Diabetes issues.. Should I be worried?

[Pedaldog.]

Type 2 for around 3 years. Over the past few months I haven't been taking care and the blood glucose levels are averaging the low teens. Yesterday I realised i had a really strong taste in my mouth. A mixture of fruit and metal taste. Just tested glucose levels and they're at 21.6 2 hours after main meal. I also have cramp like pains in both my lower legs and am not sure if that's connected. Somebody mentioned Keto Acidosis and scared me with the "Get medical help immediately" talk.
What, if anything, should I do tonight, am I okay to leave it until tomorrow and talk to my GP?

[barakta]

I would call 111 for advice and probably see a medic if you have no way of getting your blood sugars down with current meds.

[Pedaldog.]

Called 111 and they say I'll get a callback from a Medical type in the next couple of hours, thanks barakta I hadn't thought of the 111 thing.

[hellymedic]

Suspect you are more likely to develop HONK (hyperosmolar, non-ketotic) state than ketoacidosis.

This is mainly treated by rehydration.

You do need medical attention. Keyboards can't treat diabetics!

[Pedaldog.]

I got a callback to check BG's and stuff a couple of times through the night and they are still high (17.8 at -65:30) but slowly reducing. Advised to see my Diabetes GP today. I have been avoiding taking care of the Diabetes, no idea why, and this has given me a "Wake up call" so I'll start living the right way for this.
I suspect, Helly, that you're right as things are getting a little better with having plenty of liquids.

[Pedaldog.]

Helly. Intermittent claudation? I've had a LOT of painin both my calf muscles for a few days. I though it was a RSI from being sat in a car for over 9 hours on Monday. Should I mention this when I see my GP?

[ElyDave]

the cramps and twitchng in the calf muscles are very likely to be a symptom of the high BG there.   

Pre diagnosis it looked like a bunch of snakes writhing away in my calves, and I'd be jumping out of bed most nights with cramp.  As I understand it the direct cause is the electrolyte imbalane caused by the high BG, overspilling into the urine via kidneys and causing the dehydration as well.

Is it time to talk to your doctor about going onto insulin as well?

[chrisbainbridge]

I hope this does not come across wrongly.  I think I too would be in denial for quite a while if I developed diabetes.  To do so as a cyclist who takes exercise, etc is very annoying and frustrating.

I just wonder if your 9 hours in the car was accompanied by a series of high carbohydrate garage snacks to drive your BG so high.

A very good colleague at work who has developed type 2 (possibly due to statins) told me a couple of days ago that there is now a recommendation for the LCHF diet on the Diabetes UK page.  She has seen her BS come down and lost a bit of weight through switching and is really enjoying the diet.  would this be worth trying before starting insulin?

[ElyDave]

I hope this does not come across wrongly.  I think I too would be in denial for quite a while if I developed diabetes.  To do so as a cyclist who takes exercise, etc is very annoying and frustrating.

I just wonder if your 9 hours in the car was accompanied by a series of high carbohydrate garage snacks to drive your BG so high.

A very good colleague at work who has developed type 2 (possibly due to statins) told me a couple of days ago that there is now a recommendation for the LCHF diet on the Diabetes UK page.  She has seen her BS come down and lost a bit of weight through switching and is really enjoying the diet.  would this be worth trying before starting insulin?

Certainly there is evidence that that could help. I assumed no other factors involved than a progression of the condition.

Not enough info in the OP really. Other things to think about
- reduce excess weight if any
- reduce/eliminate high GI carbs
- mix of strength and CV exercise to improve insulin sensitivity
- get used to pre and post meal testing to understand influence of diet on the condition

Don't see use of insulin as bad and an irreversible step, it's just a helping hand whilst you sort out the above, which can then get you back into the right place.

As for denial, that was never an option. If I didn't grab diabetes by the balls nobody was going to do it on my behalf.

One more question to the OP, have you had any structured diabetes education? There are some good courses available depending on where you are.

[T42]

Being an enthusiastic cook and luvver of beer (Germany is just next door), it took me around 5 years to accept T2.  I had violent shin splints when walking for the best part of a year.  Gentle exercise - in my case wandering up through the woods looking for mushrooms -  and a better diet took care of them over 3 weeks.  Then we got bikes.

Anyway, diabetes is slow to do permanent damage. If you can take it in hand now the chances are you'll be fine for years.  My doc reckons I had it for 10 years before diagnosis, so that makes 36 years I've been living with it.

