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Injecto

What about not taking insulin

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Go with me on this train of thought.

 

What if you woke up one morning, had perfect BGs, and then just decided to stop taking insulin AND stop eating. That way your BGs, in theory, should not go up or down. BGs won't go up because you don't eat and take in extra carbs. BGs won't go down because without insulin your cells can't get the glucose in the blood.

 

NOW, what would happen? I would assume, from personal experience from when I was dxd, your body would start using fat as energy (and thus burning fat = weight loss). How does this "Energy" get used? If your cells require insulin to feed them and keep them running properly, then how can you stay alive (at least temporarily) with just the energy from burned fat (as happens within the first few weeks before getting dxd as a Type 1)?

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Go with me on this train of thought.

 

What if you woke up one morning, had perfect BGs, and then just decided to stop taking insulin AND stop eating. That way your BGs, in theory, should not go up or down. BGs won't go up because you don't eat and take in extra carbs.

 

If only! What about basal reqs? Don't you have any? I'd be high in about 2 hours.

 

NOW, what would happen? I would assume, from personal experience from when I was dxd, your body would start using fat as energy (and thus burning fat = weight loss). How does this "Energy" get used? If your cells require insulin to feed them and keep them running properly, then how can you stay alive (at least temporarily) with just the energy from burned fat (as happens within the first few weeks before getting dxd as a Type 1)?

 

I'm trying to follow but having trouble! Here I go:

 

1. in the fictional, impossible no up no down scenario while not eating food, you would of course starve to death. But really, basal requirements (hormones, cortisol, adrenaline, liver releases, etc etc) would most likely be sending you to diabetic ketoacidosis. If this somehow didn't happen, normal ketosis would occur, I suppose, or whatever normally happens to people's bodies as they starve to death. Either way, it's fair to say that death by starvation is what would happen.

 

2. Is the question really "how does the process of ketoacidosis keep us functioning?" Someone might be able to answer that one. After all that typing, I don't really have a good answer to that! oh well. It's the journey that counts I suppose.

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Your liver would continue to dump glucose steadily into your bloodstream, elevating your BG. Meanwhile, your muscles wouldn't be able to get any energy, given that glucose wouldn't be able enter them. So you'd start digesting your own tissue, enter DKA and be dead within a week.

 

But of course, insulin is eeeeeeeeeevil because it makes you fat. Allegedly. :rolleyes:

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I believe that you could live off your your own fat reserve for a while... burning ketones instead of glucose for energy. You may even be able to survive on a low-carbohydrate diet as was used prior to the discovery on insulin.

 

I have been trying to find out more about this dietary treatment of Type 1, in particular; how well, and for how long could a person live on it.

 

I have found this interesting article but I'm not sure I want to pay good money to read it:

Dietary Treatment of Diabetes Mellitus in the Pre-Insulin Era (1914-1922)...

Before the discovery of insulin, one of the most common dietary treatments of diabetes mellitus was a high-fat, low-carbohydrate diet. A review of Frederick M. Allen's case histories shows that a 70% fat, 8% carbohydrate diet could eliminate glycosuria among hospitalized patients. A reconsideration of the role of the high-fat, low-carbohydrate diet for the treatment of diabetes mellitus is in order.

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Your liver would continue to dump glucose steadily into your bloodstream, elevating your BG. Meanwhile, your muscles wouldn't be able to get any energy, given that glucose wouldn't be able enter them. So you'd start digesting your own tissue, enter DKA and be dead within a week.

 

Now that's a bit extreme on the other end isn't it? I was obviously having symptomes for 6 weeks before I was dxd, and had risky high Ketones and did not die in one week. But the point is understood, but not what I was asking.

 

You obviously don't die immediately, and the body burning fat keeps you alive for the time being, but how?

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Another interesting article:

A low-carbohydrate, ketogenic diet to treat type 2 diabetes...

 

This study may have only tested the theory on Type 2s but it references Type 1 in the reasoning and I suspect could have been tested on Type 1s if there was not an ethical dilemma with that.

The [low-carbohydrate, ketogenic diet (LCKD)] improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants. Because the LCKD can be very effective at lowering blood glucose, patients on diabetes medication who use this diet should be under close medical supervision or capable of adjusting their medication.

