Pancreatitis Insufficiency?

[pinkiepunksmummy]

Hi, after being diagnosed as Type 2 4 & 1/2 years ago, not being able to get good control and trying several meds, Pancreatitis Insufficiency has now been mentioned.
My blood sugar is always high (6-9) in the morning before breakfast, then hypo between breakfast and lunch, (2-4) then high after lunch (9) and gradually getting higher towards bedtime (9-12).
Dietician says I am eating the right things, good diet, etc. but my cholesterol is like a heavy drinkers (hardly ever drink) I'm allergic to statins and have multiple food allergies so on a limited diet and cook virtually everything from scratch.
I have just been diagnosed with borderline Crohn's and waiting for results of a Sechat scan for Bile Acid Malabsorption, have a sigmoidoscopy next week to look for ulcerative colitis.
Is pancreatic insufficiency the same things as Diabetes Type 3 C?
Do my symptoms fit?
I am 39 and have no close relatives with Type 2 or any of the 'risk factors', have always eaten healthily, haven't changed my diet since diagnosis as there was nothing to change really, and I don't really understand how I could be type 2.
Also, with the Crohn's, etc., I have lost nearly three stone and my diabetes has not improved.... Surely if it was type 2 this would have had an impact on blood sugar levels??
Thankyou for reading

 

[catapillar]

trying several meds, Pancreatitis Insufficiency has now been mentioned.

What medication are you on for your diabetes? You profile says you're on glimepride - if you are taking that with breakfast that might be causing the pre lunch hypos? you should really discuss your hypos and whether that requires a dose adjustment with your medical team.

I've not heard the phrase pancreatic insufficiency before. Have you had a cpeptide test to see if your pancreas is functioning to produce insulin? From the blood sugar numbers you have mentioned, it sounds like it is.

Is pancreatic insufficiency the same things as Diabetes Type 3 C?

Type 3c is when you don't have pancreatic function due to damage cause by pancreatitis.

I am 39 and have no close relatives with Type 2 or any of the 'risk factors', ...with the Crohn's, etc., I have lost nearly three stone

So, are you now under weight? Because, if you had 3 stone to loose and that has left you normal or overweight, then that suggests you were overweight to start with? & being overweight is is a risk factor for type 2 diabetes.

 

[mist]

being overweight is is a risk factor for type 2 diabetes.

Although some people on here refuse to accept this truth.

 

[pinkiepunksmummy]

Okay, I meant being overweight is/was my only risk factor, though not massively so (dress size 16, now 10-12).

I'm taking Glimepiride, 2mg with main meal of the day, not with breakfast.

No C-peptide test as yet, got to have all gastro tests completed first -
Diagnosed with Colitis, probably Ulcerative, but have to wait for biopsy results for definite diagnosis.

HbA1c has dropped from 69 to 51 in six months with no dietary or medicine changes - however, I realised I haven't needed any steroids in the last six months, in the previous six months I needed to have four courses of prednisilone.

 

[Ledzeptt]

Hi @pinkiepunksmummy

I'm a T3c following acute pancreatitis. One of my (numerous) conditions is "exocrine pancreatic insufficiency" in addition to diabetes. The pancreas doesn't just produce insulin, it produces enzymes to digest food in the stomach.

Therefore, before eating, I have to swallow synthetic enzymes (the most popular brand in the UK seems to be "Creon"), else my food just passes straight through my body and I'd lose weight very quickly and end up malnourished.

I'm not sure if this is relevant to you... In addition, the pancreas triggers the generation of "intrinsic factor" in the stomach to absorb vitamin B12 from food (or supplements). Mine doesn't function, so I have pernicious anaemia and need to have B12 injections.

I'm happy to answer any questions that you have.

 

[catapillar]

however, I realised I haven't needed any steroids in the last six months, in the previous six months I needed to have four courses of prednisilone.

