Fasting and insulin dosage for type 2

[nolly53]

I am a type 2 diabetic taking 2 Metformin 500mg with breakfast along with 18 units Novamix 30 and the same with the evening meal. I successfully managed to lose 10kg and halve my insulin dosage a couple of years ago after researching the Newcastle trials and reading David Cavan's book. Things have been fairly steady since then.

Having watched some of Fung's videos on fasting, I am interested in giving it a go, but am terrified of experiencing a hypo (I have a brother who ended up in A&E last week with a hypo).

Can someone point me to a link with advice on insulin-dependent type 2 diabetics and fasting please?

As a side issue, I cannot cope with excessive fat - e.g. 2 fatty sausages or a fatty steak and I am sick. Also my statin dose has been increased to bring down my cholesterol so I don't want a change in diet to push that up.

There is no point in talking to my GP or my diabetic dietician, both of whom were very sceptical when I suggested that I was going to reduce my carb intake after reading Cavan's book.

Nolly53

 

[bulkbiker]

What are your blood sugar levels usually like and how long are you thinking of fasting?
I'm an unmedicated Type 2 so not in a position to give you advice from experience but I think you can pay for an initial consultation with the IDM programme if you wanted to. You may want to consult with your doc or at least tell him what you are intending (I know you said it would be pointless but at least you have had the conversation) as they may be able to advise how to reduce inulin levels or stop them altogether.
Also I would say how many carbs per day are you currently having? as fasting I have found is much easier if you are pretty low carb to begin with.

 

[Resurgam]

Your taking insulin makes all my experience irrelevant - but fasting puts up my BG levels, I needed to alter the times I eat to have an early and late meal in order to get a stable reading, as lunch and dinner close together threw me high and then I went low mid afternoon.
Perhaps if you test to see what happens to you during modest fasts - so you can see how trends are developing, rather than trusting that the technique is right for you.
I just eat low carb foods and find I have normal results and have nothing to wear from a year ago when I was diagnosed, everything either flaps around or falls off. Even my feet have shrunk.
You'll need to get advice from your nurse, or maybe doctor, depending on who is supervising, as your insulin requirements will change. My level at diagnosis was 17.1 mmol/l and now I can be at 6 after eating, so just reducing carbs is a pretty powerful suppression of diabetes.

 

[nolly53]

Thanks,
My last HbA1c was 57. About two thirds of my BG readings are < 10 with the odd one less than 5. I could bring them down with more insulin but am reluctant to having watched Fung. I may try reducing carbs first before trying fasting.
Nolly53

 

[ringi]

I am writing this based on books (and research papers) I have read, as I have never been on insulin.

This would be a lot easier with MDI, as you would have more control. Would your GP be willing to switch you to MDI instead of mixed insulin, on the bases it would let you dose for the number of carbs in each meal so give you more flexibility on what you eat? (You don’t have to tell your GP what you are planning to do with the flexibility……)

The current Newcastle diet study has everyone stopping all drugs at the start of the diet, and only restarting if their BG is over 20. If I recall correctly in Fung's book on fasting he talks about people reducing their insulin dose before a fast, letting their BG get close to 10, so they don’t have to correct a hypo while fasting. Hence it seems that the experts are willing for someone to have a higher BG for a short time, so as to allow change.

Remember the aim of fasting is to let your body have/produce as little insulin as possible, so it can use up some of its fat stores, hence remove fat from your liver etc.

I assume you are a true Type2 with your body clearly producing some of its own insulin, and hence there is no risk of DKA. I also assume you have a BG meter, and know how to monitor your BG.

As the greatest risk is overnight, I expecting skipping breakfast and lunch would be a sensible way to start. Maybe reducing the insulin dose the night before and not having any insulin with breakfast, then monitor to see what happens. A high BG while fasting does not mean the fast has failed.

Or go for a 72hr fast, letting your BG get up to just below 10 first (by reducing insulin) and only using a small dose of insulin if your BG gets way out of control, being willing to eat lot of quick acting carbs if your BG gets too low (under 5 if insulin used in last 24hr).

Whatever you do will be taking a risk, as going on as you are now is a long term risk. But fasting while on insulin without a helpful GP is a risk. Personally I think a higher BG in the short term is worth it to reduce the risk of hypos while you are fasting.

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If you had a helpful GP, then SGLT2 inhibitors would be a option to discus with him/her, as they may allow you to come off insulin, and there's no risk of a Hypo directly from there usage. (If used with Inslin, there is stil the risk of the Hypo from insulin.)

 

[nolly53]

If I recall correctly in Fung's book on fasting he talks about people reducing their insulin dose before a fast, letting their BG get close to 10, so they don’t have to correct a hypo while fasting.

That sounds like great advice.
Thanks for the info. Clearly for patients not on insulin, fasting carries much less risk, but this suggestion gives me some re-assurance.
The only carb that I have for breakfast is a slice of toast, complemented by 2 poached eggs, bacon tomatoes and mushrooms. If fasting, presumably I scrap all of this?
Nolly53

 

[nolly53]

.. and I presume that whilst fasting there is no need to take any insulin.
Nolly53

 

[ringi]

.. and I presume that whilst fasting there is no need to take any insulin.
Nolly53

Measure what your body does, but much better to under dose on insulin as you can always add more, but can't remove it.

 

[ringi]

The only carb that I have for breakfast is a slice of toast, complemented by 2 poached eggs, bacon tomatoes and mushrooms. If fasting, presumably I scrap all of this?

I never have toast or bread at home. If I was you, I would drop the toast. I expect your 2 eggs, bacon, tomoties etc is enough for a complete breakfast on its own.

Fasting is just not eating, but you must drink lots of water. If more then about 3 days, you need to think about salt, lots of people drink brone broth with added salt.

It is well worth getting Fung's book on fasting and spend at least a weekend reading it. It is better writen then most of his blog posts as the publisher has copy editors etc. A small investment in your health.