Type 1 - Fat Stores for Energy

Q: Hi Ginny,

I was diagnosed with type I when I was 8 (I'm 27 now). I take good care of myself, my last a1c was a 5.1 in April 2010 and they're usually in the 5 - 5.5 range. No diabetic complications of any kind, I'm fitter than most non-diabetics and my other blood tests are great as well. I don't have a sweet tooth and I try and keep my carb intake under 100g a day, but my metabolism is insanely fast so it's not always easy to do. I rarely go to the doctor for diabetes info - they have not been of help to me in many years and I seem to do better with the information I read and by testing new things on myself. My last resort is usually to go see an endo if I can't get a question answered or find my answer through a credible source so here I am. Anyway...onto the question....

Question

Do diabetics use fat stores for energy like a non-diabetic? I'm not entirely sure about this since glucagon exists for emergencies to release glycagen, but if diabetics don't produce natural glucagon, would the body revert to breaking down fat for a lot blood sugar?

Meaning, if there was little to no insulin in my body, or maybe just a small daily dose of lantus, would my body break down fat stores to utilize as energy? I'm asking because I want to shed some fat (probably just 2-3 pounds) so I can make a weight class for a rowing shell and need to find out how this works so I can find a way to work around this.

Thanks,
f.

A:

[From Dr. Robert E. Jones, MD, Medical Director of the Utah Diabetes Center.]


Ginny,


I agree that fat cells in people with T1DM are similar to non-diabetics.


Insulin is anabolic (allows us to store fat/glycogen) and anti-catabolic (prevents the breakdown of fat and glycogen). When insulin levels are low (such as fasting in non-diabetics or insufficient insulinization in people with T1DM), free fatty acids are released from fat cells. People with T1DM are clearly different because non-diabetics will make just enough insulin to maintain normal glucose levels whereas those with diabetes get hyperglycemic. Glucagon, growth hormone and catechols also interact by promoting lipolysis (fat breakdown) and hepatic glucose production, and in the case of people who have a pancreatectomy, ketosis is delayed several hours in comparison to people with T1DM who stop their insulin. This last observation has been attributed to glucagon deficiency in pancreatectomized individuals. Glucagon secretion in most folks with T1DM continues for many years post diagnosis, and autonomic insufficiency with catechol deficiency is a late complication.


I would encourage him to exercise and not lower his basal insulin dose.


Rob


[From Lisa Loertscher RD, CD, CDE]


Hi F.,


Kudos to you for maintaining excellent control of your diabetes without issues of low blood glucose! Staying consistent with your healthy lifestyle/personal health profile and losing 2-3 pounds requires continued vigilance with adequate basal and rapid insulins while creating an overall calorie deficit to induce weight loss.
To lose weight you basically need to consume less calories than you burn each day (or burn more calories than you eat). If you're eating a low carb diet, <100 g/day, take a look at the amount of fat and protein calories you're eating and cut back on these calories to create a deficit. Consistently choose leaner proteins like skinless poultry, fish, loin & sirloin cuts of beef and pork; cottage cheese as opposed to cheddar and Swiss and less fried and/or deep-fried foods. Watch the added fats such as salad dressings, mayo, butter and healthy oils and nuts as these pack a lot of calories in small volumes. By reducing your calories by 500 a day, you can theoretically lose one pound a week since one pound equals 3500 calories. Another way to reduce calories is to limit your overall fat grams to 65 per day.


Continue your regular exercise, monitoring your glucose frequently. While moderate-intensity exercise can cause hypoglycemia in type 1 DM, very strenuous high-intensity exercise like rowing at maximal exertion can cause an adrenaline response that can elevate your blood glucose rather than lowering it. The point is you may not have to consume additional carbohydrate before strenuous exercise, as you do with moderate exercise, unless you are hypoglycemic before you start. Checking blood glucose before and after exercise, and sometimes during, is the only way to know your glycemic response to various types and intensities of exercise. You may be able to avoid treating high BG resulting from intense exercise sessions with additional insulin, which as you know is a storage hormone.


I hope this is helpful. Best of luck to you in reaching your goals with rowing!


