The progression of Type 2 Diabetes and Victoza and weight loss

VictozaJust as a quick recap, I was diagnosed with Type 2 Diabetes back in July 2012, and quickly worked my way up to the maximum dose of 2550mg of Metformin per day whilst losing 2 stone and then supplemented with up to 120mg of Gliclazide per day and within a year putting on 3 stone thanks to the incessant amount of hypo’s I experienced and having to eat to ensure my blood sugar didn’t crash.  After coming off Gliclazide in October last year I managed to lose 1 stone (14lb), and started Victoza a month later.

At the same time as starting Victoza and having to deal with all the side effects of nausea, diarrhea (again) and stomach bloating, I also had my test strips restricted to 50 per month which I felt was ludicrous.  However, since running with Victoza for 6 months now, starting at 0.6mg per day and increasing to 1.2mg per day, my blood sugar has rarely dropped below 5 mmol/L and never below 4 mmol/L which, and as I type this sounds a bit callous, I rarely now need to test my blood sugar.  I test it when I need to, if I don’t feel good, but I don’t religiously test before and after meals like I had to with Gliclazide.

In the past 6 months since starting Victoza I’ve lost another 20 pound bringing my weight loss in 7 months to 34lb, truly staggering!

It’s not been easy though, my daily regime of food is now almost like a vegetarian.  The first 4 months eating a small bowl of muesli for Breakfast and 3x slices of ham and a salad for lunch and dinner, and that’s it.  However, in February (3 months in) weight loss had halted, which wasn’t a good sign.  I was set a goal of losing 19lb in 6 months  by my Diabetic Nurse to remain on Victoza, so I had to do something.  I saw a Diabetes Dietician which to the surprise of my Diabetic Nurse said I was doing everything right, albeit add some potato to the diet.  A month went by and still no weight loss, but no weight gain and my Diabetic Nurse wasn’t happy with the results.  However, my Diabetes Dietician said if I wasn’t losing any weight, but neither gaining any weight, it was still a success due to the additional insulin my body was creating, any normal person without additional insulin would be losing the weight.  2 months after adding potato to my diet I started losing weight again, first it was 8lb, then 4lb and again my Diabetes Nurse wasn’t happy at the reduced weight.  The next month was 4lb again, this time she looked at the overall weight loss, even though she said she had hoped for more, the total weight loss was now 20lb on Victoza and 34lb in total.  What normal person loses 34lb (2st 6lb) in 7 months, and not forgetting my body is creating a huge amount more insulin which goes against me.

Thankfully I’ve now hit the 6 month mark, I did lose 1lb more than the goal set and am now on a 3 month repeat prescription (at least for the time being).

Victoza is a quite a miracle on two fronts, not only does it suppress your appetite and for me give me heart palpitations if I try to over eat, so it helps me lose weight instead of gain weight, but it also helps in reducing my blood sugar.  My A1c at diagnosis was 11.2%, I managed to get it down to 6.8% then 6.4% with Gliclazide working really hard but that involved at least two hypo’s per day,  every day.  With Victoza my A1c has increased back to 6.8%, my DSN would prefer to reduce the Metformin from 2550mg to 1000mg or max  1700mg per day but equally can see and understand that by doing so my A1c will be in the 7 or may 8% or maybe higher so for the time being has let it ride.  I’m waiting for my latest A1c results which I think will be higher still because I’ve had to add more potato and bread to the diet to keep the weight loss going.  Don’t get me wrong,  I’m eating about 1500 calories a day with Potato and Bread but for 4 months prior where my A1c was 6.8% I     was eating only 700 calories per day.   It wouldn’t surprise me if my A1c is in the high 7% range bordering into 8% because of this, but I’ll wait and see what the results come back as in a week.

My DSN is still pushing for Gastric band and sleeve although I’m still trying to push that back as I really would prefer to avoid any kind of surgery.  My last major surgery was 19 years ago and I was told by the Surgeon I would be back in work within 2 weeks, it took 9 months recovery and that was prior to being diabetic.  Who knows what it could be now, and with any kind of surgery comes risks, so as much as it may help, I still feel that Surgery is a last resort.

So I’m doing very well on Victoza.  My main concern now is if my A1c gets into the 8% and it’s deemed Victoza is not being effective enough and Victoza gets withdrawn or if the weightloss stops and equally because of the high cost of Victoza it’s again deemed not as effective and withdrawn from therapy.

Now my day equates to 2 pieces of wholemeal toast and a bowl of muesli for breakfast, a jacket potato with some tuna fish for lunch and a chicken salad for dinner.

