T2DM Hyperglycaemic despite low carb diet

[Bex72]

Lots of factors at play so probably a complex one to unpick:
Type 2 since Early August 2020, very well controlled with Low Carb diet.
Taking Sertraline antidepressant sine Dec 2021, aware that this can make BG harder to control.
Feb HBA1C 48mmol/l. Thyroid tested and told it had become under active and to increase thyroxine (Hashimotos diagnosed 14 years ago).
HBA1C in June 2022 was 79 mmol/l
High stress for years, several v stressful situations in succession. On waiting list for counselling.
Tried Metformin in the early days and stopped due to extreme nausea etc.
Late June tried Gliclazide for 2 weeks, severe hives, possible reaction. Stopped and switched to slow release Metformin. BG still rising, dose doubled after 4 days. BG still rising So prescribed linagliptin in addition ( I cannot take over 1000mg of sr Metformin as my kidney function has just been identified as not being good). Still have hives, so taking daily antihistamines.
A couple of days in and levels still rising (last night was 26.7mmol/l and 19.6 this morning).
DN doing a dip test on urine today and says if ketones present I will need to attend A&E, likewise if levels still high in a couple of days I should attend A&E.
I get a warning sign of high BG by way of blurred vision. I’ve had this for several weeks now and am not driving as a result.
I am trying to counterbalance stress but am now feeling quite ill.

If anyone has a similar experience, it would be good to hear. Equally, any advice welcome. Thank you

 

[Mbaker]

At this stage all of thr Type 1 tests may need to be done. You might have been in the honeymoon phase previously when diagnosed as Type 2.

 

[Oldvatr]

If your sugars are in the twenties, and you are still low carbing, then please make yourself aware of the possibility of diabetic ketoacidosis. It is not a good day to become severely ill since the NHS ambulance service will not be quick to respond if you need them. One symptom of DKA is fruity breath and sweat, so do you have somenone with you to keep watch? You will not smell it yourself. Please do not delay calling for assistance if you feel unwell especially in this heat in the Red Zone today.

 

[Antje77]

A couple of days in and levels still rising (last night was 26.7mmol/l and 19.6 this morning).
DN doing a dip test on urine today and says if ketones present I will need to attend A&E, likewise if levels still high in a couple of days I should attend A&E.

This sounds like your DN is aware of a possible misdiagnosis, and with those numbers testing for ketones is a wise course.
If you feel unwell in any way, but especially stomach ache or nausea, go to A and E, a possible ketoacidosis is an emergency.

You'll want a referral to an endo, and tests to see how much insulin you're producing yourself (C-peptide).
If low, they might want to test for antibodies as well.

Auto-immune conditions often come in groups, so your Hashimoto's puts you at larger risk for T1.

Take care, and don't hesitate to seek urgent help when in doubt!

 

[Daibell]

Hi. You could be a Late onset T1 and not T2. Ask for the two tests for T1 i.e. GAD and C-Peptide to be done urgently It is likely you will need to move on to insulin. Yes, if you stay with a BS reading in the 20s go to A&E if you feel unwell. I've been down this route and my GP initially refused me insulin as she didn't understand LADA and assumed at my age T1 was impossible - she was wrong.

 

[Bex72]

Thanks all so much for your replies, you realised what I hadn’t. I’ve now been diagnosed with LADA, although of course a blood test has been sent to lab too. My ketones were 2 and bg 22mmol/l. I did go to A&E and was seen and treated rapidly. The triage nurse said they’d do the tests quickly in case they needed to be bricking it, this humour really made me laugh. Fortunately no DKA but on the way to it. The nurses and doctors have all been superb. It will be my third day here tomorrow. Hopefully my bg will fall enough to get home soon. Lots to learn now about autoimmune diabetes. I’m also having problems with hives which is possibly autoimmune. I have very swollen, irritated skin and the skin around the cannulas is joining in. Antihistamines are becoming less and less effective. The ketones are back to normal, bg hovering between 19 and 22 mmol/l. Thanks again for your helpful advice and sharing your knowledge. I was quite tearful when told but at least I now know there was a reason for feeling so unwell and I can be well again.

