Diabetes and Work

[Duane Charles]

I’m a newbie and have posted an introduction elsewhere. As I’ve said I have recently been diagnosed with type 2 and whilst I understand about eating regularly and taking my medication with something food. It is somewhat difficult as I work in the fast food industry, therefore taking breaks can be difficult and I don’t want to be eating when I get home as this is usually after midnight. Just wondering what others do?
It has been pointed out to me by my manager that other members of staff have commented on mood swings. What sort of workplace support is there? How do I get get them to understand what I’m going through as a newly diagnosed diabetic?

 

[Leadinglights]

How regularly and what you eat will depend on the medication you take as it may be important that you take that at particularly times with food.
However as you have had pancreatitis then that may indicate that you may not be a straightforward Type 2 and therefore the medications you have been given may not be appropriate as those with pancreas issues are Type 3c and would often be treated as Type 1 thus needing insulin, you should bear this in mind if your current treatment does not work in managing your blood glucose levels.
Both medication and diet are important if it is certain you are Type 2 as is staying hydrated.
Are you testing your blood glucose with a home monitor.

 

[Duane Charles]

Thank you @Leadinglights, I have 2 monitors but have been told by my Diabetic Nurse the medication (Metformin and Alogliptin) don’t cause hypos and therefore don’t need to monitor. That said I have been keeping an eye on my levels.
I do my best to keep hydrated but over many years (probably 30) my fluid intake has dwindled.

 

[Leadinglights]

Thank you @Leadinglights, I have 2 monitors but have been told by my Diabetic Nurse the medication (Metformin and Alogliptin) don’t cause hypos and therefore don’t need to monitor. That said I have been keeping an eye on my levels.
I do my best to keep hydrated but over many years (probably 30) my fluid intake has dwindled.

The whole point of monitoring is so you have control of your condition as you can check on progress (good or bad) day to day, week to week and test the effect of your meals so you can take action asap not wait for a shock when lo and behold your HbA1C has shot up.

 

[Duane Charles]

The whole point of monitoring is so you have control of your condition as you can check on progress (good or bad) day to day, week to week and test the effect of your meals so you can take action asap not wait for a shock when lo and behold your HbA1C has shot up.

I was surprised when they said that too. I need to be more pro-active in my monitoring regime. I did ask about them giving me a monitor but for the reasons mentioned above it was declined. I have just had a reminder from my surgery that I’m having my annual diabetic review tomorrow. I will ask about 3c, are there any other questions I should be asking?

 

[Leadinglights]

I was surprised when they said that too. I need to be more pro-active in my monitoring regime. I did ask about them giving me a monitor but for the reasons mentioned above it was declined. I have just had a reminder from my surgery that I’m having my annual diabetic review tomorrow. I will ask about 3c, are there any other questions I should be asking?

Perhaps if you look at this link to the main DUK site it will explain things and prompt you with questions you could ask.

What is type 3c diabetes?

You may have heard of the more common types of diabetes like type 1, type 2 and gestational. But there are actually many other types of diabetes that aren't as well known. Type 3c diabetes develops because of the damage to the pancreas, which can happen for a few different reasons. And although...

www.diabetes.org.uk

 

[Duane Charles]

Perhaps if you look at this link to the main DUK site it will explain things and prompt you with questions you could ask.

What is type 3c diabetes?

You may have heard of the more common types of diabetes like type 1, type 2 and gestational. But there are actually many other types of diabetes that aren't as well known. Type 3c diabetes develops because of the damage to the pancreas, which can happen for a few different reasons. And although...

www.diabetes.org.uk

Thank you again, I have on a couple of occasions mentioned that I don’t have a gall bladder due to numerous attacks of pancreatitis. So far this has been ignored, but will definitely be bringing it up at my review in the morning. I can’t have an MRI due to having a pacemaker, but would an ultrasound be capable of seeing the damage to my pancreas?

 

[trophywench]

I really don't know the answer to that but think at that conversation tomorrow, I'd want to ask for an appointment for best advice from a consultant endocrinologist at the hospital, were I you.

 

[Proud to be erratic]

@Duane62, do not be surprised if there is minimal understanding tomorrow about T3c. People with T3c are a tiny, tiny percentage of the overall nos with Diabetes. Take that in your stride if you can and, also if you can, have the link from 2 posts above handy on your phone.

You might find tomorrow stressful if you feel you are not being heard; try to not let that get to you. If things don't conclude completely satisfactorily put your request for a referral to an Endocrinologist in writing - ideally as an email and send a copy to someone else. Ask for a written confirmation of your request and a copy for you of the referral request. It's amazing how the possibility of written evidence motivates organisations to do the correct thing.

