Type 2 Winter effect?

[Stephen Lewis]

This will be my first autumn and winter on insulin. During the summer I managed to get my insulin dose down from 68 units per day to 11 units per day. In previous years on tablets only my A1cs always went up between August and November and dropped again in April.

I am trying to follow a low carb diet but in the past couple of weeks my BG levels have been rising to usually between 6.5 and 7.6 with a few in the 8 to 10 range. The higher levels seem to occur on colder days. Also instead of losing weight, 12 - 15 lbs, from July to September I am now putting weight back on, 1 - 2 lbs in the last week.

Does any one else have this winter effect and are there any suggestions so that I can continue to reduce my weight and insulin?

 

[Dixon1995]

This will be my first autumn and winter on insulin. During the summer I managed to get my insulin dose down from 68 units per day to 11 units per day. In previous years on tablets only my A1cs always went up between August and November and dropped again in April.

I am trying to follow a low carb diet but in the past couple of weeks my BG levels have been rising to usually between 6.5 and 7.6 with a few in the 8 to 10 range. The higher levels seem to occur on colder days. Also instead of losing weight, 12 - 15 lbs, from July to September I am now putting weight back on, 1 - 2 lbs in the last week.

Does any one else have this winter effect and are there any suggestions so that I can continue to reduce my weight and insulin?

Im type 1 but... I notice higher blood sugars on colder days and I assume my body is trying to conserve glucose or my body releases more sometimes due to it being cold and using more energy when trying to stay warm... coupled with the constant batterings of cold bugs etc I would say this is why we notice the increase. Where this comment ends is that I don't know what to suggest for a type 2 so hopefully one will be along shortly

 

[Stephen Lewis]

Im type 1 but... I notice higher blood sugars on colder days and I assume my body is trying to conserve glucose or my body releases more sometimes due to it being cold and using more energy when trying to stay warm... coupled with the constant batterings of cold bugs etc I would say this is why we notice the increase. Where this comment ends is that I don't know what to suggest for a type 2 so hopefully one will be along shortly

Thanks Dixon, hope I get a suggestion.

 

[Jaylee]

Hi,

Sorry. Another T1. My insulin sensitivity is higher in in warmer environments?

@Stephen Lewis , what insulins & regime are you prescribed?

 

[Stephen Lewis]

Hi,

Sorry. Another T1. My insulin sensitivity is higher in in warmer environments?

@Stephen Lewis , what insulins & regime are you prescribed?

Humolin 30/70 - down to 7 units before breakfasts and 4 before supper plus 500 mg Metformin 4 times a day. I also do a blood test 4 times a day.

 

[bulkbiker]

Humolin 30/70 - down to 7 units before breakfasts and 4 before supper plus 500 mg Metformin 4 times a day. I also do a blood test 4 times a day.

Can I ask how "low carb" you are aiming for?

 

[Jaylee]

Humolin 30/70 - down to 7 units before breakfasts and 4 before supper plus 500 mg Metformin 4 times a day. I also do a blood test 4 times a day.

Thanks. Humulin is a long acting & short acting mix. (From memory.)
Again, from memory, it needs a strict timing with meals.. As a T1, I use a separate long acting & fast acting. (Done so for over 30 years.)
I like you, I keep my carb count down. However. It's my long acting (basal.) that may need to change (a tweak.) regarding the heat. (I find I notice it more whilst in hot climates on breaks.)

If you are a low carber? You may need to consult with you HCPs & look at MDI? (Multiple daily injections.)

You would be essentially injecting for whatever carbs you consume (pending you insulin to carb ratio.) whilst a long acting insulin deals with the base line BG?
Disclaimer; I'm not a health care proffessional. Just a long term T1. I can't help regarding weight. Mine has been satisfactorily consistent for years...

 

[Stephen Lewis]

Can I ask how "low carb" you are aiming for?

I am aiming for 80 gms and I am usually just over - 80 to 90. I also try and keep my calorie intake to between 1,000 and 1,200 and go to the gym 4 or 5 times a week.

