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Thought I was doing ok...

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This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.

HJenks71

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My diabetes journey

I apologise in advance, but this is going to be a long one – I thought I was doing really well, but a couple of conversations recently have made me very confused and now I have no idea what’s going on and I was hoping that hearing other peoples’ experiences might be able to point me in the right direction. I will keep this as brief as possible, but it’s been an action-packed year!

So, a bit of backstory – I’m 53, female and hadn’t been to a doctor for years – hadn’t had anything that made me think it necessary. Then my Mum (who had been 100% fit and independent, looking after the garden and house single handedly as well as walking her dog twice a day at the age of 83) was taken suddenly ill at the beginning of November last year. She fought with everything she’d got, but it wasn’t enough and she died at the beginning of December. January – March was spent dealing with her funeral and interring her ashes and her horrendous sister. I wasn’t very well in February – felt fluey and completely lost my appetite. I got over that, but still didn’t feel well and was losing weight. I put this down to the grief and stress of losing Mum. But then it all came to a head at the end of March when I collapsed at home.

I was taken into hospital where I was diagnosed with diabetes (don’t know the type – that will be explained later), in DKA, a serious kidney infection and sepsis. I then spent 6 weeks in hospital, 3 in ITU and 3 on the normal ward while they got my kidney (mainly) under control.

While in hospital, I saw the diabetic nurse 2 or 3 times who just told me when to check for ketones and to tell the DVLA that I was on insulin. They also said they’d sent a blood sample to Exeter to find out if I was type 1 or 2 but it would take ages to get the results back. (Literally all I was told). They wouldn’t even come and see me when I was discharged as there was potentially COVID on my ward. When I was discharged, I was insulin dependent – regime was 30 units Abasaglar mornings and 7 units Novorapid with each meal. I had my hbA1C tested once in hospital when I was fist admitted and it was 118 – there’s no other record of it on my notes that I can currently access, although I have requested them all for the time I was in hospital.

I was discharged on the 3rd May and I was still very weak from the sepsis and kidney infection at this point – still on long term antibiotics and no appetite at all (I lost 20kg from December – June). Next interaction I had with the diabetic unit was in June when the diabetic dietitian rang me. She was really useful and it was at this point I discovered that I needed to base the Novo injections on the amount of carbs I had per meal, so if we had a carb free meal then I didn’t need to take any. At this point, still on same doses of insulin and blood sugars averaging about 8 – 9.

I also made contact with my GP, who turns out to be a specialist in diabetes and has been the reason I’m still relatively sane. He ordered blood tests. My hba1c was now 43 – mostly, I suspect, because I’d hardly eaten anything in hospital (the food was beyond disgusting) and had started to really cut down on carbs and just eat more healthily. He reduced my Abasaglar to 26 units on a morning and told me to experiment with the Novo depending on the carbs in my meals. Blood sugars were now high 7 – high 8s depending on time of day. I get a letter from the diabetic unit cancelling the clinic appointment I had in September and moving it to December (!).

Follow up with GP in September – blood sugars now average low 7s. Blood pressure normal after stopping steroids. Hba1c down to 41. GP reduces Abasaglar to 10 units in the morning and keeps novorapid the same. Makes first mention of potentially transitioning me from insulin to tablets.

End October – blood sugar still average low 7s. Reduced Abasaglar to 5 units am. Novorapid to 4 units per meal and to add in metformin 500mg morning and evening. One horrendous day of side effects from the Metformin, but then settles down. I had asked my GP whether I needed to keep the appointment t the diabetic clinic as they hadn’t been in touch. He advised that I did, but should be asked to be discharged to GP care.

November – hba1c down to 39. Blood sugars mid – high 6s. GP stops the insulin, adds in 5m Linagliptin on a morning. Tells me to keep monitoring blood sugars and go back in 10 days. Blood sugars remain stable at mid-high 6s.

I then get a call out of the blue from the diabetic department! Now, bear in mind, so far as they’re aware, I’ve had no conversations about my diabetes since the end of April. She says they’ve had a cancellation for that Friday’s clinic and would I be able to come then instead of 20th December. So, I said yes, I could. She then asked in the most patronising tone if I’d been able to monitor my blood sugar (!!). So, I told her that yes, it was averaging 6 – 7, I was off insulin and my hba1c was 39. There was an immensely long pause and she said “How have you managed that?” So, I told her it was with the support of my GP, eating healthily and taking more exercise. So, she said that she would speak to the consultant, but would recommend that I be discharged to GP care and not to worry about the clinic appointment. The consultant (with whom I had never spoken, but had an appointment in mid-January) might still want to see me. Fine.

