Detemir leads to less weight gain than NPH?

over at another website people are talking about why detemir would lead to less weight gain than NPH. for people here who have been on both, did you find that you gained less weight, or even lost weight, on detemir as compared to NPH? for whatever difference you saw, why do you think they happened? or were there no difference in your weight when you switched from NPH to detemir?

I have only used the OTC insulins and don’t have any experience with detemir. However, I did have two articles in my library that cover studies/discussions on this topic. The conclusion? Detemir does seem to affect weight gain LESS than NPH. Here are links to the two articles:
http://www.medscape.com/viewarticle/554303_print
http://www.drugs.com/clinical_trials/new-data-shows-unique-levemir-weight-benefit-continues-after-two-years-2045.html

Due to personal time constraints, I don’t “follow” any discussions in this forum or any others. However, I vaguely remember that you were concerned about increasing neuropathy with your Dad. How is he BTW? Dr. Bernstein has repeatedly claimed that normalizing blood sugars (that’s “true normal” and not the organ-damaging levels recommended by the medical establishment) would reverse neuropathies as well as most complications. That has been my own personal experience as well as that of several close friends who chose to bring their blood sugar levels below the 5.4% level (my own A1c just two weeks ago tested 4.6%). I have only used OTC insulins (Regular and NPH) and continue to do so after nearly ten years of MDI insulin use. However, I am fairly active and rarely use more than a few units of NPH per dose as sort of a “poor man’s basal.” I continue to use the OTC insulins after all these years only to serve as an example to doubters that not only can it be done, it can be done very successfully. In other words, in order to talk the talk, I had to walk the walk. If you need any advice or help with your Dad, perhaps we can set up a dialog via PM. However, I’m not sure how PMs work on this particular forum and would have to explore what's required.

thanks, nutrijoy. i think you have to make a friend request to me, and then i accept you? the last time i talked to my dad, he wanted the name of a podiatrist. but he said it was only for getting someone to cut his toe nails. i have a feeling it may be for more than that, but maybe he didn't want to say more. i will have to draw him out more.

nutrijoy, could you tell me what your daily routine is? what do you usually eat. your exercise your shot and testing schedule? you are a model of success that i want to learn from. i've heard that NPH and R are not as predictable in their action as Lantus/Detemir and Humalog/Novolog. How do you keep from getting hypos?

also, how did you come to discover that you had diabetes? how old were you at the time? do you have diabetes in your family?

That’s quite a handful but I’ll do the best that I can since I never set up a “profile” that contains information on me or my background. My mother was insulin-dependent and did a fabulous job taking care of herself. She lived alone during most of her senior years until I quit my job and moved back in to care for her during her final year. When she passed at the age of 88, her death hit me pretty hard emotionally since I had been caring for her and we had become even closer. I had read many studies about extreme emotions, whether joyful or sad, could trigger the onset of diabetes in those with the gene(s). Two years after she died, I started to develop neuropathy including foot drop syndrome. I self-diagnosed my condition and more or less confirmed it with numerous finger prick tests taken throughout the day over the course of two weeks. The A1c test I ordered (through my Life Extension membership) came back at 6.1% and I have never tested higher than that. To the medical establishment, I was NOT diabetic. I finally found a top-rated endocrinologist who ran me through exhaustive tests (he spent over 3 hours with me) and confirmed that I was indeed diabetic. The endo labelled me as T2DM (due to my age which was 63 at the time) and prescribed various oral meds over the course of nearly five months. With no improvement in my blood sugar levels and worsening neuropathy, I had two C-Peptide tests taken and both were at the very bottom of the reference range.

