New to the forum. Query about Type 2 Meds

[Coanda_24]

@Leadinglights thank you so much for your advice: I will look at my diet.

@rebrascora Thank you so much too for your post. My hypos have been between 3.2 and 3.9. They always happen late evening just before or shortly after bedtime. I know they’re happening because I start to have a sensation like I’m getting a migraine, start shaking and I get a strange feel like my heart is racing. I use an Acu-chek Instant.

In terms of my stomach I don’t have any known Gall bladder or pancreas issues. My symptoms (since late December) are:
- feeling uncomfortably full after eating a meal.
- bloating and distension
- muscle spasms and cramping
- GERD (although this has settled having taken a PPI for a month. The GERD has actually been happening for a few years and sometimes I have had difficulty swallowing and food not passing my food pipe easlily.
- a feeling of trapped wind
- gurgling (upper and lower abdomen left and right) for hours after eating
- Days when I feel like I’m gettting a UTI
- burping (dry and wet) sometimes ‘tasting’ the food I ate 5/6 hours earlier in the burp
- bouts of diarrhoea within hours of eating (30 mins to 12 hours)
- days when everything I eat goes straight through: urgent diarrhoea within 30 mins of eating then more 2/3 hours later.
- lack of appetite (although this could be more to do with anxiety).

I don’t know exactly how delayed emptying works, but when I do check sugars I do constantly find that my sugars peak 2 hours after eating and by 4 hours after eating have returned to normal (whatever that is at the time). Having read the stories of T1 Gastroparesis suffers often they can’t predict how long after eating sugars increase which makes insulin management difficult. I don’t know whether I can take some reassurance from my readings.

Since this last weekend my symptoms had slowly started to calm down and I was starting to be able to eat a little more. Which is why I felt so discouraged at the issues with Glic. One hope is that stabilising BGs would reduce the symptoms: I wonder if it’s possible for high sugars to disrupt digestion without it being Gastroparesis.

I am awaiting an appointment for a Gastroscopy to eliminate any other causes. However this week I was told my stool sample test taken last week was raised, suggesting possible bowel inflammation. Reading around on the internet, I understand that it is possible that taking PPI’s can give a false reading. My Gp had referred me to the local hospital’s lower GI triage service for advice or an appointment.

 

[Drummer]

Thank you so much for your replies. I think you’re right about blame: Diabeties has always be a secret shame. I think the issue here is that, maybe, with my ongoing stomach issues this wasn’t the best time to start playing around with medications. I’ve not taken Gliclazide since Monday on my Nurse’s suggestion. Today, my fasting sugars have been 7.5 - 9 and two hours after food between 11 and 13 - I just despair. The support at my GP surgery is really good so I hope we can come up with a plan when I see my nurse tomorrow.

The after meal numbers are just due to the high carb foods. If you switch over to something more nourishing and easier to digest than grain based foods you should soon see a difference.
A meal of scrambled eggs with grated cheese added at the end of cooking so it melts but doesn't go stringy is a good start to the day for me. I usually slice a tomato very thinly and put it on top, cover with the plate I will use, then by the time I get cutlery and am sitting down to eat the tomato is warmed through. I have suggested the same thing to others and they have mentioned substituting finely sliced spring onion for the tomato. It is a bit too pungent for me, but I have a very acute sense of taste and smell.

 

[AndBreathe]

@Leadinglights thank you so much for your advice: I will look at my diet.

@rebrascora Thank you so much too for your post. My hypos have been between 3.2 and 3.9. They always happen late evening just before or shortly after bedtime. I know they’re happening because I start to have a sensation like I’m getting a migraine, start shaking and I get a strange feel like my heart is racing. I use an Acu-chek Instant.

