Do insulin injections worsen insulin resistance?

[Vectian]

What is so scary about it?
Injecting insulin, avoiding hypos, carb counting to calculate insulin dose or more?
I was diagnosed with Type 1 in my mid 30s and after 20 years of this, I have no complications, am healthier than other my age and live a very full active life.

Not that, it's the higher risk of all sorts of nasty things, even injecting insulin leads to a higher rate apparently. I read somewhere that T1 can take 20 years off your lifespan.

 

[Inka]

Not that, it's the higher risk of all sorts of nasty things, even injecting insulin leads to a higher rate apparently. I read somewhere that T1 can take 20 years off your lifespan.

That’s using old figures. Care and tech for Type 1 has greatly improved. Injecting insulin keeps us alive!

 

[Leadinglights]

Not that, it's the higher risk of all sorts of nasty things, even injecting insulin leads to a higher rate apparently. I read somewhere that T1 can take 20 years off your lifespan.

That might have been the case years ago but now with insulins and technology I think that is a very pessimistic view.

 

[Vectian]

The trigger for Type 1 is currently unknown (there might be more than one). It’s an auto-immune condition. You need the Type 1 genes but most people with those genes don’t develop Type 1. Something in the environment starts the auto-immune response. Possible suspects are cows milk, viruses, damage to the gut, etc.

It depends what I eat but I take around 15 units of insulin in total a day.

No, it’s not really scary, although it is a pain in the bum. The reason it’s not scary is because we’re lucky enough to have insulin. Before that, Type 1 was a terminal condition.

15 units seems like not much? Do you have the long lasting insulin as well? Is it 1 unit per 10g of carbs? What is scary to me is the higher risk of all sorts of nasty complications.

 

[helli]

Not that, it's the higher risk of all sorts of nasty things, even injecting insulin leads to a higher rate apparently. I read somewhere that T1 can take 20 years off your lifespan.

High blood sugars whether Type 1, type 2, Type 3c, etc will take 20 years (or more) off your lifespan and what remains is likely to be unpleasant with all the nastiness you have read about.
However, nowadays there is much more technology, etc, to manage Type 1 diabetes so that this statistic is meaningless as it is based on historic data when much of blood testing was once or twice a day with urine, insulin was mixed insulin which required a fixed amount of carbs. It does not take into consideration basal bolus injections, carb counting and dosing for "normal" eating let along CGMs and insulin pumps.

 

[Inka]

15 units seems like not much? Do you have the long lasting insulin as well? Is it 1 unit per 10g of carbs? What is scary to me is the higher risk of all sorts of nasty complications.

I have a pump. Yes, 15 units is the total insulin I take per day, including both basal/background insulin and bolus/meal insulin. My meal ratios vary. They don’t have to be 1u to 10g carbs, they can be 1u to 25g, 1:8, 1:14 - whatever works.

Everyone, diabetic or not, is at risk of something. Not being diabetic doesn’t protect people from heart disease. People with diabetes have an incentive to live healthy lives and we also have regular health checks that people without medical conditions don’t have. I know plenty of people my age who are less healthy than me.

 

[Proud to be erratic]

Hello @Vectian, I'm afraid you are already starting to bump into the confusion that arises with Diabetes: whatever the general rules for D are - YOUR D either doesn't know those rules or doesn't choose to play by those rules. So to highlight just one aspect of this quandary, the carb content of any single food has a theoretical number or measure in general, but that number might not work well for you.

We talk about foods such as potatoes and rice being fairly high carb; we also extend that theory in that vegetables growing above ground being noticeably less high carb whereas root vegetables are considered higher than green veg. But, alas, once eaten and your metabolism starts there can be a lot of fibre content which simply digests very much more slowly or much of it doesn't digest at all. Undigested fibre passes straight through. So there can be a theoretical carb content for (say) parsnips but depending on their age and how that vegetable is cooked the fibre content can significantly affect the final amount of glucose that arrives in your blood stream. I find roast parsnips very moreish and the roasting seems to make them digest more readily.

The net outcome is that many of us ignore the carb content of many veg other than potatoes - until we learn (from trial and learning) that a particular vegetable can not be ignored! Once you get your mind around the indivudual exceptions - then you bump into meals that seem to ignore any carb content guidance or rules, simply because of the mix of individual food stuffs changes everything again. This fun and games is relevant not just for insulin dependent folk, but also for T2s trying to keep on top of their HbA1c.

Incidentally, I have absolutely no pancreas and my insulin needs have reduced in the last 12 months as I seem to improve my BG management and reduce my glucose variability; there is many a day when my daily bolus is around 10 units - from Multiple Daily Injections (MDI). My Time in Range (TIR) is over 75%. We are all different and need whatever insulin we need.

 

[Vectian]

I have a pump. Yes, 15 units is the total insulin I take per day, including both basal/background insulin and bolus/meal insulin. My meal ratios vary. They don’t have to be 1u to 10g carbs, they can be 1u to 25g, 1:8, 1:14 - whatever works.

