Insulin resistance

[Emmasndco]

hi,
A little bit about me , I was diagnosed type 2 aug 2014. Been on various meds, currently on metformin, gliclazide, trulicity and humulin I insulin. Try to LCHF with no more than 50g carbs per day. I exercise regularly. my gp has come to the conclusion that I’m very insulin resistant. I’ve been on insulin around 3 months. My blood sugar levels have gradually increased since December with readings between 17 at the lowest and Hi.

I have a couple of questions

1. My Gp believes I an still making plenty of my own insulin (following a c peptide test) any ideas why he has put me on insulin? Surely it is just putting even more insulin in my body that I don’t need.

2. I had a phone call with my diabetic nurse from the hospital today. I explained that my evening dose of insulin (26 units) leaves me sick and not wanting to eat after around 10-15 mins of injecting. She blamed the trulicity for doing this, which I think is bizarre. Any explanations on her thinking?

Thank you.

 

[mazza 2]

Hi
Welcome to the forum. There are lots of people on here who can give you great advice and are very supportive. I've only been diagnosed just over a year so I'm still learning. It would help members on here if you could let them know your HbA1C results. Also, what is your daily diet like. You say you are low-carbing, but that can mean different things to different people. So if you could give us a rough idea what you have for breakfast, lunch and dinner, that would be helpful. I agree that when you are making to much insulin, why give more. I don't know if you have read Jason Fung's book, "The diabetes Code" but he explains things really well. He advocates a low carb diet with intermittent fasting, which lots of people have done and managed to reverse their diabetes. Anyway, try not to worry and I'm sure lots of people will respond shortly.

 

[Winnie53]

Emmasndco I crossed over to type 2 diabetes in 2005 so was 10 years diabetic without any treatment in 2015 when I began eating carbs in the 30 - 42 carb range. Today, I probably eat just under or above 50 carbs a day. We are very fortunate as type 2's because we can manage our diabetes with diet and exercise alone.

The problem with treating type 2's with insulin and medication is that the insulin worsens insulin resistance and the medication gives you the false impression that you're okay as the diabetes continues to progress - (which your doctor likely doesn't know; so glad he told about the severe insulin resistance because he's right!). Too often, when type 2's inject insulin, it allows the disease to progress and within two or so decades, the complications begin. Chronic Kidney Disease is a huge problem down the road for us when glucose levels and hypertension aren't well controlled.

This is what lead Canadian nephrologist Jason Fung to begin searching for other treatment options for his diabetic patients, who often had Chronic Kidney Disease too. He supports his patients by using fasting (and the low carb diet). After years and years of following the standard of care - (medication, sometimes insulin) - he had a treatment strategy that works!

I think you'll find this recent interview with him life changing...

After listening to his online lectures and interviews - (there are many) - I join mazza 2 in encouraging you to read The Diabetes Code by Jason Fung, MD. One of our group's members recently had surgery, read the book, began intermittent fasting, and after more than a year of "kind of eating low carb", has significantly dropped her glucose levels. Her surgeon was amazed at how quickly she's healing!

There is hope.

That said, there's some thought that when diet and exercise don't work, there's a possibility that "heavy metals" in the body are the driver of the uncontrolled diabetes. That said, I'd take a hard look at what foods you're eating, your actual carb count, and adding intermittent fasting first before exploring that possibility.

Glad you're asking questions. I struggled for 10 years with my diabetes before I found the low carb diet. It and now intermittent fasting have made all the difference for me. Hopefully, it can for you too!

 

[Bluetit1802]

hi,
A little bit about me , I was diagnosed type 2 aug 2014. Been on various meds, currently on metformin, gliclazide, trulicity and humulin I insulin. Try to LCHF with no more than 50g carbs per day. I exercise regularly. my gp has come to the conclusion that I’m very insulin resistant. I’ve been on insulin around 3 months. My blood sugar levels have gradually increased since December with readings between 17 at the lowest and Hi.

I have a couple of questions

1. My Gp believes I an still making plenty of my own insulin (following a c peptide test) any ideas why he has put me on insulin? Surely it is just putting even more insulin in my body that I don’t need.

