See the answer could be one of the many variables in this disease. If it is the actual amount of insulin in the body that causes the fat storage then keeping a number closer to 120 would allow more weight loss and be a good thing. If it’s all about calories and it does not matter how much insulin is in the body then keeping closer to 80 is a good thing.
Is the amount of insulin driving the fat storage or is it driving the hunger and causing someone to overeat?
Will the cure ever be found?
Will I survive the teenage years of my daughter? Will she clean her room this weekend finally?
Oh wait…that is for another discussion which will be fruitless and consequently carbless…
I was once in a study at Joslin that required me to be off all diabetes meds for a month, so I stopped my metformin, which was all I was taking at the time. Without the MF, I was much more careful with the carbs and ate more saturated fat. My cholesterol went down 50 points. They didn’t even remark on that.
When I was in another study of Lipitor and my cholesterol went down 10 points, they said, “This drug is working for you.”
Doctors are trained to diagnose a problem, prescribe a drug, and send the patient on his/her way.
The reason I think GL is useful is for calculating combo boluses. I’d rather take, say, 2u of insulin over 2-3 hours than all at once. That being said… I only eat about 40 cho a day.
I also like my fastings between 70-100ish. I’m extremely unhappy if I go over 120 and hover over the CGM, not wanting to overcorrect, bla bla. So, the usual conundrum. Even eating LC, am I better off using more insulin and keeping my BG where I like it, or using somewhat less and letting them drift a little higher? When I TAG I’m using even more insulin, albeit fewer corrections. I’ve drawn a line, obviously, but do still sometimes wonder. Still puzzled by the 11 lb loss. Not complaining though!!
Another factor: if “tight control” means you get a lot of lows, you’ll probably overcorrect those lows. I know it’s almost impossible not to eat too much when you’re feeling shaky. And IR seems to increase with a low, probably because of counter-regulatory hormones like epinephrine, so a food that would normally make me go up 20 points might make me go up 50, and the effect can last all day.
Eating more to cover lows can result in weight gain. Or perhaps the constant insulin infusion is affecting your appetite. Low insulin can cause ravenous hunger because the cells are starving because the glucose can’t get in. I know a woman who lost weight for this reason after going on insulin.
So getting more even control with a constant low infusion of insulin might result in fewer lows and hence eating less and hence lower weight. The problem with pumps is that Bernstein says every pumper he’s seen has scar tissue at the infusion site.
I think BGs are more important than a few pounds of weight.
I think too that it’s important to look not just at the number itself but the shape of the curves on plotted points? This is obviously easier w/ a CGM that plots it out for you but I get clues to back off or pick up the pace (of my insulin rates/ ratios…) from the shapes of the curves. 80-79-78 is much different than a 110-90-70?
I had an UltraSmart meter that produced some useful repots and glucosurfer.org also allows you to import our meter data to obtain what I think is a pretty useful graphic depiction of BG results. I am not sure doctors will pay that much attention to it if I start talking about thinking about this but the data is there and I feel like I’m doing something useful for myself.
I guess I am a believer in the idea that normalized blood sugars establishes a metabolic state that helps weight loss (fat loss). I think this is particularly true for type 2s. Fat loss occurs when your body enters ketosis, people enter this state all the time, it is why we don’t die in our sleep. But the hormonal signals to enter this state are that insulin falls and glucagon rises. For a T2 with an elevated fasting blood sugar and insulin levels, this happens like “never.” Is it any surprise we see weight gain in T2s?
And for the insulin dependent, this is also true. This is one reason one should not set your basal levels too high, it impedes ketosis. But that is not enough. I think your body won’t signal (with glucagon) to enter ketosis and start mobilizing fat until you need energy. And you won’t need energy until your blood sugar gets down normalized levels.
This is why I believe that it is much easier to lose weight and maintain body composition when you have “normalized” your blood sugar down to the 80s rather than walking around all day with a blood sugar of 120 mg/dl.
Although this is not settled, there is certainly the potential for weight gain because of the anabolic effects of insulin. For people with T1, there is the complication that the reduction in excretion of glucose will have a weight gain effect outside of calories. The problem is true for people without diabetes because if your calorie intake is in carbohydrate there will be wider insulin fluctuations. The nutritional establishment fights this idea but it is clear that it is possible so when confronted with the argument, they say that the changes are too small to be significant but it doesn’t take long before they tell you that the way to lose weight is to make small changes in calories which will accumulate over time.
It is true, as Judith says, that you can overpower low-carb eating – I do it twice a week myself – but it is still the most reliable approach for most people for glycemic control and weight control.
