Can you eat anything and cover with insulin?

[princesslinda]

I have a very non-compliant T2 co-worker who has been diabetic x 8 years. She's right now on Byetta, metformin and Glipizide....A1C around 8. Doc has told her the next step is insulin, which she has fought going on for about a year now. She regularly drinks full-sugar Cokes and eats pretty much anything she wants. FBS usually runs in the upper 200's, post meals are generally averaging 160...though sometimes if she eats low carb, she'll crash to 70 and feel horrible (would probably be more w/o the Glipizide).

She's decided that at her next visit, she'll just do it, as she doesn't feel she has the willpower to deny herself the food and drink she loves.

My question: If she gets on insulin and still continues to eat as she wants of high-carb bad foods, can she take enough insulin to cover things and not have complications?

She's about 300 lbs, and I assume if she has to take lots of insulin she'll gain weight...but will anything else happen to her? She thinks insulin will allow her freedom to eat "like everyone else," without suffering consequences. I'm sure it can't be that easy....and i'm concerned about her.

[Cluck]

Perhaps this poor woman needs a therapist as much as insulin therapy?

It sounds like she is in denial and/or unaware of the consequences of her weight and those kinds of BG readings.

In THEORY insulin allows someone to eat whatever they want (my diabetic nutritionist told me this) but that is really pure bullpoo. Limiting carbs, means injecting less insulin and more stable BG.

[Subby]

I find the idea very unlikely. I am a type 1 with resistance, so perhaps in some ways in a similar boat. No way could insulin cover a normal soft drink. It's slow especially when you are resistant. For me rapid insulin takes up to 1 hour to work. Soft drink will spike me in 5 minutes. Not really a competition is it? How about planning for it... well, the profiles are still all wrong, even if I took insulin ahead of time say near an hour (prebolused) exactly right.

Then, even if she thinks "ok I'm spiked, but I can use insulin to get under control easily", well, that doesn't work so well for me (and others). Once you are spiked badly it can take hours and hours to get back down. Then you might go too low...

If you run high all the time this next problem may not be such an issue. But, if you run high all the time, you are definitely courting complication disaster.

So assuming you are shooting for good control, if the insulin isn't matched correctly, constantly, you may find yourself hypoing, which unless dealt with with extreme discipline, will likely lead to a liver dump and extreme rebound, adding in any carbs you eat as you feel like you need it... rollercoaster doesn't start to describe the effect of unchecked carb eating for me, or probably most resistant insulin users.

Now of course it should be YMMV because everyone's M does V. Let's just put in a word for t1s who eat md or high carb and get low 5s for A1cs. They are around (although I don't think softdrink would factor in). There is huge range between people and their success matching a certain amount of carbs, especially counting t1s with little to no resistance. But I think the chances are very slim for this person to get the hoped for reality.

[princesslinda]

Amazing at how many T2s can live in denial....I watch her eat donuts with Coke and cringe. She'll check her BS, if it's too high take 1/2 a glipizide then drop 3-4 hrs later and have to eat something else.

I thought perhaps the thought of insulin would frighten her...but she wants to eat carbs so bad, she'll do whatever it takes.

Do those on insulin ever reach a point when their blood sugars aren't able to be covered by it? Other than weight gain, what happens if one is taking a large dose of insulin. I understand one can go low if too much is taken...but with a ton of carbs, would lows be an issue? Might be in a T2 who still has some pancreatic function.

Sad to watch a train wreck and be powerless to prevent it.

[princesslinda]

Thanks for your explanation Subby...I couldn't imagine it working as she thinks it will....otherwise we'd all want to be on insulin so as not to have BS issues.

She may be in worse shape on insulin than she is now.

I've never seen anyone T1 or T2 here on the forum actually admit to drinking "real" sodas....that's why it amazes me when my diabetic co-workers (T2) do just that.

[Subby]

Do those on insulin ever reach a point when their blood sugars aren't able to be covered by it? Other than weight gain, what happens if one is taking a large dose of insulin. I understand one can go low if too much is taken...but with a ton of carbs, would lows be an issue? Might be in a T2 who still has some pancreatic function.

Sad to watch a train wreck and be powerless to prevent it.

