Type 2

I am a 74 year old male and was diagnosed with Type 2 Diabetes in April 2015 and put on Metformin 500mg x 4 subsequently reduced to x 2 after 3 months after my next blood test in August.

As I have had Pernicious Anaemia for 45 years as a result of stomach surgery in 1959 I am well used to the exhaustion caused by that, however now with diabetes, I seem never to have any energy and feel so tired all day long.

My diet has been "approved" by a dietitian and I do 20-25 minutes a day on a mini exercise bike. I'm six feet four inches tall and weigh twelve and a half stones (having "lost" half a stone) in the last seven months

I sometimes feel as if I'm verging on the edge of a hypo, but as I've never had one before wonder if it is possible to have one with Type 2 and on such a low dose of Metformin.

23 Replies

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  • Thanks bigleg,

    My doctor is not very communicative. When he gave me the diagnosis he sent me on an 8 hour (spread over 4 weeks) NHS course that was so intensive and with my age and deafness I struggled to keep up with it.

    However I learned the importance of diet, exercise and foot care from what I could read and understand from the handouts.

    Exercise I took care of myself by purchasing a mini exercise bike but when I went back to the doctor after my second HbA1c blood test he said the results were "very good" (40 down from 51) but it was it was only on my "suggestion" that I might reduce the Metformin that he agreed that I could and even then he hesitated about by how much until I said "two a day"? I don't pretend to understand the test results but the doctor has scheduled for me to have another one in February 2016 - a gap of six months.

    He wouldn't give me any advice on diet, simply referred me to an NHS Dietitian and when I asked him to examine my feet he was most reluctant to look let alone touch.

    As I attend the surgery every 3 - 4 weeks for my B12 injections I have asked both the practice's nurses for advice and both replied "I don't do diabetes".

    Prior to my 40 minutes (allotted) appointment with the Dietitian I was sent a form on which I had to fill details of everything I ate or drank for 3 different days which was easy because my diet for six days a week is practically identical and I provided the manufacturer's nutritional value charts for every item of food.

    When I did an analysis of the carbohydrates/sugar content of daily consumption I calculate that my intake is less than 50% of the RDA which leads me back to my original question about hypos - is it possible to have one with Type 2 and on such a low dose of Metformin or, turning the question on it's head - am I not getting enough sugar in my diet?

    I got the impression from the course that diabetes care was "important" but my experiences so far (apart from the nurses doing the course presentation) have been to the contrary and almost dismissive. "Come back in six months and we'll see how you're going" or "I don't do diabetes"

  • Thanks for your reply John045

    I'm gradually coming round to think that the exhaustion I'm feeling has more to do with the effect the exercise I'm doing (for the diabetes - as instructed) is having on my B12 levels and my Pernicious Anaemia which I've had for nearly 45 years.

    Prior to the diabetes diagnosis in the Spring I never did ANY exercise, knowing full well that after any physical effort I would soon "run out of steam" so this has come as a bit of a double whammy and I'm probably going to have to either reduce the 20-25 minutes a day exercise or negotiate with my GP an increase in the number of B12 injections - down from 4 weeks intervals to 3.

    I wish you well for the future

  • And what has your GP said about this?

  • Hi Andyman,

    If you can read my response to bigleg you'll see that my (Egyptian) doctor is very uncommunicative and I don't think he would appreciate me making an appointment to see him to ask so simple a question.

  • I dont think its a simple question. You think you are verging on Hypos that's not good.

  • Hi I was put on Metformim .caused me lots of problems,if you look on line you will see that many other people are having problems ,l m now on Glytacibe 1 tab a day,But I'm on a virtual no carb diet as are a lot of others type 2 diabetics,it given me a better result,why not give it a try.? p

  • Hi double22,

    Sorry to read of the adverse effects Metformin caused and I'm glad you have found a suitable alternative. Did you have to get your doctor to prescribe Glytacibe and what does it do as I am so new to this I haven't got a clue?

    I guess that prescribing dosages of Metformin, (like with my B12 injections) it is not a case of "one size fits all" regardless age, height, weight, lifestyle and metabolism so perhaps I shouldn't be too amazed that it was down to me to suggest lowering my Metformin to my doctor who simply agreed and said come back in six months.

    I feel so alone with this as the only other two people I've known with Type 2, my father and sister are both long dead so I can't ask them for advice and I have no means of checking my levels until the next test in February.

    Meanwhile I've read about snacking, but if I did that whenever the feeling of "exhaustion" hits me I would end up the size of an house - so I resist the temptation.

    Keep well...

  • Clive,

    you mention that your sister and father had diabetes.

    There is a third sub-class of diabetes - MODY (Mature Onset Diabetes of the Young)- which is more akin to type 1 than type 2 and tends to be later onset - there are various sub-types of MODY and they all have different characteristics and respond to different regimes but they are specific genes and they are dominant genes - ie if you have the gene then you will develop the diabetes.

