Hypo and Creon

[Palestine Pete]

Hi everyone,
Can anyone please help?
I had a Whipple procedure 8 years ago, following pancreatic cancer at the age of 68.
I've been on Creon capsules and a basal/bolus insulin routine ever since.
I learnt to count carbs, read Dr Bernstein and lived a fairly normal life since then, with HbA1c's of 38 and 39.
Then a little under a year ago, I developed what seemed to be Irritable Bowel Syndrome, with Diarrhoea .

After a while it started getting worse, and an attack would wipe me out for the rest of the day.

I started cutting out foods that seemed to aggravate the IBS, including Marmite, broccoli, Guinness, bacon, etc. but it was still there.

My GP sent me for various tests and could find nothing.

My Gastro Enterology specialist, said they had been finding, that patients who survived longer than the average of 3 years or so, find that they need to increase the amount of Creon (digestive enzymes) with each meal.

So after speaking with his nutritionist / dietician , I upped my dosage to 200,000 units of Creon per meal.
Success! Sort of!
It cured the diarrhoea but somehow changed my reaction to insulin.
I've always worked on 1 unit of Novo Rapid to 1 Carb portion, and It served me well.
Injecting insulin at my usual 1:1 ratio, I had the worst hypo I've ever had, down to 2.5, and severe trembles. I had to drink about 500 millilitres of Lucozade and then rub Glucogel into my gums and cheeks to get back up.
Now even though I have cut the dose of Creon right back to 1x10,000 unit capsule per meal, I am still unable to inject any Novo Rapid, as it plunges me right into a hypo!
I have to rely on a mere 4 units of Lantus at night, (reduced from my normal 12 units).
Luckily I had recently bought the Freestyle Libre sensor, or my life would have been even worse with finger prices every half hour!
Has anyone else experienced anything like this, and if so is it a permanent state of affairs, or will I get back to something approaching normal?
Any other thoughts or ideas would be welcome.

 

[Starburst02]

Hi everyone,
Can anyone please help?
I had a Whipple procedure 8 years ago, following pancreatic cancer at the age of 68.
I've been on Creon capsules and a basal/bolus insulin routine ever since.
I learnt to count carbs, read Dr Bernstein and lived a fairly normal life since then, with HbA1c's of 38 and 39.
Then a little under a year ago, I developed what seemed to be Irritable Bowel Syndrome, with Diarrhoea .

After a while it started getting worse, and an attack would wipe me out for the rest of the day.

I started cutting out foods that seemed to aggravate the IBS, including Marmite, broccoli, Guinness, bacon, etc. but it was still there.

My GP sent me for various tests and could find nothing.

My Gastro Enterology specialist, said they had been finding, that patients who survived longer than the average of 3 years or so, find that they need to increase the amount of Creon (digestive enzymes) with each meal.

So after speaking with his nutritionist / dietician , I upped my dosage to 200,000 units of Creon per meal.
Success! Sort of!
It cured the diarrhoea but somehow changed my reaction to insulin.
I've always worked on 1 unit of Novo Rapid to 1 Carb portion, and It served me well.
Injecting insulin at my usual 1:1 ratio, I had the worst hypo I've ever had, down to 2.5, and severe trembles. I had to drink about 500 millilitres of Lucozade and then rub Glucogel into my gums and cheeks to get back up.
Now even though I have cut the dose of Creon right back to 1x10,000 unit capsule per meal, I am still unable to inject any Novo Rapid, as it plunges me right into a hypo!
I have to rely on a mere 4 units of Lantus at night, (reduced from my normal 12 units).
Luckily I had recently bought the Freestyle Libre sensor, or my life would have been even worse with finger prices every half hour!
Has anyone else experienced anything like this, and if so is it a permanent state of affairs, or will I get back to something approaching normal?
Any other thoughts or ideas would be welcome.

Hi Palestine Pete. I had Whipple surgery for Pancreatic Cancer 15 years ago. I am also diabetic after surgery but was able to control with diet/exercise until having to start basal insulin beginning of 2017. I am having a great deal of trouble adjusting to even basal insulin (side affects for me are bad), and now my doctor is talking to me about adding rapid acting insulin. I have not experienced any low sugar episodes on basal. I have also been on Creon since surgery. My diabetes was diagnosed AFTER I started taking Creon to aid digestion. It is a known side affect of Creon that it can cause high blood sugar. Creon causes fast blood sugar spikes (the amalayse in Creon metabolizes carbs super fast apparently) in less than an hour of eating meals or snacks. If your fast acting insulin kicks in within 15-20 minutes and it is causing low blood sugar, you may want to have your doctors check to see if you are experiencing gastroperesis, or slow emptying of food from you stomach. It is not uncommon for someone who has had Whipple surgery to develop this complication. If you still have part of your pancreas left, and if it is still pumping out some insulin, this also can complicate blood sugar control. I have read reports that it is very difficult for people who have had pancreatic resection to control blood sugar because of the unpredictable volume of insulin the remainder of their pancreas produces. And that this gets more difficult with time. Maybe your pancreas has started releasing insulin again? Dosing for Creon for me is always based on fat grams in a meal. The rule that works for me is one Creon 12000 for each 10 grams of fat in a meal. When you add insulin therapy and start having to count carbs as well it gets even more complicated.

I hope you are able to resolve the issues with your insulin soon, and that you continue in good health.