Just been diagnosed with Type 2 Diabetes and struggling a bit

[silver minion]

Ah very interesting! well I need to loose weight for sure! But I see your point with keep track of carbs. I was a bit worried because I'm taking both insulin and metaformin and I though I was supposed to keep my sugar under 6 at all times and I'm nowhere near that - I'm always between 7 and 9.

I checked back on your original post and you mentioned your hbA1c was well over 100 at diagnosis. When my hbA1c was 133 last July my fingerprick readings were often in double figures when I started checking. (I don't have a CGM)
Your readings show that you are reducing your blood glucose, so don't fret about individual readings unless you are going below 4.
It's generally recommended not to reduce blood glucose too quickly as it's kinder on the fine blood vessels and nerves. As long as the overall trend continues downwards and your TIR is fine, you should see a reduction in your next hba1c results.

 

[Kingsleyh]

I checked back on your original post and you mentioned your hbA1c was well over 100 at diagnosis. When my hbA1c was 133 last July my fingerprick readings were often in double figures when I started checking. (I don't have a CGM)
Your readings show that you are reducing your blood glucose, so don't fret about individual readings unless you are going below 4.
It's generally recommended not to reduce blood glucose too quickly as it's kinder on the fine blood vessels and nerves. As long as the overall trend continues downwards and your TIR is fine, you should see a reduction in your next hba1c results.

thanks for the reply 🙂 Yeah it was originally 133 and then 3 weeks later it was down to 97 and I have another one in May so hopefully that will be lower again. I guess the most important thing right now is to get the hba1c lower which from what I've read is keeping the daily average down also.

 

[rebrascora]

Having realistic expectations of what you can achieve is really important when managing diabetes with insulin, otherwise you will end up very demoralised and probably burnt out from trying too hard to achieve the unachievable. That is why I like the TIR (Time In Range) guidelines better than the 4-7 before meals, because you are either inside that range before your meal or you are not and if you aren't, then it feels like an immediate failure, whereas the 70% is over a much longer period.... days, weeks months, so it evens out when you have better days and not so good days and therefore you have a much better chance of achieving that 70% or better.

 

[Kingsleyh]

So I saw the nurse at my GP this morning - she is a nurse practitioner and knew more about diabetes treatment. I showed her my libre graphs and she said it was fine and to continue with the reduced medication I'm taking.

She also said my cholesterol was too high so she's prescribed me some statin thing for that.

In addition she's also prescribed me some Dapagliflozin and said hopefully I can come off the insulin soon. She also tickled my feet with something. Thankfully I could feel the tickling.

Another abscess developed on my stomach the other day and they gave me antibiotics for that and it's burst open a bit so they dressed it this morning and put a plaster - hopefully that will heal up soon. I waiting for a while to start exercising more as it makes it hard with the location of the abscess.

Anyway more drugs for me - but hopefully will result in success!

 

[everydayupsanddowns]

Sounds like very positive progress @Kingsleyh - well done 🙂

Hope the new meds help settle things down and the wound heals up speedily to allow you to exercise more easily. Are there less bend-stretch things you can do in the meantime?

 

[Kingsleyh]

Sounds like very positive progress @Kingsleyh - well done 🙂

Hope the new meds help settle things down and the wound heals up speedily to allow you to exercise more easily. Are there less bend-stretch things you can do in the meantime?

Thanks very much 🙂

Yeah I can do some upper body stuff still - just not too much walking.

 

[Lucyr]

The suggestion is you need anything average of 130 gms of carbs for it to work properly.

That isn’t true. The suggestion is to avoid a low carb diet as it can make you more at risk of DKA which is a potential side effect of dapagliflozin. Carbs don’t “make the dapagliflozin work properly”.

 

[Leadinglights]

I'm on metformin and dapagliflozin. The suggestion is you need anything average of 130 gms of carbs for it to work properly. I found it started to pee more. You should be given ketostix to check your urine for ketones. I was told only necessary if felt unwell. I checked last month having been on them for 6 months but it was fine.
My last hba1c in December was 44 and the hcp believes the SGLT2 was helpful. It is supposed to be good for heart health.
I don't know how it works with insulin.

I don't think that is actually the case they 'need' carbs to work but that very low carb increases the risk of something called euglycemic diabetic ketoacidosis where high ketones can occur even if glucose levels are not high. This applies to the 'flozin' meds.
What never seems to be stated is what amount of carbs people should have but that may vary depending on the individual. I know one poster who has less than 100g per day.

 

[Kingsleyh]

I don't think that is actually the case they 'need' carbs to work but that very low carb increases the risk of something called euglycemic diabetic ketoacidosis where high ketones can occur even if glucose levels are not high. This applies to the 'flozin' meds.
What never seems to be stated is what amount of carbs people should have but that may vary depending on the individual. I know one poster who has less than 100g per day.

I see. I'm eating low carb at the moment but I haven't been tracking my actual carb intake - but I'm thinking it's going to be pretty low at the moment. When I start on the dapagliflozin I'll start keeping track of my carbs for a while - the nurse said it would cause more urination as it expels sugar through the urine.

