Type 3, catch 22

[Civilised Devil]

Hello everyone, newbie posting looking help, October last year diagnosed Pancreatitis, Last week diagnosed Diabetes type 2, going by the definition, Type 3.
Here is my problem, with the Pancreatitis, I was told explicitly to watch my diet, specificly stay away from fats especially red meat, as little fat intake as possible it agrivates the pancreas even with Creon and causes a flare up of the Pancreatitis. Last week I was Diagnosed with Diabetes The advice was stay away from Carbs compensate with increased consumption of fats. When I was ill with pancreatitis I lost 5 stone in weight and am now skin and bone, I desperately need to put on weight. So what I need is a low fat, low carb, weight gain Diet, Please anybody any Ideas?

 

[EllieM]

Last week diagnosed Diabetes type 2, going by the definition, Type 3.

Just a thought from a T1, but is your T2 diagnosis confirmed by a c-peptide test to see how much insulin you are producing? I thought T3c was caused by lack of insulin production from your damaged pancreas?

T2s can't process carbs properly because of a metabolic disorder and typically over produce insulin. If your problem is insulin under production then I don't think the T2 classification is necessarily that helpful. In your position I would be looking for help from an endocrinologist asap, though I'm guessing you've already seen one for the pancreatitis? What did your DN say when you explained about the low fat diet required by the pancreatitis? You need a consultation (phone or email if necessary) with a health care provider now, as you can't afford to lose any more weight.

T1s can eat a low fat diet, but they need insulin to do it. As a T1, insulin is my best friend....

Obviously you can eat protein but I suspect that it is going to be very difficult to get enough calories from protein alone. (Hopefully you like fish and chicken?)

Good luck. You'll probably have to wait a while for a reply now as it's getting late in the UK....

 

[JoKalsbeek]

Hello everyone, newbie posting looking help, October last year diagnosed Pancreatitis, Last week diagnosed Diabetes type 2, going by the definition, Type 3.
Here is my problem, with the Pancreatitis, I was told explicitly to watch my diet, specificly stay away from fats especially red meat, as little fat intake as possible it agrivates the pancreas even with Creon and causes a flare up of the Pancreatitis. Last week I was Diagnosed with Diabetes The advice was stay away from Carbs compensate with increased consumption of fats. When I was ill with pancreatitis I lost 5 stone in weight and am now skin and bone, I desperately need to put on weight. So what I need is a low fat, low carb, weight gain Diet, Please anybody any Ideas?

You really need to know whether you're making insulin still. A T2 makes waaaay too much and is insensitive to it. A T3c, like you, doesn't make enough or any at all, and should most of the time, be on insulin jabs. T3 is more like T1 and requires entirely different treatment than T2 would, as they're opposites on the diabetic spectrum, so to speak.

There's just three macro nutrients, and you're cutting out two of them... I doubt you can survive on protein alone. Get a C-peptide test done to see whether and if so, how much insulin you're still making. And get yourself a doctor/specialist who knows what they're taking about. You've got no weight to spare and with the currently prescribed diet you're bound for malnutrition and complications.

Do NOT let this go. They're mucking about with your life here.
Jo

 

[Civilised Devil]

Just a thought from a T1, but is your T2 diagnosis confirmed by a c-peptide test to see how much insulin you are producing? I thought T3c was caused by lack of insulin production from your damaged pancreas?

T2s can't process carbs properly because of a metabolic disorder and typically over produce insulin. If your problem is insulin under production then I don't think the T2 classification is necessarily that helpful. In your position I would be looking for help from an endocrinologist asap, though I'm guessing you've already seen one for the pancreatitis? What did your DN say when you explained about the low fat diet required by the pancreatitis? You need a consultation (phone or email if necessary) with a health care provider now, as you can't afford to lose any more weight.

T1s can eat a low fat diet, but they need insulin to do it. As a T1, insulin is my best friend....

Obviously you can eat protein but I suspect that it is going to be very difficult to get enough calories from protein alone. (Hopefully you like fish and chicken?)

Good luck. You'll probably have to wait a while for a reply now as it's getting late in the UK....

Hi, the T2 diagnosis was done in the hospital last week, don't trust it that's why I think I'm T3,lack of insulin. The diabetes nurse didn't know what to say she is after all a diabetes nurse not a pancreatitis nurse what the Diabetes needs is in conflict with what the pancreas needs. I have been taking My Blood sugar count and recording it contacted, the Diabetes center this morning,still waiting, with covid 19 no access to any Docters unless your admitted to A&E

 

[Civilised Devil]

You really need to know whether you're making insulin still. A T2 makes waaaay too much and is insensitive to it. A T3c, like you, doesn't make enough or any at all, and should most of the time, be on insulin jabs. T3 is more like T1 and requires entirely different treatment than T2 would, as they're opposites on the diabetic spectrum, so to speak.

