Confused

[Annk]

Have been possibly diagnosed with late onset diabetes. Seems to be confusion between type 1 and 2. So have been given metformin, glyclazide and an insulin pen to use as and when I want to eat carbohydrates in the evening. This seems odd to me and my GP doesn’t understand what’s going on. Any advice would be welcome. Has anyone else had this confusion during the early stages of diagnosis?

 

[Bruce Stephens]

Has anyone else had this confusion during the early stages of diagnosis?

Lots have, yes. It can be hard to be sure, sometimes, and many members have been treated as Type 2 for years before eventually being recognised as having Type 1.

 

[Inka]

Hi @Annk A number of people here have been diagnosed with Type 1/1.5 later in life so you’re not alone. Have you had the Type 1 antibodies tests and the C Peptide test to try to determine your type?

Who prescribed the Metformin, Gliclazide and insulin? (You said your GP was confused)

How’s your blood sugar? The only one of your meds I’d raise an eyebrow at is the Gliclazide, simply because you’ve got insulin and, if you’re Type 1. Gliclazide can squeeze the remaining life out of your islet cells.

 

[rebrascora]

Hi and welcome from me too.

Yes, getting the correct diagnosis can be tricky. Ideally you need to be referred to a specialist diabetes clinic under a consultant and have the appropriate tests done as mentioned by @Inka above. If your insulin producing beta cells in your pancreas are failing then taking Gliclazide is like "flogging a dying horse" as it's mode of action is to stimulate them to produce more insulin and if they are already under strain due to decreasing numbers then putting them under increased pressure of production makes them more vulnerable.
Presumably you have been given a BG meter to test your levels? What sort of results are you getting?

Would you mind giving us a bit of information about how you came to be diagnosed? Did you have symptoms and if so, what were they and did they come on suddenly or develop slowly over a period of months or years? Or perhaps your diabetes was identified through a routine blood test and you weren't aware of any symptoms? Do you know the result of the HbA1c blood test used to diagnose diabetes. It will usually be a number in excess of 47 but can be into 3 figures if things have gone badly awry. Obviously you should only give us as much information as you are happy to divulge but it can give us a better insight into what may be going on and enable us to give you more appropriate advice.

 

[Annk]

Hi @Annk A number of people here have been diagnosed with Type 1/1.5 later in life so you’re not alone. Have you had the Type 1 antibodies tests and the C Peptide test to try to determine your type?

Who prescribed the Metformin, Gliclazide and insulin? (You said your GP was confused)

How’s your blood sugar? The only one of your meds I’d raise an eyebrow at is the Gliclazide, simply because you’ve got insulin and, if you’re Type 1. Gliclazide can squeeze the remaining life out of your islet cells.

Gosh lots of questions, I’ll do my best.
I’ve had the type 1 antibodies test and I believe it was positive but can’t find the record now. My gp prescribed the glyclazide when I wasn’t getting on well with the metformin, but that was because he put me on to a large dose and I’m sure put me into a constant hypo- this was before I was testing for blood sugar levels.
My blood sugar levels are generally good, they go up in the evenings, I take my tablets in the morning so I guess there isn’t much left in my system by then.
The insulin has been prescribed by the diabetes nurse at my local hospital with a brief conversation with a doctor for confirmation which I did not hear.
My GP is supposed to be the diabetic lead at my surgery but honestly I don’t have much faith in him.
I am supposed to be having further tests done, organised by a consultant before my next zoom meeting with her in 4-6 months. I feel a bit in limbo not knowing what to do re tablets and insulin.
Thank you for your reply

 

[Annk]

Hi and welcome from me too.

Yes, getting the correct diagnosis can be tricky. Ideally you need to be referred to a specialist diabetes clinic under a consultant and have the appropriate tests done as mentioned by @Inka above. If your insulin producing beta cells in your pancreas are failing then taking Gliclazide is like "flogging a dying horse" as it's mode of action is to stimulate them to produce more insulin and if they are already under strain due to decreasing numbers then putting them under increased pressure of production makes them more vulnerable.
Presumably you have been given a BG meter to test your levels? What sort of results are you getting?