 

[Stephen Lewis]

Thanks. Humulin is a long acting & short acting mix. (From memory.)
Again, from memory, it needs a strict timing with meals.. As a T1, I use a separate long acting & fast acting. (Done so for over 30 years.)
I like you, I keep my carb count down. However. It's my long acting (basal.) that may need to change (a tweak.) regarding the heat. (I find I notice it more whilst in hot climates on breaks.)

If you are a low carber? You may need to consult with you HCPs & look at MDI? (Multiple daily injections.)

You would be essentially injecting for whatever carbs you consume (pending you insulin to carb ratio.) whilst a long acting insulin deals with the base line BG?
Disclaimer; I'm not a health care proffessional. Just a long term T1. I can't help regarding weight. Mine has been satisfactorily consistent for years...

I have been considering asking for a move to 2 separate insulins one long acting and one short acting for after meals instead before. I also think I will change to the 'libre' testing system so I can control the short acting more accurately. Any comments about this?

 

[kitedoc]

Hi @Stephen Lewis, I have heard people who were prescribed the mixed insulins found they were more prone to gaining weight. Just an anecdotal comment.
Maybe in summertime more physical activity could increase one's sensitivity to insulin compared to wintertime, in addition to absorption of insulin being better in hot conditions.
Adaption to a cooler season might also could stress to the body and up go the blood sugars for a while due to this stress.
Best Wishes with your thoughts on asking for a change of insulin regime !! Sometimes you can only 'suck it and see'!!

 

[Stephen Lewis]

Hi @Stephen Lewis, I have heard people who were prescribed the mixed insulins found they were more prone to gaining weight. Just an anecdotal comment.
Maybe in summertime more physical activity could increase one's sensitivity to insulin compared to wintertime, in addition to absorption of insulin being better in hot conditions.
Adaption to a cooler season might also could stress to the body and up go the blood sugars for a while due to this stress.
Best Wishes with your thoughts on asking for a change of insulin regime !! Sometimes you can only 'suck it and see'!!

I did gain about 10 lbs when first on the insulin in February to June when I started being able to reduce the dose and my weight came down (also low carbs) so fact not anecdotal. If my GB starts going up again because of the cold I do not want to start increasing the insulin dose and I am not sure how much less I can eat.

 

[kitedoc]

Hi @Stephen Lewis, Hopefully a change in insulin regime will help. I think you are referring to wehat is called basal/bolus. Basal - long acting insulin to cover between meals and overnight and short acting insulin before each meal. If so, the beauty of it (I am Type 1) is that I could skip a meal if I needed to just by omitting the short-acting insulin before that time. With the mixed insulin you have no choice, once the insulin is in you cannot take in back out and are thus obligated to eat breakfast and lunch and dinner. What I could not understand is why are you taking the second mixed insulin dose at supper. ? The short-acting part of the mix might lower your BSL during the first few hours after supper, according to its profile (the drug companies produce graphs/charts showing the amount of insulin in the blood after injection and its blood sugar lowering effects (google ;pictures of insulin profiles and then seek out Humulin 30/70 and also look at basal bolus regimes as a contrast)
so Humulin 30/70 at supper - Do you need a big supper? Most of those I have spoken with on mixed insulin regimes take the second dose with the evening meal.
And how much fuel does one need at night when resting and asleep compared to the day ?
Again, hopefully your doctor and DN can advise on what would be the best insulin regime for you.

