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knarfny 03-31-2017 10:37

Confused...
 
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:

hftmrock 03-31-2017 17:38

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


knarfny 03-31-2017 19:25

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.

Quote:

Originally Posted by hftmrock (Post 1205113)
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?featur...&v=da1vvigy5tQ


VeeJay 03-31-2017 20:53

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.

knarfny 04-08-2017 10:31

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.


Quote:

Originally Posted by VeeJay (Post 1205177)
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.


knarfny 04-08-2017 10:45

Should this matter, I am currently trying to stick with 50%P, 30%F, 20%C. Some days I am 40%P, 35%F, 25%C. Trying to consume about 1G protein for every pound of body weight but having a hard time reaching 200G daily.

hftmrock 04-08-2017 15:07

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

hftmrock 04-08-2017 15:09

Quote:

Originally Posted by knarfny (Post 1206569)
Should this matter, I am currently trying to stick with 50%P, 30%F, 20%C. Some days I am 40%P, 35%F, 25%C. Trying to consume about 1G protein for every pound of body weight but having a hard time reaching 200G daily.

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:

hftmrock 04-08-2017 15:31

please watch this regarding ketones and ketosis


knarfny 04-08-2017 18:18

I have no problem adding fat, but, I don't just want to lose weight, I want to build muscle as well.

How is that possible with so little protein?

The general rule is 1G of protein per pound of body weight, or, up to 1.5G for "cutting" and "losing" fat.


Quote:

Originally Posted by hftmrock (Post 1206585)
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:



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