Wanting to be in the driving seat...

[Mark T]

In about a month and a half I have got my appointment with the diabetes consultant. The first time he saw me, I was put on metformin. Since then I've dropped ~15kg in weight and my HbA1c has dropped from 9.9% to 6.6% - so all good.

I'm suspecting that my next HbA1c will be around 6%. My theory is that it is being driven mostly by my overnight levels. However, my post-prandial response is pretty much unchanged from the beginning - the only thing that has changed is where I start from.

I want to drive my treatment. I have this niggly feeling that he is going to either leave me on my current medication levels or reduce me (the PCT target is 6.5%). But I would rather that he reviewed it and tried to normalise my post prandial response. It would be nice to be able to have a cake occasionally and not have to watch it send me into double figures (OK, I could just have the cake and not test, but I know what it is going to do).

Am I being silly here? or just too much of a control freak?

I don't expect to be able to go back to eating as I did (that would take insulin) but I do find there are little things such as before we might pop into Costa for lunch and a cake after shopping, these days we don't.

 

[Caroline]

I think you are doing pretty well, and it is normal to want to keep tight control. The cake or trip to Costa might send the numbers up a little, but as everything else is going so well, you desrve a treat every once in a while. It is the 'naughty' treats once in a while that help to keep us all sane, but see what others have to say as well.

 

[AlisonM]

I don't think it's an unreasonable aim Mark. I think you might take along a little list to your next appointment so you don't miss out any important points.

 

[Pumper_Sue]

Hi Mark,
it's your body so you should be able to have a reasonable discussion with the consultant regarding your aims and treatment.
As to eating cake you can just make your own and substitute some of the flour with ground almonds and use an artifical sweetner to replace some of the sugar as well. This will bring the carbs down a lot.

 

[Mark T]

...As to eating cake you can just make your own and substitute some of the flour with ground almonds and use an artifical sweetner to replace some of the sugar as well. This will bring the carbs down a lot.

Yes I know, and generally we use this technique if we are going to bake some cookies/biscuits as a treat for me.

However... it's very difficult to get Costa (or XYZ coffee shop/restaurant) to bake theirs with almond flour and sweetener.

 

[Northerner]

I think this is definitely where someone on a fast-acting insulin has a better deal Mark, although I have to say I don't 'bolus for a biscuit' - pumpers have the best deal of the lot in that respect.

I can certainly understand how you feel about your levels going high if you indulge, not so much in a treat, but more just wanting to do something that would once be normal and not 'controlled' by your worries about BG levels. I would stop off for that coffee but probably choose something that would have the least impact, maybe some kind of pastry where the fat would slow the digestion. If you've exercised (done a bit of shopping etc.) prior to it then you will be more sensitive to your insulin so again there should be less impact. Your BMI is now good, if not better than you'd like, so how about a nice cream-filled choux bun or chocolate eclair? I find they hardly affect my levels, although obviously not good calorie-wise. 🙂 Exercise after eating will also help reduce the impact, of course.

I think, in time, you will become more relaxed, but not complacent, and trial, error and experience will teach you what you can enjoy and what to avoid. You've already done remarkably well 🙂

 

[Lilies]

Consultants appointment.... How do I get one of those? Seems my gp is in charge oh and I get a diabetes nurse appt at some point in the next year

 

[Mark T]

Consultants appointment.... How do I get one of those? Seems my gp is in charge oh and I get a diabetes nurse appt at some point in the next year

I got mine because at the time I was diagnosed they could not tell if I was a Type 2 or not (based on age, weight, etc). Some hospital diabetics centres do allow self-referral (not-mine) but most need a referral from your GP.

 

[veganlass]

I am going to be in the driving seat and as its my body. I will be in control.

I have lost 1st 3lbs since March. My Bg's are coming down and mostly pre meals in single figures now. I plan to lose another 7 lbs and then (HBA1c permitted) will only test occasionally , as I dont want to be paranoid about testing.

My first HBA1c is tuesday and I hope (gut feeling) it will be about 5.

I plan to get my HBA1c 3 monthly as I guess thats what the DSN will suggest.

Heaven only knows if I get a consultant appointment. Not been mentioned yet, perhaps the DSN is awaiting HBA1c result. I see she has a diploma in Diabetic care so she is obviously quite knowledgeable.

 

[mcdonagh47]

I'm suspecting that my next HbA1c will be around 6%. My theory is that it is being driven mostly by my overnight levels. However, my post-prandial response is pretty much unchanged from the beginning - the only thing that has changed is where I start from.

