Don't know what to do anymore (long read)

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gll

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Hi all.

Some of you know the struggles I have been having lately. I just wanted to vent and possibly get some feedback on everything.
I don't know what's normal and what's not anymore.

My approach had been to eat within the 2-3 rise rule and take whatever meds necessary.

(sorry this is its a long read)

I went to GPs for fluid retention and what I thought was high blood pressure.
I had been trying to loose weight (and had lost about 12kg and unknown weight loss beforehand) and then I was suddenly gaining weight which I assume was the excess fluid.
Symptoms making me think was high blood pressure was frequent headaches and migraines, floaters in vision, feeling like my heart was pounding. Feeling rough overall.
It was the halt of the weight loss that made me stop ignoring stuff and just go to get seen and not the other symptoms.
Thirst and frequent peeing was a thing but wasn't really on my radar as an issue.
I had pre-eclampsia with daughter's pregnancy so experienced high blood pressure before.
Headaches had been ongoing for a few years but the other stuff, I would say about 4-6 months prior maybe?
BP was 160/100 ish at nurse and she took bloods.
A gp appointment was already booked for the following week so no bp meds to be prescribed until I had seen gp and blood results were back in.

I had got a text between bloods getting done and seeing the GP saying I had a prescription for folic acid to pickup so actually kinda breathed a sigh of relief and assumed that was all that was going on. :confused:

Got to the gp appointment and started talking about the fluid build up and bp and he scanned my blood results and he asked me how my diabetes was going. Awesome way to be told a diagnosis right. (hba1c - 91 - 14 on the meters)
He did the run of mill questions once he realised this was all news to me, told me to diet and exercise 🙄. Full of helpful info right there.
Anyway was given metformin, some creams for blisters I had on my legs from the fluid build up and cream for what he said was psoriasis on my face and low dose ramipril. He said getting my BP down should help with the excess fluid.
Was booked in to see the nurse again for another bp check for the following week and sent on my way.

I suppose my story probably compares to most on here which was panic, scared to eat anything as I didn't know anything etc etc. Started metformin and the other meds and creams, read a lot off the interwebz which left me more and more confused.

Had the bp review and had a chat with the nurse and given the standard bunch of booklets and was told to come here to do the learning zone. BP still the same so booked in again for another 2 weeks for review.

I hit the site and was reading the forums here and I figured I could follow the sound advice of testing my food tolerance and try and eat to that and fit it into weight watchers plan for weightloss which I had been doing. If I have a tiny bit of wiggle room in a diet I have more success longer term. (spoiler gliclazide is slowly undoing this work 😡).
I got a meter and a bp monitor and got to testing.
I would say average bg was 6-8 and seeing 11 on the meter was pure panic (oh how things have changed).

As for BP, my home readings were much much better (115 / 70 ish). Long story short here, spoiler - I have white coat syndrome where my bp is actually okay but I test higher in clinical situations, my home monitor lines up with the nurses readings so high bp taken off the table now.
I also mentioned the food testing and asked if they wanted any of the readings and she offered me a meter and test strips on repeat.

Anyway by the start of December metformin wasn't agreeing with me and was to give it a break for a weekend and reintroduce. That failed and was switched me to 1 x 40mg gliclazide (the one that helps you to just make more insulin yourself - I call it turning on the tap).
I had another bp review the same week and during the appointment someone else was called into check my legs/fluid so had a quick review of my meds and immediately doubled my gliclazide dose as it was too low given my hba1c. Was put on water tablets.

Over the next few weeks waking readings were okay but slowly starting to go up, the same previously ok foods were starting to spike me higher and longer one day and the next they were okay again.

By just before Christmas I was concerned and called GPs again. Was asked to try slow release metformin but only 500mg. Xmas to new year my tummy wasn't fantastic but was determined to go over the first couple of weeks to see if it settled. (gliclazide still in the mix)

bg was still getting more erratic. Good days and bad days were becoming more noticeable vs just bad mealtimes. Bad days waking readings were hitting the low to high teens and good days were about 10.
On bad days I would end up just having some cold meat for breakfast / lunch to let levels come down themselves as the gliclazide would only do so much. Would often take until 5pm to get to somewhere in single figures and I could have dinner. Still massively limiting carbs with evening meal. (eg meat veg and a couple of baby potatoes or microwave rice that doesn't do much to my bg).

