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The diagnosis I've been expecting . . . . .

A

andrew_333

Active Member
Messages
27
Hello all

At the end of last April I had a blood test because my blood pressure was a little high. The result showed a high level of glucose, so I was sent for an HbA1c test and a GTT and warned that I was almost certainly diabetic. I felt quite badly done to because I'm not anything like overweight, I regularly do 10 - 15 mile mountain walks and my diet is reasonably good. I'm guessing it's genetic because my dad was T2.

Because I have an absolute phobia of blood tests I put it off and off until last week, but I did join this forum and read up on all the useful information, and realised that low carbing was the way to go. On reflection I was quite horrified at the amount of bread, potatoes and crisps I shovelled into myself! So since the beginning of May I've been eating as if I had already been diagnosed.

So when I went to get the results this morning my poor GP was very confused because the GTT clearly showed I was in the diabetic range, but my HbA1c came back at a fantastic 5.4, or 36 in new money. He just couldn't understand it, so I had to confess that without a formal diagnosis I had already started a low carb diet.

So I'm obviously disappointed to find out that I am T2, but I'm delighted with the HbA1c result :lol: My GP was very helpful - he didn't flinch at my low carb diet, and was sympathetic about my blood test phobia when it comes to medication for blood pressure. I see the diabetic nurse tomorrow for "advice" and to discuss cholesterol etc., so hope she is also enlightened about diet and treatment.

Although my HbA1c result was good, I've been put on 500mg of Metformin, which I'm actually glad about because of the benefits to the heart. And there was no quibble when I asked if I could have the modified release tablets :D I didn't ask about self testing because I really didn't think I had a chance, but I will probably do that myself anyway - if I can get round my phobia of even little needles :oops:

Even though I've been reading loads on this site over the past few months I'm sure I will still have some questions for those with more experience, but for now I'm thinking it could have been a lot worse! :|

Andrew
 
Hi Andrew and welcome to the forum, I know you have already been looking at all the threads but now you are a member you will also get the benefit of all of us at your fingers tips as well. :) Do ask as many questions as you want as the folks on here are so friendly and helpful, they are worth their weight in gold.

You seem to have followed the same route as I did. I suspected I was diabetic a couple of months before my formal diagnosis, found this forum and started low carbing. Come my blood tests I got a lowish HbA1c but a dismally high GTT. Luckily my GP saw the funny side when I sheepishly
girl_blush.gif
admitted to low carbing and to my delight he told me to carry on the good work. I have just had my first 6 monthly HbA1c test so fingers crossed my change in diet will be vindicated yet again.
 
Hi Andrew and welcome to the forum :)
Here is the information we give to new members, in case you haven't already seen it. Ask all the questions you like as there will always be someone who can answer.


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 30,000 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

Another option is to replace ‘white carbohydrates’ (such as white bread, white rice, white flour etc) with whole grain varieties. The idea behind having whole grain varieties is that the carbohydrates get broken down slower than the white varieties –and these are said to have a lower glycaemic index.
http://www.diabetes.co.uk/food/diabetes ... rains.html

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

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.
----------------------------------------------------------------------------------------------------------------------------------------------------

Please sign our e-petition for free testing for all type 2's; here's the link:
http://www.diabetes.co.uk/petition/

Do get your friends and colleagues to sign as well.
 
Hi Andrew and welcome :)

Stunning result and a great doctor so well done :clap: :clap: :clap: Make sure you let the DSN know why things are working out for you. The more GP's and DSN's who we can convert the more people we can help.
 
Well xyzzy, doesn't look like my DSN wants to be converted! After feeling quite positive following my visit to my GP yesterday the DSN has managed to thoroughly depress me today. She blathered on about the risk of complications and, predictably, stressed the importance of carbohydrates when I told her I'd reduced my carb intake by more thn 80%.

She also reckons that I'm "probably" T2, but because I'm only 46 and not at all overweight I might be T1 - NOT what I wanted to hear!! She was also concerned because I'm losing weight - not a dramatic weight loss but a steady and noticeable loss, which I put down to no more than low carbing. Having said that, I can't really afford to lose much more weight so hope that it stabilises by itself . . . . .

She gave me a booklet produced by the local health authority which stresses the importance of carbs and low fat. I have also been invited onto a four week "xpert" course and referred to a dietician, who will probably spout the same thing.

I've been asked to go back for foot screening next week, and on a more positive note she did say she was going to give me a blood glucose meter, though I don't know how many strips I'll get.

Apparently my GTT result was 11.6, so I'm only just into the diabetic threshold. And with an HbA1c of 5.4 (36) I was feeling quite chipper. But it doesn't take much for a so called "health professional" to knock your confidence. All in all it wasn't a positive experience :cry:
 
Unfortunately some are designed that way lol. Not good I know, think they don't like it when we know a little more thatn they do.
Anyone know how long the course is to turn you unto a diabetic nurse?
 
Think you are lucky then Squire. I've just been searching, the nurses at my practise have been there a long time, and maybe they have worked with diabetics for a while. As T2 is more prevalent just wondered how up to date they are.
 
Yes I believe I am lucky. I just Googled her and here she is.


