Can a morbidly obese T2 effectively become T1 due to 50% body fat??

[Binky21]

After 17 yrs of diabetes, I am in diabetes fatigue and my health in general is not working too well.

At first got good control through strict low carbing 40gms/day. After 18 months I got fed up (never lost any weight and if was very restrictive). Went onto metformin and reasonable carb control, maybe 100 - 120 daily carbs . Overtime, a few years, it went to Metformin and over night insulin (didnt want sulphonylureas? sp? ) but that got stopped when we got up to 50 plus units overnight and still no noticeable improvement in waking BG. Doctor said it was too dangerous and to try something else. After another few months, we decided I could go on to short acting insulin at breakfast to get the numbers down for the day. Fasting didnt do it, not eating carbs etc.

So over the years, we got into a pattern and I took short acting insulin before meals. When I got up to about 100 units short acting (over 3 meals) they decided to put me on vildagliptin (metformin and?? mix). This helped keep the insulin at 100 for a little longer, maybe a year. Then covid came and with lookdowns etc, my eating got away on me (So bored with everything) and locked up at home, I began to put on weight again for the first time in over a decade. Put on about 10kgs. Then my insulin needs went up to around 150, even having a cup of coffee spiked my BG by about 1 whole unit of BG and the Dr said no, we have to change this so we attempted to use long acting insulin, once daily. Got to 40 gms and stayed on roughly 110 insulin short acting. But 2 things happened with it, that were less desirable. More than 40 units results in raging candida and as I have a peak insulin period around lunchtimes, I started to get hypo's, repeatedly. So I dropped back to 40U Lantus and have now about 120 units of short acting during the day. But with the weight gain and the inactivity over the last few years, my insulin sensitivity is very poor and my HBA1C has moved from 48 to 57.

My diet needs to change as I am eating about 300gms of carbs a day. The insulin makes me ravenous and nothing much is working. I wake to BGs of 9 - 10, 11 if I eat badly the night before. Today for example, I took 40 lantus in the evening and my twice daily vildagliptin, BG 9.4 on waking, a bap with 2 small sausages, brown sauce and 2 cups of coffee. Took 45U Insulin. 2hr reading 15.4, took an additional 15 humulin. Now at 4.5 hours after breakfast, I am at 7.6. I will have to eat again soon and whilst this is my least insulin resistant time of the day, another meal with spark the situation again and I'll probably head into dinner at 7.5 - 8.

I have tried intermittent fasting but now I have so many pills and supplements to take that I cant manage it any more as I need to have a decently full stomach at least twice a day. Exercise too is out as I await a surgery on both knees due to arthritis. The insulin makes me hungry all the time so whilst I am rededicating my self to getting the carbs down, I am not sure that I will be able to actually get weight off because of the exercise and hunger things. Though that is my aim.

I have had hypothyroid for about 30 years and take carbimazole for that. I take an SSRI, an ace inhibitor for BP, a statin for cholesterol, 2 types Insulin, the Vildagliptin and an antihystamine and medication for IBS. I have never had any particular tests done on me past the initial sugar test and regular HBA1C's.

So at the end of all this, I have to ask, do fat people have (for obvious reasons) supernatural levels of insulin resistance? What should I do (what is sustainable and realistic?) I dont think I could do extreme low carbing again and it never solved my morning glucose problem in any event. Also do long term diabetics who are obese require a lot more insulin (I am 150kgs) or can they more easily tip over into Type 1?

Grateful for any and all help

B

 

[Jaylee]

Hi @Binky21 ,

I'm sorry to hear of your recent issues.

T1? Simplest way of explaining, is caused by an auto immune response killing beta cells in the pancreas producing insulin.
You could ask for a gad or c pep test to find out what your pancreas is playing at?

But on the whole, it's not usual for T2 to switch conditions.

Best wishes..

 

[Member496333]

100-120g of carbs is still far too much for a lot of type 2. 300g is just picking a fight. I would address that before overcomplicating anything. And don’t necessarily expect results overnight.

EDIT: but be extremely vigilant with medication vis-à-vis hypoglycaemia.

