Could someone clear up how reversible insulin resistance is?

[jm164441]

Until recently, I was operating under the belief that insulin resistance was 100% reversible and would be completely eliminated once I got to a normal weight. However, after almost 50 pounds lost over 4 months and on the verge of normal BMI, my glucose tolerance remains pathetic. In fact, it's gotten worse. 4 months ago, I could take ~30g carb and not go over 130mg/dl. Now, I can only take ~15g and hit the same blood sugar.

Is IR a permanent thing that only drugs can treat? Am I simply always going to have this ludicrous amount of resistance, except when I exercise? My A1C one year ago was 5.5 (no diet) and I'm not even diagnosed yet, but I seem to be deteriorating so fast I'm utterly befuddled.

 

[Hotpepper20000]

Until recently, I was operating under the belief that insulin resistance was 100% reversible and would be completely eliminated once I got to a normal weight. However, after almost 50 pounds lost over 4 months and on the verge of normal BMI, my glucose tolerance remains pathetic. In fact, it's gotten worse. 4 months ago, I could take ~30g carb and not go over 130mg/dl. Now, I can only take ~15g and hit the same blood sugar.

Is IR a permanent thing that only drugs can treat? Am I simply always going to have this ludicrous amount of resistance, except when I exercise? My A1C one year ago was 5.5 (no diet) and I'm not even diagnosed yet, but I seem to be deteriorating so fast I'm utterly befuddled.

How do you know you are insulin resistant?
5.5 A1C is non diabetic.

 

[jm164441]

My blood sugar goes to 160-170 if I eat 50g+ carbs, the highest I've seen is 190, and my blood sugar typically takes 3-4 hours to settle down, double that if it's a high fat meal.

More worryingly, I have this bizarre symptom where I get burning, stabbing pains and numbness in my fingertips, tops of my feet, and my toes whenever my blood sugar goes above ~130. I don't recover fully, and accumulate a bit more permanent pain every time this happens.

 

[Squire Fulwood]

I apologise if you have already watched all the Jason Fung footage on the subject but just in case you haven't ....

 

[jm164441]

I haven't seen his stuff but I've heard of it. I'm watching the video you linked me, thank you. He's basically a proponent of low carb dieting right?

Well, the numbness/pain has me absolutely terrified to eat carbs so I only eat about 20 a day, but I guess my main problem is how to come to terms with the fact that I'm stuck doing this for the rest of my life. I'm scared of developing crippling permanent neuropathy, as I'm only 25, but I wonder how I can keep this up without burning out.

I could be wrong, but it doesn't seem like there's any medical remedy other than an extremely strict diet for anyone who needs to keep their sugar in the normal range. Everything seems to be targeted at keeping people <200.

 

[Squire Fulwood]

I haven't seen his stuff but I've heard of it. I'm watching the video you linked me, thank you. He's basically a proponent of low carb dieting right?

Well, the numbness/pain has me absolutely terrified to eat carbs so I only eat about 20 a day, but I guess my main problem is how to come to terms with the fact that I'm stuck doing this for the rest of my life. I'm scared of developing crippling permanent neuropathy, as I'm only 25, but I wonder how I can keep this up without burning out.

I could be wrong, but it doesn't seem like there's any medical remedy other than an extremely strict diet for anyone who needs to keep their sugar in the normal range. Everything seems to be targeted at keeping people <200.

I believe Dr. Fung also advocates intermittent fasting and has had success with it.

 

[jm164441]

I find he's correct about a lot of things. I had a fatty liver in 2014. I had elevated AST/ALT in 2014, and very high triglycerides (333) 1 year ago (the same time that my A1C was 5.5) but after watching the video, I don't really share Jason's exuberance for diet as a cure.

I've been doing intermittent fasting and LCHF for 4 months now, I've lost almost 50 pounds. I'm 1 pound away from a normal BMI. My FBG is in the 70s, and yet if I eat 20g of carb, my blood sugar will rocket up 60 points. The beta cells aren't coming back online, assuming they aren't already dead. Or maybe they've been alive the whole time but the IR is simply insurmountable? Who knows.

I'm glad that I can seemingly arrest the process of my disease with these diet restrictions, but I've only undertaken these restrictions because I have an apparently hyper-aggressive case of diabetic neuropathy. According to the video, my IR should have reversed by now, and I should have a bit more leeway to eat carbs, right? But that's not what's happened.

And I do believe IR is to blame because a couple weeks ago I ate something like 300g carb in a single sitting, instantly regretted it, then exercised continuously for the next 6 hours, in hopes of warding off the numbness/pain I knew would follow if my blood sugar went too high. It's a completely impractical solution but it worked! My blood sugar didn't reach ~130 and I miraculously escaped more pain. I can only amount this to exercise lowering my IR/glucose level, but this only lasts as long as I exercise. I don't seem to have gotten the IR reversal at rest that I thought weight loss would bring.

 

[Squire Fulwood]

If you go along with the theory that the cells all stuffed up with sugar then it is essential to exercise in order to use some up otherwise you will tend to not be able to get more in. I found that walking was extremely effective which meant that I went for a 3Km walk each morning. Less would have been equally effective since the blood sugar noticeably lowered in the first part of the walk.

