Diabetes, bile acid malabsorption and Colesevelam

[CMH]

Hi all,

Looking for some advice on behalf of my partner. He has quite a complex medical history because he suffers from haemochromotosis, bile acid malabsorption and diabetes which he controls with insulin. His diabetic consultant is unsure whether his diabetes is type 2 or caused by damage to his pancreas caused by the haemochromotosis.

For the bile acid malabsorption, he has been prescribed a medication called Cholestyramine, but it has been giving him some really nasty side effects. We were researching possible alternative treatments when we came across one called colesevelam. As well as being used to lower cholesterol and treat bile acid malabsorption, it is also sometimes prescribed to type to diabetics to help with glycemic control. Does this automatically rule it out as an option for James? Or is there a possibility he might be able to take it and adjust his insulin doses to compensate? Unfortunately, he has yet to see a gastro consultant about his BAM. He’s already been waiting for months and there’s not indication of how much longer it will be. His GP is not very familiar with its treatment options so we’re trying to find out as much as possible about treatments.

 

[helli]

Hi @CMH sorry to read about the struggles your partner is going through.
I am not familiar with Cholestyramine but my (non-trained medical) feeling is that it depends upon his insulin regime.
Can you share with us what type of insulin he takes and whether he adjusts his insulin dose depending upon what he eats and what activities he does?
If he adjusts his dose, he should have more flexibility. But, if he is on a fixed dose, this may be more challenging.

 

[CMH]

Hi @CMH sorry to read about the struggles your partner is going through.
I am not familiar with Cholestyramine but my (non-trained medical) feeling is that it depends upon his insulin regime.
Can you share with us what type of insulin he takes and whether he adjusts his insulin dose depending upon what he eats and what activities he does?
If he adjusts his dose, he should have more flexibility. But, if he is on a fixed dose, this may be more challenging.

Hi helli,
Thanks for your quick reply. He takes 12 units of Lantus every day. He also has novorapid. Initially, he was told to take 6 units with every meal, but that didn’t work for him as the BAM leads to chronic diahorrea so half the time he wasn’t absorbing anything from what he ate which led to hypos immediately after most of his meals. He was then advised to stop taking novorapid before meals and instead to just use it correct blood sugar highs after meals which worked much better because he could wait to see if he was absorbing anything before injecting. Sometimes he doesn’t need novorapid at all. Obviously this is probably going to change when he has found a treatment that works for his bowel issues!

 

[everydayupsanddowns]

Welcome to the forum @CMH

I know little about haemochromatosis, but there is an overview of various flavours of Type 3c (including haemochromatosis) here if it helps

What is type 3c diabetes?

You may have heard of the more common types of diabetes like type 1, type 2 and gestational. But there are actually many other types of diabetes that aren't as well known. Type 3c diabetes develops because of the damage to the pancreas, which can happen for a few different reasons. And although...

www.diabetes.org.uk

As he has access to both long-running and mealtime doses, it does sound as if his insulin regime ought to be flexible enough to adapt to an alternative medication, with a little cautious adjustment? In a way that one might need to on basal:bolus if embarking on a course of steroids (which commonly change overall BG levels, though upwards in that case).

A conversation best had with his specialists really 🙂

 

[rebrascora]

Hi and welcome from me too.

Sorry to hear about the health challenges your partner is experiencing. Diabetes on it's own is difficult and frustrating enough. I just wondered if his bile acid malabsorption might be better treated with Creon which is a (prescription only) digestive enzyme supplement. We have quite a few Type 3c diabetic members on the forum who need Creon to help digest fats, proteins and carbs as well as insulin to manage their diabetes.

Has he had a Faecal Elastase test to assess his pancreatic enzyme production or deficiency? Chronic diarrhoea can be a symptom of Pancreatic Enzyme Insufficiency and if it is likely that the Haemochromatosis has damaged his pancreas, then it may well have resulted in PEI as well as insulin dependent diabetes, since the pancreas is responsible for both functions.

 

[John Gray]

Cholestyramine (comes in 4g packets of white powder) was originally designed to reduce cholesterol, before the days of the statins.
It has also been found useful to make stools more solid / reduce diarrhoea - a sort of "loperamide (Imodium) light".
I never had any trouble when I was on it, apart from the difficulty of getting the dose right to cope with a varying diet and a confused stomach...