Called back again in the new year to let them know metformin wasn't working out. Spoke to the pharmacist (who apparently handles most T2 patients) and he decided introducing Empagliflozin was the best option. (the one where it stops your kidneys sending glucose back but instead makes you pee it out).
Numbers almost instantly dropped and waking was usually around the 8s and wouldn't push past 10 at all after meals and would generally return to there or even down into the 7s before the next mealtime.

A couple of weeks in numbers had started to creep once again. Diet pretty much unchanged. However, eating to my tested +2-3 rise was/is a disaster as it was even more inconsistent. Sometimes it is within the rise but other times it just ends up out of control and takes hours and hours to come down again. Noticing not just the odd rubbish day but a few days in a row before seeing some good ones again.
Waking had gone back to 10-13 most days.

End of Jan hba1c went from 91 to 61. Was worried the good outweighed the bad. Really doesn't help to be heard when their test don't reflect what you and your meter are saying.

That brings us up to this week.
I'm doing a libre trial and using diabox that has been and calibrated and spot checked.
Have confirmed the bad days are now just stay steadily high. Over the last lot of conversations with issues I was always being told how a fingerprick doesn't tell the whole story and its probably just spikes. 🙄
The first full day of using it I was 0% time in target which the upper limit is 9. For the last 6 days of using it diabox
(which tends to be more accurate with the highs) is showing 20% in target.
Libre is a little kinder with 47% but is way off when fingerpricks say I'm high but fairly on point with the normal 🙄.

So another phone call...
Gliclazide has been doubled. I can have 2 x 40mg twice a day (from 1 x 40 twice a day) and allowed to play around with the dose.
Yesterday was the first day of dosage increase.
Started the new dose (6am) with a finger prick of about 13 so just had some sliced cold meat for brekkie to give things a chance.
Numbers were steady lowering but had to go out into town about half 9.
Was in the 6s by 10.30am and felt pretty terrible and was still dropping (I know not hypo but much lower numbers than I'm used to).
I had a few mins to get the bus home (40 min trip) so made a (probably poor) call to get a steak bake from gregs to try and raise them a little bit (30g ish of carbs). I really didn't have options to get much else with location and time and didn't think JBs were needed but some normal carbs would be better.
Since it is a new dose I wasn't sure how much more effective it would be and didn't want to still be dropping while traveling.
Saw a rise up to about 8-9 over the next 90 mins, levelled off and saw the start of a fall showing (and felt much better). Was planning on no carbs for lunch and see where things settled.
Then my alarms started going off with a further fast rise up to the high teens. The highest point was about 4pm (6 hours after eating) and caught a 17 on finger prick and 19 on diabox at different points. Once I saw it was finally on the way down, I fell asleep and sensor indicated I evened out around 9pm in the 6s and a flat ish line until 11.30pm when I woke up and did a 6.9 fingerprick to confirm.

Was too late for 2nd gliclazide dose so flying solo. Had instant noodles for dinner (one of the "normally can eat that barely moves my numbers" things) and have just had another trip into the teens and has been steadily stayed around 11-14 for the last 3 hours. Meds probably not being effective at all at this point so I should totally account for that. Have taken morning meds now and they are coming down again.

So usually I'm pretty consistent with medications and timing of them. I kinda messed up with sleeping when I did yesterday but was just exhausted.

Overall, mentally I'm exhausted.
I try and be very careful with diet but its like playing roulette with my bg with the same foods.
Are such big inconsistencies normal?
Was the steak bake yesterday a completely dumb move (although tasty) and that is the entire reason I spiked so long and high (+12 with a peak at 6 hours)?

I'm tired of feeling like I am harming myself by (for example) having a weetabix for breakfast. I know there are other things I could have. Some days it is totally fine, others bg is just trashed. Whatever way my tummy likes that bit of fibre 😉 But still, I am feeling bad for eating the blandest breakfast cereal to make sure my guts stay happy.
I never used to have food anxiety but it is really is starting to be a thing.