In terms of my stomach I don’t have any known Gall bladder or pancreas issues. My symptoms (since late December) are:
- feeling uncomfortably full after eating a meal.
- bloating and distension
- muscle spasms and cramping
- GERD (although this has settled having taken a PPI for a month. The GERD has actually been happening for a few years and sometimes I have had difficulty swallowing and food not passing my food pipe easlily.
- a feeling of trapped wind
- gurgling (upper and lower abdomen left and right) for hours after eating
- Days when I feel like I’m gettting a UTI
- burping (dry and wet) sometimes ‘tasting’ the food I ate 5/6 hours earlier in the burp
- bouts of diarrhoea within hours of eating (30 mins to 12 hours)
- days when everything I eat goes straight through: urgent diarrhoea within 30 mins of eating then more 2/3 hours later.
- lack of appetite (although this could be more to do with anxiety).

I don’t know exactly how delayed emptying works, but when I do check sugars I do constantly find that my sugars peak 2 hours after eating and by 4 hours after eating have returned to normal (whatever that is at the time). Having read the stories of T1 Gastroparesis suffers often they can’t predict how long after eating sugars increase which makes insulin management difficult. I don’t know whether I can take some reassurance from my readings.

Since this last weekend my symptoms had slowly started to calm down and I was starting to be able to eat a little more. Which is why I felt so discouraged at the issues with Glic. One hope is that stabilising BGs would reduce the symptoms: I wonder if it’s possible for high sugars to disrupt digestion without it being Gastroparesis.

I am awaiting an appointment for a Gastroscopy to eliminate any other causes. However this week I was told my stool sample test taken last week was raised, suggesting possible bowel inflammation. Reading around on the internet, I understand that it is possible that taking PPI’s can give a false reading. My Gp had referred me to the local hospital’s lower GI triage service for advice or an appointment.

Whilst nobody here can diagnose you with anything, your symptoms are not necessarily tied to Gastroparesis, it could just as easily be related to a gluten intolerance or many other things. I have to be strictly gluten free, but if I do have gluten (knowingly or otherwise), I have several of those symptoms.

Have you had any bloods done to eliminate things like Coeliac Disease and other "stuff"?

 

[Leadinglights]

Are you still taking the metformin as several of your symptoms you listed are ones reported my people who are not tolerating metformin. Just a thought.

 

[Coanda_24]

Are you still taking the metformin as several of your symptoms you listed are ones reported my people who are not tolerating metformin. Just a thought.

Hi, thanks for the response.Yes, I’m still taking my usual dose. My GP acknowledged it was probably amplifying the symptoms but was unlikely to be the cause as I have tolerated it well for years.

 

[Coanda_24]

I had an appointment with my GP nurse. She’s let me have two Libre samples so we can get an idea of what my sugars do over time. In just under two weeks she arrange an appointment with her and the Hospital specialist diabetes nurse who visits once a month to look at options. She was saying that having Hypos on 40mg of Glic - considering how high my sugars have been - has thrown her a little! One suggestion might be to go onto something like Dapagliflozin.

I’m aiming to we watch my carbs and use the libre to work out what works and what doesn’t.

 

[Proud to be erratic]

I had an appointment with my GP nurse. She’s let me have two Libre samples so we can get an idea of what my sugars do over time. In just under two weeks she arrange an appointment with her and the Hospital specialist diabetes nurse who visits once a month to look at options. She was saying that having Hypos on 40mg of Glic - considering how high my sugars have been - has thrown her a little! One suggestion might be to go onto something like Dapagliflozin.

I’m aiming to we watch my carbs and use the libre to work out what works and what doesn’t.

Well done to the GP Nurse in providing you with Libre for 2 x fortnights. That makes so much sense in finally trying to get proper visibility of what is going on.

While it would be perfectly possible to wear the 2 sensors in close succession it might also be prudent to wear one for 2 weeks , analyse those results and consider if there are any changes in your medications, your meal routines and perhaps simple activity differences that might show some underlying causes or effects. Then take stock and after that meeting with the visiting Diabetes Specialist Nurse (DSN) make a plan before wearing the 2nd sensor. That could be an efficient use of the Libre resource.

