A bad flatline this time



Ha thats hilarious but your right he does - too many carrots. I agree, I think he’s reaching into type 1s fears about getting type 2 and double diabetes as well and the problems that causes as type 2 is mainly about insulin resistance and metabolic syndrome but its a stretch now I’ve spent the last day reading !!
Im working on a different theory now - one at least my doctor for now seems to agree with me on. So far, since I started fasting at 7pm last night - I have take 50 units of homolog and not eaten anything and my CGM is completely flat . For the hell of it - after my post above, I injected another 12 units from 3 different pens at the same time IM about 11.45 - 1 hr later I’ve dropped from 134 to 128 in 1hr - I think conclusive proof that humalog is not working for me anymore !!!


I have to dig up the studies but I think there is solid evidence that insulin promotes growth in most tissues and high exposure in peripheral tissue (i.e. not liver or pancreas, but all the other ones) increases cancer risk, for instance. And I do think the evidence is piling up that higher insulin use is associated with worse cardiovascular outcomes:

My impression from reading the literature is that insulin is a bit like a metabolic clock, which essentially paces how fast your body should age. High insulin = accelerated aging. And remember that all insulin-dependent diabetics are exposing their peripheral tissue to much more insulin than would normally be seen in a healthy person, where the vast majority of insulin secreted by the pancreas is first taken up and utilized by the liver.

So I would suspect that the correlation between high insulin usage and adverse outcomes is not an artifact, but a real effect. That said, you need the amount of insulin you need; high BGs from under-insulinization ire also going to cause a lot of complications. So ideally, I would imagine you’d want to use the minimal amount of insulin to get the lowest A1C you can. For a given person there’s probably a curve where there’s some optimal tradeoff between A1C and insulin dose, and the optimal A1C may not always be in the normoglycemic range.


yikes that’s scary!!! hope that an insulin switch fixes your problem.


Yes thanks for this - it does make sense - but they never discuss doses - but if you consider that an insulin resistant type 2 person has a pancreas that is already pumping out massive amounts of insulin and if the type 2 person in question is not controlling it / eating lots of high carbs then they are also injecting large amounts of insulin - the factor of what they have in their body to any type 1 is going to be very large. Even a type 1 who is on a largish dose of insulin, wouldn’t be injecting anything near that scenario I think - so it would appear this is mainly a type 2 issue. The treatment to avoid this problem for type 2 then becomes the norm, reduce carbs, reduce exogenous insulin being taken, lose weight, increase sensitivity, take metformin to reduce excess sugar (that needs more insulin).


I finally tried what @eric said in his wiki about low aerobic exercise and that it can drop your BG without insulin being required - level 3 and 4 and went for a bike ride (flat) so my heart rate was raised a little but not too much. Worked a treat, could see the CGM responding 10mins after i started and my blood sugar started to fall from 140 until now it has dropped to 70 - I guess i’m going to have to bike ride a lot this weekend before i see the doctor monday !!


@TiaG When I had the “Is too much insulin dangerous?” discussion with my doc he did mention some NIH studies that correlated higher CV risk with higher insulin dosages, but he pretty much discounted the findings because he felt the cohort was predisposed to CV risk, and the more insulin the participants took generally the worse their Bg was being controlled so their CV risk would be greater.

He did not think that higher exogenous insulin needs led to higher CV risk because of the insulin.

This was going to be a topic of research for him on his return to UTSA, but, alas, he passed away before he got there.


Exercise amplifies any insulin you have. So just the basal in your system can drop you with a certain amount of exercise.


My GP also brought up the topic of “too much insulin is bad for your health” discussion and wanted me to be on oral meds. But the logic is lost on me. The oral meds were of the classification whereby the pancreas is caused to produce more insulin. So unless I am incredibly obtuse- wouldn’t it have the same effect as exogenous insulin?

