Insulin for keto/low carb

Well, while on the Bernstein diet my triglycerides were about 36, my HDL was 99 and my LDL was about 190. I ended up with stents. After reading Good Calories/Bad Calories I started ignoring my LDL numbers. Probably one of the biggest mistakes I have made in my life.

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I have had my LDL analyzed twice and my small LDL particle number was quite good.

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In general terms, the Low density cholesterol is sticky and light which is why it sticks to arteries and it doesn’t move from blood flow, so it builds up and causes plaque.

I haven’t had any of the LDL drill down tests.
I worry about total cholesterol and LDL.

I can’t tolerate statins so diet is my only hope to keep my lipids in a good place.
I’m on a modified low-fat high carb diet. It feels like a doable diet that I can tolerate for the long term.
I never felt that way when I was on low carb.

I’m trying to drive down my insulin usage, but I haven’t really found a way yet. I know the usual exercise and low fat helps me with that.

I read that an average non diabetic produces 0.5-0.8 units per kilo per day. That puts me in the zone, but I’m wanting to stay in range with less insulin if I can.

I’m already down a bit because I’m trying to shed a few pounds so I’m eating less.

I have to say I do not really understand where my basal requirements come from. I need 24 units of basal insulin a day.
But that’s with no eating. So where is this sugar coming from?
I mean yea my liver will dump some but 24 units worth?

I know eating fat causes insulin resistance esp in me, but does burning my own fat cause insulin resistance?

These are things I’m starting to think about that I’ve never thought about before.

I did a few 12 hour fasting days, and yea I needed 12 units on those days for the 12 hour period so I know my calculations are spot on.

Remember back in school or in diabetes education, we were taught that when there is no insulin, our bodies break down muscle protein and fat for fuel. That means insulin is not needed for that.
So I am having a harder time figuring out where all this glucose comes from

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It’s my understanding that the liver releases glucose in the form of glycogen. It does this around the clock, whether you are eating or not. The purpose of basal insulin therapy is to metabolize that liver glucose release and nothing more.

The body also stores some glycogen locally in muscles for them to use when dietary resources are not available. This is a limited resource that needs to be replenished for use again.

The liver’s ability to source glucose even when you are not eating is what makes it possible to survive while sleeping and also to survive when fasting, even fasting for many days.

Another function of the liver is to produce ketones as an alternate fuel source. Our body can metabolize ketones without the need for insulin. In fact, I’ve read that the brain and heart actually prefer to use ketones when they are available. Plus the ability to use either glucose from carbs or ketones directly provides metabolic flexibility.

People who eat the Standard American Diet or SAD, consume so many processed carbs each day, their bodies do not need ketones for fuel. That metabolic pathway becomes disused and the body simply provokes hunger pangs so that people then just feed it more carbs, the fuel it is used to.

When I lost 25 pounds about 10 years ago, my body was obviously burning my stored fat. I did not notice any insulin resistance at the time. In fact, I had recently cut my total daily dose of insulin down from 80 units/day to less than 40 units/day.

I see insulin resistance as not just a single thing caused by eating. When people become T2Ds, the hallmark of their disease is the body-wide resistance that every cell in their body resists taking in insulin that would normally metabolize glucose for energy. Their cells want no more glucose; they are stuffed full.

In fact their bodies have taken lots of glucose out of circulation and stored it as fat in many places that creates ill health. They pack fat into the liver, pancreas and other abdominal organs. This causes metabolic mayhem.

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I was aware of that, I’m just surprised how much glycogen my liver drops. It’s about equal to the glucose I eat. So it just seems like a lot.

I find that for me net carbs don’t work. So I cover for most of the carbs. Just subtracting a few grams of fiber.

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I’d just lie to say that observation may not be causation. A lifetime, leading heart disease. Can’t be just turned around and isn’t caused in a few years.

I’m sorry that I posted such a wordy response when not needed or even requested. I was fooled by this comment you made.

When you responded with “I was aware of that,” I realized that my comment was over the top and pedantic. I apologize for that and I will be much more careful interpreting your remarks going forward.

That doesn’t seem surprising to me. Many clinicians think that a 50/50 split between basal and bolus insulin is nominal.

I agree with you Jack, I had already had type 1 for 50 yrs, but all of the fat certainly did not help. Another Bernstein follower died during that time when he had a heart attack and a stroke on the same day.

I also can’t ignore the severe migraines and the sudden low blood pressure I had while eating 30 carbs a day.

I followed this way of eating for 11 yrs and it clearly was not good for me in the long run. It works very well for some and it is harmful for others.

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Try not to read too much into it Terry. I was just stating that I was aware of the livers function, I was just surprised by the volume of sugar my liver is contributing.

My liver produces half of my glucose by way of glycogen.
Glycogen is stored glucose that it gets from the food I eat.

So where it’s getting all that glucose is a mystery to me.
The math doesn’t add up.