 

[EllieM]

My understanding (happy to be corrected if I've got it wrong) is that insulin resistance (IR) tends to increase with weight, and high blood sugars damage insulin producing cells. So T2s can get stuck in a weight increasing (too many carbs for their bodies to cope with) IR increasing and insulin reducing cycle. At which point they may need injected insulin. Unlike a T1, who will always need insulin, reducing IR (when you need less insulin) and blood sugar (your beta cells may recover) means that long term insulin isn't necessarily a given.

You're in a really difficult position @Binky21, you have my intense sympathy. While I agree that a cpeptide test would be helpful, in your position I'd try lower carb.

I take it your doctors haven't offered you any other treatment to help with weight and/or insulin resistance?

 

[Member496333]

Also be aware that c-peptide, while obviously a valuable tool, won’t reveal the reasons for any deficiency. If you were shown to be underproducing then it could be a fatty pancreas. Only antibody tests would confirm T1 but I’m led to believe that even those tests aren’t always conclusive.

You definitely need to declare war on carbs as a first measure and decrease meds in lockstep as and when necessary. If that hasn’t put a dent in your glucose after several months then you probably do have insulin deficiency problems. But remember it can take years for a T2 pancreas to recover, so tenacity with low-carb/keto is the way to go for at least the medium term.

 

[Daibell]

Note that insulin can't make you feel hungry or make you gain weight. It simply enables the body to metabolise carbs and if you have too many you will be in a 'carb-hit' cycle where the body craves more carbs (we all love sweet things!). Try to break the carb habit by having proteins and fats to keep you feeling full. You obviously have other medical conditions which may not be helping. Has the GP offered you one of the weekly injectables in the 'glutide' family?

 

[Rokaab]

I have had hypothyroid for about 30 years and take carbimazole for that.

Just as a thought, I know hypothyroidism can make losing weight a lot more difficult, but I thought that carbimazole was for hyperthyroidisn (which is what I have and is the opposite to hypothyroidism - I take carbimazole for said hyperthyroidism).
If you are hypothyroid and taking carbimazole, I'd be wondering why
Note obviously I'm not a doctor so could be horribly wrong but that seems odd to me

 

[Member496333]

Note that insulin can't make you feel hungry or make you gain weight.

Sorry but this objectively false. Insulin, in excess, absolutely can and will make people gain weight. Hyperinsulinemia is the primary driver of obesity and metabolic syndrome. Just because using insulin doesn’t make everyone fat doesn’t mean it plays no role. Making fat from glucose is one of its primary objectives, and the more you have sloshing about at any given moment trying to mop up excess glucose, the more fat will be made. Right up to the point where there is nowhere left to store the energy and the person becomes diabetic.

 

[Oldvatr]

Just as a thought, I know hypothyroidism can make losing weight a lot more difficult, but I thought that carbimazole was for hyperthyroidisn (which is what I have and is the opposite to hypothyroidism - I take carbimazole for said hyperthyroidism).
If you are hypothyroid and taking carbimazole, I'd be wondering why
Note obviously I'm not a doctor so could be horribly wrong but that seems odd to me

https://www.nhs.uk/medicines/carbimazole/

 

[ianf0ster]

I have no idea as to exactly how much weight gain is to be expected from taking carbimazole for over active thyroid, but a quick google suggests an average of 12kg after 24 months (according to PubMed) - which seems a lot to me. Of course people with over active thyroid tend to be very skinny with huge appetite and if not on medication they find it almost impossible to put weight on.

My wife used to have over active thyroid (hyperthyroidism) and was taking Carbimazole but it gave her bad muscle aches, after treatment with radioactive iodine this turned to underactive (hypothyroidism) so now she takes Levothhroxine .

I note that you are also taking a statin. As you probably already know, statins (and steroids) are the main medications which cause raised Blood Glucose - just what a T2 diabetic doesn't want. So unless your lipid ratios are poor, or you have hypercholesterolemia , I suggest you consider if a reduced dose of statin (or even no statin) may be more suitable for you.

Note that there is evidence (from the Huge US Framingham Heart study) that people with low or average cholesterol suffer heart attacks as much as those with raised cholesterol. Also that the 3 major risk factors for heart disease were High Blood Pressure, Diabetes, and Cigarette Smoking. Both Diabetes and High Blood Pressure tend to be improved by Low Car eating.

