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Confused...

7K views 32 replies 6 participants last post by  Bunjee 
#1 ·
I posted as a "New Diabetic" on this forum back in March of 2014. Things were confusing then, but even more confusing now.

Following my Type-2 diagnosis back then, things progressively got worse. A1C throughout 2015 was a 13, I was only tested once. I was taking about 20-units of Lantus daily, but I wasn't on Humalog at this point. I think we eventually bumped that Lantus up to 30-units daily.

Throughout 2015, I lost some serious weight. It eventually got me worried, so I finally went to see a new Endocrinologist in January of 2016.

Here are my results from January 2016:

Code:
A1C: 12.1 [<5.7 Normal Range]
GLUCOSE: 398 [70-100 Normal range.]

TESTOSTERONE: 208L [261-827 Normal range.]
FREE TESTOSTERONE: 3.78 [4.8-25.0 Normal range.]
C-PEPTIDE: 0.578 [0.9-7.1 Normal range.]
ESTRADIOL BY TMS: 8.3 [10.0-42.0 Normal range.]

GAD65: >250.0

CREATININE, URINE: 76.20 [Within range.]
CREATININE, 24-HOUR URINE: 1829 [Within range.]
CREATININE CLEARANCE: 159 [Outside range.]
PROTEIN, URINE: 6.9 [Within range.]
PROTEIN, 24-HOUR URINE: 166 [Outside range.]
I had other testing done, a "Comprehensive Metabolic Panel", mostly within range; except for my A1C of course, my "Testosterone Free & Total" was all out-of-range, my Endocrinologist compared me to an 80-year old man.

Following these test results, my Endocrinologist bumped up my Lantus to 40-units daily, 20-units in the morning and 20-units in the evening. I also started taking Humalog, basic formula at this point, i.e., 2-units for a small meal, 5-units for a medium meal, and 10-units for a large meal. She advised I stay away from "large" meals.

Once I started taking Humalog, my life went back to "normal". No more waking up at night, I stopped hallucinating. At night, post-dessert, my numbers would go as high as 550 and I would start hallucinating. Either way, that stopped. That was a crazy time, my wife used to watch me like a hawk.

In March of 2016, my Endocrinologist put me on an insulin pump with a CGM. Likely the biggest mistake in my opinion. That did nothing but make it easier for me to eat garbage because it was so easy to dump insulin into my system. In fact, she told me that a type-1 has it easier than a type-2 because there is no "guessing". You don't produce insulin, so you simply figure out your carb-to-insulin ratio, and take insulin when you eat. She told me that I could eat whatever I wanted, in theory, and I could simply cover it with insulin.

While I stuck with the same Endocrinologist office following that advice, I switched to a new nurse practitioner, which advised me to speak with the nutritionist at the office. The nutritionist was the best person I spoke with throughout the process, a lot more helpful than my Endocrinologist or the nurse practitioner(s). She actually looked at my CGM report(s), adjusted my basal rate, and more.

By the end of 2016, I had hit about 215-pounds. Back in January of 2016, I was about 160-pounds! I normally float around 180-pounds but dropped to 160 from uncontrolled diabetes.

Early 2017 was no different than the rest of 2016. My basal was about 25-units daily, and I would bolus about 50-units daily. That was consistent for a while. Even then, I was still 200-plus most of the time. My latest A1C was 8.7 I believe. Better than a 12, but still high.

Finally, early February 2017, I started to exercise and change my lifestyle. One thing I could not stop was dessert, but other than a very large and unhealthy dessert, I was doing good.

Basal remained at 25-units daily, but my bolus dropped from 50-units daily with an average blood sugar of 200 to about 20-units daily with an average blood sugar of 130 with a deviation of +/- 49. Carbohydrates down to about 190G daily, but 132G were from my dessert alone. My dessert consisted of four Entenmann's Rich Frosted Donuts and a serving of milk, for a total of 132G of carbohydrates. I ate that like clockwork because it was simple, and even though bad, 12-units of insulin square over 4-hours would cover it and I would not go above 140 at night. To me, that was good, considering what I have been through in the past.

Either way, I felt great.

However, throughout the month of February, even with my lifestyle changes, I held steady at 206-pounds. Sure, my body changed a bit, I felt stronger, I was stronger, but I was putting in a lot of work and not seeing the results, on the scale at least. I know a lot of people say "ignore the scale", but, at 5' 7", no scenario makes me healthy at nearly 210-pounds.

Enter March, I started using MyFitnessPal and tracking my calories. I wasn't losing weight because my calories IN were higher than my calories OUT. I also bought a Fitbit, which led me to purchase the new Apple Watch, all for the fitness, activity and health application(s).

I started incorporating cardio into my weight training. I weight train four days weekly, and I burn about 200 calories daily five or six days a week by running. I also stopped eating my donut dessert, and have a moderate snack at night, a serving or two of Popcorn Indiana Kettlecorn, which is about 42G of carbohydrates, in some cases 63G.

Here is where things get confusing.

My average blood sugar since I started this new routine in early March is a 122 with a deviation of +/- 22. I'm consuming about 136G average carbohydrates daily.

I do not need to bolus at all anymore. I had to adjust my basal to 1-unit per hour for 24-hours, but, every day at around 2PM I go low, so I've adjusted to 0-units basal insulin from 2PM until 7PM.

Some nights I have three servings of popcorn, which would be 63G of carbohydrates out of the 136G total for the day.

I do not bolus for the popcorn, and that's right before bed. In the past, I would have needed about 6-units to cover the 63G.

Not only do I not have to bolus, I had to adjust my nighttime basal to 0-units of insulin from 12AM until 7AM. That's 12-hours daily that my basal rate is 0-units!

I am literally down to about 12-units of insulin daily, basal only.