I came into all of this with positivity and determination to manage what I could and take medications to keep things under control. I feel like I get some control and then its like a switch gets flipped and things go downhill again and I inwardly groan at the thought of fighting to be heard at the GPs.
I come off the phone from their appointments being made to feel like I am overreacting. The other day I was told 11-14 all day "wasn't that bad". Clearly she's never been there at dinner time with a banging headache knowing it will be a disaster if you eat the wrong thing or even eat the right things and it all goes to hell anyway. I know it can be higher/worse but its so insulting and belittling. I rarely go to the gp for help and when I do I fell like I'm wasting their time afterwards.

The peeved off part of me wants to sod it, eat "normal person" stuff and let my hba1c go wild so they will actually take things more seriously and the sensible part of me says don't be so silly - you will feel like crap and potentially cause more problems.

What happens with patients who get put on metformin and just get on with normal life and largely ignore even eatwell advice?
Do things spiral as fast or do they just not know? Am I expecting too much from medication and limiting carbs to be effective?

What I perceive to be happening. My pancreas is a toddler. Some days with some gentle encouragement (aka meds), it behaves for the most part and everyone is happy. Other days it is a day filled with tantrums and flailing about screaming loudly where no amount of coaxing will get it to behave itself and then suddenly the tears dry up and it is all smiles again.

Advice, thoughts, feedback welcome 🙂

(also thanks to @rebrascora for listening and encouraging me to write this post xx)
 
I just firstly wanted to say I read it all, and can completely understand. This reminds me how my diabetes started out, they’d add more tablets and increase doses but every time it would either work for a short time then bgs would go up again, or not work at all. I felt like my body was just going “oooh shiny new drug what’s that I’ll try doing that” then a couple of weeks later stopping being bothered to do it. I figured it might be a case of my pancreas only having so much it could do.

I’d probably be tempted to ask to try one of the newer injectable drugs that support weight loss as well as BGs, just as something else to try that could support both your bg and weight loss efforts. But even they didn’t work for me for long which in the end is why I just switched to MDI insulin, to get some sense of control. That wasn’t easy option by any means, as my pancreas chips in when it feels like it, but at least meant I could do something about the highs.
 
Could missing some meals/eating hardly anything be encouraging your body to pump out glucose? Mine does if I wake up high and don’t eat. That’s my first thought.

You don’t mention your weight, but personally I’d be thinking about insulin or similar. I wouldn’t want to be in the teens so much.
 
The part about your pancreas being a toddler - I still get this now and it’s a perfect description. Yes I have insulin, but I will go through huge changes in doses where I need to suddenly double or halve my insulin, and they’ll last either for a few days or for a few months. It’s worse if I’ve gone through a period of not being really on top of medications and testing, where presumably my pancreas has had to work harder to make up for it.

I think my theory is that the pancreas is working as hard as it can, sometimes it can’t work any harder and starts to tire, other times it gets a bit of a break (either through new different meds, or diet, exercise, less stress, whatever), and then turns up for work with renewed energy sometime later.
 
Could missing some meals/eating hardly anything be encouraging your body to pump out glucose? Mine does if I wake up high and don’t eat. That’s my first thought.

You don’t mention your weight, but personally I’d be thinking about insulin or similar. I wouldn’t want to be in the teens so much.
I didn’t add this but I’d also suggest insulin, but only after trying ozempic/equivalent. Just because if that does work for you then it is easier than insulin.
 
I would happily try ozempic or other in the same class (although after metformin side effects I am wary of the tummy ones) and or insulin but I'm not being heard by HCP.
At this point I would say just something to correct high numbers would be welcomed.
4 months ago if you mentioned insulin or other injectables I would be like hell no. Now, it is yes please if it works.

The nurse is phoning me back on Tuesday to see how the glyclazide dose is working out. Maybe something did ring some bells with her, who knows.