With a ton of carbs, for many (most?) people it becomes virtually impossible to dose correctly. So the overwhelming odds are you will either be skating high or shooting for the ground. Dosaging is (should be) a balancing act in every single circumstance, no exceptions.There is no situation that insulin will cease to be effective in bringing BG down at some dose: finding an exact or ultimately stabilizing dose becomes the problem, and by a problem I mean a cryptic crossword you have no hope of solving, in many volatile-carb situations.

[Subby]

Thanks for your explanation Subby...I couldn't imagine it working as she thinks it will....otherwise we'd all want to be on insulin so as not to have BS issues.

She may be in worse shape on insulin than she is now.

I've never seen anyone T1 or T2 here on the forum actually admit to drinking "real" sodas....that's why it amazes me when my diabetic co-workers (T2) do just that.

Well, the situation changes a lot if she commits to cutting out the worse carbs, if she is vigilant, tests a lot, adapts, etc. The more she does pretty much like what a t2 does in removing spiking foods (but with the added question of insulin dosage involved), the better stability she can find and insulin might be great. But chances are low with soda and donuts and denial.

[sarahspins]

Oh my, I am laughing so hard.... she's obviously in poor control.. she's already morbidly obese, and convinced that insulin is going to magically make everything better.

How hilarious! People sure do have some silly ideas!

Oh, and I should add, as a T1 I do eat pretty much whatever I want, and cover it with insulin, but within reason. Drinking a regular coke, is absolutely not within reason! A lot of us T1's work VERY hard to be able to achieve tight control on insulin... and be able to do that without gaining TONS of weight.

[GeishaGirl]

Insulin does absolutely NOT mean you can eat whatever you want. Like Subby, I'm also deep in IR. I'm technically only "overweight" according to charts (hovering around 200lbs, but tall) so I can only imagine how resistant she is at 300!

Here are the things I really can't eat because they shoot me up so high so fast that insulin just can't keep up:
Skittles
English muffins
normal pasta (Dreamfields is okay)
any kind of pure pure candy, with little fat
large amounts of chocolate/ice cream/etc
Potatoes
More than 1/2 cup of rice -- and that's brown rice, mind you, white rice is a no-no.

Bring her THAT list and see if she things insulin is easier. Frankly, I just think I'm double-screwed -- got the IR of a type 2, but have to try to dose and correct myself, which is unpredictable.

Also keep in mind I still have "mediocre" control -- a1cs tend to be in the low 7s. I'm still discovering the foods that destroy me. There are probably plenty more.

[princesslinda]

I hope that her doc will give her a realistic idea of how it will be with insulin....but I doubt it will make any difference. She's on a destructive course, totally in denial about her diabetes. She's only 35 years old.

Thanks for the info guys. I can see how much work you allhave to do on a daily basis to get good results and maintain good control...I guess it is laughable (and a bit sad) for someone to think insulin will be their saving grace w/o a lot of hard work and discipline.

[acstokes]

This is a sad situation, but I believe insulin would be a better choice than oral meds for her. Insulin dosage can be more accurately correlated with carb intake to significantly reduce and stabalize BG and A1c.

She would need a combination of a slow release basal insulin supplemented with bolusing of fast acting insulin---probably 4-5 injections per day. There would be a learning curve for her and a period of dosage calibration both which require self discipline and will power. If she has enough self disipline, an insulin pump would be ideal because accuarate boluses can be self-administered at the exact time a high carb snack is eaten, the insulin immediately goes to work, and there's no need for daily injections.

There may be long term implications of high insulin usage, such as insulin resistance---I don't know---her physician would need to decide that.

While my opinion is that insulin would be better choice, from what you say about her she may not have the self discipline nor will power to stick to any kind of insulin regimen; however, one things certain, the way she's behaving she will eventually wind up on insulin whether she wants to or not. I believe better sooner than later.

Fred

Type 1.5
Medtronic MiniMed 722 user

[jenb]

I'm very sad for your friend. No matter what, she is going to have to accept that lifestyle changes are the only way to good health. Insulin is no panacea, and if she is not disciplined now, she will not have the discipline to be successful with her insulin therapy.

I think Cluck mentioned that your friend might seek some therapy; I agree. She needs to have someone help her come to terms with her disease. Then she should find a CDE or read some books to understand the changes she'll need to make in her diet and exercise regimen...