 

Prior to the advent of exogenous insulin for the treatment of diabetes mellitus in the 1920's, the mainstay of therapy was dietary modification. Diet recommendations in that era were aimed at controlling glycemia (actually, glycosuria) and were dramatically different from current low-fat, high-carbohydrate dietary recommendations for patients with diabetes. For example, the Dr. Elliot Joslin Diabetic Diet in 1923 consisted of "meats, poultry, game, fish, clear soups, gelatin, eggs, butter, olive oil, coffee, tea" and contained approximately 5% of energy from carbohydrates, 20% from protein, and 75% from fat. A similar diet was advocated by Dr. Frederick Allen of the same era.

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I think someone newly diagnosed and someone managing for years is quite different as a newly diagnosed person is losing cells where a manging person, they have been gone for awhile, so the effects would be much sooner. As your fat turned to glucose, it would not be utilized so it would do no good. I guess you would starve even if you were fat.

I wonder if you have any glucose production in your intestines?

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About 20% of type 1's have zero insulin production, and would die very quickly of DKA. The rest might last a bit longer, but I think a week is rather generous.

 

Without insulin in your body the following events will occur

 

1) most tissues (apart from neurones) will be unable to take up glucose. It would then increase in the blood and spill out into the urine.

 

2) without insulin to turn it off the liver will first break down glycogen, and dump it into the blood stream. When it runs out of glycogen it will start breaking down proteins to turn into glucose. This blocks the break down of fats by the liver, and instead it will start producing ketones.

 

3) without insulin your fat cells will dump fat into the bloodstream, which along with ketones is what the body will burn for energy. The brain can survive on ketones quite happily, but it doesn't need to - neurones do not need insulin to take up glucose. In particular heart and kidneys can metabolise both fats and ketones

 

eventually the liver dumping ketones into the blood stream will overcome the blood's buffer system, the blood will become acidic, and then you're really big problems will start - having a high blood sugar is the least of your problems.

 

Ask a pumper when a set goes bad, how quickly they start feeling ill. That will give you an idea how quickly your body can be driven into acidosis without insulin.

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As I understand it, fat is not turned into glucose in animals... it is turned into ketones.

The glycerol part of a triglyceride started life as glucose and so can go back, but it is not a huge amount.

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NOW, what would happen? I would assume, from personal experience from when I was dxd, your body would start using fat as energy (and thus burning fat = weight loss). How does this "Energy" get used? If your cells require insulin to feed them and keep them running properly, then how can you stay alive (at least temporarily) with just the energy from burned fat (as happens within the first few weeks before getting dxd as a Type 1)?

 

You seem to have some misconception here. Cells don't require insulin to feed them. The purpose of insulin is to transport glucose into muscle fiber as a way to provide fuel needed for energy burning activities like muscle contraction, whether it's flexing your arm, your heart beating, your intestines squeezing the contents along to be packaged up down in the bowel for eventual elimination from the body.

 

The problem that occurs in untreated type 1 diabetics is that the body ends up losing its capacity to utilize glucose, which then leads to fat burning at a rate which is far greater than any lipogenesis which may occur. This can occur fast enough that ketones can build to toxic levels, or if that doesn't occur, eventually to where so much fat has been burned that the supply isn't adequate and there is still no insulin to make use of the glucose. The person starves. The diets that were used to prolong a type 1 diabetic's life before insulin was found and made available fed the diabetic in enough quantity to prolong that period of starvation.

 

So obviously it's not an ideal situation, but it's not an immediately fatal situation as you seem to be thinking it might be.

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The diets that were used to prolong a type 1 diabetic's life before insulin was found and made available fed the diabetic in enough quantity to prolong that period of starvation.

 

Now there's a sentence to send a chill down the spine... a reminder of how lucky we are in comparison.

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Yeah, you need insulin no matter what if you need it, eating or no. Eating is essential to keep it from getting too low after you take the insulin.

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You seem to have some misconception here. Cells don't require insulin to feed them. The purpose of insulin is to transport glucose into muscle fiber as a way to provide fuel needed for energy burning activities

 

I didn't say the cells feed on insulin, so no, I do not have any misconceptions or misunderstandings.

