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Put on insulin too early...?

G

GlazedDoughnuts

Well-Known Member
Messages
196
Hi All,

I've had a bit of a strange saga with my doctors surgery. There is a short version of this post right at the bottom

Basically I was my docs around 1.5 months ago who referred me for a blood test the results were as follows:
Blood Glucose level: 9.3 mmol/L
HbA1c level (DTTC aligned: HI 7.0% (4.2-6.2) - I assume the numbers in the bracket is the normal range?
R hBA1c new units: 53 (20-42)

I then saw another GP in my practice, she said my levels arent too bad, but they're elevated and asked why I had approached the docs re: diabetes...? I explained it runs in my family and that for the last 3-4 months I'm struggling to wake up in the mornings/add on mass via weight lifting. Also noticed a decrease in strenght and a loss of half a stone in a week by no apparent reason (I was eating around 2400k a day, I weigh 11.8 stones).

She grumbled something and gave me Metformin, two x 500mg once a day.

When I first started my Metformin, all was good. I felt like my old self during the day, full of energy and chirpy. But still woke up to pee 2-3 times every night around 3-6am. My blood sugars in the morning have always been around 7.5 - 10.

Over the next couple of weeks I noticed BG levels were starting to rise slow after eating, from sitting in the 6s it was creeping up to 7/8/9. This is two hours after. Now im starting to experience numbers of 11-14.

My diet consists of lean protein, complex carbs and healthy fats. I started noticing no matter how many carbs I was eating I had keytones in my pee.

I went for my one month review. Showed the nurse my BG levels that I kept a log of and mentioned the keytones, she looked a little concerned and saw my doc. She came back saying the doc thinks I should be on insulin so I should go see him.

My Doc told me if I've got keytones present and have elevated blood sugars at night/morning I ought to be in Insulin. Ok doc, I have no issues with that. He took me off Metformin too.

This is where things became a little odd

There was a mix up with Insulin pens, the doc prescribed me with the wrong pen, no biggie, we're all humans and make mistakes. I called up my surgery and told them.

A doctor called me back, one that I've never seen/spoke to before. She was rather abrupt and said the following:
"Theres a note to call you back, why?"
I explained the pen stuff.
"Did the hospital give you insulin?"
"No Dr. XYZ did"
"WHY? Do you even know what to do with it?"
"Yes Dr. XYZ explained to me"
"I dont get why you're on it, and I dont know you so I'm going to get your doctor to call you back"

Um ok. A few hours go by I call up the surgery, my doc has done me a prescription. I went in to collect it after work and asked if I could see my doc (he prescribed me disposable insulin pens), but I already have the insulin so I wanted to be prescribed the right pen instead (save NHS costs and all that).

I had the joy of seeing the doc who spoke to me over the phone.

My partner and I entered the room and I explained what happened and asked her if she could precribe me the correct pen.
And the conversation that took place was as follows:
Doc: "WHY are you on insulin? Did they even check here if you had Keytones?"
Me: "Yes they did on my initial appointment and I have ketosticks that I've been testing with."
Doc: "Well its not on my notes here, I dont understand why Dr.XYZ has given you insulin"
Me: "Well the nurse told me at my first appointment to start thinking about insulin use, also I've been testing myself with the Ketosticks, I'm not making this up...""
Doc: "Well that keytone test wasnt done here...Well you could be treated with more pills, you're at an early stage. I dont get why Dr. XYZ done this and now hes off as well!"
Me: "What would you consider the best cause of action?"
Doc: "More pills, although you would need insulin in time"
Me: "So other than the risk of hypos will injecting insulin damage my body?"
Doc: "No"
Me: "Well I'm happy to go with Dr. XYZ suggestion and go on insulin, I don't like the idea of using various pills for the rest of my life, wont that stress out my kidneys?"
Doc: "Ok well I'm going to give you the pen anyway, I just think you should of been given more pills."

Now that's left me confused, my diabetes nurse and GP say insulin, this doc says the complete opposite.

When it comes to health issues my thought process has always been "nip it in the bud" I have no issues with insulin use, but the way this doctor spoke last night I left the surgery thinking I had done something wrong and that my Dr. is wrong in giving me insulin?

The way she spoke about my Dr. over the phone and in person to me gave me the impression that she probably has some issues with him.

She also gave me a prescription for the pen in another Doctors name, but she signed for it. Is that normal?

I'm 24, I'm just over my BMI, but its not all fat, I've been weight lifting for a bit and have put on some solid mass, the GP/Diabetes nurse had no issues with my height/weight.


Short version of thread
GlazedDoughnuts has keytones in pee regardless of how many carbs he eats.
His GP gives him insulin.
Another GP intervenes and pretty much interrogates GlazedDoughnut and partner and says NO WAI, MOAR PILLS FOR YOU, you're in early stages of diabetes.
Gives me prescription for insulin pen under another Doctor's name.
GlazedDoughnuts left confused, has his Dr. prescribed him insulin wrongly? Has GlazedDoughnuts done something wrong?
 
