Possible type 3c?

N

NeetaMD

Member
Relationship to Diabetes
Type 3c
Hello
I am here because I have symptoms suggestive of type 3c but no diagnosis yet. I am retired nurse and had loads of tests but not an OGTT.
I believe I may have had undiagnosed pancreatic problems for years. Over 15 years I have had several left chest pain (through to back) episodes with ambulance to A&E and many cardiac tests drawing a blank. Looking back maybe a problem with my Pancreas?
In more recent years increasing diarrhoea, low vitB12, and raised HBA1C ( but only in prediabetes range) Attended 9 months prediabetes course but my lifestyle was already very healthy!
I have inherited raised cholesterol on Statins so ultra careful with diet, exercise and time restricted eating over many years.
However I believe these lifestyle choices have kept my HBA1C lower but recently I have been losing weight quite rapidly and now on the verge of clinically underweight, thirsty and tired (although I continue to run, walk and stay active)
Am due to see Gastroenterology in 2 weeks after a whole raft of tests for diarrhoea that are negative yet no one has suggested an OGTT.
I tried a CGM for 2 weeks and often 14 mmols after a meal with carbs. Even sometimes above 7 while fasted and running. Never low.
I can’t keep losing weight and need answers and appropriate treatment.
Anyone else had a similar journey?
 
NeetaMD said:
Hello
I am here because I have symptoms suggestive of type 3c but no diagnosis yet. I am retired nurse and had loads of tests but not an OGTT.
I believe I may have had undiagnosed pancreatic problems for years. Over 15 years I have had several left chest pain (through to back) episodes with ambulance to A&E and many cardiac tests drawing a blank. Looking back maybe a problem with my Pancreas?
In more recent years increasing diarrhoea, low vitB12, and raised HBA1C ( but only in prediabetes range) Attended 9 months prediabetes course but my lifestyle was already very healthy!
I have inherited raised cholesterol on Statins so ultra careful with diet, exercise and time restricted eating over many years.
However I believe these lifestyle choices have kept my HBA1C lower but recently I have been losing weight quite rapidly and now on the verge of clinically underweight, thirsty and tired (although I continue to run, walk and stay active)
Am due to see Gastroenterology in 2 weeks after a whole raft of tests for diarrhoea that are negative yet no one has suggested an OGTT.
I tried a CGM for 2 weeks and often 14 mmols after a meal with carbs. Even sometimes above 7 while fasted and running. Never low.
I can’t keep losing weight and need answers and appropriate treatment.
Anyone else had a similar journey?
Click to expand...
I don’t believe the OGTT is used routinely as a diagnostic tool any more, (perhaps during pregnancy, that’s about it, I think) More reliance is given on the HbA1c. How long ago was your most recent? If it’s more than. couple of months ago, things might be changing, and it should be repeated if you’re now showing more symptoms of diabetes (thirst, etc). The other thing to bear in mind is that the HcA1c can be affected by the blood composition at the time, (ie, if you’re anaemic it tends to read higher, I’m guessing there may be conditions that could make it read lower). So keeping a record of finger prick tests, or your CGM graph, to show your HCP might be a good idea.
 
Robin said:
I don’t believe the OGTT is used routinely as a diagnostic tool any more, (perhaps during pregnancy, that’s about it, I think) More reliance is given on the HbA1c. How long ago was your most recent? If it’s more than. couple of months ago, things might be changing, and it should be repeated if you’re now showing more symptoms of diabetes (thirst, etc). The other thing to bear in mind is that the HcA1c can be affected by the blood composition at the time, (ie, if you’re anaemic it tends to read higher, I’m guessing there may be conditions that could make it read lower). So keeping a record of finger prick tests, or your CGM graph, to show your HCP might be a good idea.
Click to expand...
Thanks for the advice but the HBA1C was only 45 a couple of months ago but as it is an average so as I eat my food in a 9 hour window the fasting periods could artificially reduce that average? I don’t normally use a CGM nor have other methods to check blood sugar but maybe I ought to . Saw the Diabetic nurse who gave poo-pooed the idea!
 
NeetaMD said:
Thanks for the advice but the HBA1C was only 45 a couple of months ago but as it is an average so as I eat my food in a 9 hour window the fasting periods could artificially reduce that average? I don’t normally use a CGM nor have other methods to check blood sugar but maybe I ought to . Saw the Diabetic nurse who gave poo-pooed the idea!
Click to expand...
I was wondering if the unexpected weight loss, and thirst had been in the last couple of months, since your last HbA1c, and if so, whether a more recent one would show a deterioration in your levels.
 