 

What Is Insulin And What Does It Do? (I jsut used this because I didn't want to type my own explanation).

 

"The pancreas then secretes insulin in response to the increase in blood sugar. Most cells of the body have insulin receptors which bind the insulin to the cell. When a cell has insulin attached to it, the cell then is able to activate the other receptors. These receptors are designed to absorb glucose from the blood stream and move the glucose into the inside of the cell for energy.

 

Without insulin, the cells in our bodies would not be able to process the glucose and therefore have no energy for movement, growth, repair, or other functions. Insulin is key to unlocking the door of the cell to allow the glucose to be transferred from the bloodstream into the cell. "

 

On the other hand, I am a pumper, who has ZERO insulin left over (tested on two separate occasions with PepC tests).

 

And actually, I decided as a test to stop taking insulin as of 7PM last night, and stopped eating. My BGs all day have been flatlined (well, in truth, going between 5.5 and 4.4).

 

FYI, I am a pumper.

 

I think my question is not understood.

 

Your body obviously tries to make do without the ability to use Glucose as an energy source before you die of starvation, so my question is how does the energy from burning of fats keep you alive in the mean time. Obviously the body stores fat for a reason, assuming it will need it at a later date, for USE in the event of fasting/starvation. The ketones issue is just a terrible side effect of the bodies poor alternate method of keeping you alive, but none the less, how does fat burning feed your body, it can't transform into glucose to be used VIA (I will never say BY the cells again) the cells because that's what you need insulin for. So how does the body use the burned fat?

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You must be taking a basal dose of insulin Injecto. I don't make insulin either. I have forgotten at night to put my pump on after my bath and woken up (fasting) with blood sugar in the 25.0 / 450 range and feeling quite sick. My blood sugar before bed was right on target.

 

You can't just stop eating and stop taking insulin. You can stop eating and stop bolusing if your pump basal is set correctly. You can't just stop taking insulin all together.

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Let me ask Injecto's questions in another way?

 

1. Do muscle cells need insulin to make use of the energy in fat? Other questions related to this are: a) Does fat need to be converted to glucose before it can be 'burnt' to provide energy? B) If fat has to be converted to glucose, isn't insulin needed to carry the glucose so produced into the muscle cells?

 

2. The above questions with respect to protein: Do muscle cells need insulin to make use of the energy in protein? Other questions related to this: a) Does protein need to be converted to glucose before it can be utilized by cells? If so, isn't insulin needed to carry the glucose so produced into the muscle cells?

 

A question (or a wonderment) unrelated to Injecto's post. I understand that brain cells and heart cells do not need the mediation of insulin to get glucose transported to within them. Why didn't evolution do the same with other cells, instead of making these other cells rely on the complex insulin mediated glucose transportation? Couldn't evolution have avoided this unfortunate and messy business of diabetes? :-

 

Unrelated to all the posts in this thread, as a Canadian, and also as an Indian, allow me to congratualte Americans on Obama's election to presidency.

 

Regards,

Rad

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In the strongest possible terms, I do not advocate stopping insulin in a Type 1.

 

If you insist on this experiment, please, check your BS and ketones every couple of hours, even overnight.

 

I do think that it may be wise to consider minimizing the use of insulin while maintaining better glycemic control, without spikes, by reducing the number of refined carbohydrates eaten. But it is almost certain, as Nancy pointed out, that you will still require basal insulin.

 

In the absence of insulin the body is free to release fat from triglycerides and convert it to ketones which provide a good source of energy for brain, muscles etc... insulin is not required for the cells to burn ketones as energy. Ketosis is a normal state that occurs during periods of fasting (such as overnight) or even in some communities around the world who do not eat carbohydrates as a staple of their diet. Many health professionals make the mistake of thinking that ketosis is "bad" but they are simply confusing it with ketoacidosis... which is a serious condition and to be avoided.

The ketogenic diet is used by some as a treatment for epilepsy, and is also an effective way to lose excess fat without hunger cravings.

 

Once again - Fat is not converted to Glucose by Humans.

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On the other hand, I am a pumper, who has ZERO insulin left over (tested on two separate occasions with PepC tests).

