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Type1 Fasting Advice Please

Discussion in 'Fasting' started by Foxytina, Sep 13, 2018.

  1. Foxytina

    Foxytina Type 1 · Member

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    Since January I've been following LCHF strictly and have lost 3.5 stone. Need to lose another 2 stone. My weight loss seems to have stalled so decided to try fasting to see if it would help. Missing breakfast seemed the best option as I'm usually not hungry first thing. Being type1 I was a bit concerned but decided to give it a try. I am on day 5 now. Unfortunately my blood sugars rise during the morning and I've had to take a small dose (4 units) of short acting (Humalog) first thing to prevent this happening. I believe part of the purpose for fasting is to reduce insulin levels. My question is if I'm introducing insulin is there any point in fasting or will it still work?

    I realise my basal (Lantus) may be the problem for the rise. However if I increase it I get into trouble with lows overnight.

    For info, I have been type1 for 42 years. Good control. Last 3 HbA1c's 40, 43, 43.

    Thank you in advance.
     
  2. bulkbiker

    bulkbiker Type 2 · Oracle

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    I am always very wary of giving any advice to Type 1's as I have no knowledge of insulin usage whatsoever.
    I have heard however of people splitting their basal dose to get a more even level? Is that something you have done or tried?
    It may well be a good idea to get your basal correct before trying fasting. As I say that is just my thought from a very poor knowledge level.
    @Mel dCP would you be able to help here?
     
  3. LooperCat

    LooperCat Type 1 · Expert

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    Ooh, it’s a tricky one. I often only eat one meal a day, but I’m on a pump and have done fairly extensive basal rate testing to get my levels right so I can do that. Lantus is a tricky one, because it has quite a peak and a tail off, and doesn’t often last the full 24 hours. A couple of questions...

    What is your Lantus regime - are you taking it once a day (when?) or splitting it?
    Are you using a glucose sensor or finger pricks?

    The rise in the morning sounds awfully like dawn phenomenon - I never noticed it until I went LC, I think the carbs in my diet masked the effect before. Your liver dumps glucose and cortisol into your bloodstream to get you going for the day - people with pancreases just deal with that by releasing some insulin, but we have to do it ourselves. I’ve got my pump pretty well timed to squash that, but had to wake up at sparrow-fart o’clock to inject a unit or two in an attempt to head it off at the pass when I was on injections.

    Congrats on the weight loss, and the amazing Hba1c btw!
     
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  4. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    I've fasted with type 1 but on a pump and did not have to adjust the basal.
    The rise sounds like DP as suggested but could you fiddle with the timing and amount of the night time dose so that you don't go low overnight or take that morning basal sooner? Your liver will respond to a need for glucose by shunting more out of your liver even if its only a mild hypo. With me I can get high by exercising with low insulin levels which is somewhat counter intuitive!
    If you have extra insulin on board it will store more of what you eat as fat or may make you hungrier at the first meal of the day bearing in mind that the insulin lasts for 4 hours (if the manufacturers). By taking it you are telling your body that food is on its way so there is no need to use stored fat.
    I think the strategy is spot on for someone who has lost a good amount of weight but got stuck. Often thought that if I gave up eating I'd have fantastic blood sugar control!
     
  5. Foxytina

    Foxytina Type 1 · Member

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    Thank you for your response bulkbiker. I think my basal is the problem and I have replied in more detail about this to @Mel dCP.

    From reading your posts I believe you are an experienced and knowledgeable faster, so do you think the small amount I am injecting will stop fasting from working?
     
  6. Foxytina

    Foxytina Type 1 · Member

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    Thank you for your reply Mel dcP. I’ve taken Lantus for years but over the past six months I have found it more and more difficult to control my bs and I really think I need to change to something else.

    I used to take Lantus before bed. Then I found it wasn’t covering me late evening and I had to take a small correction dose of short acting. After reading on the forum about split doses and some finding this worked with Lantus, I decided to give it a try. So I changed to taking it at 8a.m. and 7-8p.m. That got me into all sorts of trouble, but the worst was going low overnight. I kept reducing the p.m dose down and down and although things improved I was still getting overnight lows. Stopped the p.m dose completely and am still getting lows. Don’t understand that as my a.m. dose can’t possibly still be working - could it? So now I take 9 units at 7 or 8a.m. which normally keeps me stable throughout the day and evening.