I want to drive my treatment. I have this niggly feeling that he is going to either leave me on my current medication levels or reduce me (the PCT target is 6.5%). But I would rather that he reviewed it and tried to normalise my post prandial response. .

Not much he can do about post prandial responses other than Rapid acting insulin - you have lost your First Phase Insulin response, the commonest feature of T2 diabetes.

 

[Northerner]

I am going to be in the driving seat and as its my body. I will be in control.

I have lost 1st 3lbs since March. My Bg's are coming down and mostly pre meals in single figures now. I plan to lose another 7 lbs and then (HBA1c permitted) will only test occasionally , as I dont want to be paranoid about testing.

My first HBA1c is tuesday and I hope (gut feeling) it will be about 5.

I plan to get my HBA1c 3 monthly as I guess thats what the DSN will suggest.

Heaven only knows if I get a consultant appointment. Not been mentioned yet, perhaps the DSN is awaiting HBA1c result. I see she has a diploma in Diabetic care so she is obviously quite knowledgeable.

I doubt if it will be as low as 5 veganlass, so don't be disappointed if it is higher! 5% is on the low side even for a non-diabetic and if your pre-meal figures are only recently into single figures I think that you are more likely to get something in the region of 6.5-7.5%. My lowest HbA1c since diagnosis was 5.2% and that was due to readings in the lower end of normal (i.e. in the 4s and 5s), plus many hypos (below 4). It is currently 5.4% but I have much better levels than you have been having as you are relatively newly-diagnosed. I have known people with an HbA1c at 5% or below, but it is very rare.

I'm not trying to dash your hopes, just hoping that you don't raise your expectations too high!

 

[Mark T]

Not much he can do about post prandial responses other than Rapid acting insulin - you have lost your First Phase Insulin response, the commonest feature of T2 diabetes.

Well on the 600 cal diet they claim that the people got their first phase response back, so ..... actually, no, I don't want to go there 😉

Putting negative side effects to one side, I'm questioning whether a sulfonylurea or even a meglitinide might be better for me at this stage then metformin. Obviously I must of had some degree of insulin resistance and insulin secretion ability to be able to put weight on. But I'm not convinced that I have huge amounts of either right now.

From what research I've done, Victoza might be a better choice (it apparently is good for weight maintenance and isn't so prone to hypos) - but I doubt they would let me anywhere near that given it's cost.

The main factor will be if I can maintain my weight with eating extra rather then dropping like a stone (and yes cream cakes are tempting Northerner 🙄)

 

[trophywench]

Ho Hum.

These days, it is my understanding that a DSN can only be a DSN with a University degree which can only be obtained at a University whilst simultaneously working exclusively in the Diabetes clinic (and Mental Health SN's in the Psychiatric dept etc)

A Diploma in diabetes care round these parts means the nurse has attended Warwick Uni Med School and done their course, which I'm assured takes a whole afternoon ......... I have a feeling my informant was a bit wrong about that and it probably does take longer - they do tend to be fairly competent over at Warwick when all's said and done ..... but in any event her diploma however good they are there, does NOT make my GP surgery nurse that did it, a DSN.

 

[Northerner]

Ho Hum.

These days, it is my understanding that a DSN can only be a DSN with a University degree which can only be obtained at a University whilst simultaneously working exclusively in the Diabetes clinic (and Mental Health SN's in the Psychiatric dept etc)

A Diploma in diabetes care round these parts means the nurse has attended Warwick Uni Med School and done their course, which I'm assured takes a whole afternoon ......... I have a feeling my informant was a bit wrong about that and it probably does take longer - they do tend to be fairly competent over at Warwick when all's said and done ..... but in any event her diploma however good they are there, does NOT make my GP surgery nurse that did it, a DSN.

It would seem to depend on what level the Diploma is at. A postgraduate diploma is a full year, and presumably this is what qualifies a DSN. A quick google reveals a diabetes course for primary care nurses running over 4 weeks, which I imagine is the kind of course more practice nurses undertake.

 

[HelenM]

A Diploma in diabetes care round these parts means the nurse has attended Warwick Uni Med School

seems that at Warwick a certificate in diabetes care takes 6 full study days plus a case study, audit of care and 3000 word project.

a Masters in Diabetes is one year full time but longer part time, that needs 180 CATs, or you can do a bit less (same courses) and get a Postgraduate Certificate (60 CATS), a Postgraduate Diploma (120 CATS).

They do some non certificated courses. There's a 3 day one ' Intensive Management in Type 2 Diabetes'

http://www2.warwick.ac.uk/fac/med/study/cpd/subject_index/diabetes/