Darian,
I am going to respond to to your comments separatelyas there are important insights involved. Having said that, these are just my opinions, which have evolved over many years. By way of background, as a T1, I was well controlled for the first 15 years. My HBA1c, after they started measuring it, was typically about 6%. But my control started to deteriorate, and the HBA1c edged upwards. It peaked at 8.6% 6 years ago, and my daily insulin requirement peaked at 60 units at the same time. I realised that I was becoming increasingly insulin resistant, and that I had to start doing things differently. The main tactics I used was to build muscle through resistance exercise, and to eat low carb. I have built a fair amount of muscle and lost a similar amount of fat. I weigh much the same, but my insulin sensitivity has improved enormously. Eating low-carb has also a helped a lot, and my HBA1c is back in the 6.0-6.5% range. My total daily dose is down to about 35 units of insulin. I still have problems from time to time, but they are nothing like what they used to be. My blood sugars are relatively stable, and I have a real sense of being in control.
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Originally Posted by DCaplinger  ... I don't eat a very big breakfast. The dietician told me she wanted me to eat 3 carb choices for breakfast. I generaly get about 42 grams at breakfast, which would put me right on her target. I end up spiking about 2 hours later, however, it's usually about 6 hours after I have had breakfast, before I can really eat again, because of my job. Unfortunately, that usually leads to me going near hypo stage by 11:00 am, fully one hour before I can eat again.
My education nurse has been trying to think of snacks that I can buy, ...... |
You really shouldn't have to "feed the insulin". What do you think is making you go low before lunch - the Lantus or all that Novolog you inject before breakfast? If it is the Lantus, you need to reduce the dose and look at other options for keeping your fasting numbers in check. If it is the breakfast Novolog, you can fix it by eating a breakfast that contains very little carb and reducing the bolus accordingly. I used to have a similar problem, and I resolved it by eating a breakfast that contains hardly any carbs. It means that I don't require a big breakfast bolus, so my morning blood sugars are very stable.
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Originally Posted by DCaplinger ... my dietician wants me to consume roughly 210 grams of carbs per day. ... |
IMHO, the
last person you should be listening to is a dietician. Thery haven't got a clue. Putting an insulin resistant diabetic on a high carb diet is like advising an alcoholic that drinking alcohol will relieve their distress.
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Originally Posted by DCaplinger ... The problem is, I've gained 40 pounds since this all started. Some of that is due to my smoking cessation, however, I know some is because the insulin is doing it's job at the cellular level (at least somewhat). ... |
Feeding the insulin will make you put on more weight. So you need to adjust your insulin so you don't need to snack. In fact you should be doing what it takes to lose fat and build muscle. That is the only sustainable way to to improve insulin sensitivity.
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Originally Posted by DCaplinger .... I do understand what you mean about the possible resistance. What would be a good way to approach that? I've seen a few T1's here that also take metformin. Should I talk to my Endo about that? I'm wide open to ideas, and I'm listening. ... |
Improving your body composition by losing fat and gaining muscle will improve your insulin sensitivity, reduce your insulin requirements and improve your glycemic control. Eating low-carb also helps. Cut out all the white foods - potatoes, bread, rice, cereals, pasta and anything made with flour and or sugar. It obviously reduces your bolus requirements and basal requirements seem to decline too. The combined effect of these two tactics is dramatic. You could also try using Metformin. I found that taking 500mg before bed reduced my fasting blood sugars and enabled me to reduce my bed time basal dose (I was using NPH at the time). There are other insulin sensitising drugs (Actos and Avandia), but I would keep away from them if possible.
Exercise, diet and Metformin should do it for you. But it will require hard work and discipline. Also, don't expect too much support from doctors, dieticians and CDEs. They don't seem to get it.
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Originally Posted by DCaplinger .... Thanks for being patient with me. I have a lot of questions, .... |
Ask away ...