Jen

[ShottleBop]

According to Dr. Bernstein, high doses of insulin themselves can have deleterious effects on the cardiovascular system.

As Subby has already noted, using high doses of insulin to control blood sugar levels is darn near impossible: Think again of traffic. You’re driving down the road and your car drifts slightly toward the median. To bring it back into line, you make a slight adjustment of the steering wheel. No problem. But yank the steering wheel and it could carry you into another lane, or could send you careening off the road.

When you inject insulin, not all of it reaches your bloodstream. Research has shown that there’s a level of uncertainty as to just how much absorption of insulin actually takes place. The more insulin you use, the greater the level of uncertainty.

When you inject insulin, you’re putting beneath your skin a substance that isn’t, according to your immune system’s way of seeing things, supposed to be there. So a portion of it will be destroyed as a foreign substance before it can reach the bloodstream. The amount that the body can destroy depends on several factors. First is how big a dose you inject. The bigger the dose, the more inflammation and irritation you cause, and the more of a “red flag” you send up to your immune system. Other factors include the depth, speed, and location of your injection.

Your injections will naturally vary from one time to the next. Even the most fastidious person will unconsciously alter minor things in the injection process from day to day. So the amount of insulin that gets into your bloodstream is always going to have some variability. The bigger the dose, the bigger the variation.

A number of years ago, researchers at the University of Minnesota demonstrated that if you inject about 20 units of insulin into your arm, you’ll get on average a 39 percent variation in the amount that makes it into the bloodstream from one day to the next. They found that abdominal injections had only a 29 percent average variation, and so recommended that we use only abdominal injections. On paper that seems fine, but in practice the effects on blood sugar are still intolerable. Say you do inject 20 units of insulin at one time. Each unit lowers the blood sugar of a typical 150-pound adult by 40 mg/dl. A 29 percent variability will create a 7-unit discrepancy in your 20-unit injection, which means a 280 mg/dl blood sugar uncertainty (40 mg/dl x 7 units). The result is totally haphazard blood sugars and complete unpredictability, just by virtue of the varying amounts of insulin absorbed.

[soso]

I also feel that it is very sad for this poor young woman.

I am def not IR in fact I have more problems because of my sensitivity (as in with exercise) that I do with sustained highs, but even so I can say emphatically that matching high doses of insulin with high doses of carbs is the highway to he11... It doesn't even work for me with moderately high carb items and believe me I've tried. She is going to ride the rollercoaster big time, or best case scenario be high, but not quite as high as she could be..
I think the best thing you can do for her is persuade her to give a dose that blunts the worst of it, but not give correction doses for the first few months..
Sorry you have to witness that.. I know it can be distressing...

[notme]

Your friend, Linda, will find herself careening on a road of chasing highs and eating through lows. The difficult part of poor control is poor control. When my blood sugar hits and unreasonable high, it is much harder to get those numbers down. I find myself injecting far more insulin than I would ever normally take just to get to a semi normal (yet high) number. Then within seconds you find yourself bottomed out in panicked low. The first inclination you have when you are low is to eat and to eat too much. It has taken me years to figure out how to eat just enough to bring my blood sugar to where it needs to be without over eating and once again finding yourself at the very high end of the scale. There is also a not so funny side note that you rationalize that you CAN eat that food because you are low.

This constant rollercoaster will lead to weight gain. I don't think anyone could have explained all of this to me. Your friend will find herself in a frustrating battle for her life if she gains more and more weight and her numbers are no better. Starting off at 300 pounds would be difficult enough without the battle of learning how to use insulin correctly.

[Beckernj]

I can eat anything as a type 1 and cover it. My doc says the only reason I can is because I am 19 and weigh 145lbs and am 6ft 2 lol. sounds like your co-worker needs some help with her denial of proper treatment tho.

