Saturday, 11 June 2011

Knowing the unknowns

It’s fair to say that my last blog might have seemed a bit panicky. I had a letter telling me my GAD antibodies definitely made me type 1, not type 2. So I showed the letter to my GP surgery and got myself an appointment as soon as I could with the diabetic nurse. I also went down the hospital to get my HBA1c test done. The GP nurse confirmed the diagnosis and wrote a letter to the diabetes clinic at the hospital where I was to be treated. Apparently type 1 patients are treated through the hospital and not at the doctor’s.

In the spirit of ‘doing it myself’ I phoned up the diabetes clinic at the hospital and asked for an immediate appointment. Stuff it if I was going to wait for the letter of referral to get lost in the post. The clinic were very helpful and when I called them on the Thursday I got an appointment for the following Monday. In the mean time I was to monitor my blood sugars four times a day – before each meal and before bed and write down everything I had to eat.

I felt terrible. All the old symptoms were coming back – tiredness, apathy, constantly going to the toilet (number one not number two – how appropriate), and the dehydration. I was controlling my diet but the numbers were high, from 12 in the morning up to as high as 21 in the evening at one point. The only good news was that as I now had type 1 I could explain it. I was going to need insulin and once I got it things would change. Well change they did, or not, depending on your point of view.

I turned up for my appointment fifteen minutes early. The bloke next to me had turned up for his 15 minutes late. He got seen and I got bumped by half an hour. I wasn’t in the best of moods anyway. Whilst waiting for my bus to the hospital a driver of the W7 heading to Crouch End wouldn’t wait an extra two seconds to let a woman board who was buying her ticket. That’s broken Britain! He couldn’t wait two seconds before he pulled up five yards down the road to stop for the traffic lights. I demonstrated my displeasure by banging on the door and making certain obscene gestures. It’s fair to say I was on edge.

Ellie, the diabetic nurse, was great. She sees people with type 1 diagnoses regularly and obviously spotted something wasn’t right about my type 1 diagnosis. Ketones! The key is in the presence, or otherwise, of Ketones. The way Ellie explained it to me was that when your body can’t access the sugar from food it takes the energy it needs to prevent starvation from the fat in your body. Unfortunately a by-product of getting thinner is that the process of breaking down the fats leaves ketones which are acidic. This increases the acidity of your biological system and makes you pretty sick.

My urine was tested and not a single ketone was found. According to Ellie I definitely had type 2 and not type 1. Definitely! The only suggestion that I was type 1 were the increasingly high sugar levels and the presence of GAD antibodies.

Sugar levels increasing are relatively common in Caucasian people with type 2 and they commonly need to go on to Gliclazide or some such drug to help produce more insulin. She also upped my dose of Metphormin from two 500mg tablets, to three. I’m currently on day two of taking the full regime and things are stabilising but still high.

As for the GAD antibodies, well, people with type 2 aren’t tested for GAD antibodies so it might well be that such low levels like mine (16 rather than being in the 100s as is usual) are pretty common. It was interesting to me that such a thing is not commonly known, neither by the Oxford team or by either of the two diabetic nurses I saw. GAD antibodies, by the way, are the bombed out buildings left after the war between the antibodies and your pancreas.

So there you have it, type 1 for a week!

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