Did your GP Nurse give you a code that would allow either your GP Surgery or the DSN to view your results through LibreView? This is a Web based platform run by Abbott and allows you to log into to see extra data that isn't on the LibreLink app on your phone or on the Libre Reader. But from the given code someone you authorise can also look at your results for analysis purposes.

 

[Coanda_24]

Well done to the GP Nurse in providing you with Libre for 2 x fortnights. That makes so much sense in finally trying to get proper visibility of what is going on.

While it would be perfectly possible to wear the 2 sensors in close succession it might also be prudent to wear one for 2 weeks , analyse those results and consider if there are any changes in your medications, your meal routines and perhaps simple activity differences that might show some underlying causes or effects. Then take stock and after that meeting with the visiting Diabetes Specialist Nurse (DSN) make a plan before wearing the 2nd sensor. That could be an efficient use of the Libre resource.

Did your GP Nurse give you a code that would allow either your GP Surgery or the DSN to view your results through LibreView? This is a Web based platform run by Abbott and allows you to log into to see extra data that isn't on the LibreLink app on your phone or on the Libre Reader. But from the given code someone you authorise can also look at your results for analysis purposes.

Hi thanks for your comments they does make sense in taking the time to reflect. Yes, I’ve given my nurse access so she can keep an eye on things. It’s very interesting- I can’t help but scan it!

 

[Leadinglights]

Hi, thanks for the response.Yes, I’m still taking my usual dose. My GP acknowledged it was probably amplifying the symptoms but was unlikely to be the cause as I have tolerated it well for years.

Some people have suddenly started to get a problem and that has been because the specific brand was changed and the coating or additives can be different and they have not tolerated that

 

[Proud to be erratic]

Hi thanks for your comments they does make sense in taking the time to reflect. Yes, I’ve given my nurse access so she can keep an eye on things. It’s very interesting- I can’t help but scan it!

Just curious, but are you physically scanning, ie using a reader rather than a phone. Or did you mean you can't help glancing at the display on your phone, after waking the phone up? If this sounds a strange question, until quite recently we could only get readings by bringing one's mobile close to the sensor; the auto display that is provided today is a new upgrade. But the small hand held Readers have not got that upgrade.

Yes this new revelation about what your BG is doing is intriguing. If you decide to finger prick and compare readings with the sensor outputs don't worry if there isn't a perfect match; this can happen for some people (I was one of those). But getting readings that are "in the right zone" is still brilliant for what you want to achieve and my 12 months experience with Libre was that the trend arrows were always right - even when the nos were not so close.

 

[Coanda_24]

The after meal numbers are just due to the high carb foods. If you switch over to something more nourishing and easier to digest than grain based foods you should soon see a difference.
A meal of scrambled eggs with grated cheese added at the end of cooking so it melts but doesn't go stringy is a good start to the day for me. I usually slice a tomato very thinly and put it on top, cover with the plate I will use, then by the time I get cutlery and am sitting down to eat the tomato is warmed through. I have suggested the same thing to others and they have mentioned substituting finely sliced spring onion for the tomato. It is a bit too pungent for me, but I have a very acute sense of taste and smell.

Thank you for the advice. I tried this for lunch yesterday and it was nice! Good for my BG too!

 

[Coanda_24]

Some people have suddenly started to get a problem and that has been because the specific brand was changed and the coating or additives can be different and they have not tolerated that

That’s interesting to know. I must admit I’ve taken it for so long I just stop thinking about the brands and packaging changes when I get a repeat prescription. Will try and read up on this.

 

[Coanda_24]

Just curious, but are you physically scanning, ie using a reader rather than a phone. Or did you mean you can't help glancing at the display on your phone, after waking the phone up? If this sounds a strange question, until quite recently we could only get readings by bringing one's mobile close to the sensor; the auto display that is provided today is a new upgrade. But the small hand held Readers have not got that upgrade.