Here is another view of the problem from Dr Malcolm Kendrick.

https://drmalcolmkendrick.org/2015/01/23/thinking-about-obesity-and-diabetes/

 

[LucySW]

Hi All.

I've been meaning to ask people about this. I'm Type 1 and have been on low carb for nearly five years. At first I kept strictly to 30g carb/day, since then it's been looser, but mostly 45g carb or less/day, with occasional lapses eating 20g of a treat.

But I've found unfortunately that the less carb I eat, the more my body reacts to it when I do eat it. When I eat 15-20g carb at one go, my BG soars to 13, 15 mmol. That is a higher response than I used t5o get. Obviously I can't tolerate that (I aim to keep between 4.6 and 5.6), but the more insulin I take as a correction dose, the less it works. The only way I can get that high BG down is exercise. A fast walk, or 15/20 minutes on the crosstrainer, ie aerobic exercise, will get my BG down again. While just insulin will mean that I have to take ever-higher doses for less return.

So it's good that I have discovered that exercise works. But what's bad is that low carb hasn't made me insulin sensitive. I think it's the reverse. Even though I'm Type 1 and don't have very much insulin, surely that's insulin resistance to the insulin I inject. To keep to my target range, I need to be more stringent in my low carbing than before.

So it seems that for me, exercise offers the only real path forward.

 

[Brunneria]

Going back to the original question, insulin resistance can vary quite a lot (depending on things like exercise, medication, carb intake, other hormones, etc.

Then you get other stuff involved too

For instance, your ability to release insulin depends on how much insulin you usually need. Production ramps up and down, depending in recent requirements. This means that the lower carb you go the more out of practice you are at releasing enough to deal with a higher carb intake. It can take a few days for production to ramp back up if carbs are increased, resulting in a few very high spikes till insulin production increases again.

Both the spikes and the increased insulin will also cause insulin resistance to rise too. Since it is excessive exposure to insulin that causes insulin resistance.

Then there is beta cell death. Or they may be being smothered by a fatty liver. It is the beta cells which produce insulin. So if they are worn out and die, you won’t get their function back. If they were ‘smothered’ in fat and you remove that fat, then they may start to function again. Depends on several factors. Beta cell regeneration has been observed in young mice. Is it going to happen in the average adult/middle aged/elderly human? VERY unlikely although some people try and trigger it with fasting.

Probably fair to say that once you have had high levels of insulin resistance, then you will always have some degree of glucose dysfunction and a tendency towards insulin resistance. However, exercise and avoiding circs that drive insulin resistance back up should keep things ticking along at a lower insulin resistance level.

Hope that helps.

 

[Brunneria]

@LucySW

Are you still in the Type 1 honeymoon? Or have your beta cells given up the ghost completely?

I have been assuming (sorry if I am wrong) that @jm164441 is a type2 diabetic. So what I said to him will only have any relevance to you (beta cells ramping up) if you are still honeymooning.

 

[LucySW]

@LucySW

Are you still in the Type 1 honeymoon? Or have your beta cells given up the ghost completely?

I have been assuming (sorry if I am wrong) that @jm164441 is a type2 diabetic. So what I said to him will only have any relevance to you (beta cells ramping up) if you are still honeymooning.

My honeymoon seems to be indefinitely extendable, subject to my being good.

But the same insulin resistance phenomenon applies to Type 1s. It's not their insulin, of course, it's injected; but still at some times it is much less effective than at others. And low carb seems, over time, to lessen the effectiveness.

What I don't know of people's experience is whether carbing up slowly makes the body less sensitive to carb. I don't want to take that risk.

 

[kitedoc]

Hi @LucySW, From my readings, 52 years as a TID but not as professional advice or opinion:
What I wonder, as a TID on an insulin pump, is how to 'grade' low carb diets and whether 'grading' corresponds to level of blood glucose response to injected insulin.
For example, the 'range' of low carb high fat diets varies from maybe 20 g up to say, 120 g/day.
And do we have any evidence that as T1Ds that 20 g carbs per day is any better health-wise and BSL-wise than say 60, 80 or 120 of carbs per day?
Most low carb, high fat diet studies are with persons with T2Ds.
Can we directly compare how BSLs of a person with T2D on a low carb diet are with someone with T1D on the same amount of carbs per day? I would guess highly unlikely.?
We could perhaps think that a T2D on insulin might come closest in comparison to a person with TID but have the studies been done?
My guess, and that is all it is, is that the lower one goes with carbs as a TID the more risk of some resistance to the effect of insulin. Also realising that the lower the carbs in the diet the more fat and protein is needed. I have read that fat may increase insulin resistance and ? 50% plus of the protein will be converted to glucose by the liver anyway.
Perhaps, and this is pure conjecture, for each TID there is a tipping point or range where carbs vs protein and fat is optimal - that is the amount of carbs plus amount of glucose from protein and whatever that works out in fat %, gives the best insulin sensitivity. It is likely to be individual because of other factors like amount of exercise performed daily, whether the person is in a growth phase, menstrual cycle, seasonal cycle and importantly whether the person's gut biome is optimal for his/her metabolism.* That is a lot of variables.
My questions for you @LucySW, not as advice or opinion are: Is it worth trying more % carbs in order to have more flexibility with your insulin's effect, particularly if you really need your insulin to be working well such as during an infection etc?
Can you find an optimal level or series of levels of % carbs/protein/fat vs insulin response?
What, if anything, might some changes to your gut biome achieve or not?
see * www.wis.wander.weisman.ac.il/life-sciences/blood-sugar-levels are-highly-individual/ 19/11/2015
Best Wishes.