I had been requesting a prescription for insulin but was denied repeatedly. “Let’s just give it another few months (with different oral meds each time)” was the typical brush off. Finally, I had had enough, became “non-compliant”, and purchased OTC insulins on my own in an effort to reverse the foot drop because it hampered my ability to walk normally (and it was getting worse). My neurologist had told me that there was no cure and had recommended physical therapy. After about 30 days in aggressively lowering my blood sugars into the 5% club (5.5%), my foot drop symptoms began to fade. After 90 days (5.2%), it had regressed to the point of virtual reversal (i.e., no more physical symptoms). It took two years for my neuropathy to fully go away, however, but I have been 100% complications-free for nearly a decade now. Incidentally, I will be 74 this year so you might consider me to be an “elderly person” with health stats that rival someone in their forties or fifties. Other than insulin and an occasional puff of albuterol (for life-long asthma), I do not require any other meds although I do take metformin for its anticancer properties.

I’ll post details of my journey into normalizing my blood sugars using Regular and NPH insulins in a subsequent post (it's getting late). This will provide you with enough information to at least understand my decision to go against the wishes of my own doctor; something that I would never recommend for anyone else to consider. Now I HAVE helped others start OTC insulins against their doctors’ wishes but with this important disclaimer: they were the moving party and made the decision to start insulin strictly on their own (absolutely no prompting or recommendation from me).

this sounds like brian's story. he went otc insulin as well when his endo wouldn't prescribe it.

that is quite a story. you have used your talent to help yourself and others- that's what gives life meaning!

i wonder if you were running high blood sugars before your mom's passing, although it makes sense to me that the stress of that could have been a trigger. even though both my parents have/had diabetes, i thought i would avoid it since i was never obese, i was always active. it was when my husband got a blood sugar meter and i tested on a whim that i saw i could hit over 200 with a bowl of oatmeal. but ever since i was little i have always felt tired and dragged out after high carb meals. i think that was an early sign. plus getting yeast infections when i was pregnant with both my children.

my mom built an addition on to our house which she designed herself. she always wanted to be an architect. she was an icu room nurse/supervisor. she went downhill fast- about 3 weeks of torture- better than some anyway. we took her from the hospital to die in her home she designed with the sounds of her canaries around her. we never knew to give her basal insulin, which i later found is necessary during a diabetic's last days. i told my husband that if he is taking care of me during my final days, just to overdose me with insulin because i don't want to die slowly. sorry to be macabre, but i'm just keeping it real. looking forward to hearing more about your experience.

First, a minor correction: My mom passed in 1999; I was 61, not 63, when my D was diagnosed. I have been complications-free since the age of 63. I did use my Mom’s meter and periodically tested my FBG periodically while she was still living (an older OneTouch model). The results were always in the 82 to 83 mg/dl range. It wasn’t until a year after she died that those numbers began to gradually climb into higher territory but still remained under 99 mg/dl. I began to adjust my diet and activity levels at that time since it was a clear indication things were beginning to change in my body. Since I had already quit my job to care for my Mom, I never returned to work due to the emotional impact that her passing had on me. Instead, I simply retired and concentrated on technology issues and, of course, going on long daily walks on a scenic rec trail every morning. I still continue the walks to this day and just got back from one. I walk about 10K over a 2+ hour period five to seven days a week and this morning was no exception. In town, I put more miles on my shoes than I do on the tires of my vehicle. I also have a home gym that I use from time to time. I’ll go into dietary issues later; perhaps in yet another post, but want to focus on my insulin regimen first.

To address your concerns regarding the predictability between the analog and natural insulins, I have discovered (from my patients when I was a pharmacist and Dr. Bernstein’s monthly telecasts) that all injected insulins will have some degree of variability based on the amount injected, anomalies in/at the injection site (e.g., site rotation, formation of scar tissue, lipoatrophy, lipohypertrophy, etc.) and various idiosyncratic factors. The primary differences are the onset and duration of action rather than any hard or fast rules regarding predictability. For example, in the local Support Group that I recently joined, I have superior blood sugar control, at least to my standards, using OTC insulins than others who use analog/basal insulins. There aren’t any secrets involved. It only requires one to be observant, know how to “listen” to one’s body, learn how one much one unit of a given insulin will lower blood sugar (in one's particular body) and how much one gram of carb (as well as protein) will raise it. The only challenge or task in the equation is to not only balance the two but to marry the results (impact) to something much more critical: the time factor(s) involved.

