Diabetes and oesophagectomy

[xmasbabe59]

I had an oesophagectomy (keyhole) in December 2021. I've made a slow, steady recovery and feel very lucky to be as well as I am today. I eat well but of course in much smaller quantities.I'm a type 2 diabetic and prior to my op I had my diabetes well controlled using Metformin and diet.

I was told, at diagnosis, that diabetes can go either way after this op. It could get better or worse. Mine has become harder to control, even with Insulin, Metformin,Gliclazide and a low carb diet.

Is there anyone who has experienced this and, if so, how do you manage to balance your blood glucose levels against eating smaller but more frequent meals?

Many thanks

[Tilly1000]

hello, yes have experience of this, difference being type 1 diabetes, the diabetes became uncontrollable, lots of hypos, especially due to the “dumping” caused by the operation, if your not aware of it I’ll leave you to look it up but after trying many different things we found that when dumping was experienced the blood sugar would plummet dramatically so as soon as a sign of dumping we knew that was the point to eat fast & slow acting carbs, we also found the measures of insulin taken before the operation were causing hypos due to the change of the body structure so it went from 15 units a day to just 1, we went to the see a diabetic consultant but she admitted there wasn’t much research into this subject so she didn’t know how to help so we found it was down to us to come up with a plan that worked for us.

[xmasbabe59 in reply to Tilly1000]

The diabetic specialist nurses have been very good but I always feel they don't really understand my condition no matter how I try to explain it. What to eat, when to eat, how much to eat/ drink etc!I've come to the conclusion that there aren't any definitive answers and, as you say, it's down to us, as individuals, to work out what's best for us.

It's good to know that there are others out there dealing with the same/ similar problems.

Many thanks

[Littleandoften]

Hi xmasbabe59 and Tilly1000

I’m interested in your replies as I posted on this a few days ago. I’m not diabetic but get dramatic highish and low blood sugar with dumping. I’ve currently got a CGM and finger prick to compare readings. Uploading a daily graph of a day this week. I’m taking Creon too. Just trying to manage with food but who knows what to eat as every day is different.

Blood sugar

[xmasbabe59 in reply to Littleandoften]

Thanks for your reply.I totally agree that everyday is different, diabetic or not. A food that causes no spikes one day can cause havoc the next and dealing with dumping is yet another thing. We just have to do the best we can and keep trying. Even on bad day's I remind myself how lucky I am to have come through this major surgery.

[purplekey]

hi I’m sorry you are struggling with your blood sugar levels. I was not and am not a Diabetic but since the op have had many unexpected bouts of hypos, nausea, tremors etc. which are quite scary. I have learnt now after 2 years to recognise the difference between hypos and dumping syndrome ( which are caused by eating too much, too much fat or too much sugar). I carry with me at all times a 100 ml can of Coca Cola which stops the hypo within mins. This seems to get in my blood stream quicker than the dextrose tablets which I find hard to dissolve quickly. As a type 2 diabetic I would question your dr wether you need all your diabetic drugs now especially the insulin. As we ex oesophagus patients struggle to take in our full compliment of calories I would think your Diabetes wouldn’t be a problem and a lot of drugs could keep dropping your blood sugar too much. If I was you I would speak to your gp/ diabetic nurse and plan to reduce your drugs, stop all high sugar food ( which you probably don’t take anyway being a Diabetic) and increase protein and carbohydrates like rice, pasta, bread potato if you can. Eat every 2 hours too.

I too have found that support is lacking in the medical profession but have found this site has helped me a lot. Good luck.

[xmasbabe59 in reply to purplekey]

Thanks for your reply.I've been diabetic for quite a few years now and always had good control. I spoke to my diabetes nurse today and have been taken off insulin and in a couple of weeks my Gliclazide is being reduced..

Unfortunately my diabetes will always be a problem. I can eat a food one day with no problems but the same food the next day could cause spikes. There are many factors which affect blood glucose so I'll just have to see how I go on with my reduced medication.

Watch this space!

[PopandMo in reply to purplekey]

Sorry to intrude on the conversation but I too am struggling with hypos and terrible shakes nearly every afternoon. I’m not diabetic and eat regularly, always including carbs like oatcakes and cheese, starchy veg soup etc for lunch. I carry glucose tablets and cereal bars but it can take half an hour or so to recover. I must try the coke to see if that’s better. I tried a banana the other day and that worked quite quickly. It’s making me really anxious and afraid to go out.

