T3c diagnosis

[Duane Charles]

Apologies if this is in the wrong part of the forum. As you’ll be aware I’m trying to find out if I’m T3c or T2. Because of previous bouts of Pancreatitis, the last being in 2008. I was informed by my GP earlier that a scan wouldn’t show any damage to my pancreas. Can someone who has T3c explain to me how their diagnosis was reached, especially if you have had bouts of pancreatitis?

 

[Leadinglights]

Apologies if this is in the wrong part of the forum. As you’ll be aware I’m trying to find out if I’m T3c or T2. Because of previous bouts of Pancreatitis, the last being in 2008. I was informed by my GP earlier that a scan wouldn’t show any damage to my pancreas. Can someone who has T3c explain to me how their diagnosis was reached, especially if you have had bouts of pancreatitis?

I think that is the first time you have mentioned how long ago your last pancreatitis bout was so that may have a bearing on how likely you are to be Type 3c. I would have expected you to have had problems before now if that were the case.

 

[rebrascora]

I think that is the first time you have mentioned how long ago your last pancreatitis bout was so that may have a bearing on how likely you are to be Type 3c. I would have expected you to have had problems before now if that were the case.

I don't think the length of time after a pancreatitis attack is necessarily an issue. The inflammation causes damage to the tissue and over time it can necrotize and once it gets to a critical point where the remaining beta cell mass is insufficient to balance BG levels, it starts to exhibit as diabetes.

 

[Wendal]

Hi Duane,The diagnosis of 3c is usually just arrived at so basically if you have had damage to your Pancreas caused by acute or chronic pancreatitis,or had your pancreas partially or fully removed after say having cancer or other conditions,and then you develop diabetes symptomatic of Type 1 then it is classed as 3c.
So basically Type 1 but a different cause and if you have had repeated pancreatitis attacks like you suggest then necrosis of your pancreatic cells is very likely.
PS do you take Creon which usually happens due to damage to the Pancreatic exocrine cells as distinct from your endocrine which are the insulin producing ones.

 

[Wendal]

As Barbara says the length of time varies a lot and can be many years after an acute Pancreatic attack whereas it can also be a short time ( just depends on severity of attack and degree of necrosis ( mine was 18 months) but I have only had 1 attack.
If you have had several which is more indicative of a chronic condition ( however if your last attack was in 2008 then that seems to be a big gap) then it is much more likely you will have extensive damage but a CT scan will reveal that.
Did you have your gall bladder removed in 2008 or earlier?

 

[Duane Charles]

Hi Duane,The diagnosis of 3c is usually just arrived at so basically if you have had damage to your Pancreas caused by acute or chronic pancreatitis,or had your pancreas partially or fully removed after say having cancer or other conditions,and then you develop diabetes symptomatic of Type 1 then it is classed as 3c.
So basically Type 1 but a different cause and if you have had repeated pancreatitis attacks like you suggest then necrosis of your pancreatic cells is very likely.
PS do you take Creon which usually happens due to damage to the Pancreatic exocrine cells as distinct from your endocrine which are the insulin producing ones.

I took Creon for a while whilst trying to overcome a bowel issue just after the operation to have my gall bladder out. Unfortunately it didn’t help my symptoms and I moved onto another medication that I’ve been taking for the best part of 14 years.

 

[Duane Charles]

As Barbara says the length of time varies a lot and can be many years after an acute Pancreatic attack whereas it can also be a short time ( just depends on severity of attack and degree of necrosis ( mine was 18 months) but I have only had 1 attack.
If you have had several which is more indicative of a chronic condition ( however if your last attack was in 2008 then that seems to be a big gap) then it is much more likely you will have extensive damage but a CT scan will reveal that.
Did you have your gall bladder removed in 2008 or earlier?

I had my gall bladder removed in 2007, the attacks of acute pancreatitis were over a period of 8 years, the first being in 1998

 

[Wendal]

Morning and thanks for that Duane.OK you had several attacks of acute pancreatitis rather than having chronic but a long while ago.
It may well be your previous acute episodes brought in by gall bladder issues were alleviated by the gall bladder removal and hence you have not had an occurrence since.
However over time your beta cell function has very slowly diminished to the point where it is no longer producing enough insulin so you are now Type 3c.
Or you have developed Type 2 independently so can you remind me when were you diagnosed with Diabetes and do you mean you have been on a similar medication to Creon so to help you digest your food as Pancreatic Enzyme Replacement Therapy.
I was told I could have another acute pancreatitis attack after my only one in 2021 even after my gall bladder was removed so I am in no hurry to go through that again.
I looked at some research looking at how soon after an AP attack people developed diabetes and it was on average several years later but with an upper range up to about 10 years so with it being a small cohort your experience could well be not too unusual.

