My Results – 10 Days In

Here’s a plot of my insulin over the last month or so. I started the 16/8 Intermittent Fast (skip breakfast and lunch) about 10 days ago.

Insulin Levels

My daily insulin levels have gone from around 100 units a day to 55 units a day. All by skipping breakfast and lunch and just eating later (5PM-11PM).

I have had good blood glucose numbers over the same period. Here’s the chart over the last 30 days.

ABG-30day-2016-08-09

My average blood glucose has stablized and is much lower than the peaks from earlier. My pump lists:

Days 7 Avg 125
Days 14 Avg 126
Days 30 Avg 147

It is worth noting that most of the days earlier my bolus was around 30% of the total and the basal was around 70%. That was because there were days where they were 50-50. But most days were much lower. If the recommendation is 50%-50% then my basal was set too high. Yet I never went low. Something is really broken with this whole ever-increasing insulin model.

Fasting seems like a great reset to the ever-increasing insulin model. I am not sure how fast to drop my basal rates. I am now at 26 Units for the day. I think I will drop the insulin every other day by .25 Units per hour.

Nobody else should do what I am doing just because I am doing it, please. You can see how careful I am being to make sure I don’t go high.

 

My Current Experiment

In searching for the solution to Insulin Resistance I ran across the concept of the Intermittent Fast. The guy who’s most prominent in this is Dr. Jason Fung. Here’s Dr Fung’s YouTube channel.

He’s got quite a few videos. One of the better ones is about an half hour long.

The points in the video are:

  1. T2D is reversible – it doesn’t have to be chronic and progressive.
  2. There are examples of people who have stopped being diabetic (via diet, weight loss, etc).
  3. Drugs only treat the symptom not the disease.
  4. T2D is a disease of too much Insulin Resistance.
  5. Treatments are targeted at blood sugar not Insulin Resistance (Metformin being an exception albeit temporary in effect).
  6. The blood sugar isn’t the problem, it is the insulin levels that are the problem.
  7. In 10 years, you are at 100 units of insulin (that’s me).
  8. Never actually treated insulin resistance.
  9. Patients who reversed their disease did so by fixing their insulin resistance.
  10. Giving insulin to a T2D is like giving alcohol to an alcoholic.
  11. Scenario: start insulin, gain 15-20 lbs. Complain to MD who says “go exercise”. It was the insulin which caused the weight gain.
  12. Disease of too much sugar. Cut out the sugar/refined carbs. Stop taking sugar.
  13. Fasting is the most effective way to lower insulin.
  14. LC will lower sugar but not necessarily insulin.Sugar will drop but not necessarily insulin.
  15. Fasting – body will start burning sugar. After that body will start burning fat.
  16. People fast around the world through their entire lives – most major religions.
  17. Insulin levels drop during a fast.  Burn off sugar from your system. Does both at once.
  18. Fasting is not harmful. You don’t enter starvation mode. The metabolism increases during the fast.

Great video. Next post I take a look at my own person experience at this.

 

Only Three Things in What We Eat

There are only three things in what we eat; carbohydrates, protein and fat*. Each of the three have a different effect on the glucose level in our blood (Blood Sugar level). The effect is shown in the following graph.

  • Carbs spike blood sugars to high levels for a short time.
  • Proteins don’t spike blood sugar as high but they are around for a longer time.
  • Fat has the least amount of spike to blood sugar but they have a very long active time.

The curve shows why LCHF works for most people. If you reduce eating carbs and replace them with fat you greatly lower your glucose load and your insulin in the process.

*There is a 4th thing – alcohol. The body burn alcohol quite nicely. In fact, it burns alcohol before anything else.

What I wish I knew about Metformin back then

From Wikipedia, here’s why Metformin is a good drug for dealing with Insulin Resistance and, for me, worked well for years.

Gluconeogenesis is also a target of therapy for type 2 diabetes, such as the antidiabetic drug, metformin, which inhibits glucose formation and stimulates glucose uptake by cells.

The phrase “stimulates glucose uptake by cells” is equivalent to “helps lower insulin resistance”. From this NIH paper (2000), you can see why Metformin works and how it doesn’t quite work well enough in a diabetic person.

The rate of glucose production was twice as high in the diabetic subjects as in control subjects (0.70 ± 0.05 vs. 0.36 ± 0.03 mmol · m−2 · min−1, P < 0.0001). Metformin reduced that rate by 24% (to 0.53 ± 0.03 mmol · m−2 · min−1, P = 0.0009) and fasting plasma glucose concentration by 30% (to 10.8 ± 0.9 mmol/l, P = 0.0002).

So diabetics produced 2x the insulin of non-diabetics (100%) but Metformin only reduced that rate by 24%. Better than nothing but not nearly enough to make the diabetic person “normal”. And insulin resistance is a progressive disease by which the cells get better and better at not unlocking for insulin.

