New diagnosis

[Worcester_Matt]

Hello all,

I have very recently been diagnosed with diabetes and I'm finding that I'm struggling to get to grips with my blood glucose level. I've been feeling run down and unwell since about Christmas, and eventually went to the doctors. They took some blood and found that my HbA1c was at 103, and they've picked up some 'liver abnormalities' that they're still investigating. Hoping for an ultrasound scan on my liver next week.

The nurse (who is wonderful) has put me on insulin straight away, and they've been brilliant at keeping me informed and helping me through the process. My mmol reading on the test meter I've been given was 17.7 on Thursday lunchtime. It went down to 11.2 mmol by Thursday night after 1 dose of insulin, but it's been fluctuating between 12 and 15 mmol since then. I'm testing 4 times a day before every meal and before bed. I'm struggling to understand why the blood sugar is rising when I'm trying to be careful and I'm taking the insulin as instructed. For example, this morning my mmol was 13.4 before breakfast. I had a normal sized bowl of shredded wheat, a regular sized cup of tea with semi-skimmed milk and 1 teaspoon of white sugar. I had a snack during the morning of a banana and a coffee with 1 teaspoon of sugar. By 1pm (5 hours later), after taking my insulin with breakfast, my reading was 15.1 mmol. I'm on 14 units of Humalog mix 25 in the morning. Is this kind of rise normal? Does this suggest that I need to up my dose of insulin? The nurse has said that I can take an extra two units of insulin per dose if I want to, which I think I will starting from tonight. I'm due to speak to her again on Monday morning, and the diabetes clinic is closed over the weekend.

They're still unsure of whether I have type 1 or type 2 diabetes. I'm 27, a little overweight but with quite a lot of diabetes in older members of my family. If anyone has any advice or thoughts about why my glucose level rose this morning then I'd be incredibly grateful. The trend on Thursday and Friday was that my glucose was gradually falling, although it spiked yesterday evening at 17.2 before I went to bed. I'm doing my best to make sure I eat healthily, and I'm keeping a food diary, but I'm a little bit lost for an explanation as to why my glucose is fluctuating like it is.

On the insulin front, is it normal that some injection sites hurt more than others? My left leg doesn't hurt at all, I could wiggle the pen around when it's injected and I doubt it would hurt, but my right thigh hurts a bit, and injecting into my stomach just below my belly button hurt last night and drew a little blood. Does pain suggest that I'm doing something wrong, or can I just expect that and learn to get on with it?

Matt

 

[HOBIE]

Welcome Matt. A banana is good for people that have just done a marathon. You sound like you have a good idea of the situation & good luck. Keep asking & write down numbers for nurse etc 🙂

 

[Worcester_Matt]

Hi Hobie, are bananas something to avoid then? I've been trying to eat more fruit (bananas and nectarines) since my diagnosis. I think I'm going to avoid them tomorrow to see how that affects my glucose levels.

Matt

 

[HOBIE]

Bananas is a good way to get carbs into you quickly. A lot of fruit is high ish in carbs. It is a minefield but dont stop eating fruit maybe try going out & going for walk or similar 🙂

 

[Robin]

hi Matt, welcome to the club nobody wanted to join. There's a lot of info on this site, it's just a question of working your way slowly round it, learning as you go. the problem with fruit is that it contains a lot of sugar, which is very quickly absorbed into the blood stream, and can elevate your levels quickly. I try and eat it as part of a meal where I've had protein and fat and not much carb for the first course, which slows down the absorption and prevents spikes in your blood sugar,
i just wanted to comment that when I was newly diagnosed, my liver function tests came back at elevated levels, and my GP got in a flat spin and sent me for a liver ultrasound, which was totally normal. by the time I got seen by the hospital, I was gradually bringing my levels under control, and my liver tests were back to normal. The hospital's view was that my liver had 'got angry' at the elevated glucose levels, and had now settled down. it's been fine ever since, so try not to worry too much about that.

