Youngish Veteran t1d - insulin is not working

[Jabba29]

I must add I am neither an endocrinologist or doctor but Someone who has taken over 10,000 injections since disagnosis to manage blood glucose and so like all t1ds have a vested interest in knowing why food does what it does to us all in every meal.

I am a nutritional scientist and very interested in all forms of information about the subject. Being open minded is a challenge but we must always be.

Love to hear differing views and understand why people have them. We all hope to know more tomorrow than we do today and all are at differing levels of ignorance.

 

[Pumper_Sue]

I have a good understanding of the differences, t2 is in most cases if diagnosed correctly as t2 is very curable. T1 is not.... Currently. 🙂

Type 2 is not curable, it can be very well controlled though as can type 1 🙂

 

[grovesy]

So

Sorry it was to demonstrate that treating a symptom not a cause.

I must support that statement :-

T2 is a condition fundamentally different to T1 with similar symptoms High blood glucose (bg) .

T1 is no production of insulin
T2 is too much and ineffective insulin. Usually insulin insensitivity.

Both can have insulin sensitivity issues though but the T1 produces no insulin

Both main symptoms are high bg.

The cause of t2 is considered in most ie non gestational or other factor to be primarily poor diet and nutrition. Metabolic syndrome. The body saying stop feeding me so much processed carbs and sugars. The huge production of insulin to cope and the resultant body fat (not in all cases ) make the insulin less effective.

Over years this results in higher blood sugars/glucose and is detected. The symptom.

The current poor main treatment (in my opinion) is usually drugs to increase insulin sensitivity - metaformin and or more insulin. My reasoning this is poor is logical and explained below.

Treating t2 as an analogy with insulin is like giving Vodka to an alcoholic.

Don't treat the symptom, treat the cause.

Short term this is fine because bg is harmful as raising the glycation of blood it attaches to the haemoglobin and then reduces the cells ability to hold oxygen. High hba1c. Fundamentally starving the body of oxygen long term in absence of increased haemoglobin (from exercise - a protection method) this creates the damage to the body we all know.

Exercise can serve to help but it isn't a good sole method of cure.

The best and most solid method for t2 treatment and cure is giving the body a chance and not eating foods that primarily are insulinogenic (stimulate insulin)

Often a t2 considers it ok to still eat this way as they just administer more insulin to cover the highs of bg (symptom), fundamentally due to lack of understanding of the condition. Tackling the cause is the best strategy

Note in T1 it is the only method using insulin and not administering insulin is lethal usually very quickly.

I have a good understanding of the differences, t2 is in most cases if diagnosed correctly as t2 is very curable. T1 is not.... Currently. 🙂

The most recent research has revealed that Diabetes has many variations and they is no one size fits all.

 

[Drummer]

Type two's who - like me - are lucky, can change their metabolism so that - like me - they could eat more carbs and not see a rise in BG levels - but I know that it is a temporary situation, if I were to continuously eat more carbs then my body would not be able to manage it and move back towards diabetes.
I have negated diabetes by removing the problem - more carbs than I can cope with.
It is not a cure as such, but as I do not over stimulate insulin production that process becomes normal for a low carb intake, and my metabolism gets back into balance and using fats for energy becomes its normal situation.
Diet and exercise are probably wise choices, but the only instruction I got at diagnosis was 'take these tablets as directed'.

 

[Eddy Edson]

Treating type 2 with insulin is perfectly reasonable if other treatments no longer work. It’s a well known phenomenon, T 2 beta cells giving up the ghost after decades of being hammered by T2 drugs.

Apols for following along an OT thread fork, but I hadn't heard that one yet. So all else being equal, it's better not to be on Metformin if you can swing that?

 

[silentsquirrel]

Apols for following along an OT thread fork, but I hadn't heard that one yet. So all else being equal, it's better not to be on Metformin if you can swing that?

@mikeyB will no doubt clarify/correct, but I think Metformin is OK, it's the drugs that are given when Met on own isn't enough, such as Gliclazide, the gliptins and flozins that are the problem in this way.

 

[Jabba29]

Sue, we will have to agree to disagree. Lchf or keto is a way of eating, Not a diet. If a t2d uses this woe it has been proven to completely remove the need for exogenous insulin and any other drug that increases sensitivity to insulin - normalize bg. A cure. The health benefits are of course self evident.

Pharma has much to answer for and regulation, research is very bias. The figures used on their drugs usually show relative risk improvement and small print absolute risk. Need to treat figures are remarkably high and side effects can never be listed with other drugs being taken.

A little time being a skeptic and forcing an open mind really opens your eyes.

Insulin seems a must for us t1ds though but the need for it can be hugely reduced with the correct/different diet or way of eating. I'm on on a bad day under 25u. Basal 18.

 

[Jabba29]

Yeah, I remember being really surprised when DeusXM admitted his low, low carb approach had left him insulin resistant. He’s so gung-ho about the benefits of low-carbing!

