What is the fundamental difference between T1 and T3?

[Zhnyaka]

My godmother recently had her pancreas removed and she thinks that if I have T1, then I can help her with her newfound diabetes, but I don't have only internal secretions, and she has nothing that the pancreas produces. When I said that if she has a lot of hypo, then she should reduce the dose, she objected that her doctor told her that she should not take less than 30 units of insulin per day and that her bg should not fall below 6. Why?!
As I understand it, due to the lack of glucagon, hypoglycemia will be more severe than in my case.
For some reason, she was told to wait until bg was 10, and only then to inject insulin, both bolus and basal. What difference does it make when to inject tresiba if it lasts 42 hours?! What are these strange recommendations?
also, as I understand it, when removing the pancreas, not only carbohydrates are not absorbed, but also proteins and fats, that is, we probably will not get a slowdown in the absorption of carbohydrates from other foods?

To be honest, I have no desire to control anyone's diabetes other than my own, but my godmother thinks I can help her

I was too young when I got diabetes, so it didn't cause any psychological trauma, but what kind of support did you want from your loved ones when it happened?

 

[Antje77]

For some reason, she was told to wait until bg was 10, and only then to inject insulin, both bolus and basal. What difference does it make when to inject tresiba if it lasts 42 hours?!

Can she have misunderstood and this advice was only meant for her bolus?

When I said that if she has a lot of hypo, then she should reduce the dose, she objected that her doctor told her that she should not take less than 30 units of insulin per day and that her bg should not fall below 6. Why?!

Does she get a lot of hypos? If not, this is only theory for now.
Her doctor advising her to try to not drop below 6 makes sense. She's new to the game, and you don't want a newly diagnosed insulin dependent diabetic to have serious hypos right away, initially aiming for between 6 and 10 isn't a bad thing until she has a better idea on her doses.

Insulin dosing is pretty much the same with T1 and T3C, but as you said, hypos can be more dangerous with T3C and a glucagon injection won't work if her complete pancreas was removed. This may be different if it was a partial removal.
[edit: after @EllieM 's reply I'm now starting to doubt myself on the glucagon injection, so please don't take my word for it until I or someone else has looked it up!]

To be honest, I have no desire to control anyone's diabetes other than my own, but my godmother thinks I can help her

She's likely correct in that you can give her some insights.
But this definitely is not your job unless you want it to be.
And it's a very hard job because you're speaking from years of experience and she's only starting with the basics, and with doctors who are having their own ideas which may be contadictory to yours.
Don't let yourself be pushed into the role of a free diabetes nurse.

You're an IT specialist, what about you help her getting the hang of translation software and have her join the forum herself? That way you are supporting her but not becoming her nurse.

I was too young when I got diabetes, so it didn't cause any psychological trauma, but what kind of support did you want from your loved ones when it happened?

It's different for everyone. I mainly wanted them to listen to all my ideas on managing my diabetes and ask questions out of curiosity, but I didn't have any insulin users among my family and friends.

 

[EllieM]

and a glucagon injection won't work if her complete pancreas was removed.

I thought the issue was that glucagon is produced by the pancreas, so a T3c may not produce any of their own, but surely a glucagon injection should still work? (It's stimulating the liver to produce sugar/glycogen.)

@Zhnyaka I must admit I don't understand the at least 30 units a day, because some people are genuinely very insulin sensitive. (My long term T1 mum who definitely produced no insulin of her own only needed 15 units a day, though as I remember she was quite low carb.) And I agree that a delay in injecting tresiba seems strange.

Presumably she's been given creon as well?

And I like @Antje77 's suggestion that you use your computer skills to get her online to join a diabetes forum, maybe in your own country so she doesn't have to worry about the language????

Like you, I was young when I got my T1, so I have no idea of the psychological implications either.

 

[Antje77]

I thought the issue was that glucagon is produced by the pancreas, so a T3c may not produce any of their own, but surely a glucagon injection should still work? (It's stimulating the liver to produce sugar/glycogen.)

I'm sure I've read this somewhere but I definitely don't have the physiological facts at the ready so I'll have to look it up. And I may have remembered wrong. But not today.
I'll add an edit to my post.

 

[Deleted member 596235]

... To be honest, I have no desire to control anyone's diabetes other than my own, but my godmother thinks I can help her.

My very personal opinion is that your godmother should
not be relying—or even worse—acting on any third-party
self-reported advice. She should be strictly following her
treating physician's advice, and the medication regime
he/she has set in place for her. And if she has concerns,
then she needs to make those clear to that treating physician,
rather than asking lay people.

And I know you mean well, but even suggesting that someone else adjust
their medications is treading on thin ice—[she should reduce the dose].

 

[Antje77]

She should be strictly following her
treating physician's advice, and the medication regime
he/she has set in place for her.

