Help guys C peptide question

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christmasfairy1

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Relationship to Diabetes
Type 1
Hi all, I've been given the run around ( following admission to hospital and insulin commenced) by the diabetes nurses on the local team.
Little back story ... had varying symptoms in Feb , called my gp and said I thought I had pancreatitis ( it was text book) was told no it's not take paracetamol every 4 hours and stay hydrated.
Fast forward to March ,I attended a clinic app with diabetic consultant , she'd never met me before but looked at me and said you really don't look well. Drew some blood and fast tracked it. Results glucose 29.9 ketones 5.0.
Ended up being admitted to hosp over night and commenced on insulin 5 times a day.
Have had a really rough time since with random hypos and 0 symptoms and just generally feeling 'mehhh'.

Had a clinic appt 4 weeks ago where a cpeptide was done ( because during the overnight hosp stay they failed to process it correctly) I also had a random urine sample which when dipped was showing leukocytes / nitrites etc and was sent off to the lab.
I called for the results and was told by a diabetic nurse the c peptide had come back as normal and urine was clear. Phone call the next day from the consultant herself who informs me cpeptide needs re doing as it hadn't been processed properly oh and by the way I had e coli in the urine !
So v long story short I had to have peptide re done last week and also a faecal elastase.
Results have come through to my gp ( can't get to speak to them) and the cpeptide is 0.43.

Now they keep telling me I'm type 1 diabetic which changed to type 3 and I cannot get any clarity.

My que being is a c peptide of 0.43 hi / low ? I'm also having symptoms consistent of pancreatic issues ( frequent disgusting stool/ gas , loosing weight and upper gastric pain.
At a recent trip for an xray one of the radiographers asked me if I have epi ( I've no idea,)
So the result being as it is , those in the know, is this hi or low and consistent with type 3 or 1???
Many thanks in advance for getting through that essay lol
Abi
 
christmasfairy1 said:
Hi all, I've been given the run around ( following admission to hospital and insulin commenced) by the diabetes nurses on the local team.
Little back story ... had varying symptoms in Feb , called my gp and said I thought I had pancreatitis ( it was text book) was told no it's not take paracetamol every 4 hours and stay hydrated.
Fast forward to March ,I attended a clinic app with diabetic consultant , she'd never met me before but looked at me and said you really don't look well. Drew some blood and fast tracked it. Results glucose 29.9 ketones 5.0.
Ended up being admitted to hosp over night and commenced on insulin 5 times a day.
Have had a really rough time since with random hypos and 0 symptoms and just generally feeling 'mehhh'.

Had a clinic appt 4 weeks ago where a cpeptide was done ( because during the overnight hosp stay they failed to process it correctly) I also had a random urine sample which when dipped was showing leukocytes / nitrites etc and was sent off to the lab.
I called for the results and was told by a diabetic nurse the c peptide had come back as normal and urine was clear. Phone call the next day from the consultant herself who informs me cpeptide needs re doing as it hadn't been processed properly oh and by the way I had e coli in the urine !
So v long story short I had to have peptide re done last week and also a faecal elastase.
Results have come through to my gp ( can't get to speak to them) and the cpeptide is 0.43.

Now they keep telling me I'm type 1 diabetic which changed to type 3 and I cannot get any clarity.

My que being is a c peptide of 0.43 hi / low ? I'm also having symptoms consistent of pancreatic issues ( frequent disgusting stool/ gas , loosing weight and upper gastric pain.
At a recent trip for an xray one of the radiographers asked me if I have epi ( I've no idea,)
So the result being as it is , those in the know, is this hi or low and consistent with type 3 or 1???
Many thanks in advance for getting through that essay lol
Abi
Click to expand...
A few 3cs here so hopefully they will be along to help.
Your epi question
Exocrine pancreatic insufficiency (EPI), an important cause of maldigestion and malnutrition, results from primary pancreatic disease or is secondary to impaired exocrine pancreatic function. Although chronic pancreatitis is the most common cause of EPI, several additional causes exist.
 
Welcome to the forum, and sorry to see you’ve been through the mill.
I can’t comment on the c-peptide, I guess it depends on the units it’s measured in. My gut feeling is that it’s low. Was it a blood or a urine sample?
Type 1 is where the immune system has attacked the beta cells (the ones that produce insulin) but the rest of the pancreas still functions normally. Type 3c is as a result of pancreatitis, or removal of the pancreas, or something else affecting the whole pancreas, in which case it may have lost the facility to release digestive hormones as well. You may need to take Creon capsules to replace them, and help your digestion.
@eggyg and @Proud to be erratic are the two Type 3c who spring to mind, hopefully they’ll see this.
 
