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Re: [IPk] musing on diet [long] AND apologies

Dear Nanette,

I really don't have much idea why you are getting so much better results
from a diet with fewer calories and a slight shift from carbs to protein
and a change in fat source ....  But it does seem to be the amount
that's eaten, not the source of the calories which is a factor, doesn't

The only thing I can think of is that you have significant insulin
resistance increase with higher bgs.  Most of us have some increased
resistance (i.e. it takes more insulin to lower from 14 to 10 than it
does to lower from 10 to 6, and a lot more insulin to lower from 24 to

If after eating you get a peak (say from a normal stable six or seven up
to 10), and at 10 you need twice as much basal as you do for the next
three hours and so on ... Snacking (lots of peaks) would have a
particularly bad effect.

At least with a disetronic you can up your basal with a percentage to
cope with high bgs!

Best wishes,

(dm 30+, 508 2+)

In message <email @ redacted>, Nanette
Chana Freedman <email @ redacted> writes
>Hi Pat,
>thanks for taking the trouble to go through my message in detail.
>Also sincere apologies to Melissa and others for my slip about MODY - I
>feel very stupid, especially to have felt so arrogantly and
>complacently convinced that I was right - maybe I was hypo when I wrote
>- I do really know the way the terms are generally used.
>>Do you use a 508?  One of the problems I have with it is that it 
>>allow multiple dual-action or square-action boluses. So unless snacks
>>are very high % CHO (over 60%), it's impossible to get such a good 
>>of insulin to carbs as with the first.
>I use a Disetronic H-tron plus - but same problem - my sense though is
>that this problem affects how I cope with high protein meals rather
>than relatively high carb snacks.
>>That, and the difficulty I sometime have in guessing how much I'm
>>grabbing in 'a handful', are my causes of poorer bgs with snacking.
>ditto - clearly a problem for anyone like me with tendency to graze -
>it is probably more difficult for me to snack a little than to refrain
>>I also find that a traditionally 'unhealthy' diet (i.e. one with a
>>relatively small level of calories from carbohydrates) is easier to
>>balance than one with the traditionally 'healthy' high level of 
>>from carbohydrates (60% or so).  This is because even humalog acts
>>in me, and I digest at a normal or slightly fast rate.  
>This does not seem to be the case for me. Humalog acts fast, and high
>carb meals seem to be ok. Meals that are high in fat and/or protein
>sometimes leave me hypo immediately after, but high for hours later.
>>The information you provided about your current diet (or the past one)
>>isn't enough to see what you have done: I would need to know previous
>>total calories, and percentage from CHO, and current total calories, 
>>percentage from CHO to see what was happening.  You appear to be
>>that you are reducing calories, reducing percentage from CHO, and
>>reducing percentage from saturated fat. You imply, therefore, 
>>percentages from protein, unsaturated fat, or alcohol, or a mix of the
>I am embarrassed, as a scientist, not to have any of this exact
>information. What I do know is that I have reduced total calories -
>percentages must also be somewhat changed, with reduced percentage from
>CHO, and reduced percentage from saturated fat. As you correctly infer,
>this would mean that I have increased percentages of other things, but
>only slightly - protein, and to some extent, unsaturated fat. Since I
>can generally manage without it, and find it complicates blood glucose
>control, my alcohol consumption has been confined to a sip or two
>(literally) of wine in the two weeks of my diet so far. Percentagewise,
>I am eating more vegetables and fish, and relatively less of the other
>>It seems that maybe Humalog acts too slow for you, too .... (but I 
>>be at all confident about that without the diet breakdown).  Any
>>thoughts from anyone about how to get a faster acting insulin?  I
>>a continuos bg monitor would help, as then I could see exactly when in
>>the half-hour up to a planned eating time it was safe to bolus.  As it
>>is, it tends to be only as I start eating, as if my bgs are on target,
>>any earlier drives me hypo as I'm eating.  Particularly if I get
>>distracted and talk a lot!
>I did a couple of trials of a continuous bg monitor a while ago (see
>the web page on IP-UK about it) - it indicated that I should bolus
>earlier for high carb cereal breakfast - I still do this - but even bg
>control after breakfast where I have changed absolutely nothing either
>in quantity or content of what I eat, has improved, since I started
>this diet. The continuous monitor did not indicate a problem of timing
>for me for other meals when I bolused immediately before eating. 
>>I don't know whether that's any food for thought - oh, nearly forgot: 
>>you are not squeamish about 'eating bambi's mother', try switching
>>beef to venison: a) it's got less saturated fat, and b), it's far more
>>satisfying - a 4oz venison burger is equivalent to a 8oz beefburger, 2
>>venison sausages to 3 pork sausages, etc.  It's just a shame that game
>>birds don't have the same advantage over blah chicken!
>Good to know. But I have vegetarian tendencies - before the diet,
>landed up eating one meal including either beef (which I now plan to
>forgo on account of the high cholesterol) or chicken perhaps once every
>week or two, if it was socially convenient or other family members
>demanded it, otherwise tend to stick to vegetarian plus fish.
>I've definitely increased the amount of fish I eat since starting this
>But the issue remains - it grieves me much to say so, but I now doubt
>that I could ever achieve such good control for days on end with eating
>a higher calorie, higher carbohydrate diet, particularly if snacking. 
>My current sense is that my insulin sensitivity (which went up
>significantly - within a few days of starting the diet, I had to put
>the basal rates down substantially to avoid being permanently hypo)
>goes down when I eat carbs, and the carb ratio that normally works,
>does not work for snacking, does not work for long meals with
>carbohydrates scattered throughout - in these cases my insulin
>sensitivity seems to deteriorate rapidly - though by global standards,
>the amounts of insulin I use are very low, about 1/3 less than
>suggested amounts in the books for someone of my height and weight.
>thanks again for all the input
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Pat Reynolds
email @ redacted
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