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BMI and insulin effectivity

Emmasndco

Emmasndco

Well-Known Member
Messages
65
Location
Milton Keynes
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Hi All, I would appreciate any advice, experiences or pointing in the direction of any information. I’m feeling a little (very) upset right now and not really sure how to help myself further.

basically I had my annual review at the hospital on Wednesday and it’s left me feeling a little frustrated. Over the last year, I have worked very hard eating low carb and exercising to lose weight and to try to lower my blood sugars /HBA1C over the last year. I have lost 16 kilos over this year totalling around 30 in total since diagnosis 8.5 years ago I’m currently 112 kilos, so still have a way to go!

meds wise I’m on full dose of metformin, pioglitazone and ozempic (which has really helped with the weight loss) a normal day eating would be breakfast- full fat Greek yog with berries, lunch chicken salad, dinner - courgetti bolognaise. I drink water most of the time with the odd cup of tea with semi milk. (That is if I manage to eat as often feel too nauseous)

My big issue is my blood sugars never seem to go down and my HBA1C is actually increased. Currently 124mmol/mol. Meter reading are usually in late teens or early 20s. The hospital is at a bit of a loss as to what to do. They are suggesting I try insulin again (tried in2019 for about a year and didnt touch my blood sugars - they doses just kept getting higher and higher) now that my BMI is lower. Can anyone tell me a bit more about how bmi effects insulin? Or have you re-tried insulin after weight loss? Have to say I’m a little reluctant to retry. Had a c-peptide test back in 2015 which showed I was producing plenty of my own insulin but just very insulin resistant.
 
Emmasndco said:
Hi All, I would appreciate any advice, experiences or pointing in the direction of any information. I’m feeling a little (very) upset right now and not really sure how to help myself further.

basically I had my annual review at the hospital on Wednesday and it’s left me feeling a little frustrated. Over the last year, I have worked very hard eating low carb and exercising to lose weight and to try to lower my blood sugars /HBA1C over the last year. I have lost 16 kilos over this year totalling around 30 in total since diagnosis 8.5 years ago I’m currently 112 kilos, so still have a way to go!

meds wise I’m on full dose of metformin, pioglitazone and ozempic (which has really helped with the weight loss) a normal day eating would be breakfast- full fat Greek yog with berries, lunch chicken salad, dinner - courgetti bolognaise. I drink water most of the time with the odd cup of tea with semi milk. (That is if I manage to eat as often feel too nauseous)

My big issue is my blood sugars never seem to go down and my HBA1C is actually increased. Currently 124mmol/mol. Meter reading are usually in late teens or early 20s. The hospital is at a bit of a loss as to what to do. They are suggesting I try insulin again (tried in2019 for about a year and didnt touch my blood sugars - they doses just kept getting higher and higher) now that my BMI is lower. Can anyone tell me a bit more about how bmi effects insulin? Or have you re-tried insulin after weight loss? Have to say I’m a little reluctant to retry. Had a c-peptide test back in 2015 which showed I was producing plenty of my own insulin but just very insulin resistant.
Click to expand...
Insulin is surface area dependant. It is used all over the body, so the bigger the body, the more insulin you need BSA is similar to BMI. So there is a mathematical link between BMI and BSA, and hence insulin. I have lost the formulae they use, and there are four variants of the formula that I know of. But they are just approximations, since they do not include girth or waistband size to establish bulk or mass effect.

well done on your attempts to reduce weight, it will certainly help, but if you exercise, then remember that will turn fat into muscle, and muscle is more dense than fat hence you can use exercise to reduce bulk, but seemingly gain weight. I was an 18 stone flounder, but now a 10 stone TOFI on low(ish) carb diet. But you may find you need to consider a ketogenic low carb diet. the other way some here have found that helps with IR is an ultra low calorie diet such as Fast 800 or Newcastle diet using shakes just as a short sharp shock. Another tool to consider is intermittent Fasting.
 
If doing the same things isn't working (on bg) than sounds time to try something different
Either short sharp shock type of diet such as very low calorie
Or increasing fasting, first skipping a meal, then 2 then a whole day regularly
Or vastly increasing exercise
Or combination of all 3.
May sound harsh but try for a few weeks, it's not for life, but might be enough to kick start your body into doing what it's supposed to do
 
Emmasndco said:
They are suggesting I try insulin again (tried in2019 for about a year and didnt touch my blood sugars - they doses just kept getting higher and higher) now that my BMI is lower. Can anyone tell me a bit more about how bmi effects insulin? Or have you re-tried insulin after weight loss? Have to say I’m a little reluctant to retry. Had a c-peptide test back in 2015 which showed I was producing plenty of my own insulin
Click to expand...
How long have you had diabetes?
If the C-peptide test was earlyish after diagnosis, things may have changed in the past 8 years.

Do you remember what insulin doses you ended up on in 2019?
The amount we need varies a lot from person to person, some need only 10 units a day, others need hundreds of units.
 
You've done great losing that weight. Keep up the good work - don't let the news on the A1c hurt that.

If the hospital are suggesting insulin, why not give it a try again. It helped me.
 
