Ileostomy and Type 2 Diabetes

[Docb]

If I can make a couple of points.

First, those who have no experience of an ileostomy should defer to those who have when it comes to the practicalities of their management. My brother had one and he gave me some idea of just how difficult things were and, @dannybgoode, I can see exactly the points you make from my conversations with him. It was a big enough problem without adding the complication of diabetes.

Second, it seems to me that you have got to get a balance when it comes to managing two conditions where treatment for one might not be a good thing for the other. I tend to take the view that being satisfied to get both things reasonably OK is better than striving to find some solution which will deal with both things perfectly.

@FiLee, you are hovering around the diabetes diagnosis limit in the "at risk" zone. in your position I think I would take that if the measures needed to reduce it played havoc with your ileostomy management. Only you can work out where you want your balance to be.

Can I also say a thank you to both for discussing the issue in such a straightforward manner. I am sure your discussions will be helpful to anybody who comes across this thread who is trying to work out how to handle multiple conditions where simple application of conventional wisdom might not work out too well.

 

[dannybgoode]

It was a big enough problem without adding the complication of diabetes.

Yes, juggling something like an ileostomy and diabetes certainly adds to the fun!

I would add also that seeing side the practical aspects of managing a stoma theres the mental side as well. It's life changing surgery and oftentimes it's been life changing for the better because it's curing something pretty hideous but also for the worse as living life forever with a bag you **** in is an interesting experience!

Diabetes too is life changing and mentally tough to deal with at times. Have them both chucked at you and it takes a huge amount of mental energy just to get your head around what you're living with.

I tend to take the view that being satisfied to get both things reasonably OK is better than striving to find some solution which will deal with both things perfectly.

Again, spot on. It is why I'm so drawn to the idea of staying on insulin. It works to manage the diabetes without impacting managing the stoma.

Sure, as a T2 (albeit of a slightly leftfield profile) there may be options that all things being equal would be better to try but if they don't work it the side effects are unpleasant at best.

As per other posts I'm going to give it a go but I'm damned sure coming straight back off the Metformin and staying with insulin if it does disagree with me!

 

[Proud to be erratic]

Thanks for your advice; and to answer yourself and @dannybgoode

My HBA1 was 51 in Jan 2024, 49 in June 2024 and 46 in October 2024.

Terrific, Fiona @FiLee, these results are good news! Is this trend sustainable for you? If it is, and I really do hope it can be, then you just need more of the same. Sustainable, or not, really WELL DONE. Don't underestimate what you've achieved, this doesn't happen without your diligence, so pat yourself on the back.

I clearly heard your plea for someone who can understand your food dilemna and medical issues! My instinct is that a stoma specialist dietician is likely to be a better option than a regular diabetes dietician. But my instinct could be flawed. Finding this person is not going to be easy and almost certainly it will need you to continue with your trial and learning while the search for the right dietician goes on (or any other specialist) . Probably in the end you might be more likely to find another you - ie someone with both T2 D and a stoma that you can share experiences with, as well as @dannybgoode.

To help you manage your expectations (and I don't want to dampen down all you've achieved in the last 12 months) your HbA1c statistics might penalise you. In the event of getting a GP referral for a D specialist appointment, you won't necessarily appear to be an important case for the D triage process - when that triage person or people are considering whether you as a T2 really do need an appointment with an Endicrinologist.

So how can we further help you with this challenge? At the very least you know we are here and we have centuries of experience in D matters. I strongly agree with @Docb that this needs to be about about finding the "balance" . You clearly know how your stoma behaves, but are not yet necessarily familiar with the curved balls that your D might throw at you in the future. These won't remotely be anything like as drastic as those curved balls your stoma can throw, not least because diabetes problems are slow moving (for you as a T2 not on any medication; they can be more imminent for me with my total insulin dependency).

Do you test your blood glucose at home, ie use a finger pricker and test meter? If you don't, this might give you some reassurance that you are doing "the right things" generally. They can also we help you validate meal choices that suit your stoma and if not ideal for managing your D, are at least OK. But testing can also be intrusive, demoralising even when you don't get the resul you were hoping for. Back to the "balance" question: has potential, but ....?

I'm going to step away now with an observation, useful I hope: none of us can manage our D perfectly all the time. PPeriodically we have difficult days and just need to get through those less good days, learn any obvious lesson if we can, then park the day and move on. Sometimes diabetes forgets or changes the rules - and doesn't tell us. When these days occur they are rarely really serious, not comparable to bad stoma days, just frustrating at the time. Meanwhile good luck.