[ant hill]

I have a very non-compliant T2 co-worker who has been diabetic x 8 years. She's right now on Byetta, metformin and Glipizide....A1C around 8. Doc has told her the next step is insulin, which she has fought going on for about a year now. She regularly drinks full-sugar Cokes and eats pretty much anything she wants. FBS usually runs in the upper 200's, post meals are generally averaging 160...though sometimes if she eats low carb, she'll crash to 70 and feel horrible (would probably be more w/o the Glipizide).
Hello Linda :), There is one thing that's helping to eat and that is she has a working pancreas but then if she plans to take on insulin then you have to watch her like the eagle circling the plain as insulin don't have a off switch after it's injected. ;)

She's decided that at her next visit, she'll just do it, as she doesn't feel she has the willpower to deny herself the food and drink she loves.
Oh yeah right!, I would wonder how long that would last

My question: If she gets on insulin and still continues to eat as she wants of high-carb bad foods, can she take enough insulin to cover things and not have complications?
There is one thing that insulin will do and that's makes her worry what to do, And of course EAT!! Also the fat that she has already will slow the insulin to react like someone here said.

She's about 300 lbs, and I assume if she has to take lots of insulin she'll gain weight...but will anything else happen to her? She thinks insulin will allow her freedom to eat "like everyone else," without suffering consequences. I'm sure it can't be that easy....and i'm concerned about her.
Has she know about complications Linda? dose she wares glasses? as that is just one of the causes of the big D.

[zoelula]

I can imagine it must be hard for Type 1's that are young and in good shape to NOT thank they can eat anything and cover it with insulin. Personally, it only took one severe hypo to put a healthy fear in me, so that I am unwilling to take large doses of insulin. It's way too easy to misjudge and take too much or too little to cover the carbs. In addition that's called "feeding the insulin" and leads eventually to insulin resistance which as many can attest makes managing diabetes that much harder.

[mazea]

I'm going to go against the grain here and say it is ok to what you like and cover it with insulin if it doesn't spike you. I find I can eat up to 8 servings of carbs without spiking more than 10mmol and be within 1 mmol of my target at 2 hours if I mix some slow carbs vegies and meat or have a lot of fat in my meal for instance a pie chips and in my flat white coffee (1 serving sugar) I usually spike to about 9 mmol. If however I have sugar without fat, I spike to about 14. So I don't have sugar without fat ever. So mixing it up a bit helps you change how quickly your overall carbs are injested.

For eg, I had what I wanted yesterday by having insulin and dividing my meal over 2 hours. I had chicken skewer kebab and vegies and potatoes which for me were low GI (I can eat potatoes but rice is high GI for me) at 0 minutes first and then (2 servings) apple pie plus 2 servings of full cream icecream (contained about 2 servings of sugar) at 40 minutes and only spiked to about 9mmol or 20 minutes. Dividing your meal in 2 is another way to eat what you want as it allows the insulin to catch up to deal with the sugar.

I occasionally eat a donut, I had one in the whole of last month, but only donut King ones. I find donut king donuts have a lot less sugar than a piece of cake but there is no way I'd be eating Krispy Cremes which contain more sugar than a small packet of sugar. I wouldn't eat low fat high sugar things like diet coke though as I suspect my blood sugar would spike to over 15mmol ( I have never tried it)

Macaroni is low GI because of it's shape so we often eat pasta by putting in macaroni rather than fettucini.

Has your friend heard of coke zero or lemonade or creaming soda zero? Maybe the donut has a lot of fat which slows the rate the sugar is distributed in the blood stream. But I don't think it is wise to have THAT much sugar at 0 minutes if you are diabetic.

[Jae]

YIKES!
Want to send her to me on every 1st and 3rd wednesday of the month?

My church has a free diabetic clinic on those nights. It is a learning curve! But oddly enough if you can visit a place like that with her it would be eye opening at best!

When you see a 34 year old Mother who is losing her foot, or you see a 9 year who is going blind.

I see a lot in here about the types 1 & 2 but they both have horrid complications. They both struggle with food. There is not a "one size fits all" diet and not a "one size fits most" one either. Everything effects everyone different from stress, weight, carbs.

Personally I was within 25 pounds of where my doctor wanted me to be when I was diagnosed so it does not take a lot of weight to push you into being "D"

All I can say is "God Bless You" and her both
Jae

[art]

As has been said
"you can't fix stupid"

Art

[Subby]

I'm going to go against the grain here and say it is ok to what you like and cover it with insulin if it doesn't spike you.

