Human Self Experimentation - The OGTT

For testing how much a gram of carbs raises your blood sugar, I think it should be done when blood sugar is normal, not low. If you do it while low you have possible liver dumping of glucose that may happen and change the results … Unless you just mean “low” as in “not high”?

Where did you get the information about dividing your ISF by your I:C ratio to get your carb factor? I know there is a relationship between them and I’d actually like to find what it is (I think it may be in Pumping Insulin somewhere, must dig that out), but for me dividing my ISF (36 mg/dl) by my I:C ratio (12) gives a 3, which is about half of what carbs really do to me.

BSC I am struggling with your post which I find fascinating and interesting. I commend you for this post.

My only misgivings are why would I as a T-2 want to do this?

As you know I follow Dr B pretty closely and his members website. If one is staying in acceptable range eating low carb what is the point of spiking oneself with this type of test?

I already know my pancreas is pooped out and doing this test for me would put me well into the 300’s. I have lost a huge amount of weight but even with that my phase 1 response is lousy and I have had to add medication to keep it in range.

I have changed medications recently and have gotten wonderful control but even with the medication change I cant go off my normal Dr B regime. I can tell it immediately if I do. Anyway, thanks for the post and I always enjoy what you write.

I think you have blood sugar problems are because you are diabetic. Any weight you have gained is probably because you have diabetes. Suggestions that you should just lose weight and you would be fine are examples of boneheaded logic.

So I wanted to do this to gauge and record the honeymoon I am having. As you, Paul and others have no doubt pointed out, 75g of carbs is “bad news” for most of us. But in this case, I’ve had a honeymoon that gave me some confidence that I would handle it ok.

Even if you don’t want to try 75g, you could use a more modest level of carbs (perhaps 25 g?) and get a clearer idea of how you are doing. It is all fine and dandy to just sit around measuring your 2 hr levels day after day, but if you really want to know how things are going, you probably should do this sort of thing. This gives you an idea about how your phase 1 response is going and whether you are peaking and falling sharply or whether you have a rather blunted response.

Well, I don’t think I will be fine if I lose weight… at all… lol But I have heard that gaining muscle mass, and losing weight do help with control… so I was just wondering if maybe that’s what was going on… is all.

I did something similar a few weeks ago when I FORGOT to take my insulin with lunch (yes – I forgot).

I went up to 18 mmol/L (~320 mg/dl) and stayed there until I caught it for my two hours after lunch at my regular blood sugar check. Oops.

Thanx, I did not mean that you should test when you are “hypo,” rather that you should test when you have a “normal” blood sugar 70-100 mg/dl. When you are high, all bets are off.

I don’t recall where I have seen the carb factor discussion. I first derived the carb factor when reading “Using Insulin” which contains overlapping information with “Pumping Insulin.” It is easy to see by definition if

ISF = (BS/Insulin) and I:C = (Carbs/Insulin)

then you would expect CF = ISF/I:C = (BS/Insulin) / (Carbs/Insulin) = (BS/Carbs)

ps. sorry for the math.

I wholeheartedly agree that gaining muscle mass and becoming lean helps your blood sugar control, but I don’t think that is it. I took up weight training a couple years ago and made great gains, perhaps adding 30-40 lbs of muscle. But I’ve plateaued and my gains over the last year in muscle mass have probably been negative. I’ve lost about 8 lbs in the last year and some of that was probably muscle. I don’t think it is a factor.

Well I was talking about me… if it was a factor for me, because my numbers have gotten extremely good all of a sudden… lol

And I guess I want to add another thing. I also follow Dr. B and the problem I’ve had is that, if I follow only the diet and exercise regime, the best I can do is an HbA1c of 6% and unfortunately it has generally been closer to 6.5%. I can totally manage the postprandials, but it does “nothing” for my fasting. My fasting is 130-140 mg/dl. I don’t find these levels acceptable, and neither would Dr. B. My attempts to get doctors to prescribe a basal insulin to bring my fasting numbers down have been repeatedly denied. So, I am hosed. Thus my long standing adventures trying to find some medication that works. It seems a change in medication will briefly turn on my systems, but then after 2-3 weeks, they turn off again.

In the US, you can buy R and NPH insulins without prescription. However, I have chosen to not “opt out” of medical care and I believe my doctors have a duty to properly diagnose and treat me. If it comes down to it, I do know I have that option.

