mmol Readings Type 2 @ 32.7

[Rickstar88]

Hi,

This mornings reading is my highest ever at 32.7mmol.

Any advice or guidance? I feel fine in myself.

I have issues with a damaged pancreas & liver that do not produce enough insulin.

Any thoughts shared would be appreciated.

Many Thanks
Rick

 

[rebrascora]

Oh dear! That is not good! Especially when you have a damaged pancreas. I suggest you probably need to double check first to make sure it isn't a rogue reading and then seek medical advice via 111, unless you have insulin to inject to bring you down??
What medication do you have?
The other thing you can do is to drink plenty of water to try to flush some of it out through your kidneys and not eat any carbs for a while until levels come down.
If levels persist in the high 20s-30s please seek urgent medical advice.
Do you have a means of testing for ketones? If not, you might want to find a pharmacy that is open for emergency prescriptions (it being a Bank Holiday) and buy some Ketostix to test your urine for ketones.

 

[Rickstar88]

Oh dear! That is not good! Especially when you have a damaged pancreas. I suggest you probably need to double check first to make sure it isn't a rogue reading and then seek medical advice via 111, unless you have insulin to inject to bring you down??
What medication do you have?
The other thing you can do is to drink plenty of water to try to flush some of it out through your kidneys and not eat any carbs for a while until levels come down.
If levels persist in the high 20s-30s please seek urgent medical advice.
Do you have a means of testing for ketones? If not, you might want to find a pharmacy that is open for emergency prescriptions (it being a Bank Holiday) and buy some Ketostix to test your urine for ketones.

Hi and thanks you ever so much for the quick response.

The liver & pancreatic damage are a direct result of alcohol dependency - I am pleased to say I have been abstinent for nearly 10 months now. I was admitted to hospital with Alcohol Related Liver Disease in March, and was discharged in April of this year. I was pre-diabetes a little time before this event.

Up until around the beginning of September, my diabetes levels, whilst being far from ideal (around 6 – 8 mmol on the morning read and 12 – 14 mmol in the evening) were, as far as I can tell, not overly concerning and manageable. However, since then, despite my abstinence, what I believed to be a recovering liver, and my dietary efforts, my levels have started to rise. These readings, on average, being in the range of 24 – 29 mmol regardless of the time of day of testing. My Gastro specialist has advised me, from bloods, that my latest HbA1c reading was twice (early 80’s) what it was after bloods taken during my inpatient stay (08 Mar – 15 Apr 2021).

I am taking Metformin & Gliclazide as well as Creon 25000 to ease some of the digestive pressure off of my pancreas. I have also been scripted a month's worth of Dapagliflozin (5mg a day) to see if this helps my levels. Had a blood test a week or so to assess its effectiveness. I have around a weeks worth of this medication left. Initially, on discharge, there was talk of me being put on self administered insulin, however, this idea was withdrawn and swapped with tablet meds. This could have been based on the fact that I was admitted due to alcohol dependency coupled with a chaotic lifestyle that goes with such an addiction issue. Under those circumstances, I really dont blame them with for not issuing me with a dangerous self injecting substance!

Another complication on 28 September of this year, I had an Ultrasound Scan the results of which I received at the end of November. The scan discovered a 1cm cyst on the right side of my liver. The type of cyst is unknown, but this should be remedied by an MRI Scan which is scheduled to happen on 07 January 2022. Once the type of cyst has been identified then a treatment plan, if required, can be put in place. I cant help but feel the rise in my levels are connected to this recently discovered cyst. As you can imagine, during my hospital stay, I had plenty of liver scans but no sign of the cyst then, so can only assume this cyst has developed quite recently, around the time my readings started going up.
But, wont get any indication from medical profession until MRI is completed and a report submitted.

So so sorry for such a long reply & thanks you for taking the time to reply.

 

[rebrascora]

Thanks for your honesty and well done on your abstinence. I was a sugar addict pre-diagnosis, so I know how difficult it is....
I would say that another possible option, rather than the cist causing these inflated levels, is that the Gliclazide has "flogged" your insulin producing beta cells in your pancreas, to death and they are no longer able to produce enough insulin to control your BG levels. Personally, I think that you may now be at the stage that insulin is necessary and I think you need to be seeking urgent medical assistance if these very high levels continue as they could be doing significant damage to blood vessels in your eyes, feet and kidneys with prolonged levels that high.
In the mean time, can you give us an idea of what you are eating and drinking and perhaps we can suggest lower carb alternatives which will help your body to cope better.

