Enjoying many of your posts John (binge reading today after a long absence here), but this one shouldn’t stand without an alternative viewpoint. The perfect injected insulin bolus for every food is in my experience a myth. YMMV but this is simply not a golden rule although it’s one I incorrectly used for many decades of MDI.
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I started taking Ozempic for same reason. I’m a fan. It does make you nauseous for awhile til you get used to it but that goes away. Cut my insulin down about 10 units. And caused a nice weight loss. About 20 lbs.
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I have had perfect boluses but usually they are not perfect.
If you have premeasired foods and you are really on top of it you can get close to perfect most of the time.
My issues revolve around the not making sense stuff. Where I’ll eat the exact same food and have different results.
I’ve learned that exercise matters, even walking around or walking to lunch without breaking a sweat, makes a big difference.
Also fat content of food causes insulin resistance. I was always taught to mix fat protein and carbs to get a flatter rise, but it’s just not true. Fat causes me to need a lot more insulin to metabolize the carbs that are included in a meal.
Also the outside temperature effects my insulin needs, in summer I use 15% less insulin.
Also if I have pain somewhere it increases my insulin needs.
There are so many variables and moving parts, it is impossible to get perfect boluses all the time but it is oh so satisfying when it goes right.
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I broke a leg last year and saw a major increase in insulin requirements!
Stress results in climbing glucose for me — I can watch it happen on the CGM.
And exercise is crucial for me, especially after lunch.
In a way I wish I always knew exactly how many grams of carbs I’m getting, but like you say, even those times when I have a very predictable routine, my numbers can be off by a lot. Another argument in favour or CGM.
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How long did it take for you to notice weight loss from when you started ozempic?
I really can’t remember. Probably within the first three months. Then it continued pretty rapidly to the point I almost got nervous ( I had had cancer previously with weight loss as symptom)
Then it leveled off at 25 ish lbs. Mist has stayed off.
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I see. I was mostly referring to the “what you eat doesn’t matter…you will (just) have to (use a basal dose) to correct for it” concept. When most T1Ds eat high carb (and certain other) foods it becomes more difficult to accurately cover with short-acting insulin and often leads to a roller-coaster ride. The long list of other variables (stress, exerise, sunshine, overall health, etc) aside, what we eat matters and IME the older I get the more it matters. I’m doing very well as a long-termer, but I believe it’s partly because I haven’t been hesistant to eliminate or add foods as my body changes/ages.
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Ha Ha, my food choices have become quite limited. 
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**From my understanding of metabolism, fat doesn’t become glucose. But it is used in place of glucose when we fast or don’t eat enough carbs. **
**When we eat fat, it requires no insulin to metabolize. That’s why people on low carb diets can eat fat freely. **
**Fats do cause insulin resistance. That’s been proven. **
**If you need to take more insulin when eating fat, that’s the reason. **
**I wasn’t aware of it when I was younger, maybe I’m more sensitive to eating fat as I age. It’s hard to say. **
**I did several experiments at home to prove this to myself. **
** Starting at 100 mg/ dl blood sugar,I ate a single piece of dry toast and looked it took about 1 unit to metabolize the carb. I peaked at 130. After 1 hour. **
Then I added a teaspoon of peanut butter to toast at 100 mg/dl and it required 2.8 units to metabolize back to baseline.It took 90 min I peaked at 142 and back down to 104
**Then I tried toast w butter and it took 3 units to metabolize, and bring me back to 105. 90 min, peaked @ 144 **
**Then The next till morning. **
**I was at 107 and I ate a tsp of butter alone. I ended up an hour later 111. **
**The next day with peanut butter and I started at 102 and ended at 109. There is mostly fat in peanutbutter but also some protein and tiny bit of carb. **
**So the fat all alone did almost nothing to my blood sugar. **
Mixing carb with fat cause me to need3x the insulin to metabolize them.
**Fat absolutely causes resistance. **
**And while we are on the subject, high glucose causes insulin resistance too. If I’m at 100, I can take 1 unit and drop 20 mg/dl. **
**At 200 it takes me close to 2.5 units for the same drop. **
This makes it difficult for my pump to manage, so I manually correct when I’m high.
I wish we could add that reality into the algorithm
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Fats and protein can be converted by the process of gluconeogenesis. This is very inefficient, possible using more energy than achieved. I don’t think gluconeogenesis occurs when there is sufficient glucose in blood.
I think I have intermittent endogenous insulin secretion. This means I have to be constantly on my toes. What works one day may not work well the next.
Whenever I think I’ve got this figured out, like a couple of perfect days, then I get a few days of having to increase boluses.
BTW - Since the original subject of this thread is insulin causing weight gain, in January 2021 I began MDI using Lantus and Humalog, January 2022 I transitioned to a T:Slim with C-IQ pump. I have lost about 12-15 pounds during those 18 months.
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As you can see, we all have different experiences and different treatment plans to handle this issue.
And I, like you, started putting on weight after years of having diabetes. With the help of the medical team I work with for some of the clinical trials, we talked about this issue.
For me and please remember this was my treatment plan. The reality’s was, I was just taking too much insulin. So I was fighting the lows and than the highs and than the rage bolus and than the eating. And as much as I thought it was no true, we did a complete wipe on my pump and just went to one basal rate based on my weight. And the magic happened, my insulin levels were way down and my blood sugars were much more level.
So for me too much insulin just caused that cycle that we sometimes end up in. We always seem to think more insulin is the answer to those highs when really those highs are due to bouncing blood sugars.
And than, I did try an off label type 2 medication. There are many options out there. Just got to find which will work the best for you. I use Victoza and take less insulin and my appetite is suppressed.
And everything with diabetes is a moving target. What works today, might not work tomorrow. Good luck with your journey!
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