[purplekey in reply to PopandMo]

Same here. I was the same. The coke seems to be the quickest method to get sugar in maybe because of the bubbles. Just a thought, the soup might be too low in calories. Try replacing it with something else or add cheese and bread to the soup. protein powder sachets From your dietitian can add 100 cal to your soup. I dont eat soup but frequently eat half a protein filled sandwich and crisps then have the other half 2 hours later or have 2 eggs and slice toast or a small quiche or quarter of pizza. I try to aim for 250-300 cal a meal every 2 hours. It is hard work but you can stop the hypos. X

[PopandMo in reply to purplekey]

Thanks for your reply. I just have a small bowl of soup and incorporate pulses like lentils for protein. I really struggle with bread, though I used to eat loads of it in the pre op days. I have maybe 3 oatcakes and 2 rye crackers with cheese and nut butter. I also have half a carton of Fresubin at lunch time. ( horrible stuff but it’s calories!) Hoping I find the solution, but I spoke to a lady who is 12 years post op and still struggles. 😕 Thank you again! ☺️

[purplekey in reply to PopandMo]

Me too but I’m ok with farmhouse bread. Cheap stuff doesn’t go down. I’m 2 years post op and life is a lot easier than it was but it a huge learning curve isn’t it to get things right for your body. X

[PopandMo in reply to purplekey]

I used to eat loads of seeded breads, never white , and I still have the odd slice of toast but my taste seems to still be changing. I’m the same as you-2 years next month , and it’s been incredibly difficult but as you say a lot easier now… but still learning! I went off a lot of foods after chemo, but some are becoming palatable again. I’m a big worrier at the best of times so I’m really just very glad to still be here this far! X

[LarryLamb69 in reply to PopandMo]

Might sound daft , but liquid gels for cycling are really easy and convienent way to get sugars quickly a small 30 gram sachet fits in pocket well a tad easer than carrying a small can of coke and desinged to enter system quickly for cycliists when they suffer a "bonk"..low blood sugars..east to purchase as well.

[PopandMo in reply to LarryLamb69]

Thank you for that idea! I actually saw them when I was looking for glucose tablets so I will definitely try. ☺️

[jay2908 in reply to PopandMo]

Just a thought, it could be the soup that’s causing your hypos, it does for me.

[PopandMo in reply to jay2908]

Hi there- do you mean in terms of too much liquid?

[jay2908 in reply to PopandMo]

Hi - it more that soup goes through my gut much quicker than solids and also it’s usually higher Glycemic Index. Also, if there are any solids in the soup, they’ll travel further down and trigger dumping. That’s my gut though, yours may be different

[CharlieWood]

I had Type 2 for quite a few years before my complete oesophagectomy 5 years ago (McKeown section). Post op in ICU and then the recovery ward I had to be put on an insulin driver as I couldn't take oral medication and I've stayed on it ever since. I gave up the rapid injections quite early on due to the risk of hypos but give myself a shot of 20 units of long acting insulin each morning. Nothing could be simpler and I think we have an irrational fear of insulin injections as being the beginning of the end. I've always been rubbish with diet control and, of course, diabetes is a progressive disease anyway so my GP has added Metformin back into the mix over the last year. After the cancer and a subsequent major heart attack I tend to view diabetes a bit down the list of my concerns.

[xmasbabe59]

Many thanks for your reply.I quite understand your view of diabetes after having a heart attack. My husband had a major heart attack a few years ago so know the problems that brings.Diabetes doesn't have to be progressive as my husband ( type 2 ) has gone into remission with diet only so, it can be done.

I would personally like to control my diabetes with diet and minimal meds. Going back on insulin hasn't been ruled out but feel Gliclazide is starting to work for me without hypos.

I accept my Bg's will be higher than they were due to only having 40% of my stomach left and having to eat more regularly but, I personally, will strive to keep my diabetes in check as hard as it sometimes feels.

Time will tell.

[Cygnet11]

Following my surgery in 2020 I became lactose intolerant and also suffered from dumping syndrome. Due to lack of professional support from the medical professionals I took it upon myself to do some research. Obviously the lactose issue was easily remedied but the blood sugar issue took a bit more effort. Eventually I found some research that suggested taking cinnamon supplements. This was the big game changer for me. Two tablets each day immediately helped the spikes in blood sugar and my life returned to some semblance of normality. I’m not saying it’s a miracle cure and I still take care with my food input but it’s been a great help. If I do feel an episode coming on I always have some dextrose tablets handy and some Lucozade in the fridge.

Take some time to research the link between cinnamon and diabetes and see if it will help you too. Good luck.

[xmasbabe59 in reply to Cygnet11]

Thank you for your reply.I'll do some research and give them a go