 

[trophywench]

Hiya - it would be best if you could try to decrease the amount of carbohydrate you are having across the board - for instance by cutting down on the sugar in drinks. You may have already done that of course - but I'd suggest you pack it up and if you can't drink it without it being sweet, fair enough - but use sweeteners.

Can I also ask firstly what insulin you are taking? and secondly for what reason you had a snack? Is it because you have your breakfast really early, so mid morning is hours and hours after that? - or because they have stuck you on an intermediate insulin or something.

However you are injecting before meals which suggests it isn't intermediate, but then you haven't mentioned taking any long-lasting insulin - which you would normally also take, to accompany the fast-acting at mealtimes - so it all sounds a bit awry somewhere! - sorry!

 

[Mark T]

Welcome to the forums Worcester_Matt 🙂

 

[Worcester_Matt]

Thanks for the information about bananas! It certainly does seem to be quite a minefield when it come to fruit. Are there any that a particularly low in sugar? I've read on other threads that oranges are quite high in carbs too, so I'll avoid them for the meantime. I'm trying to increase the vegetable intake too, to make sure I get the 5 a day.

I hadn't thought about eating fruit alongside protein and fat. I'm apparently supposed to have an appointment with a dietician in the next week or two, so I'm sure I'll get more dietary advice there. It's one of the reasons I'm keeping a food diary, as my memory can be terrible sometimes!

Thank you for the information about your liver tests too Robin. My AST count is apparently around 217, and I'm in the process of being referred to a consultant endocrinologist about it. They seem to be thinking that my diabetes and my liver are linked, and I get the impression that they're also considering whether I have something called "fatty liver". I have other gastric symptoms (which were the reason for going to the doctors in the first place), which they think are caused by the liver problems.

I've cut down my sugar intake quite considerably, although I was only diagnosed on Wednesday. I've cut out all fizzy drinks, sweets etc, so the only added sugar I have that isn't naturally occurring in food is the sugar I have in hot drinks. I'll cut that out if I need to, but I'm not sure what effect the insulin is going to have so I don't want to cut everything out straight away. The insulin I'm taking is Humalog Mix 25, which contains a rapid action insulin and a slow release insulin. I don't have the exact details in front of me, but the nurse mentioned that eventually she'd like me to move to 4 injections per day rather than two, with two injections of the slower insulin and two rapid action injections. The snacks were generally that I was hungry. I have breakfast around 8, although I'm usually awake from 6.30-7am, and don't have lunch until 1pm. I guess one of the reasons I'm in this situation is my propensity to snack during the day (and my sedentary life-style, I sit at a desk for 12 hours a day), and that's a hard habit to get out of. I'm certainly aiming to do more exercise, and my glucose levels were down to 10.1 at 7.30 tonight (having been 15 at 1pm today) after going for a 40 minute walk. I guess I'm still getting to grips with how my glucose levels fluctuate, what causes them to fluctuate and how my insulin should work to bring them down to normal.

Thank you for all your thoughts and advice, it really is welcome. I'm not too apprehensive or worried about my diabetes, but it's all absolutely new to me and there's so much to know and learn.

Matt

 

[KookyCat]