I feel like it is a fight to get them to listen and I go to them and they treat the hba1c like the holy grail and their flow chart of medication pathways that has to be followed.
Half a day in reasonable numbers and half in bad just reads as average of meh.
Finding any one person there who is prepared to talk to you and listen and even ask to see readings is my holy grail 😉

I have tried to be more consistent with eating now but totally hear you on that Inka. Will be more mindful about not skipping meals. At the very least I pick a tiny bit of carb with some protein to try and wake up some insulin production.
BMI is about 31 so much room for improvement there. Hard to tell accurately with fluid ups and downs too. 🙂
Its frustrating, they tell you to loose weight and put you on meds that encourage gain.

The other nagging thought is is water tablets + Empagliflozin putting too much on my kidneys (function tests are okay). I can't drink much more than I am to help those two to work. Water tablets were working to a point but even that is somewhat reverting back to what it was.

I appreciate the feedback and Lucy, hearing that you found the same is reassuring x
 
Are all these appointments with the nurse/GP at the GP surgery? If so, can you try asking for a referral to the hospital to see a specialist to talk about options like ozempic/insulin/etc? The GP might say “not needed yet, try this first”, but it’s worth asking. I tend to find hospitals much more open to a 2 way conversation and hearing /acting on my concerns than the nurse at the GP surgery
 
So pleased that you have documented it all here Lou as that in itself can be helpful in just releasing some of your frustration and really pleased that @Lucyr can relate to your situation so closely, as just knowing someone else has been where you are, helps you to feel less alone or that you are not imagining things or missing a vital piece of the jigsaw, which might help to make sense of it.

As regards your diet, many of us find that full fat Greek with a few berries and mixed seeds works well for breakfast and maybe some chopped nuts with it too. If you need more fibre to help your digestive system, I use psyllium husk and chia seeds in a morning drink and it has done wonders for my bowel health.

I agree with Lucy that a referral to a consultant/diabetes clinic might be the best option to push for and that for whatever reason, it sounds like your pancreas is spluttering and some days it is managing better than others. The Glic might be magnifying that problem, so that when the pancreas is overwhelmed, the Glic makes no difference because it is just not capable of responding.... like flogging a dead horse.... but other times when it is perhaps more relieved of the strain it is under, it is able to respond to the Glic and you see a drop in levels, meaning you are seeing very little consistency.
The situation with the steak bake probably pushed it too hard and it flagged again which is why levels started to rise higher later and of course missing your evening Glic probably didn't do you any favours.

It might be worth trying eating small low carb snacks more frequently to give it some better consistency if you can. Maybe just 10g carbs every couple of hours and see how that plays out. Diabetes management is really improved by planning (I am the worst person in the world for this in all aspects of life but I do make an extra effort with my diabetes, because it pays off in the long run. So make sure to have things with you that you can eat when you need to, when you are out and about. Something like Nature Valley protein bars are just about 10g each and a couple can easily sit in your bag without taking up too much space and provide a small top up if levels drop. They are quite tasty and satisfying.

I am not saying that you can never have a steak bake again, but it isn't the healthiest of options as I am sure you well know and I can see your thinking in that situation with limited options and a long bus journey ahead, but if you go onto insulin you will need to learn to carry stuff all the time so start making a habit of it now. Anyway, just really suggesting a short term trial to see if you can stabilise things a bit better through a more uniform approach. It may be that your pancreas will not like this approach either, but worth a try. So something like a bowl of soup, have half which would be about 10g and then the other half later, or I make a big pan of ratatouille and just dip into it every now and then, or a big pan of curry but no rice or noodles, although I did try some konjac rice the other day which was OK and zero carb but plenty of fibre.... I've got a great recipe for cauliflower and halloumi curry that I often just add extra veggies into and just have a few spoons of some when I fancy it. Then try 3 reasonably low carb meals a day for a few days and see how that pans out.
Diabetes really likes routine but it is something that I struggle to maintain, so the eating little and often small, low carb meals works quite well for me. It might just be a chunk of cheese and half an apple or a half a tub of olives with feta or some roasted peanuts or some cream cheese stuffed peppadew peepers.... usually things that give me a big flavour hit with minimal carbs and some fat, because the fat is satisfying and fills me up and stops me feeling hungry. I appreciate that you have some weight to lose but sometimes the fat can help, because it stops you feeling hungry.

