Hi, new to tudiabetes. I joined because even my endo doesn’t know what is going on. I have been a type 2 diabetic for ten years. Recently my sugars are always high. I tried very lo carb starting in Feb. of this year. Anywhere form 10 carbs to no more than 50. No sugar, no starch. My sugars were always high. Anywhere from 170-220. I had no idea how much Nova log to take since my carbs were so low. I am not so lo carb now, more like 70-100 carbs a day, still no sugar and low glycemic starch. Last night my BG was 168, I took my long acting insulin and without eating anything after dinner, my BG was 208 this morning. I don’t know what to do or who to turn too. Insulin is not bringing my sugars down, in fact it seems to be having the opposite affect. In the afternoons, my sugars rise without me eating or doing anything, and again my insulin is not helping. I did use new insulin to see if I had a bad batch but I got the same result. I have no clue where to go from here. Any advice is much appreciated.
If you limit carbs then your body will turn a percentage of protein into glucose. Some sources quote 58% as the conversion rate. Some people use 40%, some less. You will need to experiment on yourself to see what percentage of protein is turned into glucose.
For example, if you consume 35 grams of protein, then you may have 58% of that or the equivalent of 20 grams of carbs (35 x 58% = 20.3) turn into glucose. The process is called gluconeogenesis. If your insulin to carb ratio (I:C) is 1:10, then you'll need 2 units of insulin (20/10) to cover that protein. this example is simply used to illustrate how the math works. You will have to determine what percentage works for your body.
But you can't dose that insulin to cover the protein as quickly as you dose for carbs. I use a pump and extend the protein bolus so that I limit the maximum hourly rate to 1.2 units per hour. In this example I would deliver 2 units over two hours in order to metabolize the protein. This protein bolus is in addition to any insulin dose that you take to cover carbs.
If I were not using a pump I would be tempted to experiment using Regular insulin to cover protein. Regular has a longer duration and more closely matches the typical metabolic absorption of protein. You could, for example, use Novolog to cover the carbs in the meal and then take a second injection of Regular to cover the protein.
There's a group on TuD known as TAGgers United, short for Total Available Glucose, that doses insulin based on the nutritional content of food beyond carbohydrates. The group is not active these days but there is a lot of good discussions archived there.
I suspect that your high BGs were due to glucose conversion of your protein driving your numbers higher 3-6 hours after your meal. You may also need to adjust your long acting basal doses.
You'd think an endocrinologist would know more about human nutrition, but most don't. Unfortunately, many dietitians are unaware of the issues around dosing insulin for protein when consuming a low carb diet. In fact, most dietitians would warn you to not follow a low carb diet, even if you're trying to control high blood glucose as a diabetic.
My low carb diet, combined with daily exercise, and dosing insulin for the nutritional content of my food beyond carbohydrates not only has made my control much better. It's allowed me to lose weight, minimize the number of hypoglycemia incidents, drastically cut my total daily dose of insulin, and reduce BG variability.
Good luck. You're asking the right questions. Run your own experiment and make sure to write stuff down. It's the only way to draw good conclusions from your trials. My experience is limited as a T1D. I do not claim to know how all this works with a T2D, but I've read reports on this site of T2Ds using the TAG method successfully.
You say your blood glucose is "always high". Are you doing corrections? If you can accurately determine your ISF you can work on bringing down those numbers. Also whatever is causing these highs they CAN be controlled. Have you been tweaking doses? If your breakfast I:C is 1:10 and you are always high two hours later try switching it to 1:8 for awhile and see if that helps. Ditto your basal. Make small increases and then live with them awhile. I wouldn't spend time looking for reasons for the increased need for insulin but just respond accordingly. Also as you are Type 2, I'm assuming you have some degree of insulin resistance. Has your doctor considered adding medication to your insulin to combat the IR? Also if you are overweight, losing the weight will reduce your need for insulin.
Thanks for the reply. Yes, I am over 110 pds overweight. I having been trying to lose weight, but have been unable to make any progress. I just found out I am anemic and that might be why I can’t lose weight. I have tried almost every diet out there and the weight does not budge. Just went to a specialist to see if there is something else going on.
For breakfast I eat eggs with bacon or sausage with coffe and cream. Only 5 carbs. My BG will be high for the morning so I take a correction dose plus an extra 16 units of insulin. My BG will go up. I have tried using a higher and lower ratio e.g.
1:5 all the way up to 3 units to 1 carb. Can’t find anything that works.
Yes, I can only imagine how hard IR makes it to both lose weight and control blood glucose. Have you had your thyroid checked as that is a common thing that makes weight loss hard as well. I wouldn't just continue with high numbers, but keep tweaking your doses and your ISF (correction factor) and talk with your doctor about medication for IR. Symlin is another option that works for some people to lower insulin needs and to lose weight (though not for everyone and it is hard to dose). I would work on tweaking your insulin doses first.
I am a type 1 on shots (humalog and Levemir)
Any nutrient or electrolyte deficiency can make it difficult or impossible to lose weight.