Being on steroids is also a risk factor for type 2. There is steroid induced type 2 diabetes

 

[Jaded Judi]

Hi. I have Type 2 diabetes which I have been controlling quite well. Had it for about 2 years now. Also had Diverticulitis and on checking for this, had CT scan and consultant found I had endocrine pancreatic Insufficiency. Have had trouble with bowels (sorry) for some time and had lost weight too. Was overweight a bit so pleased. Now taking creon since July and awaiting to see a specialist. Apparently I am a puzzle as I haven't had any pancreatic problems as far as I know. Not sure which came first, the diabetes or EPI! Had tummy problems for ages!! Any help or info or hearing about others with this would be great. Ta

 

[Ledzeptt]

@pinkiepunksmummy

My DSN has just referred me to a new leaflet on diabetes and pancreatic exocrine insufficiency: it may help you... http://www.trend-uk.org/documents/TREND PEI patient v9 (approved).pdf

 

[axle 222]

Hi @pinkiepunksmummy

I'm a T3c following acute pancreatitis. One of my (numerous) conditions is "exocrine pancreatic insufficiency" in addition to diabetes. The pancreas doesn't just produce insulin, it produces enzymes to digest food in the stomach.

Therefore, before eating, I have to swallow synthetic enzymes (the most popular brand in the UK seems to be "Creon"), else my food just passes straight through my body and I'd lose weight very quickly and end up malnourished.

I'm not sure if this is relevant to you... In addition, the pancreas triggers the generation of "intrinsic factor" in the stomach to absorb vitamin B12 from food (or supplements). Mine doesn't function, so I have pernicious anaemia and need to have B12 injections.

I'm happy to answer any questions that you have.

 

[axle 222]

Hello I know this is an older post but I've just been diagnosed chronic pancreatitis,(pancreatic insufficiency) I'm currently been started on creon 25000 caps. I take insulin for what I have been told is steroid induced diabetes, currently lantus and apidra.....I had been told type 2 but after reading this forum could it be type 3c? At moment I'm under dietician as have not eaten solid food for over 12 weeks on fortisip liquid only....so have been told to not use apidra as have malnutrition....your post states this is you....any advice would be greatly appreciated....

 

[Ledzeptt]

Hi @axle 222 Sorry to hear that: it can't be much fun for you.

Whether or not you're T3c depends if your pancreas is still producing insulin or not, only blood tests can show that. (Chronic pancreatitis doesn't necessarily damage the pancreas enough to "kill" the islet cells that produce insulin.)

If you're staying on Fortisips/liquid for much longer, it may be worth asking if you can be prescribed "Scandi shake" - it comes in powder form in several flavours and you mix it with full fat milk. It's 600 cals compared to 300 for a Fortisip, but in my opinion tastes much better (more like a conventional milk shake). I suppose it depends if they're trying to keep you off dairy too.

I'd avoid the Fortijuice bottles though (the apple juice type ones) as they're very sugary and will spike your blood glucose levels.

Meantime, I recommend keeping a glass or two in your freezer, then pouring your Fortisip into the cold glass: it tastes much better!

 

[axle 222]

Hi @axle 222 Sorry to hear that: it can't be much fun for you.

Whether or not you're T3c depends if your pancreas is still producing insulin or not, only blood tests can show that. (Chronic pancreatitis doesn't necessarily damage the pancreas enough to "kill" the islet cells that produce insulin.)

If you're staying on Fortisips/liquid for much longer, it may be worth asking if you can be prescribed "Scandi shake" - it comes in powder form in several flavours and you mix it with full fat milk. It's 600 cals compared to 300 for a Fortisip, but in my opinion tastes much better (more like a conventional milk shake). I suppose it depends if they're trying to keep you off dairy too.

I'd avoid the Fortijuice bottles though (the apple juice type ones) as they're very sugary and will spike your blood glucose levels.

Meantime, I recommend keeping a glass or two in your freezer, then pouring your Fortisip into the cold glass: it tastes much better!

Thank you so very much for the information. I'm due to have another scan on pancreas as previous one was abdominal and this time going to concentrate just on pancreas as they believe the ducts are blocked....(I have a lung condition that causes lots of mucus and they are not sure if it's that...I'm also seeing dietician in 2weeks to review crown and fortisip, I was on distributive before but took off because raised b. Glucose too high...but I will certainly ask about scandi shake......Thank you so much for info...did you correct ,ie take insulin whilst on fortisip? I've been told to just have morning dose lantus and ignore for now but readings are going high.....if you don't mind my asking...

