One Week Off Insulin (Aug 23, 2016)

I’ve been off Insulin for a full week now.

So why am I still alive? After all, I needed 100 units a day on the average just one month ago. But here I am. Still Alive!

So did I just decide to ignore my Blood Glucose levels and am I on the edge of dying? Hardly. I’m still checking multiple times a day – mostly now in disbelief at how well my blood sugar is being regulated by my body. My high today was 124 and my low so far today is 109. I never got numbers like that before day after day on Insulin.

For dinner last night I took the kids out to Five Guys Burgers and Fries. I skipped the fries. I ate a bunch of peanuts and more importantly had my burger “bunless”. The choice to replace the bun with lettuce was a good one since it took away about 40 grams of carbs and left about 1 gram. The fat ratio was good and the jalapenos, etc didn’t add much to the carb count but they did add to the flavor.

All of that made my Blood Sugar at 103 around bedtime.

Addendum : Still taking Metformin. Not out of the T2D woods yet.

Weight Loss Numbers

Weight Loss on LC-HF+IF is a very strange thing. It goes in real spurts. Yesterday I dropped two lbs. Last week I had two days in a row where I lost five lbs each day. Most days I am about the same or down just a fraction of a lb.

I am down 14 lbs from a couple of week ago. I didn’t weigh myself at the start so I don’t know what weight I was to start with. I think I weighted 292 on the work scale (clothed of course).

Numbers/Charts (Aug 18, 2016)

I shut off my Insulin Pump 36 hours ago.

My Blood Glucose numbers have been great.

This will be my last Insulin dosage chart since I am no longer on Insulin. I am still on Metformin.

I will probably post numbers like these:

7 day average – 123
14 day average – 124
30 day average – 137

The LC-HF plus IF dieting has been going great. Easy to do. I don’t get hungry until after 2 PM which is when my blood sugar goes down to around 104 or so.

 

Freed from the Insulin Pump (August 17, 2016)

Yesterday morning I shut off my insulin pump and removed it from my body. Last night I removed the infusion set.

This afternoon my blood glucose is 114.

Life is good. Other than a cold I caught from my teenage son, that is and it will pass soon enough.

 

Status from 2016-08-14

IF was complicated yesterday which means I broke my fasting window a bit. Knew I was going over to visit family/friends but didn’t want to risk high carb food choices (and there were some but some LC choices as well) so I made a Tex-Mex casserole to bring along. Ate at 5 and got home after 10:30 so I had two beers at the very end and past the end of my window. Blood glucose was 125 at bedtime and I didn’t bolus.

Woke up this morning to a bit of a Blood Glucose high of 141. Not too bad at all considering my total Insulin usage yesterday was 12.1 Units down from 100 units day average before IF+LC-HF.

Didn’t do a single extra bolus yesterday and set the pump to only give out 8 units a day now.

What is the typical Insulin dosage for a T1D? That could help answer the question of how well my own pancreas is now producing Insulin and how much more it is being asked to do not that I am not taking as much Insulin.

According to this site (Calculating Insulin Dose).

The general calculation for the body’s daily insulin requirement is:

 Total Daily Insulin Requirement (in units of insulin)
= Weight in Pounds ÷ 4

So for me, that would be about 70 units of Insulin needed per day. They estimate half being for basal and half being for bolus. That means they are expecting to pump 35 units a day for basal. If you are doing LC-HF the bolus component could be ignored. Yet, I am thriving on 8 units a day and not perfect LC-HF. This implies to me that there’s nothing wrong with my pancreas it’s the overtaxing I’ve done to it over the years that made it not be able to keep up with the demand.

Going to keep a close eye on my Blood Glucose today. I don’t see it likely that it will skyrocket up but this big change downward might be a problem because it’s asking a lot more from my pancreas than it has done in years. Or maybe my pancreas has always been working fine but even added with Insulin the cell resistance has been so profound that neither of them are working all that well.

Pumping Insulin with IF

I have been pumping (using short term insulin) but only doing a basal. My pump has a syringe in it that only holds 300 units of Insulin. My Insulin usage rates have dropped from an average of 100 units a day down to less than 20 a day now. Last time I filled the syringe 5 days ago I took into account the lower Insulin usage and only filled up the pump syringe with 200 units. Problem is now the pump still has 80+ units in it. The infusion sites are supposed to be changed every 3-4 (at the most) days.