Have you read Vickie de Beer’s “Type 1 and Type 2 Diabetes Cookbook: Low Carb Recipes for the Whole Family”? Her son’s diet is low-carb, high protein and he injects to cover the protein he eats. There’s a section on how to work out the doses.

Could that be your problem, @Jabba?

So I did a Lil testing on same insulin, I had some breakfast with carbs, no or v low protein. The bg rose and normalized with bolus. This would seem to show that my Humalog isn't as effective at normalizing gng bg rises than dietary carb rises.
This could lead me to think that I'm insulin resistant when actually the bg rise from glyconeogenesis is not as responsive to Humalog. Interesting hmm.

This would only be relevant or apparent to lchf t1ds or IF t1ds as gng is more pronounced. Also only easier to test on fully fat adapted t1ds that are regularly in normal ketosis. (not DKA)

 

[mikeyB]

If your BG normalised with bolus, what’s wrong with the Humalog? Are you saying that it doesn’t lower your BG in other circumstances? That’s physiologically unlikely, to say the least. It doesn’t sit in your body deciding which glucose to lower, whether from ingested carbs or produced by other foods, which I assume is what you mean by gluconeogenesis.

Ever considered a switch to Novorapid?

 

[Jabba29]

Thanks Mike, used to be on novorapid. Changed to Humalog as I was getting same issues but more often. Tried fiasp also. After this thread I focused on other causes and it seems that exogenous insulin and Humalog doesn't effect glyconeogenesis bg rises like it does dietary glucose.

I can test this well as I'm fully fat adapted and use ketone bodies more than glucose for primary energy.

This theory can only be tested by people like me I think, t1d and fat adapted. Or possibly a t1d that is fasted but the bg drop may prevent it as gng is likely to be less effective.

My bg drops are very slow without insulin, even with exercise. This is because I'm sure due to ketone body energy production

Perhaps ketone presense could effect Humalog or other exogenous phase 2 insulin. Phase 1 could differ but as a t1d I couldn't know as I/we don't make it internally.

I love the fact this raises more great questions and many theories.

 

[Jabba29]

If your BG normalised with bolus, what’s wrong with the Humalog? Are you saying that it doesn’t lower your BG in other circumstances? That’s physiologically unlikely, to say the least. It doesn’t sit in your body deciding which glucose to lower, whether from ingested carbs or produced by other foods, which I assume is what you mean by gluconeogenesis.

Ever considered a switch to Novorapid?

The bg drop is very very slow from gng rise from Humalog administering, sometimes many hours and more is required. Quite unusual and difficult. I'm. Not convinced it may just be a more natural as iv seen rises in bg after insulin on non food bg rises.

 

[Jabba29]

Jabba, have you tried a libre or a cgm? I have been using the Libre to help adapt to LCHF. I have also been trying to add some 6/18 IF.
I find the Libre is especially useful for data during sleep, and for following the rhythm of the day.
This is a screen shot from yesterday using xdrip+
View attachment 9891
In the image above you can see I was fasting until about 1230, had brunch, dinner at 1800, then back to fasting. I also worked 1400 to 2200 and clocked up 22000 steps.
For me that is a very good day.

Thanks Benny, yes, I use a cgm, did use libre for a while, switched onto dexcom g5 and now g6. it is how I can monitor the accurate changes. the dexcom auto reads every 5 minutes and updates my phone without a scan needed as it transmits. it is more expensive (actually the g5 is cheaper if you restart the sensors) but fairly accurate especially if within close targets or not crazy fluctuations

 

[Jabba29]

Jabba, have you tried a libre or a cgm? I have been using the Libre to help adapt to LCHF. I have also been trying to add some 6/18 IF.
I find the Libre is especially useful for data during sleep, and for following the rhythm of the day.
This is a screen shot from yesterday using xdrip+
View attachment 9891
In the image above you can see I was fasting until about 1230, had brunch, dinner at 1800, then back to fasting. I also worked 1400 to 2200 and clocked up 22000 steps.
For me that is a very good day.

I have been doing 16/8 for almost a year IF with keto is a very good match. I dont get stressed on macros this micros that as we are t1ds, we have been doing this counting for a while. knowing our impact carbs is fairly easy. now impact proteins with 22 different ones is a tad harder and less info about but the cgm helps test the reaction without impact carbs muddying the water

 

[everydayupsanddowns]

Not sure if it applies in keto, but alongside carbs and insulin protein and fat are proportionally converted to glucose over a longer period.

Rough rule of thumb seems to be 50% for protein in 2-4hrs and 10-20% for fat in approx 8hrs. The carbs are faster, of course, and blended meals interact so different components slow down any carbs present only for them to emerge later. It may be that with your blend of macronutrients you are getting some late fat/protein and delayed carbs which are arriving when your bolus is beginning to flag a bit.

https://www.diabetes-support.org.uk/info/?page_id=438

 

[Jabba29]

Not sure if it applies in keto, but alongside carbs and insulin protein and fat are proportionally converted to glucose over a longer period.