Most doctors prescribe and most patients use NPH insulin as an intermediate insulin and not as a basal. Usually, the intent is to minimize the number of injections required and NPH’s delayed onset of action means that a mixture of R & NPH (usually 30/70) that is injected at breakfast will also be able to cover lunch. Perhaps that is where the unpredictability factor comes into play. Trying to second guess when and how much insulin will be required at the next meal can be difficult at best and virtually impossible to achieve accurately over the long haul. Pump users don’t have to contend with this issue; just push a button when and as needed. However, that doesn’t mean that the analog insulins are more predictable; insulin pumps just make it easier to administer and to administer accurately. I liken the use of MDI and a pump to the manual and automatic transmissions of a car. If you truly master the ability to drive with a manual transmission (MDI), you will probably be a better driver when migrating to an automatic (pump). Many “drivers” who can only use an automatic often only learn how to "brake and steer" but never truly master the many intricacies of knowing how to really "drive". Of course that doesn’t apply to everyone; just enough to make life interesting (which I encounter frequently during my walks as a pedestrian).

Here’s how I first began my own regimen. I had already read numerous books and have probably forty of them in my library. I would guess that 80% of them were less than useful to me personally but two that stood out from the crowd were Dr. Bernstein’s Diabetes Solution and Jenny Ruhl’s Blood Sugar 101. I also acquired and read Gary Schein’s Think Like A Pancreas and John Walsh’s Using Insulin, both at much later dates. Dr. Bernstein stated that a single unit of human insulin would lower his blood sugar 40 points. The patients that I had dialogued with as a pharmacist claimed a single unit of regular insulin would lower their blood sugars anywhere from 20 points for some patients up to a maximum of 30 points for others. All were larger and heavier than Dr. Bernstein who is much smaller in frame and weight so I chose 30 points as my own starting point. I then had to determine how much a gram of carbohydrate would raise my blood glucose.

To achieve that, I decided to skip a meal and chose lunch as the meal to be omitted (breakfast was not a wise choice due to the possibility of DP affecting the outcome). I checked my BG first, consumed two glucose tablets (8 grams of carb) and measured my BG again, twice: once 15 minutes after ingesting the glucose and a second time another 30 minutes later. This provided me with a ballpark idea of how much 8 grams would affect me personally. By simply dividing by 8, I got an approximation of what impact a single gram would have on me. I repeated the experiment multiple times in the weeks and months ahead in an attempt to obtain an average value that might be more accurate. However, the single test would be sufficient to serve as a starting point.

Before starting on insulin, I prepared a diluted vial of regular insulin using 3 parts sterile water to one part Humulin-R (I used a 3cc vial manufactured by Merck that is used to reconstitute powdered vaccines but is not available to the public). The dilution would enable me to draw single and half units of insulin (i.e., normal strength equivalents) with great precision/accuracy. I injected four units of the diluted insulin (equivalent to 1 unit regular strength) and tested my BG 2, 3, 4, and 5 hours later. In fact, I tested my BG up to ten, even twelve times each day initially until I felt comfortable with how regular insulin would impact my BG levels after consuming various food items including my experiments with glucose tablets. Was this degree of caution/accuracy required or necessary? No, but since I was going it alone (no one to turn to for help or with questions), I was being overly cautious for safety’s sake. I never experienced anything remotely approaching an adverse event.

I started using 3 units of Humulin-R initially with each meal and it seemed to be adequate initially (probably honeymoon phase) for my ultra-low-carb high fat meals. Gradually, this began to become less and less effective and I had to increase my dose, one-half unit at a time, but stopped whenever I was able to reliably obtain blood sugars within my target range (I set my goal at 70-85 mg/dl). I experienced almost no lows below 70 during this overly cautious period and only had to resort to the use of a single glucose table twice. Over time, I discovered that my average dose of insulin would average out at 6 units per meal but had to be adjusted depending upon carb content, time of day (breakfast required more insulin and dinner the least), and activity/exercise levels. I maintained detailed WRITTEN logs of everything for the first twelve months to provide me with a history that could be subsequently analyzed for trends and patterns.