The one thing I do really hate and I can’t put this all down to Victoza, it’s the diet as well but my stools are just like diarrhea every day of the week.  They’re never firm unless I eat more bread or potato.  I usually get up and have diarrhea then inject Victoza and wait 30 mins then have a bowl of muesli, and guaranteed within 30 minutes of eating the muesli I’m back on the toilet again with another belt of the runs, and it’s just like water.   Likewise the Victoza because it slows the stomach (gastric) emptying you always feel bloated, the middle tyre you have always feels like it’s growing which isn’t true, it’s just the bloated feeling.  So although Victoza is a win win when it comes to both reducing the Blood Sugars and helps losing weight, some of the side effects of heart palpitations if you try to eat too much, or the constant diarrhea it gives you every time you have a bowl movement although unpleasant and many may decide it’s not worth it, for me, is still worth it in my book.

Posted in A1c, Blood Sugar levels, GLP-1 - Victoza, Living with Diabetes | 2 Comments

Red marks the spot…

bloodOn this bright and sunny morning, I wondered what it must be like to be normal again? To be able to choose a shirt based on the colour you like, or how you feel you will look today rather than based on how many blood spots you can find on the shirt? No matter how many washes you do, the blood stains just don’t come out. Is the colour dark enough to hide any additional blood spots made from today? The ability to choose a shirt, just because it’s a shirt, not because it’s covering something up…red blood.

Having to finger prick 7-10 times a day, draw blood, there’s always that one bleeder that just won’t stop bleeding, you touch yourself and it smears blood over your clothes. Or there are the daily injections where for the life of me for the last 7 days every time I stick a needle into me to inject, pull the needle out, there’s blood. Or there’s the times where it doesn’t bleed, but 10 minutes later you realize it was holding back in disguise, and now there’s a red patch on your shirt coming from where you injected.

What it must be like to not hate the colour red. What it must be like looking to buy new clothes and wondering what a blood spot would look like on that colour? Will it blend in?

For one day, could my blood turn green? Or blue? Or yellow? Or some colour other than red so it can match what I’m wearing? Just one day, is all I’m asking. Is it too much to ask? Or if that’s too much to ask, just one day where a site doesn’t start bleeding again after it’s stopped?

What it must be like to be normal.

Posted in Living with Diabetes | 1 Comment

Newly diagnosed with Type 2 Diabetes? What to expect in your first year

diabetesI thought it would be good to look back on the last year or for me 18 months of my Diabetes diagnosis, for anyone that has recently been diagnosed with Diabetes on what to expect of this Chronic Disease and how it will change your life.  This guide works for both Type 1 and Type 2 although for Type 1 Diabetics the medication will be different, please bear that in mind.

Diagnosis
For me diagnosis was simple. I knew I was Diabetic, I knew other people with Type 2 Diabetes, I knew the symptoms and what would be required of me, I knew I was drinking 3 pints of drink in a single sitting, having too many toilet breaks so diagnosis for me wasn’t that hard.  For many though it can be a mix of emotions, you’ve caught something or so you may think, but it’s actually been dormant in your body for many years and has now been detected.

Diabetes Tests
If you’re like me you hate going to see the Doctor or Dentist and put it off as long as you can. Your Doctor (and Dentist) will now become regular visits. When diagnosed and titrating medication you’ll find yourself visiting the doctor every 2 weeks until your blood sugar becomes under control. Like me, you probably don’t like blood tests and have had one every 5 years if you’re lucky, well you’ll now be having blood tests and being stabbed with needles every 6 months to check your blood sugar and asked to pee in a cup and provide a sample in a test tube. Then there’s the Retinopathy scans, having eye drops once a year placed in your eyes that force your pupils to stay open and be sensitive to light so they can photograph your retina’s for any damage from high blood sugars over time, these happen once a year.

hba1c

As you have Type 2 Diabetes you’ll probably be overweight so every 6 months when you have your Diabetes checkup, think of it like your annual MOT car service, you will be weighed, have your blood taken, provide a urine sample, then a medication change may occur depending on how good your HbA1c is. You will also have your feet checked for loss of feeling (neuropathy) which is another Diabetic Complication.  You may not realise it at first but you are now sitting a 6 monthly exam, you’ll be told if your blood sugar is bad (you’ve been bad) and whether it’s no change (you haven’t worked hard enough) or if it’s better (we all hope it will be better) but here’s the problem with Diabetes. Diabetes is a degenerative disease, that means that it gets progressively worse over the years, so your blood sugar will always get worse over time. More lifestyle changes and medication will need to be made over time. That leads nicely onto the Lifestyle changes you’ll be making now you are diagnosed.