 

[Stephen Lewis]

Hi @Stephen Lewis, Hopefully a change in insulin regime will help. I think you are referring to wehat is called basal/bolus. Basal - long acting insulin to cover between meals and overnight and short acting insulin before each meal. If so, the beauty of it (I am Type 1) is that I could skip a meal if I needed to just by omitting the short-acting insulin before that time. With the mixed insulin you have no choice, once the insulin is in you cannot take in back out and are thus obligated to eat breakfast and lunch and dinner. What I could not understand is why are you taking the second mixed insulin dose at supper. ? The short-acting part of the mix might lower your BSL during the first few hours after supper, according to its profile (the drug companies produce graphs/charts showing the amount of insulin in the blood after injection and its blood sugar lowering effects (google ;pictures of insulin profiles and then seek out Humulin 30/70 and also look at basal bolus regimes as a contrast)
so Humulin 30/70 at supper - Do you need a big supper? Most of those I have spoken with on mixed insulin regimes take the second dose with the evening meal.
And how much fuel does one need at night when resting and asleep compared to the day ?
Again, hopefully your doctor and DN can advise on what would be the best insulin regime for you.

Sorry, cultural difference. By supper I mean the main evening meal that I called dinner in England. I rarely eat anything later except sometimes some cheese later in the evening. I certainly like the ability to miss or delay a meal and the related insulin.

 

[bulkbiker]

I am aiming for 80 gms and I am usually just over - 80 to 90. I also try and keep my calorie intake to between 1,000 and 1,200 and go to the gym 4 or 5 times a week.

Why so few calorie?

 

[Stephen Lewis]

Why so few calorie?

When I go above about 25 to 30 in a meal, my sugars go above 8 prior to the next meal. It has also helped me to reduce my insulin dose over the last 4 months.

 

[Deleted Account]

I also think I will change to the 'libre' testing system so I can control the short acting more accurately. Any comments about this?

Regarding the Libre, the value is in checking insulin doses rather than "controlling" them.
The Libre is wonderful in checking that your basal (long lasting) insulin is keeping you constant when you are not doing anything (e.g. eating or exercising) which could impact your BG.
I find it less useful for dosing short acting apart from in hindsight to check that the dose and timing was correct. Regarding the timing of fast acting insulin, there is a balance of matching the time your insulin starts working with the time the carbs you have eaten take affect - the Libre can help you spot if your take your insulin too early (see a BG drop) or too late (see a significant rise).
Some use the reading on their Libre to calculate any correction if the BG is too high. However, the advice I was given and my personal experience is that the Libre is not as accurate as finger pricking so I do not rely on the Libre for calculating insulin dose based on my current reading.

So, to address your point I copied above, I find the Libre useful for managing (not controlling) my long acting insulin, not short acting.

 

[bulkbiker]

When I go above about 25 to 30 in a meal, my sugars go above 8 prior to the next meal. It has also helped me to reduce my insulin dose over the last 4 months.

No I meant why are you eating so little?.. I completely understand about carb restriction.. you are eating about 8 times what I do in terms of carbs. But why so few calories?

 

[Stephen Lewis]

Regarding the Libre, the value is in checking insulin doses rather than "controlling" them.
The Libre is wonderful in checking that your basal (long lasting) insulin is keeping you constant when you are not doing anything (e.g. eating or exercising) which could impact your BG.
I find it less useful for dosing short acting apart from in hindsight to check that the dose and timing was correct. Regarding the timing of fast acting insulin, there is a balance of matching the time your insulin starts working with the time the carbs you have eaten take affect - the Libre can help you spot if your take your insulin too early (see a BG drop) or too late (see a significant rise).
Some use the reading on their Libre to calculate any correction if the BG is too high. However, the advice I was given and my personal experience is that the Libre is not as accurate as finger pricking so I do not rely on the Libre for calculating insulin dose based on my current reading.

So, to address your point I copied above, I find the Libre useful for managing (not controlling) my long acting insulin, not short acting.

Thanks that is all good information.

 

[Stephen Lewis]

No I meant why are you eating so little?.. I completely understand about carb restriction.. you are eating about 8 times what I do in terms of carbs. But why so few calories?

So it looks like I am quite a bit lighter than you and have much lower HDL(0.93), LDL(1.23) and cholestrol 2.96 though I do take statins. And you have lost a lot more weight than me. Ii looks like I should try and reduce my carbs even more and up my protein and fat that will increase my calories. Thanks for the information you have given me something to work with.