Hi GD,

The second G.P. sounds totally unprofessional. She is probably concerned about NICE guidelines in the treatment of Type2 which do not suggest Metformin followed by insulin.
http://www.nice.org.uk/nicemedia/pdf/CG ... deline.pdf

Personally I would ask for tests to define your status. It may be that you are LADA. Newly diagnosed Type2's are not given access to ketone sticks and so they wouldn't know if they have them or not. There is something going on with you and the sooner it is sorted then the better you will feel.

The nurse remarking that you will eventually need insulin is her perception of Type2 being a progressive disease for all of us but insulin rarely follows Metformin for most people.

Make an appointment to see the first G.P. and ask for some explanation about what is going on.
 
With the weight loss, ketones , diet your state of fitness and your glucose levels rising thenI'd go with your own doctor and nurse. They know you, not a doctor you've just talked to on the phone. Ketones and high glucose levels are dangerous.

(note the rest is speculation: we're not doctors! .)

The time of onset of T1 is very variable . In children it may be very rapid, as you get older it may take longer. There is a variety of T1 called LADA* that can take quite a long time to develop It maybe that you have something called LADA which is a slower onset form of T1. This latter can indeed be managed with drugs for a while, and TBH thats what usually happens in the UK but there is some research to suggest that this is not the best way to manage it. Some suggest that the early use of insulin may help preserve some beta cell function for longer.
There are tests that help diagnose whether you have autoimmune diabetes (the most common form of T1) : a c peptide which shows how much insulin and various anti-body tests (including most often one called aniti GAD)
These test however are often not done in the UK, doctors tend to manage the symptoms.
*
http://www.locallada.swan.ac.uk/faq.html
 
Dear Catherine,

Thank you, theres some info I've missed out:

My dad was a T1 diabetic and my mother is a Type 2. My girlfriends brother has been a T1 for 15 years. Between us we know a little bit about diabetes. When my dad was around his diabetes wasnt very well controlled so this led me to learn about the disease a little. The same applies for my partner due to her brother.

I have Ketone sticks at home, this is because my girlfriend is on a Ketogenic diet. She was the first the notice that I may be diabetic, tired after meals, groggy, irritated, waking to pee during very early hours & increased thirst. She asked me to test for ketones, there were plenty present!

She went out and bought a Glucometer to test my blood and we found numbers like 14/16 two hours after meals and fasting levels of 8/9/10.

When I first saw my GP I presented him with the Glucometer, he looked at the results and referred me for a blood test.

When the results came back the second GP (not the same as last nights GP) said I'm a bit young for Type 2, dont appear to be obese but in any event gave me Metformin and asked I see the Diabetes nurse.

When I met with the Diabetes nurse she checked my fasting glucose (it was a early morning appointment and I had not ate prior to the appointment, but had been on Metformin for a week and a bit) I had also been exercising (weight lifting).
She asked me about my diet, I explained due to the weight lifting it was high in protein, high in healthy fats and mainly consisting of complex carbs such as rolled oats. Each serving of my protein shake as 12g of Dextrose.

The nurse then checked my height/weight and said she's concerned as I'm 24 I shouldn't really be a T2 diabetic. So she asked me to pee in the sample bottle, she noted there was Glucose and Ketones present.

She then said to start thinking about insulin use, but before that to give the Metformin a chance. She sent me away for loads of blood tests, kidney function, cholesterol, liver function, fasting glucose and probably some other stuff. My fasting glucose came back quiet good, 7.2mmol (but I stupidly ate sugary carbs the night before) I noticed when I do this my waking sugars are lower. Yet when I eat slow digesting carbs/healthy foods they're higher in the morning?

The first week of Metformin was nice, but then my numbers started creeping up slowly. I randomly checked for Ketones and each time they were present and not a light colour either, deep pink (it may be purple but I'm a bit colour blind). So I decided to try a few more carbs, drink plenty more water and test for ketones a lot more frequently (they're cheap enough and my GF pays for them :twisted: ). Keytones always present on the darker side of the results. :***:

A month passed by, I saw the nurse. She reviewed my results of the blood tests, she said the fasting Glucose wasn't too bad and that my bad cholesterol is slightly up but nothing to worry about. She noticed the increase in glucose readings and asked how much Metformin I'm taking, I mentioned the ketones.

She looked concerned and told my original GP, he saw my immediately and said my body is using protein for energy rather than carbs, that tells him I dont have enough Insulin, therefore he is putting me on Insulin. He took me off the Metformin.

I have no concern about what my GP has prescribed me.

