Type 2 confusion

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Flnnrs

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Type 2
Hi all I'm new to all this, and very confused ive been having blood glucose reading's by finger pricking of 17.8 16.7 13.8 and 9.1. Im taking 500mg of Metformin 3 x daily. My GP has just informed me to take Dapagliflozin alongside Metformin and to stop testing my glucose levels unless I feel unwell. Any advise or comments greatly appreciated.
 
That's standard advice from GP's. But if you don't test your glucose levels, how can you know what foods affect you? I tested religiously until I worked out which foods did and did not affect me, and now I just test for new foods. You're on quite high medication levels, so I would guess your HbA1c was quite high.
As you adjust your eating patterns, you will hopefully see a reduction in the readings and ultimately in your HbA1c. Have you been given dietary advice? Many of us adopt the low carb approach, by that I mean less than 130gm in total per day. I personally have an app which I fill in each morning so I know exactly what I am having. I have adopted a mixed low carb diet / slim shakes with unsweetened almond milk, approach which suits me.
I suggest you look around the posts made by new members, and see what advice they have received. LeadingLights in particular gives excellent advice to newly diagnosed Type 2 diabetics.
 
Flnnrs said:
Hi all I'm new to all this, and very confused ive been having blood glucose reading's by finger pricking of 17.8 16.7 13.8 and 9.1. Im taking 500mg of Metformin 3 x daily. My GP has just informed me to take Dapagliflozin alongside Metformin and to stop testing my glucose levels unless I feel unwell. Any advise or comments greatly appreciated.
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Hello @Flnnrs,

My instinctive (and aggressive) response is to ask your GP if he/she looks before crossing a main road, checks his/her speedo while driving to stay away from getting fines and points on their licence, or looks in the mirror at some point while dressing and before leaving the house!

It is your Diabetes and even though GPs are not required to provide a means of testing your BG (as a T2) this should not mean you should blindly adjust your dietary habits and blindly take oral meds oblivious to whether your changes are achieving anything. Additionally to now start taking a "flozin" when neither your GP or you know if you've made progress already is almost unbelievable! But I'll step back a bit and try to see this with more facts.

How long have you had your diagnosis of T2? What brought you to that diagnosis and what was your HbA1c that led to that diagnosis? What steps have you taken between that initial diagnosis and now? Has your GP since taken another blood sample and got an up to date HbA1c, to justify more oral meds? With that knowledge we might be in a position to offer a more balanced response.
 
Thanks for your response. She plans on testing me in September 2024. I've Diabetic for 3 years due to hereditary I'm not overweight don't drink or smoke as for my last blood test last November I don't know the numbers as they never let me know as I rely on home visits due to being in a wheelchair chair
 
Flnnrs said:
Thanks for your response. She plans on testing me in September 2024. I've Diabetic for 3 years due to hereditary I'm not overweight don't drink or smoke as for my last blood test last November I don't know the numbers as they never let me know as I rely on home visits due to being in a wheelchair chair
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Why not get access to your results yourself through the NHS app or whatever online portal your GP surgery uses?
 
Flnnrs said:
Thanks for your response. She plans on testing me in September 2024. I've Diabetic for 3 years due to hereditary I'm not overweight don't drink or smoke as for my last blood test last November I don't know the numbers as they never let me know as I rely on home visits due to being in a wheelchair chair
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I'm sorry to hear about your confinement to a wheelchair and thus your dependence on people visiting you. None of that can be easy.

Does your GP have reason to think you "don't need to know" what your HbA1c is? Some people do get anxious about such things and consequently the stress from that anxiety makes matters worse. If not, you are [in my non- medical opinion] better off knowing where your BG level is and thus having a sense of how big your T2 challenge is. Similarly in knowing if you are making progress or whether you might try to do a bit more to control your BG.

If you feel you want to know your HbA1c ask (politely insist). Or look at your medical records on-line; I use the NHS app to see my data. I don't want to alarm you, but there is no hiding from the reality that your wheelchair and thus lack of mobility means you need to be careful and trying to keep your BG at a reasonable HbA1c as well as at a steady level day by day.

You've told us that you are already testing. But is that structured testing for the purpose of seeing which meals are better for keeping your BG in range. There was an excellent narrative about this from @Martin.A; I'll look for this later today.

Meanwhile I'm no expert on Dapagliflozin but I know it works by helping your kidneys to flush out some excess glucose (which means more frequent need to pee) and I think makes you at greater risk of going hypoglycaemic. If I'm right your GP should now be routinely providing you with a BG test meter so you can check if you have hypo symptoms and respond accordingly. Could @Inka please correct me if I've got this wrong? Why @Flnnrs did your GP add Dapagliflozin and just what explanation was provided to you about side effects and risks from this new medication?
 
Well 59, to my non-medical opinion, is not so bad for age 67. There is a gently growing view that as we age our ability to keep our blood in good order slows down a bit PLUS the longer term risks to us from elevated BG long term diminish.

