Hello Angela
@GracefulAng,
Is Paul wearing his Libre 2 sensor yet? If not, its time to get him to accept that he has to overcome his fear of needles and use the tech. It has a low BG setting which can alert him when he has got to 5.6 mmol/L or lower. He is very fortunate to have this tech on prescription and now has to pull up his big boy pants and take full advantage of the help this will give him. Do all you can to encourage him to do what I know that he knows is the sensible thing.
Meanwhile, although somewhere in the 8s might seem worrying because this is new territory for him, in practice it's well into "mid-range", ie between 4 and 10 and a great place to be. Since Paul is only taking a slow-acting, background, insulin (Toujeo) just once daily, his risk of going near 5 is very, very small. The Toujeo along with his food (carb) control have very gently, calmly, brought his BG down to below 10; its been a textbook illustration of BG management by you both since his diagnosis a few weeks ago.
Do not even consider reducing or stopping his Toujeo at this stage. It is doing a great job of getting his BG back to where it needs to be for his long term health. In the coming months his Toujeo dose might need further tweaking - up or down with a goal of getting his routine BG nearer to 5. That guidance should come from his GP or Hospital Diabetes Team at this early time; in time Paul will routinely recognise when to adjust his insulin as I now do.
Hypoglycaemia occurs at 3.5 mmol/L. This is always rounded up to 4 and that provides a tiny buffer or safety margin; "4 is the floor" is an expression frequently used. At 4, Paul might start to feel some of the hypoglycaemic symptoms - ONCE his body has adjusted to routinely being close to 4. Because he will have had high BG for months, possibly years, it is possible that his body (brain really) could have his inbuilt hypo awareness impaired. His gradual lowering of BG is a very safe way of getting that hypo awareness mechanism relearnt. So aiming to stay above 5, rather than the floor of 4, just adds to his hypo safety. 5.6 as an alert level is ideal at this stage.
The damage to his pancreas from the pancreatitis could not only have affected his insulin production, but also his ability to make another hormone called Glucagon. Hormones are part of our body's messaging system and Glucagon tells one's liver to release some Glucose from its store IF/WHEN one's brain has detected low BG. Its all part of a very sophisticated process that routinely happens in people who are not diabetic and who's BG stays at normal levels. It will take time to establish exactly how much damage the pancreatitis has already done and it is realistic to expect that his pancreatitis might continue.
Its all part of the difference between being Type 3c and the much more widely found Type 2, where someone is producing lots of their own insulin but their body is resisting using that insulin.
Please don't be put off asking questions, either of you. There is so much to learn. No question is silly.