Lisa

Fasting or Non-Fasting A1C

Q: My husband had a fasting a1c test and today she said the test wasnt run as a fasting A1C, it was non fasting listed in the medical chart. Could the 7.5 be different if they were done for nonfasting, compare to fasting 14 hours?

thank you

A: The A1C test can be drawn fasting or nonfasting. It is an average of all the glucose readings over the past 3 months--maybe a little more heavily weighted by the blood sugar readings over the past few weeks, but not too much. The readings don't change quickly, like our glucose readings using our meters.

Fasting or not, and given the variations in laboratory results, take the reading for what it is---a general idea of how the blood glucose control has been going. If it's causing worries, have the test repeated. Talk to your diabetes educator and your doctor to see if they think it would be best to tighten the diabetes control a little.

Take care, ginny

Diabetes Burnout

Q: Do you know anything about diabetes burnout? Sometimes it feels like everything isn't worth the fight.

A: I think everyone who has diabetes, has experienced some form of Diabetes Burnout!!!

Google search "Diabetes Burnout". There are several sites that you may find helpful.

Check out DLife Bookshelf “Diabetes Burnout: What to do when you can’t take it anymore” by William Polanski. Also try “What you should know about Diabetes Burnout” by Gary Gilles. Another great site is the Joslin Diabetes Center that has “Avoid Diabetes Burnout”.

All these sites give ideas that can help us take a different view of our self care.

ginny

Insulin Pump & C-peptide

Q: Hello i have had diabetes for 22 yrs my doc wanted 2 put me on a insulin pump but after lab work she stated i couldnt get one because of my labs somethimg about my pancreas...can u explain this 2 me?? thanks

A: I think the test you had was something called a C-peptide.

When our pancreas produces insulin, it starts off as a large molecule. It divides into two pieces, insulin and C-peptide. We don’t know what C-peptide does, but we know when it is present in the blood, the body is making its own insulin. C-peptide is measured in a blood sample to see if the body is still making insulin.

Sometimes this is important if you want an insulin pump. Often an insurance company does not want to cover the cost of a pump for a body that is still able to produce its own insulin.

Normal results for C-peptide is usually .5 to 2.0 ng/mL. Be sure and check the values from the laboratory where your test was run and ask your physician exactly what your number was.

To make sure that the results really reflect how much insulin your body is producing, you may have been asked to fast or not eat for 8 to 12 hours before the test was drawn. Any food you eat may trigger your pancreas to produce any insulin it can----which would make the results higher than they usually are.

Check again with your doctor. Follow the directions very carefully before the blood is drawn.

Are you seeing an endocrinologist? They may be able to write a letter in your behalf. Each pump company also has specialty nurses that may be able to help you as well.

Best of luck to you! ginny

FRESH food, not processed

Q: Ginny,

I am a recently diagnosed Type 2 diabetic being treated with heavy exercise and Metformin 500 mg. 1 per day. I have not been able to find anything advising me on the correct balance of Fat, Carbs and Protein ( as grams please) I should strive for each day. My doctor advised a high protein diet, but I'm questioning that suggestion.

Also, so much food has sugar in it and my goal is to try and eat fresh as it is possible, but how many grams of sugar are safe in a diabetic diet.

Thanks so very much for the help.

J.

A: J., Your physician may have suggested a high protien/low carbohydrate diet to help your body manage your response to carbohyrate metabolism (all carbohydrates turn into glucose).

We think it is importat to have a healthy diet and the basis is cutting down on highly processed foods, especially highly processed carbohydrates---not all carbohydrates. Generally people can begin with 45 grams of carbohydrates per meal---healthy carbohydrates like fresh fruit and whole grains.

I am going to forward your note to a great dietician, Lisa, who will probably give you more information as well as ask you for more information:

• what are your lipid levels,
• what is your blood pressure,
• how much do you weigh?

The amounts that would help you lose weight are very different than the amounts that you need if you are at a normal weight. As you begin your meal plan, think FRESH food, not processed food in boxes.

The meal plans for people with diabetes aren't diets per say---it is a healthy life style. They are meal plans that would be healthy for any human being. You want a meal plan that makes sense. You do not need a degree in chemistry to be able to make healthy choices.

Good luck to you. I will forward Lisa's response to you.

ginny

Byetta & Treating Diabetes

Q: Have a question that i would like to ask you about diabetes. What is the downside of using byetta for treating diabetes?

Thanks, B.

