Hello and Help!

[TheFraggle]

Hi Folks;

TL-DR: Anything else i should be doing on top of what the GP's said, i.e. ramp up metaformin if i'm getting initial blood readings of 11-17?

Background:

Last year was atrocious - emergency appendectomy, Covid caught in hospital, 24/7 crisis response cover at work, close family bereavement and an assault at work. That unsurprisingly gave me reactive depression and the GP gave me Sertraline which gave me a dry mouth and weight loss.

"Common Side Effects of Depression / Sertraline, nothing to worry about - come back when we're open face to face after covid..." - GP​

BP, Cardio, Cholesterol were all fine so I didn't push it.

Fast forward six months and i'm Tired, Thirsty, going to the Toilet a lot and more than four inches Thinner round the middle (why aren't the 4 T's everywhere?) - so I figured I'd push for an appointment.
Got an appointment - the urine test showed high ketones and glucose immediately, blood test +3 weeks later.

Call came two days later from the Diabetes Specialist Nurse and bam -

"You're diabetic."
"Take Metformin, and we'll start you on insulin in 2-4 weeks"
"You'll get a special appointment early next month on <date>. Save any questions to then"
​

Thanks. I think.

Couldn't get specifics on blood test results or or anything further and they were out of the 3 mins they'd got allocated for the call so I found this site which has been really useful.

I work in tech and am a data geek so I went out and bought a Contour Next One glucometer so I could plot the data alongside my Blood Pressure, Weight, Diet and Exercise stats to see what's going on.

Started Metformin at the weekend, one tablet per day, pains in long muscles and abdomen much better already.

Glucometer arrived today, super easy to use - between 17.6 just after two slices of brown bread through 11.4 after a weight training session and usual mile lunchtime walk.

A urine test dip strip is showing ketones and glucose, glucose is maxed, ketones in the middle of the range.

I can see how it's going to be useful to capture some data and use the checklists for the GP follow up on Monday (Last GP trainee asked me whether stomach pain could be appendicitis - bit hard after an appendectomy) and the Diabetic Nurse on the 11th, but

is there anything other than low carb balanced diet, usual exercise and the ramp up of the Metaformin prescribed (1 a day this week, 2 next, 2x 2 week after) I should be doing?

 

[SB2015]

Hi @TheFraggle

Sorry to hear about your diagnosis along with all the other things that you have had to deal with.

As you are displaying the symptoms of T1, including weight loss, and have high ketones and high BG it may be that they need to get you onto insulin a lot more quickly than they have planned. With the levels you have at present I would be concerned that you could quickly develop Ketoacidosis, and would be contacting 111, and possibly going to A&E. Sorry to sound alarmist but there are quite a few of us on here who have been treated as T2, when the advice suggests starting T1 on insulin straight away.

Please let us know how you get on.

 

[Bruce Stephens]

is there anything other than low carb balanced diet, usual exercise and the ramp up of the Metaformin prescribed (1 a day this week, 2 next, 2x 2 week after) I should be doing?

I don't think so, except to keep pressing for the various blood test results so you know what they are.

I'm guessing the HbA1c might be rather high, and actually they might suspect Type 1 rather than Type 2 (the fourth T you mention, sudden loss of weight, is a common sign for Type 1 and not usually Type 2). Similarly ketones are more a Type 1 than a Type 2 thing. Regardless, if you're measuring over 10 mmol/l consistently then Metformin isn't doing the trick.

 

[TheFraggle]

Hi @TheFraggle

Sorry to hear about your diagnosis along with all the other things that you have had to deal with.

As you are displaying the symptoms of T1, including weight loss, and have high ketones and high BG it may be that they need to get you onto insulin a lot more quickly than they have planned. With the levels you have at present I would be concerned that you could quickly develop Ketoacidosis, and would be contacting 111, and possibly going to A&E. Sorry to sound alarmist but there are quite a few of us on here who have been treated as T2, when the advice suggests starting T1 on insulin straight away.

Please let us know how you get on.

