Endoscopy cancelled high HBCA..

W

Woody1949@

Member
Relationship to Diabetes
Type 2
Hi I have gone private as I have chest pain which I think is a Hernia.
AE have ruled out my heart is the problem.
The private hospital have said I do not meet the criteria of my HBCA
being under 71 has not been met.
My HBCA has come back at 85.
They said an ENDESCOPE OR AN OPERATION are not possible at that level.
I suffer with HYPO’s and always run my sugars around 85/86 this is with the diabetes team
at my surgery’s knowledge.?
My pain has worsened and Lansaprole has not helped.
I’m at a loss as to what to do.
Has anyone experienced similar .
Thanks Jim.
 
Hi and welcome.

Really sorry to hear your endoscopy had to be cancelled because your HbA1c is too high and that you are suffering continued undiagnosed pain as a result.

Running your levels in the 80s is not advisable long term and your medical professionals should have been helping you to lower it. Unfortunately staff at GP practices are often not well enough informed about diabetes to help patients using insulin or other glucose lowering medication.

There is a lot of room to reduce that HbA1c before hypos should become a real problem, so I suspect you have not had the best support or advice. What medication are you on to manage your diabetes and what if any dietary/lifestyle changes have you made? Those can be a very important factor in reducing BG levels and therefore HbA1c without increasing insulin doses which might cause hypos.
 
Welcome @Woody1949@ Sorry to hear your endoscopy has been cancelled due to your high HbA1C. Do you test your own blood sugar? What medication do you take for the diabetes?
 
Hi Barbara.
Insulin dependant since 96.
Humalog and Tresiba.
I’m on Gabapentin for back pain which after some injections in the spine - i have reduced.
Trouble is this ongoing 6 weeks pain.
AE once they ruled out any heart problem referred me back to my surgery.
I went Private as I know something is wrong..
Jim.
It’s so minimal the difference of what they require and what my actual HBCA is.
 
Jim, do you have Libre sensors or other Constant Glucose Monitoring(CGM) system to track your levels or do you just finger prick?
What sort of doses of Tresiba and Humalog do you take?
Do you carb count and adjust the Humalog depending upon what you intend to eat? If not, this may be the reason for having hypos if you have not been taught to carb count.

Just trying to get an idea of your diabetes management regime as to where you could improve it that bit to get you to where you need to be for the endoscopy or ideally lower to a bit healthier level. Even 71 is rather high, but will be the top end of what is safe to perform the procedure, so it will be important to get it down to that.
 
Woody1949@ said:
Hi I have gone private as I have chest pain which I think is a Hernia.
AE have ruled out my heart is the problem.
The private hospital have said I do not meet the criteria of my HBCA
being under 71 has not been met.
My HBCA has come back at 85.
They said an ENDESCOPE OR AN OPERATION are not possible at that level.
I suffer with HYPO’s and always run my sugars around 85/86 this is with the diabetes team
at my surgery’s knowledge.?
My pain has worsened and Lansaprole has not helped.
I’m at a loss as to what to do.
Has anyone experienced similar .
Thanks Jim.
Click to expand...
Even private hospitals have to follow guidelines about the blood glucose levels that are needed to be before any invasive surgery or procedure as the risk of infection and poor tissue healing is much higher.
What diabetic medication are you taking as it should not be necessary to keep blood glucose high to avoid hypos, what units are the 85/86 and what is the test that gives that level.

Certainly people have been told that their HbA1C needs to be below, I think I have heard 65mmol/mol mentioned but it could be lower and may depend on the particular procedure.
 
rebrascora said:
Jim, do you have Libre sensors or other Constant Glucose Monitoring(CGM) system to track your levels or do you just finger prick?
What sort of doses of Tresiba and Humalog do you take?
Do you carb count and adjust the Humalog depending upon what you intend to eat? If not, this may be the reason for having hypos if you have not been taught to carb count.

Just trying to get an idea of your diabetes management regime as to where you could improve it that bit to get you to where you need to be for the endoscopy or ideally lower to a bit healthier level. Even 71 is rather high, but will be the top end of what is safe to perform the procedure, so it will be important to get it down to that.
Click to expand...
Libre sensors in East Kent..i have asked.
I test my bloods with Glucomed blood sensor
Humalog 12 units with my meals
Tresiba 25 units before bed.
Carb counting has not been explained to me.
Had lots of stress over the last few years of caring for my late wife and back pain
so that has not helped.
Due to see my diabetic practice nurse next month.
 