2. I had a phone call with my diabetic nurse from the hospital today. I explained that my evening dose of insulin (26 units) leaves me sick and not wanting to eat after around 10-15 mins of injecting. She blamed the trulicity for doing this, which I think is bizarre. Any explanations on her thinking?

Thank you.

With all that medication one would reasonably expect your levels to be a lot lower. It does sound like you are very insulin resistant. As you have had tests to show you produce plenty of your own insulin it is totally pointless injecting even more. The more circulating insulin in your body, the more resistant you will become, and the harder it will be to lose weight (if you need to). Gliclazide will also not be helping in this respect because all this does is force your pancreas to produce extra insulin.

According to drugs.com Trulicity can cause stomach discomfort, vomiting, acid or sour stomach etc. It also interacts with Metformin
https://www.drugs.com/sfx/trulicity-side-effects.html
https://www.drugs.com/drug-interactions/dulaglutide,trulicity.html

I am wondering if you are eating too many carbs? It is carbs that cause raised blood glucose. If you want to reduce your insulin resistance it makes sense to reduce carbs and thereby requiring less insulin. Exercise also helps, as does intermittent fasting (such as skipping breakfast). However, you would need to be very careful because of all the meds you are on and would need to do a lot of testing as well as discussing matters with your nurse or GP.

 

[Winnie53]

Emmasndco I also have severe insulin resistanceso I thought I'd take some time today to explain what it's like to get insulin levels back down. It's going to require working closely with your diabetes team to begin taking you off the medications you're on. It can't be done all at once. And this will need to be done slowly. I don't have experience with this so don't know if this would be done over a period of weeks or months. Nor do I know if yo should come off the medication and insulin one at a time, both together, or one before the other. Hypoglycemia and hyperglycemia are both concerns.

When I first began using the LCHF keto diet it took 4 weeks to get my glucose levels down strictly eating 30 to 42 carbs a day, no starch or sugar, because I was fighting 10 years of untreated insulin resistance. This was very difficult for me because so many others on the forum reported getting results in one week. I was so frustrated and scared too. What got me through those dark days was graphing my glucose levels every day. I will try to post a picture here of how I did it. That's what kept me going. MY Glucose numbers were all over the place but they eventually began trending down. More later. I've got some scheduled obligations today.

 

[Member496333]

@Winnie53, four weeks is a walk in the park. It took nearly six months for LCHF to really batter my diabetes into submission.

I was extremely insulin resistant and I’m unable to get fat, so the glucose that my body already contained just continued to overflow into my bloodstream for months. Despite being fully fat adapted and consuming virtually no carbohydrate, my blood glucose and fasting numbers in particular were all over the shop for quite some time. I most definitely wasn’t fixed inside a week

 

[Winnie53]

Jim, thank you. Your story provides hope to those of us who are still in process, like myself.

 

[lucylocket61]

We are very fortunate as type 2's because we can manage our diabetes with diet and exercise alone.

I just want to point out that this is not true for every type 2. Some also need medicine.

 

[HSSS]

I just want to point out that this is not true for every type 2. Some also need medicine.

Possibly, particularly if they aren’t actually producing enough insulin. But appropriate diet should always be at least part of the equation and explored fully, ideally if circumstances allow before medication is relied upon imo

 

[lucylocket61]

Possibly, particularly if they aren’t actually producing enough insulin. But appropriate diet should always be at least part of the equation and explored fully, ideally if circumstances allow before medication is relied upon imo

I agree partly with you, but that does not negate my correct point. Correct diet and exercise will help. However, it may not be, for some, enough to manage their condition successfully. And it may be a complete help for some time, but not always. We are all different.

'Possibly' is not correct. It is fact that some will not achieve good blood sugar levels on correct diet and exercise alone all the time, or even some of the time. Some bodies need additional help.

I labour this point as I think it is something which is neglected on this forum, and correct diet and exercise is touted as a cure all, which it may not be, not for all type 2's. Needing medical intervention too is not an issue, or a failure if needed and relied on.

edited to change 'possible' into 'possibly' as they are not the same words : )

 

[HSSS]

Sorry my use of the word “possibly” may have been misleading of my viewpoint. It was meant to infer that it is indeed possible more than just diet and lifestyle is needed.

