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 diabetic at age 30

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sjr
post Mar 30 2017, 11:49 PM

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QUOTE(JeweL_ @ Feb 16 2017, 04:13 PM)
Hi guys. Just finish see doctor. She said one month ago when I was newly discovered, my hb1ac is 11.5

Today is 8.8... Kidney, hormones all OK. And changing my metformin to metformin xr.

She say I can finish my current medicine, 2 x 850 in the morning. 1 x 850 in the evening. So after finish this I will eat metformin xr in the morning only.
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I'm sorry I did not notice your threat earlier.
To be frank, single anti-diabetic agent for a case of HbA1c of 11.5% may not be enough. You may need a second agent (if you are rich enough, you can try newer agents like sitagliptin, empagliflozin etc). If you are started with diamicron (gliclazide), daonil (glibenclamide), etc, please do find out what are the symptoms of hypoglycemia (low sugar). Low sugar for prolonged duration can cause serious complication which may be fatal.

Metformin is an old drug, but it is excellent for Type 2 diabetes. It mainly acts on your liver to suppress gluconeogenesis (making sugar from other source, e.g. fats and proteins). It also improve your insulin sensitivity (FYI, Type 2 diabetes is mainly due to insulin resistance in contrast to Type 1 diabetes which is insulin depletion/production failure). It is known to cause diarrhoea especially when you were started with high dose straightaway. You may try the Metformin-XR, the diarrhoea side effect is not as prominent.

There are a listful of complications in diabetes. You can refer to various health websites. It can affect your heart, your brain, your kidneys etc. The problematic ones are microvascular (affecting small vessels). These include diabetic retinopathy (which affects small vessels of your eyes that can eventually lead to blindness), diebetic nephropathy (which affects your kidneys and leads to kidney failure), and diabetic neuropathy (which affects any of your nerves). Diabetic retinopathy usually occurs first: it may occur even before a person being diagnosed with diabetes. The treatment is usually photocoagulation (laser to your retina). Diabetic nephropathy usually occurs 10 years from the diagnosis. Blood test for kidney function does not exclude you to have kidney involvement. It is an urine test for microalbumin that tells you so (albulin/protein usually doesn't leak out from urine. The detection of protein in urine indicates your kidney may not be functioning properly). In the early stage of proteinuria (protein in the urine) it is easily reversible by controlling your diabetes. However once blood for kidney function (mainly your urea and creatinine) become abnormal, it will not be reversible. Thus, a good control of your blood sugar is utmost important as kidney faiure is a serious complication which need lifelong dialysis/transplant.

Diabetic neuropathy is also another important complication of diabetes. I'm sure you definitely have heard of a diabetic patient who has a bad wound of his/her leg which eventually need to be amputated. It is actually a manisfestation of diabetes affecting your pain sensation of your foot and toes. Long term uncontrolled blood sugar will definitely damage your nerve endings (receptors). Affected people may not feel any pain when they've injury to their foot/toes. The moment they realized the injury, it has already been infected. Furthermore high blood sugar retards body's white blood cell to fight against infection. Eventually infection won.
Another manifestation of diabetic neuropathy is autonomic neuropathy: your blood pressure may drop when you get up from lying/sitting as a result you may feel dizzy/blackout. You might encounter a silent heart attack. You might get severe vomiting (gastroparesis), difficulty in swallowing or even diarrhoea. You might have erectile dysfunction (your kukubird cannot stand up) if you are a guy, urinary incontinence.

Keto diet may not be sole answer for non-pharmacological (method other than taking medicine) approach to your diabetic control. You will need a proper meal with proper timing. I know it is difficult to comply with diet especially timing. Breakfast is important as it is the main energy source of your day after you have fasted since last meal the night before. Skipping breakfast may not help in your diabetes and may retard your diabetes control. You may try 2 slice of bread (whichever type of bread you like provided no added sugar), any diabetic jam or butter, a cup of milk tea (no sugar) and take your metformin after your breakfast. Try to take your breakfast before 10am.
You can have your lunch at 12pm-2pm. I would advise plate method, i.e. half of your plate is vegetables (green leafy vegetables, and not those fake meat or starchy vegetables), a quater plate of protein (tofu, chicken or any meat), a quater plate for carbohydrates (rice, roti, or noodles). Take vegetables first, then protein and lastly carbohydrate. Vegetable can fill up your stomach first and usually take long time to leave your stomach.
Your dinner should be kept small in portion and should take it early (i.e. not after than 9pm): you don't need so much energy at night and it's sleep time soon. You can take few pieces of biscuits (usually not more than 4), a cup of milk or tea. You may follow the same plate method as your lunch, but definitely much more smaller portion. You should take your metformin after your dinner.
It is okay to take snack between major meals. You can take a piece of medium sized green apple, or 1 slice of bread, or 2 pieces of biscuits. As long as it is no more than a carbohydrate exchange (you can search from web what is a carbohydrate exchange).