Ask about carb counting @Woody1949@ It should help you reduce your HbA1C and also reduce your hypos. It’s not a complicated thing. You could even teach yourself if you’re able to focus on it (I completely understand you might not be able to with the stress you’ve had and your current pain). Basically, each unit of Humalog you take will cover X grams of carbs. Careful experimentation will show you what number that X is.

The first step is to tot up the carbs in your meals. This isn’t as hard as it sounds as many will be on the packet or box. Also, if you have a set of digital scales that will help too, so you can weigh any items that need weighing.
 
Appreciate what you’re saying but having been diagnosed with Brittle diabetes.?
My levels fluctuate even when I’m ultra cautious what I eat.
Gardening / decorating / walking .-getting it right all the time is so difficult.?
I think a Libre system might help but my practice nurse said they just don’t give them to type 2 diabetics.?
Thanks Jim
 
Woody1949@ said:
Appreciate what you’re saying but having been diagnosed with Brittle diabetes.?
My levels fluctuate even when I’m ultra cautious what I eat.
Gardening / decorating / walking .-getting it right all the time is so difficult.?
I think a Libre system might help but my practice nurse said they just don’t give them to type 2 diabetics.?
Thanks Jim
Click to expand...
You could apply to Abbot for a free 2 week trial of a Libre as long as you have a compatible phone and that might help you tailor your insulin to your diet.
 
Woody1949@ said:
Appreciate what you’re saying but having been diagnosed with Brittle diabetes.?
My levels fluctuate even when I’m ultra cautious what I eat.
Gardening / decorating / walking .-getting it right all the time is so difficult.?
I think a Libre system might help but my practice nurse said they just don’t give them to type 2 diabetics.?
Thanks Jim
Click to expand...

Brittle diabetes makes things harder, but even so carb counting should help you. Also, I wonder if some of the brittleness is possibly due to digestive problems? If your digestion isn’t working as it should, that can make blood sugars erratic.

Yes, being on insulin makes everything a bit harder, particularly exercise. I always check my blood sugar before I start and have some glucose or carbs beforehand if necessary. I also take them with me for too ups, if needed. I find gardening lowers my blood sugar very quickly. I think it’s all the bending. I usually keep those little 150ml cans of original sugary Coke to drink when gardening.
 
Leadinglights said:
You could apply to Abbot for a free 2 week trial of a Libre as long as you have a compatible phone and that might help you tailor your insulin to your diet.
Click to expand...
I will discuss this with my diabetic nurse who know’s they might have a change of policy re Libre.
Thank you all for your replies.
Jim
 
Woody1949@ said:
I will discuss this with my diabetic nurse who know’s they might have a change of policy re Libre.
Thank you all for your replies.
Jim
Click to expand...
How many times a day are you testing and how long since you last asked for libre? Check the guidelines for your area but in some areas T2 now qualify for libre so long as they inject insulin multiple times a day and so long as they’ve been advised to test bg 8+ times every day
 
Really sorry to hear that you lost your wife and that you needed to care for her prior to that. Sincerest condolences. It is a lot of stress and trying to manage your own diabetes on top of that cannot have been easy, so it is understandable that your levels will have been erratic/brittle especially if you were on set doses and not carb counting. Yes exercise or increased activity does affect BG levels and certainly gardening is one activity that has a reputation for causing hypos but you can learn to adjust your insulin to manage that risk and make sure to have hypo treatments on hand to deal promptly with any that do happen. You can learn a lot from people on this forum about how to manage that better as I have, but Libre can definitely help and I would certainly encourage you to apply for the free trial if you haven't already done so. we can post a link to it if you are unsure and it is commitment free, so you don't have to cancel anything if you don't like it or it doesn't work well for you. As mentioned, you do have to have a compatible smart phone for it to work, but the range of phones which are compatible is quite broad.