And I agree if that is genuinely the case it is in no way a failure. I do however think that is less common than current medical practice would suggest and many more than currently do could indeed manage with just diet and lifestyle. I think perhaps advocacy for appropriate changes, not being given by enough mainstream diabetic supports eg DN and GP and clinics, can be be so eager it can give the impression anything else is failure but I don’t think this is broadly the intention.

 

[Bluetit1802]

I just want to point out that this is not true for every type 2. Some also need medicine.

I agree with you, but the medicines (apart from insulin) are supposed to be used alongside a suitable diet. Even the manufacturers say this. Meds alone will not do the job. It is a crying shame that many doctors/nurses do not push this point. Many, many people leave the surgeries with prescriptions and think they can carry on as before. Then of course end up with even more meds and eventually insulin.

 

[mazza 2]

I agree partly with you, but that does not negate my correct point. Correct diet and exercise will help. However, it may not be, for some, enough to manage their condition successfully. And it may be a complete help for some time, but not always. We are all different.

'Possibly' is not correct. It is fact that some will not achieve good blood sugar levels on correct diet and exercise alone all the time, or even some of the time. Some bodies need additional help.

I labour this point as I think it is something which is neglected on this forum, and correct diet and exercise is touted as a cure all, which it may not be, not for all type 2's. Needing medical intervention too is not an issue, or a failure if needed and relied on.

edited to change 'possible' into 'possibly' as they are not the same words : )

I quite agree that diet and exercise does not work for everyone and some will need medication. I sometimes think it depends why you got diabetes in the first place. I think there are many reasons, for instance, the majority of people who get type 2 are overweight (regardless of why e.g. insulin resistance), it seems for these people (and it's only what I've noticed) once they change their diet and introduce exercise they seem to reverse their diabetes quite quickly. For people who are not overweight, it sometimes appears it takes longer or maybe that's only me!! But, there maybe some people who have got diabetes due to stress, anxiety or other medical reasons. With this category of people, unless they can address the reasons for their stress or medical problems, they may not be able to reverse their condition with diet alone. I appreciate it is still better to address their diet and eat foods which have low impact on insulin levels to try and keep complications at bay, but there is a place for medication for some and I don't think they have failed. To be honest, if I hadn't found this website and leant about low carb diets I would have taken the advice from my diabetic nurse and eaten all the foods which would have made my condition a lot worse. It's only my opinion, but thought I'd share.

 

[Winnie53]

When I began the low carb ketogenic diet 4 years ago, then started a local diabetes group for those who want to manage their diabetes with diet and physical activity, I had no idea how much I'd have to learn and implement before I'd begin to see results. And it's been even harder with our members. Some of them came to us with 10, 15, 25 years of insulin resistance and the complications that follow: obesity, peripheral neuropathy, chronic kidney disease, renal failure, charcot foot, and a variety of eye diseases. Did I give up and go home? No. I've stayed in the fight. And with each year, I'm finding more strategies to try.

Here's the problem I'm having with this discussion. If I come from the place that insulin and medication is necessary for a person who has been shown through lab tests that they are producing adequate levels of insulin - (please re-read the OP) - then I will take away their hope. And hope is what we most need during the dark days of failing health. But more than hope, we need strategies to find our way out of this metabolic mess we've found ourselves in thanks in great part to the way food is grown today and the "normalization" of eating processed foods that contain damaging omega-6 seed oils, 3 to 6 times, sometimes 10 times a day.

Please put your defensiveness around the topic of diabetes medications and insulin aside and instead focus on helping and encouraging the OP. Is medication and/or insulin necessary for some, yes. But, that said, I think it's a mistake to go there before a lot of other strategies are tried first. Please note: I'm not referring to the MODY, LADA, or T1DM. I'm referring to T2DM with adequate production of insulin.

Where to start?

Perhaps a good place to begin is an overview of the 5 R's which has been used by naturopathic doctors for decades until it was adopted and further developed by the Institute for Functional Medicine (IFM). I don't have access to the IFM's outline and description, but if you Google "5R's of functional medicine", you'll find a list of links to click on and read.

Will continue in next post...

 

[Winnie53]

After reading through quite a few links on this topic, this one was reasonably good. Will break it up into 2 posts.

What Is The 5-R Protocol?
by Dr. Eric Osansky, DC, a licensed healthcare professional who helps people recover from thyroid and autoimmune thyroid conditions through the use of natural thyroid treatment methods.