I do hit 200 about 90-minutes after I eat my popcorn dessert, but I rapidly drop back down to ~100 about 60-minutes following that. ~40G of carbohydrates in any meal, insulin is not even a consideration. I don't even hit 160 with so few carbohydrates.

While not accurate for some, the at-home A1C tests have always been near accurate for me. I always take the two tests from the two-pack, and they are nearly spot-on when compared to my actual A1C results. According to the at-home tests, my A1C is now a 6.1.

I want to wait until the 1st of June to actually have bloodwork again, which would be 3-months into this new lifestyle.

I guess my question(s) are, how is this possible? I have read about this "honeymoon period", but my condition(s) seems a bit unusual?

Aside from that, has anyone experienced this?

I'm at the point where I have to take off my pump as I'm dropping into lows to often.

I have not tested myself up against more carbohydrates, I am trying not to push it. On the weekends, I like to live a little and might have pancakes or French toast, but I am still cautious. Even with a few pancakes and syrup, I took 3-units as a precaution, but that did nothing but drop me into a severe low about 3-hours later.

Any advice would be greatly appreciated.

I suppose a lot of this is good news, but, disconcerting. :vs_worry:
 
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#2 ·
wow, that's a lot to digest....

Im not sure exactly what you are asking but if you are asking if its possible to go from a very high BG to one that is slightly high in a short amount of time , the answer is yes.

If I am reading this right and you cut your carbs and that enabled you to reduce your medication, then your body might benefit tremendously from a HF/VLC diet. You are eating WAY more carbs than most of us and not the good types either.

I cant give advice until I know what you are trying to accomplish totally. if you are trying to reduce or eliminate medications and insulin, I would continue to cut back your carbs and keep an eye on your numbers to make sure you don't go too low and keep adjusting the meds until you stay in the safe range.

I was 398BG and in a few weeks I went to 76BG without any medications and I am med free today. its doable and probably advantageous to do.

You don't need carbs

Please watch this video!! it is an EXCELLENT video for you to see

 
#3 ·
Thanks, hftmrock.

I'm sure you don't "need" carbohydrates, but needs and wants are completely different things. Everyone is different. I appreciate the link to the video, but I've seen them before and I am in no way interested in completely eliminating carbohydrates from my lifestyle. It's not for everyone.

Sure, I don't "need" 150G of carbohydrates from binging on donuts. I wouldn't say I "want" that either.

But, there are things I "want" that contain carbohydrates, which I enjoy. I love Chobani yogurts when I'm on the move and Glucerna shakes. Two yogurts for breakfast, a shake for lunch, that's already 57G. My favorite protein brand contains some carbohydrates as well.

Plus, growing up in Brooklyn; traditional Sunday pasta dinners, bread, pastries, cakes, the works. Telling my Grandmother "no more pasta" didn't work and would not go over well. :wink2:

I'm used to my lifestyle, but, willing to change. The changes I've made so far are pretty dramatic, at least for me. I have not touched pasta in months and the same goes for rice. Probably not a big deal for a lot of you, but, a huge deal for me.

I guess my question is, I was under the impression that as a type-1, I would "need" insulin for all carbohydrates? When my endocrinologist recommended the insulin pump, I asked if I could change my lifestyle, exercise, and she said being a type-1, I would need insulin and exercise alone would not eliminate the need.

I woke up this morning at 86. I had to suspend my basal. I ate 34G of carbohydrates for breakfast with my basal suspended, no bolus for the 34G, and the highest I went was 112, eventually dropping back down to 102. I did not think that was possible without insulin as a type-1 diabetic.

That is the part that is confusing to me.

Following my post this morning, I read a few forum threads and I see a lot of users here posting low numbers. When I say low, low to me. My endocrinologist(s) want me to stick with the 80-120. Coming from where I was, that's a huge difference. I remember a time when I would get sick if I went as low as 140 when I was stable at ~300 average. Over time, I guess my body had adjusted to a more normal number. I used to panic and binge eat when I would hit 100, which I no longer do.

Sorry for my lengthy original post, I figured the more information I shared, the better. A lot of it is likely irrelevant.

wow, that's a lot to digest....

Im not sure exactly what you are asking but if you are asking if its possible to go from a very high BG to one that is slightly high in a short amount of time , the answer is yes.

If I am reading this right and you cut your carbs and that enabled you to reduce your medication, then your body might benefit tremendously from a HF/VLC diet. You are eating WAY more carbs than most of us and not the good types either.

I cant give advice until I know what you are trying to accomplish totally. if you are trying to reduce or eliminate medications and insulin, I would continue to cut back your carbs and keep an eye on your numbers to make sure you don't go too low and keep adjusting the meds until you stay in the safe range.

I was 398BG and in a few weeks I went to 76BG without any medications and I am med free today. its doable and probably advantageous to do.

You don't need carbs

Please watch this video!! it is an EXCELLENT video for you to see

https://www.youtube.com/watch?feature=player_embedded&v=da1vvigy5tQ
 
#4 ·
I can understand the confusion because what you are experiencing is outside the norm for T1 diabetics. However, possibly not so unusual if you're body is still making insulin and does so at times you can't anticipate. That would explain why you can suspend basal and not take bolus. Sometimes.

From what I have read, the honeymoon stage can make managing blood sugar difficult at times. The progression to full insulin dependency isn't a straight line and for some can take a year or more with ups and downs.

I commend you for making dietary changes. It appears that for most of the time you are able to keep BG within a good range. It's not unusual for doctors to ask their patients to keep BG a bit high to avoid lows.

You are correct, most of us do eat far less carbs than you, but then it is more important for a T2 with insulin resistance. But your level isn't that much higher from other T1s on insulin who don't have insulin resistance.

