Type 2 questions

[Jasmack]

I have had a diagnosis of type 2 diabetes for around 5 years, this is treated with metformin at a dose of 1000mg twice daily.

My BG readings after fasting are around 20-25 and for a significant number of years my GP has been of the opinion that I must be gorging on chocolate biscuits or the like!

After a recent admission to hospital after an accident on my leg I had to have emergency surgery and was fasted for three days.

During this time I had my blood sugar monitored hourly and despite fasting my blood sugar levels were between 18.3 and 24.6, The hospital put me on IV insulin and my levels dropped to 7.1

On release from hospital I was told to go back to my diabetes nurse and was asked to record my blood sugar before & after eating breakfast, lunch and dinner.

I wake with a BG of around 20-22 which drops to around 16-18 after breakfast, around lunchtime my BG is around 18-20 and drops 14-16 after eating and at dinner it’s usually around 16-18 and drops to around 14 after eating.

I’m not overweight, I don’t eat excessively but have some symptoms such as an insatiable thirst, very frequent need to urinate, major sweating issues and frequent light headedness and shaking/ jitters.

I’m really tired of these symptoms and feel my GP isn’t interested, anyone got any idea what is going on or suggestions on what to do next?

 

[Grateful]

Welcome. You have come to the right place. I am tagging @daisy1 who can provide a very useful blurb for newcomers.

 

[Bluetit1802]

Hi and welcome,

When you are testing before and after a meal (at 2 hours after first bite) what sort of rise do you see? Is it more than 2mmol/l at any time?

Your symptoms are those of high blood sugars

 

[Grateful]

I’m really tired of these symptoms and feel my GP isn’t interested, anyone got any idea what is going on or suggestions on what to do next?

Has your GP told you the result of your latest HbA1c blood test? Do you mind sharing that?

 

[Jasmack]

What’s a hbA1c blood test?

 

[Jasmack]

Hi and welcome,

When you are testing before and after a meal (at 2 hours after first bite) what sort of rise do you see? Is it more than 2mmol/l at any time?

Your symptoms are those of high blood sugars

It drops by around 4-6 after eating

 

[Grateful]

What’s a hbA1c blood test?

It's a measure of average blood glucose levels over the previous 8 to 12 weeks. It is the key metric in the diagnosis and long-term monitoring of diabetes. More information here: http://www.diabetes.co.uk/what-is-hba1c.html.

You were diagnosed five years ago. Apparently your GP did not tell you about the aforementioned test. You should try to find out what the number was at diagnosis, and what it is now. And anytime it was tested in between.

I am not a doctor and have no professional knowledge. But your symptoms may indicate uncontrolled Type 2 diabetes, five years after diagnosis. The fact that they had to use insulin during your hospital visit is another clue.

Did your GP give you dietary advice?

Are you taking any diabetes drug other than Metformin?

 

[Jasmack]

It's a measure of average blood glucose levels over the previous 8 to 12 weeks. It is the key metric in the diagnosis and long-term monitoring of diabetes. More information here: http://www.diabetes.co.uk/what-is-hba1c.html.

You were diagnosed five years ago. Apparently your GP did not tell you about the aforementioned test. You should try to find out what the number was at diagnosis, and what it is now. And anytime it was tested in between.

I am not a doctor and have no professional knowledge. But your symptoms may indicate uncontrolled Type 2 diabetes, five years after diagnosis. The fact that they had to use insulin during your hospital visit is another clue.

Did your GP give you dietary advice?

Are you taking any diabetes drug other than Metformin?

Only Metformin 1000mg twice daily

 

[Bluetit1802]

It drops by around 4-6 after eating

Is that 2 hours after first bite, and after all meals? Do you have any exercise during those 2 hours?

If you ring your surgery you can ask for print outs of your blood test results. (assuming you are in the UK) You really need to know what they are. Have you been having regular blood tests at your surgery since diagnosis, and regular reviews with a nurse or doctor?

 

[Grateful]

Only Metformin 1000mg twice daily

@Jasmack: I am so glad you came here.

Once again, prefacing this with: I am just a stranger thousands of kilometers away. The only thing we have in common is we both have Type 2 diabetes. Your doctor should be your main source of advice.

If it turns out that your Type 2 diabetes (T2D) has been uncontrolled for five years (or even longer, since many of us go undiagnosed for years), I would (if I were you) make it an urgent priority to bring those blood glucose (BG) levels under control as soon as possible.

You may be able to get some, or all, of the way there with big changes in your diet. Exercise helps (a little bit) too. This forum is a great source of advice about the "low-carb" lifestyle. Some of us have brought our BG down to normal (non-diabetic) levels using diet alone, or diet+Metformin.

In your case, partly because of the years of high BG, this may be hard or impossible to do. Only you (and your doctor) can figure out whether it is worth a try. If I were you I would give it a strong try though. If it does not work, there are stronger drugs than Metformin, and eventually if all else fails there is insulin, which they already administered to you for a short time.

Hang in there. Awful cliché but: "it's a marathon, not a sprint."

 

[Jasmack]

Is that 2 hours after first bite, and after all meals? Do you have any exercise during those 2 hours?

If you ring your surgery you can ask for print outs of your blood test results. (assuming you are in the UK) You really need to know what they are. Have you been having regular blood tests at your surgery since diagnosis, and regular reviews with a nurse or doctor?

Yes that is 2 hours after first bite.

I have a “review” every three months, I have to fast from 8pm the night before and take in a urine sample, they fill 2 small tubes and 1 larger tube with blood, I go back a week later and I am scolded that my levels are far too high and I am sure that do not believe that I have fasted.