Unfortunately my GP is now on holiday for 2 weeks, and just before he comes back I will be on holiday for 3 weeks, so I'll see him then and ask for conclusive tests to determine which type of Diabetes I have :thumbup:
 
phoenix said:
With the weight loss, ketones , diet your state of fitness and your glucose levels rising thenI'd go with your own doctor and nurse. They know you, not a doctor you've just talked to on the phone. Ketones and high glucose levels are dangerous.

(note the rest is speculation: we're not doctors! .)

The time of onset of T1 is very variable . In children it may be very rapid, as you get older it may take longer. There is a variety of T1 called LADA* that can take quite a long time to develop It maybe that you have something called LADA which is a slower onset form of T1. This latter can indeed be managed with drugs for a while, and TBH thats what usually happens in the UK but there is some research to suggest that this is not the best way to manage it. Some suggest that the early use of insulin may help preserve some beta cell function for longer.
There are tests that help diagnose whether you have autoimmune diabetes (the most common form of T1) : a c peptide which shows how much insulin and various anti-body tests (including most often one called aniti GAD)
These test however are often not done in the UK, doctors tend to manage the symptoms.
*
http://www.locallada.swan.ac.uk/faq.html
Click to expand...

Hi Pheonix,

I've read those studies too, thats why I'm actually happy about being on Insulin. My old man managed his diabetes poorly and suffered a stroke along with loads of other nonsense, I'd rather grap this diabetes by its thorns and control it :thumbup:

I will ask for a C-Peptide test.

Well no one has the insulin pen in stock, I won't be able to get it until Monday evening, my blood sugars are soaring post meals and I'm registering a fair amount of glucose on my Ketosticks (they test for an array of things).

The Metformin helps a little, shall I take a couple or just leave my levels to elevate?
 
If your readings are soaring then I would either ring an out of hours Dr. at your surgery or NHS Direct. If your symptoms are really bad then you need to go to A@E.
viewtopic.php?f=15&t=24388

I am a Type2 so cannot help much. :(
 
Hi,

Did you get any of the disposable insulin pens from the first prescription, or could you still get them to tide you over until you can get the other one collected? You need something if your levels keep rising.

Your story sounds much like mine. I have had a year of good control as a 'type 2' then my levels started to rise and I began to lose weight again as I had at diagnosis. My Doctor said they were still acceptable and just reassured me that they just wouldn't go up suddenly and not come down and so didn't offer anything other than increased meds. The practice nurse then increased them further. By the time my fasting level had reached 14 another Doctor upped my meds further and finally referred me to the hospital. My tests there revealed keytones of 4.1 and an HbA1C of about 8.6%. The Consultant put me onto insulin there and then and ordered a GAD antibody test (I wanted to be sure I was type 1 as it had work implications for me as I am a coach driver), I got the result of this last week and it was 1943.0 so Type 1 all along. I saw my Doctor on Thursday to fill in a DVLA questionnaire and he said I believe they have classed you as Type 1 now as he waited to tick the box on the form. I said yes they did a GAD antibodies test and it came back at 1943. He looked at me and said that means nothing to me, so I had to explain that such a positive result means type 1.

Stick to your guns, the first Doctor appears to right. If you have any further issues ask to be referred to the Diabetic Clinic at the local hospital.

Hope you get sorted for the weekend.
Regards
Angie
 
Hi. I would go along with the possibility/probability that you have LADA and hence insulin is the right treatment if true. Being T2 at 22 years is highly unlikely. So, the first GP & nurse were right and I would stick to their advice. Go to A&E if you are worried.
 
Cheers, what a helpful bunch.

I went out for a brisk walk and didn't have too many fast digesting carbs, I've maintained an average of 9-10 today, so I guess I'm still making some insulin.

Ketones present all day long today, glucose registered in my sample too, however this was after meals so I guess my kidneys are doing their job and getting rid of the excess glucose :thumbup:

I've felt bad for the last few months, so I'll wait patiently for my Insulin pen.

Angie, :***: Some of these doctors honestly worry me, I'm guess I'm extremely fortunate to have a Doctor who listens to me!
 
GlazedDoughnuts said:
Cheers, what a helpful bunch.

I went out for a brisk walk and didn't have too many fast digesting carbs, I've maintained an average of 9-10 today, so I guess I'm still making some insulin.

Ketones present all day long today, glucose registered in my sample too, however this was after meals so I guess my kidneys are doing their job and getting rid of the excess glucose :thumbup:

I've felt bad for the last few months, so I'll wait patiently for my Insulin pen.

Angie, :***: Some of these doctors honestly worry me, I'm guess I'm extremely fortunate to have a Doctor who listens to me!
Click to expand...

Hi,

Glad you are managing to keep the levels reasonable. Make sure you drink plenty of water / fluids, this will help flush the glucose out and keep the keytones lower.