Diabetes isn't a one-size fits all - or even most. It is very individual. Each of us have to do what works for us.
 
#5 ·
So as the week progressed, I started to enjoy not needing and taking insulin and started to reduce my carbohydrate intake more-and-more.

Some days I would only consume about ~50G of carbohydrates, but, my average was more like 110G.

I went to my endocrinologist yesterday thinking all of this would be great news. You know, reducing my bolus from ~70-units to 0-units and getting my basal down from 24-units to about 18-units. I went there wanting Metformin to see if I could get that to make up for the 18-units via basal and completely omit insulin from my life, at least for now.

My NP told me not to get excited because I was honeymooning and this would not last long. My NP was very confused as to how I was surviving with very little insulin based on my C-PEPTIDE being a .5 last January. She called in another NP and she was even more confused. Then they called in a "Diabetes Educator" and I now had a third confused person staring at me. The endocrinologist himself; fourth person, asked me if I have ketones and I told him the only time I would test was back when my blood sugar was ~250+ and I never had them. I never test when my numbers are normal.

So, I was tested in the office and I had "small" amounts of ketones but my blood sugar was 96 at the same time.

The endocrinologist told me I had to be rushed to the emergency room. Like rushed. I told him I felt fine and would drive myself there right away.

So, I drove myself home instead and started doing research and read it's perfectly normal to be in ketosis on a low-carbohydrate diet.

My question is, since mostly everyone here is consuming far less than 110G of carbohydrates daily, are you often in ketosis?

I called my endocrinologist back and he started yelling at me telling me "This is why you NEED insulin and NEED carbohydrates!". I reminded him that I am consuming carbohydrates, some days ~50G, other days ~110G. I was told that if my body has gotten to the point where I do not need insulin for a meal that contains "X"G of carbohydrates, then I need to eat more carbohydrates with that meal so that I force my body to take insulin. So I'm consuming 30G of carbohydrates but need no insulin because my number is stable after 2-hours, then consume 60G of carbohydrates so that my body needs insulin.

I just don't get it. When my numbers were high the goal was to exercise, "stop eating junk", and never consume more than 40G of carbohydrates per meal. I've nearly reached that point and now the goal is "eat more carbohydrates and take more insulin". I just don't understand this logic.

I found a local DAOM [Doc of Acupuncture and Oriental Medicine] and I am heading there this morning. I don't know if this is the right path to take, but, I do know that I don't want to go back to taking 70-units of insulin daily. I refuse to live that way. I did and I felt like absolute crap for 6-months or more and I've been feeling GREAT the past few weeks. I am finally sleeping at night, my mood is stable, and my activity level is much greater.
@VeeJay, I am interested in your opinion on all of this. @hftmrock, I originally shot down your "You don't need carbs" comment and started to realize the benefit(s), at least for me, so I apologize. I'd like your opinion as well. I am assuming you are following the HF/VLC lifestyle and would like to know if you have ketones present?

Should this matter, I am losing weight, but, it's needed weight-loss. I'm not losing weight similar to when my numbers were out-of-control pre-diagnosis. That weight-loss was quick and I felt different back then. I am about ~30-pounds overweight right now, losing maybe 2/3-pounds weekly. My numbers have been around 120 average for the past few weeks. I am weight training 4-days weekly and running a couple of miles 6-days weekly. So the weight loss should be normal considering the amount of exercise. I usually burn around ~600 calories throughout my 2-hour workout, per my Apple Watch data.
 
#8 ·
that is too much protein. lower your protein and... (wait for it)

ADD FAT

Fat is your friend. you will lose more weight by eating more fat and lowering your protein.

I am 75% fat 20% protein 5% carbs

:biggrin::vs_coffee:
 
#7 ·
while the journey is VERY confusing... I am very proud of you.

Here is the best thing I can say

"You take the blue pill, the story ends. You wake up in your bed and believe whatever you want to believe. You take the red pill, you stay in Wonderland, and I show you how deep the rabbit hole goes." The term redpill refers to a human that is aware of the true nature of the Matrix

you just took the red pill :biggrin:

First - YES you should have ketones in your urine when you are in ketosis (NOT TO BE CONFUSED WITH KETOACIDOSIS) . You body is burning fat instead of carbs for energy. Because of this your body is producing ketones and its 100% normal and 100% healthy. I am fully keto adapted and yes I produce ketones. a side affect of this is WEIGHT LOSS!!

you are doing everything right and the only suggestion I have is to change doctors to one that understands keto.

PLEASE WATCH THIS VIDEO!! IT WILL CONFIRM THINGS FOR YOU




I think you are doing fantastic... You are in ketosis and that is great since you were on all that insulin and now you are seeing the reality that doctors just take what they were told years ago and dont think about anything that might go against their norm. The ADA is WRONG and you can live without carbohydrates

you are allergic to carbs and if your pancreas can produce some insulin (it sounds like it can) then you can live without carbs AND without insulin.

I will help you with any questions or concerns you have. I do think you MUST see a doctor but not the clowns... errr... professionals you are currently seeing. It will take time but you have to see a doctor that understands this.

Congrats on waking up to reality. its hard.


now wait until we tell you to eat more fat if you want to lose weight and lower cholesterol

~hftmrock
 
#12 ·
@hftmrock, thank you for responding, I really appreciate it. I have been feeling great for the past few months and yesterday after this whole doctor debacle, I felt like absolute crap. So this is all very helpful.

So I've been thinking a lot about a comment the NP made to me on the phone before the endocrinologist snatched the phone from her and went off on me about carbohydrates. I asked her why ketones are bad with a normal blood sugar and she said; "Because if you drop to low your body has no glycogen storage for you to recover." and then the phone was taken from her. She might have said "liver" and not "body", I don't remember. She definitely said "drop low" though, which confused me because I was always told to check for ketones when my number(s) were high, and not low.

