Physiological Insulin Resistance

insulinresistance
diabetes
physiological
(Mark Lewis) #1

I have been trying to find an answer to why my FBG levels have been increasing over the last couple of weeks. It is very frustrating and as a diabetic trying to reverse the disease it is scary (will this WOE work? Are the consequences of out of control diabetes, I am trying to escape, going to happen anyways?).

I ran across a blog post that seems to describe what may be happening in my case. It is a possible phenomenon called Physiological Insulin Resistance.

I ran across this blog post first …

“Low insulin levels activate hormone sensitive lipase. Fatty tissue breaks down and releases non-esterified fatty acids (NEFA). These are mostly taken up by muscle cells as fuel and automatically induce insulin resistance in those muscles. Palmitic acid is the primary NEFA released from human adipose tissue during fasting. Think of palmitic as a signal molecule to tell the muscles that inhibition of glucose uptake is needed and to tell the liver that increased gluconeogenesis is required because there is no food coming in.” This in turns increases the blood sugar.

One of the supporting blog post to the one posted above spoke of person experience.The author, like me, gets a consistent mild ketosis readings. Using Ketostix I am getting a consistent 15 dl reading and at high BG.

I am going to continue reading/researching down this path to determine the implications. The author of the blog’s conclusion was as long as his HbA1c is 4.4% he does not care about the high blood sugar readings. This is one voice so I want to learn more.

Has anyone researched this before? If so, what were your conclusions?

Elevated Fasting Blood Glucose
Rising Blood Glucose levels
(Mark Lewis) #2

In a comment to the second blog post above, the commenter experiences this situation was well … in found that doing the below activities kept BG readings down.

  1. Exercise the day before (empty glycogen stores to be filled again by glucogenesis first (?) ,
  2. Drink a glass of wine the day before and liver capacity is tied up getting rid of resulting aldehydes.
  3. Reduce protein intake leaving “less easy raw material” available to make blood sugar from.
#3

I think the statement about HbA1C is quite valid. Are you concerned about yours?

Are you still on medications for diabetes? Does it warrant another recheck on dosages?

Keto drives insulin down. So, I think maybe you need to give your body to reach equilibrium in its new normal. But, of course, with making adjustment to your current medications.

(Mark Lewis) #4

Yesterday coming home from work my BG was 128, I was in a fasting state over 6 hours. This morning my dawn BG was 174. Yesterday I ate 19g of carbs. It has been this way all week.

I am still taking Metformin (max dosage). I discontinued injecting Victoza about two weeks ago. Perhaps I need to get back on that. I have been keto since mid-Jan of this year. I have seen great results in both my BG readings and my HbA1C for the first 2-2.5 months. This recent experience has been disappointing. Keto has been hard work (mostly the diligent tracking is the hard part, the actual WOE was been good) and since I appear to be back to where I started it is upsetting.

I want off medication so bad and want to reverse the effect of my T2. Perhaps I jumped ahead too fast with discontinuing the Victoza. My major concern now is my health and the impact of high BG. I don’t believe the Doctors I am working with are keen on this WOE and have concerns about my Cholesterol and the health implications. I really wish I could find a doctor that was supportive and would help me determine the correct course of action given the recent turn of events.

(Cathy) #5

I discovered that my fbg was higher than I expected on a vlc diet and went on to research why this might be. Peter of hyperlipid gave me the clear answer that I was looking for. My AbA1c is normal and has been for 7 yrs… That is good enough for me. The other question that came about was, even if my glycation appeared to be abnormal, what else was I willing to do about it? Nothing. I am LC/HF with intermittent fasting mixed in and as far as I can discern, this is the best way to treat metabolic disease.

Another point that I always apply to questions of this nature is ‘how would the data look if it were in the context of ketogenic life style?’ Would the norms of a glucose burner apply? Hard to know for sure but in the meantime, I am fully and completely convinced that carbs are bad for me. And so I keto on ~ as they say! :grin:

(Mark Lewis) #6

Is there a risk of FBG to organs. I am not super clear on if it is the high BG or the high insulin that causes complications of diabetes. I am concerned will I may be able to fool my Endo with a low HbA1C, I am still concerned with the retinopathy that my ophthalmologist and I are trying to address.

(Cathy) #7

I don’t know about any risk that elevated FBG might have in the context of physiological I.R… My guess is that it is the high insulin that is problematic and having a slightly high fbg is not an issue. If your HbA1C is higher than normal #, that might be a problem but honestly, in the context of keto, …? There is no more effective way of lower blood glucose than eating a LC/HF diet. All the other stuff is noise in my opinion.

#8

Physiologic Insulin Resistance seems to be the body’s response to carbohydrates (and excess protein to a 50% lesser degree) while insulin is LOW, but I seen nothing like a fasting insulin test to say that you’re not experiencing regular insulin resistance (IR) which would mean that fasting insulin is above 13 uIU/mL.