Lifestyle changes
The first thing you will be told is you need to make lifestyle changes, that’s exactly what I did. Stop eating pizza’s 3 days a week, curries 2 days a week, you’ll soon start to realise that the foods you love the most will now be off limits, or more off limits like a Sunday roast where you only have it 1 day a week instead of 7 days a week. You’ll switch to eating more healthily like having salad with most of your meals, actually salad will be the main part of your meal, and vegetables, yes those horrible green things for the most part. Reducing portion sizes, choosing meals that are low in fat, low in carbohydrates and low in calories are also a must. Think of it as what you would eat if you were on a diet, but this is a lifestyle change, you’ll be eating this 365 days a year.

salad

All of this will help lower your blood sugar a little but not a lot, you’ll need to add some form of exercise, whether it’s a 2 mile walk 4 days a week, using the stairs more instead of a lift, walking to the shops instead of getting in the car, or doing some aerobic video workout in the home. However, that said again this won’t lower your blood sugar to normal levels for most that are diagnosed at >10% HbA1c, even combined with a new diet. So why do it? Well simply “Every little helps”. Can’t I just have medication and that’s it? No new diet and no exercise? I’m afraid not, and you’ll find out why if you keep reading.

Medication
So you’re newly diagnosed and you are now starting medication, for most Type 2 Diabetics that means starting on Metformin on a low dose and titrating up to the maximum dose of 2550mg a day. When you get above a single tablet of 500mg you’ll find these tablets or pills are like horse pills, massive! Metformin will help lower your blood sugar by moving sugar out of the blood stream and into your urine and if you are only just Diabetic around the 7% HbA1c then that may be enough for the time being.  If like me you come in around 11% mark then it won’t be enough and there will be additional supplemental medication you will need.

gliclazide

Some doctors will add Gliclazide which helps reduce your blood sugar more but can cause hypo’s where you feel sick and unwell regularly, others will add Sitagliptin, Pioglitazone or even Byetta, Victoza or Lixisenatide. I have gone through most of these and am now on Victoza. It’s important to know that every person is different, some react better to certain medication than others. There’s side effects with all these medications, even a higher risk of cancer with some. Many find it better making bigger lifestyle changes like diet, exercise and losing some weight to reduce the amount of medication needed.

I am a 2/3rds full kind of guy, I like stability, hate change, so I worked quickly to change my diet, my lifestyle, chucking out the pizzas, the pasta, the rice, the curries and the pasties along with crisps and chocolate and switching diet.  Don’t get me wrong, you can still have these but within moderation, small portions and not every day, even doing a 2 mile walk 4-5 days a week. I managed to titrate through medication and settled initially on Metformin and Gliclazide and my blood sugars had reduced from 11.2% to 6.8%, brilliant! That’s the last i’ll see of the doctor for 6 months now, that’s the medication I will be on along with a Statin to reduce heart problems (another Diabetic complication), and I won’t need to change my medication for a long time. That’s what I thought, and I was very wrong. Every 3 months our blood sugars are different, our bodies are constantly changing. This leads very nicely onto Insulin and weight gain and the downward spiral.

Insulin and weight gain
So you may have had problems with weight for a long time, you pack more weight than you should do, you’ve tried diets for a month or two or maybe three and lost weight in the past but for the most part your weight remains stagnant or sometimes creeps up rather than down. Many of the Diabetes drugs works by getting your pancreas to secrete more insulin, Metformin is the one that doesn’t, everything else either helps you secrete (make more) or help in how insulin is absorbed from your blood stream into your cells to lower the blood sugar quickly. For the class of drugs that help secrete more insulin, this will most certainly mean weight gain. This is why diet change is key, when on Gliclazide I had 2 months of stable great blood sugars but then my body seemed to change in the winter, I started getting more and more hypo’s which means you need to eat or drink something sugary to get your blood sugars out of the low danger zone and into the normal zone so you don’t pass out, and because you are eating/drinking more sugar, guess what? You start gaining weight.

weight-gain

I lost 3 stone around the 3 months of being diagnosed with Diabetes, I made the lifestyle changes but once I started on Gliclazide, weight loss all but stopped and I started to gain weight. To the effect of 3 stone in 1 year! So be careful, if you go on any medication that either helps secrete more insulin or injects insulin, it’s a very slippery slope, even more so because you are over weight. I eventually was able to come off Gliclazide and move to Victoza injections, and that moves onto the next section nicely.