 

[Antje77]

Hi @Bex72 , I'm very relieved you've had a rediagnosis. Not a diagnosis you wanted but with it you can start working out how this T1 thing works and get better.
I've been worried about you, looks like you're off at a good start now.

I hope it will become a second nature quickly, just a part of your life.

Have a hug!

 

[Bex72]

life.

Thanks so much Antje 77, I’m at home and finding some aspects of LADA easier than expected and some harder. The insulin injections are simple and painless. I am struggling to balance food, insulin and activity. Lots of hypos and hypers. This is a real learning curve. I’m sure I will get there. I’ll be calling the community diabetic nurses in the morning for advice though. I have blurred vision still and it will be an enormous relief to see clearly again. Thanks again for your kind words xx

 

[Antje77]

Thanks so much Antje 77, I’m at home and finding some aspects of LADA easier than expected and some harder. The insulin injections are simple and painless. I am struggling to balance food, insulin and activity. Lots of hypos and hypers. This is a real learning curve. I’m sure I will get there. I’ll be calling the community diabetic nurses in the morning for advice though. I have blurred vision still and it will be an enormous relief to see clearly again. Thanks again for your kind words xx

I'm so happy you are taking it in your stride and at least don't have a problem with injecting!
I never found that part an issue either, but for the ones who do it can make their life much more difficult.

It definitely takes time to find the right doses.
The thing which helped me most was testing ridiculously often (before I had my Libre) and keep meticulous notes of food (carbs), doses, activity and the times of all these things in relation to my BG.
I did this by making a grid on a sheet of lined paper with the hours of the day on top for colums, and rows for insulin dose, food, BG, activity and notes.
This way I could easily see connections between all those things, and also patterns over the days to learn to tweak my doses. For instance, it quickly showed me I needed a lot more insulin for the same amount of carbs in the morning than in the evening, which very much surprised my practice nurse who was treating me at the time (I was a supposed T2 still then).

If you can get hold of a Libre sensor, you can use it pretty much the same way: it allows you to record doses, carbs and exercise, which will then appear at the right points in your graph.

The blurred vision is very likely your eyes needing to adjust to changing bg levels, it will go away! Try if cheap reading glasses are of any help for the time being.

Would you mind changing your profile to T1 or LADA? This will prevent confusion when members react to your posts.

Wish you all the best, and don't hesitate to post with questions or to vent when things aren't going the way you want them too!
While we can't give dosing advise, we can think along with you.

 

[Bex72]

I'm so happy you are taking it in your stride and at least don't have a problem with injecting!
I never found that part an issue either, but for the ones who do it can make their life much more difficult.

It definitely takes time to find the right doses.
The thing which helped me most was testing ridiculously often (before I had my Libre) and keep meticulous notes of food (carbs), doses, activity and the times of all these things in relation to my BG.
I did this by making a grid on a sheet of lined paper with the hours of the day on top for colums, and rows for insulin dose, food, BG, activity and notes.
This way I could easily see connections between all those things, and also patterns over the days to learn to tweak my doses. For instance, it quickly showed me I needed a lot more insulin for the same amount of carbs in the morning than in the evening, which very much surprised my practice nurse who was treating me at the time (I was a supposed T2 still then).

If you can get hold of a Libre sensor, you can use it pretty much the same way: it allows you to record doses, carbs and exercise, which will then appear at the right points in your graph.

The blurred vision is very likely your eyes needing to adjust to changing bg levels, it will go away! Try if cheap reading glasses are of any help for the time being.

Would you mind changing your profile to T1 or LADA? This will prevent confusion when members react to your posts.

Wish you all the best, and don't hesitate to post with questions or to vent when things aren't going the way you want them too!
While we can't give dosing advise, we can think along with you.

Thanks Antje77
I am so pleased that I do qualify for a Libre 2 monitor and funding has been approved. Thanks so much for the information and ideas you’ve shared. This is very kind and helpful of you. Regardless of what I thought I knew about type 2, LADA is a completely different ball game. The community diabetic nurses have been fantastic. My Nan lived with Type 1 for over 50 years and as a brittle diabetic had a very tough life. My childhood was shaped by my father’s constant care for her and the huge impact the illness had on her life. I feel incredibly grateful to have access to modern technology and to know that I will be able to live well. All the best Antje x