There's just three macro nutrients, and you're cutting out two of them... I doubt you can survive on protein alone. Get a C-peptide test done to see whether and if so, how much insulin you're still making. And get yourself a doctor/specialist who knows what they're taking about. You've got no weight to spare and with the currently prescribed diet you're bound for malnutrition and complications.

Do NOT let this go. They're mucking about with your life here.
Jo

Hi, what I was told in the hospital was that I was producing little insulin they gave me a Lantus solo star pen,one injection a day with a setting of 12. I'm guessing The C-peptide test was done in the hospital but don't know for sure. As for getting a Docter, can't even get my GP, three weeks for an appointment. My reading between morning and night are roughly 10-11 points difference,a 11 in the morning and 20 at night I am eating some carbs and some fats how can I not, protein and vegetables mostly, there must be a happy medium, just have to find it.

 

[EllieM]

Hi, what I was told in the hospital was that I was producing little insulin

So that's effectively a T1 diagnosis, not a T2. They are giving you background insulin that covers you when you eat nothing at all.

This is exactly the opposite of a T2 diagnosis. Your problem is not inability to process carbs, it's lack of insulin to process those carbs.

My guess is that you need short acting insulin to cover your carbs so that you don't starve to death. Though your pancreas may be compromised, even though it's not producing enough insulin it produces other hormones that are extremely useful (eg part of the feedback loop that makes your liver pump out sugar if your blood sugar goes too low) and you really want it to survive.

If they've given you insulin they have to have given you a contact so that you can adjust that insulin dose. Your GP will be clueless. Phone the diabetic clinic to get someone who knows what T3c is. An online appointment would be enough. Stress the weight loss. You need help now.

 

[JoKalsbeek]

Hi, what I was told in the hospital was that I was producing little insulin they gave me a Lantus solo star pen,one injection a day with a setting of 12. I'm guessing The C-peptide test was done in the hospital but don't know for sure. As for getting a Docter, can't even get my GP, three weeks for an appointment. My reading between morning and night are roughly 10-11 points difference,a 11 in the morning and 20 at night I am eating some carbs and some fats how can I not, protein and vegetables mostly, there must be a happy medium, just have to find it.

Not enough insulin is not a T2 issue, not unless they've been one for possibly decades and have medication that'll wring out the pancreas to the point of exhaustion. Get yourself a decent team, because you need insulin, and probably will have to learn how to bolus for your meals. Because the diet that was prescribed will starve you. Better to have a basal like you have now, and a fast acting insulin to cover what you eat. Because the numbers you're seeing now are unhealthy, and you can't live off the air.

Again, don't let this go. They're getting it wrong and this isn't a little wart or an itch. This is a rather big medical issue and you need proper care. I don't want to scare you but your life is on the line here.

 

[Civilised Devil]

Not enough insulin is not a T2 issue, not unless they've been one for possibly decades and have medication that'll wring out the pancreas to the point of exhaustion. Get yourself a decent team, because you need insulin, and probably will have to learn how to bolus for your meals. Because the diet that was prescribed will starve you. Better to have a basal like you have now, and a fast acting insulin to cover what you eat. Because the numbers you're seeing now are unhealthy, and you can't live off the air.

Again, don't let this go. They're getting it wrong and this isn't a little wart or an itch. This is a rather big medical issue and you need proper care. I don't want to scare you but your life is on the line here.

Hi just to let you know finally got through to the diabetes nurse after 6 hours, she said it's more likely to be type 1 the NHS don't use the term T3 but because it's been caused by pancreatitis they expect that when the pancreas calms down the production of insulin will increase back to normal, that there is no need for a C peptide test because it will not influence the treatment, the readings from the blood sugar count are not that bad, and as for food switch to slow release carbs eg granary bread, porridge made from water(tried this raised my count by 7points) new potatoes, you get the picture, This is what I've been doing and my counts are still high, give it time the nurse said. Don't like this at all will see can I get a cancellation appointment with My GP and get the ball moving.

 

[Dark Horse]

Here is diet advice for people with type 3c diabetes who need to gain weight:- https://www.pancreaticcancer.org.uk/media/1886886/type-3c-and-reduced-appetite.pdf

 

[JoKalsbeek]

Hi just to let you know finally got through to the diabetes nurse after 6 hours, she said it's more likely to be type 1 the NHS don't use the term T3 but because it's been caused by pancreatitis they expect that when the pancreas calms down the production of insulin will increase back to normal, that there is no need for a C peptide test because it will not influence the treatment, the readings from the blood sugar count are not that bad, and as for food switch to slow release carbs eg granary bread, porridge made from water(tried this raised my count by 7points) new potatoes, you get the picture, This is what I've been doing and my counts are still high, give it time the nurse said. Don't like this at all will see can I get a cancellation appointment with My GP and get the ball moving.

Yeah, so... That's still really carby and will keep your numbers high. https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html might help a little make better choices while you're remaining in limbo. But keep testing, if you go moderately low carb you should be okay, with really low carb you'd hypo on the insulin.

 

[EllieM]

Yeah, so... That's still really carby and will keep your numbers high.

...Unless you can take the insulin to balance those carbs. This would be my strong recommendation, as the carbs plus insulin combination should help you gain weight.

Do you have any way of measuring ketones? (You can buy urine testing strips from most chemists but a blood testing meter is better.) Keep monitoring them and if they go high, together with high blood sugars, you need to ring 111, as diabetic ketoacidosis is a real risk for a T1/ insulin underproducer.

But it is true that new T1s get to lower their levels gradually, over days/weeks, as sudden drops can damage certain organs and they also don't want to over medicate you and risk a bad hypo (low blood sugar). Time will tell how much insulin you actually need. As your pancreas is still producing some insulin I believe the hope is that the extra lantus will give it the support it needs to cope with the carbs in your diet. Going low gi will hopefully spread the load so that your pancreas does not have to pump out too much insulin at once.

Short term highs are not that significant (as long as you don't go into DKA), it's the long term control that matters. And, in the short term, you need to gain weight. Many of the folk on here will advocate low carb because it is the best treatment for T2 insulin overproducers and allows T1s to minimise their insulin intake, which allows some to achieve better control. But plenty of T1s just inject for their carbs and while I'm not advcating a diet of pavlova and candyfloss, the nurse's suggestion of low gi isn't stupid.

@Dark Horse 's link is very informative (just repeating it here)

https://www.pancreaticcancer.org.uk/media/1886886/type-3c-and-reduced-appetite.pdf

Have they put you on any enzymes to help out your pancreas?

 

[JoKalsbeek]

...Unless you can take the insulin to balance those carbs. This would be my strong recommendation, as the carbs plus insulin combination should help you gain weight.

Do you have any way of measuring ketones? (You can buy urine testing strips from most chemists but a blood testing meter is better.) Keep monitoring them and if they go high, together with high blood sugars, you need to ring 111, as diabetic ketoacidosis is a real risk for a T1/ insulin underproducer.

But it is true that new T1s get to lower their levels gradually, over days/weeks, as sudden drops can damage certain organs and they also don't want to over medicate you and risk a bad hypo (low blood sugar). Time will tell how much insulin you actually need. As your pancreas is still producing some insulin I believe the hope is that the extra lantus will give it the support it needs to cope with the carbs in your diet. Going low gi will hopefully spread the load so that your pancreas does not have to pump out too much insulin at once.

Short term highs are not that significant (as long as you don't go into DKA), it's the long term control that matters. And, in the short term, you need to gain weight. Many of the folk on here will advocate low carb because it is the best treatment for T2 insulin overproducers and allows T1s to minimise their insulin intake, which allows some to achieve better control. But plenty of T1s just inject for their carbs and while I'm not advcating a diet of pavlova and candyfloss, the nurse's suggestion of low gi isn't stupid.

@Dark Horse 's link is very informative (just repeating it here)

https://www.pancreaticcancer.org.uk/media/1886886/type-3c-and-reduced-appetite.pdf

Have they put you on any enzymes to help out your pancreas?

(I mentioned reducing carbs while in limbo because there's only a basal available now, nothing to bolus with. As kind of a temporary patch. I do hope the situation will be rectified soon!)

 

[Civilised Devil]

Here is diet advice for people with type 3c diabetes who need to gain weight:- https://www.pancreaticcancer.org.uk/media/1886886/type-3c-and-reduced-appetite.pdf

Thank you, Thank you, Thank you. This is exactly the information that I was looking for, people don't get Type 3 at all. it's not Type 1 or Type 2 plus pancreatitis or diabetes with an after thought of pancreatitis. So Thank you

 

[Struma]

Here is diet advice for people with type 3c diabetes who need to gain weight:- https://www.pancreaticcancer.org.uk/media/1886886/type-3c-and-reduced-appetite.pdf

Really nice up to date link.