My total Cholesterol is high as is my LDL, but because my HDL is high and my Triglycerides are low (due to my Low Carb High(er) Fat, High Protein way of eating), then according to the follow-up results of Framingham my risk of either Heart Attack or Stroke is actually 30% less than that of the reference group.
See : https://www.cooperinstitute.org/201...-levels-should-not-be-interpreted-in-a-vacuum

 

[Jaylee]

Sorry but this objectively false. Insulin, in excess, absolutely can and will make people gain weight. Hyperinsulinemia is the primary driver of obesity and metabolic syndrome. Just because using insulin doesn’t make everyone fat doesn’t mean it plays no role. Making fat from glucose is one of its primary objectives, and the more you have sloshing about at any given moment trying to mop up excess glucose, the more fat will be made. Right up to the point where there is nowhere left to store the energy and the person becomes diabetic.

As someone who fo many years have been on an MDI regime. It would be unwise to add the caveats you seem to add in a cavalier fashion when basically cross posting.

Basal needs can change. I've used Lantus for many years.. The immediate could be what our friend has dosed for with the bolus for food? Starting with a basal test (whatever the diet.) would be the first move.

Any rapid swings with insulin could give the impression as it rolls relatively rapid from unhealthy prerameters into a more desirable zone or even a low? The "desire for hunger.." Second step, understanding an insulin to cab ratio with what is injected for food.

I don't disagree this stuff comes "overnight." But wearing the "tee shirt" regarding exogenous insulin, can help...

Declaring a war on carbs safely starts using insulin with basal testing, then understanding insulin to carb ratio..

Don't get me wrong. I feel you passion. Just feel your is a little misplaced under these particular circumstances.

 

[Binky21]

Also be aware that c-peptide, while obviously a valuable tool, won’t reveal the reasons for any deficiency. If you were shown to be underproducing then it could be a fatty pancreas. Only antibody tests would confirm T1 but I’m led to believe that even those tests aren’t always conclusive.

You definitely need to declare war on carbs as a first measure and decrease meds in lockstep as and when necessary. If that hasn’t put a dent in your glucose after several months then you probably do have insulin deficiency problems. But remember it can take years for a T2 pancreas to recover, so tenacity with low-carb/keto is the way to go for at least the medium term.

Thanks Jim. I am somewhat disheartened to hear 100 - 120 carbs is too much for some T2's.

I fought with low carbing for a while but at 28 - 38 gms per day measured religiously, I never lost any weight and never lost my craving for sweets. Hunger definitely wasnt an issue but boredom was. I craved an apple or a serving of root veges and hence why I went onto the higher carbs. It was also frustrating that with vlc, I was still getting morning readings of 8 or more. Also over about 7 years of this time, I was struggling with misdiagnosed PTSD which led to me being a couch potato and semi agoraphobic. So you can see how I gradually dropped out of low carbing and how the lack of exercise and isolation lead to other problems.

I dont want lo carbing to be the answer but I guess I will just have to bite the bullet and see how much I can get it down. Certainly I can get it to 150 without too much problem, the real challenge will be getting it down below 100. And as to the hunger issue, I have been substituting my sandwich lunch with meat and salad and I am having no problem going 4 hours plus without hunger. If I can just find some magic lo carb breakfast recipes then that will be half the battle. I find it almost imposssible to eat bacon and eggs after my 18 month vlc stint. Even 13 years later, I feel a bit nauseous having it (as I did today).

I am planning to get those 2 meals sorted whilst eating a normal dinner apart from banishing potatoes. Lastly, I will tackle the fruit after dinner and the hardest of all, milk in coffee and overall, less coffee.

Then it is just a case of trying to match up lo carbing with a calorie reducing diet and I may even crack losing some weight. 15kgs would make a lot of difference to my BG and knees, I suspect as well as get some weight off so I can more readily recover from my first knee op in 9 months time.

