A bit of a dilemma

[992947x]

So I am a type 3c diabetic, having had two episodes pancreatitis, three years apart in the last decade. I have reduced insulin production, my kas H1ABC was 95m and my average over the last ten years was over 100. In January, with help from my Libre it was determined that my 90 day average for glucose was 16. I have been on Lantus (long acting) and Nova Rapid (short acting) insulin for about 10 years. Some days I was taking over 100 unts per day. I have had complications - luckily I still have all my limbs, but have got diabetit retinophy in both eyes, and have also had a detatched retina in my right eye because of my diabetes.

I have worked hard to get this under control since. In February, I have started the carnivore diet, which amazingly I have kicked all my cravings, and just eat beef, bacon, cheese, sardines, cream and eggs. In the last six weeks, I have got my insulin control so I am an average of 5.2mmol, with 20 units of lantus, and about 4 units novorapid per day. I am heading for a HBA1C of <40 I suspect which is epic given how it has been before.

So my question, or dilemma is this: I believe my diabetes is the problem of lack of insulin and insulin resistance, and that although injecting the insulin helps in one way, hinders in others. I therefore want to try and reduce my insulin resistance, and feel that by injecting insulin I am not going to do this. My thoughts on this is that if I stop taking my insulin, I can reduce my insulin resistance, and need to hope that my body is producing enough insulin itself in the meantime. I consume 0 carbs and 0 sugars except those found in eggs, so I am consuming less than 10g of carbs per day. I burn around 300 calories per day through exercise, and my body is converting my proteins to sugars fine I suspect, as my average glucose has been around 5.2.

So I have not injected my insulin for about 4 days. My blood sugars have risen to an average of 7 for the last couple of days, so they have risen, as expected, which goes to show that my body is too insulin resistance to cope by itself, or not producing enough insulin (impossible to tell which, but maybe a combination of both). I am testing blood sugar was my libre, and ketones to spot high levels and the risk of ketoacidosis. I am in ketosis obviously because of my diet, but nothing excessive. I want to perserver for a month, and see if my blood sugars start coming down.

My diabetes support team hadn't heard of type 3c diabetes (I moved to the area three years ago, but was diagnosed in a different county). They tell me to eat grains for fibre, drink milk for calcium (I don't believe I need fibre, and get my calcium from Sardines), and they have different beliefs to me, after my comprehensive research into this area so I don't believe I can ask them for advice and get the right answers.

I am sure people on here have gone into remission with type 2, and there are type 1's doing carnivore and managing their insulin better. I wonder what those with similar story to mine might make to my ideas, and thoughts.

 

[Deleted member 527103]

I am not sure about your hypothesis. It s often reported that a low/no carb diet INCREASES insulin resistance rather than reduces it.
I have heard of no one with Type 1 diabetes doing carnivore and managing their insulin better - it is harder because, in the absence of carbs, out bodies break down proteins to glucose. Therefore, you need to bolus for the proteins you eat at a different time (the conversion from protein to glucose takes longer) and at different insulin to protein ratios for different types of protein.
However (as a non-doctor), I do not believe a basal of 20 units of Lantus a day indicates insulin resistance so I do not understand why you are trying this zero insulin regime when you have no problem.

 

[EllieM]

My dietician has told me that I need more insulin per carb if I eat low carb, and so far my insulin pump agrees with her. (I'm still happy to low carb, because the total insulin is less, and I find it easier to manage.)

I have no idea whether you have insulin resistance as well as reduced insulin production. But I find it unlikely (personal opinion, I am not a doctor) that having less insulin than you need will reduce insulin resistance.

So it's a question as to whether your remaining insulin production will sustain you on a zero carb diet. But please be aware that any illness is likely to boost your insulin needs so you'll need to keep some insulin in the fridge?

You could have a cpeptide test to see how much insulin you are making?

Personally, as a T1, insulin is my best friend.

 

[992947x]

My dietician has told me that I need more insulin per carb if I eat low carb, and so far my insulin pump agrees with her. (I'm still happy to low carb, because the total insulin is less, and I find it easier to manage.)