 

[Kingsleyh]

@saffron15 if you don't mind me asking - how long have you been taking metaformin and dapagliflozin. The nurse said the plan is to move me off insulin and onto just these two for diabetes management. How often do you have to check your BG when taking these and does it stay between 4 and 10mmol usually?

 

[Lucyr]

I see. I'm eating low carb at the moment but I haven't been tracking my actual carb intake - but I'm thinking it's going to be pretty low at the moment. When I start on the dapagliflozin I'll start keeping track of my carbs for a while - the nurse said it would cause more urination as it expels sugar through the urine.

If you’re eating very low carb make sure to let the nurse know this before you start taking the dapagliflozin, especially as you’ve been on insulin, as very low carb isn’t advised with dapagliflozin. You will also need to make sure you’re prescribed ketone sticks to check for DKA which you’ll be at higher risk of due to low carb and needing to use insulin previously

 

[Kingsleyh]

If you’re eating very low carb make sure to let the nurse know this before you start taking the dapagliflozin, especially as you’ve been on insulin, as very low carb isn’t advised with dapagliflozin. You will also need to make sure you’re prescribed ketone sticks to check for DKA which you’ll be at higher risk of due to low carb and needing to use insulin previously

I did say I was eating low carb but the nurse didn't say anything about DKA or about ketone sticks. I have another appointment with her next week so will ask. She told me to continue on the insulin and just add in the statins and dapagliflozin. I'm still waiting for an appointment with the diabetes nurse which is not until June.

 

[Lucyr]

I did say I was eating low carb but the nurse didn't say anything about DKA or about ketone sticks. I have another appointment with her next week so will ask. She told me to continue on the insulin and just add in the statins and dapagliflozin. I'm still waiting for an appointment with the diabetes nurse which is not until June.

Always read the leaflet in the box before taking new tablets. It will confirm the risk of DKA.

 

[Kingsleyh]

If you’re eating very low carb make sure to let the nurse know this before you start taking the dapagliflozin, especially as you’ve been on insulin, as very low carb isn’t advised with dapagliflozin. You will also need to make sure you’re prescribed ketone sticks to check for DKA which you’ll be at higher risk of due to low carb and needing to use insulin previously

I'll increase my carbs to 130g ish anyway - right now its under 100g

Always read the leaflet in the box before taking new tablets. It will confirm the risk of DKA.

(The statin one) It said not to drink grapefruit juice but I'll read more of the leaflets.

 

[Kingsleyh]

I've got a lot of tablets and injections right now:

• insulin injection twice a day
• metaformin tables twice a day
• antibiotics once a day
• dapagliflozin once a day
• statins once a day

I've never taken so many medications! Never even been sick enough to go to a doctor in the last 20 years!

 

[Lucyr]

(The statin one) It said not to drink grapefruit juice but I'll read more of the leaflets.

Every tablet has its own leaflet. Not sure why you’re reading the statin leaflet to understand dapagliflozin? It’s the leaflet inside every different medication box that you need to read.

 

[Kingsleyh]

I always go up at early morning and then up after meals but otherwise was been relatively consistent for periods of time

 

[Kingsleyh]

Every tablet has its own leaflet. Not sure why you’re reading the statin leaflet to understand dapagliflozin? It’s the leaflet inside every different medication box that you need to read.

I was reading them both - I meant I found it interesting that the statin one said not to drink grapefruit juice.

 

[Leadinglights]

I was reading them both - I meant I found it interesting that the statin one said not to drink grapefruit juice.

Some blood pressure meds also say you shouldn't have grapefruits or juice.

 

[Kingsleyh]

I had a terrible night last night I went to bed around 9pm and my BG was ticking along around 6.5 but I woke up at 11:30pm feeling unwell with pressure in my head, a bit dizzy, my hands and feet were feeling a bit pins and needles slightly and my stomach was also feeling funny, my heart started beating fast and I was a bit damp like I'd been sweating and I seemed a bit breathless.

I thought initially that it was a hypo but my BG seemed fine at 6.5 with the finger prick test and my libre showed a steady 6.5ish since I went to bed - but anyway I consumed some lucozade and huel to see which made it shoot up and then come gradually back down. I was still not feeling great after 30 mins but at least the rapid heart beat and pins and needles had gone away but I still felt a dizzy unease and pressure in my head. I called 111 to get some advice and at least a doctor called me back in another 30 mins - they said to go to A&E if feel worse but had put me on a list to see a doctor and they would call. By 3am nobody had called and I fell asleep - I woke up at 4am and called 111 saying I will just go back to sleep as was feeling ok.

This morning woke up and feeling ok - tired and wondering what happened last night. I had some constipation this morning and hard stools. Maybe I didn't eat enough or ate something that caused some problem. I'll be talking it over with the nurse tomorrow. The only thing I ate different was some canned tuna with salad leaves and black olives in a low carb wrap. And I put peri peri sauce on my tuna in the evening and also added some brown rice to get my carbs up a bit in preparation for starting the dapagliflozin.