3c

[Stevethomas]

Hi, December 2023 I had a distal pancreatectomy, they also removed my spleen, gallbladder and part of my colon. I have a history of pancreatitis which lead to the issues. The good news I’m fighting back and seem to manage my blood sugars well. My A1c is averaging at about 6.6%. I have been on Creon 25,000. However Creon does cause rapid sugar spikes. As the Creon speeds up the digestion hence fast spikes. I only take tresiba once a day with my novo pen and rapid insult should I have a spike. I have found some very useful hacks to eat almost what I want now without too much of an issue. If you want some hacks, let me know and I will share these with you. Keep well everyone.

 

[Wendal]

Hi Steve,
Welcome here and there are a few other 3Cs here whom I am sure will respond.Some have had their pancreases removed either fully or partially due to pancreatic cancer and some as a result of a chronic or acute pancreatitis attack.
Please ask any questions and good to see you doing well
ATB

 

[rebrascora]

Hi and welcome.

I would be surprised if the Creon causes glucose spikes. It just allows those glucose spikes to happen the same as they do for those of us who have a pancreas which produces digestive enzymes. For instance porridge hits my blood stream like rocket fuel in 20 mins even when made with water and double cream instead of milk, despite it supposed slow release reputation. 🙄

Most of us inject our fast acting insulin at varying times before we eat, to prevent those spikes, but there are some things which can slow the digestion of carbs a bit to reduce the speed they release their glucose into the blood stream.
It is always interesting to read what others find works for them, so please feel free to tell us about your hacks. If there is anything we haven't tried as individuals, it would be worth experimenting.

 

[eggyg]

I had a distal pancreatectomy and splenectomy in 2007, can’t believe it’s that long ago. I must say Creon hasn’t really bothered my BGs in all that time, I don’t think. If my BGs are high I probably haven’t taken enough bolus and/or eaten too many carbs! Type 3c can be a pain in the butt ( sometimes literally) but I manage fine on the whole. My TIR ( time in range) over 90 days is usually over 90% so I must be doing something right. Let us know your “hacks” and we’ll share our wins too. Good luck on your Type 3c journey.

 

[Wendal]

Hi, December 2023 I had a distal pancreatectomy, they also removed my spleen, gallbladder and part of my colon. I have a history of pancreatitis which lead to the issues. The good news I’m fighting back and seem to manage my blood sugars well. My A1c is averaging at about 6.6%. I have been on Creon 25,000. However Creon does cause rapid sugar spikes. As the Creon speeds up the digestion hence fast spikes. I only take tresiba once a day with my novo pen and rapid insult should I have a spike. I have found some very useful hacks to eat almost what I want now without too much of an issue. If you want some hacks, let me know and I will share these with you. Keep well everyone.

Steve like others have said I don’t find the Creon leads to a spike in BG levels although it’s digestive enzymes help to break down the carbs etc which can affect the timing of a BG rise but as you have found out it can be readily managed with your insulin.
Welcome any hacks that help us manage our situation better as we are here to offer support and help each other

 

[soupdragon]

Welcome @Stevethomas from another Type 3c due to pancreatitis.
Glad to hear that things are going well for you.

 

[GracefulAng]

Welcome @Stevethomas! I am here to support my husband @Busdriver60, he was recently diagnosed with Diabetes, likely type 3c. You might spot some peers here with type 3c, such as @Proud to be erratic and @Silvershoes etc.

 

[Standup]

My Pancreatic dietitian mentioned that if I increased my Creon I would get more benefit from the food and might need to adjust my insulin. Seems obvious now (a whole 6 weeks in!) but I hadn't made the connection and was getting what I thought were random spikes when I took more Creon.

 

[Proud to be erratic]

My Pancreatic dietitian mentioned that if I increased my Creon I would get more benefit from the food and might need to adjust my insulin. Seems obvious now (a whole 6 weeks in!) but I hadn't made the connection and was getting what I thought were random spikes when I took more Creon.

Much of my life things have seemed obvious after being pointed out, while I was happily ignoring the connections. In fact sometimes I can be extremely wise in hindsight.

Nevertheless, a warm welcome to you @Stevethomas.

 

[Stevethomas]

Hi and welcome.

