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After hospital visit.

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Lanny

Well-Known Member
Relationship to Diabetes
Type 2
GP nurse visit yesterday & hospital visit today went quite well! 🙂

GP nurse said it was a bit pointless to test if I’m LADA now for 2 reasons:-
1- the treatment is the same now that I’m on insulin &
2- they had already kept a close eye on how I responded to medication because I was so young at diagnosis.

My hospital team doctor more or less said the same thing & added that I’d responded well to oral medications for 11 years so, I’m definitely type 2.

As for the thyroid & feeling sleepy after meals, the thyroid is ok & she asked me if I have Apnoea. A condition where you keep waking up while sleeping at night because you stop breathing. I said yes I did have it for years since childhood & thought it was normal until my GP once asked how I was sleeping. I had a nose op done in the mid 1990’s to fix that problem.

I was born with a cleft palette which was operated once on before I was 1 year old. My parents didn’t know you need to keep going back for follow up ops while growing up: done in Hong Kong. That pulled one side of my nose down & narrowed the nostril on that side.

The mid 90’s nose op took cartilage from the inside to open the airway. I stopped having Apnoea & slept through the night. The surgeon at the time did say that cartilage can grow back & if it does I would need another op.

The doctor asked me how I was sleeping at night & I said it depended on whether I do fall asleep after eating or not. She said the problem was actually the other way round: disturbed sleep at night making me tired during the day & hitting me after eating. She’s referring me to ENT (ear, nose & throat) again.

My long term sugars at the end of Feb. 2018 were 82 down slightly from 83 five months earlier & 101 three months before that; one month after being in hospital. I was disappointed that I’d only dropped 1 from 83 to 82. But, she said that was ok as it took some time to find the right doses of insulin for me. Altough my doses were dropped recently because of hypos, 8 in 10 days, & I’m losing weight steadily, 0.75 stone in the last 3 weeks at 0.25 stone a week, that wouldn’t have shown up yet.

This is a different doctor from the one I saw the last two times & I like her bedside manner much better: she explains things & gives me the numbers.

Saw the dietitian & diabetic nurse afterwards. I gave them my food diary to compare with my blood sugars diary. I’m not used to so much praise when they were pleased by how I turned my diet completely around & losing weight. My sugars ARE rising again & my doses are being tweaked slightly again.

I asked them about carbs & cals counting. They said that being type 2 carb counting is not conclusive as an aid but, will teach me to do it when they send me another appointment in 1 or 2 months time. Concentrate on counting calories in the meantime as that will help the weight loss, which helps everything else.

All in all, I’m quite pleased! 🙂
 
Well, Lanny, that all sounds very positive. Not a single area of conflict, and very supportive and proactive. Though they are keen on hanging on to the Type 2 diagnosis. But as they say, you are now on insulin because your pancreas can’t manage to produce enough, so it makes little difference at the current time.

Well done with the diet and weight loss. Carb counting is important to both Type 2 and Type 1, despite what they say, so it will be good for you to start to learn at your next visit.

All in all, a job well,done🙂

Keep up the good work, and don’t lose that team.🙂
 
Oh, yes! The nurse is great. She was awarded an honor in the Queen’s New Year Honor’s List! 🙂
 
Sounds good @Lanny and positive
 
Sounds like a very positive appointment Lanny.
 
Sounds like you had a pretty good aappointment.

One thing that helped me gain much better control was going on MDI and carb counting , so I disagree with her there.

Imo it’s not actually very hard and their is no mystery to it, I found finding out the ratio I needed needed for x amount of carbs the hardest part, it takes a bit of fine tuning, the fun part is we get to do it every so often lol.
Their is an online BERTIE online course that you may be interested in, please don’t worry about it being for T1, the info I gained on this course helped me a lot
https://www.bertieonline.org.uk/
So did the members here.

I’ll also give a link for basal testing , which we need to do fairly often.
http://www.diabetes-support.org.uk/info/?page_id=120
 
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Thanks, Ljc. I have enrolled on the bertie course & going through it slowly. I keep getting the answers wrong & having to go back. :( But, will get it right eventually.

Do you HAVE to fast for basal tests? I find it extremely difficult to fast since just before switching to insulin & especially now on insulin. I had to plan ahead of the fasting bloodtests to be able to last the night without eating: 2/3 days not on insulin yet & up to 7 days when on insulin. I mentioned it once when I was apologising for doing the tests so late for my annual review. My doctors, GP practice & hospital. & nurses all say that type 2’s on insulin no longer need to fast for blood tests.

But, I DID find the switch to insulin very hard at first. I was eating all day, snacking between meals, as my sugars were going up & down on the insulin doses: no defined meals. Eventually things settled down & I was eating clearly defined meals.
 
Yes it can take time to settle down to a new eating regime.
I no longer fast for my routine blood tests but you have to for basal testing else it skews the results because of you need to take your mealtime insulin. The easiest way is to split it up into sections, perhaps start with the nighttime one have breakfast then have a break then repeat on another day , then do the breakfast till lunch , eat lunch then have a break then repeat it and so on for each meal Don’t try to do it in one fell swoop .

Their are some downsides to being on MDI but the rewards ie better control are oh so much greater.
 
Oh, that basal article was an eyeopener! 😱 😱

Levemir has such a short acting time: not the full 24 hours! I was told by my GP nurse, 6 years ago, it lasts 24 hours & it didn’t matter when I took it as long as it’s the same time everyday. She suggested with breakfast but, I changed it to with Lunch as I didn’t eat breakfast then & got up at different times: always eat lunch around the same time.

The hospital doctor, yesterday, seemed puzzled by why I was taking my Levemir dose at lunch & asked me why? I explained & she didn’t say anything else about it! Umm! o_O
 
I don’t see anything wrong in taking your basal at lunchtime , imo it’s what suits you. I’m no expert but I think their is some variation in how long insulin’s work in us, my Insulatard seems to work for 24 or so hours for others iypt may be less.
 
Lanny - glad you found the 'Basal' article an eye opener - cos I'm the co-author of it! LOL

You do have to fast and the article already says divide it into portions to suit yourself. If you can only manage 2 hours or 5 hours - it doesn't matter as long as you fit practically all 24 hours of the clock in, finally. D clinics advise 6 hour blocks - so you would be about 10 hrs since the last food. eg Lunch at 12.00, bolus insulin expires at say 16.30 so test then and start the 6hr fast and hourly or 2 hourly testing until 22.30, then you can eat. But that's a bit late for most people so I'd probably have an earlier still lunch and perhaps do 4hrs fasting/testing starting at 15.30 so dinner could be at 19.30 which is fine! I don't eat at all between dinner and breakfast which I also often miss anyway - so I can get 12 hours fasting/testing done dead easy. It's no good staying wake to do the overnight part though - your background needs are greater 'awake' than 'asleep'.

The active times of various insulins (except the most modern ones, cos the manufacturers no longer seem to publish such detail when they launch their new products) are also shown on the DSF website. The Levemir graph is fascinating and I find if I whack my computer screen resolution up to 300% or 400% it makes it far easier to follow the lines. Before you start, take your total dose of Levemir, and divide by your body weight (preferably naked) in kgs, to obtain your dose per kilogram.

Whatever that number is, find it on the vertical line on the left of the graph, and follow the line across to the right to see what time the insulin does what. The length of time since you jabbed it in, is on the line across the bottom.

http://www.diabetes-support.org.uk/info/?page_id=428

Once you've done it the first time, it becomes easier, honest!
 
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