Hyperglicemia and malnutrition

i have a puzzle and wonder if anyone has sufficient knowledge to shed some light on this:

a type I diabetic, withouth any other underlying health issues, eats a perfectly balanced and ideally fitted diet to her energy needs (let’s say 2500 kcal with ideal carbs/fats/protein proportions). if her glicemia is continously high (let’s say avg glicemia is 150-180 mg/dl) - will her body be able to absorb all the nutrients from the 2500 kcal diet?
how much (approximately) of the nutrients she consumes will not be absorbed?

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Matt, a T1 who is averaging 180 is probably spilling glucose to the urine for half the time. Glucose spilled into urine won’t be nutritionally available.

At an average bg of 180 I don’t think this effect is profound, not like in the pre-discovery-of-insulin era for sure.

Certainly 40 years ago the medical community stereotype of T1 kids (before A1Cs and home bg testing was available), was that “compliant” T1 kids were average weight and height, while poorly controlled T1 kids were thin and short due to spilling all the nutrients.

But back then, who knew what average bg was? I suspect the best controlled of the compliant kids were averaging 180 or more, and the “non-compliant” labeled kids were averaging much more than 300. Stone knives and bearskins, man.

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I agree with the other Tim, but I think the question was about things other than glucose?

If so the answer is, everything else will be absorbed normally.
The carbs will be absorbed and broken down into glucose, but since there isn’t enough insulin, they are passed out in the urine. How much is dependent on how often she is over 180.
180 is the spill point for glucose to be removed by kidneys.
That’s why that number is used for the highest normal range.

So yea that is basically why uncontrolled type 1 diabetics are thin. Of course other things go with running high sugars all the time, like atherosclerosis and retinopathy and kidney disease.

I was very underweight when I was diagnosed.

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Keeping a too high level of Blood Glucose can damage the body as it thickens the blood… Kidneys and eyes are the most susceptible.

I think high blood sugar levels are more about the damage it can cause. Also when you don’t have enough insulin as a type 1 you also run the risk of DKA.

Thx Timothy!
How do you think how much of the consumed nutrients will not be absorbed if she runs > 180? i couldnt find any research on that, but i think that the % has to be substantial as most diabetics in early stage get super thin even if they consume a lot of nutrients.

There is more than one thing going on.
I think there is a body type associated with type 1.
I was very thin my whole life, leaner than my brothers.
Had a very hard time gaining weight even with normal sugars.

I lost even more weight when I started spilling glucose.

At 180 you won’t really be losing too much glucose.
It is very hard on your body though.

If you can target 180, you can target 120.

@Timothy I have never been thin and I am a type 1.

@Matt When you say nutrients do you mean vitamins or calories? Because what @Timothy was saying is the actual nutrients like Vitamin B etc is probably still used. I have not a clue on if lack of insulin and utilizing all nutrients is connected.

But calories, per see carbs, you definitely lose some portion of being able to utilize carbs because when you don’t have enough insulin you can’t use them. High blood sugars represent a lack of insulin usage. Hence you have the weight loss. How much weight you lose or how many carbs you lose probably can vary per person as our usage of insulin varies too. Your body literally starts to starve when you lack insulin to use the food you eat. Hence also the danger of DKA.

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Type 1 is not associated with thinness, beyond the weight loss that occurs in acute ketosis. If anything, in infants and early childhood, higher weight is linked: https://academic.oup.com/aje/article/169/12/1428/169661
and both youth and adults with T1D are more likely than the general population to be overweight/obese, now that T1D can be treated in ways that prevent ketosis and do not require extremely restrictive diets:
Obesity in Youth with Type 1 Diabetes in Germany, Austria, and the United States - ScienceDirect
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1399-5448.2009.00519.x
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1464-5491.2010.02956.x

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@Marie20 I meant carbs, proteins and fats
In theory - being consistently @180 (super stable but high glycemia) would mean that you’re missing that extra bit of insulin to return to normal glycemia, but what you add by eating is cleared (sugars are stable). this however does not mean that the nutrients you consume are all absorbed by your body - as @Timothy said above a certain level your kidneys start to filter glucose out of your bloodstream.
So you eat 2500 kcal but your organism/cells actually get less (2500-x). the big question stands: how much less?:slight_smile:

2% sugar in urine corresponds to the dark brown on Diastix urine test strips. (The highest concentration I remember that’s actually on the visual chart). Let’s say a diabetic is running well above 180 blood glucose, and producing 4 liters of urine a day (well above average but this poorly controlled diabetic is drinking a lot of water as his kidneys work overtime) at 2% glucose in the urine.

4 liters of water = 4 kilograms.
2% of 4kilograms = 80 grams of glucose.
80 grams of glucose = 320 calories.

So 320 calories of nutrition might be lost a day. That is 13% of a 2400 calorie per day diet, getting spilled in urine. Dropping 320 calories a day from a 2400 calorie per day diet isn’t instant malnutrition.

I think to be spilling 2% sugar in urine, the diabetic in question would have to be well above 180 average. Probably 300+ average. (Just remembering back to my time using urine test strips 40+ years ago. I have to explain to all my young doctors that I was diagnosed without a blood test. I had obvious ketotic breath and when they dipped the TesTape in my urine it instantly turned jet black! So I would’ve been way above 2% at the time, but I was also obviously DKA every other way from Sunday.)

