Well
@Standup, that all sounds pretty good, even though the total panc'y was not needed.
Hi,
Do this the easy way until I get the hang of quotes...
If you mean the gaps I created to allow me to ask things in bite size bits (like here) then just put the cursor where you want a gap and press enter. Then do that wherever you want to interrupt and add a comment.
Total Pancreatectomy. Turns out it wasn't needed and a partial would have done but they didn't know that until the histology. Been out of hospital for about 6 weeks so still in some discomfort and weaning myself off the morphine. Appetite is starting to return to normal which I suspect is another factor in glucose levels being a bit erratic.
Yes, good supposition about BG management.
I don't think I actually injected myself in hospital what with epidurals, drains and everything else. I was on IV pretty much until discharge. This also happened at a weekend which I now know is a bad time to be discharged. At the moment my partner has been injecting me while I focus on recovery although I've been doing my anti-coagulant myself - much bigger needle.
Horrifying is a fair way to describe that anti-coagulant syringe. I'd forgotten that bit.
I'm also only being injected in thighs as stomach still tender.
Many of us use the stomach zone for bolus and thighs for basal. The logic is that thighs are slower release sites whereas stomach is quicker release and we want that speed to get a fighting chance of one's bolus insulin arriving into our blood at the same time as the digested food. In practice the speed of insulin travel from injection site to blood is another of these very 'individual' things.
Apparently I don't need chemo which means I was out of the hospital system much quicker than usual. One follow up with the surgeon who said all good and doesn't need to see me again. Lots of crying from the specialist nurses as they don't often get to see the good news. I counted myself one of the lucky ones considering pancreatic cancer survival rates and didn't think about diabetes.
As do I count myself as lucky.
I do have a Libre and trying not to be obsessive.
Libre noted. Have you picked up on the thread about the limitations of Libre (the things that Abbott don't tell us)? If you can't get it from a search within the Forum, let me know and I'll find the link to it tomorrow.
I have a diabetes nurse contact but there tends to be quite a delay as you have to go through the 'communications hub' and she just tells me I'm doing great. I've just got a letter from another hospital which I think is the Clinic where presumably I can ask about eye tests, feet, bloods etc although its just a generic outpatient letter
Noted. I might come back to these points on another day, but glad you've got the diabetes checks in your vocabulary!
I'm on basal / bolus and no idea about DAFNE. I do adjust the rapid depending on the size of meal and how many carbohydrates - is that the same thing? I have asked the pancreatic dietitian (on to my third health board) about courses and they have emailed someone, somewhere. To be fair the pancreatic diet side has been pretty good but at the moment that seems the easy bit.
Now I know you are just 3 months in you probably (and correctly in my opinion) would get more from a DAFNE course at a later time. The big gain is spending time amidst other insulin dependent folk to compare notes and hear what troubles them as well as asking your questions as the course goes along.
Worries? Well the unknown and quality of life now I'm looking beyond 6 months. Low levels I can cope with by setting the alarm and having a glucose tablet early.
Alarm absolutely; right now I would set that at 5.6. You are missing some essential pancreatic hormones and it is highly possible that because they aren't there to bail you out your D could turn out to be "brittle" and once it starts falling amidst more routine daily living it can take some stopping. Use every second that Libre provides to you!
But having a glucose tablet early might be a bit strong as a preliminary response. Try a biscuit or similar - slower releasing carbs with more longevity; the goal is to catch and nudge that early fall back to steady state. If you can stay not below the 6s that would be brilliant at this stage.
The highs I'm struggling with - partly as to why they occur and when should I worry? Is 12/13 after a meal 'normal'. It was 18 the other day I did wonder whether I should take a small dose of rapid?
Well overall that sounds pretty good, even though the total panc'y was not needed. You sound as though you've had a fair look at some of the immediate challenges - well done.
"Excursions" into the 12s and 13s are also fine; at 18, personally I would consider a bolus correction - but you really ought to take proper medical advice about that. Did you recover from that 18 reasonably smoothly because if yes, then a correction might have been inappropriate.
Meanwhile it sounds as though you need help in smoothing out your glycaemic variability, ie reducing the lows and highs. It would be rare if you didn't have these at this stage, given that you have no panc'y whatsoever.
Has anyone talked about bolus timings and explained pre-bolus, post bolus or even split bolus? The speed of bolus performance is a consequence of each person's natural insulin resistance, as well the actual choice of insulin type - which your Hospital Team started you on and for now is out of your control.
Everyone has some insulin resistance and many (probably most) people have different degrees of resistance at different times of the day. So part of the complexity of managing one's D is having an awareness of how your body has decreased resistance under different circumstances. It's more likely your natural resistance is greater in the mornings, reducing through the day and noticeably less in the evenings; but remember we are all different so one size does not fit everyone! My insulin resistance is certainly like that and my pre-bolus injection can sometimes be an hour before I start eating. So far this is still the easier part of judging timings in relation to insulin resistance. My resistance is very small if my BG is already close to 4 and that resistance increases according to what my BG is; in the 8s still not a lot different from low 6; but in the 10s some people not only want to add a correction on top of the food component for the bolus dose but might have to factor in a larger pre-bolus time as well to cover the increased resistance. Now the timings are getting way more tricky to determine. Also as you heal more and regain the capacity to be pretty active that renewed activity / exercise also affects (reduces) your insulin resistance. Confused? It isn't straightforward, yet with time and plenty of trial and learning these things do drop into place and become much more instinctive.
Anyway, park all of that for a later day as a taster for the future: right now you need some baby steps to find your balance between carbs being eaten and bolus needed, without you going hypo or even near hypo. Reducing the highs is a necessary 2nd priority over minimising lows. So getting your mind around carb counting is an important next step. Then your bolus will better match the amount of glucose that is going to come out of the metabolism of the food.
This has got to be enough and probably has already bamboozled you with too much info for now. Please don't hesitate to ask more or query what has already been said. There is already so much in this particular thread AND you already might be recognising that our T3c, because of total pancreatectomies, needs a somewhat different management style than those with T3c from pancreatitis.
