I think your emphasis on insulin and carb intake is unintentionally misguided and potentially dangerous. Dangerous because it can push an insulin-dependent diabetic towards diabulemia. Simply put, if someone believes that insulin is “bad” or “dark” and they should minimize it (as you stated), then it follows that one should take less insulin because that is somehow more “healthy”. Even worse, your ideas for reducing insulin intake (severely restricting most foods from ones diet, or long term fasting) are both symptomatic of the thinking that can be used to justify diabulemia.
Of course you will say that you never suggested diabulemia as a way to manage diabetes, and I know that was certainly not your intention. But as Tim12 said, you are putting your readers on that dangerous and slippery slope, intentional or not. And it is not just diabulemia. I have read on other Bernstein-friendly sites of T2 diabetics who constantly run their BG high because they are afraid of using insulin because they think it is “dangerous” and will cause them to gain weight. A bizarre set of ideas that obviously lead to very poor health outcomes.
The reality is that the weight gain you experienced could have had nothing to do with insulin usage AT ALL. In the same time you were gaining weight, so was the rest of the non-diabetic US population. https://247wallst.com/special-report/2018/11/20/the-average-weight-of-men-and-women-since-the-1970s/ “The worst period seems to be the 1990’s, when the average weight of both men and women went up by a pound per year.” … “The lack of physical activity that is prevalent across the country and poor diet — most Americans consume too much added sugar, unhealthy fat, and salt — contribute to the growing obesity problem.”
In my opinion the emphasis here should instead be on calories intake and exercise expenditure, because that is what is really driving the increase in weight. If we eat more calories than we burn (whether those calories be carb, fat, or protein) then we WILL gain weight. Of course this means we will need to take more insulin to maintain BG control. But it is NOT the increased insulin intake that should concern us, it is the ever increasing weight that drives this process.
How we lose or better yet maintain weight is very much a personal decision since that is a complicated mix of cultural and personal preferences. I’m sure my diet is quite different from yours, and that is all to the best. My take away is to use as much insulin as I need to keep my BG in range, no matter how much that is. And to find a sustainable diet and exercise regimen that keeps me at a healthy weight.
Although, I do sometimes give an extended pump bolus (dual or square wave) with intention of acting like basal. Then watch bg, and cancel early if bg has responded.
I do recognize that my position of acknowledging the phenomena of deliberately slightly overdosing insulin as a tactic for better control does share some territory with the dysfunctional thinking of someone using a lack of insulin to help them lose weight.
I can see where this connection in my logic with the unhealthy thinking of someone withholding insulin but I reject that connection. It is as tenuous as saying that supporting the regular consumption of a glass of wine with dinner somehow feeds into, promotes and gives permission to the abnormal psychology of an alcoholic.
In fact, using that fallacy, no one should ever put a cup or glass on a table meant to accommodate a known alcoholic since that implies it’s ok to pour alcohol into them. It gets a little silly.
I see where someone struggling to resist using a lack of insulin for unhealthy weight loss could use my rationale to bolster their otherwise unhealthy thinking. But there has to be a limit to otherwise healthy behavior being painted as a causal link for illness.
Let me say here: I have never endorsed the idea of withholding insulin to lose weight. That has never been the position of my comments. I will be more careful in the future to clearly exclude diabulemia tactics in the ideas I present.
I have heard before that insulin sensitivity can be increased by losing weight. This makes sense since insulin demand seems to be proportional to weight as @Terry4 mentioned above. I have never heard that reducing fat content in the diet increases insulin sensitivity. Have there been any studies about this or have any of you, in addition to @Marilyn6, experienced that?
Go to the Mastering Diabetes website. It is run by two very healthy type 1 diabetics. One of them has a doctorate in nutritional biochemistry from Berkeley and a masters in mechanical engineering from Stanford. I took their classes about 5 yrs ago. They now have a book out that tells diabetics how to live very healthy lives following a low fat high carb way of eating.
They have all kinds of studies which back up their theory that reducing fat reduces insulin resistance. When low carbing, which I did for 11 yrs, I ate 30 carbs a day, and now I eat about 275 healthy carbs taking very close to the same amount of insulin.
Eating this way involves exercise, and I don’t find this way of eating as easy as low carbing, but I feel much better eating this way.