 

And actually, I decided as a test to stop taking insulin as of 7PM last night, and stopped eating. My BGs all day have been flatlined (well, in truth, going between 5.5 and 4.4).

 

You must be producing some insulin if what you say is true. Which means the c-peptide tests were inaccurate for some reason.

 

Your body obviously tries to make do without the ability to use Glucose as an energy source before you die of starvation, so my question is how does the energy from burning of fats keep you alive in the mean time. Obviously the body stores fat for a reason, assuming it will need it at a later date, for USE in the event of fasting/starvation. The ketones issue is just a terrible side effect of the bodies poor alternate method of keeping you alive, but none the less, how does fat burning feed your body, it can't transform into glucose to be used VIA (I will never say BY the cells again) the cells because that's what you need insulin for. So how does the body use the burned fat?

 

Actually, the body burns some fat all the time. Fat is an excellent source of energy which produces ketones in its chemical reaction that releases energy to the cell. Fat has 9 calories of energy in every gram of it. It is quite a sensible evolutionary solution to the problem of needing energy sources for life functions -- rather than be wholly dependent on a single battery, if you will, have 2 kinds of batteries available to give the cells the energy that's needed for life's functions. And the great thing about it is that it's an energy source which doesn't need the mediation of insulin. The bad thing about it is that its exhaust product becomes toxic if too much fat burns for too long.

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A question (or a wonderment) unrelated to Injecto's post. I understand that brain cells and heart cells do not need the mediation of insulin to get glucose transported to within them. Why didn't evolution do the same with other cells, instead of making these other cells rely on the complex insulin mediated glucose transportation? Couldn't evolution have avoided this unfortunate and messy business of diabetes? :-

 

Insulin is used to transfer glucose into muscle (and fat) cells because the glucose represents extra, excessive food in a sense. In the muscle cell glucose in turned into glocogen which is a form of energy storage. The brain and heart need immediate energy not excess.

 

It is very significant that the foremost response to insulin is from fat cells not muscle cells.

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I believe that you could live off your your own fat reserve for a while... burning ketones instead of glucose for energy. You may even be able to survive on a low-carbohydrate diet as was used prior to the discovery on insulin.

 

I have been trying to find out more about this dietary treatment of Type 1, in particular; how well, and for how long could a person live on it.

 

I have found this interesting article but I'm not sure I want to pay good money to read it:

Dietary Treatment of Diabetes Mellitus in the Pre-Insulin Era (1914-1922)...

The rate at which you would accumulate ketones is much higher and more dangerous than with, say, a low card diet, as your body would be getting 100% of it's energy from this process. Therefore, the acidosis would set in quickly.

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i've done this a few times, where my waking level was just perfect or even a little bit under perfect but not low and i wouldn't take any bolus (humalog), but i always take my lantus (basal), no matter what my levels are, if i'm due to take it, i take it... i don't play around with that one...

 

though when i don't take my humalog in the morning, my levels go up slightly and i have to inject at lunch a little more than i'm used to...

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Now that's a bit extreme on the other end isn't it? I was obviously having symptomes for 6 weeks before I was dxd, and had risky high Ketones and did not die in one week. But the point is understood, but not what I was asking.

 

You obviously don't die immediately, and the body burning fat keeps you alive for the time being, but how?

No, it's not extreme. It's exactly what happens. When first diagnosed, your pancreas doesn't die off all at once, and you're not in a state of 100% insulin deficiency immediately. This is especially true of people diagnosed as adults.

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Injecto, the c-peptide can be falsely low for a variety of reasons. it shows how much insulin your body is making at that point in time, not how much it's capable of making if you force it to. If all of the type 1s on this board were taken off our insulin for a few hours, forced to drink a 100 gram glucose drink, and had our c-peptides tested in an hour, most of us would have a dedictable level of c-peptide.

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for Injecto's question - how does burning just fat keep you alive, you need to know about the Krebs or citric acid cycle

 

Citric acid cycle - Wikipedia, the free encyclopedia

 

When fat is used for energy it is converted into acetyl co-A, this is used to drive the citric acid cycle - in particular the energy from it is used to convert oxaloacetate into citrate. A cascade then follows, which releases energy. A part of the citric acid cycle resides inside mitochondria.