    Have to admit that 70s probably doesn't put you into the MODY category - though one type - sub-type 3 is very 'low grade' and often isn't picked up because the effect on blood sugars tends to be low.

    All types of MODY together account for about 2% of the diabetic population and there are more than a dozen sub-types which is why it isn't in most GPs consciousness.

    diabetes.org.uk/Guide-to-di...

    (MODY runs in my family - but I didn't have the gene)

    Is it possible that having increased your exercise means that you are using your B12 up faster and hence need more - athletes tend to be very aware of B12 because exercise is definitely something that ups the rate of use - hence looking for diets rich in B12.

    Not sure how that one would run past your doctor though :)

  • Hi Gambit62,

    Thanks for you comprehensive reply,

    I'm not sure about my family's history. My Dad definitely had Type 2 in his 60s and I think I remember him calling it age onset and he was careful with his diet. He didn't need to go on to insulin injections until after he had had surgery & radiation treatment for a brain tumour which killed him when he was 70 in 1986.

    My sister I think had Type 1 but as she lived in Scotland the last time I saw her was on her 60th birthday in 1999 so I know little about when she was diagnosed. She was murdered in her home in 2004 just before her 65th birthday by which time I learned that she had very poor eyesight and walked with a white stick.

    Interesting thought about exercise and B12. I have to admit that the exercise I do now is 100% more than ever I did before the diabetes diagnosis so I may well be depleting the B12 sooner. I'll see how things go and maybe slot in a few more 3 week injections (instead of the 4 weeks prescribed) - I had to fight my GP very hard to get that "concession" as he believes that "one size fits all" - but that's another story....!

  • Noticed that against another reply you also mentioned that you had had problems with sugar levels in the past which is another reason for making me think that it might be a MODY variant rather than type 2 - it's a frequent 'misdiagnosis' - my brother had it as well and got a lot of grief about not keeping to diet when he was because his blood sugar levels were completely uncontrollable on metformin - but responded very well to other medication. I If it is Mody it isn't the same variant as runs in my family - onset in 30's to mid 40s ... I was involved in a study trying to identify the specific gene which is why I know I don't have the gene.

    Hope that the three months works on the B12 ... though there are other options for supplementing (as you well know) if that doesn't work out.

  • Hi Gambit62

    Thanks for your comments and observations.

    My reference to the "Rigors" goes back to 1968 when I was on a Government sponsored course being assessed for disability registration and retraining - this being 8 years after the stomach surgery and just about the time I was "running out" of B12 reserves...

    I was sharing a room with Harry, an older man who had had the same surgery. One evening, complaining of feeling cold he went to bed and began shaking so violently that the bed rocked with him.

    I too had suffered the same symptoms, (the coldness, flashes in the eye, the shakes and exhaustion) although not quite so badly and my remedy was to eat or drink something sweet.

    Thinking this might help Harry I made him a very sweet mug of tea which worked wonders and brought him back to normality in minutes.

    He expressed his amazement as previously he'd just let the thing pass.

    Now, whether this was a form of diabetes as you are suggesting I don't know, because at that time I was having numerous blood tests for anaemia and then the two Schillings tests I would have thought that the diabetes would have been "picked up".

    How I feel now is similar to the run up to the Rigor without the cold or the shakes - just mainly the exhaustion, which is what prompted my original question - can you have a hypo when taking Metformin?

    I guess I'm just tired of being tired

  • blood tests often focus on one thing rather than doing a full spectrum - and one form of MODY gives results that would only just be elevated above normal so could easily be overlooked if the focus is anaemia as it wouldn't be relevant to anaemia.

    Anyway, only suggesting it because of the close family history - father and sister is potentially quite significant - though it could always just be 'co-incidence'

  • HI Gambit62,

    Can I pick your brains again re exercise and B12 depletion. Do you know of any links that would clarify this?

    Prior to the diabetes diagnosis this Spring I had "no need" of exercise knowing full well that whenever physical effort was involved I soon "ran out of steam" so it was avoided wherever possible.

    I would be grateful for any suggestions or ideas which I could use to present to my GP.

    Also, I read somewhere that PA sufferers on Hexo have had their time reduced by a third to two months intervals between injections. Is it a logical argument to reduce my cyanocobamalin interval by a quarter down to three weeks from four?

  • so not an expert so one thing - if you are a member of PAS - might be to ring them but quick google came up with the following

    bmj.com/rapid-response/2011...

    ncbi.nlm.nih.gov/pubmed/172...

    There is also this abstract which doesn't actually mention B12 though I think the underlying article does as it seems to be quoted by articles talking about B12 requirements of athletes

    ncbi.nlm.nih.gov/pubmed/192...

    full article seems to need a subscription unfortunately - not sure if there is a free access option.