I can only reiterate that whllst you may not feel unwell with levels this high, because your body has likely slowly got used to them, they are increasing your risk of sight damage and nerve and blood vessel damage in your feet and putting a strain on your kidneys, so it is really important to get those levels down or seek medical advice to do so.
I would also be happier if you had a means of testing for ketones because if your pancreas is becoming unable to produce enough insulin, you are at risk of DKA (Diabetic Ketoacidosis) which could put you in a coma and cause organ damage.

 

[Rickstar88]

Thanks for your honesty and well done on your abstinence. I was a sugar addict pre-diagnosis, so I know how difficult it is....
I would say that another possible option, rather than the cist causing these inflated levels, is that the Gliclazide has "flogged" your insulin producing beta cells in your pancreas, to death and they are no longer able to produce enough insulin to control your BG levels. Personally, I think that you may now be at the stage that insulin is necessary and I think you need to be seeking urgent medical assistance if these very high levels continue as they could be doing significant damage to blood vessels in your eyes, feet and kidneys with prolonged levels that high.
In the mean time, can you give us an idea of what you are eating and drinking and perhaps we can suggest lower carb alternatives which will help your body to cope better.

I can only reiterate that whllst you may not feel unwell with levels this high, because your body has likely slowly got used to them, they are increasing your risk of sight damage and nerve and blood vessel damage in your feet and putting a strain on your kidneys, so it is really important to get those levels down or seek medical advice to do so.
I would also be happier if you had a means of testing for ketones because if your pancreas is becoming unable to produce enough insulin, you are at risk of DKA (Diabetic Ketoacidosis) which could put you in a coma and cause organ damage.

Hi, and thanks ever so much for staying in touch and offering such well considered advice & guidance.

Self tested a couple of times since. At 1535 it was 28.5 and just now, at 1830 its 21.6. Despite 3 self tests today, for a couple of months now I have had to limit testing to 2 or 3 times a week. Originally, I was testing once in the morning and once in the evening, every day, however, I increased testing when I noticed that my levels were increasing for no apparent reason, well no reason that I could fathom. This testing reduction is because my surgery has told me I am testing too much despite me explaining why I am so keen to keep and eye on my levels as they slowly have been creeping up. "ohh your poor fingers" was what the nurse explained on the surgery declining my request for testing strips. I believe, as I have been told by many others with T2 it is more of testing strip cost issue.

My diet is not brilliant, but its not too bad. I have quite a bit of commercial cooking experience so quite competent in my kitchen and I find cooking at home very therapeutic. It is a very rare occasion when I eat processed foods, a little bacon, perhaps some sausage once in a while. I am not so good with starchy carbs, I have potatoes, mostly boiled, probably 3 - 4 times a week. Sometimes either rice or pasta. I like bread, nine out of ten times this will be granary or brown. Probably average 2 - 3 slices p/day. I drink coffee, at least one cup, black with a spoonful of sweetener. The sweetener I use is natural & contains zero calories/carbs etc. I started using Triple Zero Stevia around 3 weeks ago. I have a weakness for fats, creams, ice creams, cream cakes etc. I have starting using skimmed milk after switching from full fat a month ago. For breakfast I have a bowl of Shreddies with fresh strawberries, blueberries & black grapes with semi skim milk & no added sugar. Also, I keep myself well hydrated and switched from ordinary bottled water to water with added electrolytes.

Just got a book, it arrived today, called Carbs & Cals. Explains a lot about food to avoid and gives guidance on foods to go for based on the breakdown of nutritional values. Just bought some Lentils too, so will experiment with some lentil based meals too.

I dont know much about ketones but will do some research and speak to my GP (if I ever get a chance) about this. I guess we will be in contact with each other when my blood results are available.