 

[Brunneria]

My honeymoon seems to be indefinitely extendable, subject to my being good.

But the same insulin resistance phenomenon applies to Type 1s. It's not their insulin, of course, it's injected; but still at some times it is much less effective than at others. And low carb seems, over time, to lessen the effectiveness.

What I don't know of people's experience is whether carbing up slowly makes the body less sensitive to carb. I don't want to take that risk.

Insulin resistance can definitely still happen in T1s
But that isn't what I was referring to.
Post honeymoon T1s don't have beta cells that can ramp up production to adjust to increased carb intake.
T1s do that by injecting.

You may find it useful to have a look at how T1s adjust their carb ratios at different times of the day, and depending on insulin resistance. I have seen several people mention how the higher their bg, the more insulin they need. But again, that isn't going to be coming from a T2's beta cells, which is what is relevant to @jm1644

 

[Ponchu]

If reversible thru LCHF, I believe Fung reports the second 6 month period of IF and very low carb is when improvements begin to be seen.

The condition is to keep it low for months at a time.

I’ll enter month #7 in January.

Like you, I spike & stay elevated.

I will exercise patience and view this as a life long marathon.

 

[Alison Campbell]

My blood sugar goes to 160-170 if I eat 50g+ carbs, the highest I've seen is 190, and my blood sugar typically takes 3-4 hours to settle down, double that if it's a high fat meal.

More worryingly, I have this bizarre symptom where I get burning, stabbing pains and numbness in my fingertips, tops of my feet, and my toes whenever my blood sugar goes above ~130. I don't recover fully, and accumulate a bit more permanent pain every time this happens.

Have you been diagnosed by a doctor with type 2 or prediabetes? How many carbs do you eat normally?

 

[jm164441]

Have you been diagnosed by a doctor with type 2 or prediabetes? How many carbs do you eat normally?

I have not been diagnosed by a doctor with any form of diabetes. I eat ~15g carb per meal normally (or less) so I can avoid any damaging spikes. In total, I eat ~25g-35g carb per day.

I've never heard of this presentation of diabetic neuropathy even after scouring the web, but after months of it, it's become very clear that it only gets worse when my blood sugar goes above ~130 -140.

 

[jm164441]

Going back to the original question, insulin resistance can vary quite a lot (depending on things like exercise, medication, carb intake, other hormones, etc.

Probably fair to say that once you have had high levels of insulin resistance, then you will always have some degree of glucose dysfunction and a tendency towards insulin resistance. However, exercise and avoiding circs that drive insulin resistance back up should keep things ticking along at a lower insulin resistance level.

Hope that helps.

If you go along with the theory that the cells all stuffed up with sugar then it is essential to exercise in order to use some up otherwise you will tend to not be able to get more in. I found that walking was extremely effective which meant that I went for a 3Km walk each morning. Less would have been equally effective since the blood sugar noticeably lowered in the first part of the walk.

Here is another view of the problem from Dr Malcolm Kendrick.

https://drmalcolmkendrick.org/2015/01/23/thinking-about-obesity-and-diabetes/

I should have made this clear in my original post, but yes I do exercise. Nothing amazing, but I walk about 8-10 miles a day. And it's very clear that my IR goes down while I'm exercising, as my BG peaks are significantly lower if I exercise directly after eating. It's just that I notice no IR reduction benefit unless I am exercising.

Squire, it's interesting that you noted that a 3km walk is sufficient for you to lower your blood sugar. I had thought the same thing since a small walk after eating greatly reduces my blood sugar as well, but it turns out that my blood sugar goes right back up after I finish walking unless I walk for 2-3 hours (the amount of time it takes for my cells to clear that meal's sugar from my bloodstream).

 

[bulkbiker]

Have you ever thought of getting your fasting insulin and fasting blood glucose tested so your Insulin Resistance can be calculated? I'm assuming you are in the US? Will your insurance pay for those tests? Might be interesting to see...

 

[michita]

My honeymoon seems to be indefinitely extendable, subject to my being good.

But the same insulin resistance phenomenon applies to Type 1s. It's not their insulin, of course, it's injected; but still at some times it is much less effective than at others. And low carb seems, over time, to lessen the effectiveness.

.

Hi, Ive felt the same. I think it might be due to what they call physiological insulin resistance.

I'm on fairly strict low carb diet with carbs from veggies only but I inject 2 units for the meal. That seems a lot. But I don't mind this so much as I feel somehow the insulin resistance is giving me a buffer and protecting me from going too low while insulin I inject is covering for the carbs I eat.