Hi again,
Really sorry to hear about your sciatica progression. Neuropathy is a recognised consequence of diabetes that can occur when the blood glucose is not particularly well controlled; but neuropathy is not exclusively caused by diabetes. I have mild neuropathy in the soles of my feet which started during the chemo I had in mid 2020. So far mine is not particularly painful, fortunately, but I have lost some sensation and struggle sometimes to walk on uneven ground without seeming to be drunk!! There are medications that can help, but this is outside my knowledge and is something that your GP should be helping you to manage.
Incidentally brain fog can be a symptom of both high or low BG and 'a short fuse' frequently occurs with low BG. There are many (very many) factors that can affect one's blood glucose - not just carbs eaten and insulin taken. Stress is a significant factor that raises BG and stress can be from medical problems, emotional responses as well as the worries and difficulties that occur with daily living. Anything you can do to reduce stress in your life is beneficial - easy said and hard to achieve, I know!
About Glicizade:
It's unfortunate that your GP and DSN can't agree, but sadly I can (sort of) see why that occurs. Your GP by definition deals with a huge number of different medical conditions and he/she may have a reasonable understanding of T2 (which accounts for 90% of diabetes in UK), but he/she is unlikely to have a good grasp of the intricacies of T1, let alone T3c or pancreatitis. Nor will the GP's practice nurse have that specialist knowledge, which is outside of general practice and is why a GP will normally refer you to a Specialist. Your DSN should be better placed to guide you and can at least reach out to a Consultant Endocrinologist (with lots of letters after their name) and get their understanding of your needs sorted in their minds. But DSNs are busy and some were deflected into Covid response nursing, so they have a backlog and anyway might not be fully up to speed on pancreatitis and diabetes. The T3c club is very small!
But Glicizade makes your pancreas work harder to produce extra insulin naturally. The risk is that if your pancreas is producing some insulin the gliclizade will be trying to enhance that production, while meanwhile you are also injecting insulin thus increasing the likelihood of going hypo. This will also be decreasing your chance of controlling your diabetes; you know to some extent what effect your injected insulin has but have no possible way of quantifying what the Glyclazide is doing. So my NON MEDICAL view is STOP taking the Glyclazide, its likely to be worsening your risk of hypos. Unless you have a Consultant specifically telling you otherwise.
T1 vs T3c:
You are T3c, but being treated as if T1, which means you not only get insulin on prescription as a matter of necessity but you should also always get the supplementary support and treatment that insulin dependent diabetics need. Very regrettably, insulin dependency is seen by most medical people as just T1s; and T3cs can get overlooked. So gracefully accept being treated as T1, even though some aspects of T3c are sometimes even more problematic; but be prepared to politely insist that you need additional support as a T3c with pancreatitis. The cause of T1 is not the same as T3c, so the treatment isn't completely the same.
This support should include things like feet checks and eyesight checks; variation in blood glucose can lead to variation in prescription - almost by the hour - but also in the longer term damage to vision from something called retinopathy. Your DSN or GP should have set you up for annual eyesight checks, with the empathise on detailed checks of the eyeball and optic nerves, over and above the regular eye tests one needs if you would normally wear glasses. At this early stage in your diabetes you may well notice vision changes, as you oscillate between BG too low and too high; high glucose changes the shape of your eyeball and thus can lead to distorted vision. I wear glasses for short-sightedness and have noticed that sometimes my prescription is fine and sometimes my glasses aren't doing what I expect them to do. I'm over 70 and used to have free annual Eye tests; but post Covid this has been reduced by the NHS to every 2 years. However, because I'm insulin dependent my optician has accepted that I need annual tests and over-ruled the NHS guidance; they have some discretion to be ablevto do this. I separately get diabetes generated annual Eye checks for abnormalities, but these are not tests for my spectacle prescription.
About carb counting:
@soupdragon has explained the advantage of carb counting. Being short of money shouldn't stop you from counting the carbs of whatever you eat and thus taking the right amount of insulin for the food that you do eat. A slice of economy white bread or a potato still has carbs and these, along with any other food you eat can be carb counted! Almost anything that comes packaged from a supermarket has the carb content stated on the packaging; usually as carbohydrates per 100gm, sometimes per portion.
You are taking slow release Lantus insulin, which is called your basal insulin. It is intended to deal with all the glucose your body generates in a 24 hour period - EXCLUDING any glucose you eat (carbohydrates get converted by your digestive system into glucose). So if you have an adrenaline rush (which happens for all sorts of reasons during any day) your liver gets a "message" from the adrenaline hormone and releases glucose from the liver store into your blood. Your basal (lantus) insulin deals with that. When you eat you need the bolus (NovoRapid) insulin to deal with that extra glucose coming from your digestive system. Also, if from finger pricking, your BG is too high and you need to apply a correction, that is done with the NovoRapid. This bolus insulin is relatively rapid, in relation to your Lantus and lasts over a 4-5hr period; we are all different and exactly how long it last varies from person to person.
My worry for you is that if you are constantly running high, in order to avoid going hypo, then you are putting in place the possibility of irreversible damage to various organs and limbs. You should be trying to keep your BG in the range 4-10. You won't achieve this all of the time: perfection is not a realistic option. By adopting carb counting you give yourself a better chance of gaining control of your BG.
Pester your DSN to get you on a DAFNE course (ideal), or Bertie on line to get the basics. A DAFNE course with other insulin dependent diabetics gives you the opportunity to compare experiences with others. DESMOND courses won't be appropriate; they are for T2s and about how to reduce or limit your carb intake and as snapdragon has said you do not need to do that. But don't dismiss the notion of a carb counting course; I feel sure you will find it helpful.
About Libre 2:
By being treated as a T1, you should be eligible for the Libre 2 sensor on prescription. This measures your Blood Glucose continuously and by scanning the sensor with either the reader that the manufacturer, Abbott, should provide or a suitable smart phone you can get instant snapshots of your BG without finger pricking - most of the time. There are limitations in the use of Libre and there is a need to finger prick sometimes, but the advantages of using a Libre sensor makes management of your diabetes a game changer. Ask your DSN to get your name on the list; as a T3c, being treated as a T1, you should be eligible.
Enough from me for now. This is already too long. Feel free to keep asking questions, no question is stupid. Diabetes is complicated, confusing, contradictory and at times frightening. All that said, with time and experiences to learn from it gets easier. You may find that phoning DUK, as offered by Poppy at #8 of this thread, could be most helpful. You are in a complex position with at least 2 major ailments on top of your diabetes and DUK might be able to help you steer a course through the labyrinth of medical bureaucracy.
Good luck, Roland