Emmasndco said:
Hi All, I would appreciate any advice, experiences or pointing in the direction of any information. I’m feeling a little (very) upset right now and not really sure how to help myself further.

basically I had my annual review at the hospital on Wednesday and it’s left me feeling a little frustrated. Over the last year, I have worked very hard eating low carb and exercising to lose weight and to try to lower my blood sugars /HBA1C over the last year. I have lost 16 kilos over this year totalling around 30 in total since diagnosis 8.5 years ago I’m currently 112 kilos, so still have a way to go!

meds wise I’m on full dose of metformin, pioglitazone and ozempic (which has really helped with the weight loss) a normal day eating would be breakfast- full fat Greek yog with berries, lunch chicken salad, dinner - courgetti bolognaise. I drink water most of the time with the odd cup of tea with semi milk. (That is if I manage to eat as often feel too nauseous)

My big issue is my blood sugars never seem to go down and my HBA1C is actually increased. Currently 124mmol/mol. Meter reading are usually in late teens or early 20s. The hospital is at a bit of a loss as to what to do. They are suggesting I try insulin again (tried in2019 for about a year and didnt touch my blood sugars - they doses just kept getting higher and higher) now that my BMI is lower. Can anyone tell me a bit more about how bmi effects insulin? Or have you re-tried insulin after weight loss? Have to say I’m a little reluctant to retry. Had a c-peptide test back in 2015 which showed I was producing plenty of my own insulin but just very insulin resistant.
Click to expand...
Obviously I don't know you or your circumstances outside of what you've told us, but if I had a patient with a HBA1c of 124 I would be having a conversation regarding starting a mixed insulin like Humulin M3.

What insulin were you on before?

Your blood sugars are unfortunately too high and I guess you have to question whether you think your current OHA regime is sufficient.
 
Oldvatr said:
Insulin is surface area dependant. It is used all over the body, so the bigger the body, the more insulin you need BSA is similar to BMI. So there is a mathematical link between BMI and BSA, and hence insulin. I have lost the formulae they use, and there are four variants of the formula that I know of. But they are just approximations, since they do not include girth or waistband size to establish bulk or mass effect.

well done on your attempts to reduce weight, it will certainly help, but if you exercise, then remember that will turn fat into muscle, and muscle is more dense than fat hence you can use exercise to reduce bulk, but seemingly gain weight. I was an 18 stone flounder, but now a 10 stone TOFI on low(ish) carb diet. But you may find you need to consider a ketogenic low carb diet. the other way some here have found that helps with IR is an ultra low calorie diet such as Fast 800 or Newcastle diet using shakes just as a short sharp shock. Another tool to consider is intermittent Fasting.
Click to expand...
Many thanks Oldvatr for your reply and explaining how Insulin works in regards to BMI and BMA... super helpful :)

I do try and exercise, been on a 5K walk today, I have lost some muscle mass so hope I can build some back up! I do sometimes struggle with my blood sugars getting very high with more intense exercise such as body combat class at the gym (can take 2/3 days to come back down) but something like a 10/15 min walk or pilates does bring the blood sugars down by 1 or 2.

If you don't mind me asking, how did you lose your weight? You had a similar amount to lose as me.

I think you are right, I do need to change something, I spent the first part of 2020 (before covid) following Michael Mosely's fast 800 and while it didnt really touch my blood sugars, I did help me to lose some weight (which I put back on over lockdown) Im off to look up some new keto recipies, f that fails I will try fasting and then look at shakes as a last resort.
 
MrsA2 said:
If doing the same things isn't working (on bg) than sounds time to try something different
Either short sharp shock type of diet such as very low calorie
Or increasing fasting, first skipping a meal, then 2 then a whole day regularly
Or vastly increasing exercise
Or combination of all 3.
May sound harsh but try for a few weeks, it's not for life, but might be enough to kick start your body into doing what it's supposed to do
Click to expand...
Thankyou for the super helpful ideas MrsA2 and the reassurance that something short and sharp may well do the trick. ;)
 
HSSS said:
Have they ever tested your own insulin production or for antibodies? You are not typical in hba1c rising despite keto and weight loss. It’s possible you have atypical results and are LADA not type 2. Not all T1 are skinny.
Click to expand...
Thank you HSSS, I have just had a little read all about LADA, it is a possibility... it took the GP a long time to decide if I was type 1 or type 2! They went down the type 2 route after the C-Peptide test showed I was producing plenty of my own insulin. I dont think I have ever had a GAD test, I will certainly mention it as my medication has never seemed to make much of a difference and I was diagnosed anemic last year.
 
Antje77 said:
How long have you had diabetes?
If the C-peptide test was earlyish after diagnosis, things may have changed in the past 8 years.

Do you remember what insulin doses you ended up on in 2019?
The amount we need varies a lot from person to person, some need only 10 units a day, others need hundreds of units.
Click to expand...
Thanks for your reply Antje 77, I was diagnosed Aug 2014 and had the C-Peptide some time in 2015, so like you say it might be worth a retest. I think I was on Humulin I and the doses were in the 100s, think I was almost taking a whole pen worth at a time :depressed: 300ish units?
 
