John, continuing my thoughts ...
Remaining sanguine is excellent, well done. Going off on a tangent for a moment one of the generic complications of diabetes is that there are loads of factors that can affect our BG (a list of 20 was recently updated to become 42 factors) and stress is a big hitter of BG. Stress can be from emotional variations, from pure worry and even from illness. Back in 2020 I knelt on a thorn, didn't realise and later that night my BG rose inexplicably (to me). My knee wasn't painful at first , uncomfortable a day later and eventually I needed a GP nurse to treat, followed by urgent referral direct to a Specialist at my local hospital, strong antibiotics and 9 days in a leg brace to sort that out. My BG remained stubbornly high for 5+ days - simply because my body was, behind the scenes, fighting the infection. Illness (= medical stress) is a common explanation for elevated BG. I was lucky to get such prompt treatment and referral; I was undergoing chemo at the time, so very well looked after.
Something I said yesterday about carbs and insulin was lazily written by me. I should have talked about matching insulin to carbs, not the other way around. When you are going low or hypo you respond by eating high GI carbs such as Pastilles. One is at that moment, very necessarily, chasing the excess of insulin with carbs. But in general the goal is for one to count the carbs going to be consumed and take an appropriate insulin dose to offset those carbs, ie the insulin is chasing the carbs. The carb counting is the primary step. But understanding your body's metabolism and its responsiveness to insulin is an art rather than a science; so we try to manage the timings of glucose arriving in our blood stream against the time needed for insulin injected in a sub-cutaneous place to reach your actual blood. Don't be daunted by this, we all learn what works for us and over time get better at smoothing the peaks and troughs displayed on our libre graphs. And we do this without necessarily reading a reference book on metabolism!
I think it is helpful to understand a bit about who does what in the world of the NHS. This, of course, needs a 31 volume reference library and would still be wrong! But in principle Type 2 diabetes is managed at GP level - by definition. The National Institute for Clinical Excellence (NICE) have laid down that T2 (some 90% of people in UK with Diabetes) comes under General Practice and T1s are to be managed by Hospital Specialists. Other types (with descriptors such as LADA, MODY, T3 [ie recognisable by virtually no-one outside the medical world] [except Gestational diabetes]) are in such small quantities they also should fall under hospital teams.
In my
non-medical opinion no GP or Practice Nurse is going to be sufficiently knowledgeable to provide appropriate treatment for T3c. You are as if T1, but with the added complication of pancreatitis - and as you have already remarked that pancreatitis has a huge bearing on what you can eat and thus what you are willing to risk eating. So insulin dosing is a big deal to match your carb intake and this is well beyond what any Practice Nurse or GP routinely deals with. This is not me being blatantly rude about GP Surgeries, just reflecting the harsh reality that your diabetes needs the right specialist. I'm surprised that you were discharged from Hospital back to GP care, rather than to your local Hospital Team - where there would normally be a Diabetes Specialist Nurse (DSN) who works in close collaboration with Endocrinologist Consultants and both supported by specialist dieticians.
Yes, good pragmatic (and low stress) perspective.
Returning to your previous post
I know extremely little about humulin having only encountered a basal/bolus regime. To me humulin feels counter intuitive and constraining. But no doubt the hospital had a better perspective of your needs.
@rebrascora is right. I have hypo treatments close to hand at all times and everywhere in the house.
Do you drive? The answer to that has various ramifications, but could also provide a lever for getting you prescribed CGM.
The alarms can be a nuisance. In passing, have you worked through the Freestyle series of short videos. If Libre were being prescribed the NHS make viewing those obligatory. They provide a glossy spin on Libre 2, but are still pertinent even though some of the Libre limitations are underplayed.
My diabetes from having no pancreas whatsoever, is described as brittle. I can crash very abruptly, because I'm missing all of the other pancreatic functions, which might otherwise provide some checks and balances between insulin release and glucose releases from the liver store. Have you been able to make time to read up about what a normal pancreas does? I looked on the Panreatic Cancer website and found great info there; but I'm sure there was an equivalent site for pancreatitis help.
Yes, not necessarily appreciated even by Specialists.
I'm 74 this month. Now I've pushed the cancer into remission and because I diligently count my carbs (and eat my spinach) I'm taking such good care of my D and my general well being that my aspiration is for another 40 years. It's my brain cells that I can't truly keep working so well as in previous years.
Slightly less glib - I notice aches and pains more and sometimes feel older but I intend to pace myself better. I do most things I've ever done, just some less frequently. And the diabetes does cause me to get out walking, if no longer sprinting, because the exercise is an alternative way of lowering BG highs, as an alternative to taking corrective insulin doses. That reflects my confidence in my ability to manage my D - learnt over the last 3 years - rather than my desire to save the NHS the cost of a few units of insulin.
The mountain has, for me, become a more modest, manageable hill.