Then I started thinking about this. Say I stick with this lifestyle and I'm doing well but often have ketones. Perhaps "moderate". So now my blood glucose is good but I have ketones. Now say I eat something I shouldn't and that causes my blood glucose to rise. Now I have high blood sugar and ketones, no? Isn't that the "deadly" combination?

I watched that video, a few times. I've followed her on Facebook as well and found a lot of cool resources through her. Thanks for that link!

My C-PEPTIDE is a .5, so I'm producing very little insulin. She re-tested yesterday, so I'll know at the end of the week if anything changed. She said it's impossible to change and that number will stay the same or go lower.

I went to the DAOM today, but she was so focused on acupuncture, it wasn't what I expected. She does not specialize in diabetes management or planning like I expected. I had acupuncture, it was interesting, but, I don't know. I was a little confused by the whole thing. She's telling me to eat cucumbers, tofu, squash, and quinoa. When I looked up quinoa, it was loaded with carbohydrates. :vs_worry:

I have to do what you said. I have to find an endocrinologist that understands all of this and doesn't want to simply load me up with insulin. It would be really great to have a supportive doctor for once.

So with you living such a low-carbohydrate lifestyle, do you need insulin to "survive"? You likely don't need a bolus much because of your lifestyle, but how about long-acting?

I blew up from insulin, but, I was eating like crap and taking 70-units daily. Should I need to go back to insulin to survive but still stick with the low-carbohydrate, at what point does insulin cause you to gain weight? Say I need the basal rate only and it's 15-units daily, with a bolus here and there, few units daily. Will that cause one to gain weight and blow up?

You know, my gripe was never about insulin and I explained that to my doctor. It was about the pump, I just wanted to get off the pump. I wanted Lantus for my long-acting and nothing for food going low-carbohydrate. However, with Lantus I used to go low all the time, even on 20-units, so I figured I would start with Metformin.

Now I'm reading that Metformin simply isn't for T-1 diabetics. She prescribed me 1500MG daily but told me to start with 500MG for the first two weeks.

Today is my first official day without my pump, no insulin at all, and on Metformin. I started with 500MG and my stomach is dancing.

My numbers are not so great today. I woke up at 4:30AM at 138, had my usual protein shake around 6:45AM but adding milk for some fat, which was 15G of carbohydrates. I was still stable at ~140 at this point. About an hour later I hit 188 and stood that way for a few hours. At 10:45AM I finally started going down and hit a 148, all without insulin. I did not take my first dose of Metformin until 11AM, so that likely won't start working right away.

I ate Shrimp Fra Diavolo for lunch at 12:28 with a 161 reading. I didn't eat all the sauce because I was afraid of the possible carbohydrates from it. Now at 1:43 I am a 142; nearly 20 lower, without insulin.

I'm a bit nervous about sleeping with no insulin in my system. I'm afraid that my blood glucose rises for whatever reason and with ketones there, having some issue(s).


while the journey is VERY confusing... I am very proud of you.

Here is the best thing I can say

"You take the blue pill, the story ends. You wake up in your bed and believe whatever you want to believe. You take the red pill, you stay in Wonderland, and I show you how deep the rabbit hole goes." The term redpill refers to a human that is aware of the true nature of the Matrix

you just took the red pill :biggrin:

First - YES you should have ketones in your urine when you are in ketosis (NOT TO BE CONFUSED WITH KETOACIDOSIS) . You body is burning fat instead of carbs for energy. Because of this your body is producing ketones and its 100% normal and 100% healthy. I am fully keto adapted and yes I produce ketones. a side affect of this is WEIGHT LOSS!!

you are doing everything right and the only suggestion I have is to change doctors to one that understands keto.

PLEASE WATCH THIS VIDEO!! IT WILL CONFIRM THINGS FOR YOU

https://youtu.be/da1vvigy5tQ


I think you are doing fantastic... You are in ketosis and that is great since you were on all that insulin and now you are seeing the reality that doctors just take what they were told years ago and dont think about anything that might go against their norm. The ADA is WRONG and you can live without carbohydrates

you are allergic to carbs and if your pancreas can produce some insulin (it sounds like it can) then you can live without carbs AND without insulin.

I will help you with any questions or concerns you have. I do think you MUST see a doctor but not the clowns... errr... professionals you are currently seeing. It will take time but you have to see a doctor that understands this.

Congrats on waking up to reality. its hard.


now wait until we tell you to eat more fat if you want to lose weight and lower cholesterol

~hftmrock
 
#9 ·
please watch this regarding ketones and ketosis

 
#14 ·
thank you for responding, I really appreciate it. I have been feeling great for the past few months and yesterday after this whole doctor debacle, I felt like absolute crap. So this is all very helpful.

we are here to advise from our experiences and the lessons we learned. I'm glad things are getting better for you and I KNOW they will continue to do better

So I've been thinking a lot about a comment the NP made to me on the phone before the endocrinologist snatched the phone from her and went off on me about carbohydrates. I asked her why ketones are bad with a normal blood sugar and she said; "Because if you drop to low your body has no glycogen storage for you to recover." and then the phone was taken from her. She might have said "liver" and not "body", I don't remember. She definitely said "drop low" though, which confused me because I was always told to check for ketones when my number(s) were high, and not low.

Then I started thinking about this. Say I stick with this lifestyle and I'm doing well but often have ketones. Perhaps "moderate". So now my blood glucose is good but I have ketones. Now say I eat something I shouldn't and that causes my blood glucose to rise. Now I have high blood sugar and ketones, no? Isn't that the "deadly" combination?