Also, FYI, to further compound matters, due to a tumour, the whole of my right kidney was removed in 2015 so I had best look after the only one I got eh? I see a chiropodist every 3 - 4 weeks and always ask them to check for any signs of diabetes related issues.

Had a Diabetic eye check a couple of weeks ago and no damage was detected.

Once again, thanks for taking an interest, I do value everything you say.

Rick

 

[Kaylz]

Have you tried reducing your carb intake?

Most are more insulin resistant in the morning and that is a very carb heavy breakfast you are having, also grapes are often referred to round here as "little sugar bombs" and many find they can use a few grapes to treat a hypo

 

[Drummer]

Ah - well - its the carbohydrates you need to wary of - that would be the breakfast cereal, the fruit, the bread, the potatoes the rice, the pasta, maybe the skimmed milk and the cream cakes, but they are probably only a minor part of the problem.
Some people can cope with lentils and some can't - I seem to be able to get more carbs out of peas and beans, so I eat only small amounts if I eat them at all..

 

[Leadinglights]

You should be able to see with the aid of your Carbs and Cals that some of your food choices are not so good and as you are interested in cooking you will probably be able to make some substitutions which will still give you tasty meals but will be much lower carb. With levels as high as you say some urgent attention to your diet would be beneficial.
As far as testing is concerned your surgery is very short sighted as most people find testing is fundamental to getting better blood glucose control. Inexpensive monitors with the cheapest strips can be bought from Amazon. the GlucoNavil being one recommended. Monitor approx £14 and strips £13 for 100.

 

[rebrascora]

I'm like @Drummer. Much as I love lentils and beans and chick peas, they release much more glucose into my blood stream than they should but I do have a few occasionally. Bread is my nemesis and I am better not eating that at all.

Tonight I just had a rib-eye steak with fried mushrooms and 2 small pieces of sweet potato, which isn't too bad for me, served with a big side salad dressed with balsamic vinegar and a very large dollop of cheese coleslaw. BG levels are blissfully steady in the 5s after 3 days of high levels (mid teens) because I stupidly ate some bread.

Lots of testing is the key to gaining control because you need to find out which foods your body will tolerate and which send you off the scale. If you GP/nurse won't supply enough test strips then buy a cheap meter like the Gluco Navii or the Spirit Healthcare Tee2 with at least 100 extra strips and start a proper testing regime of just before each meal and 2 hours afterwards, with the aim of adjusting the carbs in that meal to reduce the spike it produces. You will find that some foods are not too bad for you but others are best avoided, like me and bread.

The reason I suggest buying one of those meters is firstly the test strips for them will almost certainly be cheaper than the meter your GP has prescribed and that is where the costs accumulate. The basic meter kit is less than £15 but you get through a lot of test strips in the first few months of intensive testing, so buying a meter which has some of the cheapest test strips makes economical sense. It is also a good idea to always have a spare meter when you are on medication which can drop your levels too low (Gliclazide or insulin). You are looking to keep the rise due to each meal down to less than 3mmols so if your pre meal reading is 15.6 then you want the 2 hour post meal reading to be less than 18.6. If it is more then you ate too many carbs and you need to reduce them next time you have that meal. Once you consistently keep that meal rise to less than 3mmols, your pre-meal readings will start to progressively reduce. I know it sounds like a right faff but it works and once you get into a system of testing it just becomes second nature and then it is just a question of building up a repertoire of meals that your body can cope with.

Breakfast is a time when most of us are most insulin resistant so reducing the carb content of your breakfast can have a massive impact on the whole day. You could try something like an omelette with whatever fillings you like (other than potatoes). I have a 2 egg omelette with mushrooms and onion and cheese and perhaps peppers or courgettes or aubergines and whatever cooked meat I have that needs using up with a side salad and cheese coleslaw. That will usually keep me going until evening without the need for lunch. Alternatively full fat Greek style natural yoghurt with a few berries (not grapes) and mixed seeds works well and you might find that cream in your coffee works is a good idea too. Cream is lower in carbs than milk and the fat will fill you up and give you slow release energy for the rest of the day. It is my daily luxury that I really miss if I run out of cream.

Anyway, I hope that gives you a few dietary ideas to try to improve those levels but please make a fuss with your health care professionals if your levels remain that high because those are really dangerous levels!