Went to see the GP next day who told me all was good and that I didn’t need to test my blood sugar any more unless I wanted to. He was pleased about me being discharged from the hospital, so, so far as I was concerned, all was going well in my world for the first time in months.

Then I get another call from the diabetic unit. They are discharging me back to my GP care, but I need to see the consultant in January because he wants to talk about my kidney. S, I exclaim “My kidney?!” and she says “Yes, you were aware that you had a kidney infection?” I resist the urge to reply that yes, 6 CT scans, 2 ultrasounds, long term antibiotics and a very serious conversation about me potentially having it removed as the infection was so persistent had given me a clue, and merely said that yes, I was, but I was under the care of the urology department for that so I didn’t understand why (10 months after I was admitted) they now felt like they had to get involved, but ok, if that’s what they wanted, I would be there in January. She then said that I needed to be very closely monitoring my blood sugar as this was probably a honeymoon period and they would probably climb rapidly and I’m in danger of going back into DKA. They are fine between 4 and 10, but if they go over 20 to seek urgent medical attention. So, I said, but I’m type 2, aren’t I? At which point they admitted that they’d lost the test results, so they don’t officially know, oops. And they’ll send me a letter discharging me and goodbye.

WHAT?! I am so confused and scared. I am a woman of above average intelligence and I just don’t understand what’s going on. I am so angry with the department – things they didn’t tell me include having to adapt the novo to what I was eating, what I should be eating, how to count carbs and the effect it had, what to do if I was ill and quite possibly a lot of other things that haven’t cropped up yet.

Thank you for reading this far – if I could make you a cup of tea, I would! In a nutshell – the questions I have are:

  1. Is this honeymoon period a thing?
  2. How do I know if I’ve got type 1 or 2?
  3. Can I pay for this test privately?
  4. Can I ask for a 2nd opinion as I don’t trust anything the department says to me – all the other care I have had has been phenomenal – it is just them.
  5. At what point do I start worrying about my blood sugars? (Currently high 5s, low 6s)
  6. Why does the consultant now want to talk about my kidney if I’m under urology (and it’s steadily improving – there is no infection and the remaining haematoma is shrinking at a good rate.
I am so stressed by all of this. I was managing so well (I thought) but now I don’t know if I am managing well, or this is just a fluke and it will come back to haunt me and I will need insulin again. I can’t relax – I am so scared of having to go back into hospital…

Any insights, general advice or just sharing experiences would be very, very much appreciated. I am extremely lucky in that I have a very good and strong support network of friends ad my husband who have all been amazing. But I’ve never been ill before and it’s a scary and lonely place…

Thank you
 
Welcome @HJenks71 🙂 Sorry about the loss of your mum x

Before I answer your questions, I’ll say one general thing: diabetes is something where you have to become your own expert. Sad but true. It’s largely managed by the patient.

To my mind, your priority is to get them to find the lost results (who lost them??) or get the tests redone because it’s hard to know your situation and future situation without knowing what type you are. You probably started off on that higher dose of Abasaglar due to your infection. Then when that was better, your insulin dose reduced. So, maybe you’re Type 2 who can now manage on tablets but maybe you’re Type 1 and in the honeymoon period. Both are possible. DKA is usually, but not exclusively, associated with Type 1. Type 1s also often lose weight unexpectedly prior to diagnosis. Was that like you?

1. See paragraph above
2. See paragraph above
3. I’m not sure and I’m also unsure whether you’d get the result any quicker if you could. The NHS lost it - get them to repeat it.
4. Yes, you can look into other local hospitals with a diabetes dept.
5. I’d start worrying when you have lots of results roughly 11-15 or more. It’s also very important you test for ketones. I’d do that if your blood sugar was 12+ or if feeling unwell.
6. No idea about the kidney but high blood sugars can cause kidney damage over time.
 
Oh my. You have been through the mill!

Firstly, I'm so sorry for your loss. Losing a parent is a life changing event.

On to your diabetes.

Your onset story is similar (aside from your loss, obviously) to how many describe the run up to a T1 diagnosis, but that's not definite. DKA is more commonly associated with T1, but with your infection and sepsis, there are further things in the mix.

For many diagnosed with diabetes, hard work at the outset can see a dramatic improvement in blood sugar levels, and for some with T1, it seems their pancreas gets a bit of a rest when insulin injections are introduced, and instead of working really hard to keep pace with the bodily requirements and failing (resulting in the high sugars), it can rest a bit and recover and for a time (some very short and some longer) allow the individual to live with normal or near normal blood sugars. However, that can change again, sometimes very quickly, without warning.

