Type 3c and insulin resistance

[DancingStar]

I'm really confused and am hoping someone here can help clarify things.

I am type 3c after having part of my pancreas removed. I use Lantus and Novorapid insulin. I have recently started the Second Nature weightloss programme, funded by the NHS. It's basically a low carb, encouraging exercise programme.

They keep talking about insulin resistance & how that can cause us to put on weight which I understand in terms of T2 diabetes. I'm not sure though how it fits in to T3c and my insulin regime: if I have insulin resistance and I'm injecting insulin would I be having hypos? Can I be T2 and T3c at the same time?

I seem to have real brain fog about this and it feels like one more thing to worry about regarding diabetes which already occupies too much space in my head.

I would appreciate it very much if any of the T3cs here could help my muddled thinking.

 

[eggyg]

I am really insulin resistant first thing in the morning. I usually inject 6 units of basal for one slice of toast and it can take up to one hour before my BG drops before I can eat. This depends on what my BG was when I woke. The higher it is the longer it takes. The rest of the day I am fine. I had a distal pancreatectomy in 2007 and I think it’s got worse as the years have gone on. That could be because I’m older or because my middle bit is perhaps a bit plumper! I’ve been on Metformin right from the start and my DSN and the hospital DSN are happy for me to stay on it.
You’ve got to remember we’re not “normal” diabetics, we aren’t autoimmune like a Type 1 although we’re on the same treatment, and we can’t go into remission by diet control/exercise like a Type 2 could. Type 3cs are a law unto ourselves. What works for one won’t work for another as we’ve all had very different journeys.
You’ll only have hypos if you take too much insulin for your needs. I assume you have a Libre? That should help clarifying if you’re insulin resistant or not. Plus the weight loss regime you’re following won’t take into account Type 3c, it will be more towards Type 2s who can be insulin resistant.
It is complicated and I’m not sure how long ago your op was but 17 years on I still get confused and don’t always get it right.
I hope this rambling post helps you a little. Ask me anything and I’ll try and help. Elaine.

 

[Proud to be erratic]

Great answer from @eggyg. Even amongst us T3s we have significant differences, never mind being insulin dependent and "as if T1 but NOT T1". Brain fog hits me frequently and I have to force myself to scrutinise things logically to gain clarity for my satisfaction.

The big first question is, as @eggyg referred to, do you already have CGM such as Libre 2?

If yes - then manage any apparently high natural insulin resistance with extra NovoRapid (your bolus). Use your CGM to alert you well in advance if you have unwittingly taken a dose of NR that is slightly too big; get that alert by setting your low alarm at the top limit of 5.6. Don't pussy foot around with a low setting near 4; let CGM tell you that you are dropping and gone below 5.6 then you can take some response carbs well before you are near hypo.

One thing that might add to the "brain fog" on this is that because you are following the low carb Second Nature weightloss programme you are probably eating "As if T2" and your bolus required for food may be lower than your normal doses. Its OK to do this, but you just need to be careful to count your carbs well for the correct reduced food bolus.

Also, and potentially worsening the brain fog here!, if the exercise programme is markedly different to your normal routines then that carefully calculated reduced food bolus may need reducing more to accommodate the consequence of the exercise. Now I can hear you crying out reduce by how much?!? This can only be determined by you from trial and learning, partly because we each get different responses to similar circumstances and partly because we can have no idea of how different the exercise is from normal or previous routines. For what little this might be worth as an illustration, I can reduce by 50% for prolonged exercise and still have too much NR on board.

The trick is to know (and remember) there are bolus dose changes in the mix; both from reduced carbs and to factor against exercise causing further lows. So use your CGM alerts to forewarn you and have a modest variety of snacks readily available. Protein bars are good choices to mitigate against exercise lows. The brilliance of CGM is not so much the precise nos being displayed, but the trend arrows advising you when change is happening.

Final thoughts / questions @ DancingStar:

How long do you anticipate this weightless programme to be? It might be you will need to adjust your Lantus basal doses to help you manage a new, long serving, lifestyle.​

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Also to comment that regular exercise regimes often result in reduced natural insulin resistance; we all have some insulin resistance and in principle T2s have such high insulin resistance that this causes their D. Yes, in theory you could be both T3c with a damaged panc'y reducing your insulin production and T2 from extremely high natural insulin resistance; in practice you are already an insulin dependent T3c and that diagnosis "trumps" any aspect of having excessively high insulin resistance.​

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Are your normal meals now below 30gms of carbs for each main meal? If yes, ie less, then I need to alert you to an additional consequence. Otherwise let's save that for a different day!​

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If the brain fog returns, do ask again. There is a lot going on as a T3c, before the weightloss programme; but losing weight is of course a good thing to pursue (just not too much loss!).​