Hi Matt
Welcome aboard, sounds like you have the right attitude to it all 🙂. I was diagnosed last year and treated the experience like a science experiment until I got to grips with it all. I too started out on mixed insulin, and found it exceedingly difficult to get control because it's too restrictive for my erratic eating patterns. You'll hear the term MDI used which means multiple daily injections and that's the pattern of insulin delivery most people use. You have a background insulin (one or two injections a day) and then an injection of rapid with every meal adjusted to the amount of carb you eat. Snacking isn't really very easy with insulin, because most snack foods contain carb and therefore need insulin (crisps, crackers, fruit, dried fruit, biscuits etc) but you can snack on no to low carb things like veggie sticks with a bit of hummus, nuts, boiled eggs, olives, cherry tomatoes, cheese, oatcakes are low in carb about 4gs so if I'm super hungry I have one with no sugar peanut or cashew butter and that does the trick. Lower carb fruits include berries, and melon, I don't much like fruit so I can't think of others but it occurs to me you might not know about the Carbs and Cals book/app, it's a really useful tool for working out carb values, there's a pocket book, a large book and an app on Apple and android. As a general rule though any carb you mix with fat will release slower than just carb on its own, so fruit salad with cream or full fat yoghurt will absorb slower than the fruit alone. Having one sugar in coffee isn't something I'd worry about to be honest, although if you drink lots of coffee it will mount up. I can drink coffee with or without sugar always have done because I'm weird like that, and now I use sugar in coffee to avoid low blood sugar because I really hate jelly babies, and anything too sweet/biscuits so I top up with a bit of sugar in my cuppa. Personally I'd rather eat my own toenail clippings than artificial sweetener because it tastes like the devil child of a jelly baby and battery acid, but since most people don't seem to notice I'm guessing I'm one of the unlucky few with the extra taste bud 🙂. Bit if you do use sweetener some find that some variations can raise blood sugar so you'll need to experiment a bit.

 

[Worcester_Matt]

Hi KookyCat and Mark T, thank you for the welcome!

I think I'm very much treating it as a science experiment at the moment, but I don't know if that's just a coping strategy. I've been pretty much fine with everything so far, but I had quite an unpleasant time on the first Sainsburys trip since my diagnosis. I suddenly felt totally overwhelmed and surrounded by everything that I felt I was suddenly not allowed to have. I've also gone through a bit of the "why me?" and the "it's not fair" stages. One thing that put it into perspective was that the diabetes clinic at our hospital is next door to the children's part of the hospital. Things could be much much worse!

Thank you for the advice about what I can replace fruit with. Trying to make sense of my glucose readings is a bit hard after only a few days, but it certainly seems that fruit is one of the causes of the spikes upwards, so I'm cutting out all fruit until I've spoken to the nurse or the dietician. I love hummus, so carrot and hummus may well be my snack of choice from now on, although I'm trying my best not to snack between meals. I'll certainly look into that App too. I've found the Apple health app on my phone quite a good way of keeping tabs on my glucose readings too, as I can start to see overall trends. I'm also not much of a fan of sweetener, but if I need to cut out all sugar then I'll look into it and try a few to see if there's any I like and that agree with me.

I did have one question about my diagnosis that seems to be a little vague with the doctor/nurse at the moment. They've done two lots of blood tests and I've had 2 urine samples looking for ketones. I can measure ketones at home with my testing kit, and I have a reading of 0.2mmol. The nurse seems to think that I have type 1 diabetes, perhaps a slow onset form, but I'm being regarded as if I have type 2 at the moment. Does anyone know how long it can take to get an accurate diagnosis of the type of diabetes? At the moment I'm worried about these ketones when my blood sugar is high, and they're being rather vague about when I might know for sure what type of diabetes I have. Other people with diabetes always seem to be clear and certain about their diagnosis, which doesn't seem to be my experience.

Matt

 

[trophywench]

Urine testing for ketones is extremely unreliable since it takes your body 4 hours to get the urine into your bladder - and it ain't much good really knowing your ketone level 4 hours ago, is it? So I wouldn't concern myself too much about urine levels if I was you.

Blood testing for ks is up to date and accurate - so only go by them. I can't advise anything about what's what with meter ketone results though - cos I've never had such a meter and simply don't know! - but someone on here will !

I should have thought TBH you are probably T1 at your age - but there are two (expensive) blood tests they can do if it doesn't become obvious soon - GAD 65 and C-reactive protein - one of these must be done soon after diagnosis but can't remember which one, sorry - but a few people on here are that type (Type 1.5/LADA/MODY) and they can tell you better about it. However one of the features of the 'slow onset' type is that it normally responds quite happily at first - to T2 drugs! So if they think you are that - why on earth haven't they stuck you on Metformin or one of the other normal T2 drugs to see if it is? Very mixed messages, I agree!