 

[Binky21]

Just as a thought, I know hypothyroidism can make losing weight a lot more difficult, but I thought that carbimazole was for hyperthyroidisn (which is what I have and is the opposite to hypothyroidism - I take carbimazole for said hyperthyroidism).
If you are hypothyroid and taking carbimazole, I'd be wondering why
Note obviously I'm not a doctor so could be horribly wrong but that seems odd to me

Thanks Rokaab, you are quite right it is hyper thyroid not hypothyroid, I was getting mixed up.

 

[Binky21]

I have no idea as to exactly how much weight gain is to be expected from taking carbimazole for over active thyroid, but a quick google suggests an average of 12kg after 24 months (according to PubMed) - which seems a lot to me. Of course people with over active thyroid tend to be very skinny with huge appetite and if not on medication they find it almost impossible to put weight on.

My wife used to have over active thyroid (hyperthyroidism) and was taking Carbimazole but it gave her bad muscle aches, after treatment with radioactive iodine this turned to underactive (hypothyroidism) so now she takes Levothhroxine .

I note that you are also taking a statin. As you probably already know, statins (and steroids) are the main medications which cause raised Blood Glucose - just what a T2 diabetic doesn't want. So unless your lipid ratios are poor, or you have hypercholesterolemia , I suggest you consider if a reduced dose of statin (or even no statin) may be more suitable for you.

Note that there is evidence (from the Huge US Framingham Heart study) that people with low or average cholesterol suffer heart attacks as much as those with raised cholesterol. Also that the 3 major risk factors for heart disease were High Blood Pressure, Diabetes, and Cigarette Smoking. Both Diabetes and High Blood Pressure tend to be improved by Low Car eating.

My total Cholesterol is high as is my LDL, but because my HDL is high and my Triglycerides are low (due to my Low Carb High(er) Fat, High Protein way of eating), then according to the follow-up results of Framingham my risk of either Heart Attack or Stroke is actually 30% less than that of the reference group.
See : https://www.cooperinstitute.org/201...-levels-should-not-be-interpreted-in-a-vacuum

Thanks for responding Ian Foster.
Yes, I have been on the large size since age 24 when I switched from being skinny. But I do have hyperthyroidism but not sure why. I dont know if its inherited but I had a cousin with it, the whole marty feldman thing. I didnt know you are supposed to put on weight with it, that was never mentioned. I opted not to take the iodine as I didnt want to end up thyroid deficient as I didnt think that would be good for my weight struggles. And the whole radio activity thing isnt too appealing. I mainly take carbimazole to keep my heart in check and because they thought it might help with IBS which can be a manifestation of hyperthyroid. However my carbimazole has stayed at the same dose for 20 years so I dont know if that is significant.

No I also didnt know statins raise Blood Glucose, no-one mentioned it Just like in my 20's when I started gaining weight and they told me I had massively high triglycerides and that I should stop drinking fruit juice because its bad for you and makes your triglycerides go sky high. No mention of why it was bad for you or the link to prediabetes etc which would have been a major red flag as my aunts were diabetic and had the same mid 20's weight gain.

I fought them off about the statin for 7 years but the cholesterol kept getting worse. I am now at 4.3 ratio, with 1.4 LDL that is with the statin. It was a bit worse before. I'll read up on the Framingham study and make a decision about whether to persevere with the statin or discontinue. 4 years ago before statin, I was TC 7.3 and 4.5 ratio, 4.5 Trigl.

 

[Binky21]

As someone who fo many years have been on an MDI regime. It would be unwise to add the caveats you seem to add in a cavalier fashion when basically cross posting.

Basal needs can change. I've used Lantus for many years.. The immediate could be what our friend has dosed for with the bolus for food? Starting with a basal test (whatever the diet.) would be the first move.

Any rapid swings with insulin could give the impression as it rolls relatively rapid from unhealthy prerameters into a more desirable zone or even a low? The "desire for hunger.." Second step, understanding an insulin to cab ratio with what is injected for food.

I don't disagree this stuff comes "overnight." But wearing the "tee shirt" regarding exogenous insulin, can help...

Declaring a war on carbs safely starts using insulin with basal testing, then understanding insulin to carb ratio..

Don't get me wrong. I feel you passion. Just feel your is a little misplaced under these particular circumstances.

Thanks for responding Jaylee.