 

[Duane Charles]

Morning and thanks for that Duane.OK you had several attacks of acute pancreatitis rather than having chronic but a long while ago.
It may well be your previous acute episodes brought in by gall bladder issues were alleviated by the gall bladder removal and hence you have not had an occurrence since.
However over time your beta cell function has very slowly diminished to the point where it is no longer producing enough insulin so you are now Type 3c.
Or you have developed Type 2 independently so can you remind me when were you diagnosed with Diabetes and do you mean you have been on a similar medication to Creon so to help you digest your food as Pancreatic Enzyme Replacement Therapy.
I was told I could have another acute pancreatitis attack after my only one in 2021 even after my gall bladder was removed so I am in no hurry to go through that again.
I looked at some research looking at how soon after an AP attack people developed diabetes and it was on average several years later but with an upper range up to about 10 years so with it being a small cohort your experience could well be not too unusual.

Thank you for this insight, the Creon was prescribed because I was having issues with eating and without being too graphic at breakfast time, I might as well have just thrown whatever I was eating down the toilet. At no time was has anyone involved in my treatment in regard to my gall bladder removal ever spoken to me about diet or the possibility of developing any form of diabetes. I had my last attack of AP in the summer of 2008 whilst at work and was in hospital overnight. I have had similar pains to AP, but these have dissipated within a couple of hours and not sought any medical advice about them. It would seem that my current GP practice are well versed on T3c and I’ll persevere with asking them to getting information on the damage to my pancreas.

 

[Duane Charles]

As Barbara says the length of time varies a lot and can be many years after an acute Pancreatic attack whereas it can also be a short time ( just depends on severity of attack and degree of necrosis ( mine was 18 months) but I have only had 1 attack.
If you have had several which is more indicative of a chronic condition ( however if your last attack was in 2008 then that seems to be a big gap) then it is much more likely you will have extensive damage but a CT scan will reveal that.
Did you have your gall bladder removed in 2008 or earlier?

I had my gall bladder removed in 2007 and yesterday at my annual diabetes review I asked about a scan to see what damage to my pancreas had been done, but was declined as it being pointless.

 

[Wendal]

Thanks Duane,
Most of us who had an AP who are now 3c probably had much more of a severe attack hence were hospitalised for weeks including time in ICU( not me) so necrosis at the time.
The link with diabetes back in 2008/9 was probably not well known so no surprises the medics did not say anything.
Again most of us may have experienced some bearable discomfort in early stages but the actual later AP attack could not be endured without a hospital admission and plenty of pain relief.

 

[Duane Charles]

Morning and thanks for that Duane.OK you had several attacks of acute pancreatitis rather than having chronic but a long while ago.
It may well be your previous acute episodes brought in by gall bladder issues were alleviated by the gall bladder removal and hence you have not had an occurrence since.
However over time your beta cell function has very slowly diminished to the point where it is no longer producing enough insulin so you are now Type 3c.
Or you have developed Type 2 independently so can you remind me when were you diagnosed with Diabetes and do you mean you have been on a similar medication to Creon so to help you digest your food as Pancreatic Enzyme Replacement Therapy.
I was told I could have another acute pancreatitis attack after my only one in 2021 even after my gall bladder was removed so I am in no hurry to go through that again.
I looked at some research looking at how soon after an AP attack people developed diabetes and it was on average several years later but with an upper range up to about 10 years so with it being a small cohort your experience could well be not too

Thanks Duane,
Most of us who had an AP who are now 3c probably had much more of a severe attack hence were hospitalised for weeks including time in ICU( not me) so necrosis at the time.
The link with diabetes back in 2008/9 was probably not well known so no surprises the medics did not say anything.
Again most of us may have experienced some bearable discomfort in early stages but the actual later AP attack could not be endured without a hospital admission and plenty of pain relief.

All my attacks of acute AP have required hospitalisation with pain relief and fluids, the stay in hospital was usually about a week. As I say I plan to persue this line of investigation with the GP

 

[eggyg]

I had my gall bladder removed in 2007 and yesterday at my annual diabetes review I asked about a scan to see what damage to my pancreas had been done, but was declined as it being pointless.

