Tag Archives: insulin resistance

The Same Yet Different

I just read a post from a woman who lives in the UK. She is also a diabetic as are many of the people I follow on twitter. Facebook is great for friends and such but twitter lets me find people who are like minded as far as my disease. Well I don’t go looking for them, Twitter finds them for me. I have some here in the States (one is on TWO of the new Dexcom G6 commercials) but quite a few are in the UK as well. I have learned as much from them as fellow diabetics here in the USDA.

The post I read was from a woman who yesterday ran a half marathon (10k) and finished it. Way to go!! Now some not familiar with diabetes may think so what. It’s only a half marathon and she didn’t finish first. Oh my good people, to me it is great that she even tried let alone did finish no matter what place it was.

Why? A diabetic knows the answer to that already, someone not so in touch with the problems of this disease may not. Let’s start with the basics. Diabetes is a disease where your body does not produce insulin to control your sugar levels in the blood. So a diabetic must double as their own pancreas since the one they were born with no longer works like it should. Normal people don’t get this as their body regulates it’s own insulin level. A diabetic has to do this the entire 24 hours of each day. It is a true 24 hour 7 day a week jobs and there are no vacation from this job. Now here is the first in lessons some don’t know. There are actually 2 types of diabetes and although they are both called diabetes they are very different creatures. Type 1 is insulin dependent and type 2 can still make it although not enough or sometimes the wrong chemical makeup, it doesn’t work right. There about 22 million diabetics here in the USA alone and out of those only a 10% section are type 1. That means I am one of about 2.2 million people here in the USA who depend on insulin to live. We do not make it on our own and so must take it several times each day. It is not a pill and though there has been some headway to make it easier, the only way to get it is to inject it through the skin.

“I’ve read that you can also inhale insulin.” There is only one and I do not know what complications it can cause or how effective it is. Most people, I do not know of any on this inhalable insulin, use injection. You can use pumps instead of needles but as some of my former coworkers can attest to, it is not a perfect solution. It also still goes through the skin. I was told years ago (decades really, I’m polishing my cane later) being a hormone insulin would not survive the human digestive tract hence it must be injected. As far as inhaling, I’d be more scared of an infection from that kind of delivery than an injection. In the 40+ plus years the only infection from insulin I’ve had is with a pump cannulas but it was on its 6th day instead of the 3 days recommended by the maker. I had to, sweated the first one off early so to make up I had to reuse the next one or I would have run out.

OK back to task, Type 2 diabetics are people whose body still makes insulin but it either makes not enough or the chemical makeup is not right and it does work as needed. Insulin does not actually control blood sugar but it unlocks the walls of cells so the sugar can get in and let the cell use it for energy. Think of it as a key for the lock on your cell wall door. If there is no key you don’t get in, if you don’t get in there is no power to run the cell and it will die. Type 2 can be controlled by pills or diet or both without needing insulin. Sadly, it can regress to the point where insulin may be needed anyway. My mom and both aunts where like after years with type 2.

Emma uses a pump and just to make things easier I will just say that if you have a hard time programming your universal remote a pump is not any easier and your remote won’t kill you if you screw it up. I don’t know her that well but I can guess from her post she does not run marathons on a daily basis. Here is another issue with diabetes, changing your routine is scary. I am far from a perfect diabetic but I try to eat at the same times and even the same foods on a rotating basis so I know how I react to each food and how many carbs are in each meal. Carbs are how diabetics count and calculate how much insulin they need for the food they eat. Each food has a certain amount of carbs that enter your body at different speeds and as a diabetic you need to be able to know how many are in each food and add them together and then calculate how many units of insulin you need. A pump can do this on its own but you still need to tell it how many carbs you are eating.

Since she was running a marathon her activity level was going to be so much higher than normal for her so she had to try and compensate for this. With a pump you can lower the background insulin you get on a temporary basis so she made the changes.

This where I noticed the biggest difference. She dropped her rate 2 units. Wow! My basal rate (background insulin) was at times only 0.250 units per hour! That equals 1 unit every 4 hours. There was no way I could have dropped it 2 units. Even as low as it was set, it still crashed my sugar level without extra work (running a marathon being as low as it can get on that list) and although it would shut off automatically,  I still needed to eat to bring it back up as it was low for hours after going low.

