Insulin having no effect whatsoever

[Paul1953]

Hi I was diagnosed with Squamous cell carcinoma in the body / tail of the pancreas in November 2022, Chemo started on 12th Dec, prior to treatment blood sugar levels were normal, when the Chemo started the levels started to increase with highs of 20.6 mmol/l this occurred whilst on steroids Dexamethasone 2mg for 3 days after the chemo. Slow acting Insulin Glargine was prescribed to be injected after breakfast daily at 6 units, after the rise due to the steroids blood sugar fell back with an average reading of 16 the slow acting insulin was increased in stages from 6-8-12-16-24 units but blood sugars are still rising and are consistently high 28.8 mmol/l I have now been prescribed Fast acting insulin (insulin aspart) to be taken as well before meals at 4 units I am now 3 days into this regime but my blood sugars still remain high.



This is now after my 4th cycle of chemo and I have another 8 to go each time blood sugars are rising higher after each cycle.



I was also prescribed Creon 25000 prior to the full diagnosis and without any tests, despite having no symptoms of pancreatic cancer.



Could this cause the insulin to be ineffective?

 

[Eternal422]

Hi @Paul1953, it could be that your pancreas is not producing any insulin, in which case the slow acting (basal) insulin of 24 units sounds reasonable but that would just handle what your liver puts out throughout the day and wouldn’t cover any carbs from your meals. The fast acting insulin is usually around 1 unit to 10g of carbs, so total daily insulin could be around, say, 50 units. Obviously this varies between people and depends on how many carbs you eat, exercise, etc., etc.

I’m afraid I don’t know much about Type 3c and how the creon might affect BG levels, there are others on here who are Type 3c so perhaps they could offer more advice for you.

 

[rebrascora]

The steroids and chemo will be causing your liver to output more glucose I imagine as they are putting your body under stress, so it is likely you may need to continue to increase the basal insulin Glargine a bit more and it could also be that the 4 units per meal of Aspart is not enough for the meals you are eating. Those are very much starting doses, but it sounds like your levels at the moment are rising faster than the insulin doses are being increased.

Who is supporting you with your insulin regime? Are you under a consultant or diabetes specialist nurse (DSN) at a hospital clinic or are you getting insulin advice from a GP or practice nurse (who may have some basic training in diabetes management) at the GP surgery? You will; eventually get to a point that things start to find a balance and the tide turns but it does take time and your treatment will be making that balance point perhaps higher than you might expect although those are still not high doses. You need to keep going back to whoever is supporting you with your insulin regime to update them on your levels and get advice on further insulin adjustments.

 

[rebrascora]

Oh and I will tag @Proud to be erratic and @soupdragon and @eggyg as other Type 3cs who may have some input on Creon but I don't think it should impact your insulin needs unless you weren't taking it when you needed to and then you would likely need less insulin because your body would be struggling to digest your food, but it can't actually generate glucose, just help digest what is in the food you eat...... But just to reiterate, I don't think those insulin doses are particularly high so there is plenty of room yet for upward adjustment and the other treatments will almost certainly mean you need more than normal doses.

 

[soupdragon]

Hi and welcome @Paul1953
I have diabetes (Type 3c) following necrotising pancreatitis.

About the Creon - it will be helping you to digest the carbohydrates in your diet (as well as the proteins and fats) but only replaces the enzymes you're not producing. If you've been taking Creon for a while it shouldn't be causing a sudden increase.

You've got a lot going on with the treatment and steroids can certainly raise blood sugar.

Hoping that you can get some support with this from your hospital teams.

 

[Proud to be erratic]

Hi I was diagnosed with Squamous cell carcinoma in the body / tail of the pancreas in November 2022, Chemo started on 12th Dec, prior to treatment blood sugar levels were normal, when the Chemo started the levels started to increase with highs of 20.6 mmol/l this occurred whilst on steroids Dexamethasone 2mg for 3 days after the chemo. Slow acting Insulin Glargine was prescribed to be injected after breakfast daily at 6 units, after the rise due to the steroids blood sugar fell back with an average reading of 16 the slow acting insulin was increased in stages from 6-8-12-16-24 units but blood sugars are still rising and are consistently high 28.8 mmol/l I have now been prescribed Fast acting insulin (insulin aspart) to be taken as well before meals at 4 units I am now 3 days into this regime but my blood sugars still remain high.