The problem with this is that if we'd all followed our doctor's advice, there would be a whole lot fewer T2 members who are seeing non diabetic numbers unmedicated.
Most of us (including myself when I was misdiagnosed as a T2) were advised to eat lots of complex wholegrain carbs and as little fats as possible, definitely no need for home testing.

I'm all for following doctors advice, provided that I understand why the advice has been given.
I've learnt lots more about treating my T1 and insulin dosing from reading around the internet, and reading how others tackle things than a doctor or diabetes nurse could ever teach me.

Dosing decisions with insulin are very much a DIY thing after the initial guidance from your HCP, I can't call my endo 6 times a day to ask how much insulin I should take. The more a patient understands about dosing insulin, the better the outcome will be. So we partially have to educate ourselves.

And I know you mean well, but even suggesting that someone else adjust
their medications is treading on thin ice—[she should reduce the dose].

Hypos can and do kill. And they are caused by taking more insulin than you need. The dose of insulin someone needs is found through trial and error, some people need less than 10 units a day, others need 300 units a day and there is no way to tell until you try. If you see frequent hypos on your prescribed dose, you definitely should not keep taking that dose until your next quarterly appointment because your doctor told you to take no less than a certain amount.

 

[Zhnyaka]

Can she have misunderstood and this advice was only meant for her bolus?

She showed the doctor's message, and she got it right. I don't understand such a reaction for tresiba, I would understand if it were for protophan or lantus, but it's really strange for tresiba.

Does she get a lot of hypos?

yes, but instead of reducing the dose, she is advised to eat more. Moreover, they advise eating porridge, even with hypo, and my advice "drink tea with sugar if you don't want to eat" seems to be something bad.

You're an IT specialist, what about you help her getting the hang of translation software and have her join the forum herself? That way you are supporting her but not becoming her nurse.

I offered it to her, but she refused. To some extent, I'm glad of this, because I don't have the slightest desire for my parents to find out about the existence of this forum and what I'm writing here.

I thought the issue was that glucagon is produced by the pancreas, so a T3c may not produce any of their own, but surely a glucagon injection should still work? (It's stimulating the liver to produce sugar/glycogen.)

Yes, it seems that glucagon is not produced in T3. And it seems that neither proteins nor fats are digested without enzymes. But insulin is also a protein. What happens if a person loses the ability to digeste everything?

Her entire pancreas , gallbladder, and duodenum were removed. But all I know is what to do if the beta cells of the pancreas have died.
In addition, she claims that she does not feel any hypo or spikes, and I am very surprised by this, because I can determine my bg quite accurately by how I feel.

 

[Antje77]

And it seems that neither proteins nor fats are digested without enzymes.

Does she take digestive enzymes with her food? Those are normally prescribed to T3C's.

She showed the doctor's message, and she got it right. I don't understand such a reaction for tresiba, I would understand if it were for protophan or lantus, but it's really strange for tresiba.

Some strange advice indeed. Is this a GP type doctor or an endocrinologist?
Can she contact her doctor or nurse to ask her questions and have them explain the reasonings behind the advice?

 

[Zhnyaka]

Does she take digestive enzymes with her food?

Yes, she was prescribed enzymes, but I don't understand anything about enzymes because my pancreas produces them.

Is this a GP type doctor or an endocrinologist?

This is an endocrinologist. Here, diabetics are not sent to the GP at all.

Can she contact her doctor or nurse to ask her questions and have them explain the reasonings behind the advice?

She has the doctor's phone number, but the doctor replied with something like "because I know what's best for you." Although my godmother is so hysterical about her diabetes that it's hard to communicate with her normally.

 

[Zhnyaka]

my phlegmatic attitude like "nothing terrible is happening, it's just diabetes" is unlikely to be able to support anyone. Аs well as my behavior a la "you can eat whatever you want and do whatever you want, the main thing is to count the dose correctly and always carry sweets with you" is not good advice for a beginner. After all, I've been living with this for 20 years.

 

[Antje77]

my godmother is so hysterical about her diabetes that it's hard to communicate with her normally.

my phlegmatic attitude like "nothing terrible is happening, it's just diabetes" is unlikely to be able to support anyone. Аs well as my behavior a la "you can eat whatever you want and do whatever you want, the main thing is to count the dose correctly and always carry sweets with you" is not good advice for a beginner. After all, I've been living with this for 20 years.

Your attitude may well be useful.
I often tell the newly diagnosed on here that it's a marathon, not a sprint, and there is absolutely no need to get it completely right from the start.
As long as you can avoid serious hypos, you have time to learn and find patterns.

 

[Zhnyaka]

I often tell the newly diagnosed on here that it's a marathon, not a sprint,

My endo loved the phrase "diabetes is not a disease, but a way of life."