Thanks - that's useful to know.
I was wondering from the meter saying "Very High" and prompting for 2 hourly retests and glad I asked. I'll keep an eye for a couple of hours and see if I can get through on 111.

 

[TheFraggle]

I don't think so, except to keep pressing for the various blood test results so you know what they are.

I'm guessing the HbA1c might be rather high, and actually they might suspect Type 1 rather than Type 2 (the fourth T you mention, sudden loss of weight, is a common sign for Type 1 and not usually Type 2). Similarly ketones are more a Type 1 than a Type 2 thing. Regardless, if you're measuring over 10 mmol/l consistently then Metformin isn't doing the trick.

Thanks Bruce. I made a joke about "Is there blood in my sugar stream" but the nurse a) didn't laugh and b) wouldn't tell me. Determined to find out - my body and my health so will find out.

DSN (i'm picking the lingo up quickly) said T2 but i'm wondering as you say if there's some news waiting for the F2F with the GP on Monday there. It's only day three of the Metformin, and i'm wondering if it's something I could up the dosage on in the meanwhile. Will find out from 111.

Bit mind boggled too - if I hadn't bought the meter I wouldn't have known the levels, and it was only luck that I could make a GP appointment next week. I'm wondering how many people are waiting ages to find out what's going on and get treatment.

 

[Bruce Stephens]

It's only day three of the Metformin, and i'm wondering if it's something I could up the dosage on in the meanwhile.

From the sounds of it Metformin might not be sufficient, at least for the moment. It increases insulin sensitivity and reduces glucose release from the liver, but the ketones suggest you're just not producing much insulin and the fairly high glucose readings suggests reducing what your liver produces isn't going to help enough.

(However, I'm not a doctor so 111 is a much better bet than me.)

 

[Leadinglights]

Upping the metformin too quickly could give you some stomach issues. I would certainly contact 111 and try to get a GP appointment sooner than next Monday.
Make sure you are keeping hydrated and watch your carb intake carefully.

 

[SB2015]

Let us know how you are getting on.

If your BG is showing ‘very high’ and you have high ketones along with the weight loss it sounds a lot like T1. It would be good to get help sooner than next Monday. As a T1 if o had levels like that and could not bring them down I would go to A&E.

If your body is not producing insulin (T1) the metformin is unlikely to make a difference since it is intended to make the insulin you have work more effectively but if you do not have the insulin in you it is not going to do that job.

Do let us know how you are doing.

 

[TheFraggle]

Update - went through 111; said monitor and contact GP, and if it goes higher or I feel worse call 111 and advise I need a response in 6 hours and need to speak to a nurse urgently.

Called GP - bounced straight off reception even highlighting the 111 advice, readings etc on the basis i'd got the earliest appointment booked they could give which is Monday.

Was out of test strips as i naively thought the 10 with the meter would last a week or two (not the case when you're learning and the meter says high - test again to confirm) so figured I'd go to the Pharmacist.

Hugely helpful - confirmed I could up the metformin straight away as long as I monitor the BG and Ketones and don't have any gastro issues. Said if I feel worse or the BG doesn't go down to a) push once at the surgery and b) go down the 111 route, or straight to A&E if I felt particularly bad or there was an alarming deviation. So have upped the Metformin and am tracking.

I'm using the Upcoming Healthcare Visit reminder pattern on Contour which is interesting but not a lot of datapoints so far, some change downward after heavy exercise and I appear to be waking up with BG higher than I went to bed with.


Have to say being able to measure what's going on helps me feel better informed a bit more in control as the GP experience so far has been underwhelming.

I'll send them the data from Google Fit, Nutracheck and Contour in an infographic before the appointment and see what happens.

 

[SB2015]

The GP surgeries are used to dealing with those with T2 and rarely see people with T1, so do not always give appropriate advice For T1. There are a large number in here misdiagnosed by The Practice .
Do monitor your levels and seek more help if your levels remain high.