I'm delighted you have had a great GP experience and trust them. Many find diabetes isn't a strength for their GP. However, in your shoes, I would feel uncomfortable not keeping an eye on my blood sugars. Things can creep up on us, and the last thing you need is a repeat of the scenarion you painted above.

Most find specialist hospital clinicians are better appraised of diabetes, and often find their advice to be closer to the mark in terms of their wellbing and longer term health.

I would not resist having the diabetes team fully appraised of your renal health. The more folks you have on your side, so to speak, the better. Far less chance of things being missed.

Finally to your concerns.

There are tests that can help clarify which type of diabetes you have, but like all tests, they are not entirely 100% bulletproof.

Again, in your shoes, I would make an appointment to see my GP (whom you trust and is likely more accessible than the clinic teams/consultant) and discuss your concern with him. He is very unlikely to be able to requests the diagnostic tests you would need to clarify your type, but it might help clear some things in your mind.

If you are still unhappy, you can ask for a second opinion, and you can choose where you go and who you see for that. It does not have to be at the same hospital, or even in the same area, but be aware if you do that, you may have a wait to see the person of your choosing.

If you opt to go down the private route, again, you can choose who you see. Your diagnostic test wouldn't be cheap, and you can go to some labs directly (without a GP referral), but the results take some interpreting. Unfortunately, they don't come out as T1 or T2, they come out as readings from your tests, which have to be viewed in the round.

I'm not sure if any of that helps, but I fully appreciate trust in your Doc is critical. If you don't trust them, it's hard to relax and move forward.

Diabetes isn't easy, for sure.
 
Hello! Thank you so, so much for your thoughtful and considered reply, it's appreciated more than you know. The weight loss was over a few months and I often lose my appetite when I'm stressed, so genuinely don't know what set it off, if it was Mum or the diabetes. Your answers to my questions help a lot and knowing what figures are getting concerning is exactly what I need to know.

I'm speaking to my GP next week, so I'll ask him (and the consultant) about repeating them. If I have to go back on insulin, so be it, but I'd obviously prefer tablets!

They think I've been diabetic for a fair while (lifestyle would definitely support that!) and it was actually the hospital diabetes team (have just remembered this, hospital was a blur) were the first who mentioned tablets, so at some point they must have thought I was type 2 as well...

Thank you once again and have a lovely rest of day
 
Oh my. You have been through the mill!

Firstly, I'm so sorry for your loss. Losing a parent is a life changing event.

On to your diabetes.

Your onset story is similar (aside from your loss, obviously) to how many describe the run up to a T1 diagnosis, but that's not definite. DKA is more commonly associated with T1, but with your infection and sepsis, there are further things in the mix.

For many diagnosed with diabetes, hard work at the outset can see a dramatic improvement in blood sugar levels, and for some with T1, it seems their pancreas gets a bit of a rest when insulin injections are introduced, and instead of working really hard to keep pace with the bodily requirements and failing (resulting in the high sugars), it can rest a bit and recover and for a time (some very short and some longer) allow the individual to live with normal or near normal blood sugars. However, that can change again, sometimes very quickly, without warning.

I'm delighted you have had a great GP experience and trust them. Many find diabetes isn't a strength for their GP. However, in your shoes, I would feel uncomfortable not keeping an eye on my blood sugars. Things can creep up on us, and the last thing you need is a repeat of the scenarion you painted above.

Most find specialist hospital clinicians are better appraised of diabetes, and often find their advice to be closer to the mark in terms of their wellbing and longer term health.

I would not resist having the diabetes team fully appraised of your renal health. The more folks you have on your side, so to speak, the better. Far less chance of things being missed.

Finally to your concerns.

There are tests that can help clarify which type of diabetes you have, but like all tests, they are not entirely 100% bulletproof.

Again, in your shoes, I would make an appointment to see my GP (whom you trust and is likely more accessible than the clinic teams/consultant) and discuss your concern with him. He is very unlikely to be able to requests the diagnostic tests you would need to clarify your type, but it might help clear some things in your mind.

If you are still unhappy, you can ask for a second opinion, and you can choose where you go and who you see for that. It does not have to be at the same hospital, or even in the same area, but be aware if you do that, you may have a wait to see the person of your choosing.

If you opt to go down the private route, again, you can choose who you see. Your diagnostic test wouldn't be cheap, and you can go to some labs directly (without a GP referral), but the results take some interpreting. Unfortunately, they don't come out as T1 or T2, they come out as readings from your tests, which have to be viewed in the round.

I'm not sure if any of that helps, but I fully appreciate trust in your Doc is critical. If you don't trust them, it's hard to relax and move forward.