For those who prefer a link, here it is - (or just read the article below)... https://www.naturalendocrinesolutions.com/archives/what-is-the-5-r-protocol/

A few years ago I wrote a blog post on the 4-R protocol. Since then it’s been updated to the “5-R Protocol by the Institute for Functional Medicine”, and I figured it would be a good idea to update and expand on the original post I wrote on this topic. If you’re not familiar with this protocol then you’ll quickly realize that it relates to the healing of the gut, and a leaky gut is a factor with most, if not all autoimmune conditions, including Graves’ Disease and Hashimoto’s Thyroiditis. And while the information in this post will focus greatly on thyroid autoimmunity, even if you don’t have an autoimmune thyroid condition, I feel that a lot of people can benefit from this information.

So let’s dive right into the protocol and discuss each of the five components

1. Remove. Although genetics is a factor with most, if not all autoimmune conditions, in order for someone to develop autoimmunity they must be exposed to an environmental trigger. And in order to reverse the autoimmune component and restore the person’s health it is necessary to find and remove the trigger. The same is true with regards to healing a leaky gut. While many people with a leaky gut will take supplements such as L-glutamine, and eat gut-healing foods such as bone broth, you won’t be able to heal your gut if you don’t detect and remove the leaky gut trigger.

This of course is easier said than done at times, as it’s not always easy to find out what the trigger is. However, these are some of the common factors which can cause a leaky gut:

Food allergens. Although many food allergens can potentially cause an increase in intestinal permeability, in the research I was able to find evidence for gluten (1), corn oil (2), and red wine (3) being factors which can cause a leaky gut.

Gut infections. In the literature there are numerous infections which can cause an increase in intestinal permeability. This includes candida (4) (5), H. Pylori (6), Blastocystis hominis (7) (8), and giardia (9). There is also evidence that small intestinal bacterial overgrowth can cause an increase in intestinal permeability (10) (11).

Drugs. Both NSAIDs and antibiotics can cause an increase in intestinal permeability (12) (13).

Stress. There is evidence that both acute and chronic psychological stress can cause an increase in intestinal permeability (14) (15).

Systemic Inflammation. I also came across a study which showed that systemic inflammation can cause an increase in intestinal permeability (16).

Finding the trigger is arguably the most difficult component of the 5-R protocol. But once this has been accomplished you can move onto the next four components, which I’m about to discuss.

2. Replace. The next component is to replace certain factors which play a role in digestion. Many people reading this have taken digestive enzymes. These include enzymes to break down protein (proteases), carbohydrates (amylase), and fat (lipase). Many people with low gastric acid (stomach acid) can benefit from taking betaine HCL with meals. Gastric acid consists mostly of hydrochloric acid, which is released from the parietal cells of the stomach. It plays a role in activating pepsinogen into the active enzyme pepsin, which in turn breaks down proteins.

Some people can also benefit from supplementing with bile salts. This is especially true for those people who have had their gallbladder removed, as getting gallbladder surgery doesn’t address the bile metabolism issues commonly associated with these conditions. But some other people can also benefit from taking bile salts, such as those who have problems emulsifying fats.

Although dietary fiber doesn’t fall under the same category as digestive enzymes, betaine HCL, and bile salts, many people don’t consume enough dietary fiber, which is important for numerous reasons. First of all, fiber helps to feed the good bacteria of the microbiota. In addition, having sufficient dietary fiber is important for having regular bowel movements.

 

[Winnie53]

Cont'...

3. Reinoculate. Many people take probiotic supplements, which is one method of reinoculating, or repopulating the gut flora. And of course there are ways to accomplish this through diet as well. But why do people have to reinoculate in the first place? Well, there are many different factors which have a negative effect on the microbiota, including the foods we eat, taking antibiotics, being exposed to other environmental toxins, and even chronic stress can have a negative impact on our gut flora.

So what is the best way to reinoculate? To be honest, we’re still in the beginning stages of dealing with probiotics, and so the approach we take now very likely won’t be the approach we take five to ten years from now. I commonly recommend a probiotic supplement to my patients, but even this comes with some controversy, as not all probiotic supplements are created equally. And some healthcare professionals like myself will recommend formulations with specific, well-researched probiotic strains, while other doctors won’t pay as much attention to the strains included, but instead will focus more on the diversity. In other words, some will recommend a probiotic which has many different species, without worrying about the specific strains.

