High readings

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Derek2210

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Type 2
Hi I have been type 2 since surgery in October 2020. My last HB1AC was 48
I am having trouble getting my readings down, today I have readings of 16.5, 17, 15, and 20
Since surgery I have been readmitted to hospital 40 times with infection and fever, 32 times I've had biliary sepsis and no one can find the source of the infection, probably inside liver
Each time I'm in for 7 days on IV Antibiotics
My last discharge was 8 days ago, I saw the diabetic nurse as my high readings had red flagged them
She was reluctant to raise my insulin as I'm on 44 units am and 14 units pm
Anyone have any suggestions please
I'm 6 ft 1, and weigh 125kg so BM is 36.4, so weight is not on my side
 
Derek2210 said:
Hi I have been type 2 since surgery in October 2020. My last HB1AC was 48
I am having trouble getting my readings down, today I have readings of 16.5, 17, 15, and 20
Since surgery I have been readmitted to hospital 40 times with infection and fever, 32 times I've had biliary sepsis and no one can find the source of the infection, probably inside liver
Each time I'm in for 7 days on IV Antibiotics
My last discharge was 8 days ago, I saw the diabetic nurse as my high readings had red flagged them
She was reluctant to raise my insulin as I'm on 44 units am and 14 units pm
Anyone have any suggestions please
I'm 6 ft 1, and weigh 125kg so BM is 36.4, so weight is not on my side
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Hello, what insulin are you using?
 
Hi @Derek2210 Are they going to do any exploratory surgery to try to find the source of infection? If that’s the cause of your highs then stopping the infections is the obvious answer. Would there be other meds you can take to keep infections at bay, eg a daily antibiotic?

You could ask for a separate fast-acting insulin, which you could use to correct your highs.
 
Inka said:
Hi @Derek2210 Are they going to do any exploratory surgery to try to find the source of infection? If that’s the cause of your highs then stopping the infections is the obvious answer. Would there be other meds you can take to keep infections at bay, eg a daily antibiotic?

You could ask for a separate fast-acting insulin, which you could use to correct your highs.
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Hi ,i have decided to go private as my surgeon at Addenbrookes is apprehensive about going in again
I have appointment in London on May 1st
I've had every scan and scope known to mankind and still no answer
I have a rescue package of antibiotics when fever begins, sometimes they don't work
 
Hi and welcome.

Really sorry to hear that you have been through such a rough time with your health in the last few years.

Can you elaborate on the surgery you had in 2020 when you became diabetic? Did you go onto insulin straight away or were you able to managed with oral meds for a while first. The reason I ask is that I am wondering if you may actually have Type 3c diabetes rather than Type 2. Diabetes type is categorised by the cause and Type 3c is caused by damage (including surgical), disease or trauma to the pancreas, whereas Type 2 is metabolic and should not generally occur following surgery. If you are Type 3c and needing insulin, then a different insulin regime and better support and access to technology would be the norm, so it can make a significant difference to your diabetes management, having the correct diagnosis.
 
Derek2210 said:
Hi ,i have decided to go private as my surgeon at Addenbrookes is apprehensive about going in again
I have appointment in London on May 1st
I've had every scan and scope known to mankind and still no answer
I have a rescue package of antibiotics when fever begins, sometimes they don't work
Click to expand...

Sorry to hear that @Derek2210 It must be a really difficult situation for you. I hope your appointment on May 1st goes well.
 
rebrascora said:
Hi and welcome.

Really sorry to hear that you have been through such a rough time with your health in the last few years.

Can you elaborate on the surgery you had in 2020 when you became diabetic? Did you go onto insulin straight away or were you able to managed with oral meds for a while first. The reason I ask is that I am wondering if you may actually have Type 3c diabetes rather than Type 2. Diabetes type is categorised by the cause and Type 3c is caused by damage (including surgical), disease or trauma to the pancreas, whereas Type 2 is metabolic and should not generally occur following surgery. If you are Type 3c and needing insulin, then a different insulin regime and better support and access to technology would be the norm, so it can make a significant difference to your diabetes management, having the correct diagnosis.
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I had a whipple for duodenal cancer I had part of my pancreas removed and was started on insulin and met forming immediately
Thank you for your reply
 
I had a feeling that was going to be the situation, so assuming you were not diabetic before the operation, then you are Type 3c and should be treated as if you are Type 1, definitely not Type 2.
Do you also take Creon to help with digesting your food?