In general I find that I can only keep my BG in a range of 40-60 (or even 80) points daily if I am eating somewhat normally and addressing the crazy T1 variations from day to day. I get frustrated with Control IQ on my Tandem pump because it sets my bottom number at 110 and that means my BG will be 110-170/190 through a normal day.
At the same time I believe that it is not healthy to get down into the 50’s every day and a huge benefit of automated insulin delivery systems is that those numbers become rare. It is really great not to have many or any lows below 70.
Lately I am using my Tandem pump without Control IQ and having pretty good BG tracings. But I know that I have lost the protection against severe lows. My biggest frustration with Control IQ is it reduces (or suspends) my insulin if I am below 110. Some of this is needed to prevent crashes into the 50’s. But I think it is too conservative and I am optimistic that we will see more customization in future updates. But I don’t think that we will ever see FDA-approved systems with the wild-West customizations of DIY systems.
And we always wonder how good do we have to be. And most of us have doctors who tell us different things than social media.
But keep up the good fight, D-friends, and don’t get hit by a bus tomorrow.
If you want to see if fat effects your insulin resistance, eat a piece of toast and see how much insulin you need to return to baseline. For me it is 1.2 units just about.
Then add peanut butter which is nearly all fat. You could also use butter.
Watch how much insulin you need for that. For me it’s 3 units.
That’s a big difference. This test was what convinced me to try Mastering Diabetes idea of low fat and high carb.
I wish I could have tested this out when I was younger because I don’t know if I am more sensitive to fat because I’m getting older or if it’s always been that way.
I barely will eat bread now but I also don’t eliminate it.
There are a lot of complex carbs that are easier to eat than you might think.
Look I was a skeptic, it’s is the opposite of everything I was taught. I read the whole book and thought it was a silly idea and that it was vegan or nearly also losing weight will effect insulin sensitivity.
But I learned fat really does cause significant insulin resistance.
I eat about 25% fat. That’s way more than the book suggests. But I still eat meat, so there is that.
@Timothy, thanks for sharing the results of your experiment. For me there are 2 ways of thinking about the impact of fat:
fat needs insulin like carbs or
fat reduces insulin sensitivity
The following experiment would be interesting (using your numbers):
Eat one peanut butter toast and 2 toasts without peanut butter.
If 1) is correct then the insulin requirement should be 3 + 2 * 1.2 = 5.4.
If 2) is correct then the insulin requirement should be 3 * 3 = 9.
That would require me eating 3 pieces of toast, where I like toast, but that’s a lot of refined carb all at once.
The science behind my theory of insulin resistance, is that fat does not require insulin to metabolize. I mean that is textbook, but then again no one told me fat would create insulin resistance.
I was always told to eat fat with carbs because it will slow absorption and therefore be easier to stay in range.
However at least for me, it is patently false. Because it requires so much more insulin to bring down and it also takes longer, so my high sugar stays high longer.
This is not just on the evidence of peanut butter toast, but all meals that are high in fat and mixed with carbs, are nightmares to dose.
Chinese food, love it but I can dose 15 units of insulin for one meal and I’ll still be high all night. ( my average meal is 6 units)
pizza, forget it, I gave up on it many years ago.
So my deduction is, that fat makes staying in range much harder than if I ate carbs alone.
Now if I was low carb it might not matter because there are fewer carbs to deal with.
I can stick to a high carb low fat diet much easier than a low carb diet and use about the same insulin.
I’ve tried a few different WOE, and I always seem to use the same amount of insulin.
@Timothy, thanks. Very interesting. I am eating high fat for so long that it is hard for me to even think about giving up fat. I have to read the recommended literature and conduct some experiments.
Randomized controlled trials (RCT) are expensive. I don’t believe any have been done to test the HCLF (high carb, low fat) way of eating, especially the ultra low-fat version. There have been many done to test LCHF (low carb, high fat), however.
It takes time to get studies done, I remember when Bernstein was out there by himself talking about the low carb high fat diet and for years getting nothing but criticism. The low fat high carb diet doesn’t seem as extreme to me.