Diabetes isn't easy, for sure.
Hello! Thank you so much for your detailed reply, it's very much appreciated. To clarify - I am testing twice a day currently and will be doing so until I have good reason not to, which is clearly not yet!

I have no problem at all with any department knowing any of my medical history, the issue I have is why they wait 10 months to get involved when it's nearly healed. I currently have so little faith in that department that they could tell me the absolute truth about everything and show me the proof and I still wouldn't accept it without outside confirmation. I've discovered that as a department they have a dreadful reputation through the rest of the Trust and that really hasn't helped... I will definitely follow your advice and speak to the GP and see what he recommends.

Thank you again for the response, hearing from people who live through it all successfully is really helping!
 
Hi and welcome.

Firstly can I say how sorry I am for the loss of your mother.

I am so pleased that you have found the forum and I am sure we will be able to answer some of your questions and hopefully alleviate a bit of your anxiety. Really good to hear that you also have a good support network at home.

1. Yes, the honeymoon period is a very well known (and poorly named) period after diagnosis with Type 1 diabetes, when your pancreas is still producing some insulin. Your DKA event was because your body reached crisis point with not enough insulin being produced to cover your needs. After a period of injected insulin and reducing carbs and perhaps exercising a bit more, the remaining beta cells in the pancreas which produce insulin, benefit from the strain being taken off them. Think of them like workers on a conveyor belt at a factory who are short staffed and working at full capacity but can't keep up and as they fall behind everything starts to fall apart, but when they get a bit of help (injected insulin) to tidy up and then the conveyor belt is started again but at a slower pace (less carbs), they can manage to cope for a while often until one or two of them fall sick and then they start to get behind and everything starts falling in a heap at the end of the conveyor and chaos (DKA) happens again. Permanent injected insulin is the answer... ie permanent new workers to help them. Sometimes the honeymoon period can allow someone to manage their BG levels well because they only need small amounts of insulin to top up what the body is producing and for other people the pancreas spits out insulin in fits and starts making it very unpredictable and hard to manage. The average length of the honeymoon period is about 2 years but it can be shorter or much longer.
If you are Type 1, then your reduction in carbs and increased exercise will be helping you to manage without insulin for now, but an illness or even a vaccination could possibly set things away again if it triggers the immune system to kill off some more of your remaining beta cells. Continuing to monitor your BG levels and also being able to test for ketones if BG levels rise, would be important to keep yourself safe from another DKA event.
I appreciate that your GP specialises in diabetes but this will likely be Type 2 diabetes and perhaps has not considered that you might be Type 1, so their treatment is based on the assumption that you are Type 2 and that might not be a safe assumption at this stage.

2. There are 2 tests which help to indicate if you are Type 1, but no specific test for Type 2. These tests are the C-peptide test which indicates how much insulin your own body is able to produce and antibody tests which look for the antibodies produced by the immune system to attack the beta cells. This will be the test which was sent to Exeter and typically takes about 6 weeks for the results to come back. Generally people who develop diabetes later in life and if they are carrying a little extra weight are assumed to be Type 2. However there are red flags here for you for a potential Type 1 diagnosis because you went into DKA which is unusual for someone newly diagnosed with Type 2 unless they have had it undiagnosed for years and you lost weight prior to diagnosis. These both suggest Type 1, so it is really good that they did the antibody tests but unfortunate that you then fell through the cracks in the diabetes clinic and by the sound of it, so did your results!
Many clinics are short staffed and struggling to cope with their workload which has increased significantly since Covid for a number of reasons and many of us are finding that appointments are being pushed back again and again. My current annual appointment has been rearranged 5 times and it looks like my consultant has taken early retirement, most likely due to stress as I know from my previous conversations with him that his department was struggling.

3. Yes, you can pay for the tests privately but I would ask for them to be repeated via the NHS at your appointment in January.

4. You could ask your GP to make you a referral to another hospital diabetes clinic, but it could take a long time to get an appointment, whereas you already have one for Jan, so I would stick with that for now and see how it goes.

5. If they start to rise and are consistently above 10 and persistent mid teens you need to test for ketones to prevent DKA developing again. You can buy "Ketostix" to dip in your urine to check for ketones if your levels rise into that mid teens range. They are about £5 for a pot of 50 strips but you could ask your doctor to prescribe them and explain that you have already had an incident of DKA which by the sound of it nearly cost you your life, so important to be able to keep an eye on that.

6. No idea unless the consultant is unaware that you are being monitored by another department for that issue. Uncontrolled diabetes is very damaging to the kidneys so it will be a concern and part of their remit. I imagine they will be aware that they have not provided the standard of care that you should have received and they are trying to get back on track and the kidney issue is probably the biggest concern.
 