While I agree with the ethical point made in the article and in many cases, I’ve felt that I was in a better position to make these decisions, the system is stacked against me. Make no mistake, most doctors believe they are the experts (and rightly some of them are), and I would expect my endo’s response to my starting insulin on my own would be to dismiss me as a patient. What doctor wants a patient that not does not comply, but openly counteracts their medical decisions. Now there are not many endos in this world, and they talk and you want them to exchange records. I really don’t think a patient with a track record like that is going to see a lot of endo’s welcoming them with open arms. So, to me, I must be careful that I do not make decisions that critically hurt my access to medical care. What if something is even seriously wrong with me? I can’t order an MRI, and I certainly can’t get any drug I want.

And besides, it is my doctors job to properly diagnose and treat me. Why should I let them weasel out of doing their job properly?

But I do appreciate the thought.

BSC I am sorry to hear that.

I think with the knowledge you bring to the table a Dr should feel comfortable with you handling insulin. I know Dr B says that sometimes it is better to avoid the endos and find a good GP that will work with you. I think Dr B recognizes that many of us put a lot of work and effort into understanding this condition such as you.

I am fortunate to have found a Dr willing to listen and he says he is getting more and more in the camp of giving early insulin to T-2’s if other things dont work. I did have to have a hard talk with him though for him to come around. In my situation another factor was the clinic has a wonderful chronic care Nurse that twists and conjouls my doctors arm. I have used her alot as a resource.

Right now I am on Victoza and getting wonderful results with it but he is open to insulin for me if that doesn’t work. He is looking out for my safety which I want him to do but he has a eye on my numbers too. My basal rates are fine but I had a huge problem with my posts and the Vicotza seems to do the trick.

As I have read you I think you are the Man of La Mancha on his quest.

Thanks for your support Pauly. I’ve heard good things about Victoza, and it is one of the things my endo offered. I may have to try it, as I will probably have to exhaust all options. But given that Byetta appears to have done nothing in the long-term, and Byetta and Victoza are the same class of drugs, I’m not all that hopeful.

Your suggestion of talking with the local diabetes center is a very good suggestion. And for many that can be a great way of dealing with these issues. I am actually in close contact with my local center and talk frequently with the nurses and CDEs there. They actually agree that a basal insulin is an appropriate course of treatment, but decline to discuss these matters with any doctors. They have apparently had some backlash for interferring with treatment.

I’ll be interested in hearing more about your long-term experience with Victoza.

Great suggestion about a GP, Pauly. Mine is a lot more open than my endo. He mostly has T2 patients, of course. I’m fortunate that he’s a doctor who is willing to learn more about diabetes.

As always, docs are justifably concerned about patients having severe hypoglycemic episodes on insulin, for which they’d be responsible.

While doctors may fear liability from patients who suffer hypos, they should also feel obligated to help patients avoid long-term complications. Misapplied drugs can have bad consequences, including over the counter drugs like Tylenol, which if you take too much for too long can destroy your liver and kill you. Life is full of risks. I find it insulting to have a doctor tell me that a basal insulin is going to “kill me” with hypos because I am an ill informed and careless patient. I have told my doctors about my studies and asked to take the insulin course at my diabetes education center, but to no avail. I have watched type 1’s be diagnosed and be sent home with insulin with absolutely no clue and not even be given insulin instruction. I saw this done with a 15 year old. Now that is irresponsible.

I do understand the seriousness of hypos. I do know that many have ended up in the ER, had truly horrible experiences. But I also know that far too many diabetics suffer terrible complications, lose many years of their lives and a key part of that is lack of blood sugar control. In this modern day, I should not be denied access to blood sugar control if it is available and affordable. I should be given proper and detailed instruction on it’s use. But believe have a “right” to control my blood sugar and to attain a long and complication free life.

Agree 100% with you, Brian. As a T1, I could easily kill myself with too much insulin. I wasn’t agreeing with the position most endos take, but that’s my take on their resistance to insulin for T2s. The other part is that it takes time to educate patients on dosing & constant fine tuning. Easier to prescribe pills.

I believe doctors are looking at the immediate risks of severe hypoglycemia & not long-term effects of uncontrolled BG (that they can blame on diabetes or the patient). This isn’t in our best interests.

Some GP’s have issues prescribing insulin to IDDM patients because they are not familiar with dosing it, and could potentially make someone go hypo, if they are incorrect…

I know you understand Gerri, and I did not mean to rant. I just have some sensitive spots. Diabetes is the only major disease where the primary “medical” treatment is patient self-care and it can be difficult for doctors to handle. You are very right, that education is the key.

Because doctors determine the insulin dose. Too much & they could be held accountable.