Let me interject a pitch here:
This forum has been very useful for me in bringing out the personal side of this problem and the extent to which real scientific information will be helpful. Beyond our work at the educational level, I would encourage everybody to help us help people with diabetes. The Nutrition and Metabolism Society is working 1) to bring these a issues to the government – I will be giving a talk to congressional workers in June, 2) to work with traditional nutritionists to get a meeting of the mind on these issues. 3) to mobilize support for research projects that will settle these questions and 4) to challenge private and government health agencies to come out and discuss the guidelines, recommendations and scientific issues in public. We need your help. You can join the Society for as little as $10 and you can volunteer to help in a number of activities. The website is http://www.nmsociety.org or you can write to me (feinman@mac.com), Lauri Cagnassola (lauricags@gmail.com or Pete Farnham (pdfarnham@aol.com).
I have recognized one thing with me. When my sugars are hovering around 80 I am not hungry and I do have the tell tale ketosis breath. When they are around 140 I am munchie, when around 200 I am starving. BUT, I am neither munchie or starving if I have plenty of insulin on board.
So you are saying that keeping the insulin levels higher and keeping numbers in the 80’s will not stop weight loss. So it’s the calories driving the weight gain and not the hormonal effect of the insulin. Right? But if setting basal levels too high also impedes ketosis then how do I keep the numbers lower
I do see that it is important to use other tools to normalize blood sugars besides insulin. Exercise and low carb will both lower glucose levels without the use of insulin. Perhaps that is the secret. To lower those numbers without the use of insulin?
Forgive me if I’m confused…a frequent state of mind in this house!
I am saying that I try to keep my fasting blood sugar levels in the 80s and my insulin levels at a minimum. Thus I want my basal insulin set perfectly. In my view, the perfect way to lose weight is a long walk in a fasted state, with my blood sugar in the 80s and only having a minimal levels of basal insulin.
Got it!
I’ve got a long way to go then as it takes quite a bit of insulin to keep my numbers low.
Always an experiment going on in this body…My basals are set pretty good, but it takes alot of insulin to keep those numbers steady…
I joined the NMSociety as a consumer member. I believe the “establishment” has behaved in a hugely prejudicial way towards the science of low carb diets. Research funding is not granted for studies. Reseach publications will not approve papers. Organizations like the ADA, which solicits me daily for my money, won’t fund these studies and actively fights against them. We cannot depend on our government and the medical “establishment” to do the right thing. We have to advocate for ourselves.
Badmoon, I can say personally, that fructose (natural apple juice in specifics) for LBS raises my BGs in 5-10 minutes while HFCS always takes 2-3 times as long. I tend to stray from HFCS goods to remedy this lag in digestion.
When I started low carbing I had two three aids that made it possible. One was a fellow TuD member who teaches biology and was able to help me understand how the particular food groups were broken down in my system (eg, fat cannot be turned into glucose as there is no pathway, but it can be used by our system as energy to break down other foods). These clear biological explanations really drove home how the WOEs would effect my body and what I could expect. The second help was again a fellow TuD member who brought an onslaught of menu ideas, replacement ideas for carb laden items, and resources of where they could be had. This was invaluable in my diet change. Lastly, “Diabetic Solution” of course, gave me hope and the realization that D could be manged.
In your writing, menu or meal replacement assistance, and high school level explanations of how the WOEs work with digestion would be a great addition, IMHO.
Thanks for posting this, it has been a very informative thread. I look forward to reading the book.
I use “Computer Planned Nutrition.” I assume they have a Web site. It’s been a long time. Can’t remember why I chose them. I think their program is designed for nutritionists working with the Exchange system, as you can have your results given in exchanges.
It might be overkill for some people. I used to use a little DOS program.
Mostly I don’t analyze meals anymore. It means I have to write what I eat (which I still do), carry the logbook out to the office in my barn, and then enter the data. I got two different portable gizmos that let you enter the data at the table. I found the most difficult part of any nutritional program is deciding which of zillions of possibilites for cuts of meat are. And most databases these days are heavily weighted with data from fast food and prepared foods.
The little DOS program had only whole foods. It didn’t even have an entry for bread. You had to construct the menu from wheat berries. It was kind of a cool program for its day. I got it pre-DX because I wondered if I was low on any nutrient. It said I was low on calcium and then listed foods high in calcium so I increased my intake of salmon.
Oh that reminds me of something I forgot to say. I encourage a chapter explaining what is not useful in the concept of “cheating”. (Basically looking upon it as something you’ve “chosen to do” rather than something you are being “made” to do, and choosing an eating plan you can not only live with but enjoy. That prevents the swinging back and forth from “being good” to “being naughty”. The word diet is also one that can be replaced by one such as meal plan. This may sound like semantics to some, but is really an important distinction that can influence both success in D management and quality of life. I came to my way of thinking from years spent working altering on the distorted view of food and body image I got growing up and helping others do the same.