Anyway, keep experimenting. The LIbre is great for showing you what is going on but you need to be as consistent as you can with your approach in order to draw any conclusions from your results. There are something like 42 factors which affect BG levels and whilst food, medication and exercise are the main players there are plenty of other things, many beyond your control, which can chip in to skew results, so keeping as much as you can consistent will help to make things a bit clearer.

Wishing you luck in making a breakthrough soon both in terms of your own management/experiments and getting more support from HCPs and hopefully a referral. Hang in there and keep pushing for more help.

Do keep us updated. Sending (((HUGS)))
 
okay okay okay I totally agree the steak bake was a bad idea (and it wouldn't be my usual go to - shall we just say it was an experiment and leave it in the past :rofl:) :D

I do carry around glucose tabs as a part of my always in my bag stuff but didn't think about the other snacky things to just bump things up a bit. Will defo add them to the kit 🙂

I tried psyllium husk when I tried a shake diet many moons ago... I will just say I am willing to try it again with caution 😉 :rofl:

I will see what I can come up with food wise with options and timings and splitting portions up a bit.

Really appreciate the feedback x
 
So nurse phoned back
Can't refer me to DSN with hba1c as it is (need to be over 75), wanted to try me on slow release gliclazide or 3 x a day gliclazide at 40mg (having some tummy issues).
Tried to explain that slow release or not, there are days where gliclazide plain doesn't work. Splitting the dose wouldn't have helped any with dealing with the steak bake thing. Took huge effort to get thru thru to her.
She's speaking to GP to see what can be done and calling back.
I literally had to say at one point "but I'm not a protocol or a chart, I'm a person" as well as hba1c not telling the whole story etc.

So frustrated right now.

will update when I get the next phonecall.
 
They want me to go back to old dose of gliclazide (40 mg twice a day instead of 80mg twice a day) as I tolerated that and double up on empagliflozin (20mg) and if that's okay I will just go onto the 25mg single tablet dose. At least I can take that with food if it isn't agreeable without.
Nurse calling back in 2 weeks to see how its going.

Still frustrated but its either going to work or its not *shrugs*

watch this space? (and the morning thread but give me a few days for this afternoons booster to finish playing havoc :rofl:)
 
Sorry they weren’t hugely helpful but it’s worth a go, got to show willing and try everything! Hope it helps.
 
So an update.

I tried the doubled up empagliflozin and it sent my BP and fluid retention way up. Didn't do anything for bg really but if fluid levels/systems were off, I'm not surprised. Been taken off that and back to 10mg.

GPs are at the end of the line with what they can do and want to refer me to DSN team.

Referral is already in motion (I think) but had another hba1c done and has come back today at 77. Not an accurate representation of where I am at now but enough to support the need for specialist input with getting medications right at the very least (I think).

Yesterday was probably the worst day. Crept all day and before bed was 25.8/27.8 (did a double test to make sure).
No keytones (providing my stix aren't a dodgy batch). Time of the month is in play but mostly in the high teens and low 20s daily, waking is around 13-15 on a "normal" day.
My meter target upper limit is 10 and caught maybe 2 readings in that zone in the last 5-6 weeks.

Had a conversation with my aunt and she mentioned she is terrible for medication side effects too. Did a little bit of looking into why I am terrible on most meds and it is definitely a thing that some people just are. There have been some ties with genetics as to why which sorta makes more sense now.

Anyway, that's a quick summary of where things are at x
 
Well I am pleased to hear you are getting referred to a specialist clinic, but sorry that you need to be. I hope you get an appointment sooner rather than later and get the support (and insulin... in my opinion) you need. Sending (((HUGS)))
It is so frustrating just reading this, let alone what it must be like living it!
 
