All other things being equal, a low carb diet will require less daily insulin than a high one. I wanted to add this in case my last comment created the impression that it did not. All other things being equal is hard to achieve since the daily insulin dose depends on a lot of variables : how tight you want your BG, how many calories you eat: hypo, iso, or hypercaloric diet will affect your insulin dosage, exercise, stress, illness, lack of sleep, phase of the moon and many more…
In my case the insulin dosage only decreased a bit because the BG control is much better. For the same lousy control I could cut the insulin quite a bit.
That is really interesting that you said cutting carbs is even more important for insulin resistant diabetics than for insulin lacking ones. That seems wrong when you think about it superficially. But you are right because with exogenous insulin and insulin resistance and a lot of carbs you will be caught up in the more carbs eaten =more insulin required =more weight gain=more carb craving=more insulinrequired death spiral and ultimately you will weight 500 lb or death whichever comes first.
No problem it is wonderful to have everyones 2 cents.
This is another problem that would cause immense complications for me.
To do my low carbs I have to add super high fibre (metamucil) or the intestine will block.
Low fat also is a problem. Because assuming say 200 grams /day protein = 800 calories and 50 grams carbs =200 calories. I need a minimum of 100 garms of fat= 900 calories for a total of 1900 calories per day. I can cut 20 grams of fat and replace by 20 grams of alcohol which is max for former AA man. To cut fat more do I increase protein even more say to 250 grams? or undo Dr. Bernstein and increase carbs to 100 grams?
We have a Reganomics type of situation were you increase spending, decrease taxes and balance the budget all at the same time.
I can sleep in bed all day and cut the 1900 calories required not sure if that is good for diabetes.
1900 total for my level of exercise will cause a small rate of weight loss
In both case with slower insulin would you not do better witha longer preprandial insulin than the fast one. The super fast acting could then be added to fine tune the 3 and 4 hour readings. Although this soungs clusy.
Since you don’t mind the two cents, here are a more cents to consider.
How long have you been eating low carb? How many carbs per day & what was your intake prior? Asking this because of your need to add metamucil. Low carb vegetables, for example, tend to be high fiber. Your system can be become dependent on metamucil. Better to eat things that have nutritional value, like flaxseed meal, that’s full of Omega 3s & tons of fiber.
How did you calculate that 50 grams of carbs equals around 200 calories? Seems that this would be variable. Not being argumentative–I’ve never counted calories. I honestly have no idea how many calories I eat.
You don’t need to do low-fat. I wouldn’t add more carbs. Sufficient protein & fat will prevent hunger & carb cravings. I eat about 120 grams of protein daily & I’m small, so increasing protein seems the safer bet. You could try adding more protein & more fat to see where that takes you regarding weight & BG control. Bearing in mind, of course, that these digest slower for your insulin doses.
I use rapid acting every now & then for correcting highs, but have to be careful. I can only use rapid acting 5-6 hours after using R. If taken too close together, they change the action of both. Never easy, is it!
Same here Bobby. I am like you. My carb ratio is 1:4 so I use a lot of insulin when I eat. Like you said T1’s don’t use a lot. My basal is 2.6 for most of the day and 2.0 overnight. It’s also hard to lose weight. I get on the scale and hope for a small drop but it stays the same. I went on the pump in Nov 09 so with golf season coming up I will be more active and hopefully be able to walk more, It’s winter in CT and play golf twice a week.
Try carb counting and MDI for at least six months and then talk to your Endo about the pump. That is what I did with my Endo making the suggestion before that. It helps control the highs.
I tend to agree with Jenny, and it is not simply a matter of semantics. Type 1s also have an impaired counterregulatory function, which means that they generally have problems with hypoglycemia as well. That means that aside from being sensitive to even small dosage changes in insulin, type 1s also do not have a normal response to low blood glucose levels induced by insulin. That means that you will be prone to lows and not have anything but the autonomic response to lows, and over time, that can deteriorate as well, leaving you without “symptoms” that a low is coming. While the treatment objectives are the same with both types of diabetes, the challenges to getting there may be quite different.
I actually think that most insulin dependent diabetic have these problems with proper counterregulatory responses. The use of exogenous insulin suppresses the natural action of glucagon in the counterregulotory response. Then over time, your body can become hypo unaware and even further, you can end up with autonomic neuropathy affecting the issues. But I am not at all clear that it has anything to do with type 1 versus type 2.