Sodium - When I was really low carb, it was hard for me to avoid sodium, so make sure your blood pressure is okay. If it is not, then you need to cut back on the salt. Electrolyte imbalance can prevent you from losing weight and cause extra fluid retention.
Vitamin D - Quite a few diabetics have low vitamin D levels, so if your doc hasn't checked, I'd check your vitamin D levels (D2 and D3).
Protein - It takes about 4 hours for my protein to start raising my bg. For me, 2 grams of protein raises me about the same as 1 gram of carbs. So that would be 50%. This means you are going to have to keep track of your protein.
Caffeine - It takes caffeine about an hour to start raising my bg. Not everyone here reacts to caffeine like I do, but some people do. 100g of caffeine will raise my BG approx 100 points. It also means I have to take an extra (about 3 hours after a meal) shot if I have too much protein at once.
A half hour walk for me is worth about 20 carbs (since I don't adjust my levemir in the morning for exercise, so I let myself have 20 extra calories when I walk for lunch.
I recently read that artificial sweeteners and artificial fats can make it more difficult for some to lose weight. Something about when you eat artificial sweeteners, your body says "I am getting sugar, so I can stop burning fat". I don't know if that is true, though.
you do not indicate if you are on metformin.
Based on my experience, I would be checking out dawn effect, and liver leakage.
Low carb and extra serious exercise are helpful but if your liver is leaking extra glucose then metformin may be needed to assist.
I take metformin ( 500 mg doses)at night time and a dose with every meal. Prior to sorting out this mess and during the day my numbers were this bad as well. FIrst thing in morning was 238.
I presently use metformin and humalog lispro and eat 1200 calories a day and 1.5 to 2 miles walking. My numbers are back under control after a serious fight straightening out the mess.
I would offer you need a good team and medical help from experts who have fought this mess.
I doubt the Insulin you are using is bad. From where I sit, it sounds like you are sugared up like a marachino cherry.(not your fault - just describing how I was with numbers like this.
In my case I had to seriously cut the diet back - low carb and walk/exercise signifigantly to wring out the excess glucose and metformin will be required to restrain the liver. Once the numbers get pulled back and insulin resistance drops, the insulin will go back to work.
In my case, I had cut back grains/bread signifigantly and make sure I ate a very low glysemic breakfast with very small amounts of carbs to reduce adding to what appears as a nasty dawn effect/numbers.
When the liver leaks excessively, it causes the body to get saturated-overloaded with glucose and then insulin can seem to do nothing. ie insulin resistance is at its max.
I am not Doctor but this looks similar to the mess I stared at.
Well, like you, I have been struggling for some time with chronically high fasting blood sugars. Not nearly as high as yours, but higher than I want. And I know for a fact that it is not because of my diet or because I am improperly dosing my mealtime insulin. My mealtime insulin is fine. And I do take metformin to help my insulin resistance. Besides the sulfonylureas, there are no other T2 drugs that help fasting blood sugars directly. So that immediately suggests my basal needs adjustment. So I have been adjusting my basal upwards and this is what you should be doing under your endo's guidance.
But in my case, even escalated basal insulin has not brought my fasting blood sugars down to normal. Which suggests something going on in my body which is raising my blood sugar. And I am in the midst of a long term search for what that is. At first, I thought I had found it since I learned I have sleep apnea. Bad sleep can cause this. So I treated my sleep apnea, but still it continues. Other areas of concern are thyroid, infections or inflammations. Although my thyroid tests were a little strange, my endo did not think it was causing a problem. I have been tested for a range of infections such as Lyme disease. All my blood tests are pretty normal, if you have abnormal blood tests that can be an issue. For instance, low sodium levels make you insulin resistant (and low carb diets require you to eat more salt). I asked my Periodontist and Dentist about whether I have an infection. They said no, but I might have a deep infection. And I have not been injured or have other things which I am aware of that would cause inflammation. And my stress level is about the same as it always is, not great, but consistent. And so I am going to press on my continued search for why my blood sugars are elevated. I hope my experience is helpful to you.
ps. It is also possible that you have lost your remaining beta cell function and you just need more insulin than either you or your endo think.
Brian BSC makes good points. I would add that yes working with Basil Insulin can be helpful but sometimes the Liver is just doing defective/ignoring the insulin and doing its own thing. Only doses of metformin can directly override the liver and its ampk chain wanting to sugar up the body. Th latest research released on jan 2013 backs up this operation of the metformin that sciences prior stock argument was we do not really know how it works and somehow it reduces insulin resistance.
The reason for the reduced insulin resistance is simple, the liver's excess glucose release is being directly cut back by metformin.
If the body has become saturated by the excess liver glucose release, extra insulin cannot override the insulin resistance it it is at its max.
Science has yet to face up that for a type 1 whose broken insulin has blocked any skeletal muscle saturation will in all likelyhood "always see" their insulin work. Type 2's though run risk that if their bodies have been running on a surplus of glucose generation and excess liver glucose release will have their bodies saturated and the insulin will work as well as distilled water circulating their blood system doing nothing.
Reduced diet, extra serious exercise and rational metformin doses at optimimum times can help get this mess cut back.