Urgent: insulin dose advice needed after full pancreatectomy

[devexity]

Hi all:

I'm posted here before as a T1 diabetic; my father joined the ranks on the 1st of December after a Whipples procedure with a full pancreatectomy. He was discharged from hospital - where he was on a Novorapid drip, BG stable between 4 and 6 - a week ago. Since then his waking readings have averaged 12 and been as high as 17.6.

His regime is Levemir twice a day, 14 am and 14 pm, and fixed doses of Novorapid at breakfast, lunch and dinner - 6, 6, and 6. In the holiday-season absence of useful medical help, I've been his amateur DSN guiding him on whacking up the mealtime doses to correct, but I don't understand why they haven't sent him home carb counting. They've given him a high calorie drink (30+g of carbs) mid morning and evening, for example, but not instructed him to take insulin when he drinks it, so his glucose is spiking all over the place and interfering with his already challenging recovery. Yesterday I had him increase the pm Levemir to 15, and he woke up at 15.6. Bah.

Help, please! The NHS 111 line has been failing to connect for me all morning. Joy to the world.

 

[catapillar]

No one here is going to be able to advise on insulin doses.

Your father is type 3c, so you might want to have a look in that part of the forum for info.

Ring 111, ring the DSN for advice.

If you think the drinks are causing spikes, consider bolusing for them.

If he woke up at 15, what did he go to bed at?

 

[tim2000s]

Hi @devexity Sorry to hear about your Father. Unfortunately, he is the victim of the way the NHS in certain parts of the country tends to work. In many areas, Fixed dose/Fixed Carbs is the standard discharge method and is applied during the honeymoon period for new T1s.

As @catapillar says, he is Type 3c which is much more like going straight into full blown, non-honeymoon T1.

Whilst we can't advise on dosing, what you can do is take a look at www.bertieonline.org.uk, which will help him with the basics of insulin management and carb counting, and I'd advise that he get in touch with his diabetes team as soon as is practicable in the new year.

 

[Books1]

Apologies phone helpfully pasted this wrongly.

 

[devexity]

Thank you, people! I knew you'd come through. 3c? I had no idea such a thing existed. Cheers for the info!

-t