I got way too cocky...

[Mexxan]

Well, I've been an ultra-lurker on here for some 6 years or so - around about my first acute pancreatitis episode. Fantastic advice, measures and methods that I genuinely utilised to drop my sugar for a couple of years using low carb and keto, but on and off. As soon as I'd see pre-diabetic levels off I'd go on a binge. I would say carbs are an addiction for me and not in a light way - I can easily sit and eat a six pack of skips in five minutes without even realising I've binged it and smash 5 fillet-o-fish in one sitting. This is NOT some achievement but just to give an idea on how difficult I find it to stop.

From 2009 I had raised triglycerides and cholesterol. This peaked last year to cholesterol being 14 and my triglycerides going all the way to 33.

So, I guess the inevitable happened. Second acute pancreatitis attack 14 days ago. Hospitalised, have a fatty pancreas aswell as liver and put on 3 metformin a day, lantus 8 units a day, benzofibrate for the triglycerides and 2 statins.

Now, I'm unsure of what I can do with regards to the 2 or 3 day fast I usedto do before Lantus. Is it viable? Luckily the senior doctor who admitted me was also an endocrinologist - her directions and the consultant's was an immediate zero fat ultra low carb diet. That's a killer for me, I love fat and meat but that's another road to pancreatitis.

With Lantus and the meds my sugars are in a kinda normal range (I think) -7's before eating and 9 to 10 after a meal. My Triglycerides have gone down to 7.2 and my cholesterol is at 6.8.But I know that Lantus is just brute forcing the the sugar and fats into my cells and I cannot reduce my fatty pancreas, liver or weight this way. Especially with the fatty pancreas - I can see this triggering either acute or chronic pancreatits again.

So how do user of Lantus, manage to fast with causing hypos or risking keto acidosis?

Cheers for reading and any advice

 

[Jaylee]

Well, I've been an ultra-lurker on here for some 6 years or so - around about my first acute pancreatitis episode. Fantastic advice, measures and methods that I genuinely utilised to drop my sugar for a couple of years using low carb and keto, but on and off. As soon as I'd see pre-diabetic levels off I'd go on a binge. I would say carbs are an addiction for me and not in a light way - I can easily sit and eat a six pack of skips in five minutes without even realising I've binged it and smash 5 fillet-o-fish in one sitting. This is NOT some achievement but just to give an idea on how difficult I find it to stop.

From 2009 I had raised triglycerides and cholesterol. This peaked last year to cholesterol being 14 and my triglycerides going all the way to 33.

So, I guess the inevitable happened. Second acute pancreatitis attack 14 days ago. Hospitalised, have a fatty pancreas aswell as liver and put on 3 metformin a day, lantus 8 units a day, benzofibrate for the triglycerides and 2 statins.

Now, I'm unsure of what I can do with regards to the 2 or 3 day fast I usedto do before Lantus. Is it viable? Luckily the senior doctor who admitted me was also an endocrinologist - her directions and the consultant's was an immediate zero fat ultra low carb diet. That's a killer for me, I love fat and meat but that's another road to pancreatitis.

With Lantus and the meds my sugars are in a kinda normal range (I think) -7's before eating and 9 to 10 after a meal. My Triglycerides have gone down to 7.2 and my cholesterol is at 6.8.But I know that Lantus is just brute forcing the the sugar and fats into my cells and I cannot reduce my fatty pancreas, liver or weight this way. Especially with the fatty pancreas - I can see this triggering either acute or chronic pancreatits again.

So how do user of Lantus, manage to fast with causing hypos or risking keto acidosis?

Cheers for reading and any advice

Hi,

I’m a T1 Lantus user. It’s basically a long acting basal insulin.
Not for any weight reasons (purely because I can’t gig on a full stomach & have short acting bolus insulin onboard with a preference to eat after.)
I can fast for 12 hours using Lantus.
Basal testing would be the first port of call to lower the chances of any errant BG. https://www.mysugr.com/en/blog/basal-rate-testing/

Testing is key. Lantus lows for me if the dose is not right can recur if I just hit it with just fast acting carbs. A little milk as a follow up can stop the rollercoaster.
I can’t help you regarding your pancreatitis. But I do know I’m a middle aged guy who 20 years back was expecting a little “middle age spread?” (Like my dad.) For me it never happened.. & I’ve been using these Glargine based basal since the late 1980s

 

[EllieM]

Welcome to the forums @Mexxan

her directions and the consultant's was an immediate zero fat ultra low carb diet.