That’s the short version of how I started. I can go into a zillion details of what is now an ongoing journey, For example, I should mention that I inject insulin up to six times per day: one for each meal; once or twice more for snacks, and, if needed, a corrective dose at bedtime. Also, if needed, each mealtime dose includes an adjustment/correction factor if I happen to be above my target range or at the low end of it. A typical example: if my BG measures 102 before dinner, I will add an extra unit of Regular insulin to my projected dose to offset what I perceive to be at least 20 points above my target range. I also include very small amounts of NPH in my breakfast and bedtime doses; typically averaging 2 units but occasionally rising to 3 units. In other words, I use it as a true “poor man’s basal” and not as intermediate insulin. I also never use NPH with my dinner dose as it tends to skew my bedtime adjustment.

If this sounds complicated, it most definitely is NOT. I know how insulin and foods affect me personally, take into consideration existing IOB, and do everything almost on auto-pilot. In other words, if my reading is high or low, I know what I need to do and just do it, almost by reflex action. There’s never any feeling of anxiety or frustration. If I erred in a dosage, I know precisely what I need to do to restore balance and just do it. That, after all, is the end game (i.e., balance). My endo, incidentally, never kicked me out of his practice as I expected him to do. Instead, he just turned me over to one of his PA’s and watched from the sidelines (my endo is a research practitioner and teaches at a nearby University). When my A1c results eventually fell to the 5.0% level, he suddenly took over my case again and told me that I was in the top 1% of all his clinic’s patients (3,000 strong). He also sits on the board of a national diabetes magazine with Dr. Bernstein and acknowledges that there is a great deal of merit to normalizing BG levels. Yet he doesn’t actually tell his other patients that due to the fear of hypos and the liability factor.

Although this post is lengthy, it is actually a short version and many details have not been included. In my next follow up post, I’ll go into the eating plans that I follow. That will include the weekly off-plan meals that I indulge in that might be surprising to you.

this info needs to be in one place that is easily searchable. have you ever considered starting a blog and collating your information? otherwise, can i copy/paste it to my blog and give you credit? i am not on the verge of needing to take insulin (although your bg numbers are already better than mine), but because of my family background and how carbs affect me right now, along with some deterioration in my fasting numbers, i am preparing for the possibility of needing insulin. so your info may become crucial to me in several years, so i'm thinking of how i am going to be able to find it then. in several years time i don't know how the landscape of diabetes treatment will look, but your method may still be very important- especially to those who can't find an endo who will perscribe insulin in a timely manner. plus, i am interested in how all these mechanisms work. thanks, nutrijoy! post when you have time- i will be checking in periodically.

Personal time constraints are the primary obstacle to my participation in writing blogs and I am not interested in “credit.” If you find anything that I post to be useful, please feel free to use it in any manner that will be of benefit to you including adding it to your own blog. Do keep in mind that what I have posted so far is merely a reflection of my personal experiences. Since we are all individuals and different, the information may or may not apply to others without modification. My overly cautious journey in the beginning was admittedly overkill but safety was of greatest concern to me at the time. I did assist others (4 individuals last year alone) in transitioning to OTC insulins at their request but it was person-to-person, involved ongoing feedback, monitoring, and other considerations. The outcomes have all been beneficial in terms of their abilities to improve their BG control and reduce complications (all had neuropathies). I’m not certain this would necessarily be the same via communications in a forum setting. My personal concern is with seniors (like your Dad) because all too often it is the older members of our society that get thrown under the bus or allowed to slip through the cracks. Jenny Ruhl addressed this issue somewhat in her articles, Do You Have A Good Doctor? and Do People with Type 2 Always Deteriorate?

