High A1C: Dealing with diabetes after Whipple surgery

I think you'll have to have an endocrinologist do a few blood tests to answer that. Depends on whether you're really insulin-resistant or insulin-dependent.

My pancreas started failing to produce enough insulin about the same time I was diagnosed with PDAC; endocrinologist put me on insulin right away. Slightly less ability to produce insulin after Whipple; pancreas performing at about 50% in that department. (Just about equally bad producing enzymes, thus Creon for me.)

You might ask if there's any hope with trying Metformin first, if that will work for you. There is some interest and research going on regarding Metformin's potential benefit in avoiding or treating PC. Just a long shot, but worth asking about (I think).

I am 2 1/2 years into my journey and after pancreatic infection and surgery have become diabetic. Just found out. night blood sugars 250 plus. Going to start with a pill and scanner. What have others found? What kind of pill or Insulin? Open into any suggestions or diet recommendations. Thank you.

That's bad news...but hopefully you still can do a lot to avoid the looming damage. I'm in my 8th decade and have No health issues, without having used any meds, surgeries. tests, supplnt.... Perhaps because of Simple and easy and Inexpensive food choices (mostly plant based with fruits and vegs and whole grain) remember the harm Ultra Processed Foods do, DT2 is one.

Physical activity (playful and enjoyable, I do brisk walks thru parks for ~1 hr most days a week) and having people to laugh and talk, to help one stay on the healthy track! I'm sure CDC or NIH or even Mayo have advice on food and exercise. Good luck!

Far from expert here, but I was diagnosed as diabetic about the same day I was diagnosed with PDAC (2 years ago, age 58). Up until then, my A1C fluctuated between 5.6 and 6.0. After diagnosis, an endocrinologist prescribed me insulin, not trying any meds like metformin first. I don't remember what tests (if any, or just experience) guided him to that decision.

Now, 14 months post-Whipple, he had tested enough to confirm my pancreas is performing at about 50% in terms of insulin production and enzyme production. As a result, I take a nightly injection of long/slow-acting insulin, and with meals (if I remember) I take enzymes (Creon) and a fast-acting insulin injection.

I have reasonably good control, but it could be a lot better with some discipline. Unless my glucose is over 300 at bedtime, I don't use the fast-acting insulin at night, as I hate being awakened at 3am with a low blood sugar alarm. Exceptions are made if I know I overdid it with carbs at a late dinner. Pasta and rice seem to keep delivering sugar for hours after consumption.

When possible, I try instead to take a long walk before bed. Exercise is always good, and walking seems to lower my glucose by about one point per minute walked. So, at 3 miles/hour, 1 mile reduces it 20 points; 2 miles reduces it by 40 points, 3 miles by 60, etc...

My long-acting insulin is a Tresiba pen; fast-acting is a Novolog pen.

When I've had chemo (Folfirinox before the Whipple, Gemcitabine+Abraxane+Cisplatin after), they've always added some steroids (dexamethasone) as an anti-nausea pre-med; I also have prescription dexemathasone tablets for 1-3 days after chemo if nausea doesn't respond to my Zofran. That can really drive blood sugar up and seems to increase insulin resistance for a while. So, on the night before chemo, of chemo, and 2 days after chemo, I increase the long-acting insulin by 25%. If I'm eating "comfort foods" during that period, I have to be extra careful and use more of the fast-acting insulin to prevent some major spikes.

I got real tired of pricking my finger to test glucose, and my endocrinologist was very understanding. Had no problem getting a Dexcom G6 "CGM" (Continuous Glucose Monitor) prescribed and covered by insurance. Switched to the G7 when it became available. It updates every 5 minutes automatically on my phone (don't have to "scan" it). Biggest annoyance along with the 5-minute delay is the additional delay in seeing a response to consuming sugar after a low-sugar alarm at 3 am. It might still alert every 5 minutes for the next 20 before your sugar increases to a more normal level.

(Actually, the biggest annoyance is how loud the alarm comes through when my phone is connected by Bluetooth to headphones or a loud car stereo. I listen to music at pretty high volumes, and the when the high/low glucose alerts override it, it's like being hit by a truck.)

Our Loudest alarms are our waist sizes...and we still are averting our attention from it toward the consequences ... we know colonoscopy tests are recommended now 5 years earlier!

Our over-consumption in all areas, especially food is disabling us earlier. But over-consumption is a symptom ...of something deeper missing: Hunger for NON-food pleasures. Play, intellectual dialogues using Critical Reasoning, watching for wonder around ... from under our feet to in the skies above. These are the pleasures we Need ... to snuff out our poisonous pseudo pleasures. Good luck friends!