Yes this new revelation about what your BG is doing is intriguing. If you decide to finger prick and compare readings with the sensor outputs don't worry if there isn't a perfect match; this can happen for some people (I was one of those). But getting readings that are "in the right zone" is still brilliant for what you want to achieve and my 12 months experience with Libre was that the trend arrows were always right - even when the nos were not so close.

Thanks for you reply. My nurse said I needed to scan it regularly. However having had the sensor for 18 hours now, I can see it updates automatically! I thinks it’s really interesting, however there are some anomalies: earlier it was telling me my sugars had dropped to 3.7, but on checking with a finger prick test they were 5.7.

 

[Proud to be erratic]

Thanks for you reply. My nurse said I needed to scan it regularly. However having had the sensor for 18 hours now, I can see it updates automatically!

I guess this is a consequence of tech upgrades and inevitably a GP Surgery Nurse is always going to struggle to keep abreast of such upgrade improvements.

I thinks it’s really interesting, however there are some anomalies: earlier it was telling me my sugars had dropped to 3.7, but on checking with a finger prick test they were 5.7.

Firstly your sensor is actually measuring the glucose in your interstitial fluids, immediately below your skin. Whereas a finger prick (fp) is measuring your actual blood glucose, taken from a fine blood vessel. The CGM manufacturers do their best to take into account the real-time lag that exists between actual and interstitial glucose by an algorithm (a clever mathematical process) that knows what the lag has been and assumes that lag will be there in the future. So puts a correction in to smooth out that lag. In general that works OK. But ....

Some of our metabolic processes are amazingly fast, as is so much of our body responses. Stub a toe and the brain registers that in no time at all, thanks to neurons carrying the messages from toe to brain and then to muscles, hand and fingers to rub our sore toe. We might presume that the changes in blood glucose across every drop of blood in our body is instant: some carbs get digested, arrive in the blood (how? The complexity of that process is in itself just extraordinary!) and suddenly that change in BG is everywhere from toe to brain ... but not quite. So one reason for differences between fp and sensor readings is the practical aspects of pressures and glucose concentrations dispersing not quite perfectly nor instantly everywhere.

Also if our BG is rising or dropping quite quickly, the relatively complex maths from the algorithm that's been assumed and incorporated into the way a screen displays a reading, gets briefly adrift. The forecasting can't quite keep up. And we get all of this from a sensor with a retail cost of c.£50, ie probably c.£35 wholesale and thus way less £ for development and manufacture somewhere in the world - after every intermediary has made their profit. So this tech is made to a suitable price point to keep it available to most of us - and I have NO issue with that - hence the sensor performance isn't perfect every second of every day.

Many users get much closer values between actual and fp with Libre 2. I didn't, but I do get terrific correlation between the Dexcom G7 and fps - so I'm a happy user of G7. A differential of 2 (3.7 to 5.7) is not great when it's so close to the hypo threshold of 3.5 (rounded up to 4.0 for a safety buffer); but that is only important for someone like me who is comprehensively insulin dependent and better accuracy at low levels is essential. The CGM manufacturers make a point of providing safety warnings to not trust sensor readings that are outside the "Range" of 4-10 mmol/L.

Bottom line: for your purposes the anomalies are interesting but in no way should you be concerned about the precise nos; the trend is the important thing. Along with: knowing if you are at the top, middle or bottom of the range; and what foods or activities cause changes in your BG?

Even precise speed of BG changes is inaccurate, depending on the manufacturer and model of CGM. Your Libre is internally recording a change every minute and it used to display a figure every 5 mins (I don't know what it's displaying since the upgrade); my G7 displays every 5 mins. But the trend arrows are more responsive than the displayed figure and my G7 alerts are even more sensitive, which could be a nuisance alerting me every minute or less to a slight trend change. (I've softened the alerting thresholds to prevent this). The anomalies are potentially fascinating, but sorting out what is a function of tech and algorithms vs what is real physiology, to the minute, is too much for me when I'm rushing to intercept a BG crash before it becomes a hypo! I'm just grateful for the vital help.