Unfortunately the pancreas is really hard to see. A normal scan won’t see anything I’m afraid. I had pancreatitis for the first time in 2001, it was caused by gallstones. I had emergency gallbladder removal and drainage of pancreatic pseudo cysts. Six years later in June 2007 I had another pancreatitis attack. They sent me for an ultrasound, this showed an enlarged spleen. I then had an MRI, still couldn’t see the pancreas properly. I then was sent to a specialist hospital in another county where I had an ultrasound endoscopy, that’s when they discovered I had a tumour/cyst as large as an apple. It was end of November by now. Consequently I was in hospital four weeks later having 2/3 of my pancreas removed and my spleen. I became diabetic three years later diagnosed Type 2 then Type 3c eight years later. I had to fight every step of the way, considering I’d lost most of my pancreas and the remaining third was atrophied. I’m afraid it won’t be an instant thing being diagnosed Type 3c, although it’s better known about now. Good luck anyways.

 

[Duane Charles]

Unfortunately the pancreas is really hard to see. A normal scan won’t see anything I’m afraid. I had pancreatitis for the first time in 2001, it was caused by gallstones. I had emergency gallbladder removal and drainage of pancreatic pseudo cysts. Six years later in June 2007 I had another pancreatitis attack. They sent me for an ultrasound, this showed an enlarged spleen. I then had an MRI, still couldn’t see the pancreas properly. I then was sent to a specialist hospital in another county where I had an ultrasound endoscopy, that’s when they discovered I had a tumour/cyst as large as an apple. It was end of November by now. Consequently I was in hospital four weeks later having 2/3 of my pancreas removed and my spleen. I became diabetic three years later diagnosed Type 2 then Type 3c eight years later. I had to fight every step of the way, considering I’d lost most of my pancreas and the remaining third was atrophied. I’m afraid it won’t be an instant thing being diagnosed Type 3c, although it’s better known about now. Good luck anyways.

Thank you @eggyg for sharing this. I want to get it sorted one way or another. Reading what has been posted so far makes me believe it to be T3c rather than T2, only because of the pancreas issues. Unfortunately I can’t have a MRI as I have a pacemaker.

 

[Proud to be erratic]

Hi @Wendal,
I think you are almost correct in your assessment below - and yet not quite correct. As I understand matters and I could be wrong:

Hi Duane,The diagnosis of 3c is usually just arrived at so basically if you have had damage to your Pancreas caused by acute or chronic pancreatitis,or had your pancreas partially or fully removed after say having cancer or other conditions,and then you develop diabetes

Agreed.

symptomatic of Type 1 then it is classed as 3c.
So basically Type 1 but a different cause

But I'm uncomfortable about this bit. We can be as if T1, but definitely not T1, or as if T2, yet not T2.

The cause of our D has nothing to do with the autoimmune condition that destroys some people's insulin production and defines a T1 diagnosis. That autoimmune condition doesn't necessarily just stop there either and T1s can, often do, have other medical vulnerabilities because of their underlying autoimmune condition.

Once pancreatic damage has occurred AND diabetes is an outcome of that damage then that diabetes may need an insulin treatment path (hence as if T1). Or could be treated satisfactorily by oral meds. Those oral meds could work forever or pancreatic functionality may decline to the point that an insulin dosing regime becomes necessary. Treatment by oral meds and/or a subsequent insulin regime could = as if T2.

It might be helpful to see this in a wider perspective: pancreatic damage can occur from many different circumstances, not just from pancreatitis. There are people who have needed to take steroids for an entirely different medical condition and those steroids have over time caused damage to their pancreas resulting in their becoming diabetic. Diabetes from steroids is also neither T1 nor T2, but it's still diabetes and needs treatment. Similarly alcoholism can bring about pancreatic damage and diabetes. An International Symposium before the Covid epidemic met to address the diagnosis and treatment for those people with diabetes from pancreatic damage, recognising that some diabetes was simply neither T1 nor T2. The Symposium came up with categorisations of T3 a-k (I think). T3c was selected specifically for damage from pancreatitis and physical damage whether from accident or surgery. But damage from steroids or alcohol and many other causes were given a different letter. At that time the WHO noted the Symposium's recommendations but didn't endorse them - so the initiative was stalled. But gradually T3c is gaining acceptance, particularly for damage from pancreatitis and I've noticed it seems to be becoming associated with other damage, such as from steroids.