Very confused as to what you are meant to eat if you aren't allowed carbs or fats. Are all your calories meant to be from protein? I would seek urgent clarification on this point as it doesn't really make sense to me. Most diets are low fat or low carb, not both.

With Lantus and the meds my sugars are in a kinda normal range (I think) -7's before eating and 9 to 10 after a meal. My Triglycerides have gone down to 7.2 and my cholesterol is at 6.8.But I know that Lantus is just brute forcing the the sugar and fats into my cells and I cannot reduce my fatty pancreas, liver or weight this way. Especially with the fatty pancreas - I can see this triggering either acute or chronic pancreatits again.

So how do user of Lantus, manage to fast with causing hypos or risking keto acidosis?

OK, am I correct in assuming that you have now been diagnosed T3c? This is diabetes caused by damage to your pancreas. I would expect you are getting lantus because your pancreas is no longer capable of making enough insulin on its own. T3c is more like T1 than T2, in that the issue is not too much insulin and insulin resistance but insufficient manufactured insulin to do everything it needs to do (keep your body going). Having said that, some people manage to have double diabetes (T1 and T2) so I suppose logically there is nothing to stop you having T2 and T3c. (Note, I am not a doctor and that is not a diagnosis).

Now as a T1 (zero endogenous insulin), I take a combination of lantus (long acting basal insulin) and humalog (short acting nolus insulin). My lantus is meant to keep me going all day and night if I don't eat. so if my lantus dose was completely right I'd be able to fast for a day without going hypo or hyper.

But, for me anyway, in practice my lantus dose is rarely exactly right, so I have to supplement it with a little more bolus wth my food at some times of day, and a slightly less bolus with my food at other times. So I would find a long fast very difficult, though not necessarily impossible.

Given that they haven't given you a bolus insulin, I am assuming that either they are expecting you to eat a keto diet, or that they expect that you own remaining insulin will help you process the carbs in meals. (Am guessing the latter, as even a person on a keto diet can need short acting insulin for correction doses.) So I am hoping that this may give you a bit more leeway on food and fasting than I have,

But if you have a hypo while fasting you'll just have to break the fast and have some carbs, I think. (Sorry).

As regards a DKA, it's caused by a high blood sugar and not enough insulin, leading to excessive ketones in your blood.. My recommendation would be to learn how to adjust your lantus so that you avoid high blood sugars and also have a testing kit for ketones so that you can test them if your bgs are high (eg when ill).

Hopefully your diabetic team have clarified how you are meant to adjust your lantus (initial insulin doses often need adjustment) and have explained about hypos, and have given you a testing kit for ketones as well as blood sugar. It's possible that they will be able to advise an adjustment to your lantus that will cope with fasting, though I am slightly skeptical.


Sorry about the long essay, and once more welcome.

 

[jonathan183]

I believe there is a risk of lactic acidosis on metformin which is increased with extended fasting. I would stick to up to 24 hour fast only (one meal a day).

I find my insulin requirements vary with fasting/exercise/what I eat as well as other factors like illness and weather ... but can adjust the dose.

You will probably find you are able to achieve your goals without multiple day fasts - time restricted eating and lowering the carbs should do the trick

 

[Mexxan]

Thanks to you all for some great advice and insights. I'm definitely going to make a start with 16:8 then try and go for omad - have to take the Benzofibrate with food in the morning.

I was expecting low fat, 6 years ago thier was no mention of low carb so I guess things are changing for the better. When I asked if that means high protein the answer was no, moderate to low, but the total focus should be on absolutely zero fat.

I can see why the zero fat so as not to trigger any over release of lipase /enzymes and start to damage the pancreas, but I think the main reason is to reduce my triglycerides out of the imminent panc attack zone.