 

[Coanda_24]

I guess this is a consequence of tech upgrades and inevitably a GP Surgery Nurse is always going to struggle to keep abreast of such upgrade improvements.

Firstly your sensor is actually measuring the glucose in your interstitial fluids, immediately below your skin. Whereas a finger prick (fp) is measuring your actual blood glucose, taken from a fine blood vessel. The CGM manufacturers do their best to take into account the real-time lag that exists between actual and interstitial glucose by an algorithm (a clever mathematical process) that knows what the lag has been and assumes that lag will be there in the future. So puts a correction in to smooth out that lag. In general that works OK. But ....

Some of our metabolic processes are amazingly fast, as is so much of our body responses. Stub a toe and the brain registers that in no time at all, thanks to neurons carrying the messages from toe to brain and then to muscles, hand and fingers to rub our sore toe. We might presume that the changes in blood glucose across every drop of blood in our body is instant: some carbs get digested, arrive in the blood (how? The complexity of that process is in itself just extraordinary!) and suddenly that change in BG is everywhere from toe to brain ... but not quite. So one reason for differences between fp and sensor readings is the practical aspects of pressures and glucose concentrations dispersing not quite perfectly nor instantly everywhere.

Also if our BG is rising or dropping quite quickly, the relatively complex maths from the algorithm that's been assumed and incorporated into the way a screen displays a reading, gets briefly adrift. The forecasting can't quite keep up. And we get all of this from a sensor with a retail cost of c.£50, ie probably c.£35 wholesale and thus way less £ for development and manufacture somewhere in the world - after every intermediary has made their profit. So this tech is made to a suitable price point to keep it available to most of us - and I have NO issue with that - hence the sensor performance isn't perfect every second of every day.

Many users get much closer values between actual and fp with Libre 2. I didn't, but I do get terrific correlation between the Dexcom G7 and fps - so I'm a happy user of G7. A differential of 2 (3.7 to 5.7) is not great when it's so close to the hypo threshold of 3.5 (rounded up to 4.0 for a safety buffer); but that is only important for someone like me who is comprehensively insulin dependent and better accuracy at low levels is essential. The CGM manufacturers make a point of providing safety warnings to not trust sensor readings that are outside the "Range" of 4-10 mmol/L.

Bottom line: for your purposes the anomalies are interesting but in no way should you be concerned about the precise nos; the trend is the important thing. Along with: knowing if you are at the top, middle or bottom of the range; and what foods or activities cause changes in your BG?

Even precise speed of BG changes is inaccurate, depending on the manufacturer and model of CGM. Your Libre is internally recording a change every minute and it used to display a figure every 5 mins (I don't know what it's displaying since the upgrade); my G7 displays every 5 mins. But the trend arrows are more responsive than the displayed figure and my G7 alerts are even more sensitive, which could be a nuisance alerting me every minute or less to a slight trend change. (I've softened the alerting thresholds to prevent this). The anomalies are potentially fascinating, but sorting out what is a function of tech and algorithms vs what is real physiology, to the minute, is too much for me when I'm rushing to intercept a BG crash before it becomes a hypo! I'm just grateful for the vital help.

Thank you so much for that explanation: it does take some getting used to but the insights are fascinating. One interesting aspect - that I hadn’t really thought about (but is obvious) - is the effect of exercise on lowering sugars. In my case just moderate paced walking for 40 minutes.

For the first day or so I did some finger prick tests just to reassure myself, but rationally I’m only taking Metformin at the moment so shouldn’t be in any danger of a hypo.

 

[Coanda_24]

Hello, I just wanted to update this thread. I’ve been moving to more low carb foods and I can see that my sugars are more stable. My GI issues persist so I’m still not eating very much. I’ve continued to loose weight. My Libre 2 continues to insist that I’m having hypos through the night!