The common features for T3 (a-k) are:

pancreatic damage resulting in diabetes;​

diabetes that is not caused by an autoimmune condition (T1) or excessive natural insulin resistance (T2);​

diabetes that sits alongside a different ailment - eg pancreatitis or in my case pancreatic cancer;​

that other ailment might well be needing medication that sits in contradiction of treating the diabetes and that other treatment might well take precedence over diabetic treatment;​

all of these T3(x) diabetes may need treatment by oral meds or insulin dosing.​

​

I've seen the Symposium's report and I thought I'd kept a digital copy. But I simply can't find it - most frustrating.

Just to add to the confusion - in 2016 there was a proposal in the United States to use the designator of Type 3 diabetes (sometimes seen as T3D) to describe the interlinked association between type 1 and type 2 diabetes, and Alzheimer's disease. I don't think this T3 descriptor has any official status and it is not recognised by the American Diabetes Association (ADA).

Apologies if this is in the wrong part of the forum. As you’ll be aware I’m trying to find out if I’m T3c or T2. Because of previous bouts of Pancreatitis, the last being in 2008. I was informed by my GP earlier that a scan wouldn’t show any damage to my pancreas. Can someone who has T3c explain to me how their diagnosis was reached, especially if you have had bouts of pancreatitis?

@Duane62, I surrendered my panc'y in return for a cure for my pancreatic cancer. So I know virtually nothing about how pancreatitis damage is measured or assessed to support a diagnosis of T3c.

My instinct is that, as @Wendal has already said, the diagnosis would be arrived at on a case by case basis AND in 2007/8/9 if you weren't a recognisable T1 anyone with diabetes was routinely diagnosed then as T2. T3c was not in anyone's vocabulary then.

I joined in this dialogue because it seemed to me from your earlier posts that you had enough background markers from your pancreatitis to make you T3c rather than T2. I still feel this is the case - but I am not medically qualified. What remains clear to me is that your GP should be encouraged / persuaded / co-erced into helping you nail this down and at the very least prescribe test strips to help you manage your diabetes; that should be regardless of whether you finally get an amended diagnosis. Your pancreatic history should set you apart from more routine T2 (not that T2 is particularly routine or necessarily straightforward!). Testing alone could be a great help for you in managing your D. If you were T3c and if you were moved onto an insulin regime that should (emphasis on should rather than definitely will) lead to you having CGM on prescription as well as coming under a Hospital based Diabetes Team. As a T2, even with an insulin regime, getting CGM is not definite.

I do think your initiative in raising the question in this thread is a good idea and might help you further understand what you are wrestling with. Have you looked on pancreatitis specific websites?

 

[Duane Charles]

Hi @Wendal,
I think you are almost correct in your assessment below - and yet not quite correct. As I understand matters and I could be wrong:

Agreed.

But I'm uncomfortable about this bit. We can be as if T1, but definitely not T1, or as if T2, yet not T2.

The cause of our D has nothing to do with the autoimmune condition that destroys some people's insulin production and defines a T1 diagnosis. That autoimmune condition doesn't necessarily just stop there either and T1s can, often do, have other medical vulnerabilities because of their underlying autoimmune condition.

Once pancreatic damage has occurred AND diabetes is an outcome of that damage then that diabetes may need an insulin treatment path (hence as if T1). Or could be treated satisfactorily by oral meds. Those oral meds could work forever or pancreatic functionality may decline to the point that an insulin dosing regime becomes necessary. Treatment by oral meds and/or a subsequent insulin regime could = as if T2.

It might be helpful to see this in a wider perspective: pancreatic damage can occur from many different circumstances, not just from pancreatitis. There are people who have needed to take steroids for an entirely different medical condition and those steroids have over time caused damage to their pancreas resulting in their becoming diabetic. Diabetes from steroids is also neither T1 nor T2, but it's still diabetes and needs treatment. Similarly alcoholism can bring about pancreatic damage and diabetes. An International Symposium before the Covid epidemic met to address the diagnosis and treatment for those people with diabetes from pancreatic damage, recognising that some diabetes was simply neither T1 nor T2. The Symposium came up with categorisations of T3 a-k (I think). T3c was selected specifically for damage from pancreatitis and physical damage whether from accident or surgery. But damage from steroids or alcohol and many other causes were given a different letter. At that time the WHO noted the Symposium's recommendations but didn't endorse them - so the initiative was stalled. But gradually T3c is gaining acceptance, particularly for damage from pancreatitis and I've noticed it seems to be becoming associated with other damage, such as from steroids.