I dont think thats a problem. Right now you are in ketosis (at least it sounds like that) and your body is burning fat for fuel instead of carbs. If you suddenly eat something that will spike your BG its very temporary and the numbers will go back down and it will probably kick you out of ketosis and the ketones will stop. Your body is very smart and adaptive. Your body switched to burning fat for energy because you were no longer eating enough carbohydrates. in doing that, ketones are produced to help give your body energy. If you eat carbs again and your body gets glucose, your body will switch to burning carbs for energy and the ketones will stop.


I watched that video, a few times. I've followed her on Facebook as well and found a lot of cool resources through her. Thanks for that link!

My C-PEPTIDE is a .5, so I'm producing very little insulin. She re-tested yesterday, so I'll know at the end of the week if anything changed. She said it's impossible to change and that number will stay the same or go lower.

what measurement is this.. here is what I found online

The reference range of C-peptide is 0.8-3.1 ng/mL (conventional units), or 0.26-1.03 nmol/L

in any case... .5 doesnt sound horribly low and please remember that if you were taking insulin, your body realizes and decides not to produce as much so it will be interesting measuring it when you are in ketosis. it might have raised a little to possibly normal number (might not but it might rise). You also dont need as much insulin if you are keto adapted.

I just saw this... are you sure that the number (.5) is that bad?

What Are Normal C-Peptide Levels?

Per the NIH, 0.5 to 2.0 nanograms per milliliter (ng/mL) are considered normal amounts of c-peptide in the blood stream upon eating and your pancreas releasing insulin to cover those carbohydrates.


I went to the DAOM today, but she was so focused on acupuncture, it wasn't what I expected. She does not specialize in diabetes management or planning like I expected. I had acupuncture, it was interesting, but, I don't know. I was a little confused by the whole thing. She's telling me to eat cucumbers, tofu, squash, and quinoa. When I looked up quinoa, it was loaded with carbohydrates. :vs_worry:

Quinoa is high and I dont eat it because of it. You are going to have to eat to your meter. if you eat something that goes high and you identify what it is, you have the option of not eating it anymore.

I have to do what you said. I have to find an endocrinologist that understands all of this and doesn't want to simply load me up with insulin. It would be really great to have a supportive doctor for once.

So with you living such a low-carbohydrate lifestyle, do you need insulin to "survive"? You likely don't need a bolus much because of your lifestyle, but how about long-acting?

you need insulin. But in ketosis, you don't need much. So if you are ketosis, the amount you are making might be enough for you. this needs to be monitored and tweaked. keep looking for Endo's with knowledge of ketosis. they are rare but they are out there. even a nutritionalist if they know about keto.


I blew up from insulin, but, I was eating like crap and taking 70-units daily. Should I need to go back to insulin to survive but still stick with the low-carbohydrate, at what point does insulin cause you to gain weight? Say I need the basal rate only and it's 15-units daily, with a bolus here and there, few units daily. Will that cause one to gain weight and blow up?

I am not on any medication and I am type 2 so hopefully others might be able to answer this. I want to only let you know my observations from experience


My numbers are not so great today. I woke up at 4:30AM at 138, had my usual protein shake around 6:45AM but adding milk for some fat, which was 15G of carbohydrates. I was still stable at ~140 at this point. About an hour later I hit 188 and stood that way for a few hours. At 10:45AM I finally started going down and hit a 148, all without insulin. I did not take my first dose of Metformin until 11AM, so that likely won't start working right away.

use heavy whipping cream instead of milk. MUCH lower carbs. Also find no carb / low carb protein powders if you havent. I have that.

I ate Shrimp Fra Diavolo for lunch at 12:28 with a 161 reading. I didn't eat all the sauce because I was afraid of the possible carbohydrates from it. Now at 1:43 I am a 142; nearly 20 lower, without insulin.

not bad on how your body reacted. you dont know whats in it so its harder.

I'm a bit nervous about sleeping with no insulin in my system. I'm afraid that my blood glucose rises for whatever reason and with ketones there, having some issue(s)

you dont have to worry, your body will stop producing ketones if you are getting glucose. but where would your body get the excess glucose? Metformin helps drive out blood glucose and you are using insulin. and please remember the lower you reduce carbs the less there is glucose in your system. your body typically cant have too high blood glucose if your not eating any/much carbs. If I was you (I am a paranoid person) I would set an alarm at least once in the middle on the night to test until you are comfortable and until you find a doctor that knows about keto

KEEP UP THE GREAT WORK!!! ITS HARD AND CONFUSING BUT SERIOUSLY IS WORTH IT!

Here is a pic of me before and after I found out I had diabetes and changed my eating to live a keto lifestyle. this is about 6 or 7 months.
 

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#17 ·
Wow. You look like a completely different person. You must feel GREAT. That is quite an accomplishment!

KETOSIS

I must be in ketosis. I have gone through thirty strips since last night and the only time I did not have ketones was when I first woke up this morning. Every test since then has show either "trace" or "small". I have not hit "moderate" yet. Even last night I don't think I hit "moderate", the color matched both "moderate" and "small", so I'm guessing I was a 30.

C-PEPTIDE ISSUE

So my paperwork shows "Reference Range" is 0.9-7.1 and I was a 0.578. Keep in mind, this is from January of 2016, which is the batch of test results that led to my T-1 diagnosis. I was only on Lantus at this point, about 20-units once daily. This is when I was still a T-2 and this result is what made me a T-1. Well, this result and the GAD65. My GAD 65 was >250.0! I might have been on 30-units of Lantus daily, I can't remember. It was either 20 or 30.