Oh wow! Thank you so much for the response, absolutely amazing. I cannot begin to tell you how much I appreciate the detailed and clear explanations, that makes me feel so much better. I'm one of those that can deal with anything so long as I understand what's happening, what might happen and why. And I now I feel like I do and more back in control.

Apparently because of the kidney infection and the length of time they think I've had diabetes (definitely supported by previous lifestyle), they were about 95% convinced that I am type 2, but this is obviously something that needs to be sorted out.

That's an extremely good point about a long wait for a new consultant so I will stick with the appointment in January and get the test repeated. The problem is, they've been so bad (and it's not just overwork, which I am extremely sympathetic about), everything they tell me could be 100% accurate and demonstrated with proof and I'd still want someone else to confirm it. Also a good point about the GP, hadn't thought of that.

Thank you again, I'm feeling much better and ready to fight!
 
Hi and welcome.

Firstly can I say how sorry I am for the loss of your mother.

I am so pleased that you have found the forum and I am sure we will be able to answer some of your questions and hopefully alleviate a bit of your anxiety. Really good to hear that you also have a good support network at home.

1. Yes, the honeymoon period is a very well known (and poorly named) period after diagnosis with Type 1 diabetes, when your pancreas is still producing some insulin. Your DKA event was because your body reached crisis point with not enough insulin being produced to cover your needs. After a period of injected insulin and reducing carbs and perhaps exercising a bit more, the remaining beta cells in the pancreas which produce insulin, benefit from the strain being taken off them. Think of them like workers on a conveyor belt at a factory who are short staffed and working at full capacity but can't keep up and as they fall behind everything starts to fall apart, but when they get a bit of help (injected insulin) to tidy up and then the conveyor belt is started again but at a slower pace (less carbs), they can manage to cope for a while often until one or two of them fall sick and then they start to get behind and everything starts falling in a heap at the end of the conveyor and chaos (DKA) happens again. Permanent injected insulin is the answer... ie permanent new workers to help them. Sometimes the honeymoon period can allow someone to manage their BG levels well because they only need small amounts of insulin to top up what the body is producing and for other people the pancreas spits out insulin in fits and starts making it very unpredictable and hard to manage. The average length of the honeymoon period is about 2 years but it can be shorter or much longer.
If you are Type 1, then your reduction in carbs and increased exercise will be helping you to manage without insulin for now, but an illness or even a vaccination could possibly set things away again if it triggers the immune system to kill off some more of your remaining beta cells. Continuing to monitor your BG levels and also being able to test for ketones if BG levels rise, would be important to keep yourself safe from another DKA event.
I appreciate that your GP specialises in diabetes but this will likely be Type 2 diabetes and perhaps has not considered that you might be Type 1, so their treatment is based on the assumption that you are Type 2 and that might not be a safe assumption at this stage.

2. There are 2 tests which help to indicate if you are Type 1, but no specific test for Type 2. These tests are the C-peptide test which indicates how much insulin your own body is able to produce and antibody tests which look for the antibodies produced by the immune system to attack the beta cells. This will be the test which was sent to Exeter and typically takes about 6 weeks for the results to come back. Generally people who develop diabetes later in life and if they are carrying a little extra weight are assumed to be Type 2. However there are red flags here for you for a potential Type 1 diagnosis because you went into DKA which is unusual for someone newly diagnosed with Type 2 unless they have had it undiagnosed for years and you lost weight prior to diagnosis. These both suggest Type 1, so it is really good that they did the antibody tests but unfortunate that you then fell through the cracks in the diabetes clinic and by the sound of it, so did your results!
Many clinics are short staffed and struggling to cope with their workload which has increased significantly since Covid for a number of reasons and many of us are finding that appointments are being pushed back again and again. My current annual appointment has been rearranged 5 times and it looks like my consultant has taken early retirement, most likely due to stress as I know from my previous conversations with him that his department was struggling.

3. Yes, you can pay for the tests privately but I would ask for them to be repeated via the NHS at your appointment in January.

4. You could ask your GP to make you a referral to another hospital diabetes clinic, but it could take a long time to get an appointment, whereas you already have one for Jan, so I would stick with that for now and see how it goes.

5. If they start to rise and are consistently above 10 and persistent mid teens you need to test for ketones to prevent DKA developing again. You can buy "Ketostix" to dip in your urine to check for ketones if your levels rise into that mid teens range. They are about £5 for a pot of 50 strips but you could ask your doctor to prescribe them and explain that you have already had an incident of DKA which by the sound of it nearly cost you your life, so important to be able to keep an eye on that.

