Any advice on diabetes meds for rare case?

[Blackwater5]

The last time I posted here it was mostly a rant as I'd just been told that I had pancreatic cancer, diagnosed so late that the most that could be offered was chemo plus taking care of symptoms.

By that time I'd lost almost a third of my body weight and last year was told I had Type 2 diabetes, prescribed Linagliptin when diet and exercise didn't work. That gave me an autoimmune disease called pemphigoid which gave me huge blisters, so that was stopped, I was given steroids for 2 weeks (but nobody said I had to stop them gradually) and then they came back. Yesterday I took the last steroid tablet and have no blisters. I was prescribed Jardiance which works by making glucose be excreted by the kidneys and causes weight loss when taken alone. During that time my BS dropped to normal although my morning fasting level was alw3ays the lowest.
On 26th May after finally being referred for a scan I learned that I had pancreatic cancer and was given pancreatic enzymes immediately as well as being told to eat lots of carbs. The duty GP was shocked when he learned I was on Jardiance, saying 'but that makes you lose weight'; and told me to see my diabetic nurse urgently. I had a phone appointment on Tuesday and I've now been given Gliclazide 30 mg which I am due to start in the morning. The nurse wants to avoid insulin for as long as possible and warned me of the risk of hypos.
So I'm wondering about the meds I've been on recently or am still on and how much they could affect hypos. I have the lowest dose (1.25 mg) bisoprolol for a fast heartbeat, only stopped steroids yesterday, stopped the Jardiance 2 days ago and am taking pancreatic enzymes so I can digest my food. I'm malnourished because myt pancreas produces varying amounts of insulin and not enough of other enzymes to allow proper digestion.

So, with 3c you can get spikes and troughs in BG, HB1ac doesn't5 act as a guide, and prick tests are the only wat of tracking BG. As an example, over the last few days I've gone from 5.3 mmol/L fasting to 6.7, then 5.8 this morning. 2nd pre-meal test was between 6.8 and 10.0, next was between 9.2 and 12.2, last was 10.3 to 14.4. Today, the first without steroids and 3rd without Jardiance was fasting 5.8, pre-meal 10.00 and early evening pre-meal 10.9. All of these results were after stopping Jardiance, no steroids today, on a high carb diet with enzymes to ensure I could digest my food.. Yje enzymes do not do anything to insulin absorption or production but some days my pancreas produce more than on other days.

So I'm wondering if anyone4 has advice apart from frequent BG monitoring and keeping high glucose sweets handy. I hope I'm aware of hypos as I'm a low dose beta blocker, a low dose ACE inhibitor and have just stopped my last steroid tablet.

 

[Daibell]

Hi. I suspect you need to be under the care of your local Diabetes Clinic rather than just the GP? I'm surprised about the high carb advice but there could be good reason when 3C. I'm also surprised about not having insulin as it will only cause a hypo if your dose is too high. Again there may be a very good reason. I would ask to be referred to the Diabetes Clinic. I did the same when I was unhappy with my T2 versus T1 diagnosis. My lovely DN was happy to do it and I am now managed by both in different ways.

 

[EllieM]

So, with 3c you can get spikes and troughs in BG, HB1ac doesn't5 act as a guide, and prick tests are the only wat of tracking BG.

Am confused, is there a reason you can't have a libre or dexcom? You've been told they definitely don't work with T3c?

Today, the first without steroids and 3rd without Jardiance was fasting 5.8, pre-meal 10.00 and early evening pre-meal 10.9. All of these results were after stopping Jardiance, no steroids today, on a high carb diet with enzymes to ensure I could digest my food.. Yje enzymes do not do anything to insulin absorption or production but some days my pancreas produce more than on other days.

Well, it's got to help that you are not currently on steroids.

I second @Daibell 's suggestion that you ask for a referral to the hospital clinic. I suspect your diabetes is above your GP (and your DN's ) pay grade. While I understand your DN wanting you to avoid hypos if possible, a hospital clinic would know how much insulin you are making and whether insulin is the appropriate treatment or whether gliclazide can give your pancreas enough of an extra boost. (I guess you never had T2 so insulin resistance is not an issue??? Hence the high carb advice for weight gain, which is OK as long as your pancreas can produce enough insulin to cope?? Disclaimer, am not a doctor, hence the ?marks in my post, but it does make logical sense to me. )

And those blood test results sound quite promising to me - let's hope they can also help you gain some weight.

 

[Blackwater5]

In reply to everyone, GPs are the only ones who have dealt with my diabetes and my online medical record still says Type 2. But I have pancreatic cancer and I guess that I'm still making insulin although there will probably come a time when I need insulin. Right now they don't want to prescribe it if something else works. So that makes me Type 3c and the only reason for testing for insulin production is to learn if I'm producing any (must be or my BG would just go up) and try something else before insulin.
It's not easy to work out what my pancreas is doing because I've been on steroids for almost 2 months (just stopped them) and started taking pancreatic enzymes a week ago. Since starting the enzymes I've put a little weight on, before then I was very malnourished because I couldn't digest my food properly. In the last few days of the enzymes and high carb food my BG has increased today. my test before lunch of a cheese sandwich and a fruit yoghurt was 10.9 mmol/L A couple of hours after a high carb protein meal replacement drink gave me a reading of 12.4 mmol/, that was at around 10 am. My fasting level today was 7.2 and I took my first gliclazide 30 mg tablet with my wheat and whole milk breakfast today.
I think my BG is still messed up by the steroids I was on and I doubt that the gliclazide would act as a magic pill within a few hours of taking it. Nobody has ever referred me to a clinic and I get the feeling they know very little about Type 3c at my GPs. It also seems that there the pancreas is a forgotten organ as I first saw a GP with typical pancreas symptoms b(but no diabetes then) at least 18 months ago and I finally had a CT scan two weeks ago.
Anyway I asked about gliclazide because I was worried that I'd have a major hypo after the first tablet but the DN knows that I'm on a high carb diet ordered by the hospital dietician. For that reason nobody is concerned about me getting my BG into a normal stable range and I was told that it was no problem if it went up to 4. Maybe that's one reason why I was given gliclazide, they didn't want me on insulin unless it's unavoidable.