You will DEFINITELY need to visit a dietitian to help you out in personalize your diet. (you can request to be referred when you visit your doctor)

Exercise is also very important to control your sugar. It not only uses up the remaining sugar as energy, but also improve your insulin sensitivity. A moderate exercise of 30-60 minutes at least 3 times a week is minimum. Moderate exercise means any exercises which cause you to be a little breathless (but you still can speak in full sentence), and you can feel your heart beating. Sweating is not included in a criteria of moderate exercise. You may jog, run, brisk walk, cycle etc. If you have knee problem, alternatively you may try walking in a swimming pool (water level not higher than your nipple line). Water in the swimming pool may reduce the burden of gravity to your knees.

Finally, I hope you can control your sugar well.

This post has been edited by sjr: Mar 30 2017, 11:49 PM
sjr
post Mar 31 2017, 06:52 AM

On my way
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Senior Member
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Joined: Aug 2008
QUOTE(rjb123 @ Mar 31 2017, 12:02 AM)
Thanks for posting here - very informative!

Are you aware of any insulin pumps being available in Malaysia?
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It is available. One of the brand is Medtronic. But I don't have any contact.
You should ask your treating endocrinologist to arrange it for you.

btw, do you really need it?
sjr
post Apr 1 2017, 01:57 PM

On my way
****
Senior Member
523 posts

Joined: Aug 2008
QUOTE(rjb123 @ Apr 1 2017, 01:44 PM)
Will enquire.

I like the idea of it, but no issue staying on injections. I use a CGMS and was looking at exploring the option of CGMS+ pump all in one.
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It costs near RM20k or even higher.
If you have no issue with injections/labile blood sugar, I suggest you to stay on, unless you are super rich...
sjr
post Apr 1 2017, 02:04 PM

On my way
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Senior Member
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Joined: Aug 2008
QUOTE(rjb123 @ Apr 1 2017, 01:58 PM)
Oh wow that expensive, and I thought CGMS was dear.

Guess I'll leave this idea - 20K is a bit too much!
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You still can try your luck to get quotation for the machine.
Who knows you're lucky getting a cheaper one...
sjr
post Apr 1 2017, 02:09 PM

On my way
****
Senior Member
523 posts

Joined: Aug 2008
QUOTE(rjb123 @ Apr 1 2017, 02:05 PM)
I'll ask next appointment, unlikely though - being non Malaysian and without insurance everything is out of pocket, no subsidised insulin etc.
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Oh, you are not Malaysian...
How 'bout getting it from your original country then?
sjr
post Apr 1 2017, 03:13 PM

On my way
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Senior Member
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Joined: Aug 2008
QUOTE(rjb123 @ Apr 1 2017, 02:31 PM)
In UK you get any diabetes related items for free (Insulin, needles, test strips etc.) but that's only valid if you live and pay taxes in UK (which I don't)

CGMS can be bought normally, so I send supplies over from UK myself.
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Ouch!
Alternatively, you can try asking if your company that you are working with could subsidise some.
Malaysians do get free insulin, but only those regular ones. Insulin analogues e.g. Glargine or Aspart are difficult to get - they are endocrinologist item, i.e. they can only be prescribed by endocrinologist provided the quota isn't full. If the quota is full, sorry, you will still have to use your own money to buy them yourself.
sjr
post Apr 1 2017, 04:08 PM

On my way
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Senior Member
523 posts

Joined: Aug 2008
QUOTE(rjb123 @ Apr 1 2017, 03:51 PM)
I'm employed under my own company, so that's a no go.

I use Levemir / Novorapid same as I did in the UK - just buying from pharmacies here as prescription isn't needed. Test strips I still buy in bulk UK and DHL them over as they work out cheaper (and CGMS supplies, not available here)
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Double ouch!
I feel you....
How much do they cost inclusive of couriering them here?
sjr
post Apr 1 2017, 04:52 PM

On my way
****
Senior Member
523 posts

Joined: Aug 2008
QUOTE(rjb123 @ Apr 1 2017, 04:12 PM)
I buy Accu Chek mobile as I like the format (cartridge with 50 tests and the finger pricker attached) which aren't available here, and don't need to carry separate parts.

50 tests cost anything from £10-18 depending on the time and how many I find. They come in boxes of 2 so 100 in total - can send 10 boxes and a spare tester for around £20 or so.
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That's really cheap. At least 50 cents cheaper compared to the local price here.
I think I'd consider teaching people doing so next time...

 

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