The common features for T3 (a-k) are:

pancreatic damage resulting in diabetes;​

diabetes that is not caused by an autoimmune condition (T1) or excessive natural insulin resistance (T2);​

diabetes that sits alongside a different ailment - eg pancreatitis or in my case pancreatic cancer;​

that other ailment might well be needing medication that sits in contradiction of treating the diabetes and that other treatment might well take precedence over diabetic treatment;​

all of these T3(x) diabetes may need treatment by oral meds or insulin dosing.​

​

I've seen the Symposium's report and I thought I'd kept a digital copy. But I simply can't find it - most frustrating.

Just to add to the confusion - in 2016 there was a proposal in the United States to use the designator of Type 3 diabetes (sometimes seen as T3D) to describe the interlinked association between type 1 and type 2 diabetes, and Alzheimer's disease. I don't think this T3 descriptor has any official status and it is not recognised by the American Diabetes Association (ADA).

@Duane62, I surrendered my panc'y in return for a cure for my pancreatic cancer. So I know virtually nothing about how pancreatitis damage is measured or assessed to support a diagnosis of T3c.

My instinct is that, as @Wendal has already said, the diagnosis would be arrived at on a case by case basis AND in 2007/8/9 if you weren't a recognisable T1 anyone with diabetes was routinely diagnosed then as T2. T3c was not in anyone's vocabulary then.

I joined in this dialogue because it seemed to me from your earlier posts that you had enough background markers from your pancreatitis to make you T3c rather than T2. I still feel this is the case - but I am not medically qualified. What remains clear to me is that your GP should be encouraged / persuaded / co-erced into helping you nail this down and at the very least prescribe test strips to help you manage your diabetes; that should be regardless of whether you finally get an amended diagnosis. Your pancreatic history should set you apart from more routine T2 (not that T2 is particularly routine or necessarily straightforward!). Testing alone could be a great help for you in managing your D. If you were T3c and if you were moved onto an insulin regime that should (emphasis on should rather than definitely will) lead to you having CGM on prescription as well as coming under a Hospital based Diabetes Team. As a T2, even with an insulin regime, getting CGM is not definite.

I do think your initiative in raising the question in this thread is a good idea and might help you further understand what you are wrestling with. Have you looked on pancreatitis specific websites?

 

[Duane Charles]

@Proud to be erratic thank you for sharing that information. There’s a lot there to take in and I will have a proper read of it when I get home from work. As for looking at specific sites relating to the pancreas and pancreatitis, I haven’t for quite a few years. When I did it was because I thought I was suffering from another condition relating to my bowels after the gall bladder removal.

 

[Proud to be erratic]

@Proud to be erratic thank you for sharing that information. There’s a lot there to take in and I will have a proper read of it when I get home from work. As for looking at specific sites relating to the pancreas and pancreatitis, I haven’t for quite a few years. When I did it was because I thought I was suffering from another condition relating to my bowels after the gall bladder removal.

You are welcome. Don't feel that you must somehow absorb and use every word or even that everything I've said is correct. You have the challenge, I don't; so you need to own what you want to do; I don't. If some of that helps sooner or later - great.

 

[Wendal]

Hi @Wendal,
I think you are almost correct in your assessment below - and yet not quite correct. As I understand matters and I could be wrong:

Agreed.

But I'm uncomfortable about this bit. We can be as if T1, but definitely not T1, or as if T2, yet not T2.

The cause of our D has nothing to do with the autoimmune condition that destroys some people's insulin production and defines a T1 diagnosis. That autoimmune condition doesn't necessarily just stop there either and T1s can, often do, have other medical vulnerabilities because of their underlying autoimmune condition.

Once pancreatic damage has occurred AND diabetes is an outcome of that damage then that diabetes may need an insulin treatment path (hence as if T1). Or could be treated satisfactorily by oral meds. Those oral meds could work forever or pancreatic functionality may decline to the point that an insulin dosing regime becomes necessary. Treatment by oral meds and/or a subsequent insulin regime could = as if T2.