Everyone, diabetic or not, is at risk of something. Not being diabetic doesn’t protect people from heart disease. People with diabetes have an incentive to live healthy lives and we also have regular health checks that people without medical conditions don’t have. I know plenty of people my age who are less healthy than me.

Makes sense. How do you know what unit to carb ratio to use? Why does it vary?

 

[Inka]

Makes sense. How do you know what unit to carb ratio to use? Why does it vary?

By experimentation. It varies depending on the meal/time of day. That is, people commonly need more insulin for the same amount of carbs at breakfast than they do at their evening meal. Everything is experimentation and change. Meal ratios often change over time, back and forth. Basal insulin needs change too, eg in response to exercise, hormones, stress, illness, etc.

 

[Vectian]

By experimentation. It varies depending on the meal/time of day. That is, people commonly need more insulin for the same amount of carbs at breakfast than they do at their evening meal. Everything is experimentation and change. Meal ratios often change over time, back and forth. Basal insulin needs change too, eg in response to exercise, hormones, stress, illness, etc.

I noticed that evening meal goes up much less, good to know That's normal. Sometimes the blood sugar doesn't go up at all after eating in the evening, like the insulin has completely cancelled out any rise and fall. Does that mean I took too much insulin?

 

[Inka]

Not necessarily @Vectian Perhaps you just timed it well. A sign of too much insulin for a meal is going too low.

 

[Dragonheart]

Some odd thoughts in this thread. I’m not an insulin user but have been counting and reducing carbs for 6yrs as a diet controlled type 2.

The carbs in veg still raise blood glucose and therefore are “real” and do count, although for most veg the amount will be low. No idea why it’s being suggested not to include those or why those carbs could be considered false.

Physiological insulin resistance (aka adaptive glucose sparing) is quite different to pathological insulin resistance typically found in type 2. It can occur when a person is low carb but is not associated with poor outcomes and disappears within days of eating more carbs. I’m not sure why it’s being spoken about as a negative thing (it’s not about starving it’s just the body using glucose judiciously) unless it’s because it results in higher dosing in type 1 (a guess as I have no idea). In type 2 it might result in slightly raised morning fasting levels but again it’s not an issue in this case if the overall levels are good.

If you are type 2 then it would be good to reduce the insulin (and low carb is an excellent way to do so) over time as yes it will increase your insulin resistance. Obviously this needs to be done with care and medical consultation and a lot of monitoring to avoid hypos. Type 2 typically have higher than normal self made insulin already that is ineffective due to IR. Adding more means higher circulating insulin which increases resistance. In type 1 injecting doesn’t typically cause excessive circulating levels as the aim is to provide just the right amount. Different conditions different outcomes.

Obviously if you are type 1 then insulin is essential for life and it’s possible you might be in the honeymoon period explaining erratic insulin needs.

Until you know what type it seems appropriate, in my mind anyway, for you to follow the medical advice and continue the insulin at levels that control blood glucose, without hypos ideally. And longer term you could consider that some type 1 do in fact reduce carbs to a degree as they find it makes dosing easier and liable to smaller mistakes. (See Dr Bernstein for example) Others don’t feel the need.

In the scheme of life a few weeks wait won’t make a massive difference to any IR but could keep you safe. There’s something to be said for reducing levels at a sensible pace to avoid issues with the eyes if you drop from very high levels very quickly. There’s no reason why you can’t come off it once you have the additional test results. (Presuming this is coeptide/insulin and antibody tests)

 

[Inka]

The carbs in veg still raise blood glucose and therefore are “real” and do count, although for most veg the amount will be low. No idea why it’s being suggested not to include those or why those carbs could be considered false.

I never said the carbs were false. Read what I said. I said that the chats/info usually refers to countable carbs so when somebody tells me they’re eating X amount of carbs and, unknown to me, they’re counting veg too, then we’re talking at cross purposes.

 

[Tdm]

The carbs in veg still raise blood glucose and therefore are “real” and do count, although for most veg the amount will be low. No idea why it’s being suggested not to include those or why those carbs could be considered false.

I never said the carbs were false. Read what I said. I said that the chats/info usually refers to countable carbs so when somebody tells me they’re eating X amount of carbs and, unknown to me, they’re counting veg too, then we’re talking at cross purposes.

Personally, i count all carbs, but then fibre doesn't seem to make much difference to my digestion.
I agree low carb can cause insulin resistance, but, as said, will resolve itself if you go back on normal carb (which, as a type 1, i can do)...low carb is more a type 2 thing..i find i can manage my diabetes as easily on full carb compared to low carb and i miss my bread on low carb.
Whilst diabetes/insulin is scary at first, it soon becomes the 'new normal' and just a bit of a pain in the bum.

