Puzzled following a Consultant review

[DavidJ]

Hi there

I am just looking for a little advice following an initial appointment with a consultant to review my diabetes.

In early August when I was diagnosed following elevated BG levels in a routine medical with work i was promptly diagnosed with diabetes as my fasting BG was 14.8. The only symptom at the time in looking back at things was the way the weight was falling off me but apart from that I was feeling fine. Because of the severe impact on my employment as an air traffic controller I immediately unloaded my system by diet, which has been since reviewed as fine by an NHS dietician and I am also on 500mg of extended release Metformin a day.

A couple of weeks after diagnosis the first A1c came back at just 5.7% but I had been warned this would be much higher and this surprised my GPs who then sent me to see a consultant because of the still question mark hanging over Type. Anyway I saw a consultant last week who without letting me even speak diagnosed me as a Type 2 beacuse I am overweight with a BMI of 27 and my cholesterol was just under 6. I tried to ask why I was getting very high post prandial peaks e.g 14 some 2 hours after eating say porridge and was told to just ignore these and not to test. Also my A1c had now dropped even further to just 4.9% and the only explanation offered as to the initial A1c and very high levels I was picked up on was that I was luckily just diabetic for a couple of days before my medical and it was just fortunate it was picked up.

Now the question I ask is does this all sound to good to be true for a Type 2? The consultant did end the conversation stating that he might in the months to years ahead have to rediagnose me as a Type 1, now investigating C-Peptide and insulin levels. The intial weight loss was more characteristic of that Type thus giving some doubts but I just feel slightly uneasy that as a supposedly well controlled now Type 2 I will be hospital monitored every couple of months which seems very strange thus putting a lot of pressure on regaining my medical certification for my employment.

Please excuse me long story but would be grateful for some thoughts.
Many thanks David

 

[cugila]

Hi David.
I am presuming that the Consultant you saw was an Endocrinologist ?

I am rather surprised to see the comment, " luckily just diabetic for a couple of days before my medical and it was just fortunate it was picked up." That is rather an odd statement. :?

In my view, although you have already had a second opinion I think in your position I would get another one, even if I had to pay for it myself. Too much is at stake here to be uncertain as you obviously are.

 

[catherinecherub]

What a relaxed attitude this man has to your health!!!
You don't need a "maybe" scenario and the sooner it is sorted then the better for you and your management. Don't accept his reply but, as cugila says, get a another opinion.

 

[hanadr]

David
INSIST on a proper diagnosis.
Hana

 

[DavidJ]

Thanks very much for your replies. That pretty much sums up my thoughts on the matter. The consultant concerned could not even grasp how diabetes could be effecting my medical licensing. As well as blood glucose levels kept low it also has to be proved that there is no heart issues, kidney, eye and neurpoathy involvement and it will maintain that way. There is very strict criteria laid down by the Civil Aviation Authority which is fully understandable and I suspect my employers will be seeking a second opinion themselves on the way forward. At 39 I have to many years ahead in my work but before all else for my own health perspective need to fully understand what is happening. A couple of people have recently mentioned things like LADA or MODY, could that be why he is keeping his options open but not clearly stating the point to me?

Thanks
David

 

[Spiral]

Excellent advice already.

I think you need to understand how the mechanism that affects blood sugar control works. T2 does not develop overnight and I also find that a puzzling statement. I'm sure others may have helpful references for you, but I found bloodugar101.com really helpful in understanding what was going on in my body. There are also sections on the differnt kinds of diabetes on that website.

I hope you get your questions answered.

 

[phoenix]

I have to say that it does sound as if your doctor is not certain at the moment .I think that it's to his credit that he is monitoring every few months and doing c peptide and insulin tests, I've read far too many cases where this doesn't happen. Sometimes the diagnosis is not clear cut. I think it sounds as if he needs to brush up on his communication skills.

LADA is a slow developing form of type 1, it can several years before the person becomes insulin dependent.
Here is website that explains about LADA.
http://www.locallada.swan.ac.uk/faq.html

MODY is a genetic form of diabetes. The site referenced above is an excellent source of info on MODY (the owner of the site has MODY and has found a lot of info on it)
MODY page http://www.phlaunt.com/diabetes/14047009.php

 

[jopar]

as Phoenix has said it's good that they are carrying out the c-peptide tests has this should hopefully provide more information to what type you are...

As you said, your diabetes was picked up in a routine health check carried out via work so it is possible that they've picked up the diabetes before it started to show symptoms which would explain your good A1c's...

It is likely that the consultant wants to review your condition as do you really want to wait 6 months to be told what the out-come is for your C-Peptide test?

I am surprised that he hasn't ask for you to monitor your blood glucose levels, as I would imagine this will provide good back ground data to support the blood tests, perhaps a wise move would to see your GP ask for the test strips so that you can collect this data which you feel will both help you to be pro-active, but also provide valuable data for clinic!!!

 

[DavidJ]

Thanks again for the replies. I have been very closely monitoring my figures from the time of initial diagnosis, even though my GP will not write a prescription for test strips ( Ebay is a saviour ). What I find strange is the fact that the lowest pre meal figures I will see and those first thing in the morning prior to any food are in the regions of 6 to 7. Post meal spikes are considerably higher yet I still come out with the A1C at 4.9%. By running averages through the convertors this does not seem to tally with what I am seeing from my own monitoring.

Cheers
David

 

[LittleSue]

Might be worth asking the Civil Aviation Authority to recommend an Endocrinologist for you to see. I used to work for a Cardiologist who monitored any pilots in the region who'd been diagnosed with heart problems, testing them every few months to ensure they were still safe to fly. I think the CAA paid for this (not 100% certain). I wonder if they have an Endocrinologist to do the same with diabetic/borderline diabetic staff? If so s/he should be fully aware of the employment issues.]

Regular hospital/GP monitoring is normal for diabetes, of whatever type. You can't just do tests at diagnosis and assume everything stays the same. If only it were that easy! Every 2 months sounds a lot, may be because of the doubt about type or because of your job.

 

[increasingly cynical]

Hi,

Your consultant seems to be blase (as many are); but whether you are type 2 or type 1 you will not be able to fly safely if your BG levels are uncontrolled. More to the point, if they diagnose you as Type 1 /LADA or similar you will lose any fliying license instantly. I fly helicopters (now sadly for personal use only); as a Type I/LAda I have kept my ability to do so only by not taking any medication - it is the medication (whether for type I or Type II ) which loses the license - high blood glucose does not generally put you at risk, although it would not be sensible ot take risks, it is the low BGs induced by medication that the aviation and driving authroities are (rightly) concerned by. So, if continuing to drive or fly is a particular aim, you need to control your BGS by diet or other "non-medical" means.

Good luck