3 weeks from the the start this time round and I've only been using tiny amounts of mct oil to cook. I did try an omelette with one egg and 3 egg whites - felt some pangs on week 2 so stopped. Tried eggs again in a small salmon and egg breakfast baguette from Pret yesterday, handled it OK. Got into let's see what may trigger mode way to quickly, tried a few doritos and all good. Next in the evening had one bite of a small double decker - am now in extreme pain in my actual pancreatitis hotspots - front left upper quadrant, rear and flank feeling tenderness and the burn about 80% on the off to A&E scale. I know the best thing I can do is slow right down and start intermittent fasting right away. I know this is anecdotal and relates to my own personal experience only, but on my first acute pancreatitis attack I went total zero fat (other than a few ml's of MCT oil per meal) and at that time I was unaware of low carb keto, so ate a very high carbohydrate and high protein diet but cut practically all processed foods. I lost 3 stones in 2 to 3 months, felt great, had no pain and my sugars were in the lower prediabetic level with no meds which had been creeping up prior. I think this is the way to go again. I'll have to somehow figure out if the low carb was more for preventing higher triglycerides than insulin - must be as the Lantus ensures constant insulin. Kicker though - if I was asked to pick 3 foods to eat if stranded on a remote island for the rest of my life they would be eggs, meat, butter.

I'm going to go to 2 small meals today but with being on 3x Metformin I'm thinking whether to drop that back to 2 - Metformin always had me concerned with the link to potential pancreatitis.

Thanks again all.

 

[AndBreathe]

Thanks to you all for some great advice and insights. I'm definitely going to make a start with 16:8 then try and go for omad - have to take the Benzofibrate with food in the morning.

I was expecting low fat, 6 years ago thier was no mention of low carb so I guess things are changing for the better. When I asked if that means high protein the answer was no, moderate to low, but the total focus should be on absolutely zero fat.

I can see why the zero fat so as not to trigger any over release of lipase /enzymes and start to damage the pancreas, but I think the main reason is to reduce my triglycerides out of the imminent panc attack zone.

3 weeks from the the start this time round and I've only been using tiny amounts of mct oil to cook. I did try an omelette with one egg and 3 egg whites - felt some pangs on week 2 so stopped. Tried eggs again in a small salmon and egg breakfast baguette from Pret yesterday, handled it OK. Got into let's see what may trigger mode way to quickly, tried a few doritos and all good. Next in the evening had one bite of a small double decker - am now in extreme pain in my actual pancreatitis hotspots - front left upper quadrant, rear and flank feeling tenderness and the burn about 80% on the off to A&E scale. I know the best thing I can do is slow right down and start intermittent fasting right away. I know this is anecdotal and relates to my own personal experience only, but on my first acute pancreatitis attack I went total zero fat (other than a few ml's of MCT oil per meal) and at that time I was unaware of low carb keto, so ate a very high carbohydrate and high protein diet but cut practically all processed foods. I lost 3 stones in 2 to 3 months, felt great, had no pain and my sugars were in the lower prediabetic level with no meds which had been creeping up prior. I think this is the way to go again. I'll have to somehow figure out if the low carb was more for preventing higher triglycerides than insulin - must be as the Lantus ensures constant insulin. Kicker though - if I was asked to pick 3 foods to eat if stranded on a remote island for the rest of my life they would be eggs, meat, butter.

I'm going to go to 2 small meals today but with being on 3x Metformin I'm thinking whether to drop that back to 2 - Metformin always had me concerned with the link to potential pancreatitis.

Thanks again all.

The double decker you mention is that a chocolate bar or something else?

Are you saying you went high carb, but IF and lost weight, bringing your sugars right down? FOr most the high carb would be a blood sugar challenge, but I guess it depends how long each fast was.

In my experience, and having read around, high triglycerides seem more associated with the levels of carbs, with higher carb oftentimes pushing triglycerides up. FOr me, going low carb brought my Trigs right down, not up.

 

[AndBreathe]

I believe there is a risk of lactic acidosis on metformin which is increased with extended fasting. I would stick to up to 24 hour fast only (one meal a day).