 

[axle 222]

Thank you so very much for the information. I'm due to have another scan on pancreas as previous one was abdominal and this time going to concentrate just on pancreas as they believe the ducts are blocked....(I have a lung condition that causes lots of mucus and they are not sure if it's that...I'm also seeing dietician in 2weeks to review crown and fortisip, I was on distributive before but took off because raised b. Glucose too high...but I will certainly ask about scandi shake......Thank you so much for info...did you correct ,ie take insulin whilst on fortisip? I've been told to just have morning dose lantus and ignore for now but readings are going high.....if you don't mind my asking...

Sorry typos.......review creon....fortijuice not distributive.....

 

[Ledzeptt]

Hi @axle 222

It's good that they're pursuing the root cause and having your pancreas scanned in more detail.

I've been on supplements more than once (and feeding tube). Initially, for the first year, I did just inject once a day with Levemir (long acting) insulin.

Thereafter, I used Levemir and multiple doses of (Novorapid fast acting) insulin for improved control.

Using the once a day method was ok'ish, but I needed to eat/drink the same amount of carbs at every meal; I don't know if you've been advised this. If you're having say 3 (the number doesn't matter) Fortisips spread out through the day, and if your insulin is the correct dosage, then your average blood glucose will be ok. However, it will go up after drinking, but I imagine you'll have been told a Lantus amount that's not too high to give you a hypo.

With Fortisips (and Scandishakes) or any drink containing carbs, your body will absorb the carbs quicker than most solid food and so your blood glucose will rise faster. The insulin will help your body absorb it and it should drop back down again (eventually).

I can't tell you how much Lantus to take: ask your GP or diabetes nurse for advice if you think your blood glucose is running too high. Please don't risk increasing the amount without checking first.

Are you well enough to exercise? A 20 minute brisk walk will quickly reduce your blood glucose if you're able. I apologise if this is a dumb suggestion.

 

[axle 222]

Hi @axle 222

It's good that they're pursuing the root cause and having your pancreas scanned in more detail.

I've been on supplements more than once (and feeding tube). Initially, for the first year, I did just inject once a day with Levemir (long acting) insulin.

Thereafter, I used Levemir and multiple doses of (Novorapid fast acting) insulin for improved control.

Using the once a day method was ok'ish, but I needed to eat/drink the same amount of carbs at every meal; I don't know if you've been advised this. If you're having say 3 (the number doesn't matter) Fortisips spread out through the day, and if your insulin is the correct dosage, then your average blood glucose will be ok. However, it will go up after drinking, but I imagine you'll have been told a Lantus amount that's not too high to give you a hypo.

With Fortisips (and Scandishakes) or any drink containing carbs, your body will absorb the carbs quicker than most solid food and so your blood glucose will rise faster. The insulin will help your body absorb it and it should drop back down again (eventually).

I can't tell you how much Lantus to take: ask your GP or diabetes nurse for advice if you think your blood glucose is running too high. Please don't risk increasing the amount without checking first.

Are you well enough to exercise? A 20 minute brisk walk will quickly reduce your blood glucose if you're able. I apologise if this is a dumb suggestion.

Hello, thank you once again....have spoken to diabetic nurse,not very helpful....so as today b.g.was at 16.2 so I've added apidra,I only gave 3units and dropped to 4.4 so I need to sort adjustments.... as for a walk ,I have limited ability, I can get up and down garden with a rest in between......lol....but thanks for your information....

 

[suzi777]

Hi snap!! I have just started with Creon a miracle I thought now the eggy burps have returned I cannot get through to the consultant and cdnt get any sense from my gps I don't know if these symptoms returned because I've taken too much Creon or not enough any thoughts? Would so appreciate thanks

 

[Ledzeptt]

Hi @suzipissedoff

The side effects listed for Creon includes gas/bloating and searching Google indicates many people have your symptoms, but it usually goes away once your body adapts to the medication.

General advice is to ask your consultant or GP to ensure you are taking the correct dose, but you will need to persevere for a while (if your pancreas is damaged/removed, you will have no choice but to take Creon to absorb the nutrients in your food).

Ps It may not be the Creon: other medications can cause these symptoms e.g. Omeprazole and similar anti acids have these side effects too (if you're taking these).