Rough rule of thumb seems to be 50% for protein in 2-4hrs and 10-20% for fat in approx 8hrs. The carbs are faster, of course, and blended meals interact so different components slow down any carbs present only for them to emerge later. It may be that with your blend of macronutrients you are getting some late fat/protein and delayed carbs which are arriving when your bolus is beginning to flag a bit.

https://www.diabetes-support.org.uk/info/?page_id=438

Hi thanks for your comment, I have seen both sides of the debate on fats being converted to glucose but biochemically and logically it seems inaccurate in that description. I'm from the camp that believes fats do not raise bg. Proteins for sure and the % is very dependant on the type of amino acid plus a Lil like the gi index for protein, mudied by the on board carbs.. Given we are in the dark on our foods on actually quality it's tough to test, especially as many foods have multiple proteins.

Ketone bodies don't seem to require insulin for transportation, adipose tissue is converted to ketone bodies in absence of insulin. Therefore logic says fat won't raise glucose or stimulate gng. The answers and questions go on. 🙂

 

[everydayupsanddowns]

Hi thanks for your comment, I have seen both sides of the debate on fats being converted to glucose but biochemically and logically it seems inaccurate in that description. I'm from the camp that believes fats do not raise bg. Proteins for sure and the % is very dependant on the type of amino acid plus a Lil like the gi index for protein, mudied by the on board carbs.. Given we are in the dark on our foods on actually quality it's tough to test, especially as many foods have multiple proteins.

Ketone bodies don't seem to require insulin for transportation, adipose tissue is converted to ketone bodies in absence of insulin. Therefore logic says fat won't raise glucose or stimulate gng. The answers and questions go on. 🙂

Well the proportion of fat that many sources suggest converts to glucose is usually fairly small (10%) - but the better known effect is the slowing of digestion. Which can mangle the absorption of carbs and mean they arrive far later than the dose that was intended to deal with them (and which may have been reduced due through a period of experimentation to avoid hypoglycaemia). Do you generally use square or dual wave boluses when dosing for meal carbs?

Like others I have been T1D for many years, and while doses generally ebb and flow from month to month I have not seen any overall trend that suggests the insulin itself is losing potency or significantly variable in quality.

Any variation I see tends to be more down to physiological changes to my individual insulin needs (activity / seasonal changes / stress etc). The insulin itself is fine - it’s just that my needs change during the course of a vial.

Having said that I have also seen Humalog and NR very slow to correct elevated BG. I would generally expect a correction for elevated BGto begin reducing my levels 60 minutes after injection, no earlier. If I introduce activity I can shorten the period - but rapid acting insulin’s are often anything but. Wrong insulin, with the wrong profile, injected into the wrong place!

 

[Jabba29]

Cortisol does complicate matters. For sure fat slows glucose absorption.

If I think about it, it has been the last couple of years when I really hit the keto diet and IF. Ketosis and glyconeogenesis bg rises seem to be resistant to exogenous insulin. I rarely eat impact carbs now and don't struggle with it, if I eat less dietary good fat gng seems to be higher and so increases my bg. Dose adjust is almost ineffective BUT the bg high doesn't feel the same or as bad. Just a cgm shouting at me. It's harder to thoroughly test as ketone blood strips are hard to get out of the gp, urine strips aren't accurate for me (mostly beta hydb.. Ketone )

I expect my hba1c to be higher, if so I think this glycation could also be harmful as less oxygen can be transported. However that assumes that the gng glycation acts in a similar space consuming way in the cell as normal glucose. My oxygenation in exercise is still far better than my carb gobbling days but too many other factors to theorize gng glycation of the cell isn't harmful to oxygen uptake.

 

[mikeyB]

When you have chronic pancreatitis the game is on. Predicting exactly when the fat in the meal will make it into the bloodstream, along with the rest of the meal, is a bit of a lottery. Still, you get used to it.

I bolus for the meal I’m eating, from long experience and carb judgement. It’s pragmatic. Get it wrong, correct it. Confounded by not enough Creon, correct it. Slow gastric emptying due to my neurological problems, correct it. Just pragmatic, as I said.

I haven’t got the time, or inclination to waste my life attempting to work out the minutiae of glucose and fat metabolism in my body. I’ve got insulin to manage the BG, mostly it works quite well. It’s not a health concern, for me, it’s a trivial distraction from the rest of what I have to cope with. It doesn’t bother me. I don’t have any complications. I’m actually more troubled figuring out how to get my socks on in the morning. There’s a proper challenge.

Once you’re on talking terms with the Diabetes Fairy, Jabba, you’ll understand all this.🙂

 

[Jabba29]

Haha fortunately I mastered socks, but only recently, I'm moving on and hoping to learn from others that have some of pieces of the large jigsaw puzzle of diabetes, endocrinology and nutrition that I don't possess. Perhaps if I get lucky I will find this famed diabetes fairy of which you speak. If I do I will let you know, it could be insightful. 🙂

 

[mikeyB]

Actually Jabba, the socks bit is true - my left thigh is so wasted with the motor neuropathy I can’t lift the foot off the floor. I’ve got a note from the DWP letting me off PE.