Finger pricking and injections
So you’re now Diabetic, there’s a mix of doctors that do and don’t want you to test your blood sugar, my previous GP preferred self management where my new GP prefers no self management and leave it up to the doctor. You will probably find yourself finger pricking at some point if not soon after diagnosis, that involves taking a small needle in a lancet and stabbing your finger to draw blood so you can offer it up like a virgin sacrifice to a test strip to check your blood sugar.

blood-test

For Type 2′s that can be up to 6 times a day if you don’t need to overcorrect with insulin, it may just be once a day to check fasting blood sugars, it all depends on how severe your diabetes is and what your GP and Diabetes Specialist Nurse (DSN) prefers. For me it was 6 times a day. On top of that you like me probably don’t like needles, but trust me you will get used to it very quickly. You will at some stage move to injectable medications like Victoza, Byetta or Lixisenatide, or even insulin and these are even less painful than a finger prick test, but you WILL get used to the needles. It’s all part of the lifestyle changes, you are now Diabetic.

Losing weight
If you can lose weight and shed some of the weight you have accomplished over the years then it will help your Diabetes and help reduce your blood sugar, but mark my words, if you thought it was difficult losing weight prior to being diagnosed with Diabetes, it will be harder now that you are diagnosed. The medication will be working against you to add weight. Maybe when sitting exams you were an average person hitting around 70% in exams, you strived to hit the 90% mark but never could achieve it, that’s what you need to hit now to try and lose weight, a lot more time and effort will be needed to try and lose weight than ever before.

Weight-Loss-h

It’s actually an ever decreasing circle, your blood sugar becomes worse over time, you add more medication (insulin) to reduce your blood sugars because that’s what insulin helps to do but that adds weight, in turn your blood sugars become worse again, you add more insulin…well you get the idea!

Your extra pouch
Call it a man bag, a larger purse for a lady, but it will contain all your diabetes gear. That will usually be a Blood Glucose Test Meter, Lancet, Test Strips, Lancets, and usually your medication. You’ll get used to carrying this around with you a lot more, think of it like a large mobile phone pouch to start with but will start to grow over time.

New Diabetes Bag

Hypo’s and Hyper’s and your mental state
Hypo’s are when your blood sugar drops too low and hypers when your blood sugars are too high. Have you ever had that horrible sick feeling in your stomach, you have a headache, you’re sweating that cold sweat, you feel weak, you feel like you’re just about to pass out unconscious and you can’t think straight? That’s what a hypo feels like, you feel completely drained, what makes it worse is you need to know this feeling and treat it with sugar to boost your blood sugar. Hypo’s can happen if you have too much insulin swimming around in your blood stream or likewise not enough sugar. With Diabetes we need to try and balance our blood sugars between two levels, 4 mmol/L and 8.5 mmol/L.

hypoglycemia

Think of it like flying a plane, for the most part you are doing good, the plane is flying great, but wind or turbulence comes along and the plane (or blood sugar) starts to drop, you have to take evasive action to avoid crashing the plane and killing everyone on board, or in this case, avoid passing out or even dying which can happen from severe hypo’s. So you treat with something sugary, and your blood sugar starts to rise, that’s great, you’re out of the danger zone! Well not quite, because to crack that wallnut instead of using a walnut cracker you just used the largest sledge hammer you could find, so now your blood sugar is starting to soar, not like a bird but like a rocket taking off for the moon. The problem is we have to stay within range like I mentioned earlier, having your blood sugar too high is like parsing battery acid through our veins, it’s not good, it poisons organs within our body and they start shutting down over time, causing things like kidney failure, renal failure, heart failure and cut off blood supply to limbs causing infections that go unnoticed and that lead to amputations. Yeah that’s not good, but unlike hypo’s that are quick to fix, these complications happen over longer periods of time so we need to keep our blood sugars as low as possible without going too low over a longer period of time. There’s that exam again! So this exam we’re now taking as a newly diagnosed Diabetic is not just once every 3 months or 6 months, but DAILY! You’re now in exam hell, taking exams 365 times a year, and each day its probably up to 6 exams, so that’s a staggering 2,190 exams a year you are now sitting. For someone that didn’t like exams, that’s a lot of exams but get those exams right and you’ll get better blood sugars and this amount of exams will become a lot lower, but if you’re above 10% on your HbA1c at diagnosis then you won’t be far off this number of exam tests.