Anyway, back on the topic of what do I eat? My eating plans vary periodically as I like to experiment with foods from time-to-time and then analyze the impact it had on my general feelings of well-being, my overall general health (based on annual full panel blood tests) and, of course, on my BG control. Instead of focusing on the specifics of what I eat, I probably should tell you what I don’t eat. Top at my “do not eat” list are processed foods. If it comes in a box, bag, or jar, especially if it contains non-food ingredients such as food coloring, preservatives, tongue-twister chemicals, GMOs, virtually anything man-made, they are off-limits to me. Exceptions may include packaged spices, soup stocks, and a few other products. In general, however, “if it won’t sprout or rot, throw it out.” There is one notable exception to the above that I can think of and that is a low carb (6gm net) Gourmet Tortilla made by the La Tortilla Factory. The first ingredient is oat fiber but it does also include some wheat flour and other “avoid” ingredients. However, I use it as a wrap and do not eat any other flour products of any kind such as breads, bagels, pasta, etc.

With that sole exception, I do not eat grains, especially corn, since virtually all corn sold here in the States is GMO-based (for those that don’t know, corn is a grain, not a vegetable). I probably should address the topic of “whole grains.” Everyone, including the USDA, most dietitians, doctors, nutritionists, and, of course, Big Agra, keeps pushing whole grains on all of us as being “healthy” food choices. But if you look at the cross-section of a grain, you will quickly see that approximately 85% of the grain is starch (the endosperm). The other 15% consists of the bran layers (outer skin or coating) and the germ or embryo that will become the future plant if it should sprout. If you eat the grain whole, it is very chewy and difficult to digest.

But most whole grains are ground into flour first, just like their white flour equivalent. The only real difference is that the bran and germ are not extracted/removed and left in the ground flour which adds fiber, protein and some nutrients to the mix. The fiber and protein will slow down the absorption of the starch but it does not stop it; it only delays or postpones it. If your beta cells still produce plenty of insulin, the delayed digestion/absorption may indeed be healthier for some diabetics by allowing their pancreas to keep up. However, for those of us with impaired insulin production, it’s going to drive our blood sugars up; it only takes a little longer than the white flour equivalent. There are a few dietitians (who are diabetic themselves) who have written about the myth-information regarding the misleading whole grain advice.

I avoid most fruits except berries and apples (mostly organic). I do occasionally indulge in small portions of pears and melons but avoid almost all tropical fruits except for kiwi and dragon fruit, the latter being a personal favorite (second only to berries). However, due to costs, dragon fruit is a relatively rare treat. Plant-based foods play a prominent role in my eating plan (I dislike the term, “diet”) as do eggs, cheese, and other high fat foods. For six days a week, I only eat vegetables (with a little fruit), eggs, cheese and other non-animal-flesh foods. Most mornings, I have a 2-egg cheese omelet with raw vegetables, berries and nuts on the side. I also occasionally have pancakes or waffles but made with coconut flour, oat fiber, and/or almond flour. Butter is used generously with the latter and the only sweeteners that I use are stevia (I prefer the liquid extract) and/or erythritol. I also eat “sushi” made with “riced” cauliflower, mashed “potatoes” made with mashed cauliflower, and similar low-carb substitutes.

Then one day a week, I eat “off-plan” and it really is off. My off-plan days are intentional and scheduled. I normally dine at all-you-can-eat seafood buffets (Asian-run) and eat primarily animal-flesh foods and selected vegetable dishes (but only if the latter are not over-cooked or bathed in unknown sauces often containing sugars and starches). I also include dessert, often two full scoops of full fat ice cream sprinkled with bits of almonds, peanuts and/or sunflower seeds. Shrimp, chicken, frog legs, beef, ribs, sausages, clams, mussels are all part of the fare. To avoid the off-plan meal from destroying my blood sugar control, I must dose with a much higher total amount of insulin, typically three to four times my normal amount. I normally require only three to six units of Regular for most meals but bump the dose up to as much as 24 units for my off-plan meals. I have to inject my high dose carefully at intervals for maximum benefit, especially since the conversion of protein to glucose can be a very slow process. I won’t bother going into the details but do generally start with a portion of my dose 30-45 minutes before the meal, another portion at the start of the meal, yet another portion at the end of the meal. Depending upon my test results, I might require an additional 3 units booster or thereabouts after I get home (I do factor in remaining IOB). Some of the mix will include NPH insulin because the delayed response of NPH is needed to offset the slow conversion rate of protein. This has kept my blood sugars reasonably stable but not really "flat line" due to the slower action of R insulins compared to the analogs. However, it is still acceptable and spikes are usually avoided (more of a gentle wave instead of a roller coaster).

