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