What do you want to know about nutrition?

Well, if it was somebody posting citations, that was probably me.

You are correct Natalie. Prime examples are my son and daughter. I’m pretty sure that he takes about 30 units of insulin for a normal meal and a lot of Levimer split into 2 shots per day as well. He is a type 1 diagnosed at age 15, but has always used a lot of insulin since coming out of his honeymoon. On the other hand, my daughter needs only 1 unit of insulin to bring her down 90 points. She has been on Metformin for a couple of years to keep her resistance in check.

Not that easy if you have a glucagon response but if not it isn’t quite as difficult… A number of T1s die in bed every year from severe lows caused by stacking so we’re clearly not in the world of impossible if a T1 is taking 10 times their required insulin.

Maurie

It varies a lot depending on where you live!

If you lived where I live, then you’d fit perfectly into the box labelled ‘needs insulin’. Criteria for entry: needs insulin. Period. Type is totally irrelevant. And once you’re in the ‘needs insulin’ box, you get your insulin and all your diabetes supplies (as well as all your other non-diabetes medication) for free.

However box dimensions vary. So for example even though all your diabetes kit was free, people in the ‘needs insulin’ box would still find it hard to get a pump and as for a CGMS, forget it. The only way you’d be able to get both of them would be to pay the full cost for it yourself.

Bsc, if you noticed, April (Anni) asked above how you put yourself on insulin. Would you favor us with the synopsis? I remember you doing it, but can’t answer the question!! :slight_smile:

Anni, you can read my story about starting insulin in this thread. I finally have control over my blood sugar. Although I still eat in a very strict manner, I actually find it somewhat of a relief to not have to worry about high fasting numbers that I could never do anything about.

ps. I am not a medical doctor. And you should always question someone who gives you advice and has a goofy face like me.

Actually, BSC posted a link to the thread documenting his changeover to insulin, which was fascinating. I’ve actually done some research and done some calculations and think I’d like to go on Levemir, if I had my druthers…but would need a script. Also suspect I’m QUITE insulin sensitive and a little would actually go a LONG way. ONE flexpen might last me quite a long time, as I weigh so little… When I calculated the starting dose per kg…it was 5 units per day…and one would start much lower than that to be careful! So, I anticipate the doc being Insulin Resistant and suggesting sulfonylureas…but darn it…I looked at the side effects and they are darned YUCKY AND there is STILL the stupid hypos to think about.

WHAT is wrong with giving my body what it used to MAKE, what can be ADJUSTED in INFINITE PROPORTIONS and what is perfectly natural? I simply do NOT understand WHY people see this as defeat? I see it as liberation! AM I NUTS??? And, NO, I’m NOT about to go out and start eating McDonald’s Big Macs 3 meals a day with Fries and real Cokes (yuck!!!)…or go to Cheesecake Factory 5 nights per week and order an appetizer, main course and dessert with a sweet, whipped alcoholic drink with 1,000 calories and as many carbs!!! And my personal goal is to keep my A1C as close to 5.0 as I can and my BG’s as close to 100 all the time as I can…

But why is doing that mutually exclusive with being on insulin?

I’m sorry…I’m afraid I brought my soap box with me tonite and I’m on a rampage!

BUT, I’m a LITTLE bit touchy. I woke up in the MIDDLE of the night with a high of 199 - thristy and headachy and miserable (not able to go back to sleep until it was time for the alarm to go off) AND my daughter is 6,000 mi away (age 22) and may have a nasty blood disease (low platelets due to anything from a reaction to meds to bad things…don’t ask…) and I’m trying to get her triaged and then HOME…

So, I’m grouchy…

Grrrr…

Don’t mess with this 112 pound grouch tonite…

Maybe I should just have a glass of wine. Won’t mess with BG (dry) and I’ll at least mellow out before my high protein supper. And I hear I can’t drink my wine on the stupid sulfonylureas…

Double grump!!!

Couple thoughts, April. Weight alone isn’t a reliable way to calculate basal dose. It is only one factor. I personally haven’t seen much difference among people of average (but varying) weights. More important factors are things like insulin resistance or lack thereof (insulin sensitivity), and how much insulin of your own you make, and probably other things I can’t think of. . In general I find the formulas in Using Insulin to be the least useful thing as we are all different. Also, when you say “one pen would last a long time”, unfortunately, open pens only last 28 days. In a pinch, you can use them after that, they aren’t “bad” but may have decreased strength and who needs that variable! When I first started on 10 units a day I threw a lot out.