The other issue I noticed was when she described making corrections for a highs the morning of the race. Every diabetic has a rate to add extra units to prevent a high once it is started. Mine is 1 unit for every 50 points over 200. It used to be 2 unit back then when I was on the pump. She was correcting a 1/2 unit for less than 200. Amazing!

Reading about how she ran her diabetes compared to my treatment brought to mind what I frequently tell other diabetics. Everyone is different and has a different treatment routine. I have been telling people that for years now but I never had actually applied it to myself until reading that post. I had always thought I must have done or been doing something wrong to create this difference. I am me. I am not Molly, I am not Emma, I am not Amy, I am not any of the other diabetics I know.

I am not doing anything wrong I am merely doing things the way that works for me. MY correction rate works for me. My basal rates, well now doses, works for me. My diet works for me. It will not work for anyone else nor should it. I can try a technique I hear from someone but I will also need to test it to see if it will really work for me.

I can stop thinking “Why does this not work for me like others?” We, the other 2.2 million type 1 diabetics, have the same disease and share common problems and issues. Our solutions though are not and should be the same. They are unique to that person. Everyone is different and should follow their won path to control.

Different Strokes for Different Folks

I read a post from a fellow diabetic this morning and after possibly breaking her site with a lengthy comment, I though why not continue it here on my own blog.  A polite way of describing the people I want to talk about are back seat diabetics or armchair diabetics. These are people who either are not diabetic and think they know what is best for us/me or they are diabetic and think their solution is the absolute cure to this disease so everyone needs to follow their advice.

Molly, at huggingthecactus.com (hope I got that right Molly), was talking about a recent experience she had while out to eat and her sugar dropped. Been there, done that. I loved her approach. It mirrored mine so much, great minds think alike. She used common easily obtainable items to prevent a low.

I have been for years told by my, now former, endocrinologist that I should carry a glucotab bottle or get some of the paste to keep with me for any lows I get. I just laugh. I had tried that years ago and found it very not my style. One, they taste terrible. They are very strong sugar substances that use sour flavors to try and conceal the very sweet  taste. Yes, I used the term TRY. It does not work in my opinion. Second is the low sugar content of each pill/tablet. Each one when I bought them was about 3 grams of sugar and 3 grams of carbs. Duh, sugar is a carb. I would down the entire 10 tabs and still have to get candy from a machine to get back to normal. 30 grams plus to get back to normal.

I currently, like Molly did, use regular soda to boost my sugar level when it gets low. A Mountain Dew has 46 grams of carbs in a 12 oz can. Some days it only stalls my drops instead of reverse it and then at other times it will send me into low earth orbit, well at least my blood sugar.

My point here is there are no two identical people on this planet. Even identical twins are not doing the exact same things at the exact same times hence what may work for one would not work the other. There are about 8 billion people on this planet so even if they all were diabetic, thank God they are not, there would be 8 billion different treatments for lows. Every person is different so every person must find their own fix to each incident. Let’s be honest about it, the same fix does work every time even with the same person. Just go back and re-read the last paragraph.

Molly talked about working out earlier, before her incident, and that brings up another issue, exercise. Everyone reacts differently to it and does it in different amounts and intensities. Please do not tell me I’m correcting it wrong simply because I’m not following my “prescribed” treatment to the letter. I have had 40 plus years learning my body and how it responds to my environment. I can probably tell you what will drop my sugar level or raise it and how fast before I even touch a food or weight.

I tried an insulin pump (twice), one that was supposed to be fully automatic. That means it decided how much basal insulin it was going to give me with no input from me such as having to set a specific basal rate at a specific time. It would read my sugar level and make the changes on the fly. It works great for a lot of people but not for me. My diagnosis as a type 1 diabetic was called into question because of the settings we were using and the way I reacted to it. The results are yes, I am most definitely a type 1 diabetic. You know what the kicker was for getting a C-peptide test (a test of whether your body makes any or enough insulin of its own)? When I was going to start the pump I ran out of Toujeo insulin (basal) and the insurance company did not authorize a refill. I don’t blame them. They just paid for an $11,000 pump. I ended up going for 3 almost 4 weeks without my basal insulin. I can hear the gasps out there. Relax. You really could not tell I wasn’t on any. Sugar level were higher at times but not nearly as high as they should have been.

