Insulin Affecting Weight Loss

[frankbegbie]

Yes it really gets you down when you get no results.
After I got diagnosed with Type2 I read a few books and watched some videos, mainly Jason Fung.
I was really encouraged by what I read and watched, believing this needn't be as bad as I thought.
The LCHF diet took a bit of getting used to as I had been like most people encouraged to eat plenty of fruit and veg and low fat food along with high fibre bread.
But I eventually constructed a diet that I could live with and was low carb as well.
After months of living this way my blood sugar was lower but there was no weight loss.
So tried a longer fast over 5 days; all that happened was I got weaker and weaker so had to abandon it.
Same thing happened again when I tried it a few weeks later.
I sort of gave up on the LCHF diet and started eating a lot of what I used to eat.
So the Thyroid problem is my 'last chance saloon' really.
If it's 'normal' I don't know what I'll do.

 

[Bewildered]

No, my GP surgery won't do GAD, Cpeptide or any additional tests due to costs. At one point a few years back there was an interim DSN who questioned my T2 diagnosis as I had a very rapid progression... but it never went beyond that, and she left, I'm probably just going off a misguided assumption that I have days where I can eat perfectly and do all the right things, but still need a fair bit of insulin; then other days where the requirement is much less and my blood sugars are better. So it could be days of less resistance and days of more resistance... I'll never actually know.

I haven’t read all the way through this thread but i was treated as type 2 for 5 years despite my protests that i thought i was type 1, with a long list of supporting factors. GP refused to do the test so eventually ( when my weight plummeted and i had pressure areas on my knees and sacral area, felt like death etc etc ) I paid to go privately for a consultation, the Dr took one look at me and sent me to A&E, where I then had the test done on the NHS as i had DKA and his words were ‘you’re not type 2’ just by looking at the state of me. I know you say you are struggling with your weight but I wasn’t on insulin at this point so that may be the difference between us. It helped to know that I wasn’t going mad, that the 3 medications i was on and low carb diet not working with my readings was actually down to misdiagnosis and inappropriate treatment, I am still struggling mind you and have put on loads of weight. But if you feel you need to know, maybe ask your GP to do a blood form to have this done privately? It might help to know?

 

[HSSS]

Dr Bernstein might be another one to look at. He is and advocates to type 1 so comes at keto from an insulin user point of view and might have some insight that’s helpful

There’s still a bit of room to reduce carbs and therefore insulin if that’s what takes to get the weight shifting. Just please be very hypo aware as you do so

 

[luceeloo]

Dr Bernstein might be another one to look at. He is and advocates to type 1 so comes at keto from an insulin user point of view and might have some insight that’s helpful

There’s still a bit of room to reduce carbs and therefore insulin if that’s what takes to get the weight shifting. Just please be very hypo aware as you do so

Thank you - I have his book

 

[luceeloo]

As well as Fung, google Westman. He is getting good results on 20g of carbs a day.
If lowering the carbs more isn't effective enough. Has the doctor or perhaps an endo, spoken to you about adding one or more of the several T2 meds that can help and may reduce your insulin need.

If you want more evidence have a look at the ViRTA health publications.

They follow a similar keto diet to Westman and have been getting lots of people off insulin.
https://www.virtahealth.com/research#Papers

So yesterday I decided to take the bull by the horns... 15g Carbs and 1100 calories. I corrected in the AM as I didn't like the 9.9 morning high, but didn't bolus for lunch or dinner. After watching Westman, I decided to halve my basal last night, from 44 units to 22 units. I woke up this morning with 6.9... which is considerably lower than my normal fasting reading. So, the experiment will continue throughout the day today.

 

[bulkbiker]

So yesterday I decided to take the bull by the horns... 15g Carbs and 1100 calories. I corrected in the AM as I didn't like the 9.9 morning high, but didn't bolus for lunch or dinner. After watching Westman, I decided to halve my basal last night, from 44 units to 22 units. I woke up this morning with 6.9... which is considerably lower than my normal fasting reading. So, the experiment will continue throughout the day today.

Wow that's a pretty impressive result for a short space of time..
Well done and just remember to keep an eye on your numbers to avoid hypos.

 

[luceeloo]

My blood sugar was more temperamental yesterday, and I had to correct a little more despite eating minimal carbs (14g, and about 1000 calories). It was hovering around 9 a bit more than I'd like, but my protein was probably a bit higher than I'd usually have, so that may account for the spikes. I'd also run out of almond milk so had normal semi-skimmed in my coffee - back to almond this morning.
Instead of keeping my basal at half, I added an extra quarter. So I'm now at 3/4 of my original dose and will see how that goes. Woke up to 7.2 this morning,
The experiment continues...