    However I am definitely getting DP, presumably because no basal cover by that time. I also take Metformin a.m and p.m; without it I have much higher readings. I take this immediately I wake to try and halt the DP but sometimes it’s too late, so then up my short acting a little to get back to normal after breakfast. Whilst trying to fast in the mornings I have been taking the Metformin immediately plus 4 units of Humalog. Sometimes that keeps me in the normal range, sometimes not. This morning I was ok until 11.30 a.m when my bs rose to 9.

    I couldn’t live without my Libre!! That’s how I know I’m going low during the night. The lows start early, about 2a.m until the DP begins and that can vary from 5a.m to 7a.m. I also finger prick with Abbot strips on the Libre to ensure the blood tests and sensor readings haven’t drifted too far apart, usually once a day. Some sensors haven’t been too good and I’ve had them replaced, but overall it’s been an amazing aid.

    I’m seeing my DN next month and will discuss the problem and ask for a change of basal.

    Thank you, re the weight loss and results. I couldn’t have done it without this forum and my Libre.

    Any thoughts on the above and whether there is any point in fasting, would be greatly appreciated.
     
  7. Foxytina

    Foxytina Type 1 · Member

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    Thank you for your reply @NicoleC1971. In my previous reply to @Mel dCP you will see more detail about my basal regime. I hadn’t thought about the liver responding to my overnight lows, which could explain the early morning highs as well as DP. I think I’m coming round to thinking I should give up on trying to fast until I’ve sorted out this basal problem. Disappointing as the weight loss is now so slow. Only lost 1lb last month. Better than putting on I know and sure and slowly is good, but 1lb a month is just TOO slow for my liking, hence why I thought fasting would help. Oh well .........!
     
  8. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    Sorry I responded too quickly adn its been 7 years since I was on MDI....A pump smooths things out better than 2 lumps of basal doses which as you have found out do not do what they promise 'on the tin; (I am assuming your jab sites are okay and not causing weird absorption of your dose?)
    . It makes sense to smooth out the basal then work to minimise the insulin whilst keeping your fantastic control (v.jealous of that). I am guessing you are a lady? If female and over 40, If so head over to DietDoctor where they suggest fasting as a useful tactic to re start stalled fat loss. If it all feels like you are really gritting your teeth to do the fasting (perhaps indicated by your frustration) then perhaps its too much or too soon and you should ease back? Anyway 12lb is a stone more or less in a year so not to be sniffed at!
    Final thought is that you could track progress with other metrics e.g. have you lost inches ? Do you feel better? Try making a scorecard of all the things that you are doing this for because the scales are not that great of an indicator.
    This may be controversial but there is some thought that SGLt2 inbibitors (canegeflozin etc.) could be prescribed for type 1s. It works by mimmicking the mechanism by which the body helps you pee out glucose when you are hyper and is know to help with weight loss though not worth doing if you are on a low carb regime.
    TMI probably but some things to keep your DN busy!
     
  9. donnellysdogs

    donnellysdogs Type 1 · Master

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    You need to do basal tests whilst fasting... that’s the whole point of basal testing. You need to have your bolus and food and then wait 10 hours until more food and monitor the last 5 hours religiously to see how your basal insulin copes.....

    Splitting Lantus is not normally advised...
     
  10. donnellysdogs

    donnellysdogs Type 1 · Master

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    I get chronic DP and have to have my insulatard at 3am as my bloods easily rise from 5 to 15 after 3am. When I get up at 6am I also have to have another dose of insulatard and also a dose of bolus novorapid just to get out of bed!!
    In the evenings I have a tresiba jab at 4pm.

    Don’t worry about having to have an injection of bolus before getting up. It’s not that rare to need something to combat rises during the morning.

    It is better to have a bolus or different regime so that you have flexibility of eating when you want to rather than having to. It really doesn’t matter if you have to have a bolus in the mornings without eating providing your bloods prove you need it and that you don’t go hypo either!

    I have tried every conceivable bulk standard regime possible... in the end this is the one I got for me.

    I am still playing around with it as my life has changed so drastically in the last 6 months. Whilst I still have my CGM funded I am going to try going back to levemir to see if I can find a routine that avoids the 3am necessary injection to stop rises occurring then. Personally I don’t feel I will but its worth a go once more to try and get rid of the 3am insulatard jab. I have to have 12 units at 3am compared to the 5 units at 6am and the bolus as well to try to curb my rises. This is without eating.
     
  11. donnellysdogs

    donnellysdogs Type 1 · Master

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    I used to have only 1 meal a day, so it is possible to fast... but having the 1 meal a day made it so easy to basal test that having a meal extra was counted by me as a bolus test!!

    I now try to have two meals per day.
     
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