A: Dear B., After working with many patients that are taking Byetta, there seems to be just a few downsides:

1) This medication needs to be injected twice a day. (Even patients who did not want to inject any medication, have found that the injections do not hurt and are not hard to do) and

2) The biggest side effect seems to be nausea. (Many patients look at the nausea as a positive because they then don't eat as much). Nausea time varies from just the first few injections to several weeks, but for most patients it decreases over time. A very few patients have stopped the medication due to vomitting. Other side effects that have been noted are diarrhea, dizziness, headache, jittery feelings and an acid stomach.

If you also take an oral medication that contains a sulfonylura, be sure and discuss your dose and any possible low blood sugars with your doctor before you start your Byetta.

If you want additional information, also look at www.Byetta.com, check with your pharmacist or certified diabetes educator.

Take care, ginny

Fasting Blood Sugar & A1C

Q: Hello,

Thank you for addressing my question!

I have done a few home fasting glucose tests after many evenings of going to the bathroom and came out with different numbers each time. One morning it was 121, the next morning 97, another 105, and this morning 80. Here's my question, when I have my cholesterol and thyroid test done this week they will be doing an A1C. With the numbers up and down, will this one test be able to determine if I'm pre-diabetic or not? My test will be at 9:45 am after an evening fast. I know an A1C gives an average, however if there isn't any previous A1C, what do they compare this one to? I'm thinking if I'm running under 100 the day of the test, how can the test determine weather or not my sugar was elevated on the two previous occasions.

Thanks,
M.

A: M., What great questions!

Lets start with the fasting glucose readings you have done. Normal is generally 70-100. Prediabetes is occuring when fasting numbers are between 100-126. Diabetes is diagnosed when fasting numbers are above 126 on two occasions. You and your physician will talk about your fasting readings, your AIC test and together will decide about a diagnosis of prediabetes and what kind of treatment you may need. There are options of exercise, diet changes and medications.

You are right, the AIC test is an average of all your glucose readings. It is an average of the readings over the past 3 months. The results are given in a percent, with 4-6% being normal. The test is looking at how much of the red blood cells are coated with sugar or glucose. The higher the average glucose has been, the greater the percent of the red blood cell membrane is coated in glucose. In addition to the AIC percent reading, the tests are now coming with a calculated average glucose reading too. Here is an example:

Your AIC is 4.4%. That means only 4.4% of each red blood cell membrane is coated in sugar or glucose. That is a very normal amount. To find your average glucose reading with a AIC of 4.4%, we multiple the AIC by 28.7 which equals 126.28. Now we subtract 46.7 which equals 79.58, which means that over the past 3 months, your average glucose readings were 79. Each day the readings may change a little, but if there isn't a diagnosis of Diabetes, the swings are usually very small.

Please take care and be sure and discuss your test results throughly with your physician, ginny

Agent Orange & Diabetes

Q:ginny,

my diabetes has been determined to be related to my exposure to agent orange in Viet-Nam.... My treatment consists of Metformin, glypicide and of course, exercise, a controlled diet, and closely monitering my blood sugar..

What is my long term prognosis if I closely follow my treatment program?

My concern is,,,,,, Will a committment to such treatment be effective if agent orange is the cause of diabetes or will agent orange demand different treatment?

A: J., There are no guarantees with any treatment, but whatever you do to keep your blood sugars in the normal range, keep your lipids in the normal range and your blood pressure normal will give you the best chance for a healthy life. I do not know how agent orange is thought to affect human bodies in regards to diabetes, but I will begin to check. Give me a chance to check with an endocrinologist and get more information to you.

It is sometimes difficult to control blood sugars, blood pressure and blood cholesterols but the treatment of medications, a healthy diet and exercise will help with all of them.

I will post any information about agent orange as soon as I can. Please take care, ginny

Q:Thank you Ginny,

I only asked my questions inregards to agent orange because I have no known diabetes history in my family and all treatment for diabetes seems to be the same without regard to causation..... this seems peculiar to me for I believe there are some health issues that treatment is somewhat different when considering the cause of the illness...

It just seems the medical profession is only treating the symptoms of diabetes and not the particular cause suffered by individual cases..

But........ I must admit to harboring some anger at having this darn disease and I have no choice but to endure it and am the last person qualified to tell my doctor what to do...

Thank you again for your response and I look forward to hearing from you again...

J.