T1D FBG puzzle

(Louise) #1

Hello, need some help/ideas for my T1D husband!

We’ve been keto since Jan 2017, and it works really well for both of us (I’m not diabetic). We’ve lost heaps of weight, and he has dropped short acting insulin completely. He has also halved his basal insulin (long acting) requirements. His BP dropped too, which meant he had to drop the BP tablets. His recent (3 months ago) HbA1C was 5.2% - lowest reading ever. We also do IF - very often OMAD, at most 2 meals a day. He checks his ketone levels and his blood measures are usually between 0.5 - 3.

However, in the last 4 months or so, his FBG tends to be in the ~8 range. He’s even increased the amount of basal insulin (usually 14 units at night and morning, up to 16), and takes Actrapid for protein coverage. We’re really puzzled as to why this might be the case. I’ve gone through Dr Bernstein’s book, and I understand that this may be multi factorial…gluconeogenesis, glucagon, stress, but we’re not sure how to tackle this. His BP has gone up again slightly too. I’m hoping that he doesn’t have a creeping insulin resistance.

Any thoughts would be really appreciated.

Thanks!
Louise

(You've tried everything else; why not try bacon?) #2

Has your husband’s HbA1c also gone up? If not, he is probably experiencing “glucose sparing,” which is sometimes also called “physiological insulin resistance,” a stage of full fat-adaptation in which the muscles burn fatty acids, and save glucose and β-hydroxybutyrate (the principal ketone body) for the brain and other organs that need them. If the glucose has risen somewhat and the HbA1c remains the same, then he should not increase his insulin.

I believe I’m right about this, but you might want to see if you can find some verification on the Type I Grit site.

(karen) #3

I don’t know what that means. I was wondering if your diet has started increasing in protein?

(Louise) #4

Hello Paul.

Thanks for replying!

His HbA1C has gone down from Dec '17 (around 6.4) to April this year where it registered 5.4. We were surprised as his FBG seemed to be up and down, even on keto. I did read about the physiological insulin resistance … and speculated whether this was the issue too. Is this something then to worry about, since our low carb doc is quite insistent on him keeping his blood sugars in the normal range (around 5)?

I’ll shoot the question to T1 grit as well

Thanks
louise

(Louise) #5

Hi Karen,

thanks for replying. Actrapid (not sure about the spelling) is the insulin used to cover protein and has a life over 2-3 hours. Even when taking this it didn’t seem to touch sides, although it’s inconsistent. Sometimes the pattern seems to work and drop the sugars and sometimes not, even when the food is the same.

I think that our protein consumption has been consistent - although I wonder with the OMAD whether we should be eating it all in the evening. Just suits the lifestyle, I guess.

He’ll take his standard basal insulin in the morning, not eat breakfast or lunch, and do exercise, and the BG has gone up when we measure before dinner. It’s pretty frustrating…

Best regards,
Louise

#6

Louise, I remember hearing about exactly this with a T1D on keto: that after a while, his blood sugars went up to a new level but then stabilized there. I think I remember something from a recent to Two Keto dudes podcast on this. Can you search for a podcast with a T1D in the last few months? It sounded like the rise was expected and not a problem.
Congrats to both of you on your success!

(Louise) #7

Thanks, I’ll check. Could be the Troy Stapelyton one.

Best regards,
Louise

(You've tried everything else; why not try bacon?) #8

Now, of course, I see the bit in your original post about the HbA1C!

Not being a doctor myself, I couldn’t really say, but since his HbA1C is the lowest ever, I would guess that his BG level is okay. It might be a really good idea to try raising the issue with the doctor by asking if he thinks this is a case of glucose-sparing, or if something else might be going on. Since he’s a low-carb doc, I would also tend to do whatever he advises.

Also, for what it’s worth, here is a presentation Dr. Stapleton did a few years ago. Check out what he has to say at 4:50 and at 5:50: