What type of diabetic am I now?

[juliekem]

Having been a type 2 diabetic for 11 years, I suffered a bout of pancreatitis and some sort of kidney problem in late November which resulted in me being put in the ICU in an induced coma for 10m days and then another 12 days in hospital. I have from the start had very high triglyceride readings (60 at the highest.)
Whilst I was in the coma they put me on insulin and my trigs went to normal.
Now I have been put onto 2 different types of insulin (a "background dose) and insulin before meals (which I am finding impossible to manage.) My bg readings are very high all the time (in the teens and twenties.) Before all this happened my bg was 6.something in the mornings.
Am i
I a type 1 diabetic now? How am I ever going to get my bg readings down? Beleive me I have asked the diabetic team about this.
They have now given me a Libre2 device but it is having to tailor my insulin to my proposed meals which does not seem to be working. What do others do?

 

[LittleGreyCat]

@juliekem I assume that you are now T1 due to the pancreatitis doing bad stuff to your pancreas.

You might be classed as T3c but reading about this, there is no clear agreement.
https://www.diabetes.co.uk/type3-diabetes.html
Whatever the label, it seems that you are now dependent on insulin so should probably discuss and act as though you are T1.

 

[Andydragon]

@juliekem I assume that you are now T1 due to the pancreatitis doing bad stuff to your pancreas.

You might be classed as T3c but reading about this, there is no clear agreement.
https://www.diabetes.co.uk/type3-diabetes.html
Whatever the label, it seems that you are now dependent on insulin so should probably discuss and act as though you are T1.

I don’t believe a type 2 can become a type 1. You can be a misdiagnosed type 1 of course

There are many type 2 who are dependent on insulin. There are also other types as you mention

but discussing and acting like a type 1 when you aren’t officially a type 1, I don’t see that’s a sensible approach to be honest

we also cannot diagnose. Need to get answers officially from doctor

 

[LittleGreyCat]

I don’t believe a type 2 can become a type 1. You can be a misdiagnosed type 1 of course

There are many type 2 who are dependent on insulin. There are also other types as you mention

but discussing and acting like a type 1 when you aren’t officially a type 1, I don’t see that’s a sensible approach to be honest

we also cannot diagnose. Need to get answers officially from doctor

Type 3c (if you accept the definition) is diabetes caused by a disease such as pancreatitis damaging the pancreas.
Logically therefore this could happen to a non-diabetic or to a diabetic.
In which case the prior state of diabetes is irrelevant.
This is absolutely not (as described) a progression from T2 to T1.

So if the pancreas has failed due to pancreatitis you are effectively in the same position as a T1 - your pancreas is not producing insulin.
I note that @juliekem doesn't provide details of diabetes control and medication prior to the pancreatitis but if the pancreas has been damaged then effectively being T1 (that is, not producing any significant insulin) seems to be the most likely outcome.

 

[HSSS]

I don’t believe a type 2 can become a type 1. You can be a misdiagnosed type 1 of course

There are many type 2 who are dependent on insulin. There are also other types as you mention

but discussing and acting like a type 1 when you aren’t officially a type 1, I don’t see that’s a sensible approach to be honest

we also cannot diagnose. Need to get answers officially from doctor

How does a type 1 become type 1? No one seems to be certain but it’s lack of insulin and autoimmune and there’s a lot of reports of it being post viral. Type 3c is often put in together with this type when the pancreas is damaged by surgery or illness. So what is there about any of this that cannot happen to a type 2?

What I would agree with is type 2 doesn’t morph into type 1 in and of itself purely by progressing to insulin either because insulin resistance is so high nothing else gets levels down (well apparently doesn’t as low carb is often not even attempted) or because eventually after years of pumping out hugely excessive levels the pancreas has “worn out”. Many seem to think it does, mixing up “insulin dependent” with “type 1.”

 

[EllieM]

So if the pancreas has failed due to pancreatitis you are effectively in the same position as a T1 - your pancreas is not producing insulin.

My guess is that @juliekem now has double diabetes, ie T1 (or T3c) combined with the insulin resistance of a T2. So the chances are that she may need pretty large doses of insulin to maintain normal blood sugars. In her position I'd want a cpeptide test to find out how much insulin production is left (and whether there is a chance that low carb can result in dropping the insulin) but am guessing that she's probably stuck with it. It will probably take a while to get the insulin doses right as the insulin doses will just have to keep going up till the bgs normalise, but this is where you really need input from the experts, your diabetic team.

If your previous fasting bgs were in the 6s, then I'm assuming that low carbing has worked up to now to keep your levels mostly under control. Insulin will work too, but it will take a time to work out the correct doses and ratios. In the long term you'll possibly find that the insulin gives you a bit more dietary freedom, as you can inject to bring your levels down.

Personally, I have a T2 father and my insulin ratios suggest that I have quite a bit of insulin resistance. So I eat lowish carb (less than 100g per day) and use that to keep my insulin quantities (and weight) from ballooning out of control. One note of caution is that you'll need to check for ketones if you have high bgs (in the teens or above) as with too little insulin in play then DKA becomes a possibility and I'm sure you don't want any more time in ICU in a coma.

Good luck, and I'm sorry this has happened to you. It's a tough diagnosis, but once you get your ratios sorted it's not the end of the world. And you've now got a great case for NHS goodies such as a libre.... Lots of virtual hugs.

 

[juliekem]

Thanks everyone. I am not getting clear answers from the diabetic team. My main problem is that they have asked me to determine how many grams of carb I intend to eat and then inject 15 minutes before my meal. Trouble is I don't know how much I am going to eat of a articular meal or whether I might fancy a dessert after (like some fruit.) Apart from that my bloods are not going down but stay in the teens or even 20s at night. They drop at least 10 overnight. Do others inject according to their meter readings rather than planned meals? I will obviously be raising this at my planned telephone conversation with a diabetic nurse due 18th Feb but am curious to find out how others cope as I used to be on Metformin and Jardiance before as well as keeping my carbs really low, but have been told not to go keto any more.

 

[juliekem]

My guess is that @juliekem now has double diabetes, ie T1 (or T3c) combined with the insulin resistance of a T2. So the chances are that she may need pretty large doses of insulin to maintain normal blood sugars. In her position I'd want a cpeptide test to find out how much insulin production is left (and whether there is a chance that low carb can result in dropping the insulin) but am guessing that she's probably stuck with it. It will probably take a while to get the insulin doses right as the insulin doses will just have to keep going up till the bgs normalise, but this is where you really need input from the experts, your diabetic team.

If your previous fasting bgs were in the 6s, then I'm assuming that low carbing has worked up to now to keep your levels mostly under control. Insulin will work too, but it will take a time to work out the correct doses and ratios. In the long term you'll possibly find that the insulin gives you a bit more dietary freedom, as you can inject to bring your levels down.

Personally, I have a T2 father and my insulin ratios suggest that I have quite a bit of insulin resistance. So I eat lowish carb (less than 100g per day) and use that to keep my insulin quantities (and weight) from ballooning out of control. One note of caution is that you'll need to check for ketones if you have high bgs (in the teens or above) as with too little insulin in play then DKA becomes a possibility and I'm sure you don't want any more time in ICU in a coma.

Good luck, and I'm sorry this has happened to you. It's a tough diagnosis, but once you get your ratios sorted it's not the end of the world. And you've now got a great case for NHS goodies such as a libre.... Lots of virtual hugs.

Thanks for this. They have actually given me a Libre 2 which has alarms for low and high bg so I am very lucky!

 

[juliekem]

My guess is that @juliekem now has double diabetes, ie T1 (or T3c) combined with the insulin resistance of a T2. So the chances are that she may need pretty large doses of insulin to maintain normal blood sugars. In her position I'd want a cpeptide test to find out how much insulin production is left (and whether there is a chance that low carb can result in dropping the insulin) but am guessing that she's probably stuck with it. It will probably take a while to get the insulin doses right as the insulin doses will just have to keep going up till the bgs normalise, but this is where you really need input from the experts, your diabetic team.

If your previous fasting bgs were in the 6s, then I'm assuming that low carbing has worked up to now to keep your levels mostly under control. Insulin will work too, but it will take a time to work out the correct doses and ratios. In the long term you'll possibly find that the insulin gives you a bit more dietary freedom, as you can inject to bring your levels down.

Personally, I have a T2 father and my insulin ratios suggest that I have quite a bit of insulin resistance. So I eat lowish carb (less than 100g per day) and use that to keep my insulin quantities (and weight) from ballooning out of control. One note of caution is that you'll need to check for ketones if you have high bgs (in the teens or above) as with too little insulin in play then DKA becomes a possibility and I'm sure you don't want any more time in ICU in a coma.

Good luck, and I'm sorry this has happened to you. It's a tough diagnosis, but once you get your ratios sorted it's not the end of the world. And you've now got a great case for NHS goodies such as a libre.... Lots of virtual hugs.

I had DKA when I was admitted to the ICU - apparently I nearly died so my family were warned. I thought DKA was just with metformin oh dear! I will be bringing all these thought up at my telephone appointment x

 

[EllieM]

I had DKA when I was admitted to the ICU - apparently I nearly died so my family were warned. I thought DKA was just with metformin oh dear! I will be bringing all these thought up at my telephone appointment x

DKA is unfortunately still a common illness that diagnoses T1, and still kills some T1s who are diagnosed too late. But I've been T1 for 50 years and never had it, because I was diagnosed early and since then have always had injected insulin in my system. Hypos however, are an ongoing issue, which you will discover for yourself once your levels go back to normal range. (But having a cgm with alarms should make them far less of an issue, just make sure you've always got sugar with you in case you start to go low.)

 

[Hopeful34]

Thanks everyone. I am not getting clear answers from the diabetic team. My main problem is that they have asked me to determine how many grams of carb I intend to eat and then inject 15 minutes before my meal. Trouble is I don't know how much I am going to eat of a articular meal or whether I might fancy a dessert after (like some fruit.) Apart from that my bloods are not going down but stay in the teens or even 20s at night. They drop at least 10 overnight. Do others inject according to their meter readings rather than planned meals? I will obviously be raising this at my planned telephone conversation with a diabetic nurse due 18th Feb but am curious to find out how others cope as I used to be on Metformin and Jardiance before as well as keeping my carbs really low, but have been told not to go keto any more.

You need to check that your basal rate is right first of all, link below
https://www.accu-chek.com/sites/g/files/iut341/f/accu-chek-aviva-expert-how-to-test-a-basal-rate.pdf
the easiest one to do first is overnight. If your basal rate is wrong, carb counting for meals won't work.

I decide what I am going to eat at a meal, count the carbs in it (I weigh everything), then do a blood test and give the indicated insulin and any correction needed 15/20minutes before eating. If my blood sugar is high, I don't eat until it is at a more reasonable level. If after the main course, I decide I want a dessert, I repeat the process. If, on a rare occasion, I eat less carbs than I've given insulin for, I simply have a piece of chocolate or something else to make up the carbs I've given insulin for.
Are you checking your blood sugar on a finger prick test, as whilst the Libre works well for some people, it doesn't for everyone, and until you are sure a particular sensor is accurate, it's not advisable to inject according to the reading on it/some people never do. It's only licensed as being accurate when your blood sugar is above 4 and under 10.

 

[juliekem]

You need to check that your basal rate is right first of all, link below
https://www.accu-chek.com/sites/g/files/iut341/f/accu-chek-aviva-expert-how-to-test-a-basal-rate.pdf
the easiest one to do first is overnight. If your basal rate is wrong, carb counting for meals won't work.

I decide what I am going to eat at a meal, count the carbs in it (I weigh everything), then do a blood test and give the indicated insulin and any correction needed 15/20minutes before eating. If my blood sugar is high, I don't eat until it is at a more reasonable level. If after the main course, I decide I want a dessert, I repeat the process. If, on a rare occasion, I eat less carbs than I've given insulin for, I simply have a piece of chocolate or something else to make up the carbs I've given insulin for.
Are you checking your blood sugar on a finger prick test, as whilst the Libre works well for some people, it doesn't for everyone, and until you are sure a particular sensor is accurate, it's not advisable to inject according to the reading on it/some people never do. It's only licensed as being accurate when your blood sugar is above 4 and under 10.

This is kind of you but I am afraid I do not understand the terminology. Carb counting is not working for me but the form you linked to is incomprehensible to me.

 

[HSSS]

You need to go back to your team and tell them you need further information and education so you can be confident with your carb counting (and understanding how to check your basal) . I’m sure I’ve seen mention of an online course in here somewhere.

 

[Bash_]

Having been a type 2 diabetic for 11 years, I suffered a bout of pancreatitis and some sort of kidney problem in late November which resulted in me being put in the ICU in an induced coma for 10m days and then another 12 days in hospital. I have from the start had very high triglyceride readings (60 at the highest.)
Whilst I was in the coma they put me on insulin and my trigs went to normal.
Now I have been put onto 2 different types of insulin (a "background dose) and insulin before meals (which I am finding impossible to manage.) My bg readings are very high all the time (in the teens and twenties.) Before all this happened my bg was 6.something in the mornings.
Am i
I a type 1 diabetic now? How am I ever going to get my bg readings down? Beleive me I have asked the diabetic team about this.
They have now given me a Libre2 device but it is having to tailor my insulin to my proposed meals which does not seem to be working. What do others do?

Hi Juliekem

I agree, believe me it's not always easy, but then again I've had a few more years than you to come to terms with it and also Coeliac for three years. I've added a few points which, hopefully will make sense on the diabetic side.

I liken being a diabetic to being on a military exercise and sadly you have to plan and think what could go right and wrong. Food is right up there and I've travelled all over sometimes on charity events (Round Table and later years Rotary International) and needing to know where your next meal will be and when is important. Now before I bore you to death hope the following will be of assistance.

Firstly your here and secondly your type 1 diabetic that's all great news if you think of the many that aren't. I've been type 1 like you since 12 years of age and it's not stopped me from doing anything or going anywhere.

3. Libre2 means your also on the best monitoring system, its absolutely brilliant.
Suggest setting alarms for both High and low blood to alarm you night or day. Waking at 3am is better than falling into hypo (low blood or hyper (high blood).

4. If high bloods are experienced, drink plenty of water (will help flush sugars from kidney and assistance to reducing high sugars). But not a long term solution

5. You mentioned...
They have now given you a Libre2 device but it is having to tailor my insulin to my proposed meals which does not seem to be working. What do others do? RATIOS SEE BELOW.

In practice your body clock often responds differently at certain times of the day called ratio's

6. Have you been explained about ratio's
If not you need to ask to speak to a Dafne nurse (at the diabetes centre) their usually brilliant at explaining libre and ratio's... only they will usually ask you to manually collect 3 days data before changing insulin etc.

7. I personally (for example) have 3 ratio's during the day.
Breakfast 2:1. Example only as carbs change with foods
60 carbs is 12 units of insulin for me

Lunch 1:5; to 1. 60 carbs is 9 units

Evening meal 1 to 1
Eg 60 carbs equal 6 units or 100 carbs is 10 units hopefully you understand concept.

I'm 59
7,000 to 20,000 steps a day and usually on the go most of the day, but take it from me the more you monitor and take note of what your eating the easier it gets. My balance has been made easier since March as we can't eat out.. I suppose you could say every cloud has a silver lining.

Stay safe and get to know your diabetes nurses or consultant well, they love tests and notes libre2 will help them tremendously

Hopefully some of the above will be of benefit

M

 

[Bash_]

This is kind of you but I am afraid I do not understand the terminology. Carb counting is not working for me but the form you linked to is incomprehensible to me.

Hi Juliekem

Few points

Scan libre if screen reads 9 and doesn't tell you if it's falling or rising WASH your hands to remove and sugars from fingers etc and do a blood test (for example) if 6 then your sugar has fallen as the libre trails behind albeit not by far.

The (free) libre app on the phone may help with this and their free technical support team should be able to help you with setup.

Julie need to clarify something
If you have high bloods before a meal you can consider the following

give insulin for the carbs your planning eating but add additional insulin at the same time to compensate for the high you have at present.....
You need to eat well and find a way to make it work.. not rule your life.

M

 

[Hopeful34]

This is kind of you but I am afraid I do not understand the terminology. Carb counting is not working for me but the form you linked to is incomprehensible to me.

Sorry, I know the first page was for people on an insulin pump, but the 2nd page would apply if you are on injections.
If you google 'check basal rate for insulin', you will be able to find it explained better I think. It's a way of checking that your long acting insulin is keeping your blood sugar fairly steady, then when you eat, you use your short acting insulin to cover the carbs you are going to eat.

 

[LittleGreyCat]

My guess is that @juliekem now has double diabetes, ie T1 (or T3c) combined with the insulin resistance of a T2. So the chances are that she may need pretty large doses of insulin to maintain normal blood sugars. In her position I'd want a cpeptide test to find out how much insulin production is left (and whether there is a chance that low carb can result in dropping the insulin) but am guessing that she's probably stuck with it. It will probably take a while to get the insulin doses right as the insulin doses will just have to keep going up till the bgs normalise, but this is where you really need input from the experts, your diabetic team.

Very well put.

Mr. Picky might note that T1s can also have insulin resistance but I think that you summed up the main issues very well.

 

[EllieM]

Mr. Picky might note that T1s can also have insulin resistance but I think that you summed up the main issues very well.

Believe me, you're preaching to the converted there. My team look at me blankly when I tell them I think I have T2 tendencies (my dad is T2 and I'm borderline obese) but I keep my insulin down and my weight from increasing by low carbing. With an insulin ratio of 1 unit to 3 g I am definitely insulin resistant.