I've used both NPH and Levemir and not had any issues with weight gain. I believe that weight gain is an issue when you don't adjust your basal dose properly. NPH is often part of conventional insulin therapy which uses fixed doses of mixed NPH and R. Because conventional therapy results in poorly matched basal and boluses and further requires you to monitor and eat extra to avoid lows, it is often tied to weight gain.

Personally, if you split your NPH between 2 and three shots to establish a good basal rate I don't think you would find it all that different weight gain wise from Levemir.

thanks, brian. nutrijoy, have you been following the afrezza thread? my father would not be good at making calculations for insulin. he has some cognitive/psychological issues that would interfere with that. for example, he often doesn't close his car/truck door. it's just left open. still, he lives semi-independently. he is with my brother and his family, so there are people watching out for him.

i think for seniors like my dad, afrezza looks like a safer alternative, although it still requires vigilance and some calculation. just not as much as using the other insulins. would you agree? family members could even help with giving afrezza since it seems to be less time-consuming and require less skill.

v, you may have a point but do keep in mind that Afrezza is purely a mealtime/bolus insulin and comes in fixed dosage units of 4 and 8. It would not be possible to fine tune the dosage to more precise requirements. For example, if someone needed 3 units to attain their desired target/goal, they would still have to take the 4 unit dosage; then correct for the excess unit if it takes them too low by eating a glucose tablet or more food. The reverse is also true. If their pre-meal level was already elevated and the person wanted to add a corrective unit or two to attain their target goal (e.g., a 5 or 6 unit dose), they would not be able to do so. They could only choose to take either 4 or 8 units but nothing in-between. I think MikeP addressed this in his thread. On balance, however, if your Dad lacks the desire, interest or ability to micro manage dynamic dosing anyway, then Afrezza could be an acceptable alternative to what he is doing now which, according to you, has not provided control over his blood glucose levels within safe ranges.

There are two additional considerations that all patients considering inhalable insulin must consider. The first is that a basal insulin may still be required in conjunction with Afrezza. That means your Dad would still have to contend with injections (of the basal). The second consideration is the potential impact that it could have on lung tissue over an extended period of time. There is already a label warning that Afrezza is not to be used by asthmatics (like me) so there must be some sort of concern over the effect it might have on pulmonary tissues over the long haul. It would concern me if a patient considering Afrezza has a long history of smoking even if they quit years ago. I have personally seen too many of my pharmacy patients in the past come down with emphysema/COPD in their later years and the use of Afrezza could become a trigger. Pfizer withdrew exubera, its inhalable insulin, after only a year on the market because of possible links to lung cancer and other pulmonary issues. The official reason for the withdrawal was “due to poor sales” but Big Pharma is almost never completely forthright in their public proclamations. Nonetheless, virtually anything would probably be better than what your Dad is currently doing/using and while he may not be able to fully “normalize” his blood sugars, he may be able to lower it enough to slow down his progressive decline into complications.