Anni, hon, I hear you. What you are going through is the pits. :frowning:

I hope your endork is cooperative – and even if he does suggest sulfonylureas, it doesn’t mean you have to accept them. I was offered Metformin when it first came out, but insulin was working just fine, and I couldn’t see any reason to accept the side-effects of Metformin, so I refused it.

The interesting quandary on sulfs is, if you’re like me, they will do absolutely nothing – working no better and no worse than sugar pills (well, maybe a little better – sugar pills raise the BG!). On the other hand, if they DO have an effect, then it means you do have a significant beta cell mass, and the cells are susceptible to being “goosed”. That’s when the hypoglycemia hits. Personally, I’m glad I didn’t respond to sulfs – they are really questionable. But just remember that with insulin, hypos hit too.

Talk in detail with bsc – he can tell you exactly what he did. I hope your doctor will authorize Levemir, but in bsc’s case, his doctor would authorize NOTHING, so he did it with NPH and R, which is what we all did, lo these many years ago. While it’s true that these insulins are not as CONVENIENT as the newer ones, they still work – you just have to work around their idiosyncrasies.

Of course, it goes without saying that if you decide to start on your own, you have to be ULTRA-cautious. And willing to treat your body like an intricate science experiment, with all the documentation, and careful varying of variables, and all that stuff. Which I’m sure you’re willing to do! :slight_smile:

Hoping for the best for your daughter – the uncertainly is mind-killing. Hugs!!

Re the original question, it might be interesting to employ a perspective like Tolstoy’s “How Much Land Does a Man Need?” and lay out what a person needs to eat to survive (pre-insulin diabetes diets were around 400-450 cal/ day…) and then perhaps add in various activity levels?

Thanks, Zoe…I was being facetious. First of all…I know that open pens don’t last forever. Actually, the Levemir site says their pens last 42 days (exactly) if properly preserved - not refrigerated…but at 3ml per pen, my calculated dose still outlasted the pen…

…but, to your point…of course, insulin resistance DOES make a HUGE difference. However, C-peptide test during a period of HIGH blood glucose in December showed very low insulin resistance along the continuum and my doc said that any weight I lost (she did not want me to lose any more, but, alas, I have lost another 10 lbs)…would make me MORE insulin sensitive…

So that is where my comments came from. Of course…IN VIVO always trumps IN VITRO!!! :slight_smile:

Pre-insulin diets weren’t surviving – they were just dying more slowly.

I am a newly diagnoised Type 2 diabetic an I am following Dr Bernsteins Low Carb diet and I am interested in learning more about the possible vitamins/nutrients that may be missing from a low carb diet. Are there any specific vitamin supplements one should take? How does a low carb diet (30-40 carbs per day) effect your kidneys, cholesterol, blood pressure? Are blood pressure pills and cholestrol pills recommended for diabetics even if your numbers are within the normal range to protect against the possibility of kidney diease/heart diease?

I truly believe low carb is the best option for diabetics and unfortunately this option isn’t being widely promoted by doctors/dietitions across the US. I was diagnoised early and controlling with diet/exercise only - I took the time to research diabetic diets and luckly discovered low carb. I’m convienced that if I were to follow the ADA diet recommended by my doctor and dietition I would be taking medications/insulin in no time.

Diabetics need to be informed honestly about the best diet for controlling diabetes and from there its ultimately the diabetics responsibilty to control it. I think the ADA is doing a disservice to diabetics by recommending a high carb diet because they don’t think we can handle anything else long term. In my opinion, life without lots of carbs is alot better than life with diabetic complications.

Nat…it’s been kind of humorous. My doc’s have been watching me with interest as I have had my own private “out of body experience” since DX in Dec…

My body has become a “lab experiment.” I even spoke of it as that…

I record data, speak of it in the third person…observe as though I were the “subject.” VERY precise recording of data, by the way.

And, of course, it started because none of the damned docs would listen to me on the thyroid symptoms, so I was FORCED to document every single med change, symptom change, test result…until I played their game as well as they did and proved that YES it WAS the T3 that was the culprit… Take it away, TSH rises, symptoms debilitate me AND, oh by the way, BG goes OUT OF CONTROL, thank you very much…

Now, as of Friday last, my internist calls me an “outlier” and “thanks God” for my “Endocrinologist” who can explain what the heck is going on…

In any event…do not want to start my own insulin…much prefer the guidance of a medica practice…but hoping for the best and intend to PUSH like hell for it… :slight_smile:

I think I may use family history as the trump card…“Sulfonylureas did not work for my cousin who is on insulin and I understand he presented just like me…” Tee he… “waste of time” “got sick as hell and it did not damn good.”

sue type 2, you articulate the choice many of us T2s face perfectly, life without lots of carbs vs life with diabetic complications. Like you, I believe it’s a no brainer.

