High levels despite low carb and insulin

What kind of levels are you seeing usually?

mortigger1968 said:

Hi im so confused and scared and at a loss my endo says im very insulin resistant and to do lchf which i have been doung since january which i have and my levels will just not drop at all i eat full fat greek yoghurt and berries for breakfast or boiled eggs and 2 oatcakes
Lunch is usually salad and meat
Evening meal is usually meat and veg
If i have a pudding its low cal jelly snd cream
Fbs are always very high between 12 and 14 ...im petrified i dont knlw what to do i wudnt mind if i was eating rubbish but im not ..my endo thinks im lying as he says low carb should lower it

Click to expand...

...And if you are doing proper low carb, and even with the oatcakes you're pretty low by the sound of it, your endo should take you seriously and order tests (C-peptide & GAD) rather than call you a liar. People can make mistakes when dieting, sure, but that doesn't make them liars. And I don't see a huge trespass here. Not like you're eating bread and spuds and whatever. Appaling manners, honestly!

Seems like acute resistance, and that your body is always trying to shed glucose no matter what you do or how much insulin you use to hold it back. Perversely, this isn’t always necessarily a bad thing - glucose is arguably better off in the blood where you stand a chance of burning it off than it is locked up in tissues and organs. You would probably benefit from extended fasting but you’d be well advised to research carefully and also be very vigilant with glucose monitoring and insulin dosing while you’re doing it.

JoKalsbeek said:

...And if you are doing proper low carb, and even with the oatcakes you're pretty low by the sound of it, your endo should take you seriously and order tests (C-peptide & GAD) rather than call you a liar. People can make mistakes when dieting, sure, but that doesn't make them liars. And I don't see a huge trespass here. Not like you're eating bread and spuds and whatever. Appaling manners, honestly!

Click to expand...

All true, but my understanding is that OP is already using exogenous insulin and is still unable to clear the blood, which in the immediate term means the resistance needs tackling. I’m not offering medical advice, but this strikes me as a case that will require hardcore dietary intervention in the form of extended fasts. Endogenous insulin production is kind a moot point just now considering that none of it is going to work anyway.

mortigger1968 said:

Thsnks im looking into fasting atm

Click to expand...

Check out IDM. Intensive Dietary Management. Spearheaded by Dr. Jason Fung, who is a bit of a trailblazer in treating type 2. He also has two well renowned books, The Obesity Code and The Diabetes Code. Be aware that with that level of resistance you would likely find that your glucose levels would initially climb when fasting. Link below if you’re inclined to have a look.

https://idmprogram.com/

Questions that I would ask a T1 so maybe not totally helpful here are:
What insulin are you on and when do you take it? What are levels like through the day?

Yes it can be done alone without supervision, but not for longer than maybe 48h initially. And as already said, you would need to monitor your glucose and insulin fastidiously or run the risk of unexpected hypoglycaemia. Have a read around here and do a lot of research, and please don’t rush into anything based on the musings of a total stranger from the internet

Jim Lahey said:

All true, but my understanding is that OP is already using exogenous insulin and is still unable to clear the blood, which in the immediate term means the resistance needs tackling. I’m not offering medical advice, but this strikes me as a case that will require hardcore dietary intervention in the form of extended fasts. Endogenous insulin production is kind a moot point just now considering that none of it is going to work anyway.

Click to expand...

Hey Jim,

Just think the OP should know where she's at, as T2's rarely get ketoacidosis, and other types, well... You know. Just a little concerned, and that's why I'm hammering on tests.

JoKalsbeek said:

Hey Jim,

Just think the OP should know where she's at, as T2's rarely get ketoacidosis, and other types, well... You know. Just a little concerned, and that's why I'm hammering on tests.

Click to expand...

Yeah sure thing, and endogenous insulin production, or possibly lack of it, is very likely to come to the fore if and when fasting begins to shed the glucose. Baby steps I reckon.

It would be good to know a

Jim Lahey said:

Yes it can be done alone without supervision, but not for longer than maybe 48h initially. And as already said, you would need to monitor your glucose and insulin fastidiously or run the risk of unexpected hypoglycaemia. Have a read around here and do a lot of research, and please don’t rush into anything based on the musings of a total stranger from the internet

Click to expand...

bout insulin regime before promoting fasting - what type of insulin and if OP adjusts doses. Fixed doses could cause issues here.

mortigger1968 said:

Im on novorapid 24 units 3xday tresiba 48 units and levwls of 12 to 14

Click to expand...

Thanks @mortigger1968 so fixed doses may present a problem if you fast as you’d probably not be confident changing doses.
So levels stay between 12 and 14 all day?
Have you asked about your basal being checked to see if that is right? Also if you only eat significant carbs at one meal, the oatcakes at lunch do you see lower levels before lunch? Have your team said why fixed doses?

@Diakat yes you are right of course. I think I just assumed that any decent endocrinologist would be on the ball with the insulin dosing, but I should probably know better than to trust a HCP when it comes to diabetes. Regardless though, I still take the view that if insulin resistance is this acute (for it surely must be) then aggressive dietary measures can only help.

Jim Lahey said:

@Diakat yes you are right of course. I think I just assumed that any decent endocrinologist would be on the ball with the insulin dosing, but I should probably know better than to trust a HCP when it comes to diabetes. Regardless though, I still take the view that if insulin resistance is this acute (for it surely must be) then aggressive dietary measures can only help.

Click to expand...

I agree that diet is an excellent tool and long term for T2 it is important. However , in this case it sounds like medical supervision may be needed.

Diakat said:

I agree that diet is an excellent tool and long term for T2 it is important. However , in this case it sounds like medical supervision may be needed.

Click to expand...

Yeah I would agree with that wholeheartedly seeing as OP is on fixed dosing.

There are a lot of us initially misdiagnosed type 1's out there, it happens too often. I was one of those for over 9 years. A type 1 no matter how good the food is for you, if it has any carbs you need insulin for it. Whenever I hear a salad makes your BG's go up I am reminded of when I would eat a salad and my Bg would go above 16. Things like berries, broccoli, yogurt all still have carbs. Plus low carb can also mean you have to compensate for protein too. You can also be insulin resistant along with being a type 1. I would suggest a c-peptide and a Gad test. the gad will help identify if you are a type 1 and the c peptide will tell you how much insulin you are making.

Some people end up having a problem with a specific insulin too and it will start to take a longer time to work or not work as well. Who knows why, but I've run across a few people like that. Sometimes switching insulin brands work, some people switch to Fiasp and have good success.

But if you switch to fiasp, you will have to learn to carb count, you might check with your doctor about taking a carb counting class so you can take a more accurate dose per the carbs you actually eat. You will have to learn what ratio you need, and how to count carbs but if you're going to be on insulin, you will be able to get a better handle on it. Taking a set dose means you are sometimes taking too much that you are not actually using and that won't help if you are insulin resistant, it might make it even worse.

Hi @mortigger1968 - forget fasting, what you need is to be able to match the carbs you eating to the insulin you are taking, which is why carb counting will help you manage these highs, as well as taking correction doses for managing levels when they do go high.

You need to get back in touch with your diabetes nurse or consultant and speak to them about adjusting your insulin doses, we can't help with that, but it will get your levels down and back in control again.