 

Glucose is converted to pyruvate, which is then converted to acetyl co-A which is then fed into the citric acid cycle to release energy.

 

NOTE that both energy pathways are the same - glucose and fats are converted into acetyl co-A, which is then used to create ATP. This pathway requires oxygen to work.

 

The reason why glucose is so important to muscle cells, is because the conversion of glucose to pyruvate releases some energy, but does not require oxygen. Powerful muscle contractions can limit the supply of oxygen, which would be disastrous if you were sprinting hard. However the buildup of pyruvate inside the muscle cell would eventual stop the conversion of glucose to pyruvate, and hence energy, so the muscle converts pyruvate to lactate, which can diffuse through the cell wall, and is carried away by the (intermittent) blood supply.

 

Note fats ALWAYS require oxygen for metabolism, and so is a rubbish energy source for muscle cells that can cut off their own blood supply.

 

one more thing about fat metabolism and ketones. Fat metabolism does not involve the production of ketones apart from ONE exception, and that is...

 

Gluconeogenesis by the liver uses up oxaloaxtate (which you will notice is part of the citric acid cycle), and so halts the citric acid cycle. However the first steps of fat metabolism is the creation of acetyl co-A. The liver responds to the rising concentration of acetyl co-A by converting it into ketone bodies. Ketones are made by the liver in response to low stores of glucose.

 

insulin switches off gluconeogenesis by liver - if your insulin level drops to zero (type 1 diabetes), your body responds as though you have zero glucose. zero insulin = maximum gluconeogenesis = ketones +++ = rapid onset of DKA.

 

Why didn't evolution do the same with other cells, instead of making these other cells rely on the complex insulin mediated glucose transportation? Couldn't evolution have avoided this unfortunate and messy business of diabetes?

 

Neurones are unable to metabolise fats. Making them sensitive to insulin could be potentially disastrous, as low levels of insulin (when glucose is low) could deprive the brain of energy.

 

Insulin is an important regulatory hormone - it is one of the oldest hormones found in animals. It's job is to store fat when glucose is plentiful, and release fats when glucose is scarce.

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On the other hand, I am a pumper, who has ZERO insulin left over (tested on two separate occasions with PepC tests).

 

And actually, I decided as a test to stop taking insulin as of 7PM last night, and stopped eating. My BGs all day have been flatlined (well, in truth, going between 5.5 and 4.4).

 

FYI, I am a pumper.

 

Injecto!!! You are a pumper, do you not realise that in your "going off insulin test" you are still getting basal, you are still getting insulin, from 7pm on?

 

Or are you really saying you completely removed your pump/ stopped delivery? You need to answer this question - not just for the sake of clarity but for your own understanding!

 

It just doesn't make any sense to equate "fasting with basal insulin", with "going off all insulin". Two completely seperate scenarios. The question of how ketosis and DKA works is fair enough but I'm not suprised at the confusion on the thread, you've mixed water and oil here.

 

Hopefully you'll clear this up, here. (Did you go OFF the pump? Or just abstain from food and boluses?) Because the idea of turning the pump off ("no insulin") and seeing if you wake up feeling fine is really quite potentially a dangerous one. I'm amazed you don't realise this: have you not had a set play up? Out of interest what's your TDD?

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I have been trying to find out more about this dietary treatment of Type 1, in particular; how well, and for how long could a person live on it.

 

Frank... what's your actual interest in this specific question, if I may ask? It's so easily answered, and has been in this thread (and is what your research is pointing to). The only "alternative treatment" is to eat a low carb diet and minimise DKA (maybe some supplements and exercise will slightly help, too), which will still lead to elevated levels and result in days, weeks or maybe months of painful sickness with a fast encroaching death. What's the mystery in that? It's why the only fate of most type 1 diabetics would be to die a painful death, in the thousands of years before insulin was discovered.

 

Sure there were probably some exceptions in some way, some who would go on for years or months, very low requirements, lifestyle or bodies unique and conducive to prolonging the situation. Others who were type 2s and improved their insulin utilisation and "recovered". But ... are you seriously considering the idea type 1s should go off insulin in the chance they might have a good few months in them rather than days? Why oh why? I think the whole line of suggestion is a bit on the nose.

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