I find my insulin requirements vary with fasting/exercise/what I eat as well as other factors like illness and weather ... but can adjust the dose.

You will probably find you are able to achieve your goals without multiple day fasts - time restricted eating and lowering the carbs should do the trick

I came to the Forum late 2013/early 2014, I can only thing of one person who experience Metformin associated lactic acidosis, so it strikes me the frequency would be quite low, per populatio. Clearly, my observations are just that, and not the result of scientific trials.

Of course, that doesn't mean it can't or won't happen to any given individual at any time, just trying to see if there is some perspective on it.

 

[Mexxan]

Yup, Double Decker is chocolate bar here in the UK, delicious and my favourite (although, I discovered Butterfinger bars on a trip to the States - easily up there in joint 1st).

As for the previous diet, the ONLY additional fat used were literally drops of MCT oil (I remember clearly, as I had to buy it from the States as the prices here were huge at the time). I used to par-boil all meats to reduce any fat content and consumed chicken mainly for the first month. My wife is an outstanding cook of Indian cuisine so a lot of my meals were moderate amounts of dry seasoned grilled chicken and very large amounts of different and delicious spicy veg dishes including dhal's with chapati's (about 3 or 4 per meal) and I'd eat this probably twice a day. I bought a Weber Smokey Mountain a few months before and the only thing I changed was adding smoked lean cuts / skinless meats to the mix later, maybe around a month to a month and a half after. I ate a LOT of papaya after every meal, and a little Aloe vera pulp. Isupplemented with grapeseed extract, vitamin C, no meds at all.

I did none of it for weight loss really, for me it was pain relief and eradication. After a few months and with all the complements that I looked way thinner, I really started to think about what was happening with my weight and sure enough even though I knew I was losing some, I was surprised that it was by so much - I'd anticipated moderate to high weight gain with all the carbs. Now, an important note here is that I didn't know high triglycerides potential to cause acute pancreatitis until I was talking to the A&E doctor and I definitely know they were way higher than normal at the time - this is something that I did not monitor or the consultant put an real emphasis on during recovery, weight loss or at the time of being discharged - I had been prescribed statins and fenofibrate for years prior but didn't really take them for any duration due to experiencing cramping (I think I should have taken the fibrate for sure) that was years before my first attack.

So yeah, very high carb and zero fat diet lead to no increase in sugars, no crazy highs - I remember I used to finger prick before breakfast and get around 110 to 116 roughly and 2 hours after I'd be around 160 to 180 ish, and significant weight loss.

I really wish I had maintained it, I even re-introduced my essential 3 around 4 months after AP day - eggs, red meat and butter, with eggs being first and had no I'll effects, no pancreas pain. I remember my weight loss stopped but slowly but I didn't have significant weight gain. Then around 6 month mark I started on the junk again. I ignored my wife's plea's to get back on the lifestyle that helped me and went full irresponsible with occasional flutters of 3 day fasts to get my climbing blood sugars down to prediabetic levels every 6 or 7 months over the years - with significant boosts in motivation in fasting when I discovered keto, but sadly I'd always fall for the Sirens of junk food and excessive amounts of it. Literally processed and / or fried everything. No finger prick testing for months and months apart, no taking fibrates/statins only occasionally taking Metformin when diagnosed type 2 - 18 months after AP day. It's like the whole life threatening and changing event never happened, even though I was feeling sicker and sicker and diabetes was / is raging - I can't fathom how utterly stupid I've been. All those years on, I learnt a lot of great advice and guidance and utterly failed to implement it. This time it has to be different. My pancreas has been screaming out for help for years and I just kept on hammering it - even knowing I was doing so. First time was genuinely not even knowing, this time I feel foolish and ungrateful - not in a feeling sorry for myself mopey way, but more of double slap with a back hander wake up call.

 

[Mexxan]

Yup, Double Decker is chocolate bar here in the UK, delicious and my favourite (although, I discovered Butterfinger bars on a trip to the States - easily up there in joint 1st).