6. No idea unless the consultant is unaware that you are being monitored by another department for that issue. Uncontrolled diabetes is very damaging to the kidneys so it will be a concern and part of their remit. I imagine they will be aware that they have not provided the standard of care that you should have received and they are trying to get back on track and the kidney issue is probably the biggest concern.
Oh and my bg meter also does ketones, so I'm well set up there. Phew
 
My diabetes journey

I apologise in advance, but this is going to be a long one – I thought I was doing really well, but a couple of conversations recently have made me very confused and now I have no idea what’s going on and I was hoping that hearing other peoples’ experiences might be able to point me in the right direction. I will keep this as brief as possible, but it’s been an action-packed year!

So, a bit of backstory – I’m 53, female and hadn’t been to a doctor for years – hadn’t had anything that made me think it necessary. Then my Mum (who had been 100% fit and independent, looking after the garden and house single handedly as well as walking her dog twice a day at the age of 83) was taken suddenly ill at the beginning of November last year. She fought with everything she’d got, but it wasn’t enough and she died at the beginning of December. January – March was spent dealing with her funeral and interring her ashes and her horrendous sister. I wasn’t very well in February – felt fluey and completely lost my appetite. I got over that, but still didn’t feel well and was losing weight. I put this down to the grief and stress of losing Mum. But then it all came to a head at the end of March when I collapsed at home.

I was taken into hospital where I was diagnosed with diabetes (don’t know the type – that will be explained later), in DKA, a serious kidney infection and sepsis. I then spent 6 weeks in hospital, 3 in ITU and 3 on the normal ward while they got my kidney (mainly) under control.

While in hospital, I saw the diabetic nurse 2 or 3 times who just told me when to check for ketones and to tell the DVLA that I was on insulin. They also said they’d sent a blood sample to Exeter to find out if I was type 1 or 2 but it would take ages to get the results back. (Literally all I was told). They wouldn’t even come and see me when I was discharged as there was potentially COVID on my ward. When I was discharged, I was insulin dependent – regime was 30 units Abasaglar mornings and 7 units Novorapid with each meal. I had my hbA1C tested once in hospital when I was fist admitted and it was 118 – there’s no other record of it on my notes that I can currently access, although I have requested them all for the time I was in hospital.

I was discharged on the 3rd May and I was still very weak from the sepsis and kidney infection at this point – still on long term antibiotics and no appetite at all (I lost 20kg from December – June). Next interaction I had with the diabetic unit was in June when the diabetic dietitian rang me. She was really useful and it was at this point I discovered that I needed to base the Novo injections on the amount of carbs I had per meal, so if we had a carb free meal then I didn’t need to take any. At this point, still on same doses of insulin and blood sugars averaging about 8 – 9.

I also made contact with my GP, who turns out to be a specialist in diabetes and has been the reason I’m still relatively sane. He ordered blood tests. My hba1c was now 43 – mostly, I suspect, because I’d hardly eaten anything in hospital (the food was beyond disgusting) and had started to really cut down on carbs and just eat more healthily. He reduced my Abasaglar to 26 units on a morning and told me to experiment with the Novo depending on the carbs in my meals. Blood sugars were now high 7 – high 8s depending on time of day. I get a letter from the diabetic unit cancelling the clinic appointment I had in September and moving it to December (!).

Follow up with GP in September – blood sugars now average low 7s. Blood pressure normal after stopping steroids. Hba1c down to 41. GP reduces Abasaglar to 10 units in the morning and keeps novorapid the same. Makes first mention of potentially transitioning me from insulin to tablets.

End October – blood sugar still average low 7s. Reduced Abasaglar to 5 units am. Novorapid to 4 units per meal and to add in metformin 500mg morning and evening. One horrendous day of side effects from the Metformin, but then settles down. I had asked my GP whether I needed to keep the appointment t the diabetic clinic as they hadn’t been in touch. He advised that I did, but should be asked to be discharged to GP care.

November – hba1c down to 39. Blood sugars mid – high 6s. GP stops the insulin, adds in 5m Linagliptin on a morning. Tells me to keep monitoring blood sugars and go back in 10 days. Blood sugars remain stable at mid-high 6s.

I then get a call out of the blue from the diabetic department! Now, bear in mind, so far as they’re aware, I’ve had no conversations about my diabetes since the end of April. She says they’ve had a cancellation for that Friday’s clinic and would I be able to come then instead of 20th December. So, I said yes, I could. She then asked in the most patronising tone if I’d been able to monitor my blood sugar (!!). So, I told her that yes, it was averaging 6 – 7, I was off insulin and my hba1c was 39. There was an immensely long pause and she said “How have you managed that?” So, I told her it was with the support of my GP, eating healthily and taking more exercise. So, she said that she would speak to the consultant, but would recommend that I be discharged to GP care and not to worry about the clinic appointment. The consultant (with whom I had never spoken, but had an appointment in mid-January) might still want to see me. Fine.

