Type 2 becoming Adult Onset Type 1 after chemotherapy

P

Pookie

Well-Known Member
Relationship to Diabetes
Type 2
Does this make any sense? I was a fairly settled diet-controlled (with Metformin) Type 2 diabetic. But now I have had 9 months of ovarian cancer with 6 courses of chemo and a big operation. All treatment finished 3 weeks ago. During the chemo the short-term steroids pushed my BG sky high and when the prescribed Glicklazide didn't fix it I was started on the Abasaglar insulin each evening. So now the position is that I just have that Absaglar (8 units) but I had a test which apparently SEEMS to show that I may be Adult Onset Type 1. My questions, if anybody can help or advise, are how likely I am actually to revert to simple diet-controlled T2 again now all the treatment is over? I hate injecting insulin, I am very underweight, have little fat to inject it in and bruise constantly. How different is the management of T1 and T2 and what should I expect? And then I read somewhere that there's some sort of pump you can have inserted INTO your body that automatically dispenses the right amount of insulin whenever you need it. Is this just a rumour or something still in trial? I'm desperate to avoid more injections!
Can anybody make any sense of this? I'd really love to know what to expect....
 
Pookie said:
Does this make any sense? I was a fairly settled diet-controlled (with Metformin) Type 2 diabetic. But now I have had 9 months of ovarian cancer with 6 courses of chemo and a big operation. All treatment finished 3 weeks ago. During the chemo the short-term steroids pushed my BG sky high and when the prescribed Glicklazide didn't fix it I was started on the Abasaglar insulin each evening. So now the position is that I just have that Absaglar (8 units) but I had a test which apparently SEEMS to show that I may be Adult Onset Type 1. My questions, if anybody can help or advise, are how likely I am actually to revert to simple diet-controlled T2 again now all the treatment is over? I hate injecting insulin, I am very underweight, have little fat to inject it in and bruise constantly. How different is the management of T1 and T2 and what should I expect? And then I read somewhere that there's some sort of pump you can have inserted INTO your body that automatically dispenses the right amount of insulin whenever you need it. Is this just a rumour or something still in trial? I'm desperate to avoid more injections!
Can anybody make any sense of this? I'd really love to know what to expect....
Click to expand...
You really have been through it in the last few months so it must be concerning as to what your on going treatment is likely to be. So say you had a test that showed you as being Adult onset Type 1 often called LADA so you can look that up if you want. If that test was an antibody test then that would be fairly conclusive. Sometimes that condition can initially be managed with oral medication but as you already need insulin then it is likely that you will continue to need it. It maybe the precise insulins and regime may change. The management of Type 1 and Type 2 is very different but some people who are Type 2 will still need insulin.
A pump can be an option but it is not an easy option and your Health Authority would only fund if you meet the criteria which at the moment I suspect you wouldn't.
There are many posters here who are LADA so it would be worth you looking at some of their posts and asking questions.
 
Sorry to hear about your health problems @Pookie That must have been exhausting and very stressful. I wish you well.

As regards the diabetes, how long ago were you diagnosed as Type 2? Perhaps you were Type 1 from the beginning? Type 1 comes on more slowly in adults. But first, I’d ask for a few details about the test you had, so you have a full understanding of what’s going on. I say that because you also mention steroids. Steroids themselves can cause a form of diabetes. You ask if you’ll be able to revert back to your old diabetes control methods. That depends, which is why I’d check what tests they did and what the tests showed, including any numbers they give you.

Type 1 is currently incurable. If you do have Type 1, it might progress slowly, but Type 1s will always need insulin at some point.

You also mention an insulin pump. No, it’s not implanted. It’s a wearable device like a kind of mini drip, I suppose. You program it according to the basal insulin you need, then give yourself extra via the pump when you eat, if needed. There are pumps that work with CGMs and software to adjust your insulin, but it’s not something you can forget about as you’d need to know how to work your pump in manual mode. But - most Type 1s don’t have pumps. They use injections.

Where are you injecting? Some areas are easier than others depending on your fat distribution. How’s your blood sugar?
 
Welcome to the forum @Pookie

Sorry to hear about the confusion and uncertainty about your diabetes.

It does sound as if you need some clarity and clarification about your diabetes type, which unfortunately, given the fickle and frustrating nature of diabetes at times, may need to emerge over time.