But now that we’re on the subject, you ever notice when you get scared or startled your liver dumps glycogen and adrenals drop adrenaline.
That causes your sugar to surge, but then it vanishes.
I was always told to not dose this kind of surge.

So yea I guess my liver can suck it back up again. It seems like there is a missing piece.

My body uses a fair number of carbs as fuel. My liver is pulling half of my carbs in for glycogen production, which it then dumps on me the next day or so.

So the math doesn’t work out. I cracked open my old text books and none of them go into detail about numbers and amounts, only process.

I can’t tolerate statins either. I have genetically high cholesterol. My endo prescribed Ezetimibe. It seems to be having a beneficial, if not incredibly amazing, effect. Just something to look into, if interested.

Zetia caused me to have neuropathy.

I am type 2, still make Some insulin. You mean one graham, or 15 grahams, as loose called full carb? I doubt any bread is low carb, but foods lower In carb, should take lessor insulin. Type 1 needs more insulin, per food, per day. To eat more low carb, I eat more protein, or healthy fat. Carb. Foods are difficult for diabetics. Jim

Depends on the foods Jim. I eat around 275 carbs daily on about the same amount of insulin I used when eating a low carb diet of 30 carbs. 21 total units. I am a type 1. My last A1c was 4.9.

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What % are you below 70 (if you don’t mind my asking)? My last A1c was 5.1, but I’m below range too frequently still, so to me my A1c is reflecting too-frequent lows. I’m trying to get better, but it’s hard when also trying to avoid highs. It’s so easy to go too much one way or the other. It’s so frustrating trying to manage this disease, b/c I’ll do one thing exactly as I did before (it seems) and my numbers can be so vastly different.

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I hope you don’t mind me jumping in here. My A1c is typically in the range of yours but I don’t consider myself low until it drops below 65 mg/dL. I can fairly consistently keep the amount below 65 at < 5% with the amount below 55 at < 1%.

I don’t consider this level of hypos as dangerous since I hold my glucose variability down to < 20 mg/dL. This means that when I do approach my hypo range, it does not happen quickly and my CGM gives me sufficient warning to take action. These lows can typically be averted with a single glucose tablet.

If you want to shoot for a normal A1c (< 5.7%), I recommend that you work on your glucose variability first. I consider low glucose variability as measured by standard deviation (SD) at < 25 mg/dL and coefficient of variation (CV) at < about 22%.

Glucose that swings too much will produce hypos which invariably rebound to highs. Hyperglycemia invites over treatment and will often lead to hypos. As I’m sure you know, it’s a vicious cycle.

Once you have glucose variability tamed, your average glucose and A1c will follow. And your quality of life will improve as well.

I try to keep my range between 70 and 140. I rarely go over 140, but I do go under 70. Like Terry, I have to go below 65 or even 60 before I consider myself low. I have my alert set for 80 during the day, so I can try to catch lows.

I very rarely check to see where I am according to percentages. I don’t really want to spend time on the sites that chart it at this point. I know in my head how I am doing since I have been doing this for decades. Last time I looked I was around 90%.

I do have days like today. I am eating all of my regulars meals, I am taking less insulin, and I still can’t keep my glucose levels up for anything. This happens every once in awhile and this morning I was wondering if it had anything to do with the coming full moon. I am somewhat serious. I should really chart it. I am too old for hormones to be playing a part. I can’t even do my normal bike riding today, because I just keep dropping too low.

Wisdom tells me that I need to drop my Tresiba, but usually 11 units work well. I really need a pen that will give me 10 1/2 units, because I don’t want to go back to using a syringe.

I will continue to walk this tightrope, until I can’t anymore.

Edited to add that I am not below 70 90% of the time. I am in range 90% of the time last time I looked. When I am out of range it is almost always because of lows. I usually feel fine in the 70-80 range. Actually when I was high even over 200, I felt fine.

Thanks for your input! Yes going too low or too high makes one feel miserable - the more so, the more frequently these swings happen. I do try to be conservative in treatment, so standard deviation is important, as you say.

I personally don’t like going below 80, because that’s when I start feeling hypo, and, given various amounts of insulin-on-board, can easily turn into a veritable low. I do go into the 60s about 3-5% of the time, but for me, that’s too much, just in terms of wanting to feel good physically. Anyway, I’m just going to try to improve… thanks again!

M. Surely you cannot compare insulin need for 30 grahams carb, vs. 275 grahams carb? I generally eat only 3 to 4 carbs per meal. I use 10 units Lantus per day, perhaps 2 units mealtime Ins. and one 500 mg metformin per meal, but I am type 2. I think I begin to have hands shake at near low of 70. I consider under 70 going low myself. I am age 77, diabetic 36 yrs. Low carb helps not gain excess pounds.

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You offer many details , which is likely useful to do many of fellow diabetics. I love almonds and walnuts, but likely eating excess amounts, often do not measure a portion. I often skip a meal a day, use low carb protein drink. Bad news is it’s processed food, but an easy short cut. I appreciate your frequent detsils. Jim