 

[Rickstar88]

Thank you to all for taking the time to respond to this post.

Your comments have been a real eye opener for me. Did not know anything about ketones but have now researched it and realise how important they are. Also, now need to pay more detailed attention to my diet as well as the need to give my surgery a kick up the preverbal you know what. Also, will be buying a spare kit & testing strips on line.

Have put a plan in place, with my daughter, neighbour and a friend to keep them abreast of any high reading to be aware I may need help if I become uncontactable. I do live in Retirement Housing with emergency pull cords everywhere that link to a 24 hr monitoring station if needed.

Big massive thank you to you all.

 

[rebrascora]

So pleased you are now more clued up. You can buy Ketostix over the counter at most pharmacies for about a fiver for a pot of 50. Ketones and DKA are less of a concern with Type 2 than Type 1 but I am not totally convinced that you are bog standard Type 2 (possibly Type 3c since you have pancreatic damage), so definitely a good idea to be able to test for ketones to keep yourself safe. You should test for ketones when your levels are persistently above mid teens and seek medical advice if you get a reading of more than 1, especially as you don't have and insulin to inject to bring your levels down.

 

[Alan S]

Thank you to all for taking the time to respond to this post.

Your comments have been a real eye opener for me. Did not know anything about ketones but have now researched it and realise how important they are. Also, now need to pay more detailed attention to my diet as well as the need to give my surgery a kick up the preverbal you know what. Also, will be buying a spare kit & testing strips on line.

Have put a plan in place, with my daughter, neighbour and a friend to keep them abreast of any high reading to be aware I may need help if I become uncontactable. I do live in Retirement Housing with emergency pull cords everywhere that link to a 24 hr monitoring station if needed.

Big massive thank you to you all.

I've read all the replies so far; you have had good advice. However, if changes to your carb load don't lead to a significant improvement quickly I suggest you should contact your doctor to discuss this ASAP. I am just a diabetic, not a doctor, but it appears to me that insulin is needed at this stage, possibly replacing the oral diabetes medications. Actually, I suggest you make that appointment regardless.

While you wait to see the doctor this technique I used to review my menu for better blood glucose levels might help. I realise you are in a retirement home and might have limited ability to change the menu but you might be able to leave some excess carbs on the plate.

Start with whatever you eat now.

Eat, then test after eating at your spike time and if BG’s are too high then review what you ate and change the menu next time. Then do that again, and again, and again until what you eat doesn’t spike you. You will get some surprises, particularly at breakfast time. The so-called "heart-healthy" breakfasts are NOT for most type 2's. Similarly, you will find variations through the day - the same thing will have different effects at breakfast, lunch, dinner and supper. But I can't say how they will affect others - only how it affected me - which is why we all need to test ourselves.

As you gradually improve your blood glucose levels, review the resulting way of eating to ensure adequate nutrition, fibre etc are included and adjust accordingly.

Then test again. Test, review, adjust, always towards better and better blood glucose levels.

And no - you won't have to test so intensively for the rest of your life. As time goes on and you build your knowledge you won't need to test as often because many of your results will become predictable as your numbers improve. You will be building your own personal Glycemic Load database. As that happens you can reduce the intensive testing to "maintenance" levels. I still do two or three fasting tests and several one-hour post-prandial tests randomly each week. Just to be sure that things aren't changing. I may do a few more if I am adding a new dish to the menu or trying a new restaurant. But I no longer need to test after every meal or snack.

 

[Alan S]

Originally, I was testing once in the morning and once in the evening, every day, however, I increased testing when I noticed that my levels were increasing for no apparent reason, well no reason that I could fathom. This testing reduction is because my surgery has told me I am testing too much despite me explaining why I am so keen to keep and eye on my levels as they slowly have been creeping up. "ohh your poor fingers" was what the nurse explained on the surgery declining my request for testing strips. I believe, as I have been told by many others with T2 it is more of testing strip cost issue.

I just noticed that. Sorry, but that advice by the nurse is absolute nonsense. Do it right and your fingers will be fine even if you test 10 times a day.

If the surgery will not approve more strips then consider paying full price for strips in the short term as an investment in your future health.