Anxiety & Type 2

[johnd1981]

Good morning, hope you are all enjoying the weather!

I was diagnosed with type 2 in 2017 and I've initially struggled to get my levels down. I went on the ultra low calorie diet in October 2023 and I lost a lot of weight and my levels came right down and I was off of empagliflozin and metformin. I got back in to bad habits after finishing the programme and in my latest hba1c (April 7th 2025) was 85. I started taking metformin again but I was really inconsistent with eating and at times I was forgetting to take my medication. It all came to a head when I had a major relapse with anxiety in May. I was taken off Sertraline in August 2024 and after various stressors I relapsed at the beginning of May. I'm still really struggling with the Anxiety which is largely focused around Health Anxiety - I know, pretty weird that I wasn't a lot more vigilant with my Diabetes
Doctor/Diabetic Nurse wanted me to start taking Dapagliflozin + metformin which I had put off starting. I'm scared to take medications and I've had a really dodgy stomach for quite a while with the anxiety. Coinciding with the reoccurrence of my severe Anxiety in May I changed my diet drastically and have cut out all the bad stuff I was eating like chocolate/sweets and reduced portion sizes massively. When I first started testing my bloods again in May they were up around 14mmol/l (morning fasting test). I've now lost 2 stone/12.7kg - (actually lost 9 stone/57kg since 2017) and my levels on a morning are consistently around 7mmol/l and have been under 7mmol//l as low as 5.6. This is with just 1 x 500mg prolonged release metformin taken on a morning. The Doctor advised to stay at this until my stomach settles and then raise to 2 x 500mg and maybe increase thereafter.

I know it's impossible for people on a forum to confirm but one of the things I'm worrying about and that I think is fuelling my health anxiety is the thought that I've damaged myself with the negligence over my diabetes and blood glucose control. I do have the tingly feet, neuropathy? My latest eye test showed background retinopathy in my right eye. I've also had an ECG which showed blood pressure was fine but it said Possible left atrial enlargement and Right bundle branch block. Finally my blood check showed my overall cholesterol levels were fine but my Triglycerides were 4.0mmol/l and my HDL was 0.88mmol/l. All these tests were done when I was eating like c**p.

I've taken major steps to lower my glucose levels with the diet. At the minute I'm finding it difficult to do my walking with the anxiety and also to increase the medication. Hopefully I will increase the activity and meds as I feel better.

I guess what I'm asking is does it sound like I could have had something like Hyperosmolar hyperglycaemic state (HHS) or DKA or could still have them now or is this highly unlikely with my bloods now being down consistently under 8mmol/l?

Thanks if you've made it this far and I'd massively appreciate any feedback/advise.

 

[silver minion]

Sorry to hear that your health is causing you anxiety. It is good that you are working on your diet and exercise to manage your blood glucose levels. Your current fasting levels are going in the right direction. Congratulations on your weight loss. That will help with your overall cardiovascular health as well. It does take time for things to improve. It's often said that managing your diabetes is a marathon not a sprint. Your heart issues may not be diabetes related but I understand your concerns. I don't have any experience of HHS or DKA but someone who is more knowledgeable will hopefully be able to help.
Don't beat yourself up about before. You can't change the past but what you are doing now is good.

 

[Leadinglights]

It is unlikely you have DKA but as a precaution you could get some ketone urine testing dip sticks from the pharmacy.
One thing to remember is you can't change what is past so put that behind you and move forward with a plan of action. It looks as if you have made a good start with some changes to your diet and that will be just as if not more powerful than oral medications so looking at that and focusing on some changes, if you can remember to take the metformin then that may help, taking with food mid meal can help minimise any stomach issues.
Have a look at this link for some ideas for modifying your diet into a new way of eating, finding meals you enjoy won't make it seem like a chore. https://lowcarbfreshwell.com/
Slow progress is better than no progress.

 

[johnd1981]

Thank you both for taking the time to read and reply.

I will order some ketone test strips just as a check. Thanks

 

[everydayupsanddowns]

Sorry to hear you have been experiencing such significant health anxiety @johnd1981

From what I understand of HHS, I think it’s pretty unlikely you have been experiencing it, certainly not when your BG levels have been below 10mmol/L.