Went to see the GP next day who told me all was good and that I didn’t need to test my blood sugar any more unless I wanted to. He was pleased about me being discharged from the hospital, so, so far as I was concerned, all was going well in my world for the first time in months.

Then I get another call from the diabetic unit. They are discharging me back to my GP care, but I need to see the consultant in January because he wants to talk about my kidney. S, I exclaim “My kidney?!” and she says “Yes, you were aware that you had a kidney infection?” I resist the urge to reply that yes, 6 CT scans, 2 ultrasounds, long term antibiotics and a very serious conversation about me potentially having it removed as the infection was so persistent had given me a clue, and merely said that yes, I was, but I was under the care of the urology department for that so I didn’t understand why (10 months after I was admitted) they now felt like they had to get involved, but ok, if that’s what they wanted, I would be there in January. She then said that I needed to be very closely monitoring my blood sugar as this was probably a honeymoon period and they would probably climb rapidly and I’m in danger of going back into DKA. They are fine between 4 and 10, but if they go over 20 to seek urgent medical attention. So, I said, but I’m type 2, aren’t I? At which point they admitted that they’d lost the test results, so they don’t officially know, oops. And they’ll send me a letter discharging me and goodbye.

WHAT?! I am so confused and scared. I am a woman of above average intelligence and I just don’t understand what’s going on. I am so angry with the department – things they didn’t tell me include having to adapt the novo to what I was eating, what I should be eating, how to count carbs and the effect it had, what to do if I was ill and quite possibly a lot of other things that haven’t cropped up yet.

Thank you for reading this far – if I could make you a cup of tea, I would! In a nutshell – the questions I have are:

  1. Is this honeymoon period a thing?
  2. How do I know if I’ve got type 1 or 2?
  3. Can I pay for this test privately?
  4. Can I ask for a 2nd opinion as I don’t trust anything the department says to me – all the other care I have had has been phenomenal – it is just them.
  5. At what point do I start worrying about my blood sugars? (Currently high 5s, low 6s)
  6. Why does the consultant now want to talk about my kidney if I’m under urology (and it’s steadily improving – there is no infection and the remaining haematoma is shrinking at a good rate.
I am so stressed by all of this. I was managing so well (I thought) but now I don’t know if I am managing well, or this is just a fluke and it will come back to haunt me and I will need insulin again. I can’t relax – I am so scared of having to go back into hospital…

Any insights, general advice or just sharing experiences would be very, very much appreciated. I am extremely lucky in that I have a very good and strong support network of friends ad my husband who have all been amazing. But I’ve never been ill before and it’s a scary and lonely place…

Thank you
Yes the 'Honeymoon' is a thing. Some Adults dxed with Diabetes are sometimes called LADA ( Latent Autoimmune Diabetes in Adults) or, jokingly, Diabetes 1.5. In this there often is a honeymoon period following diagnosis, lasting while the remaining Beta Cells thrash themselves to death.
In addition DKA is strongly associated with Type 1 while Type 2s tend to suffer HONK.
You definitely need the tests again, like C-peptide or GAD antibodies, to rule out or confirm Type 1.
 
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Oh and my bg meter also does ketones, so I'm well set up there. Phew
You will need Blood Ketone test strips for it if your new meter does ketones. These are usually more expensive than the Blood Glucose test strips. Is your doctor prepared to prescribe Blood Ketone test strips for your meter? If not you can buy them online or you could just buy a pot of Ketostix to dip your urine, which would be more cost effective but not as accurate as it takes several hours for ketones to get from blood to urine.
 
Yes the 'Honeymoon' is a thing. Some Adults dxed with Diabetes are sometimes called LADA ( Latent Autoimmune Diabetes in Adults) or, jokingly, Diabetes 1.5. In this there often is a honeymoon period following diagnosis, lasting while the remaining Beta Cells thrash themselves to death.
In addition DKA is strongly associated with Type 1 while Type 2s tend to suffer HONK.
You definitely need the tests again, like C-peptide, to rule out or confirm Type 1.
Thanks. What's honk? I'm seeing the consultant in January so will get them to repeat the tests then. Appreciate your response
 
Hello! Thank you so much for your detailed reply, it's very much appreciated. To clarify - I am testing twice a day currently and will be doing so until I have good reason not to, which is clearly not yet!