The other problem is hyper’s, the opposite of hypo’s, hypo being low and hyper being high. If you don’t keep yourself within the range and go high is when you have a hyper attack, you also feel unwell, but a different unwell and you may or may not recognise it. The first is headaches, a throbbing thudding headache, you feel the pulse in your head and your neck, you feel tired, lathargic, and you may not realise it until after the effect but you are grumpy and getting into heated arguments and lose your temper extremely quickly. You’ll realise it more when your blood sugars return to normal and that argument you were in just a little earlier you now realise you sounded like a stupid, argumentative oath! You will lose your temper very quickly, the smallest of things will annoy you when you are hyper.

When you are hypo or hyper your mental state changes, you cannot think straight, so you are constantly feeling unwell when within these ranges.

Sick days
For me sick days was when I had the flu, man flu, it was when I felt really sick and just couldn’t get out of bed and go into the office. You’ll find with Diabetes whether it’s Type 1 and Type 2 you’ll have a lot more sick days, sometimes more than your employer will permit. It’s important to let not only family and friends know you have Diabetes, they may be more understanding and realise when you are low and high quicker than you do and try not to get into too many arguments with that big oath of an ogre you may have become, but also to let you’re employer know.

sick

If they are an understanding employer they will understand what Diabetes can become and be more forgiving that you may need more sick days because you are now living a chronic disease. For me those sick days have become more, and sometimes it can just be because you’ve had too many hypos and feel utterly, drained and sick, for me I hit an all time high of 17 hypo’s in one day, I just wanted to end my life, I didn’t but that’s how I felt.

Danger and how to overcome it
Hypo’s are the immediate danger, you can pass out or even die if left untreated and your blood sugars don’t rise, you hear about people dying in their sleep, you’ll be surprised that a lot of people that die in their sleep have Diabetes due to being unaware of the hypo because they were sleeping. When I hit 17 hypos in a day luckily I did have an additional form of protection. I had decided to self-fund (pay for) a CGM (Continuous Glucose Monitor), I wanted to protect my driving license and just imagine what would happen if you had a hypo whilst driving, you not only lose conciousness, but you lose control of the car, you crash, not only injuring yourself but others, maybe even death! I had invested in a CGM to protect myself as I was having a lot of hypo’s when I went onto Gliclazide. These are an injectable sensor you inject into your arm or abdomen, wear for 5-15 days, have a wireless receiver that you carry and it tells you what your blood sugar is doing every minute of the day. A CGM also allows you to rest your fingers from all that painful fingerpricking. They are not cheap, they cost a small fortune and for the most part are not funded on the NHS, but if you do a lot of driving, or become hypo unaware and are at risk of a lot of hypo’s especially at night then a CGM can be your best friend, mine is Anna and my significant other!

Reversing Diabetes
So you’ve read all about this reversing Diabetes.  Well yes it is possible, if you’re pre-Diabetic or have a HbA1c around 7-8% then yes you could reverse Diabetes, but it’s a lifestyle change of diet and exercise, it may be possible.  For anyone vastly overweight and have a much higher HbA1c it’s either not possible or extremely unrealistic that you would be able to reverse Diabetes.

reversing

Reversing Diabetes is only possible in Type 2 where the pancreas hasn’t entirely shut down and unable to produce insulin, if you are a Type 1 Diabetic reversing Diabetes is off.  Although to be completely honest, reversing Diabetes for anyone suffering from Type 2 is like running 10 marathons in 10 days, extremely unlikely and you’ll probably kill yourself quicker if you try.  So don’t expect any quick ways out of this Chronic Disease, especially if you’re overweight.  Reducing your weight to an average BMI is the best course but for most with Type 2 that have struggled with weight all their lives, this just isn’t going to happen unless you’re that lucky to be a winner of a lottery and have a lot of luck on your side, in which case it might be achievable, but for the most of us it would just be a dream.

Will I need to inject insulin?
Probably one of the biggest questions most Type 2 Diabetics will ask around diagnosis.  The simple answer is for the most of us, yes over time.  If you can get away with diet and exercise alone to keep your blood sugar in tact then great for you!  For most of us we will need other forms of medication whether tablet/pills or injectables, but they don’t have to be insulin, at least not to start with.

injection_2227502b

However, over time when these become less effective on your body and your blood sugar then yes you will need to transition to injecting insulin.  For most it’s not a matter of if but a matter of when.  For people living in the UK and some other countries, you’ll find that once you start injecting insulin you go onto a restricted driving license, in the UK with DVLA it’s a 3 year renewable driving license.  It sucks, thankfully I’m not quite there yet but many of my Type 2 friends are and are on restricted licenses.  If you can stay away from injecting insulin but use tablets/pills or other injectables that help secrete more insulin from your pancreas or help absorb insulin better, stick with these for as long as you can, as I mentioned earlier, the more insulin the more weight gain, so it becomes a very slippery slope.