[vantage]

Hi Pedaldog.
As a type 1 for 36 years I'd agree with absolutely everything ElyDave said. Right down to the night time cramps having me hopping out of bed in agony.
The taste in your mouth is also well known to me and is a warning that you're on the border of ketoacidosis which you really don't want. The glucose levels of 21.6 are also way too high.
You need to sort this out.
Whilst I'm sure that the doc informed you of the consequences of poor diabetes control when you were diagnosed I wonder if you've actually met anyone suffering those consequences. It can put things in perspective. Cue me.
Like you, I mistreated my condition although I did it for much longer. Years. I had this thought in my head during those years that "It'll never happen to me".
Due to the sheer amount of laser surgery on my eyes to try and hold back the retinopathy my night time vision is severely restricted and it's getting to the stage that night time rides are becoming kinda dangerous for me. The last one had me not seeing a 7 inch kerbstone and almost wrecking the bike.
The effects it's had on my blood is that the major arteries in my legs are so blocked that I've been told it's highly likely I'll lose the legs. They can't say when though but I'm now using a walking stick at the age of 39 despite having been a cyclist all my life.
Trust me, you don't want any of this malarkey. Do yourself a favour and take it seriously.

[IJL]

One of the challenges of T2D is getting people to take it seriously, I was once told that by the time it is diagnosed most people will have had  elevated glucose for 10 years.  Its often picked up when a Hba1c blood test is done as part of other tests.  In many cases people will not notice any symptoms as they will have developed over years.  However years of raised glucose levels can cause havoc particularly with the circulation and this in turn affects other organs. 

There are a lot of options to treat T2D, but it must be monitored and in most cases treated, don't ignore it.

[Pedaldog.]

Thanks for all the replies. I'm down to 13.2 now and gradually starting to feel less of a panic. I'm going to see the GP who is the main Diabetes related one at my surgery. He's not in today so I'll do the 8am on the phone thing tomorrow. Part of me worries that I am "Self Sabotaging" and that's something that I need to look into with a Hedologist sometime soon.  For today I'm just testing glucose levels every 2 hours and aware that I might need to call somebody if they get higher again.

[T42]

Whilst I'm sure that the doc informed you of the consequences of poor diabetes control when you were diagnosed I wonder if you've actually met anyone suffering those consequences. It can put things in perspective. Cue me.
Like you, I mistreated my condition although I did it for much longer. Years. I had this thought in my head during those years that "It'll never happen to me".
Due to the sheer amount of laser surgery on my eyes to try and hold back the retinopathy my night time vision is severely restricted and it's getting to the stage that night time rides are becoming kinda dangerous for me. The last one had me not seeing a 7 inch kerbstone and almost wrecking the bike.
The effects it's had on my blood is that the major arteries in my legs are so blocked that I've been told it's highly likely I'll lose the legs. They can't say when though but I'm now using a walking stick at the age of 39 despite having been a cyclist all my life.
Trust me, you don't want any of this malarkey. Do yourself a favour and take it seriously.

+1.  If you're combining high BS (blood sugar, not bullshit) with high cholesterol your coronary arteries can block up too, which - speaking from experience - is not nice.

[IJL]

I'm not sure that testing so frequently is much help and locally we don't prescribe testing equipment for people with T2D, if you're otherwise well, eating and drinking etc no immediate harm is going to come from raised glucose.  You need a Hba1c test which will give an indication of what your glucose levels have been doing over the 2 months and a plan from there, are you on any diabetes medications?

[ElyDave]

I'm not sure that testing so frequently is much help and locally we don't prescribe testing equipment for people with T2D, if you're otherwise well, eating and drinking etc no immediate harm is going to come from raised glucose.  You need a Hba1c test which will give an indication of what your glucose levels have been doing over the 2 months and a plan from there, are you on any diabetes medications?

Which is utter madness and goes against NICE criteria.

How is a T2D expected to understand which foods affect their blood sugar adversely if they cant do pre and post meal tests?   I'm sure the overall cost of testing is much lower than the price of hospital admissions for complications, but the GPs don't pay for that do they.

[IJL]

From NICE

Do not routinely offer self-monitoring of blood glucose levels for adults with type 2 diabetes unless:
•the person is on insulin or
•there is evidence of hypoglycaemic episodes or
•the person is on oral medication that may increase their risk of hypoglycaemia while driving or operating machinery or
•the person is pregnant, or is planning to become pregnant. For more information, see the NICE guideline on diabetes in pregnancy. [new 2015]

[hellymedic]

Helly. Intermittent claudation? I've had a LOT of painin both my calf muscles for a few days. I though it was a RSI from being sat in a car for over 9 hours on Monday. Should I mention this when I see my GP?

Rest pain or pain when walking?

