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

Possible cure for Type 1 using cancer drugs?

Q: What's the latest in the possible cure for Type 1 using the 2 already approved cancer drugs? Are there any local studies?

A: I think the two cancer drugs you are talking about are the drugs Imatinib (Gleevec) and Sunitnib (Sutent). These are drugs that block an enzyme that is believed to be a factor in autoimmune diseases. The studies looking at these drugs is being done at the University of California with mice. There is no study calling for patient participation yet that I know of.

Harvard University has been studying how to activate genes that tell cells how to transform themselves and begin working another way. They are studying how to change cells in the pancreas that make gut enzymes that help digest food and have them make insulin instead. This has also been done in mice but they think it is at least two to five years from being tried in humans.

There may be other studies, but two clinical trials that I know of who are accepting patients are:

• A drug called Otelixizumab is under investigation in the DEFEND trial. This study is looking at how the beta cells in the pancreas are destroyed by the body itself and they wonder if the drug can stop or slow down the destruction process. This study is under way in phase 3 clinical trials and they are accepting volunteers. You must be a Type 1 and have been diagnosed with Type 1 in the last 90 days. Check defend@tolerx.com or call 1-877-515-6672.


• At Massachusetts General Hospital there is a study under way by Denise Faustman, in phase 1 clinical trials, studying the Bacillus Calmette-Guerin (the TB vaccine) which seems to decrease the abnormal immune cells that attack and destroy the beta cells. Since the BCG vaccine has been used safely for about 80 years, they are busy trying to determine the doses that are needed and the possible side effects. They are accepting volunteers for future clinical trials. Look up DiabetesTrial@partners.org to email this study group for more information. Scientists are getting closer and closer to finding a solution for Type 1.

Stay healthy until there is a cure for us!

Ginny Burns RN MEd CDE