Leadinglights said:
A few 3cs here so hopefully they will be along to help.
Your epi question
Exocrine pancreatic insufficiency (EPI), an important cause of maldigestion and malnutrition, results from primary pancreatic disease or is secondary to impaired exocrine pancreatic function. Although chronic pancreatitis is the most common cause of EPI, several additional causes exist.
Click to expand...
Update!! , had the faecal elastase result back this afternoon, apparently its <15 what that means is anyone's guess
 
Update!! , had the faecal elastase result back this afternoon, apparently its <15 what that means is anyone's guess
 
Here’s the range for cpeptide. Was it from blood and stimulated (after food) or not?

mine was 265 pmol with bg of 18 so low end of intermediate. Guessing yours is intermediate too but depends what your bg was when taken.
 
christmasfairy1 said:
Oooo that's extremely low then, thanks for adding this.
Click to expand...

Yes, it’s low but that matches what you’ve been told - that you’re probably Type 3c - so in a way that’s a good thing as it’s confirmation. Hopefully you can now receive the necessary treatment and feel better.
 
Hi @christmasfairy1

I'm Type 3c following pancreatitis - treated as Type 1 with the addition of Creon (pancreatic enzymes) to deal with the EPI (exdocrine pancreatic insufficiency = lack of digestive enzymes).

The faecal elastase test that you had measures the amount of digestive enzymes that you are producing. As well as producing insulin and glucagon to control your blood sugar the pancreas also produces digestive enzymes. If your pancreas has been damaged you won't produce enough digestive enzymes to digest your food.

The largest issue is with digesting fat, as enzymes which digest carbohydrates and protein are produced in other parts of the digestive system as well as the pancreas.

Below 200 on the faecal elastase test indicates EPI, below 100 indicates severe EPI.
Looking at your result you would need replacement enzymes. Most of us take Creon but there are other brands.
Taking the enzymes should help with the digestive issues that you're experiencing.

It's good to hear that you're seeing a consultant - I'm assuming that is an endocrinologist for the diabetes? You will need to push for digestive enzymes if they have not already been prescribed, usually starting on a fairly low dose and increasing until the symptoms are under control. If your GP does not prescribe them then you may need to push for a referral to a pancreatic (HPB) team. I was started on Creon (and followed up) by the specialist pancreatic dietician.

You might also like to look at the NICE guidelines for pancreatitis which mention annual vitamin and mineral blood tests and DEXA (bone density) scans every two years as it is more difficult to absorb some vitamins and minerals with EPI.

Welcome to the Type 3c group! It's good to hear that you're getting support with the diabetes now and hopefully the support with the EPI will follow soon.

It's a lot to deal with, especially at the start. Please ask if you have any questions.
 
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soupdragon said:
Hi @christmasfairy1

I'm Type 3c following pancreatitis - treated as Type 1 with the addition of Creon (pancreatic enzymes) to deal with the EPI (exdocrine pancreatic insufficiency = lack of digestive enzymes).

The faecal elastase test that you had measures the amount of digestive enzymes that you are producing. As well as producing insulin and glucagon to control your blood sugar the pancreas also produces digestive enzymes. If your pancreas has been damaged you won't produce enough digestive enzymes to digest your food.

The largest issue is with digesting fat, as enzymes which digest carbohydrates and protein are produced in other parts of the digestive system as well as the pancreas.

Below 200 on the faecal elastase test indicates EPI, below 100 indicates severe EPI.
Looking at your result you would need replacement enzymes. Most of us take Creon but there are other brands.
Taking the enzymes should help with the digestive issues that you're experiencing.

It's good to hear that you're seeing a consultant - I'm assuming that is an endocrinologist for the diabetes? You will need to push for digestive enzymes if they have not already been prescribed, usually starting on a fairly low dose and increasing until the symptoms are under control. If your GP does not prescribe them then you may need to push for a referral to a pancreatic (HPB) team. I was started on Creon (and followed up) by the specialist pancreatic dietician.

You might also like to look at the NICE guidelines for pancreatitis which mention annual vitamin and mineral blood tests and twice yearly DEXA (bone density scans) as it is more difficult to absorb some vitamins and minerals with EPI.

Welcome to the Type 3c group! It's good to hear that you're getting support with the diabetes now and hopefully the support with the EPI will follow soon.

It's a lot to deal with, especially at the start. Please ask if you have any questions.
Click to expand...