I don't know if the .578 is bad, that's what my NP tells me so I just listened to her. I never researched it to be honest. I just read what you posted about "Normal C-Peptide Levels" and that 0.5 is normal if I just ate. I don't remember the details of the test, not sure if I ate. I went for the test early in the morning and if they told me not to eat, they would have said not to eat in the morning. But, the night before I likely ate five donuts, so who knows if I was still releasing insulin to cover for that. It would have only been 12-hours later.

My test from yesterday I should have back soon and I had ketones when the test was taken. I'm curious on the results too.

INSULIN TO SURVIVE

So you said "you need insulin. But in ketosis, you don't need much. So if you are ketosis, the amount you are making might be enough for you.".

So how do I know if the amount I'm making is NOT enough for me? Is it as simple as I live this lifestyle and things are going good but one day suddenly my numbers rise, which means what I'm making is no longer enough and at that point I will have to resume taking insulin? Is it that "simple"?

Not enough insulin, your blood glucose rises, you need more insulin. Right now, numbers stable without, so A-OK?

OTHER

I will try the heavy whipping cream, or maybe light whipping cream. I still want protein to be 50% of my caloric intake and I know or heard that excess protein will turn into carbohydrates. But, so far, I consume a minimum of 160G of protein daily and it doesn't raise my numbers at all. Not only is it protein but my protein shake consists of 6G of carbohydrates!

NIGHT

You said "but where would your body get the excess glucose? Metformin helps drive out blood glucose and you are using insulin.", but, I stopped insulin. I took my pump off. So my bolus stopped about two weeks ago, my basal was reduced to 15-units daily. Now I'm done with that and on Metformin.

I already do exactly what you said. I have two to three alarms set for the middle-of-the-night and I wake up to check my number. I was so used to the CGM, I have been doing this for a few weeks since I stopped using it.

So you're thinking that if my numbers naturally rise when I'm sleeping then I'm producing glucose, which should make the ketones go away?

That makes me feel better! I'll still wake up to check and confirm for a few weeks, can't hurt.

I reached the bottom of the topic and see your picture again. Really, unbelievable!

Thank you again for all the back-and-forth!
 
#16 ·
I have seen this youtuber a lot and I like him a lot. It might be worth watching some of his videos - goody beats

 
#18 ·
I think you are on the right track with all of this. I dont understand how you can go from type 2 to type 1. I honestly have not heard of that but I am new to this too so it might be normal.

I hope others with type 1 can jump in with some info to clear up any other questions.

Ketones are there because your carbs are so low that your body is burning fat for energy and need the ketones to help fuel you

Here is a very short video about nutritional ketosis and ketoacidosis



If you body is producing no insulin you can have a problem. I think you would know that right now and your blood tests will show this. if your body is producing 'some' insulin (and I think it is if your BG goes from a number like 160 - something like 110... insulin is whats lowering it.) it sounds like you are still able to produce some insulin.

So here is the difference between ketoacidosis and ketosis.

Ketoacidosis... your body produces no insulin and the blood glucose just stays in your bloodstream and then ketones come out VERY high. that is a very dangerous thing.

Ketosis - your body produces 'some' insulin and you are not eating carbohydrates enough to fuel your body so it switches to burning fat which cause ketones to come out. Please note that the ketones you are seeing in your urine is EXCESS ketones that are being flushed out. If you were in ketoacidosis the number would be VERY high. Yours is not so it shows you that you are ok. all the rest of the ketones are working for you as energy for your body.

you are not having ketoacidosis if the ketones you see in the urine is low. ALL ketones are excess in ketoacidosis and it will be high.

your doctor is worried about ketoacidosis and its not the same thing. You are monitoring this. Please find out if your body is producing insulin at all. it was .5 of the C-peptide so that tells me you are producing some insulin (even if its only a little)

you are doing great and you are a rare person that is seeking out inormation to make the best choices for yourself.

Please try to find a good endo that can help you. We here can give opinions and what we experienced but the doctor is the one who specializes on this and if he/she knows nutritional ketosis they will be your guide in this.
 
#19 ·
So how do I know if the amount I'm making is NOT enough for me? Is it as simple as I live this lifestyle and things are going good but one day suddenly my numbers rise, which means what I'm making is no longer enough and at that point I will have to resume taking insulin? Is it that "simple"?

Not enough insulin, your blood glucose rises, you need more insulin. Right now, numbers stable without, so A-OK?
thats what I feel. you are monitoring so if its too high and isnt going down or its trending up, go to the doctor to see if you need to up doses or meds or go back on isulin. if its in the normal range or at least close to normal but stable then you monitor it and try to get it in the normal range as much as possible.

yes... if you dont have enough insulin (this is type 1) then your blood glucose rises and you need more insulin

in type 2 you have enough insulin but your fat cells resist it (insulin resistance) and the blood glucose stays in your system. and you need meds to help

Im wondering if you are type 1.5 (I just heard about this and dont know much about it)
 
#20 ·
sorry for the number of posts but I read your comments and want to reply to one more thing

So you're thinking that if my numbers naturally rise when I'm sleeping then I'm producing glucose, which should make the ketones go away?
not exactly and that wouldnt be good. people's bg rises during the night for some unexplained reasons but just because it goes up doesnt mean that the ketones disappear but they CAN coexist. its only if your body produced NO insulin that this is a problem and I dont think you have that

if you are in ketosis (looks like you are) , then you will usually see a trace or small amount of excess ketones in your urine.

the blood test you took should be eye opening and could help in knowing how to proceed because it will tell you if you are producing insulin on your own
 
#21 ·
@hftmrock

FIRST RESPONSE

Yes, I am producing some insulin. As per my NP, I am "honeymooning", which is why that is happening.

Maybe their concern is that I no longer use insulin and one day or night my honeymoon is over and my blood glucose rises to a level I can't control.

