A rare breed - secondary Type2 diabetes..

[BenMMellor]

Hi,

I've recently been diagnosed as Type2 diabetic. This has come about due to a severe gallstone attack last october causing pancreatitis. That led to inflamation, then necrosis of my pancreas over Xmas 2011. I ended up losing 80% of my pancreas.

The remaining 20% seemed to be working ok and coping with the adjusted diet I'd put myself on following the near fatal pancreatitis. Sadly that coping declined in mid October and my GP diagnosed me as having secondary type2 diabetes. My HbA1C was 30 and my bg test was the same. He and the diabetci nurse put me on Gliclazide straight away and over the last few weeks I've done some more minor adjustments to my diet and am now keeping my bg between 5 and 9.

It's all been a whirlwind again following me thinking I'd just got my life and mental state back on trak a year on from the major incident (I was also hosptilised in Feb 2012 with a 20cm pancreatic pseudocyst that was the 2nd near miss!)

Doing some reading, it seems that gliclazide essentially causes what remaing islets I've got to produce a bit more insulin - but this will eventually cause them to 'burn-out' and then I'll be on insulin. The question in my mind is if this is the right medication for me at this time or if metformin might be better and place less stress on the remains of my pancreas?

 

[paragliderpete]

Hi Ben. I'm on both Metformin and gliclazide.both drugs work in totally different ways, and you may find that because of your reduced insulin production metformin will not work for you.
Metformin in general works by reducing insulin resistance, stopping the liver producing glucose and slows the digestion of carbohydrate from your diet. However like me i suspect you will still need the gliclazide.
I used to have the concerns as you about burning out my last bit of insulin production, and many articles have raised this question. However I have never found any scientific study that has found this to be the case.
I hope this is of some help to you. if you are very worried about gliclazide, then another option would be to consider going onto insulin, or possibly a GLP1 inhibitor such as exanutide xr. I've tried having the discussion with my gp, unfortunately his stance was that as I had good control, he would not consider changing my drugs.
Another problem for me is that I'm a pilot , and I'm sure that I would get more grief from the CAA than I already do taking Gliclazide

 

[hallii]

I m a bit puzzled, surely a damaged pancreas is what causes T1 rather than T2?

With reduced pancreatic function you would struggle to produce enough insulin. Most T2s start of with loads of insulin and a working pancreas, true, the pancreas may fail later as a result of "overwork" , but that doesn't make them T1 they still have insulin resistance.

I don't suppose it matters really, as long as the treatment keeps your BGs under control.

H

 

[BenMMellor]

@Pete - thanks for the info. I'll raise it with my DN next week when I next see them. As she said on my first visit, I don't fall into your normal catergory T1/T2 diabetic group as my onset was due to pancreatitic damage. Given I can still produce insulin it may be why they just have me on glic at the oment as metformin might cause the bg to stay high.

@hallii - my pancreas isn't so much 'damaged'- more none exisitent. I suffered acute pancreatitis and pancreas in essence went into 'turbo' mode and produced too much pancreatic enzymes and 'ate' itself. I have the head left where all the main 'tubing' is, but that's left me with only 20% of a normal healthy pancreas. The other 80% ended up as 'mush' and was drained from my body by surgical intervention then natural absorption.

Even my GP classes me as a special case as secondary diabetes it pretty rare.

I've come to the conclusion that it's all about moderation and I can still enjoy my food by making a couple of swaps. I'm not letting my wife have all the 'Hotel Chocolat' I buy when on business trips.. she has to save one or two for me as a treat!

 

[phoenix]

I m a bit puzzled, surely a damaged pancreas is what causes T1 rather than T2?

With reduced pancreatic function you would struggle to produce enough insulin. Most T2s start of with loads of insulin and a working pancreas, true, the pancreas may fail later as a result of "overwork" , but that doesn't make them T1 they still have insulin resistance.

I don't suppose it matters really, as long as the treatment keeps your BGs under control.

H

Actually it's neither . Occasionally called T3 (pancreatic)
see my answer in this thread viewtopic.php?f=15&t=15283

 

[Robinredbreast]

I m a bit puzzled, surely a damaged pancreas is what causes T1 rather than T2?

With reduced pancreatic function you would struggle to produce enough insulin. Most T2s start of with loads of insulin and a working pancreas, true, the pancreas may fail later as a result of "overwork" , but that doesn't make them T1 they still have insulin resistance.

I don't suppose it matters really, as long as the treatment keeps your BGs under control.

H

I am type 1 and that usually means the pancreas is kaput, no longer working,not functioning as the pancreas ,as mine was, attcked by my own body and destroyed it.

You have been through a pretty awful time. I hope,in time, things get better for you . I wish you all the best RRB