New to all this

[Cosmic]

Hi
My husband has been told he has type 2 diabetes after a routine blood test, however after speaking to the nurse was told it was 'borderline' as his level is 51. Not sure quite what this means
Explained to her that he had necrotic pancreatitis in July 2021 due to a gallstone blocking the pancreatic duct (very grateful to all in NHS that he is still alive and well especially as it was during Covid) and she said that could be part of it, we said we were told to check for Type 3C by the Consultant but nurse at GP's said they do not test for that. Do we need to push for Type 3C diagnosis
Any help gratefully appreciated
Many thanks

 

[Leadinglights]

Welcome to the forum
The threshold for a diabetes diagnosis is anything over 47mmol/mol so 51 is actually just on the first rung of that ladder so very much worth taking some action in terms of dietary changes.
Pancreatitis can indeed lead to a Type 3c condition and as such may need to be treated as Type 1 if the damage has resulted in the pancreas not producing enough insulin.
There are quite a few people with Type 3c on the forum so hopefully they will be along to comment.
I expect it is unlikely that with an HbA1C of 51 that his nurse will at this stage have prescribed medication but will give him a chance to make dietary changes. This may be sufficient depending on the damage to the pancreas and medication may be required.
As it is carbohydrates which convert to glucose it is those that need to be reduced in the diet. Have a look at this link for some ideas for modifying his diet.
https://lowcarbfreshwell.com/

This is the link to the information about Type 3c https://www.diabetes.org.uk/diabetes-the-basics/type-3c-diabetes

 

[JohnSimpson64]

Folks on here who are way more knowledgeable than me will be able to fill in some gaps, but here's what I know from pure experience:
1. Usual boundary for T2 diabetes is a blood test/measurement called HbA1c which is above 48mmol/mol ….. which at 51 fits in with the ‘borderline’ thing.
2. A good number of GPs and GP based Diabetes Nurses do not know about (or have even heard of) Type 3c. They MAY know it as Pancreatogenic Diabetes or Secondary Diabetes …. both meaning much the same thing as T3c and which I’m pretty sure Pancreatitis falls into.
3. Type 3c diagnosis as far as I know is usually done by a hospital based ‘specialist’ diabetes department - which you would have to be referred to (no self-referral available in NHS AFAIK) by your GP or Consultant.
4. The HbA1C measurement can only be taken/repeated after 3 month periods so I would expect this to be done/monitored by the GP ….. mine wasn’t and I ended up with mega raised blood glucose after around 18 months. Which at least got me an instant referral to the hospital diabetes unit lol.

Hope that helps clarify if nothing else.

 

[rebrascora]

Hi and welcome.

Sorry to hear your husband has had pancreatitis and is now showing signs of diabetes. There is no specific test for Type 3c diabetes however, with a history of pancreatitis and the consultant suggesting that diabetes may result, then it would make absolute sense to diagnose him as Type 3c rather than Type 2, however the nurse will not be sufficiently knowledgeable to do that. The HbA1c test gives you a diagnosis of diabetes if you have a reading greater than 47. Some GPs and nurses may schedule a second test shortly afterwards if the result is only just over the diagnostic threshold to give the patient an opportunity to reduce it or to confirm the diagnosis, particularly if there are no symptoms.... which you would not generally expect at that sort of level.

The treatment for Type 3c diabetes varies according to how much insulin the pancreas is still managing to produce and since your husband's HbA1c is only just over the threshold, then they would be very unlikely to prescribe insulin at this time and perhaps no medication at all, because some dietary changes and perhaps increasing activity levels if he is able may be all that is needed to push that HbA1c back down. The important thing is that they have tested him for diabetes and things are not too bad at the moment.

If it gives you some perspective, my HbA1c was 114 at diagnosis and 6 weeks later it had gone up to 116 despite cutting all sweet stuff, plus all bread, pasta, rice, potatoes, breakfast cereals, anything containing flour and any other carb rich food from my menu, so I was started on insulin at that point. I was also on Type 2 medication at that time of max dose Metformin and Gliclazide. So there is some way to go before your husband's levels get anywhere near that bad and hopefully at this stage, some dietary changes will improve his results, for the time being. If he doesn't make dietary changes, then his pancreas will come under increasing pressure and probably fail quicker, so he will need insulin sooner, but will probably have to go through the plethora of Type 2 medication before they eventually prescribe insulin, because it is a kind of last resort and whilst it works well, it is a very powerful medication and it is quite complicated to use and very easy to overdose or underdose with. It isn't like normal medication where you take the stated dose every day and can then forget about it. So if your husband doesn't need it yet and at that level I would say he doesn't, then a few dietary changes and perhaps a bit more daily exercise or activity may well enable his poorly pancreas to limp along for a good few more years without medication.

Does he need Creon yet to help with digestion?