 

[HSSS]

Is 1000 calories normal for you? It really is not very much at all. That sounds like low carb, low fat and probably low protein too! Is that a deliberate choice rather than low carb alone or even low carb and moderate fat/protein rather than high? Whilst I realise protein may having dosing issues for insulin users it is essential to maintain a good intake to protect lean muscle and the metabolism.

I’m wondering if you had some liver dumping of glucose going on as a result of the drastic changes hence the variability.

 

[NicoleC1971]

Wow - I just watched one of Westman's lectures. It actually makes sense, I've taken notes, and I'm going to immediately drop the carbs completely.
As for T2 meds, the Dr had me on Metformin, then Glicazide, Lyxumia, Dapagloflozin, Canagloflozin, and I've probably missed out something. The Endo took me off Canagloflozin in favour of going on to a full insulin regime. I have an appointment with a new DSN at my practice in a couple of weeks time, so I'm going drop my carbs, record the results, and then see if she'll work with me on reducing insulin and maybe adding the Canagloflozin back (as it really worked for me). I still have a prescription for metformin slow release, but have issues tolerating it. However, I'm going to persevere with it.

Well done on all the effort you are putting into to get as well as you can physically and emotionally. I am guessing from the persistent weight getting stuck that you are simply quite insulin resistant. Can you indicate how much insulin you are on as well as the meds? If you can get your insulin needs to deal with the food you are eating, as low as possible with the hope that you can come off the insulin or reduce the dose this will help liberate some body fat supplies. Sounds as if you are now in a place to move forward with a very low carb approach coupled with a med review. As you know from Dr Fung the 'flozins' help by expelling the glucose from your body provided you can do so without complications such as UTIs etc. As you know lowering your blood glucose is not treating the root cause of the insulin resistance so your blood glucose is a greater marker of that insulin resistance but you could take a look at a proxy such as triglycerides/hdl ratio as well as the hba1c. Physically I'd stop looking at the scales and find some better measure of body composition such as photos front and side on of your waist and stomach or using a tape measure to track the changes that matter in this area.
The final piece could be resistance training if you're not already doing this? e.g. kettle bell swings, squats, lunges, push ups etc. etc. which will build muscle (more glycogen storage capacity) and make your more insulin sensitive (the goal).
Whatever you want to try I'd go for the very low carb/keto approach )ensuring you are not filling up on too many bulletproof coffees and fat bombs of course) first of all as this is going to give you the most bangs for your buck and it is important to get consistent before adding in additional exercise for example. You may well need to adjust your drugs especially insulin. If you do that's going to be a great sign that its working!
If none of the above works then it wold make sense to check that your body is producing normal insulin levels.

 

[optimist1]

Wow - I just watched one of Westman's lectures. It actually makes sense, I've taken notes, and I'm going to immediately drop the carbs completely.
As for T2 meds, the Dr had me on Metformin, then Glicazide, Lyxumia, Dapagloflozin, Canagloflozin, and I've probably missed out something. The Endo took me off Canagloflozin in favour of going on to a full insulin regime. I have an appointment with a new DSN at my practice in a couple of weeks time, so I'm going drop my carbs, record the results, and then see if she'll work with me on reducing insulin and maybe adding the Canagloflozin back (as it really worked for me). I still have a prescription for metformin slow release, but have issues tolerating it. However, I'm going to persevere with it.

I hope Westman works out for you, I saw @bulkbiker also linked Virta, that is another good source. Anything from Westman, Phinney and Volek is worth taking onboard.

Some people do have continuing trouble, even with Metformin slow release. Has the doctor told you how long to try, before giving up on it. It can take a while. Metformin, Dapagliflozin-SGLT2, Lyxumia-GLP-1, used with insulin. That is something I would like from my doctor, if I needed to. Swapping Dapagliflozin back to Canagloflozin would be worth asking, if you found it worked better for you. They also took you off Glicazide, when they added insulin?

My blood sugar was more temperamental yesterday, and I had to correct a little more despite eating minimal carbs (14g, and about 1000 calories). It was hovering around 9 a bit more than I'd like, but my protein was probably a bit higher than I'd usually have, so that may account for the spikes. I'd also run out of almond milk so had normal semi-skimmed in my coffee - back to almond this morning.
Instead of keeping my basal at half, I added an extra quarter. So I'm now at 3/4 of my original dose and will see how that goes. Woke up to 7.2 this morning,
The experiment continues...

