I do not know if I am just underwhelmed, confused, or upset. The diabetes clinic certainly seemed a waste of time, though.
I was asked if I wanted to go back on Gliclazide, after having already explained that I experimented with it and it did not work for me, backed up by a print out of my fasting levels for the year. In the end it was accepted that it does not work, but the fact it was even initially considered pretty much left me feeling a complete lack of confidence.
No mention was made at all of the C-peptide result, other than by me in explaining why I ended up being there. Maybe it was totally irrelevant, but given a couple of opportunities to dismiss my mentioning it was ignored.
The type 2 pathway goes though a second and third intensification to taking three medications. Even though I am prescribed three (Metformin, Sitagliptin, and Gliclazide) and for a while did take all three before deciding it not worth taking something with no effect. But apparently that means I am only taking two drugs, I guess pathways can spiral back on themselves.
The outcome, after the doctor went away to check with a consultant, was to be prescribed an SGLT2 inhibitor and to talk to the dietician. The former was one of my (good) G.P.'s original suggestions before I asked for the C-peptide and antibody tests. And something the G.P. who said my C-peptide level was normal could have prescribed. I was asked if I was happy with the prescription, which I kind-of was not but I am not very good in those situations so all I could say was I can at least try it. Which is true, they are the experts and despite everything I have read and learned I have no real expertise to second guess them.
I never thought to ask why the Gliclazide stopped working, I probably should have, but I doubt I would have got a satisfactory answer.
The talk with the dietician was slightly difficult as I struggled to think of what I normally eat. But the outcome was that things were generally okay, eat more vegetables, make sure I get enough protein, and try to exercise more. I have recently found myself struggling a bit with my memory, not in any serious way, and assumed it was just an early effect of ageing. But it is a symptom of B12 deficiency so more likely to be that. So I am not sure if my difficult remembering what I eat was because of that, or I have discovered that I am not that interested in food any more and my relationship with it is more functional.
I did also ask the doctor if she felt Metformin could have caused the B12 deficiency. I got the impression she was not aware of a connection, but she did not and thought it probably a combination of things. But it is something to consider if things remain a problem in a few months after taking the course of shots. Which makes sense. But the nurse yesterday, after the final shot, said to make a G.P. appointment to see if I need to come back in three months for another.
(My B12 result was 178 out of a range of 187 – 883, which is only a small amount so needs to be confirmed with an M.M.A. test, and on a scale of 0 – 280 I score 2,093 (severe functional deficiency) so I have no idea which results takes precedence in how badly deficient I am as M.M.A. can be elevated without deficiency.)
Although I feel Sitagliptin has caused some weight gain, it being the opposite of the normal reaction and with only three Yellowcard entries I did not feel confident it was worth raising.
The one good thing to come out of it was doing a urine test, as I assume that did not show any ketones as nothing was mentioned. Because near the top of the Dapagliflozin leaflet is a list of symptoms for which you should contact a doctor or hospital straight away, and I have all of them save weight loss. Though admittedly I do not tend to smell my urine to know if that has changed odour. So it is my weight I have been watching as a D.K.A. sign.
Which is something I will have to do more seriously now as that is a rare side effect of SGLT2 inhibitors. Although saying that now, I was not warned about that by the doctor, so I guess is not a risk they are concerned about. I was only warned I will urinate more often at first, even though I practically want to go all the time anyway. Which is to be expected given my levels.
When I woke this morning my level at 7am was 16.5, when the nurse tested me at around 10:30am I was 15.1. That from having only drunk water. So these tablets better be good. They simply stop the transport of glucose to the kidneys, so even work on type 1, so they should definitely work. Although removing glucose from the blood means the pancreas is less stimulated, so produces less insulin, reducing the benefit. Hence the D.K.A. risk. And mine is literally working flat out. At least I thought that was what the C-peptide result showed, now I am not sure about that.
Also had my worst ever blood pressure result, I cannot remember exactly but around 150/100. My home test yesterday was 134/89, which was around the upper end of my usual range. I also brought my home testing results from the summer so the nurse was not worried but the doctor was. So she was keen on Metformin and the dapagliflozin as being good for cardiovascular health too.
So I am just left with confusion over what is happening in my body when I thought I knew. I have no idea what precisely I am feeling, or what I am supposed to feel, other than it was a waste of time and being fed up. But I have something new to try, which might fix everything.
