Diabetes post whipples

[The missus]

Hi I an new to this site as my husband had a Whipples in February this year. He had very high blood sugars 2 weeks post op (4 days after his discharge). He had to go back to the surgical assessment unit as he had a wound infection, it was purely by chance that he produced a urine sample to be tested that they found the high blood sugar. Initially this was put down to the wound infection. He had to stay in for a few more days while the diabetes was stabilised.

3 weeks after all this, he remains on insulin but his blood sugars are not doing anything like they should do with the insulin being changed every so often by the specialist nurse ( who has no experience at all about pancreatic cancer or whipples).

He had a neuro endocrine tumour which was totally resected ( which is absolutely brill - i know and am grateful for) but we have yet to have the initial O/P appointment when we hoped to hear a lot more about the actual extent of the surgery, what type of NET it was and to what extent the diabetes may be due to the NET/infection or whether he was just going to be a diabetic anyway.

Sorry, I digress = my question is - Has Anyone who was not diabetic going in for surgery, been diagnosed with diabetes so quickly post surgery and if so - how long did it take the diabetes to settle down - the major issue seems to be that blood sugars plummet in the evening after his evening meal, despite a good intake of carbohydrates and ever decreasing insulin ( Novomix).. I have searched this site for an answer and have not found anything. I have found something n an american site but they measure their blood sugars differently so I don't really know how that equates.

The only other thing that I am finding myself wondering, is whether, now he needs to increase his carbohydrates (he is eating quite well and tolerating the carbos) t hat this is a malabsorbtion issue (of carbo's) and not an insulin issue. If that is the case, should he not increase his creon ? From reading the american sites - it strikes me that he is on a low dose (10,000 units) and only takes 2 with a meal and 1 with a snack.

Any thoughts ?

The Missus

[AnneD]

Hello,

As you say it's "brill" that your husband has had his tumour completely resected.

As regards the diabetes I can tell you about my own situation.

I had a Whipple's in December but had already had a distal pancreatectomy therefore I became diabetic immediately after the surgery.

I use a long-acting insulin ( Lantus ) once a day and a short-acting insulin ( Novorapid ) with meals.

With a lot of monitoring and some fine adjustments, my diabetes is pretty well controlled.

I'm four months post surgery now and coping well.

I have no pancreas at all and use Creon 10,000, 4-5 capsules with a meal although I don't eat big meals.

You should be able to judge if the dose of Creon is right by whether he has steatorrhoea.

As for the American diabetes sites, you need to divide their figures by 18 to get the English equivalent of blood glucose levels.

Eg:

10 ( English ) = 180 ( American ).....................7 ( English ) = 126 ( American )

Hope this helps!

Anne.

[PCUK Nurse Jeni]

Hi there,

I work for pancreatic cancer Uk as support manager.

I would like to ask, when you say the blood sugar levels "plummet" in the evening, do you mean that they fall?

How low do they go? Are there any accompanying signs such as dizziness, palpitations, headache? is it relieved by eating?

It is possible that the type of NET tumour may be an insulinoma, which secretes insulin. However, this is not properly regulated by levels of glucose in the body, as in a healthy person.Therefore, the levels of insulin rise, and cause low blood sugars. It may be that your husband does not need the novamix? That said, usually, when the NET is removed, this should right itself, and insulin levels should return to normal. It is still worth checking out and it would be a good question for the oncologist. You are right that the diabetic nurse specialists seldom know a lot about Pancreatic cancers, NET's or pancreatic surgery. They mainly deal with the vast majority of the population who get diabetes, unrelated to cancer.

I can be contacted at support@pancreaticcancer.org.uk if you need further information.

KR,

Jeni.