As of today, they want me on a GLP-1. They want a lot of things that they don’t get.
But, it was an interesting conversation. The doc said that I am very insulin resistant and that GLP-1s help with that. He said it helps control postprandial BG, which I am also having trouble with.
He also told me that Komodo Dragons are the source of GLP-1’s in some way (but the reception was kinda bad). He said “normal” lizards only live 5 years, but Komodo dragons live 40 years. He was a pretty good salesman. I guess that if it is good enough for a Komodo Dragon, then it’s good enough for me.
There are lots of type 1s on GLP-1s, including myself. I started at a lower dose and worked up, as many people do, but found what my personal limit was. (When the dose was too high, my blood sugars were very difficult to control for the first 48 hours of the week.) I’ve been taking different GLP-1s for 11+ years and am not looking back. It really makes my life easier.
@mohe0001 , like @allison I’ve also been taking GLP-1s for almost a decade now. I use half the insulin that I used to, my BGs are much more stable, no FOTF highs anymore, life is better with them. Yes, there are other advantages too, cardiac benefits, some have kidney benefits, better satiety at mealtime and who knows maybe I lose a pound or two (I could stand to).
There are drawbacks - there always are. The real question is are the drawbacks worth the benefits? Only you know that @mohe0001 . Myself, I’m a fan.
I don’t think I’m gonna end up on GLP-1’s, but I’m gonna play along so I can get genetic testing done and interpreted. Expect me to come hassle you all for info about that.
The Doc DID make a comment about my “diet.” I eat like a racoon in a garbage can. I feel like I have a pretty restricted diet from being vegetarian. I also just never stop moving or talking or thinking and I’m almost 200 lbs. It requires a lot of feed to keep this animal moving. I’m probably 20 - 30 lbs overweight. I thnk I’m pretty insulin resistant.
I just don’t know how much I can change my diet. I’m dosing ridiculously high bolus dosages - ones that could be bordering on ‘kinda lethal,’ or ‘kinda dangerous.’
I don’t know what to think about what happens to some of these large build, high energy ex-millitary guys on the GLP-1’s. Their sex drive evaporates, they quit smoking and drinking, and they get all sappy and depressed. I don’t want that to happen to me. Also, the murmmers about vision side effects if you have even a scrap of retinopathy freaks me out. I’ve been T1 for over 30 years.
But I’m also super conservative about ‘new’ drugs. You know they have to force girls like me to upgrade our tech at the barrel of a gun.
I could be wrong and someone please correct me if so, but pump bolus and Sub-q injection for bolus ~25 units is supposed to be all that a person ‘s dermal layer can handle at a time? So if someone is blushing +25 units they should break that up into 2 or more sub q injections or pump boluses
I dunno, elver. Some people complain about poor absorbtion if its larger than 6 or 8 units. I might need 6 - 10 units in the morning just to cover a piece of toast. It’s bad. That’s why he is recommending the GLP-1’s.
I’m on a pump. If I were on manual injection, the dose would be larger.
I need to start being careful if a dose is 15u. I’m overdosing to prevent post meal highs, but then I get an inevitable low 4 hours later. I’m nervous at 15 u because if your at a resturant and the food doesn’t show, that can hit you pretty hard. But, also, that’s just a unreasonabley high dosage for me. I shouldn’t be dosing 20 units for a meal. That’s insulin resistance.
If I’m ‘off’ at all on those large dosages, it gets problematic. Taking those large dosages regularly, can increase the number of severe lows pretty rapidly.
In my case I get satisfactory recovery after a couple of hours (still higher than target but not that high) and I see the start of recovery after 60 minutes or maybe 90.
AAPS has an algo to handle this; they call it the “Super Micro Bolus” or “SMB” (whatever; I chortled with my endo about the term but he didn’t seem to understand how dumb it is). I call it “basal stealing”; the bolus for a meal also includes the upcoming basal for about an hour (don’t quote me on the time). AAPS reduces the basal to 0 for the same time.
For pump users there is a slight risk; there is no option of cancelling the basal to deal with a server error of the type you describe. MDI users of course do not have that option. I really hate it when my wife goes full Sir Henry and demands my meal now because I’m a diabetic.
Can it? I see those problems anyway and I don’t bolus much about 5IU.
I do see the problems more when I eat more; when I’m alone my TDD is about twice my basal, maybe 25IU/day, and that, even now, accords with the 120g/day diet I was given when I was 12 and a newly anointed diabetic. When my wife is cooking my TDD rises to 40IU/day; guess whose food you would want to eat!
I don’t get those highs, I’m in control all the time when my wife is away.
What I am saying is that decreasing food intake makes my T1 management much easier but that is not a life I enjoy.
This is the exact path I travelled for many years before 2012. I aggressively used insulin to “preempt” expected post meal hypers. I prided myself in being able to catch the diving white knuckle hypos that usually followed. I was fat, distracted, and emotionally distraught.
I have memories of “successfully” avoiding car and bicycle accidents. Until I didn’t. I put my and other people’s lives at risk. I’m not proud of who I was back then. Bernstein’s law of small numbers was a truth I resisted for many years before I finally gave-in in 2012. It was one of the best decisions I’ve ever made.