I am going to tag a few of the experienced Type 3c members @Proud to be erratic @soupdragon @Wendal who can maybe relate more to your situation and give you more focused advice.
Getting a more flexible insulin regime might be a good place to start and a CGM sensor system like Libre if you don't have it and are just finger pricking to monitor your levels. That might help you to balance your levels better, particularly if you are having repeated infections as that will mess with your BG levels and insulin needs and high BG levels will make you more prone to infections, so it can be a vicious circle, so having a more flexible insulin regime and better monitoring might help you to get on top of the repeated infections. Hopefully the above members can give you advice on things to ask at your coming appointment too.
 
rebrascora said:
I had a feeling that was going to be the situation, so assuming you were not diabetic before the operation, then you are Type 3c and should be treated as if you are Type 1, definitely not Type 2.
Do you also take Creon to help with digesting your food?

I am going to tag a few of the experienced Type 3c members @Proud to be erratic @soupdragon @Wendal who can maybe relate more to your situation and give you more focused advice.
Getting a more flexible insulin regime might be a good place to start and a CGM sensor system like Libre if you don't have it and are just finger pricking to monitor your levels. That might help you to balance your levels better, particularly if you are having repeated infections as that will mess with your BG levels and insulin needs and high BG levels will make you more prone to infections, so it can be a vicious circle, so having a more flexible insulin regime and better monitoring might help you to get on top of the repeated infections. Hopefully the above members can give you advice on things to ask at your coming appointment too.
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Yes I take Creon, any help from anyone would be greatly appreciated
 
Yes your class of diabetes is Type 3c - which once you need insulin and not just tablets - should be treated just like Type 1 diabetes as far as drugs are concerned BUT not by most GPs who just are not experts and are not supposed to be that anyway, for any medical condition. The Metformin MIGHT be having some effect on eg kidney and/or heart protection but not likely to be having much beneficial effects on your blood glucose, since it just doesn't - it only helps your body to use your naturally produced insulin - and I can't guess whether you still produce any of that. On the assumption that you don't - it can't help in that way.

Any mixed insulin - as Humulin M3 definitely is - is unlikely to be of lifelong help to anyone in this day and age. OK it's very OK in the interim until your actual natural production of insulin is properly evaluated - but with ongoing infections - difficult to test since ANY other bodily medical condition increases the blood glucose because when the body ramps up its antibodies to fight whatever's wrong with it - that just is what naturally inevitably occurs. I have no idea whatsoever about the internal workings of Addenbrooks but why on earth cannot you request your oncology consultant to immediately arrange for their diabetes experts to see you PDQ and advise you properly on an ongoing basis? OR at the very least tell your GP that you need expert assistance with it all asap and ask what if anything he/she can do to help you be seen by the appropriate experts?
 
Pleased to hear that they got all the cancer. Is your diabetes management just overseen by your GP or a nurse at your GP practice then? Who started you on insulin and who adjusts your doses?
 
rebrascora said:
Pleased to hear that they got all the cancer. Is your diabetes management just overseen by your GP or a nurse at your GP practice then? Who started you on insulin and who adjusts your doses?
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Hi. The hospital Diabetic team diagnosed Type 2 in 2022, I'm under the care of diabetic nurses at GP surgery I've only seen her once although I have appointment on 8th May
I was in hospital last week with infection and biliary sepsis
My blood was high teens all week whilst on iv antibiotics but the diabetic nurse was reluctant to change dose
I'm on 44 Units of Humiln before breakfast 9am and 14 units in evening 7pm
 
You really need to be under the treatment of the diabetes specialist clinic at the hospital. Your diabetes is actually more complex than Type 1 and the nurse at your GP surgery does not have the level of knowledge or experience to support you.... plus you are wrongly diagnosed if they have you down as Type 2 and this also needs rectifying. You may have to be politely pushy to get that referral but it is really important.

You will really struggle to manage your BG levels with a mixed insulin especially when you are getting frequent infections and you need much more support. High BG levels mean that you are more at risk of infection because bacteria thrive on glucose and infection raises BG levels, so you need to be able to adjust your insulin doses when necessary to keep your BG levels in range as much as possible when an infection starts and you really can't do this effectively with a mixed insulin. You need a basal/bolus system, where you have separate fast acting and slow release insulins. You are at risk of Diabetic KetoAcidosis DKA if you don't manage to keep your BG levels in check. Do you have anything to test for ketones? Perhaps a pot of strips to dip in your urine to measure ketones..... the usual brand is Ketostix. If not, ask the nurse for some. When your levels are mid teens or above you need to test for ketones and if you get a reading of more than 2, then you need to seek urgent medical advice/attention. DKA can kill you because your blood turns acidic and toxic and without prompt treatment, can cause organ failure, coma and death in extreme cases where medical assistance is not sought. It is very, very serious, so you need to be able to test for ketones.
 
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