A 25% reduction in basal is a good result. You must be pleased that you see a way ahead. There may not be a need to have more than 75g/day of protein. There are keto protein calculators. Personally, I would add some more healthy fats, to boost the calories up a bit. Once the insulin is sorted, weight loss may be easier. It's all looking good so far.

 

[luceeloo]

Some people do have continuing trouble, even with Metformin slow release. Has the doctor told you how long to try, before giving up on it. It can take a while. Metformin, Dapagliflozin-SGLT2, Lyxumia-GLP-1, used with insulin. That is something I would like from my doctor, if I needed to. Swapping Dapagliflozin back to Canagloflozin would be worth asking, if you found it worked better for you. They also took you off Glicazide, when they added insulin?

The Metformin slow release struggle has been going on for at least 2 years, previous to that I'd been fine taking it for quite a while. I keep being told to persevere... but I do have a new DSN that I see in two weeks time, so will spell out just how long I've been trying it for! I had the Lyxumia at the same time as Lantus (which did nothing for me), but they discontinued both Lyxumia and Dapagliflozin before I went on to fast acting. I had no issues with any of the 'Flozins'. They were great for my blood sugar, great for weight, and I didn't even mind the constant peeing or drinking water! I'm hoping that if I can prove that I can keep my hba1c down, then they'll let me phase out the novorapid and go back on to one of those.

 

[optimist1]

OK, so it is just met and insulin. I would talk about your long standing issue with met. As you know it doesn't suit everyone. The Canagloflozin could well help reduce your insulin dose and well worth asking about.
As to Lyxumia-GLP-1, for you it sounds like it didn't help much. I was the opposite and a GLP-1 helped a lot. Perhaps one of the later, weekly ones could have some benefit and worth discussing?
Both Canagloflozin and a GLP-1 can be used with basal and bolus insulin, I don't know what the NHS rules are and perhaps an endo would have greater prescribing scope. They do have a combined Lyxumia (lixisenatide) and basal insulin.
https://www.sps.nhs.uk/medicines/insulin-glargine-lixisenatide/

Hopefully in a couple of months, the new diet will let you have minimal meds. How are you feeling with any initial dietary side effects, It can be a hard couple of weeks?

 

[luceeloo]

OK, so it is just met and insulin. I would talk about your long standing issue with met. As you know it doesn't suit everyone. The Canagloflozin could well help reduce your insulin dose and well worth asking about.
As to Lyxumia-GLP-1, for you it sounds like it didn't help much. I was the opposite and a GLP-1 helped a lot. Perhaps one of the later, weekly ones could have some benefit and worth discussing?
Both Canagloflozin and a GLP-1 can be used with basal and bolus insulin, I don't know what the NHS rules are and perhaps an endo would have greater prescribing scope. They do have a combined Lyxumia (lixisenatide) and basal insulin.
https://www.sps.nhs.uk/medicines/insulin-glargine-lixisenatide/

Hopefully in a couple of months, the new diet will let you have minimal meds. How are you feeling with any initial dietary side effects, It can be a hard couple of weeks?

It's funny you say this - I haven't been online for a couple of weeks. I saw my DSN earlier today, and we're keeping Toujeo, dumping both Novarapid and Metformin, but adding in Dapagliflozin and Ozempic. I couldn't be happier about this!

 

[optimist1]

I'm pleased for you. It sounds like a good mix. That and diet may reduce the Toujeo dose. The first few weeks of Ozempic gave me gut issues, but worth working through for me. I took an antacid.

How is the low carb going? Your body should be getting adjusted to it, any issues?

 

[luceeloo]

I'm pleased for you. It sounds like a good mix. That and diet may reduce the Toujeo dose. The first few weeks of Ozempic gave me gut issues, but worth working through for me. I took an antacid.

How is the low carb going? Your body should be getting adjusted to it, any issues?

Today I had a call from the DSN to say that the Ozempic idea was being shelved for a bit, but that the consultant had recommended that Dapaglaflozin could be added. An hour later I had a text message to advise that the dapaglaflozin idea has been shelved too by one of the prescribing GPs at my surgery.
Back to square one.
Can't help feeling that my care comes down to basic cost.

 

[optimist1]

I'm sorry to hear that. Can an endo over-ride the GP and consultant? Although the consultant is onboard with a SGLT2. Is there an appeals process, with the consultant's support? One could argue that only insulin isn't 'best practice' for you, given the weight.