I have no problem at all with any department knowing any of my medical history, the issue I have is why they wait 10 months to get involved when it's nearly healed. I currently have so little faith in that department that they could tell me the absolute truth about everything and show me the proof and I still wouldn't accept it without outside confirmation. I've discovered that as a department they have a dreadful reputation through the rest of the Trust and that really hasn't helped... I will definitely follow your advice and speak to the GP and see what he recommends.

Thank you again for the response, hearing from people who live through it all successfully is really helping!
Hi, I was diagnosed with diabetes a couple of years ago, when I got really unwell and it turned out I had really high ketones and an hbac1 of 15. I had also been losing weight. Straight onto a basal insulin, with bolus added later. I asked to be prescribed metformin in April which has meant I have reduced basal insulin by 2/3 and take 4-6 bolus a day. Because I was slim and very active with a healthy diet, they also thought that I might be type 1, and was tested. But I’m type 2 (my dad was a slim type 2). Anyway I don’t think I’ll ever be able to come off insulin, but my hbac1 is now 5.2. I was never referred to the hospital but my diabetes nurse is great, much better than the GP. So just to say I’ve had a similar journey to you. I would say your GP has supported you through this really well, but I would carry on testing your blood for now. I don’t really understand how they could lose your blood test results as they’re all computerised. I think it’s more likely that the tests were never done, maybe your samples never made it to the lab.
 
Interesting! That definitely makes sense.

Thanks so much for your story, it's good to know there's a chance I'm type 2.
 
You will need Blood Ketone test strips for it if your new meter does ketones. These are usually more expensive than the Blood Glucose test strips. Is your doctor prepared to prescribe Blood Ketone test strips for your meter? If not you can buy them online or you could just buy a pot of Ketostix to dip your urine, which would be more cost effective but not as accurate as it takes several hours for ketones to get from blood to urine.
I've got the strips already, fortunately, so good to go. Thanks for the advice, appreciate it
 
Thanks. What's honk? I'm seeing the consultant in January so will get them to repeat the tests then. Appreciate your response
Official definitions ....it often affects elderly T2s on insulin in care homes who become dehydrated ...

Hyperglycemic hyperosmolar nonketotic coma (HONK) is a dangerous and life-threatening complication of type 2 diabetesthat has been renamed hyperosmolar hyperglycemic state (HHS):






















  • Symptoms: Extreme thirst, frequent urination, nausea, weakness, dry mouth and tongue, fever, seizures, confusion, and coma










  • Causes: High blood glucose levels, often due to undiagnosed diabetes, not taking medication, or illness





    • Treatment: IV fluids, electrolytes, and insulin to correct fluid and electrolyte losses, hyperglycemia, and hyperosmolality










    • Complications: Shock, blood clots, brain swelling, and lactic acidosis





    • Mortality: HHS has a higher mortality rate than diabetic ketoacidosis (DKA)










HHS is a medical emergency that requires immediate treatment by a healthcare professional.
 
What's honk?
It’s a form of diabetic coma when your blood glucose levels are very high, but you don’t have ketones, and is seen more in people with Type 2 and very high (over 33)blood glucose levels.. It stands for Hyperglycaemic Hyperosmolar non ketogenic Coma, or similar.
Edit: @Burylancs got there before me!
 
It’s a form of diabetic coma when your blood glucose levels are very high, but you don’t have ketones, and is seen more in people with Type 2 and very high (over 33)blood glucose levels.. It stands for Hyperglycaemic Hyperosmolar non ketogenic Coma, or similar.
Edit: @Burylancs got there before me!
Thank you! And @Burylancs also. It is possible that's what it was - the symptoms match. It was my husband who told me it was dka, but he's not the best at details (as lovely as he is) so it's possible that dka was mentioned as a possibility, he's latched onto it and now it's what happened... I've requested my medical notes so I'll find out at some point!
 
Official definitions ....it often affects elderly T2s on insulin in care homes who become dehydrated ...

Hyperglycemic hyperosmolar nonketotic coma (HONK) is a dangerous and life-threatening complication of type 2 diabetesthat has been renamed hyperosmolar hyperglycemic state (HHS):





















  • Symptoms: Extreme thirst, frequent urination, nausea, weakness, dry mouth and tongue, fever, seizures, confusion, and coma








  • Causes: High blood glucose levels, often due to undiagnosed diabetes, not taking medication, or illness



    • Treatment: IV fluids, electrolytes, and insulin to correct fluid and electrolyte losses, hyperglycemia, and hyperosmolality








    • Complications: Shock, blood clots, brain swelling, and lactic acidosis



    • Mortality: HHS has a higher mortality rate than diabetic ketoacidosis (DKA)








HHS is a medical emergency that requires immediate treatment by a healthcare professional.
Thank you!
 
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