I really like seeing a range of replies that seems to reflect the range of experience people get with type 1, insulin therapy and carbs. I believe this range is worth being visible at all times. I think absolutism will bite someone in the bum at some stage, if it becomes the accepted norm. Hence why I'm often a bit of a pain myself in pointing out there are varied experiences in quite a number of things D related (and life, for that matter).

Thanks for posting your experiences in detail.

[foxl]

I have a T2 (PCOS is her dx, "officially," but she runs ca. 200 fasting most of the time) coworker, who lives on sugared cereal, rice, ramen noodles, and SUGAR-sweetened sodas.

She pays lip-service to following a low-carb diet and professes to admire me in my efforts. I have never seen her test. She is around 30 years old.

Last week, she had two molars extracted. And was asking about anesthesia for a cleaning.

She is a kind person, and a good worker. I worry for her very life.

[Morris "Type 1"]

While I am new to this whole diabetic thing, some things have been made abundantly clear by 'evidence' be it empirical or anecdotal is almost of no difference to me because I am following the advice offered to me here on DF.. "test, test, test". This testing has given me the chance to experiment with what I eat and to see how it effects me.

What have I learned?

37.5g of breakfast carbohydrates, called weetabix shoots me sky high in blood glucose.

I am on insulin, I have rapid acting as well as the slow release stuff and there is no way i can risk trying to match those carb highs.

At first I was feeding my insulin, sticking to a dosage told to me by the hospital and that was a bit of a mistake.. Why?

Because I was getting highs and lows which were somewhat uncontrollable. If I added insulin I needed to eat again later to compensate and not to mention the fear of having a hypo, which was entering my dreams and messing up my daily life a bit as I worried about taking walks etc. I love to walk for miles, I was finding that my sugar was dropping below what I was told to be a safe reading.. 6.0. I was reaching 3.5, yet not really feeling an ill effect which in a way worried me more.

So this brings me to the point of my post in this thread now, I am now on day three of low carbing and I haven't needed my novorapid. At the moment I believe that I require my lantus injection in the evening, 16 units, because I am hovering consistently around 6.0 mmol/l and soon I want to lower that further to around 5.0.

I peeked once to 7.4 a couple of days ago during this, besides that one high I have found that I rarely go over 6.4 at the moment.

In fact, later today I will upload a graph of my sugars and try to explain what I have changed a long the way.. I have only been keeping great BG readings because of the meter's memory.

I used to eat a lot of bread, 2 toast for breakfast, 2 bread for a sandwich at lunch and occasionally have bread with dinner. Also during lunch I would have salad, oranges, nuts, potatochips, onions.. The plate would be too full also. Dinner would too frequently consist of mashed potato, pasta, rice, pastry, extra sauces such as sweet chilli - in excessive amounts..

Now I am eatting zero bread or 'bad items' such as white rice or chocolate, I don't even miss it. Do you know why I don't miss it? I would miss my feet more, I like being able to see, I especially don't want a heart-attack.. Thank you very much.

Some research information I discovered yesterday through subby's recommendation for material to read explained that a blood glucose level of a healthy non-diabetic person is around 4.7mmol/l and increases above that severely increase the risk of heart attacks and organ failures. Apparently the 6.0mmol/l that I was told by my doctor as being safe, is in fact inaccurate and likely to risk my life. So, in time I want to reduce this reading further, but for now, just a few weeks after diagnosis.. I am comfortable with a stable 6 with no sharp spikes or lows.

Best of luck trying to change her ways, although you may find it of extreme difficulty as the more you push the larger her resistance to your advice will be. When you are met with that large resistence, change your tactic abruptly, perhaps buy her some sugar laden food and tell her to enjoy it, don't worry about the consequences.. She will be shocked, if you notice her reaction to be glazed over and sort of stunned.. Say to her, "Your health is more important than this", and walk away.

When we do things that contradict the expectation, the well rehersed and pre-programmed response that would automatically be expressed becomes halted. She won't know how to react to you in that instance, it is highly likely what you say following that point for the next few seconds will become of profound interest to her.

Oh and also, from what I was reading yesterday also spoke about how our body anticipates a set amount of carbs based on the meal (or maybe meals) before, so if you suddenly try to low carb you will drop very low because if the body is able to create any insulin it will at the quantity that would have been suitable for the high carbs before it.

