Case study – part three
What happens next?
- Pre-surgery: Mr White gains weight and feels stronger in the three weeks between being told he is to have the total pancreatectomy (when he met the surgeon, dietitian and diabetes team) and the date of his operation.
- The surgery: The operation goes well. He makes a good post-op recovery and is medically fit for discharge from hospital 9 days after the surgery.
- On the ward: He receives more education on BG monitoring, insulin administration, insulin storage, hypos, driving, injection sites and DKA while as it is all quite new to him. He also has the opportunity to practice checking his own BGs and giving his own insulin on the ward with the nurses there for support and to answer questions.
- Discharge: By the time he goes home, he is eating and drinking and taking some milky oral supplement drinks.
- Medications: He is on a basal bolus insulin regime with two injections per day of a long acting (background) insulin and injections of a quick acting insulin at mealtimes.
Meeting at the GP surgery
Ten days after he goes home he is seen by his GP practice nurse for a drain dressing change. He describes struggling with erratic BGs. He describes a pre meal BG of 15mmol/l but within 2 hours it is 3.0mmol/l.
He is also struggling with diarrhoea which is pale and greasy and has bloating and wind.
The practice nurse asks the GP to see him while he is at the surgery.
Conversation between the GP and Mr White
What would you suggest to Mr White?
With the knowledge and experience you have, what would you suggest Mr White does regarding his PERT dose and insulin dose? It does not matter if you don’t know or have an incorrect answer, thinking about it and having a go at answering will help your learning.