I would suggest that if folks want to follow a specific way of eating that they try both of the diets. I thought that the low carb high fat was working beautifully for me, except that it kept all of my lipids extremely high. I should have known to stop the diet then, but I didn’t even stop it after getting two heart stents. My A1c at the time was 4.6. One man who belonged to the Bernstein forum at the time had a stroke and a heart attack on the same day and died. This diet isn’t good for all people. I finally stopped it after 11 yrs because of frequent blackouts from low blood pressure and complex migraine headaches. Those ceased after I switched my diet to a low fat plant diet. My body was warning me that it wasn’t being well taken care of.
I can’t say for sure whether the diet caused me to need heart stents, but it definitely caused my lipids to all rise dramatically. That should have been a warning, but a popular book I was following at the time said that you could ignore high LDL as long as the HDL was high too. Some of the cardiologists who were quoted in the book later said that they were misquoted. No one else in my family has ever needed stents and both of my parents lived until they were 89. My father’s father did die in his 60’s from a sudden heart attack or stroke when I was 2.
I was on my 51st year of having diabetes. I used urine testing for the first 22 yrs of having diabetes, and I would say that I was mostly uncontrolled until at home blood testing became available. My control since then has been very good.
All bodies are different. Dr Bernstein has done extremely well eating low carb and high fat. It is clearly not good for everybody. I would have saved myself a lot of misery, if I had changed my diet when my lipids all rose so dramatically.
I feel the need to warn people and tell them what happened to me and others. If they do follow Bernstein then they need to watch their lipids and watch for other signs that their bodies aren’t happy.
I am more careful now, but I really don’t see how a low fat diet can be harmful. I feel good and my diabetic control is excellent. And I am forced to exercise more than I normally would which is good for this almost 71 yr old body.
I think the fact that both LCHF and HCLF avoid highly processed carbs suggests these packaged foods are not good for anyone. Any way of eating that combines eating high fat and high carbs leads to poor health. Highly processed and palatable carbs only makes things worse.
I would also add that industrially-produced seed oils are not good for human health. They are produced in a process that closely resembles an oil refinery, not a food processing plant. High heat, pressure, and chemical “cleaning” are all used to produce “vegetable oils,” oils that don’t contain any vegetables! These seed oils include sunflower, safflower, cottonseed, corn, soybean, and canola.
I am always on the fence about olive oil. I really want to use it, but I know that it is difficult to get a pure oil. I also can’t stay within 10 to 15% fat if I add it. I am a fan of flavored vinegars and I just hope that they are ok.
The Kellogg Company is being boycotted, so I was looking at which foods they make. I realized that I haven’t used anything they make for almost 20 yrs.
I’ve worked closely with support groups involving diabulimia victims so the issue strikes a little closer to my heart, maybe.
Another thought is that it is so easy to get wrapped up in the minute-by-minute decisions about insulin and food and bg that it’s hard to get a long term viewpoint on weight management at the same time. I fully agree the two are related at the micro and macro level. Maybe if it were as easy for me to graph my weight and insulin dose over years, it would be as compelling as my CGM trace for the past two hours.
I salute your altruism volunteering your time to this important issue. It is a real and valid concern.
All during the 10 years I was gaining 1-2 pounds per year, I faithfully went to my endo appointments. The first thing they did at each appointment? Right, they weighed me and dutifully entered it into my chart!
Yet, never once did they observe and remark to me that my weight has been going up on a slight, yet dependable, uptrend for many years. That observation, combined with the marked increase in total daily insulin should have triggered a conversation, but didn’t.
Well, thank you!! I just learned a whole lot. I always heard eat low carb and high fat but my lab work is reflecting the effects of a high fat diet. It is amazing to me that the only valuable info comes from this forum. Really. I always like what Marilyn says and listen closely to her because she obviously does work so hard at controlling her diabetes. All of the information is so valued though!!
Now that I am a senior woman, my endo strongly feels that weight gain is good to prevent me from becoming “fragile.”
At one of my recent appointments the nursing assistant entered my weight wrong as 10 pounds below my actual weight. My endo noticed it right away and was very concerned. So she was happy when it was a mistake. I actually preferred the other weight because my clothes would fit better….
I weigh 10-15 pounds more than I did 5+ years ago. My doctors are happy about that and I have determined that I am not going to stress about it. Because I have enough other things to stress about….
Interestingly my TDD of insulin is not much higher than when I weighed less.