Going on in the paper.

The rate of gluconeogenesis was three times higher in the diabetic subjects than in the control subjects (0.59 ± 0.03 vs. 0.18 ± 0.03 mmol · m−2 · min−1) and metformin reduced that rate by 36% (to 0.38 ± 0.03 mmol · m−2 · min−1, P = 0.01). By the 2H2O method, there was a twofold increase in rates of gluconeogenesis in diabetic subjects (0.42 ± 0.04 mmol · m−2 · min−1), which decreased by 33% after metformin treatment (0.28 ± 0.03 mmol · m−2 · min−1, P = 0.0002).

It keeps getting better. A diabetic person is 3x better at gluconeogenesis but Metformin ws only able to reduce that so that the diabetic person was at 2x the normal person.

And note, Metformin is about as good as it gets in that category of drug. Looks like it can help, but not solve the issues with gluconeogenesis. Something is better than nothing but don’t get lulled (like I was) into assuming all is well. If we keep filling up those protein stores than the same problem which happened to us with carbs will also happen to us with proteins.

 

LCHF Personal Observations

I like the Low Carb High Fat diet. The 18 months I spent on it nearly 20 years ago probably put off my becoming a diabetic by several years. I was at a good weight while on the diet – down from 260 lbs to 225 lbs. The only thing that got me to stop was the feeling that my heart wasn’t doing well on the diet. I had no numbers to back up that opinion. Just felt like I was having some arrhythmia on the diet. And that was after a long time on the diet.

When I did it a couple of years ago I had good results. HbA1C numbers were great (6.4). Triglycerides and other blood numbers were excellent. Doctor was amazed. I was one of the few patients he had who was doing well. However, the diet wasn’t a cure but needs to be kept as a permanent way of life. When I went off the diet the weight came back on quickly and with a vengeance.

Problem is that LCHF only works so well for me now and I think I understand why – at least partly. It has to do with the way the body converts protein to glucose in a process called Gluconeogenesis.

The body doesn’t do nearly as good of a job of converting protein to glucose as it does of converting carbs to glucose. It does it much slower. So if I eat a dozen chicken wings at night my morning blood sugar is up from if I eat nothing or something with carbs instead. The glucose from carbs was gone hours before. Meat was still digesting and being turned into glucose hours later. The problem for me with a LCHF diet over time is that my body got really, really good at Gluconeogenesis.

Wikipedia describes the process as:

In vertebrates, gluconeogenesis takes place mainly in the liver and, to a lesser extent, in the cortex of the kidneys

To put it in personal terms, my liver is really good at converting protein from food into glucose. It would much rather take it from what I eat than take it from me. And LCHF puts no restrictions on when you should eat so for me this means I can no longer get a good blood sugar level from eating LCHF. I can get a better blood sugar but I can’t lose much weight and I am stuck with that demanding diet for the rest of my life. I already feel defeated since I’ve done this before and was only able to do it for 18 months.

I don’t feel this reduced my insulin resistance much either. Sure it must have helped some since the body doesn’t convert protein to glucose as quickly but the other edge of that sword was the longer hours that the glucose was in my bloodstream.

So far I have dodged many of the more severe issues related to T2D. I got a nerve conduction test which indicated very mild neuropathy but my eyes and kidneys have been doing well.

What I have been searching for is something to reset my body’s insulin resistance. Metformin is the oral med which helps me with that but doesn’t work well enough to keep my blood sugar regulated on its own.

I am sure someone will tell me that I didn’t eat enough fats and ate too much protein and that is why I have failed to achieve healing with LCHF. I am sure that’s true.

 

TED Talks

Want to spend a very confusing day? Watch a bunch of TED talks on the T2D subject by different speakers.

Here’s a sampling:

  1. Vegetarian guy who says meat is the problem with everything that ails us. His buddy the vegan weightlifter. Another vegetarian guy. They tell me I am not getting enough starch. They have not got the slightest clue about insulin resistance. My conclusion is they own stock in casket manufacturers.
  2. Paleolithic diet critic who is an archaeologist who points out the holes in the Paleo diet. Seems like the truth is we no longer have the ancient grasses food nor range fed animals so we are pretty much screwed either way.
  3. Food pyramid critics who say all those carbs aren’t all that good for us. (All of them fall into this category).
  4. Fat has been good for us all the way along woman. She is right. The belief that fat makes us fat is flawed and disproven.
  5. Guy who says everything we can possibly eat is poison.
  6. Sugar is the problem guy.
  7. Throw out the food pyramid woman. Fits in with Low Carb advocates.

They all have some unique insights. They all have some overlapping points.