I would be surprised if the Creon causes glucose spikes. It just allows those glucose spikes to happen the same as they do for those of us who have a pancreas which produces digestive enzymes. For instance porridge hits my blood stream like rocket fuel in 20 mins even when made with water and double cream instead of milk, despite it supposed slow release reputation. 🙄

Most of us inject our fast acting insulin at varying times before we eat, to prevent those spikes, but there are some things which can slow the digestion of carbs a bit to reduce the speed they release their glucose into the blood stream.
It is always interesting to read what others find works for them, so please feel free to tell us about your hacks. If there is anything we haven't tried as individuals, it would be worth experimenting.

Hi, I know everyone has different approaches to dealing with spikes. However I found that before eating any carbs eat some fibre first. For example. I eat 2 shredded wheat for breakfast with spoon full of sweetener. So 10 minutes before I will eat either a raw carrot, a tomato or 2. Anything thats a vegetable. Do not eat fruit though. This will double your spike. After eat breakfast drink a pint of water with a squeeze of lemon or lime in it. Your blood sugar will be stable and no spikes. Try it you be amazed.

 

[Stevethomas]

My Pancreatic dietitian mentioned that if I increased my Creon I would get more benefit from the food and might need to adjust my insulin. Seems obvious now (a whole 6 weeks in!) but I hadn't made the connection and was getting what I thought were random spikes when I took more Creon.

Creon will be speed up the process. No-one will tell you what really happens when taking Creon. I did several tests and the results showed a huge difference. I had a long chat with the professor who is an expert in all things pancreas. He explained the how Creon works in your system and that Creon is farmed from pigs, as they are the closest to us in turns of digestion. Creon works by ensuring the vitamins and minerals needed for the body to work and digested quickly. However this then leaves the glucose left in your system. Hence the fast spike. You need to adjust you fast acting insulin either 30 minutes before or 10 minutes depending on which insulin you are using.

 

[rebrascora]

That sounds like Jesse Inshausbe aka The Glucose Goddess advice. I have her book. Some of her advice works well for me but because I do not produce any insulin, injecting my mealtime insulin at the appropriate time before eating is key for me in preventing spikes. In the morning, that means injecting before I get out of bed or even sit up as my levels start rising the moment I become vertical and will rise by 5-6 mmols within 30-40 mins before I even think about food, so insulin has to be injected as soon as I wake up.

 

[Proud to be erratic]

Apart from the more conventional approach to managing spikes, such as getting improved bolus timings and possibly splitting my bolus - both of which need a determined mental consideration in advance of either taking that bolus or eating - I have a very different "hack" to help manage them.

I'm lucky enough to have the Dex G7 CGM, which allows me to view my graph as it progresses on my phone in Landscape as well as Portrait. When I see those spikes and turn my phone on its side, the Landscape view delivers a far more reassuring landscape of undulating topography and very much reduced peaks! Slightly less tongue in cheek, we splash this term of "spikes" around but without any real declaration of when is BG change a spike or just a record of necessary and routine change. The portrayal of constricted time on the bottom axis of the Libre graphs unquestionably make many BG changes look like a spike, when they really are not so dramatic

I also use the fibre first approach in my meals, whenever I possibly can. I've been doing this for almost 12 months and it works for me. At home it's really easy, just possibly a bit intrusive to the rest of the family who don't want a salad starter. When eating out it very much depends on the venue. Restaurants often have a side salad option which I'll choose (even if I'm the only one having a starter). Fast food venues are more tricky. I don't "blindly" follow all GG's hacks, but I do think that the fibre lining of the colon at the start of a meal makes sense. The longer I've been doing this the more convinced I have become that this is a pretty simple help to this wide ranging and longstanding digestion challenge - that only those of us with CGM are aware it is happening.

Personally I have mellowed and am less concerned about "spikes". The troughs (ie lows below 4) do still very much bother me and inevitably I'm concious that I'm getting older and thus more vulnerable to cognitive decline even more rapidly. I try very hard to prevent any time below 4; not always successful - BG crashes sometimes just happen and I can't explain why, until my hindsight makes it more obvious!

T3c is challenging at times.

 

[Stevethomas]

That sounds like Jesse Inshausbe aka The Glucose Goddess advice. I have her book. Some of her advice works well for me but because I do not produce any insulin, injecting my mealtime insulin at the appropriate time before eating is key for me in preventing spikes. In the morning, that means injecting before I get out of bed or even sit up as my levels start rising the moment I become vertical and will rise by 5-6 mmols within 30-40 mins before I even think about food, so insulin has to be injected as soon as I wake up.