    Also came across an article reporting on a study with athletes involved in shooting which showed that B12 supplementation tended to improve their accuracy ... but don't think it had

    There might be something useable in this link

    medscape.com/viewarticle/71...

    mention on p2 - including one bullet point about micronutrients ... as well as specific ref to B12 in another bullet point - also some discussion on p8 ... and a load of references to studies

    though reality is that studies are talking about the need to make sure you have enough B12 if you are involved in high performance athletics of some sort but doesn't actually look at the implications of taking exercise where a B12 absorption problem has already been identified.

  • Thanks once again Gambit62 for those useful references. They gave me a lot of reading...

    Agreed that most of the references apply from the other end of the spectrum but as a previously "sedentary subject" taking up exercise there is an implication of an added B12 need.

    Take care now and keep well

    clivealive

  • My thoughts the same vis-a-vis sedentary to active - really hope you don't have a battle trying to get your GP to see it that way as well.

  • Type 2 diabetics do not have full on hypos, we have "false hypos" which can occur in non-diabetics too when we miss a meal or don't eat enough. Some other meds can cause hypos in Type 2s - like sitagliptin or gliclacide so unless you have problems with metformin and are advised to go onto further meds because you are not keeping your levels in check - which it sounds like you are managing to do so I can't see you having to take anything (but I'm not a medic).

    I'm on Metformin 2 x 1000mcg a day, I've got the slow release one and have had no problems. I would advise you to look on the Diabetes UK website for more information and advice. Have you done any diabetic eductional courses? They will help, you can self refer to the Xperthealth.org.uk course, I did it two years ago and it was excellent.

    A lot of doctors are not experts in diabetes and as someone else said neither are some dieticians. You need though to make sure that you get the right information and support - especially all the annual tests etc that must be done.

    Going virtually low carb is not suitable for everyone, I am lower carb (approx 150g a day plus 45g if I need a snack or its a special occasion), medium protein and low/med fat (high fat doesn't work for me). You need the carbs for energy (and yes I know before anyone says it, that your body will get energy from you fat stores but if you haven't got a lot of fat it takes it from your muscles!) Anyway, I would definitely ask to see another GP and try and ask for some further tests to see if you have any other underlying problems and I'm sure your pernicios anaemia isn't helping.

    Hope that you can get something sorted.

  • Thanks ceejayblue for your comprehensive and reassuring response.

    I must admit to having some difficulty in determining how much the P.A. is impacting upon the diabetes and vice versa as some of the "tiredness" symptoms and side effects are the same.

    Throughout my adult life I have suffered what was known as rigors - a state whereby I go extremely shaky when tired or exhausted and the only remedy is to stuff sugar into me. These and the P.A. were caused by my having had two thirds of my stomach removed in 1959 at the age of 17 due to a perforated peptic ulcer.

    Fortunately as I grew older and with life less stressful I have not had these rigors to the same extent but, as I said in my original post "I sometimes feel as if I'm verging on the edge of a hypo" which feel similar but of course stuffing myself with sugar now is not the done thing....

    Thanks again for your useful advice.

  • You're welcome. :)

  • Hi clive my husband was diagnosed with Type 2 Diabetes two years ago and was on metformin plus statins plus high blood pressure after studying this I came across several doctors one named Dr Michael greger who runs a not for profit site Nutrition . org ,,, we went on a plant base diet and his blood suger levels are normal and his blood pressre has gone down. (within 4 weeks) type two can be reversed and quickly please look this up and do your own research ....... by the way I had anaemia but 10 years ago was diagnosed with coeliac and have been gluten free (I am not saying this is you) we take b12 drops which we put under our tong now we don't eat meat

    PLEASE look this up and let us know how you get on good luck

  • I was diagnosed with coeliac after year of feeling unwell, a specialist asked me about my family history

    my mother also suffer from pernicious anaemia she used to fall asleep half way through her meals she had osteoporosis and had a stomach ulcer operation she died at 69 but had the body of a 90 year old , the doctor thought she may also have had this condition coeliac it runs in family, after three month of not eating gluten my life was transformed and was sad that my mother never had the chance to get well. please look into this as well do you research sometimes you have to say enough you just want to feel well, if I eat gluten by mistake it feels like every bit of energy is drained from my body not a nice feeling

  • Hi suefone,

    Thanks for your comments.

    Although some of the symptoms of coeliac mirror those of P.A. I have never had any adverse affects from gluten and am pleased that you have improved health wise by eliminating it from your diet.

    I was saddened to read about your mother and sorry she didn't get the treatment she needed.

    Please keep well and I wish you good health for the future.

    clivelaive

  • Thank you , no what I was saying is coeliac causes P.A plus other illness as it stops you getting nutrients via the gut as it is damaged and does heal till you stop gluten( but maybe not you)

    it an autoimmune disease . Any how lots of peoples have reversed their type two by going on a plant based diet which we have been on for just over four weeks and my husband blood sugar was down to 5 we will go back to the doctors after the holidays and see if he is class as no longer a diabectic I will keep you informed, my husband says his feeling great at the moment .

    but please take a peek at dr greger vlog we found very interesting as he does all this for non profit at nutrition . org I found him on youtube take care sue

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