This is why I can’t wrap my heart around jardiance. It’s a drug that lowers the spill threshold of glucose.
So you will pee out your calories. It is sounds like the same idea as letting your sugars go high for weight loss.
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My early diabetes education 40 years ago, was all about not spilling glucose in urine. Before home bg testing that was the only possible definition of “control”. And now there’s Jardiance which on purpose causes users to spill glucose in urine. So yes I have a hard time wrapping my mind around that too.
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@Matt,
The thing to look at is not just the blood glucose level, but also the amount of insulin she takes.
For example, if you take 10 units of insulin per day, no matter if you eat 2,000 calories, or 4,000 calories, your body can only take in a certain amount of the carbs.
If your total insulin use increases to 20 units, you can get more from your diet then you could when you took 10 units. Maybe with 20 units you could get all of the carbs in 2,000 calories, but not all of them that would be in a 4,000 calorie diet.
In the first example, with 10 units, your BG would be higher than the second example with 20 units. But really, it’s the amount of insulin you are taking that determines the amount of carbs you are able to absorb from your diet.
If you want to determine the amount of carbs that can be processed, calculate it with her IC ratio and her total insulin use and her BMR.
(BMR is calculated based on muscle mass, age, gender, activity level, hormonal factors, etc.)
Eric, in my experience there are some nonlinearities in insulin response that make it more complicated than simple proportionalities.
A nonlinearity that I know of, is that insulin seems “more effective” at lower bg than higher bg. So someone averaging 180 bg needs measurably more insulin than they would, if they were averaging 100 bg. But wait, doesn’t high bg mean you aren’t taking enough insulin? So we have competing nonlinearities.
Exogenous insulin doesn’t come with C-peptide and isn’t coordinated with glycogenolysis in the same way in diabetics, that it is in normal people. (Although I’ve heard folks talking about pumps that do all 3 of insulin, peptide, and glucagon to try to mimic the non-diabetic concert of all 3.) These effects might be much more important than anything we’ve touched on here. While I have a knob to adjust my insulin and can watch my bg go up or down as a result, I don’t have any such knob for my C-peptide and the only time I’ve had glucagon it was from an EMT so I can’t say I have any experience for what I’m missing.
Agreed. I’m not saying it’s easy to calculate or even possible to do 100% accurately.
My point is simply that looking at BG is not the right thing to look at, but rather looking at total insulin amount is more relevant.
X number of units pushes X number of carbs into the cells.
And then there’s all kinds of factors, like higher activity level means that same number of units can push more into the cells, etc.
All right, now I see your point. The person averaging 180 might be taking more units (sensitivity nonlinearity or any number of reasons) and thus gaining more weight, than the person averaging 100. Even though the one at 180 is dumping some glucose into urine.
Most practitioners see the relation as dose being proportional to weight, with weight being the cause of needing more units. But there’s obvious feedback the other way, because the bigger the dose (or at least, bigger than necessary) the more the gain in weight.
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So maybe a simpler way of expressing it might be…
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if you are taking 10 units, any carbs over the 10 unit amount won’t lead to weight gain…
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if you are taking 20 units, any carbs over the 20 unit amount won’t lead to weight gain…
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if you are taking 30 units, any carbs over the 30 unit amount won’t lead to weight gain…
So the more insulin you take, the more weight you can gain, as long as you are eating enough to cover the insulin.
(If you are not eating enough to cover the insulin, you have a bigger problem - you are in a hypo coma.)
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@Matt
Commonly when people first start using insulin they gain weight. Probably the strongest reason for this is all of a sudden that extra food they ate because they were losing weight is now being absorbed because they have the insulin to absorb it.
So yes, taking more insulin to balance blood sugars better should mean you are able to actually use more of the carbs that you are eating and hence should help stabilize weight and maybe weight gain if you are eating more calories than you need.
And @Robyn_H I was really wondering the same thing since we have all heard of people that purposely use less insulin and run high blood sugars to lose weight. I’m kind of glad you asked that as it makes it more clear what goal Matt had in mind. I was thinking of asking the same thing.
So the real data on this that has been published counteracts everything you said because it is pretty clear that in fact, T1s are more likely to be obese than the general pop, not less. While purposefully taking less insulin/running high is a (disordered) way to regulate weight, most people with elevated A1cs aren’t doing so in a way that generates enough ketosis (or even any) to do that (thankfully for them). I can run in the 200s all day long without going into ketosis if I have enough basal insulin in me, but am just inadequately covering all of my food. While I may pee out some, it’s not enough to be a buffer against weight loss. Also keep in mind most T1Ds are facing not only absence of insulin, but also amylin, which helps regulate satiety and other aspects of metabolism. Plus we not only eat when hungry, but also to treat lows. Lots of reasons weight management can be challenging.
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Ok I actually read that t1 obesity is on the rise.
I personally have not met a t1 who is obese.
I do a lot of volunteering for JDA and I don’t know why I don’t run into this.
I don’t treat lows with food anymore because with my pump I hardly go low.