In Summary
This is what my last 18 months post diagnosis of Type 2 Diabetes has become, I’m striving to lower my weight (which I have now started to do now starting Victoza which helps food intake) and also lowering my blood sugar, but every day is a new test, some days are better and some days are worse, but you do the best you can when you can.  I still eat the odd pizza, the odd curry or pasta, some snacks like crisps or chocolate but all within moderation, they are more of a treat than a daily occurrence.

For a look at Type 2 Diabetes medication, take a look at another blog post I wrote that helps explain the medication available.

Also be aware that just because you are overweight doesn’t mean you are Diabetic, and that weight has caused your Diabetes.  Yes it can have an influence but there are millions of people that are overweight and obese in this world we live that are not Diabetic and do not show signs of Diabetes.  Here’s a great video from a Health Care Professional that is something all newly Diagnosed Type 2 Diabetics should watch.

You may also want to check back on my blog here regularly as I am always writing posts, this is a blog dedicated to Diabetes, I do talk a lot about CGM’s but it’s 100% about Diabetes and the life we now live as a Diabetic.

Posted in Blood Sugar levels, Living with Diabetes, Type 2 Diabetes | 5 Comments

Victoza update

Ivictoza haven’t done a Victoza update for a while so thought I would give an update.  I’ve been on Victoza now for over a month and some strange things have happened.

All the sickness feeling around injections and meal times have disappeared which thankfully is great.  Even the skipped heart beats although I’m not sure it was directly linked to Victoza because they started a couple of days before my first injection but lasted for a good 3 weeks, have all stopped now.  The only side-effect I’m still getting is that I feel 90% full so when I eat a large meal I’m feeling full and get indigestion and acid reflux if I try to eat too much, and when I say a large meal, it’s a relatively small meal for most but what has now become a large meal for me.  That large meal c0mprises of 1/2 a small onion, 1/2 a small bell pepper, 3 slices of ham or chicken, a piece of lettuce you can place in the palm of your hand and a small tomato.  Yes it doesn’t sound much does it?  That’s a large meal for me now!

The strange thing though is since Christmas and to the New Year I’ve been able to eat some Christmas snacks since my tooth sockets after the extraction just prior to Christmas have got a lot better.  I’ve been able to consume a lot more snacks than I can a meal.  Not too sure why, I’m not feeling full as quick with the snacks but maybe it’s because it’s snacking and I’m spacing them out more, but eventually will feel full if I keep on snacking.

So how is Victoza doing for me?  Well my blood sugar a month in is doing a lot better, it’s not as good as I had my blood sugar with Gliclazide but it’s better than not having anything at all.

With Metformin 2550mg and Gliclazide 80mg a day I was finding Fasting = 4.6 mmol/L, pre-meals 4.2 mmol/L, 2 hour pp = 7 mmol/L for a non-carby meal or <10 mmol/L for a heavy carb meal.

With Metformin 2550mg and Victoza 1.2mg a day I now find my Fasting = 7 mmol/L, pre-meals 6.7 mmol/L and 2 hour pp = 8.3 mmol/L for a low-carb meal.

Certainly my blood sugars are not as low as they used to be and I would still like them to be lower as my average BG is around 7.9% per day on a low carb <750 cals and <75g carbs, but I’ve not had any hypos for 3 months and that is a great feeling.  There is talk of reducing my Metformin after the 6 month mark and maybe sooner but to be honest I can’t see this happening with my A1c being high unless something else gets supplemented in.  Maybe Gliclazide because it worked so well may be added back, it added weight which I don’t want but that’s certainly an option, or adding something like Sitagliptin may be another option to try.  I have a feeling though that I will be switched from Victoza to Lixisenatide for 3 months to see how that works, it’s 25% cheaper than Victoza, and then they may look to supplement on top of that.  Anyway I’m at least glad my BG has now reduced since being taken off medication, just need to try and get it lower if I can, but that won’t happen without further medication/titration and I’m at the limit of what Victoza can be prescribed at in the NHS.

Lixisenatide for anyone that doesn’t know is a GLP-1 just like Victoza, it’s another brand name from another pharmaceutical (Sanofi) where Victoza is from Novo Nordisk.  As it’s a GLP-1 it has very similar properties and effects to what Victoza should have, e.g. feeling fuller by slowing gastric emptying, reducing blood sugar levels, it’s just a newer and cheaper drug, so the NHS seem to want to prescribe it over Novo Nordisk’s Victoza.

