Am I cured now?

[JamietDE6]

Morning
need some collective advice. I am heading towards what I suspect is my final clinic appointment for a while. After initial diagnosis 3 months ago (type unknown), I am now averaging 88% time in range. This is 3.9 - 10 mmol. My original treatment was exclusively insulin basal and bolus but now exclusively Metformin 2 g a day.
my question is this. Every morning I hit anything up to 14.5 following breakfast. Typical breakfast maybe low carb slice of bread with an egg or Greek yoghurt with a banana. I am aware of the dawn phenomenon. Often I also find the afternoons will hover between 10-12 mmol. Discussion with DSN recently comments were - this is really good control and also I was told the only reason I see these spikes is because I have a Libre, I did not really understand that logic??
So as I say, if i now live out my days regularly exceeding NICE recommended levels for diabetics what can I expect the long term effects to be? I am left a bit puzzled.

 

[Satan’s little helper]

Morning
need some collective advice. I am heading towards what I suspect is my final clinic appointment for a while. After initial diagnosis 3 months ago (type unknown), I am now averaging 88% time in range. This is 3.9 - 10 mmol. My original treatment was exclusively insulin basal and bolus but now exclusively Metformin 2 g a day.
my question is this. Every morning I hit anything up to 14.5 following breakfast. Typical breakfast maybe low carb slice of bread with an egg or Greek yoghurt with a banana. I am aware of the dawn phenomenon. Often I also find the afternoons will hover between 10-12 mmol. Discussion with DSN recently comments were - this is really good control and also I was told the only reason I see these spikes is because I have a Libre, I did not really understand that logic??
So as I say, if i now live out my days regularly exceeding NICE recommended levels for diabetics what can I expect the long term effects to be? I am left a bit puzzled.

Hello,

Are you checking these Libre numbers against a BG meter? The banana maybe a contributory factor to the “14.5?”

Edit, you see these trends, because you have the Libre. I don’t follow your nurse’s logic either.

 

[JamietDE6]

Hi yes the Libre for me has been incredibly accurate. Even better when you download the Shugga app.I always verify with a BGM but can tell a high anyway usually as my eyes start to feel a bit sore

 

[Inka]

I’d ignore that @JamietDE6 When I was first diagnosed with Type 1, if I ate my normal breakfast and didn’t bolus, my blood sugar would be 3.8 before lunch - BUT after breakfast it spiked right up into diabetic numbers (13 or 14or even 16) Nobody ever suggested me stopping my morning bolus.

Added to that, my breakfast was carby (cereal and toast). More carbs than a banana. Being 10-12 isn’t good either, if you’re there for any length of time. I can’t remember all your history but I’d be considering going back on small amounts of insulin personally. I read that something like 25% of LADAs have no antibodies.

 

[Satan’s little helper]

Hi yes the Libre for me has been incredibly accurate. Even better when you download the Shugga app.I always verify with a BGM but can tell a high anyway usually as my eyes start to feel a bit sore

Was I right in reading you were on insulin. But now “exclusively Metformin 2 g a day.?”

 

[JamietDE6]

Hi Both yes 1 g at breakfast and 1 g for dinner. Thanks Inka I was wondering if I should be adding a small amount of insulin back in to the regimen . DSN seems fixated on removing it though.

 

[rebrascora]

I think you may be doing yourself no favours by eating mostly low carb. My gut feeling is that you may be disguising your LADA by doing this, which is why the DSN is keen for you to be off insulin because they likely think you are Type 2. Many of them have no idea of the power of a low carb way of eating and it worries me that you might be left without insulin if this turns out to be your final appointment.
Spiking up to mid teens on a relatively low carb diet suggests you are Type 1/LADA to me. Do you keep a food diary and show it to the DSN so that they can see what you are eating?

 

[JamietDE6]

Hi Rebrascora. Yes I do record the food associated with spikes on the various apps I have. The DSN has access to my Libre as well. I was wondering about LADA and the possibility of a honeymoon period. After my next appointment I may decide via my GP to transfer specialist care to another hospital as I am between the borders of 3 at my home and the GP is very happy to refer to any.

 

[Satan’s little helper]

Hi Both yes 1 g at breakfast and 1 g for dinner. Thanks Inka I was wondering if I should be adding a small amount of insulin back in to the regimen . DSN seems fixated on removing it though.

Your were diagnosed 3 months ago? Early days yet. You also seem pretty clued up.
Far be it from me to go against an HCP. (I still don’t understand your nurse’s logic.)
But with regards to your insulin. Even lowering carbs as a T1 will never remove the need for it.

Basal, for starters, will always be what you require.

 

[Inka]

Hi Both yes 1 g at breakfast and 1 g for dinner. Thanks Inka I was wondering if I should be adding a small amount of insulin back in to the regimen . DSN seems fixated on removing it though.

I agree with @rebrascora Eating low carb will potentially mask your true situation. I’d consider eating more normally and keeping close records of your food and blood sugar during that time. Then speak to the nurse again.