 

[JohnSimpson64]

If it gives you some perspective, my HbA1c was 114 at diagnosis and 6 weeks later it had gone up to 116 despite

Crikey Barbara, and I thought mine was bad enough at 112 and a waking BG of 20! I was initially put on a couple of combos of Metformin/Gliptin and MetforminSR/Gliclazide but to be honest whilst they did gradually reduce the BG over a number of weeks they made me feel worse than just having the Hyper. It seems that a percentage of people just can’t tolerate them. Hence why once the hospital got involved they switched me to 100% insulin.

 

[rebrascora]

Crikey Barbara, and I thought mine was bad enough at 112 and a waking BG of 20! I was initially put on a couple of combos of Metformin/Gliptin and MetforminSR/Gliclazide but to be honest whilst they did gradually reduce the BG over a number of weeks they made me feel worse than just having the Hyper. It seems that a percentage of people just can’t tolerate them. Hence why once the hospital got involved they switched me to 100% insulin.

We were both about the same level at diagnosis then, but there are people on the forum who were up into the 130 and even 140 levels I believe. Dread to think how ropey they felt! 🙄 . Thankfully, I didn't have too much problem with the medication. Bit of a dicky tummy and some nasty cramps building up to the full dose Metformin, but that is pretty standard. I was only on the Glic for 6 weeks until I started insulin, but I don't believe I had any issues with that. I wonder if Gliclazide can upset the pancreas if you are Type 3c and prone to pancreatitis because it puts pressure on it to produce more insulin and if it is already on it's last legs, it is like flogging a dead horse. They continued my Metformin for another 4 months after I started on insulin, perhaps because no-one thought to tell me to stop it.

 

[Cosmic]

som

Thank you we have been told his diet is ok as he doesn’t eat much bread cakes etc but lots of veg not allowed citrus fruit because of pancreatitis so not sure what else to change but thanks

 

[rebrascora]

Can you give us an idea of what he typically eats for breakfast lunch and evening meal?

Unfortunately the NHS does not have a good reputation for advising people about diet for diabetes, so we are sometimes a bit skeptical here on the forum of the advice given by NHS staff.
I appreciate that you say he doesn't eat much bread or cake, but how frequently and how much. I don't eat bread at all anymore as it really causes my levels to spike. I don't eat breakfast cereals, including porridge for that reason. I eat a small portion of potatoes maybe about once a month. I don't eat rice or pasta at all. I have a good varied diet but I don't need these carb rich foods to eat well.

 

[Cosmic]

Hi and welcome.

Sorry to hear your husband has had pancreatitis and is now showing signs of diabetes. There is no specific test for Type 3c diabetes however, with a history of pancreatitis and the consultant suggesting that diabetes may result, then it would make absolute sense to diagnose him as Type 3c rather than Type 2, however the nurse will not be sufficiently knowledgeable to do that. The HbA1c test gives you a diagnosis of diabetes if you have a reading greater than 47. Some GPs and nurses may schedule a second test shortly afterwards if the result is only just over the diagnostic threshold to give the patient an opportunity to reduce it or to confirm the diagnosis, particularly if there are no symptoms.... which you would not generally expect at that sort of level.

The treatment for Type 3c diabetes varies according to how much insulin the pancreas is still managing to produce and since your husband's HbA1c is only just over the threshold, then they would be very unlikely to prescribe insulin at this time and perhaps no medication at all, because some dietary changes and perhaps increasing activity levels if he is able may be all that is needed to push that HbA1c back down. The important thing is that they have tested him for diabetes and things are not too bad at the moment.

If it gives you some perspective, my HbA1c was 114 at diagnosis and 6 weeks later it had gone up to 116 despite cutting all sweet stuff, plus all bread, pasta, rice, potatoes, breakfast cereals, anything containing flour and any other carb rich food from my menu, so I was started on insulin at that point. I was also on Type 2 medication at that time of max dose Metformin and Gliclazide. So there is some way to go before your husband's levels get anywhere near that bad and hopefully at this stage, some dietary changes will improve his results, for the time being. If he doesn't make dietary changes, then his pancreas will come under increasing pressure and probably fail quicker, so he will need insulin sooner, but will probably have to go through the plethora of Type 2 medication before they eventually prescribe insulin, because it is a kind of last resort and whilst it works well, it is a very powerful medication and it is quite complicated to use and very easy to overdose or underdose with. It isn't like normal medication where you take the stated dose every day and can then forget about it. So if your husband doesn't need it yet and at that level I would say he doesn't, then a few dietary changes and perhaps a bit more daily exercise or activity may well enable his poorly pancreas to limp along for a good few more years without medication.

Does he need Creon yet to help with digestion?