Can you explain to me what a basal test is? And also insulin to carb ratio. Do you mean mine specifically? I get frustrated with the nurse who is diabetic whose idea of insulin to carb ratio is very different to mine I imagine because of my insensitivity to insulin.

 

[Binky21]

Note that insulin can't make you feel hungry or make you gain weight. It simply enables the body to metabolise carbs and if you have too many you will be in a 'carb-hit' cycle where the body craves more carbs (we all love sweet things!). Try to break the carb habit by having proteins and fats to keep you feeling full. You obviously have other medical conditions which may not be helping. Has the GP offered you one of the weekly injectables in the 'glutide' family?

Oddly enough, the Dr did say last month she could sqaueeze me into the parameters for a glutide but the side effects of UTIs and Candida are ones I have fought for a long time anyway and reading about gangrene freaked me out so I said no at the moment.

 

[Member496333]

As someone who fo many years have been on an MDI regime. It would be unwise to add the caveats you seem to add in a cavalier fashion when basically cross posting.

Basal needs can change. I've used Lantus for many years.. The immediate could be what our friend has dosed for with the bolus for food? Starting with a basal test (whatever the diet.) would be the first move.

Any rapid swings with insulin could give the impression as it rolls relatively rapid from unhealthy prerameters into a more desirable zone or even a low? The "desire for hunger.." Second step, understanding an insulin to cab ratio with what is injected for food.

I don't disagree this stuff comes "overnight." But wearing the "tee shirt" regarding exogenous insulin, can help...

Declaring a war on carbs safely starts using insulin with basal testing, then understanding insulin to carb ratio..

Don't get me wrong. I feel you passion. Just feel your is a little misplaced under these particular circumstances.

I was disagreeing with a particular, bolded portion of a statement falsely claiming that insulin cannot cause weight gain. In excess, in the setting of hyperinsulinemia, it can and does. Don’t mean to sound terse but this is incontrovertible fact.

 

[AndBreathe]

@Binky21 - strikes me you have a lot going on.

The recurrent candida can be a mechanism of high blood sugars in some. High sugars don't cause thrush, but it does provide and environment for it to thrive, so it is likely that could improve if you manage to get your sugars into a better place.

Many find the Flozin meds helpful, but I appreciate how starting them with recurrent thrush already could be a bit of a stumbling block for anyone. As I understand it the gangrene is very rare, and if any of us look at the potential side effects of any medication we might take it can be scary. I mean, even aspirin can look ultra unpalatable, and Ibuprofen an eye opener: https://bnf.nice.org.uk/drug/ibuprofen.html#cautions

I'm certainly not telling you I think you should take the meds, but just trying to say it's worth looking at the likelihood of some of these things.

If your doctor has you on carbimazole it seems likely your thyroid has been over active at some point.

The thing about thyroid disease it our thyroid is a cornerstone of our metabolic health and it governs, controls and influences so many of our systems. If it is out of kilter, that may not be helping you with weight gain and the metabolic chaos you seem to be describing

When did you last have your thyroid checked out? When you have that checked, do you have full bloods done, looking at all your thyroid hormones, general health indicators and vitamins. It really is a balancing act.

To be honest, in your shoes, right now, I'd be asking for a BIG MOT, going through everything from diabetes, blood pressure, lipids, thyroid and any other conditions you have. If there has been a single condition focus each time adjustments have been made, it may not have done you any favours.

 

[zand]

To throw a little extra into the mix, have you had your vitamin D levels checked? I have read that if the levels are low then weight loss is more difficult. It certainly seems true in my case.

 

[Jaylee]

Thanks for responding Jaylee.

Can you explain to me what a basal test is? And also insulin to carb ratio. Do you mean mine specifically? I get frustrated with the nurse who is diabetic whose idea of insulin to carb ratio is very different to mine I imagine because of my insensitivity to insulin.

Hi, here is an explanation on what basal testing is.. https://www.mysugr.com/en/blog/basal-rate-testing/

Insulin to carb ratio is pretty much how many grams of carbs 1 unit of bolus insulin could deal with.
However not all carbs digest at the same rate to alow the insulin working profile to compliment it? Timing of the dose is key, too..

Hope this helps..