Insulin deficiency - newly diagnosed

Sounds like he might be a 3C candidate.

https://www.diabetes.co.uk/forum/category/type-3c-pancreatic-diabetes.73/

@Tophat1900 Is one of our resident experts.

Hi and welcome,
Sorry to hear about your husband's recent diagnosis.

He won't have T1 because that is caused by an autoimmune condition, where the body's own immune system destroys the beta cells in the pancreas that create insulin.
And he won't have T2 because that is (usually) a disease of hyperinsulinemia/insulin resistance, where the body produces so much insulin that it ceases to be effective.

As Bulkbiker says, it sounds more like T3c which is where the pancreas fails to produce enough insulin through damage, whether that is removal of some/all of the pancreas from an operation, or damage to it from pancreatitis.
https://en.wikipedia.org/wiki/Type_3c_(pancreatogenic)_diabetes
and
https://pancreapedia.org/reviews/pancreatogenic-type-3c-diabetes

The best course would be to contact your endocrinologist again and ask for a proper diagnosis to be confirmed.
The reason this is important is because although 3cers need insulin, there are a number of specific differences between 3c insulin users and T1 and T2 insulin users, and in future, your husband may well benefit from being treated by health care professionals who are aware of these differences. It should also be clearly recorded on his notes.

Hi. It can be confusing as many medics don't really understand how to categorise or test for diabetes types other than 'standard' T1 & T2. Type 3C may be relevant and refers to a significantly damaged pancreas. Where the insulin producing beta cells are failing after childhood, late onset T1, aka LADA, is labelled. It's the same as T1 but can come on more slowly. If your partner hasn't had a C-Peptide test I would ask for one. This test measures the level of insulin produced and is a guide to the right treatment. From what you say it appears that the beta cells are not producing enough insulin and injecting insulin has rightly been prescribed. For a T1/LADA it will normally be two insulins called the Basal/Bolus regime. The Basal is a 24 hour insulin and the Bolus is for mealtimes. Check that your partner has been told how to adjust the Bolus to take account of the amount of carbs in the meal (called carb-counting). Your partner will need to adjust the amount of Basal injected as experience is gained and the same for the Bolus. The GP/Nurse should advise but come back here if they are of no help.

3c is a bit different for each person, if your partner's pancreas is no longer producing the insulin required then insulin will have to used to make up the difference. There just isn't an alternative if the damage is permanent. It sounds like his insulin is being measured and that really is the important part. Damage to the pancreas, to beta cell production or just physical damage to the pancreas. Steriod induced or pancreatitis are forms of damage seen in T3c

It sounds like the endo has decided it is 3c by ruling out T2 or T1....

I hope he has been given guidance on how to use insulin and an appropriate starting dose point. Over time you learn to figure out doses based on what you are eating. It's not easy, but it does get better. You just can't get by on an insufficient amount of insulin. Insulin plays a role in so many other functions apart from glucose control.

Kristine001 said:

Thank you everyone for your answers!

Now it all is starting to make some sense. His C-Peptide was tested and is half of the minimum norm. His doctor ruled out T1 and T2 and prescribed 2 types of insulin. It seems like the doctor just didn't explain it well enough.

Click to expand...

I suggest continuing to ask for explanations why his c peptide is lower than normal - possibilities include a) he is LADA heading to T1 due to autoimmune destruction of pancreatic beta cells, b) severe/acute T2 where constant high pancreatic fat and glucose levels can "exhaust" beta cells and damp down insulin production, or c) T3 where other trauma to the pancreas destroys or inhibits insulin production.

Aside from a low C peptide, the other diagnostic test for LADA/T1 is an autoimmune antibodies panel, especially GAD65. Pragmatically this means a continuing dependency on insulin, but challenging in the LADA phases where you may still sporadically produce your own insulin.
An exhausted T2 pancreas is the one that typically responds best to strict low carb/keto diet plus weight loss, better exercise regime - as the body loses toxic glucose and fat levels in the pancreas for some this can eliminate the need for injected insulin or other drugs, provided the regime is maintained.
I know very little about T3 - pragmatically sounds like the treatment is basically same for T1 and equally is not reversible?

That said, insulin resistance can play havoc with the health of non diabetics and any type of diabetics, so worth trying to keep BG levels under control as much as you can manage but please don't guilt trip!