Still tastes in my mouth like I am in ketosis but not as much as some mornings. Probably the late night beers.

Two Weeks into IF + LCHF (From Aug 2016)

My goal was to reduce my Insulin from the pump and not mess up my blood sugars. I went on Intermittent Fasting and it’s working great. My insulin usage over the past 45 days is:

If diabetes is really a chronic irreversible disease then this should have led to some very bad Blood Glucose numbers from what I have done to my drop my Insulin levels over the last 2 weeks. I have cut my numbers from around 100 to around 25 units. The drop down has been fairly smooth.

The one pop up was my trip to the Frozen Custard shop for a pretty big frozen custard cone. I pumped a lot that day to counteract the custard. Perhaps I should have tried to leave it alone (eat the custard and not pump for it) but old habits die hard.

SO what are my Blood Glucose levels? Glad I asked.

No more erratic highs. Daily average Blood Glucose level before IF was 159. Average after is 122. Very steady numbers and nothing over 150.

So is it working? By every test I have at my hands IF is working fantastically well.

Your mileage may vary.

Status from 2016-08-13

My morning blood sugar at 6:30 AM was 115. Normally I would do a pump bolus but today I decided to skip the extra Insulin. Three hours later (after my shower) the number is 138. I also lowered my basal amounts by 0.25 units an hour a few hours ago so that can account for some of the rise. I am going to once again not bolus (give more Insulin). Perhaps my body takes a while to kick in providing insulin on its own when it has been habituated to externally provided Insulin.

Also I have noticed that after a shower my blood sugar seems to be higher. Not advocating going European or some crazy thing but we do seem to take a lot of showers in the US. I’ve noticed that the Blood sugar after a shower tends to drop faster than the Insulin I have provided would indicate that it should.

If this is still a manifestation of the Dawn Effect then even that will decrease with time.

So I waited an hour and measured again (with no bolus at all this morning). Instead of seeing a high number I was back to 113. If I had given Insulin it would have not dropped so quickly.

INSULIN IS KILLING ME!!!

End of the Day 2016-08-13

Did a couple of things today. Decided to double down on my level of Insulin drop. Lowered at first to 12 units per day and then dropped to 8 units a day. Did no boluses in spite of a couple of “higher” numbers (130’s 2 hours after my LCHF meal). Decided to remeasure a little later and the numbers were down. End of the day my number was 125 which felt pretty good considering how far down I dropped my Insulin for one meal.

Let’s see how things look in the morning.

Status Aug 12, 2016 (Reprinted)

I had some good news this morning when I stepped onto the scale. My weight had dropped another 5 lbs. 10 lbs in 2 days. Looks like a switch got thrown to get rid of water weight. Plus, it’s been hot and humid here.

My insulin use was way down, too. Two days ago my insulin use was 42.0 and yesterday my insulin use was 29.2. My waking blood sugar was up a bit at 132 and it bounced up to 140 by a couple of hours later but that’s not abnormal for me.

My meal yesterday was satisfying. In fact, I ate until I felt sick of eating. Sick to my stomach of eating.  My total calorie count was too low at 1146 cals. I tried hard to eat Lower Carb and Higher Fat but only got to (% cals from source)

Carbs 11.6%
Protein 22.6%
Fat 42.3%
Alcohol 23.5%

I had less Craft beer than the day before (2 vs 3). However I did feel the effects a lot more than the day before. I attribute this to having less carbs to flatten out the response to the beer.

 

Status from Aug 11 2016

Great start today

My weight was down 3 lbs from yesterday.

Set a New Basal Rate of .25 units per hour less.

Woke up at 5 AM to a Blood Glucose of 111. Did the bolus to get me from 111 down to 105 (just a few tenths of a unit). Took my number two hours later and it had jumped to 143. Rather than doing a 3 unit bolus I decided to do 2 unit bolus. Will be interesting to see the results I get. Wonder what would have happened if I had not done the few tenths of a unit bolus.