I agree with Dr. Jason Fung and others that the best way to deal with IR is fasting and I see nothing about fasting, other than a reference to 6 hours and that’s probably still releasing calories into your system through digestion.

In a T2DM, keto will not make the problem worse and will probably reduce IR over time, but if you’re not at least intermittent fasting, then insulin doesn’t have enough time to get low and allow the body’s cells to upregulate insulin receptors again so the beta cells in the pancreas can reduce their production of insulin.

(Mark Lewis) #9

I have not gone the IF/F route yet. I think that may be the next step. At least to eliminate some of the variables at play.

Something strange is happening in my body that I have not been able to explain. I started getting dizzy spells when standing up or after short bursts of exertion to the point of passing out on a backpacking trip. Just from a data perspective, I think it is reasonable to think that LC/HF is failing me. Though to put that in context it has been 2-3 weeks that this has been going on, so there may be other factors (I could point to a lot of possibilities) that are causing this issue.

Again, I really wish I had a supportive GP or Endo to help me discover the issue. I have tried to reach out to a number of Facebook Keto group to find a GP/Endo that is Keto friendly in my area with no success.

#10

I would think that the alternative to LCHF/keto is eating carbs, so I think it’s just the management of T2DM that’s the issue and not LCHF.

I reversed T2DM after an early instance of self-diagnosed Diabetic Ketoacidosis (DKA) when my blood glucose was over 525 mg/dL, but being a former paramedic, I dealt with it on my own since I hate hospitals, and every single time I tried to reintroduce carbs, my weight/BG/FBG/A1C always went up and it was only consistent LCHF and eventually fasting that has reversed T2DM.

IANAD, but I can offer my insights as someone who came from a pretty bad place with diabetes, and you can only do what you feel comfortable with doing, so if you were a friend of mine, I would support you in anything you choose.

I think this is a good choice, and I’d give serious consideration to a fasting insulin test, because if it is high as I suspect, that’s a metric that you can monitor that’s a better indicator of your condition.

(Mark Lewis) #11

I agree with this. I am not trying to troll in the “failing me” statement. I am just frustrated and honestly worried about what is happening. I really appreciate your input.

#12

Your dizziness sounds like orthostatic hypotension, which might be helped by drinking more water and/or taking in more salt and possibly other electrolytes. People say you need around 5g of sodium a day on LCHF, which is about 2 tsp of table salt.

#13

That’s okay, I didn’t think you were trolling or anything similar, if my BG was high despite a normal A1C, I’d also be concerned about the effect on something as sensitive as the retina and it’s effect on eye health.

(Cathy) #14

Physiological I.R. is different from Pathological I.R… The former means that insulin has been down regulated due to lack of need where as Pathological means that it has been up regulated. Two very different situations with unfortunately similar names.

(Barbara Greenwood) #15

I’ve seen a blog which said the physiological insulin resistance would be better called adaptive glucose sparing.

(paddy0761) #16

Nigella Sativa

(Mindy Noxon Iannotti) #17

Interesting that I was googling the same thing and came to this Paelohacks article as well.

My details, briefly, LC on and off since 2010, bouts of Paleo and Whole 30 and just off the rails carbville. Last May I got disgusted and went full on keto. Between then and say October I lost 25 pounds. Oh, I’m a 50 yr old woman, btw. Felt great on Keto and definitely was in Keto based on blood, breath and how I felt. I am not diabetic. During the early days I was getting glucose readings in 80’s and 90’s. my A1c is 4.3.

Fast forward thru the holidays where I did not keep the faith and gained 10#. Sick of it again, been Keto, strict Keto 3 weeks, bg levels in the low 100’s, not in Keto, and no energy, exhausted. Clearly still a sugar burner even with <20 carbs, moderate protein. So that get me googling.

In honesty, when I started last May, I was probably having an extra pc of dark chocolate, a bite of my daughter’s potato here and there, and maybe an every other week ice cream. So, now in retrospect I think my carbs last year were 30-50 or so, and I was in Keto. I need energy. I am so exhausted all the time and Ketosis is not coming…so crazy as it sounds, I’m going to experiment with lower protein and a few more carbs, maybe 20/ meal (eat 2 per day). Today I had some carbs, and 60 minutes PP was 103, vs 122 yesterday when it was zero carb. If anyone can explain this, I’ll listen. I also listen to KetoTalk and The Keto Diet Podcast, and I know there are levels of Keto, I just want to find mine and make it stick.

(dylan) #18

I had this and it seems its lowering. 2.5 year LC 18 months SKD. I come to this as an athlete. My Hba1c was 5.6 pre keto in adaptation went to 4.9 then returned to 5.5 but I feel is from Phys IR. Has to be the glucose clearing. My performance and output has returned. My body comp has been remarkable in the change. I ever go to a Dr they’d probably force feed me statins prolly. My chol ratio is 2.8

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