Hi Barbra, Just wanted to say I applaud your positive outlook and well-thought-out plans to care for yourself! You’re asking questions and are open to learning from others…this attitude set’s you on a good path towards a healthier future. Way to go :o)
Hi, Barbra,
C-Peptide is not the right test to determine if you have LADA or Type 2. many of us who are in the early stages of LADA have normal C-Peptide levels. The antibody tests would give you a definitive answer. However, since you are going on insulin anyway, there is another easy way to find out. Most Type 1s are very sensitive to insulin. I take 2-6 units of basal insulin as compared to a Type 2 who might take 20 times that much. It is really important that you find out if you are insulin sensitive as this will result in a very different insulin regime. The amount of insulin that a Type 2 takes could kill a Type 1. If you get a result from tiny amounts of insulin, then you probably have LADA.
Well, insulin requirements tend to be very individualistic, and while a petite young woman taking 200 IUs of insulin a day could be reasonably presumed to be insulin resistant, there are many type 1s who take 50-100 IUs a day and would certainly would not be assessed to be type 2s. In either case, since insulin is the proper treatment for both T1 and LADA, it does not really matter. By the time many LADAs get properly diagnosed (grrr), they have spent far too long with elevated blood sugars, increasing their insulin resistance, and destroying what little remained of their insulin production.
To some extent, but the inflammatory response on the Islets caused by the body’s immune system completely destroys the alpha cell function (responsible for glucagon production) in people with type 1, while this function remains intact in patients with type 2, even those who require insulin.
This is so I can inject prodigious amounts of insulin and not go low the glucogon system still works well. If it no lower works the disease must be more or a nightmare. With a lot of insulin resistance and external insulin weight gain is a problem this may affect type 1 and type 2 more so type 2.
It is my understanding that the autoimmune attack typically displayed in type 1a diabetics spares the alpha cells which are responsible for glucagon production. Most type 1 diabetic still retain full glucagon production capability although the signals triggering glucagon secretion may start to get messed up by things like hypounawareness and autonomic neuropathy, all things that occur in both t1 and t2. I’d be interested in sources you have indicating otherwise.
bsc, I always wondered about that. My BG would come down from 200 to 60 in no time and then it would flatten out at 60. My glucagon production capability must work like a charm. Without it I would have died many deaths already.
This is a poorly-understood area of research; as with anything, the rule seems to be “not in all cases”. While some people with type 1 do retain endogenous glucagon production which most often occurs after meals (it is not suppressed, ironically enough, causing many people postprandial highs that do not occur in people without diabetes), but in others, the inflammation renders that slightly less than fully functional. These individuals tend not to have higher postprandial glucose levels, but are also much more prone to hypos to begin with.
I realize that this is a very old discussion, and I have a hunch that you’ve since been properly diagnosed as a T1 (or 1.5 or LADA - whatever term fits).
Getting an accurate diagnosis is extremely important. Not only for piece of mind and getting the correct treatment, but also when trying to get insurance coverage for things like pumps, test strips, and CGMs. Most insurance companies limit what they will provide for Type 2s. That one little change in an ICD-9 code (from T2 to T1) can prove to be essential for those mis-diagnosed. I had to fight for a proper diagnosis just to get the appropriate care and supplies. Once my antibody test came back positive, I was officially a Type 1 and my insurance company approved everything.
AFAIK, the only true, definitive test to determine type is an antibody panel. If it’s positive, it is T1. Even if the c-peptide is still in the normal range, it is T1. Any “normal” BG is likely the result of the “honeymoon” period (which can be very long in LADAs).
My diagnosis story is similar to others out here who were diagnosed T2 and then T1 after our blood sugars kept on the rise and oral meds didn’t work anymore.
For you…only time will tell if your tests show that you aren’t in the T1 range. Only you would know your blood glucose levels, but if they were in the 200s most of the time and your endo was ok with that, it would be a sign for you to get a new endo. Never would a good endo say that this was ok.
One thing I learned was to fight for my care. I was too trusting and nearly wasted away to nothing.
I agree with you that getting an appropriate diagnosis is important. What is really sad is that there are many forms of diabetes recognized (see http://care.diabetesjournals.org/content/26/suppl_1/s5.full), and getting an appropriate diagnosis is not only important to proper treatment, but in fact the medical and insurance system can exact a terrible penalty on the poor patient suffering from a diagnosis in error.
Even if you don’t test positive for autoantibodies, that does not necessarily mean you are a type 2 suffering from insulin resistance. As noted in the above, “Patients with any form of diabetes may require insulin treatment at some stage of their disease.” And patients with any form of diabetes deserve approprite insurnace consideration of the medically appropriate treatment indepedent of a desire to give the patient a label like an ICD code.
