High blood sugars first thing am

[Titch 91]

Hello @Titch 91, glad the nurse is responsive.

In an earlier posting I suggested that because your diabetes has been damaged by steroids, you should, strictly, be categorised as T3c. I have that just a tiny bit wrong, in that its one of the T3 sub-groups, probably T3d rather than c - I can't remember; but this is splitting hairs: you aren't an autoimmune T1 nor an insulin resistant T2. The point is that, as a T3something, you should be under a Hospital based Specialist Team for diabetes (which the T3 sub-groups attract) and that team is so much better placed to reconcile the endocrinology (ie diabetes treatment) with steroid use and both existing damage as well as prospective damage and side effects from steroids.

Hospital teams are accustomed to identifying when insulin is needed and prescribing accordingly - whether it is as a short term fix or longer term solution and should be much better placed to get other tests and/or scans organised, if needed.

If you are still in trouble after doubling the Glic ask (pester/ cajole/ insist) for an Urgent referral to a Hospital Team. With the best will in the world, your GP Surgery and their personnel are highly unlikely to have the skillset to sort out your present challenges.

A little more about T3 sub groups: in the USA a few years ago there was a proposal to recognise other types of D, apart from T1 & 2, specifically those arising from other damage to the pancreas. An international symposium proposed sub-categories from a-k, covering a multitude of reasons why pancreatic damage occurs; this array of T3 flavours didn't get agreement by the World Health Authority (WHO). But the symposium and discussions brought about a growing awareness that there were very many reasons why people got diabetes and damaged pancreatic functions often needed quite different treatments, often with that treatment needing to be co-ordinated with the cause of the damage. As well as Pancreatic cancer and partial or total pancreatectomies (usually attributed to T3c), there was pancreatitis, alcohol abuse, steroids (from prescription or abuse in pursuit of abnormal fitness), accidents and many more. I had a link to that list, but can't find it! Anyway awareness by many medical professionals of any of the T3 sub-groups is not terrific in UK today, but there does seem to be a growing awareness of T3c at least - judging by the few who appear on this and other forums.

Hoping things improve very soon for you.

Hey, thanks for your reply. It's all so confusing to me. The GP told me it's steroid induced diabetes but they've just treated it the same way as type 2.. I will see what happens by the end of the week with my sugars and go from there. Thank you for all that info it's helpful knowledge to have and put back to the nurse. 🙂

 

[Leadinglights]

Hey, thanks for your reply. It's all so confusing to me. The GP told me it's steroid induced diabetes but they've just treated it the same way as type 2.. I will see what happens by the end of the week with my sugars and go from there. Thank you for all that info it's helpful knowledge to have and put back to the nurse. 🙂

How are you feeling now, have the stomach pains subsided. Did you manage to check for ketones?

 

[Titch 91]

How are you feeling now, have the stomach pains subsided. Did you manage to check for ketones?

Yeah thankfully the stomach ache has gone, my vision is still blurry and I feel really thirsty though. They've delivered them to my neighbour who currently isn't home! My carer is gona knock again later or try in the morning. I take it I just pee on the stick and it will show up whether I have ketones or not?

 

[EmmaL76]

Feel like such a pain to my GP surgery. Always on the phone to them about one thing or another! I Will fill out the online form and request a call back. Thanks

Please don’t feel like a pain, you have a real concern and that’s what they are there for.

 

[Proud to be erratic]

Hey, thanks for your reply. It's all so confusing to me. The GP told me it's steroid induced diabetes but they've just treated it the same way as type 2.. I will see what happens by the end of the week with my sugars and go from there. Thank you for all that info it's helpful knowledge to have and put back to the nurse. 🙂

Alas, this happens a lot still and I find it disappointing; I fully accept that GPs can't be knowledgeable about everything and anything medical - its not a reasonable expectation. So they need to know a little about everything; a lot more about medical complaints that they frequently encounter; and who to seek help from for those diagnoses that aren't routine.

By coincidence I was at a hospice meeting this morning where, without naming who or which region this GP was from, we were told about a long-standing GP with special responsibility for palliative care in that Practice - who had only a shallow awareness of the regional hospice and what the hospice could provide to help reduce that GP's workload. It transpired the GP was so overloaded he/she didn't seem to have the time to look at possible regional resources. GP overload isn't helping them to pause, take stock and then tap into the right expertise; it probably feels easier to prescribe and turn to the next patient. In a different meeting we had been discussing how the Hospice could best reach out to the 70+ GP Practices and explain what the Hospice already provides, along with what further palliative treatments the Hospice might take on if it was needed. The Hospice is a long-standing County NHS resource, which gets a tiny bit of their income from the NHS and the rest from charitable activity or bequests. So the problem is as much about getting the dots joined, in an environment where Primary Care Trusts (PCTs) have become Cost Centre Groups (CCGs) and now merged into Integrated Care Systems (ICSs) - to be under Integrated Care Boards (ICBs). Confused? So are the GP Practices I suspect!

Anyway, this wonderful forum generally has someone who knows something more about anything that might be confusing you, so do at least ask. I had to learn the hard way (through lockdown) how to get the 6 specialists (from 2 Counties and 2 different Hospital Trusts) who were looking after me better co-ordinated and more responsive to my needs. Oh, and a GP who told me in an email that because I was under Specialists the Practice couldn't help me ... which led to an interesting and slightly abrasive (on my part) dialogue; but got resolved. All of that hugely increased my understanding of the 'system'.

 

[Titch 91]

Doesn't look like the double glicizide has taken affect 16.3 this am.. hoping they will come down a bit later.