Best of luck

[Morris "Type 1"]

Just to add, since I can't edit my post now, that it seems to me a 70 isn't desperately low based on how I feel at around 63 (3.5mmol/l).. Except her body is used to super high numbers which I have found personally when I was running high that even lower-yet-still-high numbers were making me feel unwell.. It has taken time to get my numbers down but I am now at a place where before I felt unwell, now with those so-called good numbers I feel incredible. So will she, in due course, if she stops being emotional and lazy about it.

[DeusXM]

One thing I would say is that the 'insulin experience' differs very greatly between T1s and T2s. I would agree with mazea in that generally, a T1 can eat what they like provided they cover with insulin - but of course there are issues as to whether insulin can cover things sufficiently.

With T2 generally there is an added issue of insulin resistance or something else that means the insulin isn't doing its job. This introduces a significant variable into the equation. Based on that, I would say that a T2 simply cannot use insulin in quite the same way a T1 would.

What I don't get though is why she would unnecessarily challenge her own body by drinking regular soft drinks. It doesn't even make sense when there is a hassle-free alternative right there in front of you.

Everyone knows I have my own opinions on carb intake but I certainly believe that when you have a choice of two essentially identical things to eat or drink, and one has fewer carbs, you pick the lower carb one every time because it's just easier.

[foxl]

I would also say, for the SHORT term, maybe there is not a consequent spike if you cover food with more insulin. Maybe in the short term there is not weight gain.

But in the long term, there probably are consequences. From somewhat higher A1c's. From having a more insulin in your system. From the higher calories. Just guessing and from reading.

[DanG]

I've never seen anyone T1 or T2 here on the forum actually admit to drinking "real" sodas.

Me!!
Me!!

I don't drink diet soda. When I drink soda, it is real soda.
Very little real soda, but it sure ain't-a-gonna be diet soda.
Diet soda is unsatisfactory for any sugar crave, whereas, a bit of real soda will satisfy the urge.

Plus, diet soda is a vile substance. I have no idea why or how the multimillion dollar multinational industry makes it. It is purely a vile taste. It is pure vile non-food. My body would die if all I ate was diet sweetened food.

There - I am type 1, and I admit to drinking "real" soda.

[Subby]

Me!!
Me!!

I don't drink diet soda. When I drink soda, it is real soda.
Very little real soda, but it sure ain't-a-gonna be diet soda.
Diet soda is unsatisfactory for any sugar crave, whereas, a bit of real soda will satisfy the urge.


Sugar cravings? Why do you get them, is the question I am wondering? I don't, if I avoid excessive sugar, other carbs that spike me badly or create carb cravings, and high BG levels.

[DanG]

Sugar cravings? Why do you get them, is the question I am wondering?

It might be more mental than physical, really.
I mean - an occasional donut is just... tasty.
An occasional soda is just... tasty.
A diet soda is merely vile... never tasty.
The natural food dudes like Rodale, etc have always said that sugar is addictive, hence, the crave. Proven science? - I doubt it. Practically speaking? - I think so.

I don't really ever have a crave, but it is a desire, so I eat a bit, and cover with a bit of insulin or less food at the next meal - to cover for the eating.

[Subby]

You chose the word, not me. I think you are very lucky if you are in a position that you can doubt that sugar is addictive.

Or, maybe that is unlucky. The knowledge of addiction or cravings is one heck of a motivator to really avoid foods that spike you unacceptably...

[Morris "Type 1"]

*Drinking a 'sugar-free' pepsi-max right now, lalala*

*had a sugar-free redbull with dinner*

*had a tastey steak for dinner*

I hate how sugar makes me feel.

[Subby]

I know what you mean. I had normal soft drink (soda) a few weeks ago as a hypo fix, overdoing it as I was unfamiliar with it, and it really was a horrible sensation it in particular gave me as I spiked. Although I'm ok with small amounts of glucose powder, juice or the like, for hypo fixes.

With those drinks, like pepsi max and red bull, here's something else to keep an eye on... the caffeine and other stimulants. The hit or buzz from caffeine is a release of adrenalin, and something that adrenalin does is trigger a release of sugar from your liver into your bloodstream. People's mileage varies as to whether this is a big problem, a little problem, or not. Like most things D related. It may not affect you but if you get some unexplained trends after those drinks, it's something more to think about.