Yesterday’s Meal

I did a (rare for me) calorie count of my dinner last night. At 1661 calories. Did the percent of calories from various sources and got:

Carbs – 16.9%
Protein 11.31%
Fat 36.6%
Alcohol 35.2%

That’s a day of counting calories and taking into account the types of calories.

 

Mayo Advice #5 – Don’t Stop the Insulin (Repost from Aug 2016)

Here’s where they are totally right and totally wrong at the same time. From the Mayo Clinic site (Avoid weight gain while taking insulin).

Take your insulin only as directed. Don’t skip or reduce your insulin dosages to ward off weight gain. Although you might shed pounds if you take less insulin than prescribed, the risks are serious. Without enough insulin, your blood sugar level will rise — and so will your risk of diabetes complications.

I get what they are saying. If you need insulin to regulate your blood sugar and you go off it then you’ve got serious problems up to death. The thing a diabetic should be watching isn’t the amount you were prescribed. It should be the amount needed to regulate your blood sugar. No more.

My doctor started me out by telling me that I needed to take 40 units of long-lasting insulin. When that led to a high HbA1C number he said that I needed to add meal-time insulin. I wish they would not call it that. So many false things there. He told me to use the 2nd Insulin and use 8 units before every meal. The diabetic nurse told me that was wrong and she had him fix the prescription.

They got me nutritional training and told me to count carbs. Not count as in limit, but to bolus for the amount of grams of carbs in what I was eating. Good advice for high carb meals. Not great when you consider gluconeogenesis. That all got me to a decent point of glucose control but was about 60 units a day (40 of basal and 20 of “meal-time” (fast acting) Insulin. In the last 5 years I have progressed to around 100 units a day (varies by my carb intake). It’s only now that I am getting lower than when I was diagnosed.

I am using less by doing LCHF (really mostly LC) and Intermittent Fasting (IF). Yesterday I used a total of 47 units of Insulin. I will lower my basal (constant) Insulin rate tomorrow to drive my Insulin levels even lower.

 

Mayo Advice #4 – Ask the doc for more pills (Aug 2016)

Here’s the full text of this next piece of advice (Avoid weight gain while taking insulin) from the Mayo Clinic website.

Ask your doctor about other diabetes medications. Some diabetes medications that help regulate blood glucose levels — including metformin (Fortamet, Glucophage, others), exenatide (Byetta), liraglutide (Victoza) and pramlintide (Symlin) — may promote weight loss and enable you to reduce your insulin dosage. Ask your doctor if these or other medications would be appropriate as part of your diabetes treatment plan.

I like the goal – reducing Insulin dosage. When I started Insulin my doctor wanted to take me off Metaglip. Only part of that made sense. The Glipizide part of Metaglip is a Sulfonylurea which stimulates the release of more insulin from the pancreas. But we’ve already determined that too much insulin is the problem. Sulfonylurea drugs also decrease insulin resistance which they would pretty much have to do in order to help the extra insulin work.

The diabetic care nurse knew more about the drug than the doctor did. I was able to convince the doctor to prescribe Metformin which the doctor was convinced could not help since my pancreas (he said) no longer produces insulin. He clearly had the meds mixed up. But he has told me since then that as long as it is working for me (and it is) that he will keep prescribing it.

I was on Byetta (Exenatide) which was getting decent results when the diabetic nurse recommended I go to the “gold standard” of care which is insulin with the pump. The mechanism of Byetta is (wikipedia source).

  1. Exenatide augments pancreas response
  2. Exenatide also suppresses pancreatic release of glucagon in response to eating…
  3. Exenatide helps slow down gastric emptying
  4. Exenatide has a subtle yet prolonged effect to reduce appetite…
  5. Exenatide reduces liver fat content

Byetta has some side effects that bother people enough to get them to stop taking it. It’s a shot, like Insulin, so there’s that inconvenience.

I have no experience with the other classes of drugs but if the drug’s net effect is to increase the level of insulin in your blood then it’s bad. Good that it is reducing your blood sugar. Bad that the insulin is what does the damage.

From what I can tell, Metformin is one of the best and it only gets you half way to normal. So yes, ask your doctor about these drugs but focus on the question of whether or not the drug increases the insulin level in your blood. If so, be skeptical.