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Not all type 1 are or were thin. I have gained weight since I’ve been on insulin 34 years. I am still in the normal Weight range.
But look how difficult it must be to be say obese and type 1.
You will need a lot of insulin to support the extra weight.
You also need to be in top of it. Because if you are not closely watching it, you will lose weight.

I know there are some obese type 1, but I’m sure it’s less than the population as a whole. I don’t have data to back that up.
It’s just my own perspective, knowing quilt a lot of type 1 people.

The AMA sites ectomorphic children should be followed for possible development of type 1 diabetes.

Are you circumventing around whether or not one could intentionally run a little high as a means of controlling weight, or intentionally absorbing fewer of the carb calories than one actually consumes? That’s kinda what I’m reading between the lines, but I might be way off base.

When I was younger and partied still, I used to attend events where there was another Type 1 woman who did exactly this. She was quite the diabetic role model outside of these events, with amazing control (way better than me at the time!) and all the cool tech of the day. She would intentionally not bolus for the prevalent junk food at these things, though, to avoid the calories, and she was most definitely very slender… And totally neurotic! It’s not healthy for mind or body, but indeed can be done if someone is obcessive enough to stick with it.

I’m pretty sure nobody has quantified an exact amount or formula for how much nutrition can be urinated out, though. It’s going to be different for everyone depending on how your body is working and the composition of the food eaten. It would be impossible to know without collecting and analyzing all the urine.

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Actually, Type 1s and weight gain/obesity is a pretty hot topic right now, if you follow the symposiums and chatter. Now that we’ve got all these awesome tools to control BG and more and more people are finding their way to favorable A1cs, they’re discovering that we’re blowing up like balloons. Of course, it’s not everyone, but the problem is way bigger than you expect. It’s why there’s so much current focus on researching the Type 2 meds for Type 1s. They’re looking for ways of controlling BG that aren’t completely dependent at throwing insulin, which is essentially a growth hormone, at it.

As a 5 foot tall woman, I don’t have much surface area to hide 5 or 10 extra pounds. So anything about weight management catches my attention. There’s actually a lot of discussion about it amongst Type 1s, even here on this site.

Yes I am aware of that. And with me too. The tighter I made my control, the easier I gain weight.

I think about what I’m eating every day all day. I know how many carbs I eat and I have a good idea how many calories, although I don’t really count calories on purpose.

I need to account for every carb with insulin.

When your attention is pointed at what you eat, you become aware of what you eat.
It’s not like we can’t gain weight. But if we were eating 5000 calories a day, we would know it. A lot of people just eat all day and don’t really know how much they eat.

We diabetics really can’t do that. When I get to a point that I’ve taken 25 units of insulin in a day bolus, I know I’ve had a days worth. If I’m at a party etc, I might be at 35, and say wow I need to stop eating.

Do you know diabetics who aren’t like this? An average type 1 like me using 25 units bolus in an average day, surging to 100?
And not worrying about it or stop eating?

This has become a fascinating subject for me. Maybe I’m too wrapped up in my own experience to realize some people do that.

Understand that I was diagnosed at a time when we didn’t know a lot and we didn’t have a lot of the tools we have now, so I learned to be very regulated in my eating.

Throughout my 20s I pretty much ate the same 5/6 meals because I knew how to dose them.

Now I have a cgm and pump and I know how to count carbs. So I’m not as limited as I used to be.

But maybe people who were diagnosed more recently were not forced into that way of eating.

I know how tough it is to lose weight as a type 1, I always crash when I try to lose weight. I really want to lose 15 lbs, but I guess I’m not that motivated right now.

If I had 100 to lose maybe I would be less motivated. Hard to say.

:clap: :clap: :clap:
Thank you @Tim12 for this elegant yet straightforward solution!

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Are you circumventing around whether or not one could intentionally run a little high as a means of controlling weight, or intentionally absorbing fewer of the carb calories than one actually consumes? That’s kinda what I’m reading between the lines, but I might be way off base.

@Robyn_H
Actually the origin of this question was quite the opposite:
how not to loose weight? if a person has a well tailored diet and eats accordingly, but looses weight intuitively I would advice to eat more kcal. but we have another issue at hand - not well balanced diabetes. and with more kcal controlling sugars is an even greater challenge. so i started wondering how much do we actually loose. maybe instead of adding kcal and rebalancing glycemia, simply focusing on rebalancing glycemia would be enough?

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Robyn, I think we are brushing up against diabulimia here. I have helped with counseling and support groups where i’ve seen the problem first-hand.

And Matt, note that many definitions of diabulimia include an A1C of 9.0 or above, which would be an average bg of 240 or higher. The examples I overlapped with, had A1Cs in the 12-15 range. High A1Cs are not at all rare among teen T1s so it takes more than a high A1C to diagnose diabulimia vs poor (or even just typical) teen control.

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Thanks. I didn’t know there was a word for that kind of behavior. I don’t think she would have qualified, technically, with that A1c. (Of course, I never saw her actual labs or anything, so maybe?). It was more like a conscious decision when she wanted to indulge without any penalty to her appearance. But it was a compulsive enough motivation that it definitely struck me as unsound. I’m afraid that since @Matt said I missed the mark on this one, I’ve derailed the intended conversation.

@tim12 you are right - that would definately be the case if someone purpously keeps a higher glycemia to lower the effective nutrients absorption.

@Robyn_H no worries. it was a detour but a truly interesting one!

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