[Morris "Type 1"]

oooo thats good to know!!!

Thank you, i will be monitoring that!

[mazea]

I really like seeing a range of replies that seems to reflect the range of experience people get with type 1, insulin therapy and carbs. I believe this range is worth being visible at all times. I think absolutism will bite someone in the bum at some stage, if it becomes the accepted norm. Hence why I'm often a bit of a pain myself in pointing out there are varied experiences in quite a number of things D related (and life, for that matter). Your welcome subby.
I think diabetes is like clothes sizes. There really isn't a one fit for all method of treating diabetes. Everybody finds the best way to manage their unique blood sugar levels, food responses and basal requirements. Most people manage their diabetes really well. And occasionally some people don't care- like the lady the diabetes educator told me about at my first appointment. The educator had a diabetic patient didn't take care of her diabetes. When the patient was at home, she ate chocolate and sugar all day. The educator came to her place once and the patient was sitting in a wheelchair with both feet amputated still eating a whole sheet of chocolate. I know a t2 diabetic with one foot amputated, and a type 1 who had kidney failure and a transplant so due care about diabetes is needed I think.

[DanG]

The educator came to her place once and the patient was sitting in a wheelchair with both feet amputated still eating a whole sheet of chocolate. I know a t2 diabetic with one foot amputated, and a type 1 who had kidney failure and a transplant so due care about diabetes is needed I think.

I agree that due care about diabetes is needed.
What is interesting is - how did some of us loooong ago attain that due care learning? The doctor told me I would know more about the diabetes than he would. Hence, I seldom visited a doctor - why did I need a doctor, as I was told it was mine to deal with - so I dealt with it, no internet, no email in 1974.

You are speaking about diabetes educator, etc - as an adult 35 years ago when I started insulin, I was told - here is the insulin, go use it. I don't think I ever attended a class. I was told that diabetics have short life span and can have problems. Not so far - I guess something is being done correctly - like no diet sweeteners, eat mostly whole foods, try to limit eating processed foods. I could do more exercising, but am not thoroughly sedentary. Plus, I'm thankful for what this life is and realize I am probably past my expectancy - both feet and both eyes are intact, and, all of our kids are adults. What else is there?

[zoelula]

Also, Type 1's as well as Type 2's can develop IR.

[shiftzor]

Your welcome subby.
I think diabetes is like clothes sizes. There really isn't a one fit for all method of treating diabetes. Everybody finds the best way to manage their unique blood sugar levels, food responses and basal requirements. Most people manage their diabetes really well. And occasionally some people don't care- like the lady the diabetes educator told me about at my first appointment.


Actually I fear that most people don't look after themselves as diabetics, do not forget that people on this forum are the minority not the majority of diabetics.

Bolus insulin's such as Novorapid try to mimic phase 2 release of Insulin by the pancreas. In a type 2 who has at least some remaining pancreas activity injecting insulin can help to prolong it's life. You could then argue that a type 2 could eat higher GI foods than a type 1 because they have a pancreas as backup however you would be wrong because the insulin resistance will make the spikes higher and the BG harder to control.

Answer to the original question is NO! It doesn't matter who you are or what you do, believing that a phase 2 release can match any amount of carbs or any type of carb you consume would be wrong.

It sounds like someone looking for the easy way out, I really hope that one day there is a magic cure but sadly right now it doesn't exist.

[LancetChick]

Sounds like this woman's problems could be better handled by someone who counsels morbidly obese people rather than fellow diabetics. Whether she can handle her carb load with insulin or not, she's eating too much junk!

I'm a high carb/high insulin bolus type 1 who finds that blood sugar management is much easier with a high carb load (which gives me no blood sugar spike at all if I dose correctly) than a low carb load (which will almost always give me a small spike). The first time I saw Dr. Bernstein spew his dogma about not being able to control blood sugar using high volumes of insulin and carbs I knew I could not trust another word he said, because he was just dead wrong. Not for everyone, mind you, but for me. It was like hearing someone lecture about how eating too much sugar causes type 1 diabetes, it was that ridiculous.