As for the previous diet, the ONLY additional fat used were literally drops of MCT oil (I remember clearly, as I had to buy it from the States as the prices here were huge at the time). I used to par-boil all meats to reduce any fat content and consumed chicken mainly for the first month. My wife is an outstanding cook of Indian cuisine so a lot of my meals were moderate amounts of dry seasoned grilled chicken and very large amounts of different and delicious spicy veg dishes including dhal's with chapati's (about 3 or 4 per meal) and I'd eat this probably twice a day. I bought a Weber Smokey Mountain a few months before and the only thing I changed was adding smoked lean cuts / skinless meats to the mix later, maybe around a month to a month and a half after. I ate a LOT of papaya after every meal, and a little Aloe vera pulp. Isupplemented with grapeseed extract, vitamin C, no meds at all.

I did none of it for weight loss really, for me it was pain relief and eradication. After a few months and with all the complements that I looked way thinner, I really started to think about what was happening with my weight and sure enough even though I knew I was losing some, I was surprised that it was by so much - I'd anticipated moderate to high weight gain with all the carbs. Now, an important note here is that I didn't know high triglycerides potential to cause acute pancreatitis until I was talking to the A&E doctor and I definitely know they were way higher than normal at the time - this is something that I did not monitor or the consultant put an real emphasis on during recovery, weight loss or at the time of being discharged - I had been prescribed statins and fenofibrate for years prior but didn't really take them for any duration due to experiencing cramping (I think I should have taken the fibrate for sure) that was years before my first attack.

So yeah, very high carb and zero fat diet lead to no increase in sugars, no crazy highs - I remember I used to finger prick before breakfast and get around 110 to 116 roughly and 2 hours after I'd be around 160 to 180 ish, and significant weight loss.

I really wish I had maintained it, I even re-introduced my essential 3 around 4 months after AP day - eggs, red meat and butter, with eggs being first and had no I'll effects, no pancreas pain. I remember my weight loss stopped but slowly but I didn't have significant weight gain. Then around 6 month mark I started on the junk again. I ignored my wife's plea's to get back on the lifestyle that helped me and went full irresponsible with occasional flutters of 3 day fasts to get my climbing blood sugars down to prediabetic levels every 6 or 7 months over the years - with significant boosts in motivation in fasting when I discovered keto, but sadly I'd always fall for the Sirens of junk food and excessive amounts of it. Literally processed and / or fried everything. No finger prick testing for months and months apart, no taking fibrates/statins only occasionally taking Metformin when diagnosed type 2 - 18 months after AP day. It's like the whole life threatening and changing event never happened, even though I was feeling sicker and sicker and diabetes was / is raging - I can't fathom how utterly stupid I've been. All those years on, I learnt a lot of great advice and guidance and utterly failed to implement it. This time it has to be different. My pancreas has been screaming out for help for years and I just kept on hammering it - even knowing I was doing so. First time was genuinely not even knowing, this time I feel foolish and ungrateful - not in a feeling sorry for myself mopey way, but more of double slap with a back hander wake up call.

That was like a confessional - apologies, lol

 

[jonathan183]

I came to the Forum late 2013/early 2014, I can only thing of one person who experience Metformin associated lactic acidosis, so it strikes me the frequency would be quite low, per populatio. Clearly, my observations are just that, and not the result of scientific trials.

Of course, that doesn't mean it can't or won't happen to any given individual at any time, just trying to see if there is some perspective on it.

Metformin has lactic acidosis listed as very rare but very serious side effect, with risk increased by prolonged fasting. May affect up to 1 in 10,000 listed on the patient information for slow release. People may be fortunate but personally I would not unnecessarily increase risk of it ... hence my earlier post

 

[AndBreathe]

Metformin has lactic acidosis listed as very rare but very serious side effect, with risk increased by prolonged fasting. May affect up to 1 in 10,000 listed on the patient information for slow release. People may be fortunate but personally I would not unnecessarily increase risk of it ... hence my earlier post

This is just another incidence where people must do their own reading, understand the risks and benefits and place their bets. Irrespective of whether their decision is marginal or clear, one should be mindful of side effects when making any changes, whether lifestyle or meds.

Many would consider 1:10,000 a fairly low risk, but others consider 1:1,000,000 high.
,