Incidentally, I have personally not experienced any issues with weight gain myself using insulins; even with my extravagant off-plan meals (mostly high protein/fat) that are limited to one day per week.

it seems basal is almost a no brainer. 2 fixed shots- just some headache in the beginning figuring out the correct dose. then with afrezza (setting aside lung health concerns for the moment), my dad could eat some standardized portion meals to fit in with the 4 and 8 unit dosing. that would take away some flexibility and freedom, but it would gain in hypo avoidance while still giving fairly good numbers (just my impression of the afrezza thread going on right now). my dad has never smoked- no allergies- no breathing issues. but i didn't know about that other inhalable insulin. scary. according to 23andme, i have Alpha-1 antitrypsin deficiency. my variant: "MS: Has one M and one S form of the SERPINA1 gene. A person with this combination may have decreased AAT levels but is not typically at increased risk for lung or liver disease."
anyway, if my dad progresses down the diabetic complications road, i see basal and afrezza as the insulins with the lowest risk/ highest potential benefit.


PS How did your mom get such good control? Was she dependent on others for much of her final years? if not, what strategies did she use to get such good control? both my paternal grandparents lived to be around 94. they were married when my grandfather was 15 and my grandmother was 17. one was northern european and the other 100% italian. what an insight i had into healthy life style watching them. i grew up in a farm family, so they lived right down the road. the thing i know about my lifestyle is i sit on my butt too much trying to get mental stimulation reading. my grandparents were doers, not deep thinkers. they were always moving pretty much until the evening. my view of 'old age' is shaped by them. they were both working in the fields in their 80s. my dad with stage 4 colon cancer was working in the fields this past summer! but guess what- no colon cancer cells were found in his lungs after undergoing chemo for months. and he has diabetes at the same time. he's tough.

My Mom was an amazing woman and I and my siblings all benefited from her genes. Throughout school, my siblings and I always had IQ tests that scored in the high 120’s and 130’s. Not quite menses class but good enough to be able to figure things out without too much difficulty. In my Mom’s case in battling diabetes, she was very much like Dr. B and started with reusable glass syringes and stainless steel needles that had to be sterilized by boiling after each use. A sharpening file was included with each package of SS needles. Measuring her blood glucose levels was performed using urine-based test strips and matching the colors with a chart. She kept a written log of all of her results, notes on what she ate, and the amount of insulin taken.

The dietary advice that she received from her doctor was far more accurate than the advice that has been doled out by governmental agencies and the medical establishment in later years. It all changed when the food manufacturers began their aggressive campaigns of marketing processed foods and spreading misinformation and promoting their toxic preparations as being healthier food choices for us all. And, of course, the start of the fast food chains began back then. However, my mother always scratch cooked/baked her own meals so these convenience foods did not play a significant role in her diet. She had already discovered from simple observations that, from a dietary standpoint, diabetes was a cause-and-effect disease. Certain foods and food ingredients would drive her blood sugars up but steamed vegetables, fats and small portions of meat would not. Dynamic insulin dosing was never considered back then and she used fixed doses except at dinner because sometimes she had very light meals at night. My mother simply used diet adjustments to achieve tight control.

Mom never had an A1c test that I know of but, based on her log (that I still have), her AVERAGE blood sugar measurements were in the range of 99 mg/dl. That’s considered good control even by today’s standards. Even the list of “forbidden foods” advice printed in a 1917 cookbook (Diabetic Cookery by Rebecca W. Oppenheimer) is far more accurate than anything that the A.D.A., U.S.D.A., and the majority of dietitians (including much of the medical establishment) has been recommending to diabetics for the past fifty years. Surely that’s an indication of malfeasance or a good example of the dumbing-down of America. Fortunately, my mother was spared all that and simply let her commonsense and real world observations dictate her food choices. She was virtually complications-free when she passed at 88 (five months shy of her 89th birthday) except for a touch of numbness in her left foot and a spot of psoriasis in the area of her right knee. It was only when she began to struggle with mobility issues and preparing her meals that I decided to move back to the family home to care for her. Although my posts are technically off-topic, this is YOUR thread so I’ll respond according to your wishes and direction.

i like going off topic and i like when others go off topic. it's more interesting that way. thanks for all you ideas, nutrijoy!