Having said that, however, I need to explain that while I can, and occasionally do, have such things as banana splits and lunches consisting entirely of chocolate, for the most part I eat healthy whole grains, vegetables, lean meats and unrefined products. I could get away with drinking regular sodas if I did so with a big meal, but I have never liked the heavy, syrupy taste of regular sodas, so I never drink them.

From my point of view, this woman's problem is primarily her choice of carbs rather than her overall carb load, which would certainly be helped with supplemental insulin. If she's like most people, then her overall carb load is an issue as well, but I just see this as a common addiction/bad habit that is difficult to break without help. Donuts are easy, and anything that requires preparation is a drag in comparison. Bad habits are tough to break, so I hope one day she opens her eyes and seeks help. Until then, it probably doesn't matter what you say.

[Spock]

Then what would be an ok amount of carbs per meal? (assuming 10 carbs per 1 unit of insulin)

[dandy83]

I'm with Spock - how much is too much to bolus or to think you can cover?

Also, why are spikes so bad if they come down? I'm stilll pretty new, and I think I'm getting decent control - withthe exception of my AM routine: I regularly have spikes around 180 (+ or - 30) 1 hour after breakfast because I eat a nice high-carb/high fiber/high protein (hellloooo KASHI!) breakfast before I go to the gym. Is it so bad to spike that high if it is always back down to the 60-90 range another hour later? I'm hesitant to eat a smaller breakfast because a) I'm hungry! and b) I know I'm going to the gym and that the spike will last for no longer than 1 hour. and c) this spike doesn't seem to cause rollercoaster other people are talking about. I'm generally set for the rest of the day in a nice range.

So, how much is too much carb content in one meal?
And how bad are spikes? Are short high ones very high spikes (how high is very high?) worse than longer, moderately high spikes?

[Subby]

I'm with Spock - how much is too much to bolus or to think you can cover?


The amount that you can cover well. It varies, sometimes wildly, between people and how they tolerate carbs and how effective insulin therapy is for their body.

As far as the question posed at the start of this thread, that's unlikely to be sucking on softdrink and eating donuts and the like through day, and being one of those disposed with problems with tolerating carbs to boot (a type 2 with significant insulin resistance).


Also, why are spikes so bad if they come down? I'm stilll pretty new, and I think I'm getting decent control - withthe exception of my AM routine: I regularly have spikes around 180 (+ or - 30) 1 hour after breakfast because I eat a nice high-carb/high fiber/high protein (hellloooo KASHI!) breakfast before I go to the gym. Is it so bad to spike that high if it is always back down to the 60-90 range another hour later? I'm hesitant to eat a smaller breakfast because a) I'm hungry! and b) I know I'm going to the gym and that the spike will last for no longer than 1 hour. and c) this spike doesn't seem to cause rollercoaster other people are talking about. I'm generally set for the rest of the day in a nice range.


It's worth contrasting what you describe - a far cry in both diet and approach from the subject of the thread.

.I watch her eat donuts with Coke and cringe. She'll check her BS, if it's too high take 1/2 a glipizide then drop 3-4 hrs later and have to eat something else.

There is so much range in these questions of diet, BG ranges, insulin or med use, it's extremely open. While it's pretty straightforward to see that this lady has an unfortunate attitude, or lack of understanding, about control, and what sounds like an atrocious diet, you are obviously controlling your diabetes with vigilance and choices. As for the spike, you will need to make up your own mind. I wouldn't be overly concerned myself, if you do get this rock steady control you allude to afterwards, although I would probably be trying to do something about it anyway. Whatever the spike, it's good to avoid.


So, how much is too much carb content in one meal?
And how bad are spikes? Are short high ones very high spikes (how high is very high?) worse than longer, moderately high spikes?

For "how many carbs" see my first sentence.

I have not seen anything that shows that short larger spikes are worse than longer ones. There is a general very vague principle that it's staying elevated that does the worst damage. That said, non-diabetics don't spike above 120 or so, whatever they eat. And they are not the ones dropping off with diabetic complications. In the general aim of modifying what we can to try and replicate normal blood sugars, reducing spikes is part of it. But it always comes down to individual choice as to what is acceptable or worth aiming for, or not.