I have enough insulin for an army, at least until it expires in 2021. I have TONS of it. Pens, vials, you name it.

No matter what, even if I continue to control this without insulin, I will always test my blood glucose and I will always keep a pen with me "just in case". I don't plan on telling myself that I'm not a diabetic because I am not taking insulin.

I don't think my doctor(s) fully understand that.

I did a lot of research today and might have found a new supportive endocrinologist and a dietitian. But, the dietician wants me to have "medical support" before she agrees to work with me.

I'll know more this week.

SECOND RESPONSE

Funny you said that. My primary thinks I'm a 1.5. Hopefully I will have more answers soon!

THIRD RESPONSE

I will post my results here at the end of the week once I receive them!

She drew blood yesterday mid-afternoon, no fasting or anything. Based on reading, there is debate as to whether or not you should fast prior to a C-PEPTIDE test because of the reason you posted earlier.

I'll mention that to her and see what she has to say.

Enjoy the rest of your weekend and thank you again for the time and information! I'll work on increasing the fat a bit and reducing my carbohydrates a bit more!
 
#22 · (Edited)
My attention span is short today (med side effect), but I wanted to comment that much of what docs know about Type1 diabetes is based on CHILDREN. Children GROW and they need carbs to grow or to keep up with their genetically defined growth pattern (Dr. Bernstein does not disagree with this). Maybe that is part of the problem. Your endo isn't basing his/her recommendations on ADULTS with type1 - you no longer need to grow. In addition, too many carbs can create insulin resistance in type1 diabetics as well.

Now the only carb my endo is concerned about is citrus because it's already been shown in me that I heal slowly and citrus actually demonstrably helps. That may not be your issue at all - but it showed clearly on small wounds that I had that would not heal. So, with my low carb high fat plan, I agreed to include citrus since, for me, its no different from a med.

FYI - initially 1.5 was suspected, but my c-peptide was actually above normal and GAD was negative. Next time, doc did it and c-peptide was below normal and I had some kind of islet antibodies which was a definitive test as well for 1.5. I wonder if the c-peptide came up the first time that way because I was fasting and the 2nd, I wasn't? Don't know.

Ok, hope to reread this thread when brain is working better.
 
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#23 · (Edited)
That may not be your issue at all - but it showed clearly on small wounds that I had that would not heal. So, with my low carb high fat plan, I agreed to include citrus since, for me, its no different from a med.
Although I don't have specific wound-healing issues, a month or so ago I landed in Urgent Care with a freak accident on my ring finger (something about a ring and washing dishes and a hairline crack that made the ring pierce my finger and my trying to cut the skin off and making a bloody mess ... ). They got my ring off, gave me tetanus, lots of bandages and sent me on my way.

Just the month before, a friend for decades had sent me some healing gel made from Manuka honey. He's from NZ originally, where it comes from. He had a bad bike accident, had some in the house from a company that wanted him to represent the product, and figured he'd document if/how it worked. (You can see under Testimonials at https://honeyforhealing.com/how-it-works/ )

Anyway, that evening I applied it, then again 4 hours later, and in the morning I could see only some discoloration where the wound had been. Seriously! I called him and said 'Before I believed you, but now I'm a believer!" Got a cut on my finger last night, this morning it was slightly infected and swollen, used it, and bang - it has healed and there's no evidence where it was.

He said Manuka has become so valued in NZ, prices soaring, supplies short, that it's like drug wars!

Anyway, Manuka honey creams/ointments/etc are around from others, I've no monetary interest in his product, but I can definitely recommend it. Truly amazing stuff.

(oops - sorry for the tangent in your thread knarfny!)
 
#25 ·
@hftmrock

Wanted to share some information with you.

I went to see my new endocrinologist and he provided me with some answers.

As you know, my original doctor told me to get to the emergency room because I had ketones present.

My new endocrinologist said it's perfectly normal to have ketones present with a low-carbohydrate diet, which doesn't even mean a true keto diet. He suspects anything less than 100G of carbohydrates daily should cause ketones. Perfectly normal. He doesn't agree with it, but that's another story. You shared all of this with me, so you were spot-on.

Now, here is what is dangerous, but it depends on the person and the amount of control that person has.

Ketones aside, a low-carbohydrate diet means I have no glycogen storage. One day I slip up, whether it be drinking alcohol, to much yard work, my blood glucose drops quickly. It's going to be very hard for me to recover because I have no glycogen storage. I have no carbohydrates in my system, therefore no "sugar". I might have worded that a bit differently, I'm working off memory. I'm pretty sure that's what he said.

The other potential problem is insulin resistance. My original carbohydrate-to-insulin ratio was 13:1 and sensitivity 35. Now, on such a low-carbohydrate diet with extremely high protein, that has changed and will continue to change. Thing is, without experimenting, I won't know what the change(s) are and if I ever decide to "cheat" or indulge, I won't know what to bolus.

The concern is one day I cheat, or, I order a diet soda and it's actually not diet. My blood glucose shoots up to 300. So in the past I would need ~6-units to get myself back to a normal number and it would take about 2-hours; give or take. Now, I might need only 2-units and it might only take 30-minutes. But, if I accidentally take 3-units, I'm in trouble.

He described it as giving a non-diabetic 3-units of insulin, it would kill them. He feels that is the situation I might face at some point.

The way he described it was the stricter I am with my lifestyle "diet", the harder it's going to be to figure out.

If I was "perfect" all the time, he doesn't see any issues at all. But he said it's a very hard lifestyle to lead and I'm walking a tight-rope.

With all of this, he was still very confused on my near perfect numbers without the need to bolus for ~100G of carbohydrates daily, plus I have to set up a temporary basal at 0% for about 6-hours daily; more if my activity level increases.