Yes type 1 is a bigger issue. The glucose goddess has some brilliant hacks. And I also read her books and listen to her podcasts. The morning hack comes from my consultant as he is also a diabetic.

 

[Chris88]

Thanks Steve, others have mentioned eating the vegetables on your plate first to reduce spikes so I will try your hack for breakfast.

 

[everydayupsanddowns]

Welcome to the forum @Stevethomas

Glad to hear you have found some workarounds and strategies to reduce your glucose instability.

For me aside from getting dose amounts roughly right, I have been amazed how crucial it is for my diabetes to get the timing of the dose right. Almost it seems that the timing is more important than the finessing of the dose itself. My fancy pump can tweak a dose by a few hundredths of a unit based on premeal BG level - but actually my diabetes seems far more preoccupied in the general ‘push’ and ‘pull’ of activity curves rather than 0.12u increase or reduction in dose 🙂

 

[Proud to be erratic]

Yes type 1 is a bigger issue.

Steve, that is very humble of you. Sometimes I also think T1 is a bigger issue and then at times, particularly when my BG is crashing like a 2 ton boulder from a great height, I feel my T3c is the bigger thing. At those moments the only explanation that I can find has nothing to so with counting or timing: I just don't have any of the pancreatic hormones and can't do whatever I need to do on behalf of my missing panc'y quickly enough.

Please don't misunderstand - I'm not feeling sorry for myself, I'm grateful to be alive. Its just an inevitable comparison, or a dispassionate what if question ...

Earlier I said T3c can be challenging at times. I must add frustrating, because its so contradictory. These 2 characteristics must equally apply to T1s. On Wednesday I had a normal reasonable day. Not a unicorn day but tweaks worked and generally not a stressful D day - as was Tuesday. But 24 hrs on, the complete reverse. Identical breakfasts and no lunch all 3 days. Both very similar activity wise and very similar 30-40 gm carb evenings. But I woke on Thursday and realised the day was starting very differently, BG around 10 and needing almost 2hrs for the brakfast bolus complete with correction, to kick in and indicate I was falling before I could start eating. So it went on; generally a day of many G7 alerts and trying to resist over-reacting. I ended that 24 hrs with about 40% TIR and the plain stress of a day of hassle.

None of this is catastrophic. Its 'just' stressful, makes no sense and analysis after the event simply doesn't help. I know to park this and move on to today.

The glucose goddess has some brilliant hacks. And I also read her books and listen to her podcasts. The morning hack comes from my consultant as he is also a diabetic.

That is also reassuring in principle.

 

[rebrascora]

If it is any consolation Roland, we Type 1s get those days too.
My prebolus timing has been pretty steady at 45 mins before breakfast for years and then a few weeks ago, my morning insulin started kicking in much quicker for no obvious reason at all and even when I was waking up high and like yourself would normally need an hour or two, it was just suddenly dropping like a stone after 30 mins. It was the same at other times of day too and being so used to my body sluggishly responding to bolus insulin for several years, it was tough to break old habits and adopt new ones, especially as I expected to revert to normal the next day or the day after. Now after just over a week, I am back to sluggish absorption again and having to wait 45 mins and run up and down stairs 10 times to try to encourage it to get going. 🙄

You are right though that Type 3c can be more complicated than Type 1 and I had meant to raise that topic after @Stevethomas comment, but you have done it for me. I think the thing with Type 3c is that there is a much broader range of experience and treatment than with Type 1, because some will be managing on oral meds, some on just basal and some on a full basal bolus regime depending upon the extent of the damage to their pancreas. I would imagine there will also be some who don't yet need Creon or other PERT, so lots more variables as well as the potential loss of regulating hormones to trigger the liver to release glucose when hypo.

 

[martindt1606]

None of this is catastrophic. Its 'just' stressful, makes no sense and analysis after the event simply doesn't help. I know to park this and move on to today.

That is also reassuring in principle.

Just back from annual GP check with diabetes nurse. She's good to talk to but glazed over when i explained i was at a total loss as to why i hit 19.5 yesterday evening. She did "tut" when i explained i bolused an additional 11 units (original meal time bolus 8 units) and changed infusion site after 6 units. She almost fell off her chair when i showed her my BG was 5.8 on waking up this morning. It was stress i don't need at the time but its happened before and will happen again. Irrespective of the challenges throughout the day she was more than happy with a HBa1c of 52. Personally i'd like 7 days with Time in Range above 80%.............but theres always (at least) one day that defies all logic and rules.