I have no idea whether you have insulin resistance as well as reduced insulin production. But I find it unlikely (personal opinion, I am not a doctor) that having less insulin than you need will reduce insulin resistance.

So it's a question as to whether your remaining insulin production will sustain you on a zero carb diet. But please be aware that any illness is likely to boost your insulin needs so you'll need to keep some insulin in the fridge?

You could have a cpeptide test to see how much insulin you are making?

Personally, as a T1, insulin is my best friend.

Hi

Thanks for such useful comments. I agree with everything you say, but at the same time see it upside down. You elude to this yourself. For example, about needing more insulin per carb if you eat less carbs, is likely to be true because of gluconeogenesis, where protein is converted into carbs to make up for the shortfall. I would raterh need 5 units of insulin per carb if I eat 5 carbs per day (from eggs for example), than 2 units per carb if I eat 200g of carbs. I think you are saying the same thing.
Also, as atype 1 insulin is your friend. If I was still type 2, I would say insulin was my enemy but with 3c, I am conflicted about whether insulin in an enemy or a friend. I kind of feel that I would prefer to keep it as a friend that is happy for me to call on them in emergencies!

RE C-peptide, I did have one about 4 years ago, and was told I had some insulin production, but it was very low. It would be interesting to get an updated one, but last time I asked my diabetes clinic they gave me a bit of a funny look. I think when I got back to clinic with completely different numbers next month, they might be more interested in letting me have one.

Thanks again for your balanced, well thought out comments.

 

[992947x]

I am not sure about your hypothesis. It s often reported that a low/no carb diet INCREASES insulin resistance rather than reduces it.
I have heard of no one with Type 1 diabetes doing carnivore and managing their insulin better - it is harder because, in the absence of carbs, out bodies break down proteins to glucose. Therefore, you need to bolus for the proteins you eat at a different time (the conversion from protein to glucose takes longer) and at different insulin to protein ratios for different types of protein.
However (as a non-doctor), I do not believe a basal of 20 units of Lantus a day indicates insulin resistance so I do not understand why you are trying this zero insulin regime when you have no problem.

Thanks for you reply. It is always good to hear other peoples opinions.

 

[Melgar]

I am not familiar with the ins and outs of T3c diabetes, neither am I on insulin therapy, but as you suspect your insulin dosing is related to, what you suspect is, insulin resistance I will mention the relationship between insulin resistance and serum C-reactive proteins (CRP).

The level of insulin resistance is a key determinant in the development of T2DM. Following on from that, there is a relationship between Insulin resistance, systemic inflammation and the level of CRP your liver produces. In other words these reactive proteins go up in the presence of inflammation. Insulin resistance increases systemic inflammation in the body.

Your serum C Reactive Protein levels should, therefore, give you some indication as to the level of insulin resistance, if indeed you have insulin resistance. CRP levels are part of the standard blood panel (In Canada). So if your C Reactive Protein levels are high this maybe an indicator of the level of Insulin resistance.

In individuals with T2DM, CRP levels range between 4.49 and 16.48 mg/L. Mine are 1.9 mg/L with a lab range of less than 5.0 mg/L.
How helpful this is for someone like yourself with T3c I am unsure. I am happy to be corrected on my interpretation.

Association between fasting insulin and C-reactive protein among adults without diabetes using a two-part model: NHANES 2005–2010 - Diabetology & Metabolic Syndrome

Introduction Chronic inflammation is associated with the development, progression and long-term complications of type 2 diabetes. Hyperglycemia is associated with chronic low-grade inflammation, and thus has become the focus of many screening and treatment recommendations. We hypothesize that...

dmsjournal.biomedcentral.com

 

[Melgar]

You may also find this calculator interesting.

HOMA IR - Insulin Resistance Calculator - The Blood Code

HOMA-IR stands for Homeostatic Model Assessment of Insulin Resistance. The meaningful part of the acronym is “insulin resistance”. It marks for both the presence and extent of any insulin resistance… read more →

thebloodcode.com