 

[Duane Charles]

Morning all, just wanted to update you on what happened this morning. The DN has agreed to talk to one of the quacks about the possibility of having a scan to investigate any possible damage to my pancreas and T3c. They’re going to let me know later today. My Metformin dose has again been changed to 2 x 500mg. It was explained that this isn’t a high dose and I could take both at the same time with a meal. I have been referred for my yearly eye check, last one was in March last year.

 

[trophywench]

I'm pleased generally about the appointment - but am utterly puzzled about the surgery having to refer you for the eye check. I've only ever lived in the Midlands but two different Health Authorities and both used retinopathy services that are kind of independent of the GPs and hospitals though no doubt they all get paid for by the NHS. Therefore once I was on their books, they decided when I next needed checking and make jolly sure they write and tell me when my appt is, and also send me a text, which then gets an automatic text reminder a week or so before the day. If I don't hear from them (which has only happened once over 20 years ago before I moved to Warwickshire) I can search for their phone no on the internet/in the phone book and ring em. (I didn't pursue 'why' because life's too short) Just strikes me as 'odd' is all.

 

[Duane Charles]

I'm pleased generally about the appointment - but am utterly puzzled about the surgery having to refer you for the eye check. I've only ever lived in the Midlands but two different Health Authorities and both used retinopathy services that are kind of independent of the GPs and hospitals though no doubt they all get paid for by the NHS. Therefore once I was on their books, they decided when I next needed checking and make jolly sure they write and tell me when my appt is, and also send me a text, which then gets an automatic text reminder a week or so before the day. If I don't hear from them (which has only happened once over 20 years ago before I moved to Warwickshire) I can search for their phone no on the internet/in the phone book and ring em. (I didn't pursue 'why' because life's too short) Just strikes me as 'odd' is all.

I think I fell off the radar as I moved from Cheshire to The Wirral just after my last sight check. The DN did say usually you’d get a reminder automatically, but could have gone to my old address.

 

[Duane Charles]

The DN has just called me and said that having spoken with a Dr that a scan would be pointless as it wouldn’t show up any damage. They’re happy to consider insulin in my treatment, but would like to wait until my next HBA1c test which won’t be until the end of Jan. They also say that my sugars aren’t “erratic” to suggest T3c. I have asked to have an appointment with a Dr to discuss this further. The other thing I asked about was finger pricking, whilst I wasn’t asking for them to provide me with a monitor, lancets and strips, it was for the purpose of my own monitoring and whether what I was doing was working. Again, I was told there was no need to finger prick as the true reading would be through the HBA1c and that I wasn’t on Insulin.

 

[Leadinglights]

The DN has just called me and said that having spoken with a Dr that a scan would be pointless as it wouldn’t show up any damage. They’re happy to consider insulin in my treatment, but would like to wait until my next HBA1c test which won’t be until the end of Jan. They also say that my sugars aren’t “erratic” to suggest T3c. I have asked to have an appointment with a Dr to discuss this further. The other thing I asked about was finger pricking, whilst I wasn’t asking for them to provide me with a monitor, lancets and strips, it was for the purpose of my own monitoring and whether what I was doing was working. Again, I was told there was no need to finger prick as the true reading would be through the HBA1c and that I wasn’t on Insulin.

Pretty good your surgery has taken on board you questions but I should certainly ignore the advice about not testing as things can go seriously awry between HbA1C tests and as long a you adopt a systematic testing regime rather than something random, which I agree is meaningless then it is a way you are controlling / managing your condition.

 

[Duane Charles]

Pretty good your surgery has taken on board you questions but I should certainly ignore the advice about not testing as things can go seriously awry between HbA1C tests and as long a you adopt a systematic testing regime rather than something random, which I agree is meaningless then it is a way you are controlling / managing your condition.

My plan on testing would be a daily test between waking and having breakfast. I can note the readings on my phone and pull up the results for a week, month etc. These I can then show to whoever I have my appointment with.

 

[Leadinglights]

My plan on testing would be a daily test between waking and having breakfast. I can note the readings on my phone and pull up the results for a week, month etc. These I can then show to whoever I have my appointment with.

That can give variable results because as soon as you get up and start pottering around your liver will release glucose to give you energy for your organs to function. It would be more consistent to test in bed as that would then give you a fasting reading not influenced by what you were doing before breakfast.
People will also test before and 2 hours after meals to check which foods and meals they tolerate without blood glucose increasing by more than 2-3mmol/l to enable then to tailor their meals and reduce carbohydrates if needed.