It is definitely worth continuing to push for it on prescription as the guidelines for that are changing all the time, but if you find the free trial really useful it might be worth considering self funding (not cheap I know as many of us who are Type 1 self funded until we got it on prescription) as a short . short term solution to help you reduce your HbA1c to enable the endoscopy, but also to help you learn how to manage your diabetes better in the longer term. I know we shouldn't have to pay privately like this but it can be really helpful, even in the short term.
 
Lucyr said:
How many times a day are you testing and how long since you last asked for libre? Check the guidelines for your area but in some areas T2 now qualify for libre so long as they inject insulin multiple times a day and so long as they’ve been advised to test bg 8+ times every day
Click to expand...
Hi and thanks for the response.
I only see my diabetic nurse annually so it would have been a year since I asked about Libre.
I inject 4 times a day and test at the same time.
 
rebrascora said:
Really sorry to hear that you lost your wife and that you needed to care for her prior to that. Sincerest condolences. It is a lot of stress and trying to manage your own diabetes on top of that cannot have been easy, so it is understandable that your levels will have been erratic/brittle especially if you were on set doses and not carb counting. Yes exercise or increased activity does affect BG levels and certainly gardening is one activity that has a reputation for causing hypos but you can learn to adjust your insulin to manage that risk and make sure to have hypo treatments on hand to deal promptly with any that do happen. You can learn a lot from people on this forum about how to manage that better as I have, but Libre can definitely help and I would certainly encourage you to apply for the free trial if you haven't already done so. we can post a link to it if you are unsure and it is commitment free, so you don't have to cancel anything if you don't like it or it doesn't work well for you. As mentioned, you do have to have a compatible smart phone for it to work, but the range of phones which are compatible is quite broad.

It is definitely worth continuing to push for it on prescription as the guidelines for that are changing all the time, but if you find the free trial really useful it might be worth considering self funding (not cheap I know as many of us who are Type 1 self funded until we got it on prescription) as a short . short term solution to help you reduce your HbA1c to enable the endoscopy, but also to help you learn how to manage your diabetes better in the longer term. I know we shouldn't have to pay privately like this but it can be really helpful, even in the short term.
Click to expand...
Thanks again for your reply and others.
I will definitely follow your advice.
Annoying how small the margin is with my figures and their protocol requirements.
My latest HBCA done by them 85 and their requirement is 71.
On the old scale 85 is 9.9
And 71 old scale is 8.7?
So a difference of 1.2 on the old scale.
I explained to them regarding my Hypos I run it around 10 for my safety
especially at night as I have had several bad night time episodes as well as the day.
My diabetic nurse was happy with this.?
It’s a bit like I can’t wait to get you out of the door yearly appointment.
Weight/ blood pressure/ injection sites ok?/feet. HBCA result.and out.
Thanks again Jim.
 
Woody1949@ said:
Hi and thanks for the response.
I only see my diabetic nurse annually so it would have been a year since I asked about Libre.
I inject 4 times a day and test at the same time.
Click to expand...
If it’s been a year since you asked then the rules may have changed since then to allow it for some type 2 on insulin. In my area you wouldn’t qualify as only testing 4 times a day though, so whilst you say your diabetes is brittle, if you’re not having to test between meals, during or after exercise, before bed or during the night, then either your diabetes isn’t actually brittle or you’re just not testing enough? Remember you should also be testing before and during driving too.

If you found that your testing increases to 8 times a day as you try to improve your control, then I’d definitely go back and ask again and point out to your diabetes nurse that at 8+ tests a day libre is shown to be cheaper than test strips and approved in many areas for t2 on insulin testing 8+ times a day.
 
Hi yes I also test during the day or night if I feel something is oncoming.
Luckily I don’t drive I would not put myself or someone else in danger having
these hypo’s.
Thanks Jim.
I will ask my nurse next month re Libre.
 
Woody1949@ said:
Hi yes I also test during the day or night if I feel something is oncoming.
Luckily I don’t drive I would not put myself or someone else in danger having
these hypo’s.
Thanks Jim.
I will ask my nurse next month re Libre.
Click to expand...
In the meantime there is no reason not to get the free trial Libre so you would then have some data to show your nurse as to how beneficial it would be to you gaining better management and lowering your HbA1C without the risk of hypos.
You have a fair way to go to reach the criteria of 71mmol/mol especially as the HbA1C will be giving the result averaged over the 3 months prior to the test.
 
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