Gah. Advice please.

[lcarter]

So I've been eating the LCHF way for about 2 weeks.

I'm currently a type 1 diabetic, but have recently been told from c peptide blood and urine tests that this may not be the case as my body seems to be producing a significant amount of insulin that seems to indicate I am a type 2 diabetic. I've been put on Metformin which made me feel so I'll I had to change to the slow release ones. I've been on these for a week, and I'm on 3 a day. I also take Toujeo and Fiasp.

So when I first started metformin I had to reduce my insulin as I was having hypos, and my levels were about 4-9 but I think I've reduced it too much as my levels are now back up to the 16mml area.

I'm confused.

So, I'm not in ketosis, my ketones are 0.4.

I eat about 40g of carbs a day from berries, nuts carrots and other veggies.

I haven't lost any weight.

If I was a type 2, surely I would need to be reducing my insulin even more?

I feel dreadful. Headache and tiredness. Drinking plenty of water.

Increased my basal from 36 to 40 today, and I'm hoping that helps. When I was having hypos it was about 46 a day.

Any advice welcome x

 

[ert]

Welcome. I'm sorry you are having issues with your treatment. It must be stressful. You must have been referred to a specialist to be diagnosed as type 1? You need to go back to the specialist so that they can get both your treatment and a clearer diagnosis sorted. The GP will treat you if you're type 2.

 

[Juicyj]

Hello @lcarter

What a confusing state to be in.. C peptide tests are not conclusive and type 1's can have slow onset or latent autoimmune diabetes. There is a lot of mis-diagnosis with diabetes so please keep a track of your readings, insulin doses, carbs eaten.

The most critical part to your control is your glucose levels and if your blood glucose levels are now rising to 16 then you need to increase your insulin, I cannot comment on doses however you need to present this information back to your team, in the meantime are you comfortable administering correction doses to control your high levels ?

 

[HSSS]

I can’t comment about the insulin but IF you are indeed a t2 and possibly very insulin resistant after years of injecting exogenous insulin then maybe 40g is simply not low enough to overcome that resistance. The fact that you are both producing and injecting insulin suggests highly resistant to me. Some people do need to go as low as 20g.

Feeling dreadful could be the sugars being lower than you are used to (false hypo or even real ones) being high if they are back up to 16. Or maybe having gone lchf your electrolytes have dropped which can make you feel truly awful. Make sure you are getting potassium and magnesium from somewhere (food, supplements, oils etc). Drinking lots can oddly make this worse as it flushed the electrolytes through faster.

Even slow release metformin doesn’t agree with everyone.

Weight loss doesn’t always happen instantly with lchf. We hear about instant whooshes a lot but equally it can take a good few weeks to start, doesn’t mean beneficial stuff isn’t happening in the background. Are you measuring too? That often shows change first. Having such overal high levels of insulin (in order to deal with the glucose I know) might also be stalling things too. I’d get the diagnosis and levels under control before worrying too much about the weight, it might just follow along once they are sorted.

 

[kitedoc]

As a TID in low carb diet not as medical advice or opinion:

If you read dietdoctor.com you will find something called the keto 'flu and how with less insulin needed that salt, magnesium and potassium are lost in larger amounts through the urine than when you are on higher doses of insulin. People feel quite unwell until these salts are corrected as explained on the site.

And if you think you are not in ketosis consider from the same site that ketone levels vary through the 24 hours, one reading of 0.4 mmol/l does not mean much in terms of being in ketosis or not.

You have not said how much protein you are taking in and what you describe above as your diet may need attention as it appears to contain no meat or other vitamin B 12 containing food, and may be deficient in protein, iron and other vitamins and minerals. etc. Thus a dietitian may be required for advice to ensure you stay in good health.

And have you been adjusting your insulin levels in conjunction with your nurse or doctor - which is the recommended way to do so? And as your diagnosis is unclear, would it perhaps be best to wait for a clear diagnosis and to determine whether you need some injected insulin or not first?

 

[HSSS]

I eat about 40g of carbs a day from berries, nuts carrots and other veggies.

Was this just your carb intake or your full diet? I took it to mean the former but @kitedoc read it the other way apparently. If he’s right then protein and b12 etc is definitely missing.

 

[Resurgam]

The only thing we seem to have in common is the 40 gm of carb (for me that my maximum) from plant sources - I don't need medication and in addition I eat meat fish eggs cheese, and drink cream in my coffee.
I can't advise about any medication - but do suggest that you keep your diet at about those carb levels (just because it is so good to me) and treat yourself according to your needs day to day. Whatever type you are you seem to be going through a 'ping pong' effect at the moment - so the only thing you can keep stable is your diet, then test and respond to what you see on the screen.
As long as you have access to medication you might need, type doesn't really matter.
I did try ordinary Metformin along with Atorvastatin, and felt really dreadful, so am firmly of the opinion that not all medication intended for lifelong intake is worth taking no matter what the effect, if it means low quality of life.

 

[DCUKMod]

@lcarter - I'm not an insulin user, so I won't comment on that, except to say I am assuming after all your years using insulin that you are comfortable adjusting your doses as required.

If you are still producing insulin of your own, you will have been working with that, full-time, unknowingly compensating for what your pancreas created on a day-to-day, meal-by-meal basis. I also seem to recall you saying, near the beginning of the T1/T2 dilemma, that you were struggling with high numbers for a while? Forgive me if I misremember that part.

In my observation, I notee that our bodies like to run to routines, and where our body is functioning, largely as it should, our body will "look after" us and regulate our bodies to run in our comfort zones. Sometimes this means that for a period, after reducing carbs, some T2s still experience higher than expected blood glucose numbers and/or, don't start trimming up immediately. In essence, their higher than they'd expect blood glucose numbers can be fuelled by their body releasing some of it's glucose stores.

Of course, you may in the unenviable position of having a pancreas that can produce insulin, but doesn't always do it too well, therefore almost being in a reverse honeymoon period.

In your shoes, I think I'd try to stick with Plan A a little longer and see what transpires over the next week or two.

Obviously, it is very important you keep yourself in your safe zones as far as blood glucose and insulin dosing is concerned.

Finally, just me personal view on ketosis. Undoubtedly I have been in ketosis from time to time, but it isn't something I have chased. I've more usually be guided firstly by my blood glucose numbers, and secondly the bathroom scales.

Good luck with it, whatever you decide to do.