Hey folks.
Roughly four years ago, I was suspected to have developed type 2 diabetes when I was around 23 years old. Specialists outside of my GP concurred with this sentiment. My HbA1c was sitting around 8-9%. I was overweight at the time and had been all but completely immobile for almost an entire year as I was suffering from a dreadful herniated disc in my back in accordance with chronic insomnia. I poorly chose to cope with my pain via consuming ridiculous quantities of sugary foods and beverages – YouTube and Netflix aided as well, of course. Prior to this, I was an individual that decided to start eating quite healthily and begin exercising regularly on an elliptical after my mid teen years. I was very rarely overweight and my family doesn't have a history of type 2 diabetes.
At the time of my diagnosis, I weighed somewhere around 210-220 pounds (I'm 5'9 / 175cm). My doctor told me that some people are able to control type 2 diabetes through diet and exercise, thus I decided that I would attempt to do so as well before relying on medication. The prospects of risky back surgery and likely potential progression of type 2 diabetes inspired me to fight through my crippling pain and hop back on the elliptical for the first time in a year. Combining exercise with a low calorie ketogenic diet resulted in pounds metaphorically melting away, as I was able to drop 50 pounds in around 3-4 months. My weight loss resulted in my herniated disc eventually becoming asymptomatic and my HbA1c dropped to 5.2%.
Over the next three years, I increased my caloric intake, kept carbs very low, continued exercising, shed off a few more pounds until I sat comfortably at 140 and maintained a HbA1c that fluctuated between 5.0-5.6%. Things were great and my doctor, at some point during said years, claimed that I had entered remission.
At the inception of 2020, I had begun experiencing unintentional weight loss. I found myself struggling to maintain my weight at 140 pounds in spite of refraining from changing my eating and exercising habits. I had lost 10 pounds over the course of a few months, so I was advised by my doctor to speak with a pair of dietitians that specialize in advising diabetics. They told me that I was likely losing weight because of my extremely low carbohydrate consumption, yet I found this strange considering that I had essentially been neglecting carbs for the last three years. They said that my condition could be declining in spite of me having controlled my condition so well thus far, so I went back to my doctor, received a prescription for metformin and started consuming more carbs as the dietitians recommended.
A few more months passed and I continued to lose weight, eventually reaching a low of 120. I didn't even end up adding a significant amount of carbs to my diet, yet my HbA1c rose to 7-8%. At some point during the year, I noticed that exercise started having less of an effect on my blood sugar, thus my blood sugar average continued to climb. Around mid-December of 2020, I started seeing ridiculous numbers ranging from 15-20 mmol/l. I didn't know what my HbA1c was in the last quarter of 2020, but I imagine it must have been far greater than 9%. Going back to a low calorie keto diet did nothing to curb my blood sugar levels, so I called my doctor, who ended up swapping out my metformin for a metformin/sitagliptin combination. This ended up lowering my sugars, but my average readings were still far too high. A few weeks later, even after eventually adding gliclazide into the mix, my average readings were still too high. I started pondering that what was happening to me wasn't making much sense if I was supposedly an insulin-resistant type 2 diabetic, as I wasn't experiencing weight gain. I asked my GP if there was a test out there that could determine whether someone was insulin resistant or insulin deficient, suggesting to him if there was a possibility that I was instead insulin deficient. Sometime in January, my GP set me up an appointment with an endocrinologist that I had seen a few years prior, as they would likely be able to tackle my situation and shed light on what was happening to me in addition to being able to conduct certain tests. Unfortunately, I would have to wait 3 months to see this endocrinologist, so I just had to keep doing what I could while my GP gradually increased the dosage of my medications.
In April 2021, I finally saw the endocrinologist. She told me that she was going to conduct a few tests in order to determine what my HbA1c was in addition to a c-peptide test and GAD antibody test. For the time being, she started me on 8 units of basal / long-lasting insulin to take nightly. I immediately started seeing results, as nightly blood sugar readings as high as 13-15mmol/l were turning into 5 through 9s in the morning. Unfortunately, my tests were delayed a few times because the health centers I visited could only conduct a certain number of GAD antibody tests per day – or something like that. One time, I may have also neglected to remember that I had to come for the test in the morning. Oops.
Enter May 2021. My endocrinologist called me today with the test results. Even with all of the medication I was on, my HbA1c was sitting at 9%. While this is terrible, I took some comfort in the fact that it had not risen any higher than that. I just had a feeling that I knew what was coming next, but I was prepared to receive the news. First, I was told that I actually had very low insulin levels. Next, I was told that two types of antibodies were found within my pancreas, with the presence of GAD antibodies in particular being very high. I knew what this meant, but she stated it anyway: type 1 diabetes.