Hi Paul. I had a total pancreatectomy to remove what proved to be a cancerous tumour around my panc'y and had been blocking my bile duct. This instantly made me a T3c. Three months later I started adjuvant (precautionary) chemo, planned to be at fortnightly intervals, but the frequency was increased whenever my fortnightly pre-chemo blood tests dictated that.

With each chemo session the steroids pushed my BG very much higher for the 3 day duration of the steroids, plus a couple of days after. Essentially, during these periods I had absolutely no apparent control of my BG, but my DSN kept me calm, adjusted my insulin regime and reassured me enough to allow me to move past those days. I did not have CGM at that time and had (very wrongly) been rationed in my prescription of test strips; so I was only finger pricking 4x daily (and possibly only at the worst times - certainly not seeing the bigger picture that CGM allows me now!).

I now understand that the important thing is not to get low, ie below 4.0, because not only are hypos unpleasant and need immediate response, but there is evidence that regular lows accumulate and can cause neural damage, which has been linked to longer term mental decline. Whereas I've also recently been told that 'high' hypers can make you feel pretty rubbish but don't cause the same sort of long term damage. Since the chemo made me feel rotten anyway, I was oblivious to the effects of being hyper for several days each chemo session.

This is now after my 4th cycle of chemo and I have another 8 to go each time blood sugars are rising higher after each cycle.

Out of curiosity may I ask what your chemo frequency is?

I was also prescribed Creon 25000 prior to the full diagnosis and without any tests, despite having no symptoms of pancreatic cancer.

I started on Pancreatic Enzyme Replacement Therapy (PERT) straightaway and my Gastro Consultant formally recorded my dosage as in "industrial" quantities. I take around 30 x 25,000 unit capsules daily; a tub of 100 capsules last c. 3days.

Could this cause the insulin to be ineffective?

I do not believe so. But I am not medically trained. My understanding is that you need what you need and you cannot cause harm by 'overdosing' on Creon. But too much does lighten the colour and make your faeces very loose.

 

[Merryterry]

Hi I was diagnosed with Squamous cell carcinoma in the body / tail of the pancreas in November 2022, Chemo started on 12th Dec, prior to treatment blood sugar levels were normal, when the Chemo started the levels started to increase with highs of 20.6 mmol/l this occurred whilst on steroids Dexamethasone 2mg for 3 days after the chemo. Slow acting Insulin Glargine was prescribed to be injected after breakfast daily at 6 units, after the rise due to the steroids blood sugar fell back with an average reading of 16 the slow acting insulin was increased in stages from 6-8-12-16-24 units but blood sugars are still rising and are consistently high 28.8 mmol/l I have now been prescribed Fast acting insulin (insulin aspart) to be taken as well before meals at 4 units I am now 3 days into this regime but my blood sugars still remain high.



This is now after my 4th cycle of chemo and I have another 8 to go each time blood sugars are rising higher after each cycle.



I was also prescribed Creon 25000 prior to the full diagnosis and without any tests, despite having no symptoms of pancreatic cancer.



Could this cause the insulin to be ineffective?

Sorry to hear of your problems. It must be very worryung?

I am on Creon 2500 for a different reason, (Pancreas Sectioned), and it does not affect my insulin.

Your problems seem to be one for the experts?

 

[Barbie1]

I have just been through steroids and chemo and although I was aware that steroids were likely to increase my insulin needs I was quite shocked at the amount of increase. I had to multiply my basal insulin by 4 to keep my sugars under control, and that higher dose had to continue for nearly a week after the steroids ended, and dropped to 1.5 times for the next week too. (My chemo had to be stopped after only 2 cycles so I cannot tell whether those needs would have continued to increase each time as you suspect yours may.)
Sending you best wishes at such a difficult time for you