The pump suspended my insulin for nearly 4 hours (insulin half live was 5 hours) at times and I still had to eat to get it back up. Here’s a trick if you have enough will power, Skittles are like little sugar pills (they taste far better though). First, don’t swallow them as soon as you get them in your mouth. Chew on them until they just don’t seem as sweet. My opinion was it got the sugar into my system much faster. Second don’t eat the whole bag. A small bag from the vending machine has 56 grams of carbs in it. I just did about 3 to 4 of them at a time to slowly get it back up, unless it was crashing hard. They are very easy to scale to my need at the time. That whole bag is like a meal in a bag when referring to the carb count.

Like I started out saying, everyone is different and what work for one person may not work for another. I do listen to others for advice but please don’t expect me to blindly follow your example. I may use part of it or none of it. I listen learn and adapt it to my needs and wants. You should to. I will willingly tell you what I do, have done, or would do but you need to see what if anything actually works for you. I don’t think most people could get by eating 3,400 calories a day without gaining weight. I’ve eaten like this for at least 20 years and not gained (or sadly lost) any more than 5 or 10 pounds in that time.

While I was on the pump the doctor kept telling me I was eating to many carbs. I needed to cut back on them and eat more protein and fats. Hey I’d do it if I wasn’t already cramming cars to stop lows. That 150 gram “magic” carb count number is based off a 1200 or 1500 calorie diet. So at 3400 calories if you do the math, I should be up to about 310 or 320 depending on which base number you use. When I started the pump I was at about 420 carbs a day and had dropped it to about 280 to 290 a day by the end so I actually did cut them down. Using the original numbers, I was under the carb count persentage. She didn’t see it that way. It’s one the reasons I decided to leave her and go another route.

Here’s the basics of this speech. Don’t feel you have to follow the path of another find diabetic bliss. Make your own path, it is the only one YOU can follow. Listen to others who are experienced, be it more or less, with this disease. They may give you an answer or least a clue to help you find your path, just don’t feel obligated to dot the i’s and cross the t’s. Doctor or no doctor, you decide what does or does not work for you. They can look at your Dexcom or Medtronic sensor log but they are seeing only part of the story. You have lived it. Like I said listen but be realistic about how and if it will work. I argued with my former endo about said reading and won the argument, well at least I got her to agree to me trying my idea. A good doctor will listen to their patients as much as the patients should listen to the doctor. Tell them your fears and goals. Tell them why your sugar shot up because 2 hours earlier on that same graph your sugar was at 80 and falling fast. You over corrected. Look for patterns on the graphs. Again you know if you were working hard or chilling in front of the TV. It can affect that graph just as much as what you eat. Blaze your own path in this world, just be smart about it.