 

[Dragonheart]

Personally, i count all carbs, but then fibre doesn't seem to make much difference to my digestion.
I agree low carb can cause insulin resistance, but, as said, will resolve itself if you go back on normal carb (which, as a type 1, i can do)...low carb is more a type 2 thing..i find i can manage my diabetes as easily on full carb compared to low carb and i miss my bread on low carb.
Whilst diabetes/insulin is scary at first, it soon becomes the 'new normal' and just a bit of a pain in the bum.

In the uk fibre isn’t included in the carb count anyway. (Ie it’s the same as the USA net fibre count). As you say, fibre doesn’t raise glucose and may slow digestion of the carbs down a little making it a longer but lower raise from anything eaten with the fibre.

And yes low carb is much more a type 2 strategy than type 1. Mostly because insulin resistance is at the core of type 2 and it’s not inherently part of type 1.

 

[Dragonheart]

The carbs in veg still raise blood glucose and therefore are “real” and do count, although for most veg the amount will be low. No idea why it’s being suggested not to include those or why those carbs could be considered false.

I never said the carbs were false. Read what I said. I said that the chats/info usually refers to countable carbs so when somebody tells me they’re eating X amount of carbs and, unknown to me, they’re counting veg too, then we’re talking at cross purposes.

I know you didn’t use the word “false”, you used the words “erroneously” and “wrong”. And said not to count the carbs in veg. Please explain why you believe we shouldn’t count veg carbs. They can make a difference to some of us if you eat the starchier or sweeter veg and a decent amount of them. I’m not sure what list you refer to either.

Countable carbs is all the (net) carbs surely as they all raise blood glucose? (Net clarified for any USA users as fibre doesn’t raise glucose)

Ok, the reason I asked about the carb counting was that if you were totting up broccoli, carrots, etc etc you might erroneously think you were eating more carbs than you are. You say you’re seeing ketones and, if you’re not eating very low carb (hence my question about counting) then that would be a concern.

The carb amounts listed usually omit veg, so someone who counted the carbs in veg might actually be getting a ‘wrong’ figure and think they’re eating more carbs than they are when compared to the carb amounts listed. I hope that makes sense! I mean we might be talking about two different things but mistakenly think we’re talking about the same amount of food/carbs.

 

[Inka]

Not to count the carbs when the OP was saying how many they ate - because we’d not be comparing the same things. If you want to count the carbs in veg, knock yourself out.

Erroneously - ie compared to what I’d assumed and the carb amounts discussed; false - note those raised commas around the word. I’m not quite sure why you’re intent on nitpicking but I’m off to enjoy the sun.

 

[Dragonheart]

Not to count the carbs when the OP was saying how many they ate - because we’d not be comparing the same things. If you want to count the carbs in veg, knock yourself out.

Erroneously - ie compared to what I’d assumed and the carb amounts discussed; false - note those raised commas around the word. I’m not quite sure why you’re intent on nitpicking but I’m off to enjoy the sun.

Sorry but that doesn’t answer my question. I really don’t understand what you mean by wed not be comparing the same thing. We are both talking about carbs in veg. You say not to count them and I can’t work out why not, as they raise glucose still. Admittedly that depends on which veg and how many but the point remains valid.

I’m not nitpicking, and I don’t appreciate you making out I’m being difficult or petty. I doubt I’m the only one confused by your comments. I think it’s a valid request to make, when you are telling someone not to count all their carbs, that you also explain why you say that as it goes against the advice of most sources and experiences.

 

[silentsquirrel]

Sorry but that doesn’t answer my question. I really don’t understand what you mean by wed not be comparing the same thing. We are both talking about carbs in veg. You say not to count them and I can’t work out why not, as they raise glucose still. Admittedly that depends on which veg and how many but the point remains valid.

I’m not nitpicking, and I don’t appreciate you making out I’m being difficult or petty. I doubt I’m the only one confused by your comments. I think it’s a valid request to make, when you are telling someone not to count all their carbs, that you also explain why you say that as it goes against the advice of most sources and experiences.

I think the issue is consistency. I understand the DAFNE course, of which I have no personal knowledge as a T2 on insulin, advises against counting carbs in most veg. Unless you eat an unusually high proportion of your meal as veg, this just makes life easier. Less work weighing/measuring and calculating. Your insulin:carb ratio will allow for this approach; if you were to count absolutely every carb your ratio would be slightly different. It does not matter which approach you use so long as you are consistent.

As someone not on insulin, you are only concerned to know the total carbs you consume in a meal or in a day. For those on insulin, the totals are not so important, what matters most is getting the amount (and timing) of the insulin as near correct as possible. Not counting relatively low carb veg saves time, effort and stress.

 

[Inka]

Let me try again @HSSS I am talking about comparing. We (not you and me, me and OP) can’t compare or discuss if we’re not both talking about the same thing - that is, if I’m talking about countable carbs and OP is talking about every single carb in veg. So we’re happily discussing and comparing but unknown to both of us we’re comparing ‘apples and oranges’ rather than ‘apples and apples’.