It is only after being in hospital that they have started to take things seriously, in hospital where I was “nil by mouth” that they were able to see my BG levels rising through the day and when they seen it rise to 24.6 that they gave me insulin which saw my BG drop to 7 in the space of 90mins.

 

[kokhongw]

It might be helpful to share what your usual meals are like.

 

[kokhongw]

I’m not overweight, I don’t eat excessively but have some symptoms such as an insatiable thirst, very frequent need to urinate, major sweating issues and frequent light headedness and shaking/ jitters.

The symptoms you described sounds like a glucose/insulin roller coaster.

Have a read and see if this makes sense...
http://www.diabetes.co.uk/forum/blog-entry/newbie-guide-to-t2d.1858/

 

[Bluetit1802]

Yes that is 2 hours after first bite.

I have a “review” every three months, I have to fast from 8pm the night before and take in a urine sample, they fill 2 small tubes and 1 larger tube with blood, I go back a week later and I am scolded that my levels are far too high and I am sure that do not believe that I have fasted.

It is only after being in hospital that they have started to take things seriously, in hospital where I was “nil by mouth” that they were able to see my BG levels rising through the day and when they seen it rise to 24.6 that they gave me insulin which saw my BG drop to 7 in the space of 90mins.

On each of those 3 month reviews you will have had an HbA1c among other things. Fasting does not and never will affect the HbA1c result. This test is an average of the previous 2 to 3 months and what you did the night before or the morning of the test will have zero effect. All it affects is a plasma glucose test (or a finger prick test) which are both snapshots of your levels at the time of the test.

Hopefully now your doctor will sort you out with some more appropriate medication. It would seem Metformin is insufficient on its own. Please see your doctor and take along a written record of your own finger prick results and when each test was taken (before and after food, and what food was consumed)

 

[Jasmack]

It might be helpful to share what your usual meals are like.

Nothing out of the ordinary, toast & butter for breakfast, sandwich & a coffee for lunch.

Meat, potatoes & veg for dinner, Chinese on a friday

 

[miahara]

Ah! It may well be that the carbohydrates in your toast, sandwich and potatoes are the culprits. The Chinese may also figure in the equation as many Chinese dishes are pretty high in sugars and carbs.
I know that my blood sugar rises considerably if I eat bread or potatoes.
You can gain an idea as to what effect different foods have by testing and noting what you ate.

 

[Brunneria]

Hi and welcome @Jasmack

If your readings have been high for so long, with regular 3 monthly reviews, and those blood glucose levels have been running for months, then I think your treatment by the surgery has been appalling.

Those blood glucose levels are too high, and you have escalating risks of diabetic complications the longer they are left unaddressed.
I would be contacting the surgery on Monday and asking for printouts of all your test results since diagnosis, and then asking for an immediate referral to your nearest diabetic clinic.

There is a well established escalation of medication for type 2 diabetics as laid out in the NICE guidelines, and if your doc has been letting you run around with such high levels, and inadequate treatment, then you need to change your doctor.

Please do not let yourself be fobbed off with this.

You may find that you can do a lot with diet to control your own blood glucose, but that does not change the fact that your doctor is not following guidelines with regard to your care.

 

[daisy1]

@Jasmack

Hello Jasmack and welcome to the Forum Here is the Basic Information we give to new members and I hope you will find it useful. Ask questions when you like and someone will be able to help.


BASIC INFORMATION FOR NEW MEMBERS

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 250,000 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.

 

[Resurgam]

Nothing out of the ordinary, toast & butter for breakfast, sandwich & a coffee for lunch.
Meat, potatoes & veg for dinner, Chinese on a friday

Oh I could weep - no actually I am leaking a bit.
It looks as though no one ever explain that by changing your diet you can lower blood glucose quickly - they just let you go on eating carbohydrates and pushing up your blood glucose to the levels you report
I know that there is such antipathy towards people like Dr Atkins and his fad diet that stops diabetes in its tracks - but for me it just turned everything around. No high blood glucose, easy weightloss, lots of energy and feeling very happy.
I can't promise that you'll get the same results as your pancreas has been suffering all this time, but it might be worth trying a total rethink of what you are eating in the hope that if you eat low carb foods then your symptoms will at least reduce.
You might need to have insulin injected if your own insulin producing cells have died off, but if you follow the low carb approach you should at least go down into more normal less damaging levels whilst you get this sorted out.
Your BG levels falling through the day might indicate that your insulin resistance falls as the day goes on, and that there is insulin there, just being ignored most of the time. There are differing opinions about the causes of insulin resistance and how to remove it - but I'd advise concentrating on reducing carbs in your food and seeing if that lowers your BG - it has done for many, so fingers crossed it can help you.

 

[Grateful]

If your readings have been high for so long, with regular 3 monthly reviews, and those blood glucose levels have been running for months, then I think your treatment by the surgery has been appalling.

I completely agree with @Brunneria. Indeed, earlier today I wrote something similar (but much less well written or informative) in which I gave an opinion of your doctor's attitude and treatment. Then I decided not to post it because I have a lot less experience than people like @Brunneria. It is always hard to second-guess a doctor.

I am so sorry that you've had such shoddy treatment. I am also so glad that you have come here. I really hope you can sort out what seem to be multiple problems (and possible actual neglect) at your surgery.

We are here to help.

You have probably done this already, but if not: Writing a set of questions for your doctor, in advance, could help. It needs to be very short (in my experience) because the consultations are seldom more than a few minutes. That makes it all the more important to express your key concerns and try to get answers to them.