Missing Creon and effect on BG levels

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Wendal

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Relationship to Diabetes
Type 3c
Morning,
Appreciate this is mainly for the Type 3c Creon taking individuals but would be interested in a wider audience‘s input.
If you miss a Creon dose or are simply not taking enough and you experience PEI then some of the symptoms may differ depending on your diet and whether the malabsorption is mainly that of fats,proteins or carbohydrates caused by lack of lipase,amylase enzymes etc.
Firstly does that make sense and if it is mainly affecting Carbohydrate breakdown so maybe it is not quickly broken down into glucose can that mean that your BG levels stay extremely stable even if you have reduced your insulin levels drastically and still consuming carbs as normal.
Thanks in advance.
I will be asking my DSN in our regular appt on Monday but appreciate any advance thoughts
 
In general terms missing a Creon dose or just taking too little certainly makes that evident for me a few hours later. I can't tell if my offensive consequential output is from poorly metabolised fats, proteins or carbs.

I do often find a connecting pattern with unexpected lows and poorly administered Creon and just assumed my bolus exceeded what was actually digested. I also don't get my normal flat line overnight.

Malabsorption can occur even with the right amount of Creon; there can be a build up of a constraining lining inside your colon, thanks to bacteria and for me that needed a Gastroenterologist to assess and diagnose, then a relatively unusual anti-biotic that needed authorising by a higher authority, before it could be prescribed for issue only from the Hospital Pharmacy. By chance I may be experiencing a recurrence of that malabsorption from late '21 and a referral back to my former gastro was made a fortnight ago; been acknowledged - still waiting for some sort of appointment. It's cramping my style - I won't go out until Nature has summoned me to a bathroom!
 
I think it is a really good and interesting question and I wonder if diabetes management for Type 2s has ever been approached from that perspective. ie. somehow reducing production of amylase or partially blocking it, so that carbs mostly pass through undigested for those people who find reduction very difficult or if that would cause issues lower down the digestive tract. I appreciate that those Type 3cs who need Creon find bowel movements extremely unpleasant and challenging without it, but is that the fats and protein or all maconutrients, which cause that.
I think traditionally, the NHS and probably other world organizations have been resistant to the idea of reducing carbs (believing them "essential" or at least fundamental) so maybe this is something which has been overlooked.
 
I may have mentioned this in a previous thread and apologise in advance.

When I had my gall bladder out in 2007 after bouts of pancreatitis, there was no mention of watching my diet or that I may suffer from malabsorption. When I returned to work, I had a few instances which were quite disturbing to me (toilet related). I was prescribed Creon and found on 9/10 occasions it didn’t work. I am now on a medication called Colestyramine and this has solved my malabsorption issues, I have been taking it for 13 years. I don’t know if it might be worth talking to your professional team about it?
 
rebrascora said:
I think it is a really good and interesting question and I wonder if diabetes management for Type 2s has ever been approached from that perspective. ie. somehow reducing production of amylase or partially blocking it, so that carbs mostly pass through undigested for those people who find reduction very difficult or if that would cause issues lower down the digestive tract. I appreciate that those Type 3cs who need Creon find bowel movements extremely unpleasant and challenging without it, but is that the fats and protein or all maconutrients, which cause that.
I think traditionally, the NHS and probably other world organizations have been resistant to the idea of reducing carbs (believing them "essential" or at least fundamental) so maybe this is something which has been overlooked.
Click to expand...
Well the medical world are clear that our brains need glucose and will get that somehow - from fats or proteins in the absence of straight carbs. So I'm not sure that reduced carbs will become a natural alternative for most people's diets. Except that low carb diets probably leads to a reduced volume intake? On the other hand carbs from staples like potatoes, white rice and bread are cheaper sources of food, so help those on really tight budgets. Anyway I'm not sure that the NHS has overlooked this low carb option - rather than just perpetuating their poorly thought through and out of date eat well advice.

I find it extraordinary that there is what feels like a broad understanding that obesity is a growing problem (no pun intended) and that T2 diabetes seems to be increasing faster than the national population. Yet the dietary advice for newly diagnosed T2s seems so poor - judging by the newcomers questions to this forum. Some proof of my perception lies with looking at the current advice online from the NHS.

I simply can't tell from a visual inspection what is not getting digested. Seeds are sometimes obvious, but they can sometimes be seen anyway. The rest - I don't know. The Creon is advised particularly when eating fatty meals - but I've never fully understood that in my circumstance of having absolutely no panc'y and so apparently no digestive enzymes in my stomach or colon. But maybe there are some enzymes elsewhere that I am unaware of, apart from those released by my saliva?
 
Duane62 said:
I may have mentioned this in a previous thread and apologise in advance.

When I had my gall bladder out in 2007 after bouts of pancreatitis, there was no mention of watching my diet or that I may suffer from malabsorption. When I returned to work, I had a few instances which were quite disturbing to me (toilet related). I was prescribed Creon and found on 9/10 occasions it didn’t work. I am now on a medication called Colestyramine and this has solved my malabsorption issues, I have been taking it for 13 years. I don’t know if it might be worth talking to your professional team about it?
Click to expand...
I have been meaning to do some research into Colestyramine. Thanks for the reminder.
 