Twice yearly DEXA scans?!! I'm astonished it's quite that frequent, although absolutely don't doubt you.

As a matter of interest, which vitamins and minerals do you have tested?
 
AndBreathe said:
Twice yearly DEXA scans?!! I'm astonished it's quite that frequent, although absolutely don't doubt you.

As a matter of interest, which vitamins and minerals do you have tested?
Click to expand...
Should have read every 2 years. I'll correct.
Looks like the vitamins and minerals I had tested this year were:
Zinc
Copper
Selenium
B12
Iron
ferritin
folate
D
Magnesium
A
E
I think it was nine vials of blood in total (and the blood had to be taken at the hospital) but they did also check other things like thyroid hormones, liver function, coagulation screen etc.
 
Last edited:
soupdragon said:
Should have read every 2 years. I'll correct.
Looks like the vitamins and minerals I had tested this year were:
Zinc
Copper
Selenium
B12
Iron
ferritin
folate
D
Magnesium
A
E
I think it was nine vials of blood in total (and the blood had to be taken at the hospital) but they did also check other things like thyroid hormones, liver function, coagulation screen etc.
Click to expand...

Excellent, thanks, soupdragon. Your answer is both helpful and timely.

I have a discussion with my GP tomorrow to discuss a couple of things (One problem, one appointment,........... we'll see!), and I do want to open batting on malabsorption, although I have a feeling I may get better engagement from the Endo at my regular review in October. He has previously looked at mal-absorption at a high level, but "stuff" that's going on point to it.

I also have DEXA every two years, and my most recent returned disappointing (to me) results. There is a desire that I should start bisphosphates, but bearing in mind a DEXA scan only reflects how one's bones absorb radiation, it does give any clues to what's actually going on.

Bispohosphates are horrid drugs (a quote from my Endo he'd likely deny), so I'm not keep to go down that route without a better understanding of any deficiencies that could be addressed.

Thanks again. Every day is a school day in my world, but today has been a good one. 🙂
 
About 20 years ago now I enrolled myself for an osteoporosis research trial being undertaken by a company with premises on the business park in between Bham Uni and the QE Hospital - lovely setting to visit and a taxi there and back from home! (so no expense spared) I was initially attracted to it because it offered women my age without any clinical signs or symptoms of osteoporosis a DEXA scan and you would get the results of that before deciding whether you wished to take part in the next bit, ie the drugs trial. The basis was to see if starting the osteoporosis drugs earlier than once you definitely had that, would delay the onset of it or stop it progressing so fast, or what.

Anyway - I didn't have it, only 'changes commensurate with my age', so 'very slight osteopenia' but not in my spine. Of course I read all the snags of the named drugs and because I'd fairly recently had such a horrible experience with statins, thanks but no thanks, so dropped out of the trial at that point.

A good few years later was when I fell over and smashed my left kneecap - first time in my life I'd ever broken a bone. They operated and did the jigsaw and pinned and wired it back together - it healed as per any normal bone for anyone does. Consultant who'd done the op was as pleased as me, as he was again when 12ish months later he had to open up again cos my lovely patella had rejected some of the pins so he had to pick bits of loose metal out of it this time. Still nowt wrong with tendons etc - and still even to this day no sign of the arthritis in it, that one of his younger colleagues had informed me was certain to follow - to which I'd snapped that I'd worry about that when it happened thank you - not a month after I broke the damn thing!

I like you would want to be 110% sure there was nowt else that could possibly be improved before considering taking them things.
 
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christmasfairy1 said:
Hi all, I've been given the run around ( following admission to hospital and insulin commenced) by the diabetes nurses on the local team.
Little back story ... had varying symptoms in Feb , called my gp and said I thought I had pancreatitis ( it was text book) was told no it's not take paracetamol every 4 hours and stay hydrated.
Fast forward to March ,I attended a clinic app with diabetic consultant , she'd never met me before but looked at me and said you really don't look well. Drew some blood and fast tracked it. Results glucose 29.9 ketones 5.0.
Ended up being admitted to hosp over night and commenced on insulin 5 times a day.
Have had a really rough time since with random hypos and 0 symptoms and just generally feeling 'mehhh'.

Had a clinic appt 4 weeks ago where a cpeptide was done ( because during the overnight hosp stay they failed to process it correctly) I also had a random urine sample which when dipped was showing leukocytes / nitrites etc and was sent off to the lab.
I called for the results and was told by a diabetic nurse the c peptide had come back as normal and urine was clear. Phone call the next day from the consultant herself who informs me cpeptide needs re doing as it hadn't been processed properly oh and by the way I had e coli in the urine !
So v long story short I had to have peptide re done last week and also a faecal elastase.
Results have come through to my gp ( can't get to speak to them) and the cpeptide is 0.43.

