probable mistake in deciding insulin basal rate for type 2 diabetes

[waleed]

I recently stumbled into a thought that I want to share with all of you specially those with type 2 diabetes who use Insulin to manage their blood glucose .
When a person has type 2 diabetes he must have a degree of insulin resistance in the liver that is most probably caused by the presence of excess visceral fat, so he is already in an unhealthy condition. When this person is put on insulin to manage his diabetes, he is prescribed a basal rate that matches his current unhealthy condition that results in stabilizing his BG during fasting. This basal rate is likely to be higher than the average rate for non diabetic people or those with type 1 diabetes with no insulin resistance. <br>
However, although this basal rate together with a bolus regimen serves to bring BG levels to near to normal rates, it also serves to maintain the unhealthy condition of insulin resistance and not help in improving insulin sensitivity. It could be wiser to prescribe the patient a lower non diabetic healthy basal rate that will not immediately stabilize fasting BG, but will allow visceral fat to be burned for energy, and in time improve insulin sensitivity until the low healthy basal rate matches with his basal requirements once excess fat is burned and insulin sensitivity is restored. The healthy basal rate will also suppress hunger in this process.
So instead of aiming to immediately correct BG levels, it could be more correct to bring them down gradually just as they went up in the first place.
A low carb diet will help achieving this goal even faster as it will also lower insulin and induce fat utilization.

 

[Jaylee]

..... Or lowering the carbs in the first place, thus reducing insulin dosage & maintaining healthy BS range in the patient?
Why would one wish to prolong unhealthy BS with what you propose, & raise the risk of complications?

Are you insulin dependant yourself @waleed ?

 

[himtoo]

changes to medications as potent as insulin should really be discussed and agreed with a patient's care team ,
and having been on a basal bolus regime for a total of 18 years would certainly advise this to anyone reading this thread.

 

[Mep]

Who are you addressing in particular with your idea? I'm on insulin because of insulin deficiency. I'm not sure if you are referring to type 2's using insulin like myself or you are referring to those type 2's who still have sufficient insulin being produced and they are using insulin to get good BGL control? Basically you couldn't make the same rule of basal dosage for both of the scenario's I just mentioned. Yes, we both also have insulin resistance. But why are we on insulin? The reason is not always the same. For example if you have sufficient insulin you can be on insulin to help get good BGL control and then work your way towards coming off insulin (as some have stated they've done on this forum). Although for type 2's in my position, we don't come off insulin because we have insufficient insulin or no insulin in some cases being produced. I also agree that anything to do with treatment of diabetes regardless of type should be discussed with the patients medical team. I don't take medical advice from forums myself because for starters I know most if not all people here do not have the same health conditions I do... we're all a bit different with what we're dealing with. If I was to take on advice I could get myself in some trouble. I don't change anything unless I discuss it with my docs. My endocrinologist discusses my basal dosages with me.

 

[TomGreen101]

I recently stumbled into a thought that I want to share with all of you specially those with type 2 diabetes who use Insulin to manage their blood glucose .
When a person has type 2 diabetes he must have a degree of insulin resistance in the liver that is most probably caused by the presence of excess visceral fat, so he is already in an unhealthy condition. When this person is put on insulin to manage his diabetes, he is prescribed a basal rate that matches his current unhealthy condition that results in stabilizing his BG during fasting. This basal rate is likely to be higher than the average rate for non diabetic people or those with type 1 diabetes with no insulin resistance. <br>
However, although this basal rate together with a bolus regimen serves to bring BG levels to near to normal rates, it also serves to maintain the unhealthy condition of insulin resistance and not help in improving insulin sensitivity. It could be wiser to prescribe the patient a lower non diabetic healthy basal rate that will not immediately stabilize fasting BG, but will allow visceral fat to be burned for energy, and in time improve insulin sensitivity until the low healthy basal rate matches with his basal requirements once excess fat is burned and insulin sensitivity is restored. The healthy basal rate will also suppress hunger in this process.
So instead of aiming to immediately correct BG levels, it could be more correct to bring them down gradually just as they went up in the first place.
A low carb diet will help achieving this goal even faster as it will also lower insulin and induce fat utilization.

You appear to make the assumption that unhealthy people get T2 Diabetes.
Healthy people get diabetes too. Runners, professional athelites etc who have very little fat.

 

[Brunneria]

Google diabulimia.
It isn't a good thing.

 

[AnnStenekes]

Type 2 is a term which covers a spectrum. Some of us don't produce enough insulin while others have problems with absorption, etc. No one regime is going to be suitable for all of us.