The last one is the best (IMO) of all of the talks. Her key points are:

  1. Carbs are making us sick.
  2. We don’t need carbs.
  3. Cutting carbs helps T2Ds by lowering their insulin.
  4. 40%+ of heart attacks are caused by insulin resistance.
  5. Lowering carbs lowers insulin requirements.
  6. Diabetes is reversible via low carb diet.
  7. Protein and carbohydrates all create glucose.
  8. Fat is what remains and it is good.

Practically this means eating food from the outside ring of the supermarket. Nothing out of the middle rows. No pasta, no cereal, nothing made of wheat, none of the processed foods in the middle. Outside ring is vegetables, meat, dairy, eggs. Maybe 15% of the stuff in the store.

 

Insulin Resistance

I am convinced that insulin resistance is at the core of my problem. This condition is known by the names:

  • Insulin resistance syndrome
  • Syndrome X
  • Metabolic Syndrome

WebMD has an article on the subject, so the concept is fairly well agreed on. The article lists some symptoms:

conditions that are part of insulin resistance syndrome (high blood pressure, low “good” cholesterol levels, and high triglycerides)

Sounds like me to the letter.

Their recommendations are what bother me. They are the typical three (diet, exercise and lose weight). I see problems with each of these three for a T2D.

Diet Changes

The recommended diet in the article is:

fruits, vegetables, whole grains, nuts, beans, fish, legumes, and other lean protein

What are they missing? Fats – still assumed to be bad for you. The diet they recommend is largely carbohydrates. If I could handle carbohydrates I would not be a diabetic. Yet this is the standard recommendation.

Exercise

Seems like good advice. Tough to get active when you are 100 lbs overweight, though. “Work up to it” they say. Gotta laugh at that one.

Lose Weight

The recommended diet is not going to encourage any T2D to lose weight. If they eat that stuff they will pack on weight.

Conclusion

My conclusion is that while it is good to see the Medical community acknowledging Insulin Resistance as a Syndrome their approach is right out of the standard food pyramid which is what has gotten us all sicker.

 

Random Observations

I’ve been trying to put together pieces for years. Here’s some of them. I will probably add to this BLOG with more of the pieces as I think about them.

  1. Diabetes when treated with conventional (i.e., drugs) methods is a progressive, chronic disease. (I am only talking about T2D here).
  2. .The effectiveness of insulin falls over months/years. It takes more and more insulin to correct blood sugar levels.
  3. If I don’t eat for an extended period of time (18+ hours) my blood sugar doesn’t plummet even though I have a constant basal amount from the pump.
  4. Either something else in the body is producing glucose (perhaps the liver) or the insulin only acts when there is glucose present.
  5. Metformin still works for me. Just not effectively enough to not have insulin.
  6. Low Carb High Fat (LCHF) for 3 months got my weight down 15 lbs and my HbA1C down to 6.4. I did it for 18 months from 1998-1999  and it helped keep the diabetes from happening as soon as it could have. I couldn’t stick to it this last time, but I do find myself doing mostly LCHF.
  7. When I was doing LCHF I had bacon and eggs for breakfast every day. I didn’t try messing with the pump insulin levels since I assumed that I would only need to drop the basal amount if I was going low – which I was not.

DG

 

My History

I was diagnosed with Type 2 diabetes in the summer of 2003 so I’ve been learning for 13 years now. Before that I was told I was pre-diabetic around 1996 so that was 7 years until the diagnosis.

That summer day in ’03

Got a phone call from my doctor who sounded very concerned. My blood results came in any my hemaglobin HbA1C was 12.6. In the 6 months leading up to that point I had dropped in weight by over 50 lbs. Everyone told me I looked great. I was drinking tons of water and getting up four or five times a night to pee.

Medicines

The doctor put me on a oral med. That worked great for the first few years. I stopped paying attention and took my pills. Didn’t measure my blood sugar since the pills were “doing the job”.

Around 2007, I went in for a routine blood work and my HbA1C number was 10.4. Doctor put me on Byetta (shots), took me off Metaglip, and put me on Metformin. I always tolerated the Metformin pretty well with minimal side effects.

Got my HbA1C number down to around 8.4 when the doctor prescribed long lasting insulin. He also referred me to a dietary nurse who was a specialist. She told me that the insulin pump was the “gold standard” and that I needed to be on the pump for my insulin. I’ve now been on the pump for 6 years and have seen my insulin use rise steadily to where I’ve been in the 100-120 Units a day range for about the last year. No real end in sight.

 

Hello T2D Folks!

This site is intended to share my personal story of a journey to health. My goal is to document things I’ve learned about Type 2 Diabetes and hopefully find something that will work for me – ideally a cure.

This site is not intended to give medical advice. Be smart. Listen to your body and your doctor. However, recognize that your doctor may be unwittingly getting you sicker.

DG