Bottom line, I'm surviving with ~18-units basal daily, no bolus and according to him, VERY little insulin production according to my .5 C-PEPTIDE. He said that it doesn't coincide with my C-PEPTIDE and GAD65.

We did all sorts of new bloodwork, which are pending results.

He said there is a slight chance that I am a mutant of sorts, very rare, very lucky, or having the best honeymoon in existence.

I'll tell you this, I fertilized my lawn today, which consisted of walking back and forth over 14,000 square feet. Took me about 45-minutes. I was a 118 when I started and I suspended my basal when I started. I was a 42 by the time I was done and honestly, I felt fine. No sweats, no shakes, no nothing. I ate a yogurt with 18G of carbohydrates and recovered very quickly, so no issue.

This sort of goes with what my new endocrinologist said, in regards to not having any "storage". A little bit of new activity, and there was a dramatic change. Had I stood outside for another 10-minutes, I could have been dealing with some serious consequences!

Thanks for reading and I'll update again soon upon receipt of my blood work.
 
#26 ·
i'm really really glad that you found an endo that you can work with. I'm anxious to hear about your blood work numbers

I am not type 1 so I cant really give any practical advice past what you already know but I think this doctor has the potential to be an advocate to you to find the right balance of nutrition and medication to help you on your journey.

I believe you can do this and I think with the information you have and your doctor which is now a partner in this, you will be able to find that 'sweet spot' that works for you.

Please let us know when your blood work comes back. I am very curious to the results. I am still thinking that you have the potential to be 1.5

Also I wonder if you eating slower digestible carbs in smaller doses might keep your numbers from making high fluctuations.

:vs_coffee:
 
#27 ·
I was a 118 when I started and I suspended my basal when I started. I was a 42 by the time I was done and honestly, I felt fine. No sweats, no shakes, no nothing. I ate a yogurt with 18G of carbohydrates and recovered very quickly, so no issue.
curious... when did you eat before this ? what did you have? Im curious to that as well
 
#28 ·
Here's my entire boring menu for the day, plus my numbers. I try to remain consistent during the week, it's easier for me to manage. The weekend's protein comes from meat, which of course increases fat and everything else.

04:22AM: 104BG
06:28AM: 6G CARB, 40G PROTEIN [Protein Shake]
09:13AM: 135BG [NORMAL FOR ME, TREND HIGH MORNING]
09:33AM: 2-HOUR BASAL SUSPENSION
09:33AM: WORKOUT, CARDIO
10:45AM: 6G CARB, 40G PROTEIN [Protein Shake]
11:30AM: 66BG
11:30AM: 18G CARB [Greek Blueberry Yogurt]
01:16PM: 128BG
01:42PM: 1-HOUR BASAL SUSPENSION, YARD WORK
02:11PM: 44BG
02:11PM: 17G CARB [Greek Peach Yogurt]
03:18PM: 136BG
03:21PM: 6G CARB [Protein Shake]
05:04PM: 148BG
05:04PM: 23G CARB [Potatoes & Zucchini, DINNER]
06:06PM: 188BG [NORMAL, NO INSULIN]
07:21PM: 90BG
08:30PM: 84BG
08:30PM: 3.5-HOUR BASAL SUSPENSION
08:30PM: 45G CARB [Before bed to keep my numbers UP.]

01:09AM: 116BG [TODAY]
05:06AM: 90BG [TODAY, WAKE UP, 40-MINUTES AGO]

Had I not suspended my basal before bed, I would have woke up at a 40 or not woke up. Remember, I suspended basal AND ate 45G carbohydrates right before I passed out.

My "Potatoes & Zucchini", it's just called that, my grandmother's recipe. I make it my own way, and use three small red potatoes in the whole pot, which is good for seven meals.

1,670 calories eaten, 170G protein [42%], 121G carbohydrates [30%], 50G fat [28%].

I do take fish oil and a multi-vitamin. I have to get some fiber in me, yesterday was only 4G.

So my basal was suspended for 6.5-hours in total plus about 1-hour "suspended", shower and all. So that's only 17-units of insulin yesterday via basal, no bolus whatsoever.

Also, the nutritionist said 121G of carbohydrates is low but not true keto low. To my system it's keto, because I'm so used to 500G of carbohydrates daily.

My calories are low right now because I'm trying to lose weight but I'm likely going to bump them up because I'm losing about 4-6 pounds weekly so I want to acclimate up to reduce the pace a bit. I'd rather do 8-10 pounds per month, this way I reach my goal weight in only 2-months.

This is what my doctor is confused about. According to him, with a C-PEPTIDE of just under .6, I WOULD NEED to bolus for 121G of carbohydrates.

He doesn't have an answer though. He thinks it's because of the high amount of protein keeping my "system" stable, or, and he said he was not trying to scare me, this is what happens when people go into renal failure. :surprise:

But, C-PEPTIDE is from January 2016 and then October 2016. He does not think it changed, but I'll have new results soon. January it was a .56 or something and then slightly lower in October, I believe a .55.
 
#29 ·
@hftmrock

I received my A1C and C-PEPTIDE results today.

A1C is a 6.2% and my C-PEPTIDE is a 0.96.

My endocrinologist and nurse practitioner have never seen a C-PEPTIDE level increase the way mine has.

They still label me as a T-1 because of the GAD antibody levels I have and wrote me a script to have them checked again.
 
#30 ·
it sounds strange but I am very happy to know your C-PEPTIDE number is in the normal range.

it sounds like you are producing insulin on your own.

its really confusing and I don't want to guide you in the wrong direction. Type 1 is different than type 2 but it you are type 1.5 or even misdiagnosed and you are type 2, there are ways of treating diabetes better than type 1 (obviously).

Maybe a second opinion might help.
 
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