Posted in GLP-1 - Victoza, Uncategorized | Leave a comment

Back in the saddle…hopefully

CGMI told myself these past couple of days of not testing my blood sugar that I needed to get back into the saddle and that I would do, whether I like it or not.  Doing injections these past couple of days have been hard, not knowing what my BG is has been easier because I haven’t been suffering from hypo’s on Victoza, but I’m dead sure they have been running high at the best of times.

Anyway this morning came, I woke up and knew I had to insert a CGM Sensor, I just had to.  It’s a very strange feeling, I’m PRO CGM as many of you know that know me, BUT inserting a CGM sensor this morning was the hardest thing I’ve had to do for a while.  I opened the Inserter pack, opened an inserter bay sterile tray, I had already changed the batteries on receiver and transmitter last night for an easier insertion this morning.  All that I needed to do was insert the sensor, simple?

I sat there with inserter stuck to my arm for what must have been 10 minutes, thoughts going through my mind like “I really don’t want to do this”, “let’s take the inserter off” and “I really don’t want to know what my blood sugar is doing” but eventually I managed to plump up courage and press the button twice….THUD, the sensor is inserted and no bleed.  Good!  Now waiting to calibrate the CGM Sensor in the next hour and two hours and I’ll be up and running for 10 days on this CGM Sensor.  Hoping this will get me back into the swing of things, not having to manually finger prick which will still be good but I will know what my Blood Sugar is doing and can try and get out of this Diabetes Burnout.

Posted in Blood Sugar levels, CGM, Living with Diabetes | Leave a comment

D’burnout – Happy 2014!

burned_outAfter everything I’ve accomplished in this past year and a half of being diagnosed with a lovely Chronic Disease, the amount of weight (19 pound) I’ve lost since mid-October, has taken toll on me.  I’ve hit Diabetes Burnout…again!  It happened on January 1st, although was probably creeping up a few days before that.  My last CGM sensor was pulled out on 27th December and I haven’t inserted another sensor since. I’ve stopped testing my blood sugar both pre-meals and post-meals now and I’m falling down that well where I’m soon going to hit the bottom before I can start climbing back up.

Diabetes Burnout happens to the best of us (although I’m not considering myself anywhere close to being the best) but it happens.  We have to concentrate 24/7/365 on our blood sugar, keeping it between two values, cursing and swearing if it goes too high and feeling grumpy and feeling hopeless and life-force drained if it drops too low.

Diabetes Burnout can effect each of us differently whether you are Type 1 or Type 2 or something in-between but for most of us it means we’re all burned out, we don’t want to test our blood sugar anymore or do our injections or take our tablets.  January 1st was the first day I woke up with a stomach that was churning, and I just couldn’t bring myself to injecting Victoza, but I did do it…eventually.  I didn’t like it, not that I usually like it, but I really really had to force myself to do it.  Today was the same, I did it because I had to, but I really didn’t want to, every time I went to inject my stomach started feeling queasy.  I know the injections and the tablets will help keep my blood sugar in the range a little so I’m forcing myself to take them but I’m just flat out refusing to test my blood sugar.  Well, not refusing mentally, I’m not telling myself I’m not going to test, I just don’t care!  That’s how I feel right now and I don’t want to know what it is so I’m not testing to check.  Same with checking my weight, I’m sure I put on a few pounds over the weekend, but I just can’t bring myself to check.

I know this will subside, it’s not the first time I’ve hit Diabetes Burnout of constant checking and managing the chronic condition called Diabetes, I’ve lost count how many times I’ve hit it in the past year and a half, but mostly it lasts about a week before I can bring myself to insert a new CGM Sensor and force myself to do it, just like forcing yourself to do your homework as a kid when you didn’t want to.

Its not just burnout from Diabetes, it’s burnout from everything, work included.  Even though I’ve had a week off work, I guess it’s that time of year where we all feel a bit down and that feeling down affects how we feel about things, and Diabetes management is a big thing in our lives on a daily basis.

Posted in Living with Diabetes | Leave a comment

My first year with Diabetes, what a roller coaster!

2013My first year has been a mixed one being diagnosed in August 2012 with a fasting BG of 14 mmol / 252 mg/dl and post meal BG’s  22 mmol / 396 mg/dl . It took 3 months of frantic changing of medication to get to a level where my HbA1c dropped from 11.2% to 6.8%, phew what a relief was my first thought!  However, little did I know that was just the start of the biggest roller coaster of my life.