Now they keep telling me I'm type 1 diabetic which changed to type 3 and I cannot get any clarity.

My que being is a c peptide of 0.43 hi / low ? I'm also having symptoms consistent of pancreatic issues ( frequent disgusting stool/ gas , loosing weight and upper gastric pain.
At a recent trip for an xray one of the radiographers asked me if I have epi ( I've no idea,)
So the result being as it is , those in the know, is this hi or low and consistent with type 3 or 1???
Many thanks in advance for getting through that essay lol
Abi
Click to expand...
Little update....
I've now been diagnosed as having type 3c exocrine pancreatic insufficiency.

The hospital have now commenced freestyle libre (which is welcome by me as my fingers resemble a pin cushion).

I've been advised I need to take pancreatic enzymes for the rest of my life, yet its been 5 weeks and still the hospital and the Doctors are still arguing over whose to pay for them so I still don't have a prescription. ( despite being extreemly symptomatic)

My Cpeptide result was 0.43 and the faecal elastase, less than 15 . I remain on 5 injections a day consisting of 2x Levimir and 3x Novorapid. I've consequently become A symptomatic regarding hypos ( which is very scary,I always double check via finger pricking)

Due to my accident 2 years ago, I have short term memory loss and can sometimes forget if I've injected. Does anyone else use the Novorapid echo plus smart pen in conjunction with freestyle libre? Are these pens available via the NHS or private purchase only?
Anyway I want to thank all who responded to my original post ,thought I'd give a little update on my situation a few weeks down the line.
A
 
It’s good you’ve finally got a definite and correct diagnosis @christmasfairy1 but ridiculous that you’re still waiting for Creon. I hope that’s sorted very quickly. Can you complain?

It’s worrying you’ve lost your hypo awareness. Do you drive? Is it the erraticness of the 3c that’s caused this? How are your blood sugars? With Type 1, running slightly higher for a few weeks can restore awareness. I’ll tag @Proud to be erratic @eggyg @martindt1606 and @soupdragon for you.
 
Inka said:
It’s good you’ve finally got a definite and correct diagnosis @christmasfairy1 but ridiculous that you’re still waiting for Creon. I hope that’s sorted very quickly. Can you complain?

It’s worrying you’ve lost your hypo awareness. Do you drive? Is it the erraticness of the 3c that’s caused this? How are your blood sugars? With Type 1, running slightly higher for a few weeks can restore awareness. I’ll tag @Proud to be erratic @eggyg @martindt1606 and @soupdragon for you.
Click to expand...
I can't drive at the moment due to the accident, I'm really unsure why the symptoms have upped and disappeared. I used to be symptomatic at 4.0 now I can go down to 3.2 and have abs 0 symptoms.
My bs have been so erratic, my pancreas likes to pop up and have a go sometimes. Other times abs nothing and my sugars jump up to 22 ish so the charts on the old freestyle libre look like a 2 year old has drawn them with a crayon lol
A
 
christmasfairy1 said:
I can't drive at the moment due to the accident, I'm really unsure why the symptoms have upped and disappeared. I used to be symptomatic at 4.0 now I can go down to 3.2 and have abs 0 symptoms.
My bs have been so erratic, my pancreas likes to pop up and have a go sometimes. Other times abs nothing and my sugars jump up to 22 ish so the charts on the old freestyle libre look like a 2 year old has drawn them with a crayon lol
A
Click to expand...
This could be because you do not have the Creon to help with digestion of foods, you need to get that asap.
 
christmasfairy1 said:
I can't drive at the moment due to the accident, I'm really unsure why the symptoms have upped and disappeared. I used to be symptomatic at 4.0 now I can go down to 3.2 and have abs 0 symptoms.
My bs have been so erratic, my pancreas likes to pop up and have a go sometimes. Other times abs nothing and my sugars jump up to 22 ish so the charts on the old freestyle libre look like a 2 year old has drawn them with a crayon lol
A
Click to expand...

It’s spending too long low too frequently that causes unawareness. Once you get your Creon, hopefully that will help a bit. To restore awareness you’d need to set your minimum blood sugar higher ie try not to go below 5/6/whatever and correct with carbs if you do drop below. That should reset your awareness overtime. I know that that’s easier said than done with 3c.
 
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