However T2 in a wheel chair might reasonably be considered that it makes you more vulnerable to many other ailments. What date was the 59 result and how does that compare to the one before (and when were each)? What was your HbA1c when you were first diagnosed 3 yes ago and were you wheelchair bound then? I apologise for this "interrogation", I'm just trying to get a sense of the bigger picture.
 
That’s not too awful @Flnnrs Anything above 48 is diabetes. Some Type 2s here have started with HbA1Cs in 3 figures. Perhaps the doctor is taking the fact you’re a wheelchair user into account, thinking you might be more limited in the exercise you can do?
 
Could @Inka please correct me if I've got this wrong?

I don’t know about the risk of hypos with Dapaglifloxin but I know there’s an increased risk of DKA, so yes, I’d think a blood glucose meter was a good idea, but I don’t know if a GP would provide this as I don’t know the guidelines @Proud to be erratic
 
Proud to be erratic said:
Well 59, to my non-medical opinion, is not so bad for age 67. There is a gently growing view that as we age our ability to keep our blood in good order slows down a bit PLUS the longer term risks to us from elevated BG long term diminish.

However T2 in a wheel chair might reasonably be considered that it makes you more vulnerable to many other ailments. What date was the 59 result and how does that compare to the one before (and when were each)? What was your HbA1c when you were first diagnosed 3 yes ago and were you wheelchair bound then? I apologise for this "interrogation", I'm just trying to get a sense of the bigger picture.
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That result was February 2024. When diagnosed it was 52 in December 2020.
 
Flnnrs said:

HbA1c levl - IFCC standardised:​

59 mmol/mol
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That is actually not too bad and certainly not as high as many people who have managed with just metformin AND dietary changes. It seems that without an up to date HbA1C that adding another medication without making sure it is needed seems a bit hasty.
Is there any movement you could make to your diet to help alongside the metformin.
Looking at your carb intake and portion size for high carb foods may help.
Have a look at this link as it may give you some ideas of where you can make some savings on carb intake. https://lowcarbfreshwell.com/
If you do decide to take the extra medication and it is your decision the be careful of reducing carbs to quickly and going to low on carbs.
Those readings all seem a bit high if your HbA1C is only 59 but it may depend on when you took them, that is important to note when testing.
 
@Leadinglights I thought people on Dapaglifloxin and similar had to eat a minimum amount of carbs and shouldn’t eat low carb. Here’s a very recent quote from @Lucyr :

“Yes low carb is advised against with flozins because of the risk of DKA. It’s recommended to eat around 130g carb or more per day and to test ketones when feeling unwell even if blood sugar is normal.”
 
OK, so creeping up, but far from dramatic. Your GP must be being very cautious and alert to your vulnerability because of your confinement to a wheelchair.

If you have the time and capacity to focus on your general eating habits I suggest picking up on the many remarks within this forum and making small changes could be really beneficial for you. There are many routes to follow in trying to reduce your BG long term; its best to find a route that is sustainable for you long term.

If I may suggest do not make dramatic changes instantly. The addition of Dapagliflozin is one reason to make gentle, progressive changes. But even without that extra med small steady changes should help ease your mildly elevated BG down a bit and not put extra strain on your peripheral arteries or an abrupt change in the salinity of your eyes.

Is your wheelchair self-propelled or electric? My brother spent his last 10+ years in a wheelchair and the self-propelling played a big part in helping him maintain some fitness; but the electric wheelchair for when out of the house was clearly a less stressful environment for him. He, apparently, was vulnerable to kidney failure which affected his lifestyle choices.
 
Flnnrs said:
Hi all I'm new to all this, and very confused ive been having blood glucose reading's by finger pricking of 17.8 16.7 13.8 and 9.1. Im taking 500mg of Metformin 3 x daily. My GP has just informed me to take Dapagliflozin alongside Metformin and to stop testing my glucose levels unless I feel unwell. Any advise or comments greatly appreciated.
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Are those numbers from random testing or are you following a regime, eg testing on waking (fasting test), just before a meal and then again 2 hours later?
 
Inka said:
@Leadinglights I thought people on Dapaglifloxin and similar had to eat a minimum amount of carbs and shouldn’t eat low carb. Here’s a very recent quote from @Lucyr :

“Yes low carb is advised against with flozins because of the risk of DKA. It’s recommended to eat around 130g carb or more per day and to test ketones when feeling unwell even if blood sugar is normal.”
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That is exactly what I said
If you do decide to take the extra medication and it is your decision then be careful of reducing carbs to quickly and going to low on carbs.

The problem is there is no info on that is considered a suitable amount of carbs and it generally says not advised to go keto or very low carb without dietician supervision.
Some people taking that medication do say they keep to about 130g per day.
 
I can't get my results on NHS app! I assumed because I can order medication I would be able to!! Perhaps it's a Wales thing??
 
Yes, you did but as we don’t know how many carbs the OP is eating now, talk of reducing them might not be appropriate with the Dapaglifloxin. I thought it was important to paste what Lucy said due to the DKA risk. Anyone looking at the site you linked too might get the impression carbs like pasta, etc, are bad to eat and inadvertently put themselves at risk.
 
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