By January 2013 I was experiencing 3 hypo’s a day and having to treat and in the ice cold February several days I had 17 hypo’s in one day according to the CGM I self-funded.  They completely drained any life force I had left and I was really struggling through my first winter of Diabetes diagnosis. Even though my blood sugar was running around the 4-5 mmol pre-meals (72-90 mg/dl), due to hypo’s I was experiencing post meals I was putting on 3 pound a month in weight, that doesn’t sound much but in 12 months that equated to a whopping 3 stone or 42 pound! I had been seeing my GP and Diabetes team every 1-2 months and neither were concerned about the weight gain until I reached the 3 stone mark. My previous GP was great, gave me prescriptions for 204 lancets a month and 150 test strips a month but was only concerned about my HbA1c and not weight.

My GP towards September started to take an interest but then retired and I was then shunted to a new GP and DSN that are intent on serious cost cutting. Test strips were revoked completely along with lancets and medication that helped lower my HbA1c and I was labelled as “Non Compliant” because of the weight gain in the last 12 months. They also removed my medication because my HbA1c and blood sugars were now pre-diabetic.  Nobody on my medical team stopped to think it was because of the medication I was put on and a lot of hard effort put in by myself over these past 12 months, only I was the one that realised this.

So in October I had a fight on my hands, I managed to overturn the decision showing what my average fasting BG’s were and that I was feeling utterly crap with 24/7 high blood sugars and managed to get put on Victoza in November.

victoza2

I managed to get test strips and lancets reinstated HOWEVER, I was told it had to be a CHEAP brand and given a CHEAP meter by my Diabetes team and only permitted 50 test strips and 50 lancets a month which clearly isn’t enough.

lancet

Since being on Victoza for just over a month my Average Blood Sugar (A1c) reported by my CGM is 7.5% which is up from the previous 6.3%.  Not great but right on the upper limit of what we should be at with our blood sugars.  Gladly I’ve not suffered from a single hypo in 8 weeks and that’s allowing me to cut my intake drastically.

The upside of 2013 trying to look on the bright side is that I have put a heck of a lot of work and effort into controlling my Diabetes and weight this last year. For 12 months I was eating a breakfast, lunch and dinner of 1500 calories and 150g cabs prior to any treatment of hypo’s a day and was putting on 3 pound a month with the excess amounts of insulin.  Since November 2013 as I am no longer suffering hypo’s I am eating 500 calories and 75g carbs a day and have now not only stopped putting on 3 pound a month but managed to lose a total of 19 pound in 2.5 months.

However with all that effort I have put in, for me it’s nothing short of a miracle I have performed but sadly I am still being labelled as non-compliant by my new Diabetes team because of the 3 stone weight gain over the last year along with my total weight and still being asked to see a dietician.  Also my medication has been removed from repeat prescriptions and is only permitted now PROVIDING I lose a certain amount of weight per month and visit my new DSN once per month. If I don’t lose the weight set out by the DSN then I have been told that medication will be withdrawn. That’s not a nice feeling to be in but like many Type 2′s I am overweight and acknowledge I do need to lose a lot of weight but still effectively being blackmailed isn’t a nice feeling to be living with, especially seeing all the effort I have put in over the past year to reduce my HbA1c and to cut calories to try and lose weight, all of which is being overlooked on the NHS by my new Diabetes team.  Even more so that most people put on weight over Christmas and in December and through Christmas I had lost 8.8 pound.

My resolution for 2014 is to shed the remaining part of the 3 stone (23 pound remaining) I put on in the last 12 months due to the excess insulin needed and for having to treat hypo’s.  Then I would like to accomplish losing at least another 2 stone in weight to make to me lighter than I was just post Dx.

Christmas food (what little I bought) has now been chucked in the bin, I’m officially back on my 500 calorie and 75g carb diet now and will see what 2014 really does bring, it won’t be easy but this past year was no walk in the park!

Oh and one more thing, not only was I voted Best of the ‘Betes Blog in August 2013 but I have also been nominated for the 2013 Best of the ‘Betes Blogs under the category Best Advocacy of 2013.  I couldn’t have done any of what I have achieved this past year both personally for myself and under advocacy in the Diabetes world without the daily help of all of you that not only follow what I do but also have helped out in the past year.  This is now my 152nd blog post on Diabetes, truly amazing!  Most of you have helped out on a daily basis when frustrations and tempers are running high, suffering from hypo’s and morale low, thank you everyone for your continued help and support! :)

Posted in Living with Diabetes | 2 Comments