It’s interesting that your cancer treatment and steroids seemed to trigger a different diabetes experience - but it sounds as if you weren’t overweight when you were initially diagnosed T2?
 
Leadinglights said:
You really have been through it in the last few months so it must be concerning as to what your on going treatment is likely to be. So say you had a test that showed you as being Adult onset Type 1 often called LADA so you can look that up if you want. If that test was an antibody test then that would be fairly conclusive. Sometimes that condition can initially be managed with oral medication but as you already need insulin then it is likely that you will continue to need it. It maybe the precise insulins and regime may change. The management of Type 1 and Type 2 is very different but some people who are Type 2 will still need insulin.
A pump can be an option but it is not an easy option and your Health Authority would only fund if you meet the criteria which at the moment I suspect you wouldn't.
There are many posters here who are LADA so it would be worth you looking at some of their posts and asking questions.
Click to expand...
Thank you for replying. I will try and get some more information from the hospital diabetic dept who are in charge of me...
 
Inka said:
Sorry to hear about your health problems @Pookie That must have been exhausting and very stressful. I wish you well.

As regards the diabetes, how long ago were you diagnosed as Type 2? Perhaps you were Type 1 from the beginning? Type 1 comes on more slowly in adults. But first, I’d ask for a few details about the test you had, so you have a full understanding of what’s going on. I say that because you also mention steroids. Steroids themselves can cause a form of diabetes. You ask if you’ll be able to revert back to your old diabetes control methods. That depends, which is why I’d check what tests they did and what the tests showed, including any numbers they give you.

Type 1 is currently incurable. If you do have Type 1, it might progress slowly, but Type 1s will always need insulin at some point.

You also mention an insulin pump. No, it’s not implanted. It’s a wearable device like a kind of mini drip, I suppose. You program it according to the basal insulin you need, then give yourself extra via the pump when you eat, if needed. There are pumps that work with CGMs and software to adjust your insulin, but it’s not something you can forget about as you’d need to know how to work your pump in manual mode. But - most Type 1s don’t have pumps. They use injections.

Where are you injecting? Some areas are easier than others depending on your fat distribution. How’s your blood sugar?
Click to expand...
I became diabetic 3 years ago at age 63. I've never been overweight and when diagnosed as pre-diabetic I lost a stone just by changing my diet to cut out rice, pasta, potatoes, biscuits etc. Then I became diabetic and lost another stone. Made no difference to my HbA1c which was around 48. Everything then was stable, just diet control and metformin. For a year or so. Then I got cancer. The steroids were intravenous as part of the chemo, and then in pill form for 3 days afterwards. (6 sessions of chemo) By now they are completely out of my system. I had a hypo early this morning (first one for a couple of months) so am reducing the Abasaglar to 7 units. I think I may be able to reduce it further - going by past experience. Sorry to blather on, it helps me to try and see a pattern. I am waiting for the report from the diabetic consultant who thinks I may be 'Slow Onset Type 1' (is that LADA?) from which I guess I will see what test they did on me.
I am now injecting at the back of my thigh. I can't do my tummy as I bruise.
Thank you for replying to my post. I hate the unknown quality of the diabetes. I long for it to settle down and become predictable again.
 
everydayupsanddowns said:
Welcome to the forum @Pookie

Sorry to hear about the confusion and uncertainty about your diabetes.

It does sound as if you need some clarity and clarification about your diabetes type, which unfortunately, given the fickle and frustrating nature of diabetes at times, may need to emerge over time.

It’s interesting that your cancer treatment and steroids seemed to trigger a different diabetes experience - but it sounds as if you weren’t overweight when you were initially diagnosed T2?
Click to expand...
Thank you for replying! I keep asking if there's a connection between cancer and diabetes. The consultants assure me there isn't! But anyway it's the uncertainty I hate, and having to use insulin. I have never been overweight and am now quite underweight. I believe that the initial diabetes was brought on by stress and anxiety which I had quite a lot of back then. But maybe that's because I just can't think of any other possible cause...
 