Would you mind giving us a bit of information about how you came to be diagnosed? Did you have symptoms and if so, what were they and did they come on suddenly or develop slowly over a period of months or years? Or perhaps your diabetes was identified through a routine blood test and you weren't aware of any symptoms? Do you know the result of the HbA1c blood test used to diagnose diabetes. It will usually be a number in excess of 47 but can be into 3 figures if things have gone badly awry. Obviously you should only give us as much information as you are happy to divulge but it can give us a better insight into what may be going on and enable us to give you more appropriate advice.

Thank you for your reply. I was diagnosed after having two UTIs in one month and the gp was I guess being thorough and did a test on my urine for sugar levels. My HbA1C was 91 and I wasn’t aware of any symptoms.

 

[trophywench]

Metformin cannot cause a hypo, since it does not reduce the blood glucose (and hypo = too low blood glucose) What it does is help the body utilise its own insulin, or indeed injected insulin, more efficiently.

Gliclazide encourages the pancreas to produce and shove out into the bloodstream, a greater amount of insulin than hitherto.

It is possible because your body has gradually become used to operating with higher than normal blood glucose (normal = between c. 35 and 41 HbA1c) that any reduction is regarded by the body as abnormal, it responds by giving you the same symptoms as a real hypo - that's unfortunate, but not unusual for the newly diagnosed I'm afraid.

So - your GP is confused, does that mean he has referred you to the more expert medics at your nearby hospital Diabetes Outpatient Clinic? Or if not - what?

Edit - Ah, sorry, you've given us more info now.

 

[Inka]

Gosh lots of questions, I’ll do my best.
I’ve had the type 1 antibodies test and I believe it was positive but can’t find the record now. My gp prescribed the glyclazide when I wasn’t getting on well with the metformin, but that was because he put me on to a large dose and I’m sure put me into a constant hypo- this was before I was testing for blood sugar levels.
My blood sugar levels are generally good, they go up in the evenings, I take my tablets in the morning so I guess there isn’t much left in my system by then.
The insulin has been prescribed by the diabetes nurse at my local hospital with a brief conversation with a doctor for confirmation which I did not hear.
My GP is supposed to be the diabetic lead at my surgery but honestly I don’t have much faith in him.
I am supposed to be having further tests done, organised by a consultant before my next zoom meeting with her in 4-6 months. I feel a bit in limbo not knowing what to do re tablets and insulin.
Thank you for your reply

If it was me, I’d try to obtain the Type 1 antibodies test result (numbers not just ok/above normal or whatever). If a C Peptide test was done, then I’d get the result (number) of that too.

You’re right that many GPs don’t know much about Type 1 or any complicated diabetes diagnosis, so it’s very good you’re seeing a consultant. It’s also very good that you have insulin. Early introduction of insulin in LADA (slow adult-onset Type 1) can help preserve your remaining insulin producing cells for longer. Conversely, Gliclazide will squeeze the remaining life out of them and potentially hasten their decline if you’re Type 1/LADA.

If you are Type 1/LADA you may be better off on small amounts of both basal/background/slow insulin and the bolus/fast/meal insulin you’re taking now. The basal insulin is to control your blood sugar in the absence of food. You might also take the bolus/meal insulin before other meals if you need to in preference to the Gliclazide.

 

[Annk]

Thank you, I will chase up my results. My doctor has referred me on to a consultant but I’ve had one zoom meeting which was more of a review and no real progress. Have another consultants appointment 4-6 months after the last and more blood tests 2 weeks before this so it all seems to be taking a long time,

 

[Leadinglights]

Thank you, I will chase up my results. My doctor has referred me on to a consultant but I’ve had one zoom meeting which was more of a review and no real progress. Have another consultants appointment 4-6 months after the last and more blood tests 2 weeks before this so it all seems to be taking a long time,

You do seem to have been left in the lurch so I would press for a more timely appointment with the diabetic consultant and support team.

 

[SB2015]

Welcome to the forum @Annk from another late starter

You do seem to be getting some muddled info from your Practice and I am glad that you have been referred to the consultant, although I would also push for an appointment sooner than 6 months, or at least a phone call.

I think a lot of GPs immediate response to a high HbA1c is give Metformin as they assume T2. However since the positive GAD antibody test shows that you are effectively a late starter with T1 you should already be on a basal ( background) / bolus (quick acting meal time) insulin regime. Metformin would not be needed for the T1 unless there are other reasons it is needed. The specialist team should then help you to learn how to adjust your doses of insulin to match what you want to eat and to make adjustments to these for illness and exercise.

Let us know how you get on, and keep coming back with any questions.