I hope that you have got some more test strips now as you definitely need to be able to monitor at present. If my levels are high and I have high ketones I am advised to test every 2 hours (as per your test kit) even through the night, as you can develop ketoacidosis which is a serious condition that needs immediate treatment.

If you choose to wait until Monday you could try reducing the amount of carbohydrates that you are eating as all of these convert to glucose once inside you. Keep monitoring.

If diagnosed with T1 it is very useful to get specialist care from the team at your local hopsital who specialise in managing T1. This is particularly useful at the start As they will help you to learn who to manage your levels by adjusting you insulin doses.

 

[Bradford84]

Whilst I am by no means an expert, I have had lots of recent advise RE High BG and Keytones, including speaking with the specialist just yesterday. Their advice to me, and I would think it would be the same, if the reading is 13/14 for BG and Keytones 0.6 or above you need to go to A&E. If Keytones are higher than 0.7, go to A&E unless the BG is less than 10. You are better safe than sorry so I would deffo go get checked if the above applies.

This forum is great and I hope you get under control soon!

 

[harbottle]

Metformin's effects are limited, they won't make a huge impact on levels that are in double figure like that. The max dose (2000mg) can make a difference of maybe around 1 mmol/L from research I have read.

Your high readings in the morning may be due to 'dawn phenomenon' which affects some people with diabetes (The body starts producing glucose.)

The Contour is a nice bit of kit, my preferred meter (I have a little collection! The Contour was free from Ascencia care - I just answered some questions on a website and they sent me one!) but the strips are the most expensive. I find its results are consistent and the integration with Apple's health app works well. (I tend to use my Gluco Navii more as its strips are cheaper or my TrueMetrix Air.) Contour is reserved for a 'special occasion'!

 

[everydayupsanddowns]

Welcome to the forum @TheFraggle

Glad you contacted NHS111, do keep a close eye on things and don’t hesitate to go to A&E if you experience breathlessness, nausea, abdominal pain, or sense an acetone/pear drop smell on your breath.

Keep us posted with how you get on and if there are any developments.

 

[TheFraggle]

Firstly - Thanks all for the support and info, it's been really useful because week one has been a rollercoaster.

It's been an odd couple of days since last post.

I wanted data to have a discussion with the doctor with so have been using a BG tracking app on the phone, Nutracheck for nutritional info and I got a cheap MiBand 6 (£34) and some euphy P1 smart scales with bodycomp etc (£40) as I didn't have scales at home. These put data into Google Fit and Nutracheck so I could see exercise / carb intake / sleep / weight / bg.

First thing that seemed obvious was I could see BG increases from really small carbs, like 2x brown toast. So as people recommended, dropped my carb intake to v low carb level, ramped up the metformin to 1000mg/d as agreed with Pharmacist with no side effects (lucky me).
Started feeling a bit better, more energy within 12h.

Found Nutracheck is really useful for that - e.g. can scan the barcode of stuff even from Lidl / Aldi / Farmfoods and it'll give nutritional info.

Got a fitness band and body measure scales arrived. Scales showed weight stable but low on water; skin pinch and urine colour backed that up so ramped up water intake.

Low Carb + Metformin + Extra water dropped ketones so much I was re-testing because it went from heading for A&E to 0.5 so I figured as I could see what really ramping up the exercise would do. I was careful to test BG regularly, Ketones and keep an eye on Heart Rate, SPO2 and my blood pressure is optimal.

Three 5 min kettlebell workouts
a 10min 30kg powerbag workout
25 min walk
3x 5 mins Krav drills on a punchbag

and

I hit 6.8 last night before bed!!!
​

BG is higher in the morning but it's starting to come down and I'm finding a lot of low carb stuff that I like, including some great tasting frozen stuff that's microwaveable so i'm going to keep going today.

Thanks again for the support - it's a big deal and vital where the NHS seems to be overwhelmed.

 

[everydayupsanddowns]

Thanks for the update @TheFraggle

Glad your ketones have come down, and good to hear you are feeling a bit better 🙂