You (and they LOL) will get there soon, don't worry.

Oh - and have a read of this link - you are at least reacting normally to your diagnosis even if it isn't precise at the mo!

http://www.diabetes-support.org.uk/info/?page_id=50

 

[Worcester_Matt]

Thank you for your advice and the link, there's a lot of great information on that website. I've saved a lot of the pages for future reference. I agree, the situation is quite confusing and vague at the moment.

I'm increasingly puzzled by my glucose results. I had a reading of 13.9 this morning before taking 16 units of my insulin. I had 40g of shredded wheat and I measured out 125ml of semi-skimmed milk. 1 cup of tea with a tiny dribble of milk, and about 4g of sugar. No snacks or anything until 12.30pm. My blood was at 14.9. I then did my blood at 1.15pm, when it was 15.4. This makes no sense to me. It seems like my insulin dose is very low, or too low to manage my glucose. I'm going to speak to the diabetic nurse tomorrow morning. I'm also going to see my GP as my stomach symptoms are getting worse, especially with this low-food diet I'm on. Is it so unusual for my blood glucose to rise like that after eating what I had for breakfast? My evening meal last night was a homemade chicken stir fry, eaten at 7.30. Normal portion size and lots of vegetables. My glucose was 12.2 at 10pm, and 13.9 at 8am this morning. Could that meal last night still account for rising glucose levels at lunchtime today?

Sorry for all the questions! Still trying to get my head around all of this.

Matt

Edit: I've done some googling and it seems shredded wheat is notorious for sending blood sugar quite high. I'm going to try weetabix or porridge to see if that's any better, but it seems they might be just as bad. A lot of omelettes for me for breakfast!

 

[stephknits]

Hey Matt, welcome to the forum. You have had lots of great I go from everyone so far so I will try to be brief.

From what you have posted so far in terms of your proactive approach and the steps you have already taken to change bits of your diet, I would really recommend you push for MDI (the multiple daily injections that Kooky outlined) instead of the mixed insulin. That way you will be able to have a much more varied diet and be more in control of your blood sugars.

In terms of a firm diagnosis, this is ,ore tricky than you might at first think. You mention you have had two blood tests, it would be interesting to find out what they are. I suspect one would be to establish your HbA1c, which gives you a general picture of how your blood sugars have been over a 3 month period.
Another test you may have is to test your levels of certain antibodies that attack the insulin-producing beta cells in the pancreas. If you have these, then a diagnosis of type 1 is more likely. However, you may well be still producing some insulin. This was the case with me and can take a while to iron out.

There are people here who are great at all the science if you are interested. I am a little sketchy!
Best of luck 🙂

 

[trophywench]

The same blood tests which I referred to Steph! LOL

It is a great website Matt - it's a pretty good forum too actually LOL - but we are all friends, just that this one wasn't around when the forerunner of the website one was being morphed into that one.

All the articles on that website were written by diabetics, for diabetics. We have no Agendas to comply with, and no loyalties to even Diabetes UK if we think they aren't giving the best advice in anything - because it is funded by the members. (Not that it costs us anything actually because the very small amount we make via stuff the members buy from the DSF shop - so if you want anything from Amazon or M&S or wherever and do it through the shop, DSF gets and teensy kickback without costing the purchaser a single penny extra)

Just for info - I find that eating anything at all with a carb value of 10g, increases my BG by 3.0. So 40g Carb in brekkie cereal would increase mine by 12.0 and the milk a bit more on top of course. That's the equivalent of 4+ slices off a large white loaf. It's Quite A Lot ! especially at brekkie, since c.95% of all diabetics find they are LESS carb tolerant first thing in a morning.

Protein keeps a person feeling 'full' for a lot longer than carb does - carb hits you in a lump - and an our or two later you'll have your tummy grumbling at you - very noisily in some cases! - to fill it up again.

 

[stephknits]

Sorry Trophywench, your post and matt's latest post didn't appear for me when I posted!