Does anyone have their insulin measured as part of their blood test? If one were fasting and relying only on their basal exogenous insulin, and if one were NOT insulin resistant, I would imagine that the insulin in the blood would be reasonably “normal”. On the other hand, if one were extremely insulin resistant, I would imagine that there would be the exogenous and the indigenous insulin all circulating in the blood stream and therefore an analysis would reveal the blood insulin level to be very high. The “typical” story that I’ve heard of insulin resistant diabetics is that they take 100 to 200 units of insulin daily, is overweight, eats the SAD (my pharmacist).


I understand that the oral meds like metformin not only stimulate insulin production for type 2 but they also suppress hepatic glucose production which can be helpful for type 1s - leading to less overall insulin needed for a type 1 if they are producing a lot of hepatic glucose
I read this which is interesting and somewhat connected to the discussion also

My doctor put me on apidra and so far it appears to have done nothing - I’ve also been running some of my own experiments and have found something that seems to agree with some of the things written in the article
1 - when I don’t eat carbs and only protein and my post prandial sugar rise is driven by the liver (gluconeogenesis) - then injecting either humalog or apidra has zero effect for the 5hrs after the meal that happens - it’s easy to test that theory for breakfast just eating eggs - i did it Sunday and Monday with humalog and today with apidra - I injected 40 units of each after the meal and it had no effect on my blood sugar - after 5 hrs if I inject it brings it down normally for my normal dose - even more bizarrely if I don’t inject during the 5 hr it doesn’t make it go higher than if I did - so the hunalog and apidra is essentially doing nothing
2 - if I up the dose of carbs and don’t eat protein so there is no gluconeogenesis and just sugar absorption from the food - then the humalog works fine - haven’t tried apidra yet
Doctor has asked me to start documenting diet and injections - he doesn’t think it’s antibody related but liver related - but wasn’t very helpful apart from that
If that’s the case then for me at least - low carb is actually causing more problems and I have to swap back to higher carbs so I don’t get any gluconeogenesis or minimize it - that will be hilarious if that’s the solution
Also no change in diet just having humalog go up from 11 a day to 90-100 a day - I’ve put on 3lb in 6 days - does that unused humalog turn into fat somehow I wonder ?
I also clarified why he told me I was taking too much / he didn’t mean like type 2 too much and metabolic syndrome etc but he meant for my size it was too much basal and he worried about that causing lows in my sleep- he said it’s doses of 200-300 that are the worrying ones for type 2


It’s my understanding that metformin works to suppress hepatic glucose production; sulfonylurea drugs stimulate insulin production.

How much insulin do you need when you fast during the day? For me, when I eat the low carb breakfast (eggs) the protein affects my BG. For some reason, eggs have a greater impact than something like walnuts. It’s been stated elsewhere that when one is on a LCHF diet, one needs to address the protein impact on BG more so than if eating a SAD. In a SAD the carbohydrate effect on the BG is overwhelmingly more than compared to the protein effect on BG.


My fasting basal is pretty flat actually and hadn’t changed through this whole episode - I need 19 tresiba which is textbook dose for my weight and height. If I fast during the day I don’t see a rise maybe 5 bg at most if I skip a meal - which tells me my liver isn’t the problem here
When I went low carb I used Bernstein’s guide to dose protein as well as carbs and that worked first and got me down to 11 - it was 4 for carbs and the rest for protein
After some further experimenting and really ensuring my carbs are below the 40g to stop any problems with my gluconeogenesis I’ve got it down to
2 for DP, 5 for egg breakfast, 10 for lunch and 10 for dinner now and 4 for post anaerobic exercise - so total 31 - a lot higher than 11 but not scary numbers at least
The other threshold I’ve worked out is if my bg goes to 160 as had happened when it first started happening - insulin resistance kicks in and that’s what caused me to be putting in 70 or more - I’ve read that normally happens at 200 + so 160 seems low but really reinforces I have to keep my bg below 150 going forward
I guess I can live with a TDD of 50 on a 30g a day carb diet - the insulin to carb ratio is weird but the protein has to explain that - going to keep it at that for a week and see what happens