Diabetes UK have an overview page, which suggests HHS often exhibits when BG levels are over 40mmol/L (!)

Hyperosmolar Hyperglycaemic State (HHS)

Hyperosmolar hyperglycaemic state (HHS) can happen when people with type 2 diabetes – or undiagnosed type 2 diabetes – have very high blood glucose levels, also called blood sugar levels. By the time HHS is diagnosed your blood sugar levels can often be over 40mmol/l. You may not realise you...

www.diabetes.org.uk

Hope you are also able to get some reassurance about your eyes, heart, and nerves. Many people on the forum have had ‘all clear’ retinopathy results following a ‘background’ letter. I’ve been through that cycle 3-4 times now, and I’m currently all clear.

I've now lost 2 stone/12.7kg - (actually lost 9 stone/57kg since 2017) and my levels on a morning are consistently around 7mmol/l and have been under 7mmol//l as low as 5.6.

Congrats on the terrific weight loss! And those levels look really good.

Keep going! You are doing great.

 

[saffron15]

I was prescribed ketostix. Basically if you are feeling unwell you pee on the stick and check with a colour chart. It says if opened should use within 6 months. I tested for the first time 6 months after I got them. I was fine. I've now discovered they are cheap and not on prescription. If you have a monitor for BG some also take test strips for ketones but I think those test strips are quite expensive Good luck.

 

[everydayupsanddowns]

I was prescribed ketostix. Basically if you are feeling unwell you pee on the stick and check with a colour chart. It says if opened should use within 6 months. I tested for the first time 6 months after I got them. I was fine. I've now discovered they are cheap and not on prescription. If you have a monitor for BG some also take test strips for ketones but I think those test strips are quite expensive Good luck.

Yes it’s a bit annoying that those pots of 50 urine ketostix strips say they need to be ditched 6 months after opening (and aren’t available in smaller quantities).

I generally only need less than 5 out of a tub, until the pot goes out of date.

Though at £5 ish per pot they are still way cheaper than blood strips, which also go out of date, and are more like £2.50 per strip 😱 😱 😱

 

[saffron15]

I told the person who had prescribed them to me that they go out of date after 6 months and he expressed surprise ( despite being a senior pharmacist) I was really pleased to discover via the forum they do not need a prescription and are a modest price. I will buy a pot when I reach 6 months. I won't ask for another prescription which would cost the health service out of proportion to actual cost.

 

[johnd1981]

Thanks again both. I ordered some ketostix from Amazon yesterday and they turned up earlier.
I tested and it showed 0. I believe from what I've read if I had either DKA or HHS they wouldn't go away on their own without medical intervention, so I think now my bloods are much lower I can relax a bit about that. I'll maintain the healthy eating and increase the metformin when I can.

One thing I've been wondering about the Hba1c test at the doctors is; because that's an average over 3 months does it measure the spikes in sugar levels after eating too? For example, if I test on a morning and get 6mmol/l I'd be happy as that's in range but if after I ate my sugar levels went up to say 12mmol/l for example that would make the Hba1c reading higher?

 

[Leadinglights]

Thanks again both. I ordered some ketostix from Amazon yesterday and they turned up earlier.
I tested and it showed 0. I believe from what I've read if I had either DKA or HHS they wouldn't go away on their own without medical intervention, so I think now my bloods are much lower I can relax a bit about that. I'll maintain the healthy eating and increase the metformin when I can.

One thing I've been wondering about the Hba1c test at the doctors is; because that's an average over 3 months does it measure the spikes in sugar levels after eating too? For example, if I test on a morning and get 6mmol/l I'd be happy as that's in range but if after I ate my sugar levels went up to say 12mmol/l for example that would make the Hba1c reading higher?

Only if you were doing that consistently for a considerable period of time. Occasionally it won't make a difference but the aim is to find meals that keep your 2 hour post meal level to below 8-8.5 mmol/l and before eating to be at 4-7mmol/l for most of the time and then your HbA1C is likely to be in normal range.