Would you be able to access this weight loss and reverse T2 program?
https://www.diabetes.org.uk/about_us/news/nhs-low-calorie-diet-remission

or eating well.
Studies show 20g of carbs a day, can get a lot of T2 off insulin within a short time (Dr Westman). To then allow a SGLT2 or GLP-1 if needed?
https://www.atkins.com/how-it-works/atkins-20/phase-1
https://sa.atkins.com/static/default/files/documents/pdf/mealplan/Atkins - Meal Plan_Week_onePhase one.pdf

 

[Goonergal]

Sorry to hear that @luceeloo

Do you have scope to get a second opinion/ask the GP to reconsider. I think it’s pretty poor form to be offered something and have it taken away by text message without so much as a decent explanation.

 

[Andydragon]

Today I had a call from the DSN to say that the Ozempic idea was being shelved for a bit, but that the consultant had recommended that Dapaglaflozin could be added. An hour later I had a text message to advise that the dapaglaflozin idea has been shelved too by one of the prescribing GPs at my surgery.
Back to square one.
Can't help feeling that my care comes down to basic cost.

Did they give any explanation as to why? Dapa has some side effects at times that perhaps could be seen as risky for your medical history maybe? but I would like to think you should get a phone call to talk you through it, not a text.

my doctors are quite online from covid but when discussing my health do ensure it is by voice

given a consultant recommended these options, the explanations should be talked through. I’m sorry you are having bad experiences

 

[luceeloo]

I'm sorry to hear that. Can an endo over-ride the GP and consultant? Although the consultant is onboard with a SGLT2. Is there an appeals process, with the consultant's support? One could argue that only insulin isn't 'best practice' for you, given the weight.

Would you be able to access this weight loss and reverse T2 program?
https://www.diabetes.org.uk/about_us/news/nhs-low-calorie-diet-remission

or eating well.
Studies show 20g of carbs a day, can get a lot of T2 off insulin within a short time (Dr Westman). To then allow a SGLT2 or GLP-1 if needed?
https://www.atkins.com/how-it-works/atkins-20/phase-1
https://sa.atkins.com/static/default/files/documents/pdf/mealplan/Atkins - Meal Plan_Week_onePhase one.pdf

I'm already eating very low carb, but I'm taking this opportunity to reassess everything. I now realise that whilst I may have the support of the Nurse (and it is an Endo consultant that she works for), my GP surgery will always over-ride everything based on cost. That's the way that they have always been, and I don't see that changing. Eventually I'm going to have to change surgery if I want a better outcome, but that's not something I can do right now.
I'm not able to access the NHS Low calorie Diet programme - the offering around here is Oviva. I was offered that a couple of days ago. They do different types of courses. I've been offered the Diabetes Support Programme. I asked if the weight loss programme that they do is available to me, and unfortunately it's not (cost again).

Sorry to hear that @luceeloo

Do you have scope to get a second opinion/ask the GP to reconsider. I think it’s pretty poor form to be offered something and have it taken away by text message without so much as a decent explanation.

I received the text and called the practice right away. I was advised that the DSN had left for the day, and wouldn't return until next Wednesday, and she is the only person who can discuss it. Believe me, I'll be right on the phone with her on Wednesday. I understand that her hand are tied by the usual politics that reigns at my surgery, but she shouldn't have put the offers on the table in the first place.

Did they give any explanation as to why? Dapa has some side effects at times that perhaps could be seen as risky for your medical history maybe? but I would like to think you should get a phone call to talk you through it, not a text.

my doctors are quite online from covid but when discussing my health do ensure it is by voice

given a consultant recommended these options, the explanations should be talked through. I’m sorry you are having bad experiences

No explanation. We'd gone through the risks on the dapagliflozin on an earlier phonecall, and the Consultant had been happy to proceed with it. The DSN was due to call me back as she was going to confirm that the prescription had been pushed through to the pharmacy, and instead of a callback I got a text telling me that there was no changes to be made to my medication. I called the surgery immediately, and was advised that the DSN had left and wouldn't be back until next Wednesday. Apparently the GP's can't help because they "don't get involved in the diabetic cases that the specialist nurse handles"... but obviously they do because they can vetoe a prescription for a diabetic drug very easily :-D

 

[TashT1]

Changing GP surgeries won’t do much, they are being integrated into Primary Care Network, depending on where you live there might not be more than one PCN & prescribing practices will be the same. You might get some support from a practice pharmacist that works with GPs in the PCN. They have a meds management role & might see things differently to your GP. They can argue that it’s cost effective in the long run.

I would also contact my county councillor who could put you in touch with the Heath and Well-being committee, you can lobby through them to change prescribing practices.

Not easy routes admittedly but it might be worth fighting for.