First step first

I started a new job this weeks and to say that I was not nervous about it would be a bold faced lie. After my initial experience with my new pump and the adjustment I went through, I was highly nervous about how bad things could get that first week. I’ve been doing research on body fat and its affect on insulin. The reason for this sudden interest is simple. My doctor told me when I first talked to her that they have a negative effect on insulin. Being over weight like I have gotten over the last few years is bad. I’m trying to remember her exact words but its basically was that fat acts like an insulator for insulin. The more of it you have the more insulin you need because of its effects on your absorption of insulin. With this new job I plan to start losing all this extra weight I packed on since I last had a real job that I could work hard at. After leaving the factories to try my hand in human services, read that taking care of developmentally disabled individuals, and then moved into security I found myself slowly getting fat. Yes I should have cut down on my food intake but I had always planned to start exercising more to make up for it. OK well anyway………. Long story short I gained about 20+ lbs. over maybe 2 years. Enough that all my older jeans no long fit. I now am empathetic toward pregnant women who deal with this during the 9 months. OK back to topic now, this excess fat will end up costing me more in insulin. I will keep taking more insulin to do the same work as long as I stay fat. Loose this extra fat and the amount of insulin I need also will drop. Not to mention the fact I will not have to drag around this extra and that extra weight according to the height and weight chart I found on line, I should weigh about 180 lbs. max. Well at 261 lbs. currently I am 81 lbs. overweight, I take issue with the that ideal weight since have been a weight lifter and will be again. Muscle weighs more than fat so I feel that ideal weight should be a reference rather than a rock solid goal. So I have an extra 81 lbs. of fat wrapped around in my body that needs to go. Imagine all the damage it has been doing already. I found an article from Jade Teta who is an integrative physician and author on this subject from the http://www.metaboliceffect.com/science-insulin/ web page. Insulin causes many different effects on the human body and resistance to the insulin he says is not an all or nothing concept. The liver will react one way and the muscle another and to different degrees. Sorry if some of this is hard to understand. I get the basics of this all and am trying to relate it here without complicating the message. From what I read of the article, please read it yourself to get the whole message, when the liver looses its ability to sense and respond to glucose it is the party to create most of the metabolism issues. The resistance is brought on by the massive amounts of insulin given in injections and the bolus amounts although not as much. The pump gives the insulin over a longer time. An inject for me took as little as 3 or 4 second from start of plunger push to end. The pump will deliver he same insulin in a way longer time, in some cases over 1 minute. That big dump of insulin is not given in one shot but over an extended time frame, much better. Score one for the pump! I was told by my doctor that I had over the 36 years of being a diabetic, developed a lack of being able to sense lows and I now wonder if this has anything to do with that issue. In other words I fought long and hard to not get a pump and now that I was kind of led into that decision, I feel that my clod feet syndrome was a bad idea. There is no Dr. or M.D. with his name so I am just calling him Mr. Teta, says that the war between insulin and cortisol, adrenaline, and non adrenaline is what creates biggest problems for metabolic issues. Mr. Teta calls it the key to insulin resistance and also “the most insidious metabolic disturbance of the modern day”. Wow. As I said before the article has a lot of technical terms in it about triglycerides and other chemical names and processes but the under the tab of insulin and fat storage it makes me cringe. Insulin can push your body into storing more sugar as fat than it should. It make sense to me. I said earlier I was into to weight lifting more as a power building than body building but I got bigger regardless. Big arms and legs but one area I always had issues with was first the backs of my arms and then my stomach being fatter than the other parts of me. The reasoning I came to was that these were the areas I was injecting the insulin. In fact once I started in my stomach it quickly became quite visible. Quickly being maybe a year as my arms had been used for better than 20 years to give shots. If I can lower the amount of insulin maybe I can work at getting this fat off also. I just found the key to fixing all this resistance of insulin. Exercise. Plain and simple exercise. Mr. Teta says that muscle contraction is an independent method of moving glucose into the cells and also increases the number of glucose receptor on the surface of the cells. Well Mr. Teta didn’t say that but he referred to a 2010 study from the American Journal of Physiology, Endocrinology and Metabolism that discusses it. It goes on to talk about using resistance training to decrease insulin resistance and increase the body’s ability to store glucose. The growth of faster twitch muscle fibers have the best benefit for insulin and blood sugar control. I am shedding a tear now as I realize the heavy lifting I love to do but had to give up when money was tight was the one things I had been doing that was helping me with my blood sugar control. I can remember at times when I would stop lifting for either medical reasons or just to jump over a stalled workout routine and after just a few days, 4 maybe 5 that my blood sugars would start getting out of whack again. Once I started back up again they would drop right back into place and I felt better quickly again. I’m in almost full tear mode here since I love lifting heavy. It began back in high school and I kept with it  for many years after as well. I have not seen the inside of the weight  room since the beginning of last year, 2012 and can see the effects. I am fatter, weaker and my blood sugars are all over the place. I’m going to end this blog now and go eat breakfast and then this afternoon I will start a workout routine to begin getting back into shape. Seeing where I have been, where I am, and where I want to be it just makes good sense to go back to what I love.