While I personally think this blows overall, I'm finding some solace in the fact that I didn't necessarily do anything to acquire this disease. Believing that I was a type 2 diabetic and failing to control it was extremely frustrating, thus I feel some relief in a strange way; I don't feel defeated anymore. The idea of struggling and losing ground against a disease that is said to be manageable via diet and exercise alone can be devastating.
Anyway, my prescription for NovoRapid should be coming in later today. It's been a long four-year struggle, but now it's time to continue the struggle in a new light. Everything I thought I knew about my condition has changed. This being said, I do have a few questions:
1.) Ideally, what should my meal-time dosage of insulin look like in terms of an insulin-to-carb ratio? My endocrinologist merely told me to start off with 4 units for breakfast, 3 units for lunch and 5 units for dinner to start. I've read that 1 unit of meal-time insulin can be used to drop blood sugar by 2 mmol/l per unit if needed for corrections, then 1 additional unit for every 10 grams of net carbs. Is this information accurate and a good place to start?
2.) My carb intake has been dreadfully low for the last 4 years. My diet has consisted of high healthy fats, moderate protein and low net carbs but high fiber. If I want to continue a diet similar to this and not merely meet a carb quota for the purpose of judging insulin dosage, how – if at all – would I judge my insulin dosage for protein consumption? Fat doesn't seem to be an issue, but protein consumption even without carbs can sometimes spike my blood sugar levels. I do know that excess / unused protein is converted to glucose, but is there a way to quantify protein consumption for insulin injections?
3.) The target range for corrections and overall blood sugar average seems to be between 4 and 7 mmol/l. I'm quite fearful of long-term complications, considering that I've had a high HbA1c since December of last year. Should I start aiming for 4 mmol/l right off the bat, or should I aim for something higher until I get familiar with meal-time insulin dosages and their affect on my blood sugar levels?
4.) Is insulin resistance typical for type 1 diabetics? I've been told that it seems like I show no signs of insulin resistance, but that it could develop in type 1 diabetics if they gain weight and make unhealthy lifestyle choices. Is this accurate? Does the mere act of taking insulin, and an increasing amount of insulin over time, eventually lead to insulin resistance?
Roughly four years ago, I was suspected to have developed type 2 diabetes when I was around 23 years old. Specialists outside of my GP concurred with this sentiment. My HbA1c was sitting around 8-9%. I was overweight at the time and had been all but completely immobile for almost an entire year as I was suffering from a dreadful herniated disc in my back in accordance with chronic insomnia. I poorly chose to cope with my pain via consuming ridiculous quantities of sugary foods and beverages – YouTube and Netflix aided as well, of course. Prior to this, I was an individual that decided to start eating quite healthily and begin exercising regularly on an elliptical after my mid teen years. I was very rarely overweight and my family doesn't have a history of type 2 diabetes.
At the time of my diagnosis, I weighed somewhere around 210-220 pounds (I'm 5'9 / 175cm). My doctor told me that some people are able to control type 2 diabetes through diet and exercise, thus I decided that I would attempt to do so as well before relying on medication. The prospects of risky back surgery and likely potential progression of type 2 diabetes inspired me to fight through my crippling pain and hop back on the elliptical for the first time in a year. Combining exercise with a low calorie ketogenic diet resulted in pounds metaphorically melting away, as I was able to drop 50 pounds in around 3-4 months. My weight loss resulted in my herniated disc eventually becoming asymptomatic and my HbA1c dropped to 5.2%.
Over the next three years, I increased my caloric intake, kept carbs very low, continued exercising, shed off a few more pounds until I sat comfortably at 140 and maintained a HbA1c that fluctuated between 5.0-5.6%. Things were great and my doctor, at some point during said years, claimed that I had entered remission.
At the inception of 2020, I had begun experiencing unintentional weight loss. I found myself struggling to maintain my weight at 140 pounds in spite of refraining from changing my eating and exercising habits. I had lost 10 pounds over the course of a few months, so I was advised by my doctor to speak with a pair of dietitians that specialize in advising diabetics. They told me that I was likely losing weight because of my extremely low carbohydrate consumption, yet I found this strange considering that I had essentially been neglecting carbs for the last three years. They said that my condition could be declining in spite of me having controlled my condition so well thus far, so I went back to my doctor, received a prescription for metformin and started consuming more carbs as the dietitians recommended.