“Carb-up, shoot-up” is not a quality life. The standard medical professional permission to eat whatever you want and just cover it with the correct amount of insulin is a high stakes game guaranteed to leave you in a smoking heap wondering what the heck just happened.
Before 2012 my TDD was north of 80 units, today I’m averaging about 25. And all my numbers are better without all the drama!
I hesitate to write this because it all comes down to changing the way a person eats. This decision is so personal and bound up with emotional, cultural, and social implications. It’s worse than bringing up politics or religion in polite company. No one wants to change their way of eating!
I hit my personal low in 2012 (28-years in, I’m not a quick learner) and finally promised myself that I would do whatever it takes to extract myself from the personal hell that I created with my diabetes.
Don’t get me wrong! The path I’ve taken is not the only one that leads to metabolic sanity for those of us forced to take external insulin. I have not found the way of dealing with T1D, simply a way.
Listen to your heart and use your brain! Build your personal discipline one day at a time. This is a solvable puzzle.
@mohe0001 I can understand the hesitation over starting a GLP-1. Have you considered trying metformin to increase your insulin sensitivity? It was magic for me; reduced my TDD by around 20%. My only note would be to start very slowly and to insist on the extended release form. I started with 1/2 of a 500mg pill and now take 1500 (1000mg at night and 500 during the day). I have come to believe that most of us type 1s also develop insulin resistance as we age (similar to the general population). Good luck with the decision!
That’s a screenshot from AAPS. I normally post xDrip+ because that is the receiver for the G7 I use (it transmits the data locally to AAPS running on the same 'phone). This time I used AAPS because I have xDrip+ set to display the data from the G7 without smoothing (I always use the AAPS smoothing) and yesterday the G7 was particularly noisy.
The highs were also somewhat higher than my normal; my “normal” post-prandial high is 180mg/dL on my current diet+exercise level. Yesterday I was doing a lot of manual exercise and so had an increasing insulin sensitivity; this makes my BG more choppy initially (for a couple of days).
Afrezza has seemed to me for many years now to be a much better solution for post prandial highs; see the details above. Many people can’t change their diet. People who jet all over the country and snatch meals from unhealthy places like airports or truck stops really have no choice, “How do you want your carbs luv?”
@mohe0001 At the risk of giving a diagnosis when I am not a doctor and am going by what I have read from you, you are likely T2 insulin resistant along with T1 autoimmune. While there is no billing code yet for Type 1 with insulin resistance it is a known condition.
Abnormal insulin resistance is coded in some 70 genetic variants that cause the cells of the liver, fat and skeletal muscles to resist the attachment of insulin on their receptors, even though they are in need of glucose.
Those with T1 with insulin resistance have much in common with me a T2 on MDI or a pump.
I’m going to get on my soap box with my standard spiel.
The number one thing that works best to increase cellular insulin sensitivity is not any pill, potion or injection. It is regular exercise of a minimum of 30 continuous minutes daily. Walking is good, can do it most anywhere and requires really only good socks and shoes.
GLP-1s and Metformin work in similar ways, except GLP1s are insulin secretagogues which means nothing to you as a T1.
Both slow digestion a bit which causes gastric distress for some. Both reduce the amount of glycogen converted into glucose in the liver. Both increase cellular insulin sensitivity a bit. GLP1s do give a sense of fulness, decreasing appetite.
I just learned from reading a study that Metformin stimulates the amount of GLP 1 made in the gut.
Regardless of how well these meds work to increase insulin sensitivity they don’t hold a candle to regular exercise. In fact no T2 drugs work well without a carb restricted diet and regular exercise.
Those 2 things gave me near normal BG levels for 10 years until my long T2 honeymoon ended.
That’s an interesting point. About 20 years ago I knew a T1 in town who was prescribed Metformin and I always wondered about that. He was much older than me.
I’ve started eating more protien (even though it is super expensive) and it does help. I’m eating a lot less and I’m less hungry all the time.
I would typically just bump up my basal rate to decrease my bolus, but I see that just steadily increasing the amount of insulin I’m taking overall, over the course of many years of doing that. It causes me to gain weight. That increases how much insulin I need. It’s very chicken or the egg.
I appreciate the input, @Terry. Our bodies change over time and exploration of different straategies just might be necessary.
I only spoke up since your experience strongly reminded me of what I went through. T1D combined with significant insulin resistance is a tough nut to crack. My only regret is that I didn’t change course earlier. Taking ownership of where I was and accepting that it was solely my responsibility was a key change of perspective for me. Everyone’s situation is unique but we all share many characteristics.
Just know that I’m rooting for you and that I respect your decisions!
I’m not gonna quit being vegetarian because I’ve been that way my whole life. I don’t even view meat as food anymore. It’s like eating insects to me - it’s just not food, in my brain. So, maybe it’s just time that I be a better vegetarian some how. Not sure how to do that, but there’s certainly a way because people do that all over the world.