NeetaMD said:
However I believe these lifestyle choices have kept my HBA1C lower but recently I have been losing weight quite rapidly and now on the verge of clinically underweight, thirsty and tired (although I continue to run, walk and stay active)
Click to expand...
Those are, obviously, significant warning signs that should be causing concern among HCPs.
 
Robin said:
I was wondering if the unexpected weight loss, and thirst had been in the last couple of months, since your last HbA1c, and if so, whether a more recent one would show a deterioration in your levels.
Click to expand...
HBA1c has been raised for about 3 yrs and the weight loss over 2yrs but has accelerated recently. Very little fat now!
 
NeetaMD said:
but as it is an average so as I eat my food in a 9 hour window the fasting periods could artificially reduce that average?
Click to expand...

HbA1c is often described as an ‘average’ but that doesn’t really accurately describe it, if I understand it right.

HbA1c measures changes in red blood cells. Exposure to glucose leads to the creation of glycosylated haemoglobin. Once it is ‘tagged’ by circulating glucose it can’t change back. The more circulating glucose, the larger number of red blood cells will be changed, and they will continue to circulate until they are reabsorbed and replaced by fresh ones.

Red blood cells last around 112 days (3-4 months) and any sample will have a mix of fresh shiny new red blood cells, some middle-aged ones, and others at the end of their days about to be reabsorbed.

So it’s not a particularly responsive measure. Having ‘perfect’ (or disastrous) numbers on the day of the test won’t really make any difference, because the ‘story’ of the HbA1c has been building up over previous weeks and months.
 
everydayupsanddowns said:
HbA1c is often described as an ‘average’ but that doesn’t really accurately describe it, if I understand it right.

HbA1c measures changes in red blood cells. Exposure to glucose leads to the creation of glycosylated haemoglobin. Once it is ‘tagged’ by circulating glucose it can’t change back. The more circulating glucose, the larger number of red blood cells will be changed, and they will continue to circulate until they are reabsorbed and replaced by fresh ones.

Red blood cells last around 112 days (3-4 months) and any sample will have a mix of fresh shiny new red blood cells, some middle-aged ones, and others at the end of their days about to be reabsorbed.

So it’s not a particularly responsive measure. Having ‘perfect’ (or disastrous) numbers on the day of the test won’t really make any difference, because the ‘story’ of the HbA1c has been building up over previous weeks and months.
Click to expand...
Thank you for that clarification
 
Update! Saw Gastroenterologist last week for diarrhoea and weight loss who thinks I might have a pancreas problem. Just submitted stool samples for faecal elastase and inflammation. Also waiting for repeat and CT ( difficulty seeing pancreas because lack of abdominal fat means organs are overlapping!) and booked for Sehcat scan. Hope the wait isn’t too long. Feeling really poorly at times persistent headaches, tiredness, hunger and more weight loss (now in underweight range)
 
NeetaMD said:
Update! Saw Gastroenterologist last week for diarrhoea and weight loss who thinks I might have a pancreas problem. Just submitted stool samples for faecal elastase and inflammation. Also waiting for repeat and CT ( difficulty seeing pancreas because lack of abdominal fat means organs are overlapping!) and booked for Sehcat scan. Hope the wait isn’t too long. Feeling really poorly at times persistent headaches, tiredness, hunger and more weight loss (now in underweight range)
Click to expand...

You might benefit from an Endoscopy. I had one at the start of my Diabetes - confirmed there was an acute Pancreas problem. Responded very quickly to Gliclazide but there is also a chronic problem requiring Creon as well. When I have Pancreas Ache it tends to be more at the level of the stomach and at the back.
 
victorhamesse said:
You might benefit from an Endoscopy. I had one at the start of my Diabetes - confirmed there was an acute Pancreas problem. Responded very quickly to Gliclazide but there is also a chronic problem requiring Creon as well. When I have Pancreas Ache it tends to be more at the level of the stomach and at the back.
Click to expand...
Glad they were able to identify your pancreas problems and treat appropriately. I had an endoscopy a few months ago but at that time they were not especially looking for possible pancreas issues. Good news was that all looked fine and no coeliac disease or obvious tumours.
 
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