There does seem to be a wide variation in the knowledge in members of the medical profession. I know GP's can't specialise in everything and I don't think the Doctor I am 'officially' registered with specialises in diabetes in my practice (the Practice Nurse looks after us there) but some of his comments make you wonder if he really knows much about the condition at all. It was like a breath of fresh air to go the Diabetes Clinic at the hospital as they are so friendly, helpful and know what they are talking about. I even got made a cup of coffee when I went the other day :clap:

I hope you manage to keep your levels lowish until you get your insulin, if you start to get higher levels and keytones don't hesitate to get help though.

Regards
Angie
 
Firstly, as others have said, Diabetic Ketoacidosis is a medical emergency. The NHS says
The initial symptoms of diabetic ketoacidosis (DKA) develop when the body detects that ketones are being produced as a result of the breakdown of fat molecules.
The body’s response is to try to flush the ketones out of the body by making you pass large amounts of urine. This will make you feel very thirsty which, if not treated, can lead to dehydration.
Ketones are an acidic chemical, so as more are produced, the level of acid in your blood will rise. The combination of dehydration and high blood acid levels can trigger a range of additional symptoms, such as:
  • feeling sick (nausea)
  • being sick, which can make dehydration even worse
  • abdominal pain
  • loss of appetite
  • shortness of breath
Left untreated, more advanced symptoms will develop, such as:
  • rapid heartbeat (tachycardia)
  • rapid breathing, where you breathe in much more oxygen than your body actually needs (hyperventilation)
  • low blood pressure (hypotension), which can make you feel dizzy and lightheaded
  • a noticeable smell of ketones on your breath, which is often described as smelling like pear drops or nail varnish remover
  • mental confusion
  • unconsciousness (coma)
When to seek medical advice

If you think that you are experiencing the initial symptoms of DKA, and self-testing shows high levels of ketones in your urine, you should immediately contact your GP or diabetes nurse for advice. See preventing DPK for information about self-testing.
If this is not possible, call your local out-of-hours service or NHS Direct on 0845 46 47 for advice.
If you, or someone in your care, appears to be experiencing more advanced symptoms of DKA, go immediately to your nearest accident and emergency (A&E) department.
Click to expand...
Knowing that would have saved me a 3 day stay in the ICU.

Secondly, I think the 1st doctor's decision to assume T2 and prescribe Metformin when you approached him *because* you had ketones present is very questionable. Even if you are on a weird diet which produces ketones, he should have excluded T1 first.

Finally, if the ketone tests are not on the record... what exactly did stop the other doctor from doing another test? You were right there.

I guess my kidneys are doing their job and getting rid of the excess glucose
Click to expand...
Nitpick: That is not their job. The job of your kidneys is to to reclaim all of the filtered glucose back into the bloodstream, which stops working at BG of about 10mmol/l
 
Thank you all, just took my first ever shot of insulin!

I'm on Humalog Mix 50, and I've been given the burgundy pen, I know its not important but its a dark pink colour!!! I'm sure it will fit into my manbag just fine!

I also have a Novorapid 4 Silver Pen that was mistakenly prescribed to me, but of course my Insulin is incompatible :problem:

Today has been a complete mess without Metformin/Insulin, I woke up with blood sugar of 9.5, was extremely tired all day long, lunch only made things worse. Luckily my pharmacy got the pen in.

Well anyway, just before dinner I took my first ever shot, a little painful and odd injecting my belly!

My blood sugar is now 9.3; not perfect but certainly not hitting stupid numbers like 15-18. I'm only on 5 units, so thats 2.5 units of long acting and 2.5 units of fast acting, I guess its no shocker. My doc has asked me to go back soon, i'm guessing they'll adjust my levels.
 
Yes, finding the correct amount of insulin is unfortunately trial-and-error. If you need more help, just ask.

Having said that, did the doctor tell you why they put you on Humalog Mix? In the long run, multiple daily injections (MDI) will be more flexible - with mixes, you'll have to eat fixed meals at fixed times. [And NICE guidelines say to "Offer MDI regimens to young people (11 years or older; see below for under 11 years)"]

I hope you'll be feeling better soon.
 
Yeah he put me on this mix to 'try it out for a week' but gave me six 3ml cartridges :lol:
When he said Insulin I did ask if he's giving me bother slow/fast acting, he said no he'll give me a mix for now.

I can only assume he didn't want a newbie loose with two different types of insulin.

Ill speak to my diabetes nurse and see if I can get it changed, also I'd like to make use of the Novorapid 4 Silver pen I have!

Back to the gym tomorrow :thumbup:
 
Well i slept well last night, still woke up and had to pee at 3 but my morning blood sugar was 8 and no random pains in muscles like i was getting the last few days.

Im almost tempted to increase my dose by a couple of units but i guess ill wait for the diabetes nurse to "ok" it first.
 
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