First diabetes review coming up

[Teaforme]

I was diagnosed with type 2 diabetes in March. My first appointment with the diabetes specialist GP went a bit haywire. It started off with a discussion of management by diet while monitoring blood sugars to identify which foods I could handle. I had already been on a reduced carb diet for 3 weeks. But the demonstration of the blood glucose monitor showed my sugar levels to be in the high 20s, and a subsequent urine test indicated ketones. I was then sent to A&E, and discharged after a couple of days monitoring with a prescription for metformin.

Mid May, I was unwell with frequent and severe abdominal pain. I still don't know what caused it, but various tests after it had been going on for over a fortnight showed no obvious causes, and I had by then worked out that I could keep it at bay by 'not eating'. I lost over a stone in a month during this time. I have continued to eat only small meals (side plate size portions) because there is no way I want a recurrence of that debilitating pain, and have continued low carbs. I have reduced my metformin dose on the doctor's advice to only one tablet twice a day. I have lost a fair amount of weight in the last 2 months - probably 2 stone, certainly 2 dress sizes, which I could afford to do because I was overweight to start with. My blood sugar levels including my waking levels have been consistently between 6 and 7 since mid May.

I have my blood result tests back ahead of my diabetes review appointment with the GP next week. HbA1C is down to 37 (was 92 when I was admitted to hospital in March). Which is really good, and I hope I can discuss reducing or coming off the metformin.

My cholesterol levels have varied between 3.9 and 4.6 total levels, which I thought would be fine. But the GP's notes say 'to be discussed at review'. I am worried that she will propose statins, which I don't like the idea of and don't think are necessary. However the ultrasound scan checking for causes of my abdominal pain, showed a fatty liver (not caused by alcohol), and I have had high ALT readings on my liver function tests, though these are steadily coming down. What are other people's experiences of being prescribed statins without having high cholesterol levels?

The other thing I have to discuss with my GP at my review is atrial fibrillation, which my podiatrist identified when checking the circulation in my feet the other week. Is this a common thing with T2D? Bearing in mind that at the time the podiatrist identified it, my sugar levels were well under control and my weight had already come down, though I am still overweight.

 

[Vonny]

Hi @Teaforme and very well done on losing weight and getting your hba1c down though I'm sorry you've been so unwell during it all.
I doubt you'll be taken off metformin completely yet. I'm down from 3 a day to 1, but at my last review the DN said she'd like to keep me on one a day for the time being, despite hba1c of 36 because they give some protection for kidneys and heart.

At a reading of 5 I'm borderline on cholesterol. My GP tried to prescribe them but I won't take them because when I tried them I was fuzzy and lethargic and I'd rather be able to stay active. I'd be surprised if your GP tried to foist them onto you at your low levels, but I don't know if the fatty liver has any ramifications where statins are concerned.

I don't know of any link between AF and diabetes but there may well be. I only know 3 people with AF (one of whom is my dad) and none of them them are diabetic.

I hope you'll get some more definitive answers soon, sorry I'm not much help!

 

[everydayupsanddowns]

Thanks for the update @Teaforme - great to hear about your weight loss, though sorry to hear about your pain.

Losing weight, especially visceral fat around the organs can really help with their function, and seems to have been identified by results in the DIRECT trial as an important piece of the puzzle in T2.

A member posted a link to this study recently:

https://forum.diabetes.org.uk/boards/threads/nutritional-basis-of-type-2-diabetes-remission.94547/

I think statins are often recommended to people with diabetes, because of the additional cardiovascular risk that comes along with a diagnosis. How enthusiastically they are offered to people at different points along their diabetes timeline seems to vary from Dr to Dr and clinic to clinic.

Hope you find your review helpful. It’s a good idea to note down any questions you have, or subjects you’d like to discuss and take a notepad with you - because it can be very easy to forget things once the conversation begins to unfold!

Hope you find it a helpful appointment 🙂

 

[Teaforme]

Reducing the metformin to 1 tablet a day, while still monitoring my sugar levels, would be a good compromise @Vonny

I don't want to go on the statins unless absolutely necessary. My mother had unpleasant side effects when she was put on them - even though her cholesterol levels weren't high. Her GP surgery seemed to be handing them out to everyone of pension age.

@everydayupsanddowns the DIRECT trial is interesting. Although it wasn't done in a controlled way, I have lost about 15% of my body weight in a very short space of time. Whether that is something I will be able to maintain, I don't know. And after only a couple of months, it is certainly too early to say that the diabetes is in remission.
The list of questions and notepad for my appointment is a very sensible idea. I will do that.

 

[rebrascora]

Hi. That is fantastic reduction in your HbA1c. Many congratulations on that and your amazing weight loss!

I wonder if your severe abdominal pain could be pancreatitis. That might cause you a period of very high BG readings with ketones, similar to Type 1 because you are unable to produce enough insulin during an attack... whereas Type 2 diabetics don't normally get high ketones because their body is usually producing lots of insulin, it's just that they are resistant to it. If this was the case then it would make you a Type 3c diabetic..... but that is purely conjecture on my part. Might be worth discussing with your doctor although they will likely never have heard of Type 3c diabetes, they will have heard of pancreatitis.
Eating little and often sounds like a good strategy.

Good luck with your discussion on statins. I would be looking at my ratios with the cholesterol and going in clued up on how those different ratios affect your risk factors. They should be assessing you as an individual for medication including statins and only prescribing if necessary. My total cholesterol at diagnosis was 5.1 but thankfully my nurse was knowledgeable enough to assess my risk factor as low and said I didn't need statins and the consultant is of a similar mind. I eat a low carb high fat diet and mostly saturated fats and my cholesterol is slowly coming down. Currently 4.5, so it certainly should not be an automatic dispensing of statins and they should treat you as an individual and explain why they think you need them and it shouldn't just be because you are diabetic especially as your current HbA1c is at non diabetic levels

 

[Teaforme]

The review went well. I saw the nurse as well as the GP. Got a pneumoccal vaccination as a bonus.
GP has said to try coming off all metformin, but to continue to monitor sugar levels and continue with the low carb diet. No need for statins at this stage. Next diabetes review in 6 months time and to re-do liver tests and cholesterol tests then. I got weighed and found out I have lost 2 1/2 stones in 2 months. I don't have scales at home so have only been weighed at medical appointments. Personally, I think this is a bit much, but because of the effects on the diabetes, it is seen as a positive thing.

My heart rate was normal when checked by both nurse and the GP, and as I haven't noticed any symptoms from atrial fibrillation, it has been made a note of, but no action required at this stage.

@rebrascora I don't think I had pancreatitis. The diabetes was diagnosed a couple of months before the abdominal pains started. Although there was obviously some inflammation of something when the abdominal pains started - my spleen was so swollen I had to be careful bending over, and my white blood count was very high - that had all settled down by the time I had the ultrasound scan, and there no sign of the pancreas or anything else being inflamed.

 

[Molly M]

Teaforme - I am sure they will have checked it out but could it be your gallbladder that was causing your extreme pain? I used to follow one of the big diets and so many people got gallbladder issues and were in agony before surgery. It seemed to be that when you cut out fat in your diet it really affects your gallbladder.

Glad you got on so well with your doctors appointment.

 

[Teaforme]

@Molly M yes they definitely checked the gallbladder - at one stage it was the prime suspect. Luckily the pain hasn't come back.