Hi thanks yes he is on creon every time he eats if we can get it! There’s a national shortage at the moment its a nightmare thankfully I have a back up and pharmacy very helpful as they understand
Excercise I have to stop him gardening walking is difficult though 2 years ago he was dying and only given a 20 percent chance to survive now thanks to the nhs I can’t stop him

 

[Cosmic]

Can you give us an idea of what he typically eats for breakfast lunch and evening meal?

Unfortunately the NHS does not have a good reputation for advising people about diet for diabetes, so we are sometimes a bit skeptical here on the forum of the advice given by NHS staff.
I appreciate that you say he doesn't eat much bread or cake, but how frequently and how much. I don't eat bread at all anymore as it really causes my levels to spike. I don't eat breakfast cereals, including porridge for that reason. I eat a small portion of potatoes maybe about once a month. I don't eat rice or pasta at all. I have a good varied diet but I don't need these carb rich foods to eat well.

Thanks i will have to think about this as each day is a bit different but usually 3 slices of seeded bread with ham or cheese then a couple of biscuits
Evening meal depends recently chicken with egg noodles and stir fry but cold nights stew and dumplings

 

[Leadinglights]

Three slices of bread plus biscuits would be likely be too high in carbs, pushing in the region of 60g carbs for just that meal and it will very much depend on the portion size of the noodles (high carb) and dumplings (high carb as made with flour)
Maybe check the link I posted for some better options.

 

[rebrascora]

Good to hear that he enjoys gardening which is excellent for diabetes although unfortunately very limited at this time of year. Keeping moving is really important at this time of year. I set myself a target of running up and down stairs 20 times twice a day but I appreciate that might be too much for a lot of people and others may live in a bungalow of course, but moving his legs and feet regularly is really important.

I understand how debilitating and life threatening pancreatitis can be. My mother had 3 acute bouts which saw her in ICU for several weeks each time and it was touch and go. Some people are not lucky enough to survive it. I believe it is excruciating.

There is definitely a lot of room in his diet for improvement as regards diabetes management if he eats 3 slices of bread most days and biscuits as well as noodles and dumplings. These are high carb foods, which will put his pancreas under pressure and raise his blood glucose levels.
There are 15g carbs in a single slice of wholemeal bread so 3 slices of bread a day is 45g carbs minimum, but could be higher depending upon the bread and biscuits are going to be minimum 10g carbs each for a plain digestive, more for anything more interesting. I am guessing there are also potatoes in the stew as well as dumplings, so 2 high carb elements in one evening meal alone. Of course it is not a lot for a non diabetic person, but he is diabetic now and needs to take account of this.

We can give you plenty of suggestions for alternatives if you are interested.

 

[Cosmic]

Good to hear that he enjoys gardening which is excellent for diabetes although unfortunately very limited at this time of year. Keeping moving is really important at this time of year. I set myself a target of running up and down stairs 20 times twice a day but I appreciate that might be too much for a lot of people and others may live in a bungalow of course, but moving his legs and feet regularly is really important.

I understand how debilitating and life threatening pancreatitis can be. My mother had 3 acute bouts which saw her in ICU for several weeks each time and it was touch and go. Some people are not lucky enough to survive it. I believe it is excruciating.

There is definitely a lot of room in his diet for improvement as regards diabetes management if he eats 3 slices of bread most days and biscuits as well as noodles and dumplings. These are high carb foods, which will put his pancreas under pressure and raise his blood glucose levels.
There are 15g carbs in a single slice of wholemeal bread so 3 slices of bread a day is 45g carbs minimum, but could be higher depending upon the bread and biscuits are going to be minimum 10g carbs each for a plain digestive, more for anything more interesting. I am guessing there are also potatoes in the stew as well as dumplings, so 2 high carb elements in one evening meal alone. Of course it is not a lot for a non diabetic person, but he is diabetic now and needs to take account of this.

We can give you plenty of suggestions for alternatives if you are interested.

Thanks any alternative would be helpful
Yes the necrotic pancreatitis was horrible just came on suddenly with over 3 weeks in intensive care and loads more in hospital drains when he came home unable to walk as so weak but now gardening yes even in this weather going to watch beloved Norwich city football home and away
They said he would not survive but he has beaten the odds so diabetes can be sorted just need to know how thanks

 

[Drummer]

I am pretty much astonished that you were told that his diet is OK for a type 2 diabetic.

As your husband's HbA1c is not far above the lower level for diagnosis, set at 48 in the UK, then just a few reductions or exclusions might be enough to lower it to normal levels, but I think all those 'healthy' carbs need investigation - anyone needing insulin would not be doing well, I suspect.

 

[Cosmic]

Thanks we thought it might not take much

 

[Cosmic]

I am pretty much astonished that you were told that his diet is OK for a type 2 diabetic.

As your husband's HbA1c is not far above the lower level for diagnosis, set at 48 in the UK, then just a few reductions or exclusions might be enough to lower it to normal levels, but I think all those 'healthy' carbs need investigation - anyone needing insulin would not be doing well, I suspect.