I think the combination of eating less and weight loss has had a positive effect on insulin resistance. I am finding that I’m having nausea which can happen a couple of hours after taking my metformin in the morning and afternoon. I wonder could my changes in weight and diet be having an effect on my reaction to Metformin.

 

[Leadinglights]

Hello, I just wanted to update this thread. I’ve been moving to more low carb foods and I can see that my sugars are more stable. My GI issues persist so I’m still not eating very much. I’ve continued to loose weight. My Libre 2 continues to insist that I’m having hypos through the night!

I think the combination of eating less and weight loss has had a positive effect on insulin resistance. I am finding that I’m having nausea which can happen a couple of hours after taking my metformin in the morning and afternoon. I wonder could my changes in weight and diet be having an effect on my reaction to Metformin.

The suggestion of taking the metformin with a substantial meal is to help with symptoms of nausea but if you are not eating much that could be why but also taking a medication that is renowned for causing stomach issues when you already have problems in that area may not be helping. If it is not already ask for the slow release version of metformin as that is supposed to be kinder on your system.

 

[Coanda_24]

The suggestion of taking the metformin with a substantial meal is to help with symptoms of nausea but if you are not eating much that could be why but also taking a medication that is renowned for causing stomach issues when you already have problems in that area may not be helping. If it is not already ask for the slow release version of metformin as that is supposed to be kinder on your system.

Thank you again for the advice. I’m seeing my nurse and a visiting specialist diabetes nurse next week, so I will ask about slow release Metformin.

 

[Coanda_24]

Hello All. I just wanted to update my thread. I’ve been off Gliclazide for nearly 3 weeks: on 2x 500mg Metformin twice a day.

My GI issues continue and I’ve lost more weight: a total of 6kg since the beginning of Jan. still awaiting appointments from my GI referrals.

Due to the GI issues I was eating carb laden foods which were easy to digest. Over the last 10 days I’ve made an effort to eat few carbs.

I’ve been using a sample of Libre 2 and now got some more meaningful results. Some of the results have seem strange and have checked against finger prick tests: on the whole there no more than 1/1.5 points out.

What I’m finding is that my sugars are:

High in the morning, e.g yesterday ate a breakfast of a scrambled egg and a rasher of grilled bacon as I had some appetite. My sugar went up to 9 and then stayed in the 8s for 3 hours. Then it suddenly droppped.
In the afternoon, I went for a walk and then they dropped to low 4/high 3s. This morning I could only face a high protein yoghurt and the sugars shot up to 9 and stayed there for 4 hours. As I write this now 3.5 hours later they’re 8.2

In the afternoon they tend to be better, even after lunch: up to 7.5 and the down to 5s. I do tend to have smaller lunches.

From around 1600 they fall. Even if I have something with carbs - say crackers - they will struggle to go past 6.8.

The at bedtime they fall. I’m aware this can happen with accidentally lying down. Normal if this happens I check with finger prick and they’re okay: mid 4s. There was one occasion when the blood test was 3.8 and I experienced hypo type symptoms.

However looking at overnight charts when I’m asleep, my sugars fall (2.9 once!) and then they go up into 7/8s then fall back to 5s.

I struggle to eat in the evening: I’d rather be hungry and sleep rather than eat and have symptoms all night.

Things just feel chaotic at the moment with the stomach issue. A specialist diabetic nurse is visiting my GP tomorrow and I have a joint appointment with them and my practice nurse. My practice nurse says she is sure that insulin is the long term way to manage my diabetes. I guess if my bloods became more stable it’s worth doing. I’ve attached a summary of my daily patterns. I hope it’s okay to post them: apologies if not.

 

[curlyheather28]

Could you stomach a plain biscuit like a rich tea at bed time? Perhaps with a drink of milk or horlicks?