**** ********, Nurse Practitioner
RGN, BSc (Hons), Diploma (Critical Care) DIP NARTC Asthma, DIP Diabetes & Womens Health (PMTC)

I feel I am fortunate.
 
andrew_333 said:
Well xyzzy, doesn't look like my DSN wants to be converted! After feeling quite positive following my visit to my GP yesterday the DSN has managed to thoroughly depress me today. She blathered on about the risk of complications and, predictably, stressed the importance of carbohydrates when I told her I'd reduced my carb intake by more thn 80%.

She also reckons that I'm "probably" T2, but because I'm only 46 and not at all overweight I might be T1 - NOT what I wanted to hear!! She was also concerned because I'm losing weight - not a dramatic weight loss but a steady and noticeable loss, which I put down to no more than low carbing. Having said that, I can't really afford to lose much more weight so hope that it stabilises by itself . . . . .

She gave me a booklet produced by the local health authority which stresses the importance of carbs and low fat. I have also been invited onto a four week "xpert" course and referred to a dietician, who will probably spout the same thing.

I've been asked to go back for foot screening next week, and on a more positive note she did say she was going to give me a blood glucose meter, though I don't know how many strips I'll get.

Apparently my GTT result was 11.6, so I'm only just into the diabetic threshold. And with an HbA1c of 5.4 (36) I was feeling quite chipper. But it doesn't take much for a so called "health professional" to knock your confidence. All in all it wasn't a positive experience :cry:
Click to expand...

Unfortunately some of the DSN's people report are very stuck in their ways and some really have very little knowledge. Did you realise that a lot of gp practice dsn's have no formal diabetes training they are a practice nurse who has been delegated to do the diabetes. Ask to see her certificates :) I am lucky as mine is a lovely caring lady who even though was very suspicious of my evil low carbing ways when first diagnosed showed great interest once she saw it working in practice. She even arranged for me to see the practice specialist diabetes gp so I could tell him what I did but he already knew and is very supportive.

The "probably T2 " comment may have some truth in it especially if you were not overweight at the time of diagnosis. There are more types of diabetes than 1 & 2 specifically LADA or 1.5 which is a late onset variant of T1 where your pancreas slowly begins to cut out. The fact that you have been able to reduce your hBA1c back into the 5's would suggest you pancreas must be producing some insulin. If you are concerned then go back and say "Probably T2 isn't good enough I want a c-peptide and GAD tests that will tell me if I'm T2 or LADA". You may need to put up a fight as the tests cost quite a lot.

If you've cut your carbs by 80% then you may simply not be getting enough calories to maintain your weight. You can try one of the specific regimes like the Mediterranean diet or do what I do which is to follow a low carb high fat regime. It sounds bad but my cholesterol levels have actually normalised since adopting it and I am now of normal weight and managed to come of the statin with my docs consent. I am still gradually losing weight but know I could easily stop just by upping the fat content of my diet a fraction. For ideas look here http://blogg.passagen.se/dahlqvistannika/?anchor=my_lowcarb_dietary_programe_in which is done by the doctor who does loads of dietary recommendations for the Swedish Health service who actively recommend various carbohydrate restricted regimes for diabetics. For more general advice look here http://www.dietdoctor.com/lchf which is the English version of the main Swedish site that advocates lchf. The other alternative is of course to eat more carbs but expect to have to take stronger prescription medication to maintain your hBA1c

Not an expert but I can't see your weightloss as being down to that experienced by undiagnosed T1's. If you weren't on a low carb regime then a simple test would be to see if you have ketones in your urine as that's a common sign of T1 when accompanied by weightloss. Trouble is on a 20% regime you might detect ketones because your diet may have at least partially put you in Ketosis which is fine (some members have been on Ketogenic diets for years) so long as its not accompanied by raging high BG's.
 
Hi Andrew. Although your DSN was spouting the usual NHS rubbish on diet, it was good to hear she was considering late onset T1 as an option; that's quite enlightened. My diabetes GP only knows two types of db i.e. vanilla T1 & T2. She said it was very unusual when I told her my 22 old nephew was diagnoed as a LADA.
 
Thanks for your replies, Daibell and xyzzy.

My GP practice has three doctors and two nurses, and I don't think any of them have had any specific training in diabetes. The DSN's advice consisted of the usual NHS diet advice and a few booklets. Oh, and we talked about cholesterol because mine is a little high, and she assured my that cutting down on carbs will NOT improve cholesterol. Lots of people know different!

I'm hoping I'm not LADA even though I know it's a possibility. I haven't really had any symproms, and the high blood glucose was only picked up because I had a blood test for something else. And I've so far managed excellent control with diet, though I haven't started home testing yet to get a clearer idea. In hindsight I did have a noticeable thirst and increased uirination but nothing dramatic, and that has now completely gone. Also, my dad was diagnosed as T2 before he was sixty, and he was also slim and physically much fitter than me. So it might be genetic for me, but I'll have to watch out to see if symptoms develope.

Thanks for the links for the diets, xyzzy. I'm sure my weight loss is related to my low carbing. When I think of how much potatoes, bread and crisps I used to shovell into myself I've probably actually reduced my carb intake by nearer to 90%. I definitely need to up the fats!
 
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