While it can be beneficial to take a probiotic supplement, it also is a good idea to take some prebiotics, and eat food sources of probiotics. With regards to prebiotics, one can take a prebiotic supplement such as inulin or larch arabinogalactan, or you can eat prebiotic foods such as Jerusalam artichokes, asparagus, onions, chicory, bananas and other fruit, and even green tea is considered to be a source of prebiotics (17) (18). The reason why prebiotic foods are important is because they feed the good bacteria such as bifidobacteria and lactobacilli, and these foods also are good sources of short chain fatty acids.

Probiotic Supplements vs. Food Sources

But why take a probiotic supplement when there are some excellent food sources of probiotics? After all, foods such as sauerkraut, kimchi, kombucha, kefir, and a good quality source of yogurt can all be good sources of probiotics. Well, I recommend getting probiotics from both supplements and food sources, and the reason for this is because the supplements you take will have different strains than the food sources. Plus, many people simply don’t eat enough food sources of probiotics.

What About Soil-Based Probiotics and Fecal Transplants?

Over the past year I’ve had a lot of people ask me about soil-based probiotics, and I only recently started using these in my practice, and so I can’t say I have much experience with these. Some examples of soil-based probiotics include bacillus subtilis and bacillus coagulans. These are also known as spore-based probiotics. These not only are more resistant to the gastric acid of the stomach than some other probiotic strains, but some sources claim that they colonize the gut more effectively. If anyone reading this has had a positive experience while taking spore-based probiotics please feel free to share your experience in the comments section below.

I don’t get asked as much about fecal microbiota transplants, but I figured it was worth mentioning this here because this can potentially help with many different conditions. This essentially involves transplanting healthy bacteria from one individual to another individual. It seems to be very effective in helping people with Clostridium difficile, and while it hasn’t been approved for other conditions in the United States, this probably will change in the future.

4. Repair. Many people reading this are familiar with a “leaky gut”, which I briefly spoke about earlier. This is when the intestinal barrier is compromised, which allows larger proteins to pass into the bloodstream, where they normally shouldn’t be. As a result, the immune system sees them as being foreign and mounts an immune system response. Some claim that in order for autoimmunity to develop you need 1) a genetic predisposition, 2) an environmental trigger, and 3) a leaky gut. I briefly spoke about this earlier when I discussed the “remove” component of the 5R protocol. And of course this component is focusing on repairing the gut.

But before talking about how to repair the gut, it probably is a good idea to explain how one can determine if they have a leaky gut in the first place. There is testing available, as there is a test called the Lactulose/Mannitol test that can determine if someone has an increase in intestinal permeability (a leaky gut), and there is also a test from the company Cyrex Labs called the Intestinal Antigenic Permeability Screen. I have used both of these tests in the past, but these days I usually just assume that my patients have a leaky gut, especially those with Graves’ Disease and Hashimoto’s Thyroiditis.

As for how to repair the gut, this can be accomplished through a combination of supplementation and diet. One of the most common nutrients recommended by healthcare professionals is L-glutamine, which is an amino acid that serves as fuel for the cells of the small intestine. Vitamin A and zinc can also play important roles in gut healing, and herbs such as slippery elm, licorice, and marshmallow root can also help to support the gut. Foods which can help heal the gut include bone broth, cabbage juice, and fermented foods such as sauerkraut.

5. Rebalance. This used to be called the “4R protocol”, but not too long ago the Institute for Functional Medicine added a fifth component, which is to rebalance your body through sleep, stress management, etc. I’m not going to discuss this in detail here, but this of course doesn’t mean that this component isn’t important. I’m always talking about the importance of stress handling, as doing a poor job of managing your stress can have a profound effect on your health. And most people are aware of the importance of getting sufficient sleep, although in some cases it is necessary to improve other aspects of one’s health in order to help them sleep better.

Can You Address More Than One Of These Components Simultaneously?