Just to say this was my story over lockdown. I got a referral and got put on Humulin M3 insulin and then added Jardiance when 120 units a day were still not bringing me in range. However I have piled weight on and being already 20 stone when this started I am not prepared to be heading for 25 or even 30 stone - I’m just not - so I have knocked it on the head for now. Also Jardiance made me swell and gave me thrush … all other type 2 diabetes meds didn’t work and gave me awful side effects. I likened it to my GP as being tortured. Now I’ve stopped all meds I actually feel ‘well’ both physically and mentally. Not fighting constant hunger has been bliss! Am low carbing but it’s not helping me control my BG so likely I’ll be taking the insulin again soon. Don’t let this put you off trying it though as it really does work. You might be fine with the weight gain. The only thing to do is try.
 
Ideally I would go straight to insulin and give myself a break from side effects but who knows what they will do.

I have DPP-4 and GLP-1 agonist left to "try" before insulin is the only option. They wont give me pioglitazone with fluid retention being one side effect and I already have that without adding to it.
Both have tummy/digestive side effects so very much not wanting to try them as I have had enough of 5 months of ongoing side effects. Will have to see where they want to go with it all.
Also had thrush twice so far in about 2 months of empagliflozin. Minor for now in the grand scheme of other stuff I'd had to put up with but not wanting to keep going with it long term. For now the priority has been to contain the BG (LOL like that is happening).

I think what I am willing to do is:
GPL-1 I would want the daily one so we can backtrack if side effects are too much. Quicker to get out of my system.
DPP-4 not really wanting to try at all unless they say if its not tolerated we would skip GLP-1.
Insulin - background or mdi and no mixed. My routine and schedule is erratic. I would rather choose to eat or not and not worry about eating to mop up insulin. (correct me if I'm wrong in assuming that's how it works).

This really isn't a pity post, I just realise snippets in the waking thread might be hard to put together 🙂

I'm fed up and just want a solution that doesn't make me feel like crap and works.
 
You story reads quite similar to somebody on another forum I am on and they turned out to be Type 1 and put on insulin which has been beneficial.
I couldn't see if you mentioned that you had had any tests for Type 1 to be ruled out.
 
not been tested. assumed as t2. Only every received GP practice care.
At the mo getting something that works is priority 🙂

My meds are fairly low dose but no wiggle room there without more side effects.

First a1c covered the long period where the only way down during the day was to just not eat anything and I was scared to eat pretty much anything.
Started eating to my meter which worked for a short while until my okay foods ended up not okay anymore.
Now I am just trying to be sensible with eating and bg is what it is. 🙄

Short term emergency measures is to take another gliclazide and put up with the nausea to bring me back down. (nurse suggested this).
Will speak to her again this week if she is back from being off sick or at least ask to speak to someone else to find out if referral has been made yet and see if my weekend numbers warrant a more rushed referral (or not). T2 means snails pace of getting anything done it seems.
 
not been tested. assumed as t2. Only every received GP practice care.
At the mo getting something that works is priority 🙂

My meds are fairly low dose but no wiggle room there without more side effects.

First a1c covered the long period where the only way down during the day was to just not eat anything and I was scared to eat pretty much anything.
Started eating to my meter which worked for a short while until my okay foods ended up not okay anymore.
Now I am just trying to be sensible with eating and bg is what it is. 🙄

Short term emergency measures is to take another gliclazide and put up with the nausea to bring me back down. (nurse suggested this).
Will speak to her again this week if she is back from being off sick or at least ask to speak to someone else to find out if referral has been made yet and see if my weekend numbers warrant a more rushed referral (or not). T2 means snails pace of getting anything done it seems.
Even if you are Type 2 it sounds as if insulin would be beneficial as other things don't seem to be working.
 
Insulin - background or mdi and no mixed. My routine and schedule is erratic. I would rather choose to eat or not and not worry about eating to mop up insulin. (correct me if I'm wrong in assuming that's how it works).

Glad you are getting a referral @gll - hope you get some answers. And access to a more appropriate and effective treatment, whichever type you happen to end up with.

It does sound like a flexible insulin regimen (such as MDI), would be worth trying. And yes, it sounds like the fixed routine of a mixed / bimodal insulin would be problematically rigid for you.
 
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