It might be helpful to see this in a wider perspective: pancreatic damage can occur from many different circumstances, not just from pancreatitis. There are people who have needed to take steroids for an entirely different medical condition and those steroids have over time caused damage to their pancreas resulting in their becoming diabetic. Diabetes from steroids is also neither T1 nor T2, but it's still diabetes and needs treatment. Similarly alcoholism can bring about pancreatic damage and diabetes. An International Symposium before the Covid epidemic met to address the diagnosis and treatment for those people with diabetes from pancreatic damage, recognising that some diabetes was simply neither T1 nor T2. The Symposium came up with categorisations of T3 a-k (I think). T3c was selected specifically for damage from pancreatitis and physical damage whether from accident or surgery. But damage from steroids or alcohol and many other causes were given a different letter. At that time the WHO noted the Symposium's recommendations but didn't endorse them - so the initiative was stalled. But gradually T3c is gaining acceptance, particularly for damage from pancreatitis and I've noticed it seems to be becoming associated with other damage, such as from steroids.

The common features for T3 (a-k) are:

pancreatic damage resulting in diabetes;​

diabetes that is not caused by an autoimmune condition (T1) or excessive natural insulin resistance (T2);​

diabetes that sits alongside a different ailment - eg pancreatitis or in my case pancreatic cancer;​

that other ailment might well be needing medication that sits in contradiction of treating the diabetes and that other treatment might well take precedence over diabetic treatment;​

all of these T3(x) diabetes may need treatment by oral meds or insulin dosing.​

​

I've seen the Symposium's report and I thought I'd kept a digital copy. But I simply can't find it - most frustrating.

Just to add to the confusion - in 2016 there was a proposal in the United States to use the designator of Type 3 diabetes (sometimes seen as T3D) to describe the interlinked association between type 1 and type 2 diabetes, and Alzheimer's disease. I don't think this T3 descriptor has any official status and it is not recognised by the American Diabetes Association (ADA).

@Duane62, I surrendered my panc'y in return for a cure for my pancreatic cancer. So I know virtually nothing about how pancreatitis damage is measured or assessed to support a diagnosis of T3c.

My instinct is that, as @Wendal has already said, the diagnosis would be arrived at on a case by case basis AND in 2007/8/9 if you weren't a recognisable T1 anyone with diabetes was routinely diagnosed then as T2. T3c was not in anyone's vocabulary then.

I joined in this dialogue because it seemed to me from your earlier posts that you had enough background markers from your pancreatitis to make you T3c rather than T2. I still feel this is the case - but I am not medically qualified. What remains clear to me is that your GP should be encouraged / persuaded / co-erced into helping you nail this down and at the very least prescribe test strips to help you manage your diabetes; that should be regardless of whether you finally get an amended diagnosis. Your pancreatic history should set you apart from more routine T2 (not that T2 is particularly routine or necessarily straightforward!). Testing alone could be a great help for you in managing your D. If you were T3c and if you were moved onto an insulin regime that should (emphasis on should rather than definitely will) lead to you having CGM on prescription as well as coming under a Hospital based Diabetes Team. As a T2, even with an insulin regime, getting CGM is not definite.

I do think your initiative in raising the question in this thread is a good idea and might help you further understand what you are wrestling with. Have you looked on pancreatitis specific websites?

Evening Roland.As usual you are much more accurate and detailed in your communication regarding the specific facts.
We arrived back late from a long w/ end in Cumbria yesterday and I was straight back into work driving down to Berkshire so I should have qualified it.
I was trying to distinguish between Diabetic deficiency so essentially Type 1 as opposed to Diabetic resistance.
Apologies for any confusion caused by my post

 

[Proud to be erratic]

Evening Roland.As usual you are much more accurate and detailed in your communication regarding the specific facts.
We arrived back late from a long w/ end in Cumbria yesterday and I was straight back into work driving down to Berkshire so I should have qualified it.
I was trying to distinguish between Diabetic deficiency so essentially Type 1 as opposed to Diabetic resistance.
Apologies for any confusion caused by my post

Absolutely no apology needed. I can be overly pedantic and I also try to be accurate where I can as - much for the benefit of those who are not yet comfortable with their understanding of T3c or D in general. I don't always get that right either. I think we're only akin to T1 if we are on an insulin treatment path, whereas I think (but have no data to support this theory) there are far more misdiagnosed T2s who ought to be rediagnosed as T3c and given better support.

Anyway I hope you had a fine w/e in Cumbria; it's a fair old drive from Cumbria to Berks - or have I misunderstood and you had a split journey of Cumbria to home then home to Berks?