The hostility even the mention of low carb often engenders still baffles me, although I’ve come to accept it as a fact of life.

Oh, my…bedside manners???

I don’t totally remember Tolstoy’s story but there was some deal, out in some wild frontier place, where you could get whatever land you could walk in a day so the guy gets all excited, plans his day in great detail (Clif Bars, no doubt…) and walks all day and keels over at the end, to be buried in a piece of land about as big as he is.

In one of these discussions, I looked up concentration camp diets which could run to 5 or 600 calories/ day, although obviously without any sort of guarantee or anything like that, so both that and the pre-insulin diets would be too extreme so what you “need” would be somewhere above that, with attention to nutrients to publish what you need.

That just seems like sort of a marketable “hook” for a book of this nature, since usually diets sort of aim towards somehow putting what people “want” instead of what we “need”? Even the more “extreme” sort of books about food will usually aim towards “wants” by aiming towards filling meals or whatever?

When I’m trying to avoid overconsuming my drink bottles on runs, I recall the part of “Death in the Grand Canyon” (fascinating book, BTW, orgainized by type…chapter on falling, drowing, overheating, etc.) where they explain that you need two Tbsp/ hour to survive and pace myself that way…

I believe there is still (and will be for a while unfortunately) hostility in the general medical profession towards low carb diet for reasons that are flimsy at best. Around this website I have not seen these reasons cited for a while. I think the general consensus is eat to your meter. Everyone is different and some can tolerate carbs while some cannot. Even amongst those that can there are differing amounts people choose to eat.

More recently the point of contention (on this site anyways) is the thought that if someone chooses NOT to eat low carb complications are inevitable like the part of your sentence “life without lots of carbs vs life with diabetic complications” would seem to suggest. Not at all saying this is what you ARE suggesting but, understandably, if a person does choose to eat carbs they may respond with hostility merely because of their reaction to complications being inevitable vs the low carb diet per se.

Bruce, doctors who practice what they call Evidence Based Medicine (EBM) have reasons for using orals before going to insulin, primarily in people who are very insulin-resistant, producing gobs of their own insulin, and who therefore need help USING their OWN insulin, rather than introducing more into their systems. These are the people who are most likely to gain weight on insulin.

Natalie, I've had a bit of time to mull this comment of yours over, and I just don't buy it. Many of the Rx oral meds for T2 diabetics have serious side effects and carry serious risks, yet they continue to be Rx'd with little thought of moving the T2 patient to insulin. For example, Avandia continues to be marketed to T2s even though it carries with it serious risk of heart attack. Sulfonylureas are still Rx'd, and they induce lows by causing the beta cells pancreas to dump insulin in to the blood stream. Extra insulin is extra insulin, and sulfonylureas can indeed cause weight gain if one does not manage diet. Rx insulin would definitely put more control in the patient's hands.

Take a look at Actos, the med my former PCP Rx'd when I was intolerant to Metformin: Thiazolidinediones such as Actos have been linked to CAUSING congestive heart failure. My mother had congestive heart failure, and I had two coronary stents put in over a year ago. My PCP was aware of my family history, and she was the one who discovered my abnormal EKG and had me see a cardiologist. Yet, she continued to Rx me Actos. Even Metformin, with its nasty side effects, only efficaciously reduces insulin resistance in patients who have HbA1C's under 10. Moderate exercise does the same thing. I can see its use for those T2s who have difficulty exercising, but what about those T2s who can exercise but choose to not do so? Shouldn't they be counseled to get out there and exercise or be placed on insulin? When it comes to Rx insulin, why the snub?

Sorry, the medical community in general does not get a pass with me. They are failing many T2 patients by continuing to Rx them oral medication when Rx insulin would be a better choice. I am deeply disappointed and somewhat resentful that I was put on the pill-pushing merry-go-round for so long when insulin would have made better sense all along. Thank God I have a smart endo now who get it.

I am attending CDE sessions with a friend and I am astounded at the number of carbs they are saying I “SHOULD” be able to eat. When I told the CDE that I could not possibly eat that many carbs she asked me if I were sure I weren’t a Type 1. I’m finding it interesting, because I AM, myself, a fairly new diabetic…7 months in. But I’ve been low to moderate carb all the way…50-70 carbs at most.