Rest pain is SERIOUS = URGENT
Claudication - pain on walking - needs attention, not necessarily urgently.

[hellymedic]

I don't know if you smoke but if you value your limbs and the rest of your body STOP!

Diabetes and smoking together cause horrendous problems!

[T42]

From NICE

Do not routinely offer self-monitoring of blood glucose levels for adults with type 2 diabetes unless:
•the person is on insulin or
•there is evidence of hypoglycaemic episodes or
•the person is on oral medication that may increase their risk of hypoglycaemia while driving or operating machinery or
•the person is pregnant, or is planning to become pregnant. For more information, see the NICE guideline on diabetes in pregnancy. [new 2015]

Aye well, a monitor would cost the NHS £10-£20 according to Amazon. Add the recurring cost of test strips and lancets, multiply by the number of T2s in the country and you can see how much money they save that way.

Being a cyclist, though, hypos are a danger when you're following a low-carb diet so your GP could probably justify one.

They're great at dinner-parties, BTW - everything being sterile, everyone round the table can have a go.  Just set your lancet pen to "hit the bone" before passing it round. 

[Pedaldog.]

Helly. Intermittent claudation? I've had a LOT of painin both my calf muscles for a few days. I though it was a RSI from being sat in a car for over 9 hours on Monday. Should I mention this when I see my GP?

Rest pain or pain when walking?

Rest pain is SERIOUS = URGENT
Claudication - pain on walking - needs attention, not necessarily urgently.

Was pain all the time but now only when weight bearing, even that seems to be reducing now.

[vantage]

NICE are a bunch of half arsed fuckwits truth be told.
2% of diabetics in the UK are using insulin pump therapy because the dimwits at NICE make it near impossible for all but the most severe cases of T1 diabetics to use it.
That figure is 25% in the US and around 20% in other EU countries. All have realised that despite a high initial cost, the long term benefits of pump therapy are fewer complications thus saving even more expensive remedies.
Save a fiver now, spend a hundred later. That's how NICE look at it.

[ElyDave]

From NICE

Do not routinely offer self-monitoring of blood glucose levels for adults with type 2 diabetes unless:
•the person is on insulin or
•there is evidence of hypoglycaemic episodes or
•the person is on oral medication that may increase their risk of hypoglycaemia while driving or operating machinery or
•the person is pregnant, or is planning to become pregnant. For more information, see the NICE guideline on diabetes in pregnancy. [new 2015]

then those criteria have changed for the worse since I last saw them. Coupled with poor dietary advice based around "lots of starchy carbs", and little to no diabetes education unless you make a point of it yourself, no wonder the majority of T2s fail to meet the HbA1c targets.

[ElyDave]

NICE are a bunch of half arsed fuckwits truth be told.
2% of diabetics in the UK are using insulin pump therapy because the dimwits at NICE make it near impossible for all but the most severe cases of T1 diabetics to use it.
That figure is 25% in the US and around 20% in other EU countries. All have realised that despite a high initial cost, the long term benefits of pump therapy are fewer complications thus saving even more expensive remedies.
Save a fiver now, spend a hundred later. That's how NICE look at it.

+1

I managed to get myself onto a pump, based on "occurrence or fear of disabling hypoglycaemia", essentially MDI not giving fine enough control to allow exercise effectively. That took 18 months with the support of a very pump-friendly set up at Addenbrookes.  The lack of foresightedness, conflation of T1 and T2 and general "you've only got yourself to blame" attitude of the media, the public and some sections of the NHS is appalling.

[IJL]

then those criteria have changed for the worse since I last saw them. Coupled with poor dietary advice based around "lots of starchy carbs", and little to no diabetes education unless you make a point of it yourself, no wonder the majority of T2s fail to meet the HbA1c targets.

The advise is reasonable, I can't comment on the other points about pumps as I know little about them, there are a range of reasons for not testing blood glucose at home in T2D's, firstly unlike with T1D's there is no medication to use in reaction to the reading being high or low, secondly it gives a levels of glucose at that point in time rather than over a period of time which is what the more useful hba1c gives.  So in short a device that makes little difference to management of T2D but given the number of T2D's costs tens of millions.   


As to why so many T2Ds miss the HBa1c targets, I know there is great regional variation but in my experience a significant number of people with T2D, refuse to come for review and HBa1c testing despite many letters, don't take there medications, in some cases meds have not been requested in over a year.  Don't accept any health care advise, education or support.  In the past few days I have spoken to a patient who has T2D but has been to busy to collect his meds for 18 months and not attended for review in 2 years despite letters and calls.  No doubt it will be the fault of the NHS when he starts to suffer the affects of years of a raised glucose