A few more months passed and I continued to lose weight, eventually reaching a low of 120. I didn't even end up adding a significant amount of carbs to my diet, yet my HbA1c rose to 7-8%. At some point during the year, I noticed that exercise started having less of an effect on my blood sugar, thus my blood sugar average continued to climb. Around mid-December of 2020, I started seeing ridiculous numbers ranging from 15-20 mmol/l. I didn't know what my HbA1c was in the last quarter of 2020, but I imagine it must have been far greater than 9%. Going back to a low calorie keto diet did nothing to curb my blood sugar levels, so I called my doctor, who ended up swapping out my metformin for a metformin/sitagliptin combination. This ended up lowering my sugars, but my average readings were still far too high. A few weeks later, even after eventually adding gliclazide into the mix, my average readings were still too high. I started pondering that what was happening to me wasn't making much sense if I was supposedly an insulin-resistant type 2 diabetic, as I wasn't experiencing weight gain. I asked my GP if there was a test out there that could determine whether someone was insulin resistant or insulin deficient, suggesting to him if there was a possibility that I was instead insulin deficient. Sometime in January, my GP set me up an appointment with an endocrinologist that I had seen a few years prior, as they would likely be able to tackle my situation and shed light on what was happening to me in addition to being able to conduct certain tests. Unfortunately, I would have to wait 3 months to see this endocrinologist, so I just had to keep doing what I could while my GP gradually increased the dosage of my medications.
In April 2021, I finally saw the endocrinologist. She told me that she was going to conduct a few tests in order to determine what my HbA1c was in addition to a c-peptide test and GAD antibody test. For the time being, she started me on 8 units of basal / long-lasting insulin to take nightly. I immediately started seeing results, as nightly blood sugar readings as high as 13-15mmol/l were turning into 5 through 9s in the morning. Unfortunately, my tests were delayed a few times because the health centers I visited could only conduct a certain number of GAD antibody tests per day – or something like that. One time, I may have also neglected to remember that I had to come for the test in the morning. Oops.
Enter May 2021. My endocrinologist called me today with the test results. Even with all of the medication I was on, my HbA1c was sitting at 9%. While this is terrible, I took some comfort in the fact that it had not risen any higher than that. I just had a feeling that I knew what was coming next, but I was prepared to receive the news. First, I was told that I actually had very low insulin levels. Next, I was told that two types of antibodies were found within my pancreas, with the presence of GAD antibodies in particular being very high. I knew what this meant, but she stated it anyway: type 1 diabetes.
While I personally think this blows overall, I'm finding some solace in the fact that I didn't necessarily do anything to acquire this disease. Believing that I was a type 2 diabetic and failing to control it was extremely frustrating, thus I feel some relief in a strange way; I don't feel defeated anymore. The idea of struggling and losing ground against a disease that is said to be manageable via diet and exercise alone can be devastating.
Anyway, my prescription for NovoRapid should be coming in later today. It's been a long four-year struggle, but now it's time to continue the struggle in a new light. Everything I thought I knew about my condition has changed. This being said, I do have a few questions:
1.) Ideally, what should my meal-time dosage of insulin look like in terms of an insulin-to-carb ratio? My endocrinologist merely told me to start off with 4 units for breakfast, 3 units for lunch and 5 units for dinner to start. I've read that 1 unit of meal-time insulin can be used to drop blood sugar by 2 mmol/l per unit if needed for corrections, then 1 additional unit for every 10 grams of net carbs. Is this information accurate and a good place to start?
2.) My carb intake has been dreadfully low for the last 4 years. My diet has consisted of high healthy fats, moderate protein and low net carbs but high fiber. If I want to continue a diet similar to this and not merely meet a carb quota for the purpose of judging insulin dosage, how – if at all – would I judge my insulin dosage for protein consumption? Fat doesn't seem to be an issue, but protein consumption even without carbs can sometimes spike my blood sugar levels. I do know that excess / unused protein is converted to glucose, but is there a way to quantify protein consumption for insulin injections?
3.) The target range for corrections and overall blood sugar average seems to be between 4 and 7 mmol/l. I'm quite fearful of long-term complications, considering that I've had a high HbA1c since December of last year. Should I start aiming for 4 mmol/l right off the bat, or should I aim for something higher until I get familiar with meal-time insulin dosages and their affect on my blood sugar levels?
4.) Is insulin resistance typical for type 1 diabetics? I've been told that it seems like I show no signs of insulin resistance, but that it could develop in type 1 diabetics if they gain weight and make unhealthy lifestyle choices. Is this accurate? Does the mere act of taking insulin, and an increasing amount of insulin over time, eventually lead to insulin resistance?
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