Guilty said:
You've done great losing that weight. Keep up the good work - don't let the news on the A1c hurt that.

If the hospital are suggesting insulin, why not give it a try again. It helped me.
Click to expand...
Thanks Guilty, I'm a little worried about weight gain on insulin and the actual amount I may need. My consultant has suggested admitting me into hospital to test in a safe environment the amount I may need.
 
NHSNurse said:
Obviously I don't know you or your circumstances outside of what you've told us, but if I had a patient with a HBA1c of 124 I would be having a conversation regarding starting a mixed insulin like Humulin M3.

What insulin were you on before?

Your blood sugars are unfortunately too high and I guess you have to question whether you think your current OHA regime is sufficient.
Click to expand...
NHSNurse, I believe I was Humulin I before. Apologies for my ignorance, what is OHA?
 
One possible cause of high blood sugars could be adrenaline, which intense acrtivity or exercise or stress can raise. Your walk is less stressful so may be a better way of reducing some (but not all) of your sugar levels.

I lost my weight simply by following LCHF diet. I did get to ketosis for a while, but lost too much weight, so I have dialled back slightly. recent stresses have raised my bgls again, so I am cutting carbs again. As I have pointed out in other threads, I became chief cook and bottle washer, and so my late wife was also subjected to my diet in parallel, and she also lost a similar amount of flubber. She was not diabetic.

But what worked for me will not work for everyone.
I note the conversation regarding LADA possiblility, and I second the suggestion for a GAD test, and possibility a c-pep repeat, Your current bgl levels are not consistent with your reported diet, and you do need to establish your insulin levels asap. The anemia may also be affecting your blood tests. It can certainly upset the HbA1c, and there is an alternative fructosamine test that might be relevant.
 
Yes, your case certainly is a very complex one @Emmasndco. Because if you are severely insulin resistant (which is my own subtype of T2D) - then taking insulin, and high doses to boot, is seriously not good! From what I can gather - taking insulin can be good at the early stages of a diagnosis as the short and sharp treatment that is being suggested above, in terms of what the studies say. But I would not understand how it would fit 9 years down the track.... (I am the same in terms of length of time since diagnosis.) . And that must be what your medical team is considering?

So yes - being tested for figuring out if it really is severe insulin resistance, or another medical issue on top of type two, and/or a form of auto immune diabetes - is really important, and hopefully you can get your medical team to do that - especially if you are due for a hospital stay.

Metabolically speaking - there is something really complex or interesting - or however you want to put it - going on for sure. Because what with walking, and the body combat training - you are doing that on a minimal diet, from what you report, and, intermittent fasting, as well as the meds. There's no way I could do that on a bowl of yoghurt and a few berries, and a chicken salad, followed up with a vegetarian dish to make up for it in the evening. And just tea and water? I wouldn't be able to get up off the sofa to brush my teeth let alone anything else. But yes - one of the beautiful things about our humanity and our metabolisms is that they can play out very differently.

I would say you need the help of a professional nutritionist, preferably (from my perspective ) - a low carb specialist. Many of those also are very interested in the impact of exercise on the body, and in the context of low carb or keto diets.

And definitely keep a journal where you write down/key in your food intake, and drink, in detail, to really get a microscope on what is happeneing in your body, along with the BGs you are tracking too. Because if it is severe insulin resistance diabetes, you have a ton of sick fat cells (again, my own situation) and part of getting better is getting those fat cells as healthy as they can be (by shrinking, and then being replaced in time with healthy fat cells), or on the path to it, especially as you look like you are still pretty young? (Definitely compared to me). My understanding of the science of sick fat cells, and blood glucose regulation issues with insulin resistance generally - the biggest impact you can make is by what you are eating and drinking, and by not eating and drinking, as folks have said above re very low calorie diets and fasting and the attention to the carbs. The exercise is fabulous for your heart health, and enormously important for that reason. I see the shunting of excess glucose into my cells from it as a bonus.

But yes - the key to your getting better is getting to the bottom of what kind of diabetes you have, and if you have some other condition compounding your health situation. And that is what diabetes departments and hospitals and so on do best - Those wonderful tests, so you will get the best treatment for you.
 
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Emmasndco said:
Thank you HSSS, I have just had a little read all about LADA, it is a possibility... it took the GP a long time to decide if I was type 1 or type 2! They went down the type 2 route after the C-Peptide test showed I was producing plenty of my own insulin. I dont think I have ever had a GAD test, I will certainly mention it as my medication has never seemed to make much of a difference and I was diagnosed anemic last year.
Click to expand...
Anemia can mess up hba1c and may not be an appropriate test in the circumstances. As far as I’m aware it doesn’t affect blood glucose though.
if type 1 was originally considered then a retest of insulin levels and the various antibodies seems a very good idea to help solve the mystery or eliminate. There are other types too that are less common that perhaps need considering. Are you see your gp or a specialist? Maybe it’s time for a referral if you haven’t had one previously to try and get to the bottom of whats happening a find a way forward.
 
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