As far as feeling hungry, it’s not really any different than it’s always been.
My weight creeps up a little but I think it’s age more than anything
This is really eye opening to me. I really didn’t know it was a thing.
I am guessing the T1Ds who volunteer with the JDA are not at all representative of the general T1D population, just like the T1Ds here aren’t. By the way, I’m obese. I know of a bunch of other people on here who are too. And I think my T1D and the restrictive eating plans I was forced to use as a kid played a major role in my current weight, and I’ve heard others express the same thing.
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I wish it was addressed more.
I don’t only deal with volunteers but also all the public who attends the conferences or speakers.
I’ve also never seen a module about obesity in type 1 in all the years I’ve been doing this.
I think we really need to address the issue. I am going to suggest it the next time we have a conference if we ever have another in person conference.
I’ve learned a ton from going and volunteering at them. I also help out at ADA events. Which includes all types
My favorite part is seeing all the new tech that’s coming out. New insulin’s and pumps and pens and sensors.
If I can find a doctor who can speak about this, I’m going to suggest we include it in our next event.
Everyone is tightening up control, so it seems like this is a possible side effect.
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I suspect you are correct @cardamom, based not only on personal experience (I have a restrictive eating disorder that allowed me to lose a huge amount of weight, but once I broke that cycle and began eating “normally,” I gained back all that I lost and a whole lot more), but also on research that shows that restrictive eating patterns must be continued indefinitely in order to prevent such weight gain. Basically, when eating is restricted, and especially when it’s restricted severely, the body makes numerous metabolic changes in response to the semi-starvation, which then lead to weight gain when calories become available again. Granted, I’m T2, but the yo-yo effect of food restriction is well-documented in all humans. It just seems to have an especially outsized and negative effect for those of us who are diabetic.
Sadly, in my case, this meant I went from being pre-diabetic (a diagnosis which was one of the driving factors behind my extreme weight loss), to being an extremely insulin-resistant diabetic once I returned to normal eating.
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I am now only 5 ft tall, so at 106, I weigh a bit more than I want to weigh. I really don’t like that I have shrunk in my older age. I was 5’2” when growing up and except when losing a huge amount of weight when I was 8, my weight has been fairly stable.
My heaviest was when I was eating a vegetarian diet with way too much fat. I wanted to lose, so I started low carbing. I easily lost 20 lbs. After 1O yrs I started gaining weight on this diet, and because of other health problems, I switched to a low fat plant diet. I easily lost 10 lbs taking myself down to 105. I have been eating around 165 carbs on around 23 total units of insulin for 5 yrs. I do exercise. I am rarely ever hungry even when low. If I eat too much fat, I will gain weight quite easily.
I don’t really know many type 1’s in real life. I really thought that the ones I knew were heavier because they were on pumps and ate whatever they wanted for the most part.
When I eat the standard American diet, I quickly gain weight. I am aware of at least two others on this board, who are quite a bit thinner than I am. One is on a pump and one does MDI.
My mom was heavy and my son is heavy, but they both thought/think about food constantly. I love food too, but have learned to be quite disciplined.
I am now trying to lose a few lbs, but hypoglycemia is making that very difficult to do. Also with Covid, it is better to weigh a little too much, since a bad case can cause drastic weight loss.
These are just my own experiences with weight and type 1 over the years.
I might be short because I was dx in 1959, but my grandmother was only 5ft, so who can say for sure.
I wouldn’t advise any diabetic to purposely run at 180. (I’m not sure what that translates to, because I measure in mmol/L, but I remember being on the other system when the blood glucose testing meters first came out in Canada in the 70s, so I kind of remember the goal back then was to keep my BSs between 90 and 100. Anyway, high blood sugars over a long period definitely lead to complications. My sister, a Type 2, got retinopathy from highs, even though she was on oral meds. With diabetes, like anything else, I think you have to eat healthy meals, small portions and don’t eat after dinner, if you can possibly help it. Nutrients will be absorbed if the insulin is there to “unlock” the cell membranes to allow them to enter. I was a normal size teen when I got Type 1. I don’t think thin youngsters are more likely to develop it. Usually, there’s a genetic link and if there’s not, as with me, you develop diabetes because of an autoimmune disorder. If you want to lose weight, of course you have to lower both food intake and insulin, so you don’t get lows. Same with exercise. Depending on duration and intensity, lower both bolus and basal at an appropriate time interval before the exercise. This is highly individual and you have to experiment to see what works for you. Maintaining high blood sugars to eat more without gaining weight, or for whatever reason the person has-- can’t imagine what that would be-- is an invitation to retinopathy, nephropathy, and neuropathy. Thus, nutrient absorption becomes, to my way of thinking, a moot point. It won’t matter to potential side effects. Not a wise decision.
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Curious how to remain fixed on an “ideal” calorie/energy need that results in high average glucose readings. I know your examples are “let’s say” but I feel balanced when average readings are in the vicinity of 120 and standard deviation in the low 30’s. Something may not be ideal.