Pookie said:
Thank you for replying! I keep asking if there's a connection between cancer and diabetes. The consultants assure me there isn't! But anyway it's the uncertainty I hate, and having to use insulin. I have never been overweight and am now quite underweight. I believe that the initial diabetes was brought on by stress and anxiety which I had quite a lot of back then. But maybe that's because I just can't think of any other possible cause...
Click to expand...
This link may help you unravel what may have happened to you or explain and give you some ideas for questions to ask your consultant.
www.macmillan.org.uk

Diabetes - cancer treatment and your blood sugar levels

If you have diabetes, cancer and its treatment can affect your blood sugars. There is support to help you manage your diabetes. Find out more.
www.macmillan.org.uk www.macmillan.org.uk
 
Pookie said:
I became diabetic 3 years ago at age 63. I've never been overweight and when diagnosed as pre-diabetic I lost a stone just by changing my diet to cut out rice, pasta, potatoes, biscuits etc. Then I became diabetic and lost another stone. Made no difference to my HbA1c which was around 48. Everything then was stable, just diet control and metformin. For a year or so. Then I got cancer. The steroids were intravenous as part of the chemo, and then in pill form for 3 days afterwards. (6 sessions of chemo) By now they are completely out of my system. I had a hypo early this morning (first one for a couple of months) so am reducing the Abasaglar to 7 units. I think I may be able to reduce it further - going by past experience. Sorry to blather on, it helps me to try and see a pattern. I am waiting for the report from the diabetic consultant who thinks I may be 'Slow Onset Type 1' (is that LADA?) from which I guess I will see what test they did on me.
I am now injecting at the back of my thigh. I can't do my tummy as I bruise.
Thank you for replying to my post. I hate the unknown quality of the diabetes. I long for it to settle down and become predictable again.
Click to expand...

You’re not blathering @Pookie and even if you were that would be no problem 🙂 Yes, LADA is a slow-onset Type 1 that develops in adulthood. Sometimes people just call it Type 1 as it’s basically the same apart from the fact it comes on a bit slower. Eventually all slow-onset Type 1s/LADA will end up on a basal/slow injection or two (like your Abasaglar) and a bolus/fast mealtime insulin to help deal with the carbs in your meal. Although that sounds like a lot of injections, it actually gives more flexibility and allows you to eat pretty normally.

Thighs are fine to inject in but don’t use the back of them. Use the outer bits of your thigh to inject. If you’re very slim, you might also want to ‘pinch up’ before you inject. This isn’t literally pinching. It simply means using your thumb and index finger to gently raise a ‘hill’ of flesh away from your underlying muscle. Easier than I’ve made it sound.

I’ll see if I can find a diagram of injection sites for you.
 
Inka said:
Here shows some sites and the pinching up technique (scroll down to the first pics):
Click to expand...

I know the needles are much shorter than the 12mm ‘harpoons’ I used for years, but it still surprises me a little that everyone isn’t advised to pinch up. Just old fashioned, and what you are used to I guess?
 
Who are you calling old-fashioned?! :rofl: Yes, I’ve always pinched up - at the beginning with harpoons syringes and when I moved onto pens, even once I progressed to a 4mm needle, which is very short and fine but still benefits from a pinching up. I also pinch up to insert my pump cannulas, which I do manually.
 
Inka said:
You’re not blathering @Pookie and even if you were that would be no problem 🙂 Yes, LADA is a slow-onset Type 1 that develops in adulthood. Sometimes people just call it Type 1 as it’s basically the same apart from the fact it comes on a bit slower. Eventually all slow-onset Type 1s/LADA will end up on a basal/slow injection or two (like your Abasaglar) and a bolus/fast mealtime insulin to help deal with the carbs in your meal. Although that sounds like a lot of injections, it actually gives more flexibility and allows you to eat pretty normally.

Thighs are fine to inject in but don’t use the back of them. Use the outer bits of your thigh to inject. If you’re very slim, you might also want to ‘pinch up’ before you inject. This isn’t literally pinching. It simply means using your thumb and index finger to gently raise a ‘hill’ of flesh away from your underlying muscle. Easier than I’ve made it sound.

I’ll see if I can find a diagram of injection sites for you.
Click to expand...
No one has mentioned the pinching up. That's really helpful. I'll try it. I do use my thighs. Why not the back of them?
 
Pookie said:
No one has mentioned the pinching up. That's really helpful. I'll try it. I do use my thighs. Why not the back of them?
Click to expand...

Because you can’t see what you’re doing and it’s not so easy to spot blood vessels (which you need to avoid). Also, you’d probably have to stand up to inject in the back of your thigh and it’s best to sit down to inject in your thigh as that way your legs are relaxed and not taut.
 
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