Some people might wonder if they can address more than one component at the same time. In other words, if someone has a gut infection, can someone take digestive enzymes and probiotics at the same time that the infection is being eradicated? Without question the answer to this is “yes”, as most healthcare professionals address different components simultaneously, including myself. And so it isn’t necessary to focus on one of these components at a time.

In summary, the 5-R protocol relates to the healing of the gut, and a leaky gut is a factor with most, and possibly all autoimmune conditions such as Graves’ Disease and Hashimoto’s Thyroiditis. The first, and perhaps most important component is removal of the trigger, which can include a food allergen, an infection, environmental toxin, and even stress. The remaining four components of the 5-R protocol are replace, reinoculate, repair, and rebalance.

 

[Winnie53]

The reason I'm introducing the 5R's into this discussion is because for some of us, eating a low carb ketogenic diet isn't enough. For some, granted, it's that simple. But for others, like myself, there's so much more work that needs to be done, beginning with the food we eat and taking at least some nutritional supplements.

Before I go on, let me explain what I mean by supplementing. At minimum, most of us are deficient in vitamin D3, vitamin K2 (unless you live in Japan and eat natto), omega-3's, DHA and EPA, and minerals, particularly magnesium which is needed for almost 300 processes in the body, selenium, which is important for those of us with thyroid disorders, and perhaps zinc and iodine. And some of us, due to "genetic SNPs" - (Google it) - we need to take activated B vitamins - (it appears that I may be one of them; since starting a whole food B-complex a month ago, my high homocysteine level has dropped significantly).

Another quick aside, when supplementing with D3, it's important to take it with K2, possibly with magnesium too, to insure that the calcium goes to your bones, not your arteries.

When conversations with friends and acquaintances drift into the direction of "health", and I mention how inflammatory sugar, refined starches, and omega-6 seed oils - (corn, canola, cottonseed, soybean, saffola, sunflower, and peanut) - I am amazed when someone says they know and nod their head in agreement. It's rare. Perhaps I shouldn't be surprised though, because I didn't know myself until 4 years ago. I know now. And making that ONE change has been life changing for me. If I go to a restaurant and eat french fries cooked in a designated gluten-free fryer, I have stomach upset and diarrhea for 2 days. In my younger years, I ate deep fried food 3 or more times a week with no problems.

So before giving up on diet, perhaps a place to explore are the 5R's.

I think for me personally, my battle ground has been improving the profile of my microbiome and avoiding pro-inflammatory processed grains, sugars, and omega-6 seed oils.

I eat fresh, often local, organic produce with every meal to feed my "good" microbes and to help my body detoxify. Last fall, I was juggling too many obligations, stressed, and had a huge set back. 2 to 3 times a week, I'd treat myself to a carrot muffin made with rice flour - (I have non-celiac gluten sensitivity). I believe now that was all it took to feed and grow my "bad" microbes. I'm still working on getting my glucose levels back down. It's hard, but I'm back off grains and even the smallest amounts of processed sugar again. It's helping, but it's a slow slog.

All I'm trying to say here is that there's so much more that can be done to restore health than the low carb ketogenic diet, though I believe it's foundational for many diabetics.

 

[Winnie53]

Dr. Sarah Hallberg - Type 2 Diabetes Reversal
Emerging Science of Carbohydrate Restriction and Nutritional Ketosis, Scientific Sessions at The Ohio State University
October 2018
30 minutes

Encouraging testimonials... https://www.virtahealth.com/testimonials

 

[Winnie53]

Here's a second lecture by Dr. Hallberg that was given during grand rounds to doctors recently at the Cleveland Clinic Center for Functional Medicine. In it she states they take patients off of sulfonylureas medications - (like glipizide) - prior to reducing insulin...

And here's a testimonial that I believe you will find encouraging...

Nina's story: "After 20 years of taking insulin, I was completely off of it in just 1 year on Virta"

:

 

[Roseanne01]

hi,
2. I had a phone call with my diabetic nurse from the hospital today. I explained that my evening dose of insulin (26 units) leaves me sick and not wanting to eat after around 10-15 mins of injecting. She blamed the trulicity for doing this, which I think is bizarre. Any explanations on her thinking?

Thank you.

Hi, loss of appetite is among the most common side effects of trulicity. It eases over time. I had to get off it because of kidney disease, but it was also sedating me, a much less common side effect.