 

[Duane Charles]

That can give variable results because as soon as you get up and start pottering around your liver will release glucose to give you energy for your organs to function. It would be more consistent to test in bed as that would then give you a fasting reading not influenced by what you were doing before breakfast.
People will also test before and 2 hours after meals to check which foods and meals they tolerate without blood glucose increasing by more than 2-3mmol/l to enable then to tailor their meals and reduce carbohydrates if needed.

I will certainly test while still in bed and again 2 hours later. Although, I may only do the 2nd test once as I tend to have the same thing for breakfast everyday

 

[Leadinglights]

I will certainly test while still in bed and again 2 hours later. Although, I may only do the 2nd test once as I tend to have the same thing for breakfast everyday

That is a good one to start on then, as if you get breakfast right you are off to a good start for the day. What do you normally have?

 

[Duane Charles]

That is a good one to start on then, as if you get breakfast right you are off to a good start for the day. What do you normally have?

Porridge, the only problem is I don’t eat again until I get home from work which can be after midnight. I know that’s not a good thing to do and that’s the reason the DN said about taking all my Metformin with breakfast.

 

[Proud to be erratic]

The DN has just called me and said that having spoken with a Dr that a scan would be pointless as it wouldn’t show up any damage. They’re happy to consider insulin in my treatment, but would like to wait until my next HBA1c test which won’t be until the end of Jan. They also say that my sugars aren’t “erratic” to suggest T3c. I have asked to have an appointment with a Dr to discuss this further. The other thing I asked about was finger pricking, whilst I wasn’t asking for them to provide me with a monitor, lancets and strips, it was for the purpose of my own monitoring and whether what I was doing was working. Again, I was told there was no need to finger prick as the true reading would be through the HBA1c and that I wasn’t on Insulin.

Interesting. What evidence does the GP have that your sugars are erratic or not? I feel I've missed something in your postings, but will return to this thought shortly.

I will certainly test while still in bed and again 2 hours later. Although, I may only do the 2nd test once as I tend to have the same thing for breakfast everyday

If I may suggest, 2 discrete test arrangements:

A pair of tests as you go to bed to see where your overnight starts, then a 2nd as soon as you wake, while still in bed, to see how your night ends. At least for a week and see if there is a general pattern. Discount any overnights that are not part of your regular routine.

Also start testing immediately before a meal and as close to 2 hrs after to find out how your body is managing each meal. For many people porridge can produce a significant BG rise; in the first 7 days just go with that and specifically find out if that is your way. A single pr of results is not enough, you need a few to get an identifiable trend. If you find porridge is always spiking your BG it would be useful to find out what is happening after 4 hrs; this is trying to determine if your body (along with your normal daily routines) does eventually manage your porridge! Or are you constantly high after porridge?

If porridge doesn't get managed by your natural insulin then consider altering your breakfast to something that is less carb heavy and has a lot more protein; then do a series of tests to confirm that food choice.

All of this testing, along with your recording will provide much more data to inform any forthcoming review, as well as determining how "erratic" your bg is. Actually I don't think you need erratic BG to determine a diagnosis of T3c - this is a bit of nonsense to my mind d. The issue is are you a routine T2 because you have abnormally high insulin resistance in relation to other non- diabetic folk OR has your pancreatic function been damaged by your earlier pancreatitis resulting in diabetes from neither T2 nor T1? The goal is to find out what is causing or possibly worsening your D, thus get an appropriate diagnosis and thus get the right treatment. I'm not only unclear why a GP thinks erraticness of your BG is relevant at all and I'm also unclear what the status of your pancreatitis is today and if your diabetes had been brought on by that pancreatitis.

If it has THAT would seem like confirmation of T3c (in my non-medical opinion). The treatment for T3c can be by oral meds or insulin and if insulin that can be by fixed basal doses or Multiple Daily Doses (MDI). Diabetes is diagnosed from the cause, not the subsequent treatment needed. Damage to one's pancreas can ( does) cause diabetes and under that circumstance it should lead to a diagnosis of T3c.

Afternote - a fresh thought from writing this: ask your GP to support you in this testing proposal to find out what is really going on by providing you with a meter and test strips. Prescribing test meters and strips is in a GP's gift; finding out what is happening would confirm or refute the GP's claim of erraticness (still not sure of any relevance for erratic BG); a regular testing routine would provide you with knowledge to identify your periods while high and to take corrective action. If all of this leads to more BG stability for you at better levels then that will be a success - regardless of whether you are T2 or T3c.