being GAD positive would rule out MELAS. I still have ME symptoms without a known cause, and the hemiplegia episode, etc. I also have a genetic mutation which research has associated with mitochondrial disease. I already know this from my 23andMe data.
These are things that would probably have been covered in any decent appointment with a diabetic specialist nurse at diabetic clinic at the hospital. They would also have been able to give you a pot for urine cpeptide test.
The referral is for diagnosis of a genetic disease, not management of diabetes. If a GP can't refer me directly to the clinic for diagnosis, it's extremely unlikely that a nurse can either. And they would not order C-peptide, since the Dutch guidelines do not allow for that. I only got tested for GAD because I spiked in the GP's office and she called an endocrinologist who recommended testing for it.
A diabetic specialist nurse is a specialist nurse, I wouldn't be so dismissive of the offered appointment on the basis they are "just" a nurse.
Good thing I'm not dismissive of a nurse "just" for being a nurse then, yes? I'm dismissive of seeing a nurse because both me and my GP are pretty sure I need to see an internist to get the necessary referral to a mitochondrial disease clinic. And the GP won't send me to a specialist nurse for routine diabetes management, as that is not allowed here unless there is a Type 1 diagnosis or considerable complications.
 
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hi @ME_Valentijn
welcome to the forum

sounds as though you have had a rough ride recently

the forum is a great place to read lots of information on a lot of subjects
there are many friendly people here too.

do keep us updated on how your diagnosis progresses. !!
 
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