He is under weight as lost 4 stone when he was in hospital so been told to build him up

 

[rebrascora]

Ok, well these are the sorts of low carb meals that many of us have...

Breakfast....eggs are great however he likes them. Occasional bacon or high meat content sausages and mushrooms and tomato but limit to one slice of bread or better still none. I find omelettes great because they don't have a runny yolk which begs bread to soak/mop it up, or needs toast to carry it. I often have my omelette with a large leafy side salad and a big dollop of full fat coleslaw. Reduced fat products invariably have sugar added to make them more tasty.
Most days I have 3 big dollops of full fat Greek style yoghurt with a few berries which are the lowest carb fruits, so things like rasps and strawbs and blackberries and blackcurrants or even a few blueberries. In spring I use stewed rhubarb (with a little sweetener) since it grows in the garden. I also have a few mixed seeds with my yoghurt and a sprinkle of cinnamon. Occasionally I have a tiny sprinkle of nutty granola on my yoghurt too but it is less than 10g, just enough to give it extra texture. I have cream in my coffee instead of milk. Cream is lower carb and the fat helps you to feel full and slows down the release of any carbs you eat. It is also my little daily luxury so that I don't feel deprived from all the things I have given up.

Lunch: Might be a chunk of nice cheese and half an apple or some homemade soup or I might have a salad or some veggie sticks with sour cream and chive dip, or an omelette if I didn't have one for breakfast. Homemade veggie soups are so warming at this time of year but choose recipes which don't include potatoes or go easy on the potatoes or replace with swede of butternut squash. If he didn't have a slice of toast for breakfast, then maybe have a slice with his soup. I particularly like olives and sometimes I will have a pot of olives with cheese (cheese features a lot in my diet these days!) Or you could do him a fry up for lunch if he didn't have one for breakfast. Sometimes I will cook some shreeded cabbage and have that with bacon or black pudding and mushrooms and an egg and perhaps some pickled beetroot or pickled gherkins.

Evening meal. Any meat or fish you like with more veggies and less potatoes. If you are having dumplings, then don't have potatoes with it and limit him to just 1 dumpling but plenty of stew. Cottage/shepherd's pie can be topped with mashed cauliflower instead of mashed potato. Boil cauli and drain REALLY WELL, then mash with a good dollop of cream cheese and a teaspoon of mustard if you like it and top the mince mixture and then a generous topping of grated cheese and in the over to brown. Some people go half and half with cauli and potato at first, but I find mashed cauli works fine as it is. and is tasty. You can also have it with bangers or chops. I have been making bubble and squeak recently with butternut squash instead of potato which is really nice. I have my bolognaise, chilli or curry on a bed of cooked shredded cabbage or green bean or broccoli but you can get konjac noodles and konjac rice. Bare Naked is the brand name of the commonest brand in supermarkets, which is pretty well carb free, but you do need to drain and rinse it well before you heat it because the preservative fluid is a bit weird and almost fishy smelling but once it is gone rinsed off that works well.
Steak and chips is still on the menu but served with celeriac chips instead of potato and mushrooms and a side salad and coleslaw.

Just some suggestions to get you started.

 

[Drummer]

He is under weight as lost 4 stone when he was in hospital so been told to build him up

I am so much stronger now, lots of meat, eggs, fish, cheese and other dairy since diagnosis. I have gone back to work servicing knitting machines and can lift and move them around fairly easily. It is a bit of an effort when I go to the local Arts University but at the age of 72 it is not all that surprising when I try to do 30 machines in one week.
I did have a lot of fat to lose, but eating high carb low fat low calorie took my strength, I lost a lot of muscle before diagnosis. I am just relieved that I can still rebuild strength and stamina at my age.

 

[Cosmic]

Many thanks to everyone for suggestions, advice and help will look at all in more detail. At the moment he is healthy fit and active, but will see about reducing the carbs.
Just to let you know he is 76 years young and very 'stubborn' that's what the Drs said got him through the necrotic pancreatitis followed by sepsis no way was he going to give into it, so we can beat diabetes!
Thanks all good to know I can ask people who know more than me

 

[Leadinglights]

Many thanks to everyone for suggestions, advice and help will look at all in more detail. At the moment he is healthy fit and active, but will see about reducing the carbs.
Just to let you know he is 76 years young and very 'stubborn' that's what the Drs said got him through the necrotic pancreatitis followed by sepsis no way was he going to give into it, so we can beat diabetes!
Thanks all good to know I can ask people who know more than me

That is what we said about my other half's mother, had surgery for some issue with her pancreas we are not clear what and nearly died about 40 years ago but lived to the age of 98 with no sign of diabetes or needing any medication until she fell and broke her hip and then became bedridden but sadly that and constant UTIs led to her demise.