Thanks for responses and have missed Creon doses in past with no effect whatsoever but my issue has been getting up early with the dogs and having toast an hour or two before breakfast and not bothering with Creon as I tend to only use if for meals/snacks bit not a slice or two of toasts.( have done this regularly with no effects until 10 days ago)
My BG goes up a little but them comes back down and I don’t bother with insulin until breakfast.
The last 2 weeks I have had some digestive issues but no steathoria ( know I have misspelt it) or weight loss and I am just trying to work out what may be causing it.
The real surprising thing is how my BG level has reacted this last week so very stable within a range of 5-8 and I have not had any bolus insulin for 8 days and my overnight Lantus is down to 2 units and yes I have on some days reduced my food intake due but I still probably consume 100g of carb a day and I really can’t explain it.
Anyway just searching for links and one I thought may be if it is carbohydrate malabsorption due to lack of Amylase due to maybe missing Creon with the toast or then perhaps the carbs are not been broken down into the glucose hence spiking BG or the liver is producing something to compensate.
 
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Take Creon as have Pancreatic Exocrine Insuffiency diagnosed 6 years ago, all I know is if dose is to low I can experience bowel discomfort, dose to high no effect whatsoever.

Along with lot of Creon users I find that.meals with high protein & fat content requires more capsules, classic example a mixed grill or bbq meal, a high carb meal with little fat protein doesn't seem to effect dosage, no idea why but it just doesn't.
 
There's an old mnemonic that helps remember the order of digestive enzymes in the digestive tract - Percy Potter runs across the lawn every morning; then they dicovered enterokinase. So we changed it to him dong that every Monday evening.

Anyway, so it starts in the mouth and goes down the tract thus

Ptyalin
Pepsin
Rennin
Amylase
Trypsin
Lypase
Erepsin
Maltase
Enterokinase

Very useful to pass the Joint Matriculation Board GCE O Level exam in 1966 anyway!
 
I've been taking CREON for about a year now and haven't missed my usual 4 capsules per meal yet so can't be sure but given what my guts were like pre CREON I don't think I will be experimenting!

As an aside CREON is still in short or sometimes no supply at my pharmacy, is anyone else experiencing this still?

Regards,

Chris
 
sololite said:
As an aside CREON is still in short or sometimes no supply at my pharmacy, is anyone else experiencing this still?
Click to expand...
I had this issue 15 years ago and it would appear that nothing has changed.
 
I had issues getting Creon about 2 months ago so could only get the 10k capsules .My pharmacist recommended to order both 10 and 25k in case of supply issues now I have a good stock.
My symptoms do seem to be improving so perhaps it was temporary but will continue down the investigative process.
 
sololite said:
As an aside CREON is still in short or sometimes no supply at my pharmacy, is anyone else experiencing this still?

Regards,

Chris
Click to expand...

Just once & that was 3 months ago, pharmacist said would have to order 10k capsules till 25k became more available, as it happened put in for 25k four weeks later no issues.
 
Morning very early feedback.
My symptoms continue to improve as I have taken Creon with every snack/ meal including specifically my early 2 rounds of toast.
Real interesting thing is on both occasions my BG has responded in exactly the way I would expect ( post prandial rise) without bolus insulin so spiking about 3 to 4 and then coming back down.
Will not have any insulin before breakfast and see what happens and whilst it was nice not having to make decisions about how much to take the other consequences were not so pleasant
 
I’m pretty sure when Jane was given Creon during her brief dalliance with pancreatic cancer, it was for processing fats not carbs?
 
everydayupsanddowns said:
I’m pretty sure when Jane was given Creon during her brief dalliance with pancreatic cancer, it was for processing fats not carbs?
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Am sure that is the main reason for giving it as fats are the hardest to breakdown and the pancreatic enzymes play a pivotal role.
Creon also contains the other 2 enzymes which digest carbs and protein which are also the exocrine function of the pancreas and are helpful.
I was just trying to rationalise why my BG seemed not to be reacting whereas breaking down any fats would not be anticipated to affect BG.
Anyway interesting discussion.
 
Wendal said:
I was just trying to rationalise why my BG seemed not to be reacting whereas breaking down any fats would not be anticipated to affect BG
Click to expand...
I can't remember your history with Type 3c but is it not just likely that your pancreas is still producing sufficient insulin to cover that glucose.
 
Wendal said:
Morning,
Appreciate this is mainly for the Type 3c Creon taking individuals but would be interested in a wider audience‘s input.
If you miss a Creon dose or are simply not taking enough and you experience PEI then some of the symptoms may differ depending on your diet and whether the malabsorption is mainly that of fats,proteins or carbohydrates caused by lack of lipase,amylase enzymes etc.
Firstly does that make sense and if it is mainly affecting Carbohydrate breakdown so maybe it is not quickly broken down into glucose can that mean that your BG levels stay extremely stable even if you have reduced your insulin levels drastically and still consuming carbs as normal.
Thanks in advance.
I will be asking my DSN in our regular appt on Monday but appreciate any advance thoughts
Click to expand...
Hi @Wendal . I am leaning a lot (digesting!) from your posts and am interested to know where I can get up to speed on all of this. I had my pancreas removed in February and have had little or no contact with NHS since then. I read Think Like a Pancreas when I got diagnosed with LADA 6 years ago and scour this forum for clues as to what's going on with my endocrine system now. Have you found any resources that can let me understand the biology and science behind the subject please? Regards, Chris
 
Hi Chris “ Think like a Pancreas” is an excellent start and think there are some who are better experienced ( no pancreas at all) @Proud to be erratic to point you in the right direction but there is lots of help available.
Barbara- yes I will have some Beta cell function but my question remains as to why my BG has hardly responded at all when I have taken no bolus and minimal basal,no exercise,fairly normal diet but I have have symptoms of something else happening.
Where before and after my symptoms have eased/ appeared my BG responds in exactly as normal which means I require insulin.
ATB
 
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