Diabetes and Work

[Duane Charles]

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.

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.

Having just read through everything you have written and am eternally grateful for your insight as to what might or might not be happening. I will read through it all later as I’m about to set off to work. I will say that I’m not usually home from work until after midnight and therefore my regular pattern would be to have breakfast around 9 in the morning and not eat again until getting home from work. I will get back to you regarding the rest later and thank you.

 

[Proud to be erratic]

Having just read through everything you have written and am eternally grateful for your insight as to what might or might not be happening. I will read through it all later as I’m about to set off to work. I will say that I’m not usually home from work until after midnight and therefore my regular pattern would be to have breakfast around 9 in the morning and not eat again until getting home from work. I will get back to you regarding the rest later and thank you.

Yes, in hindsight I realised that. So I adjusted my original draft to just test as you go to bed and again on waking. Then whatever you've eaten late at night may or may not leave you starting the day normal, high, or possibly quite low. At least you'll know what change has occurred overnight.

Then test immediately before b'fast and 2 hrs later to find out how your body is managing that meal and the porridge in particular. It doesn't really matter whether that first meal test is at 8am or 11am.

If on a day off you have a later meal just do the immediately before and 2 hrs later, again just to find out how that meal was managed. The 2 hr interval is not to confirm all digestion is complete by then - just to provide a consistent reference point. At this stage my thoughts are centred around what is going on to cause your high HbA1c; from that a possible confirmed diagnosis and thus treatment appropriate to that diagnosis.

It could be that the metformin helps anyway - regardless of what the testing data informs you. That would be a bonus. But you just don't know what damage your pancreatitis has caused and having an HbA1c above 48 is simply not good for anyone's long term health. I've just had a 2nd hasty read of your last 20 posts and I couldn't find what was your last HbA1c. Regardless of the cause knowing how much you are into the D zone is pertinent to how to manage that.

What, please was your latest HbA1c and if its handy what was it when you were first diagnosed T2?

I see you already have 2 monitors so you could revise my possible plan and ask your GP to fund test strips - at least for a few months if only to clarify what is going on. If you were a more standard T2 then prescribing test strips could be a tiny bit contentious, in the eyes of the Integrated Care Board (ICB) who provide the overall financial allowance to a GP for prescriptions. But there should be a moment in time when a GP could (and should) use their medical training to show judgement and recognise that your history of pancreatitis makes you a different case. It may be that your GP needs a "business case" to support a prescribing decision, in case it is challenged in the future by an ICB and you help that business case by keeping the focus on your pancreatitis issue.

Do get back to me once you've had a further read. I might be out of house for a few hours tomorrow - my own plan is being developed right now!