Low Carbing and Physiological Insulin Resistance

Indy51

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As an aside, I think there is confusion between PIR and the general glucose intolerance that develops from being consistently low carb. Not a problem if you intend to stay low carb and don't have to take an OGTT. This is advice from Dr Michael Eades on how to prepare for an OGTT if you are following a low carb diet and the reasons why:

"Following a low-carb diet makes one a little glucose intolerant, which is the reason that the instructions for a glucose tolerance test always include the admonition to eat plenty of carbs in the week before the test. Why? Because all the macronutrients–glucose, fat and protein–are broken down by enzymes during the metabolic process. And all the enzymes necessary for the metabolism of the various macronutrients are made on demand but not immediately.

If you are on a high carbohydrate diet, then you will have plenty of enzymes on hand to deal with the carbohydrates you consume. If you switch to a low-carbohydrate diet, it takes a while to manufacture the enzymes in the quantities needed to deal with the extra fat and protein that your metabolic system hadn't been exposed to. This deficiency of protein/fat metabolizing enzymes is the reason people starting a low-carb diet become so easily fatigued–they've got plenty of enzymes on hand to break down carbs, they just don't have the carbs to metabolize. Once they produce the enzymes necessary to deal with the load of protein and fat, which takes a few days, they become low-carb adapted and no longer feel fatigued.

Once people become low-carb adapted then the same thing happens if they go face down in the donuts. They don't have the enzymes on board to deal with the sudden influx of glucose, and, as a consequence, their blood sugar spikes higher than it would on a person eating the same amount of carbohydrate who is already carb adapted."
 

Kristin251

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My question, and not at all judging, is those that eat moderate carbs, say 80-130 a day ( extremely high for me) , how many units of basal and bolus are you taking?? And though your A1c' s may be in normal ranges, what are the variances of bs between high school and lows?? Completely just looking to educate myself.
 

tim2000s

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My question, and not at all judging, is those that eat moderate carbs, say 80-130 a day ( extremely high for me) , how many units of basal and bolus are you taking?? And though your A1c' s may be in normal ranges, what are the variances of bs between high school and lows?? Completely just looking to educate myself.
That's not really all that relevant to PIR though @Kristin251 as individual insulin amounts vary according to factors other than food, including body type, exercise undertaken, etc. I think that would be better as a new topic than in this thread, as it would be a bit of a derailer.
 

CathP

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All very interesting thanks. I wondered what these claims of low carb-induced PIR were all about. It's not something I've noticed in my daughter. Fortunately we only 'moderate carbed' for a month or so before finding low carb, but have noticed a very significant drop in her insulin needs (and reduction in glycemic variability, which is the aim obviously).
 

tim2000s

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As I've mentioned, Low Carb PIR isn't something I've experienced either, although I caveat that with the point that I am also active and resistance train, which may be a mitigating factor. In fact going low carb, training and reducing my body fat saw my insulin sensitivity increase rather than decrease.
 
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Jamesuk9

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I suffer from this, if I eat low carb my fasting levels increase by at least 1.0, same if I refrain from eating at all. If I eat moderate carbs my fasting levels go lower and so does my low before it rises.

It baffles me and I just don't know how to correct it.
 

Indy51

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I suffer from this, if I eat low carb my fasting levels increase by at least 1.0, same if I refrain from eating at all. If I eat moderate carbs my fasting levels go lower and so does my low before it rises.

It baffles me and I just don't know how to correct it.
It's a perfectly normal and benign physiological state, so there's no need to correct it.
 
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xyzzy

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What an interesting thread! I'd think so long as your levels remain in safety it's not anything to worry about. I was always told your insulin response for a meal is based on the recent history of carb intake thus if you suddenly up carbs you'll get a few days of higher readings until your response adjusts. Obviously being able to have an insulin response for the amount of carbs you eat is the limiting factor as is the level of standard IR that stops the insulin response from working.

My personal experience is my fasting level is always my highest irrespective of average daily carbs. Until my recent relapse I based my carb intake for 4 years solely on the odd fasting test and just adjusted carbs if it started to appear to rise. I then used regular hba1c's as confirmation it was a valid approach for long term monitoring.
 
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hooha

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What is confusing me is why people think they can test whether they have physiological insulin resistance by eating large amounts of carbs and watching the blood glucose rise! That is nonsense and shows a basic misunderstanding of what PIR is, and how it affects us.

Most people with PIR notice that their morning fastings are higher, and that their lowest levels of the day are slightly higher than they used to be. Nothing huge. Nothing frightening. We are talking about a small drift over weeks or months. It doesn't rise indefinitely and it stabalises well within the non diabetic glucose range. It happens to some people in extended ketosis, whether they have diabetes or not. It has not been proven to be harmful. Since these people are in extended ketosis, they usually have excellently controlled blood glucose and excellent hbA1cs. A few days of eating higher carbs (enough to raise the individual out of ketosis) is enough to remove any physiological insulin resistance.

Here are a few links that explain it better than I can:
http://www.marksdailyapple.com/does-eating-low-carb-cause-insulin-resistance/
http://ketopia.com/physiological-insulin-resistance/ (Mainly for the attached reading list)
Hello @Brunneria I am glad I found this post. I should have found it 2 + years ago. Having reversed my type 2 db in Dec. 2016 with the Newcastle Prof Taylor diet and later with LCHF, I became depressed at my later tests, with higher than expected Fasting Blood Sugars. Recent low HbA1c 's however have restored my mood and researching this curious phenomenon of Physiological Insulin Resistance , I came across this post. I have also looked at the Dr Kraft insulin curves and noted that the low insulin response of Type 1 diabetics can be mimicked by people on low carb / keto diets. I have not found a clear explanation of whether this insulin resistance is happening mainly at the muscle mitochondria , or if it is mainly the pancreas going to sleep , producing less insulin . The flat insulin curve of Kraft type 5 suggests it is a lack of insulin response at least in part. . Why is there no response to the oral glucose taken in ? Does the pancreas really ' go to sleep? I wonder if you know a recent reference which addresses these questions in simple English ? Thanks.