new here and new to low carb eating

Just a quick intro. I became diabetic a year ago as a result of having to take Prednisolone for an Autoimmune condition. Although over the year I managed to reduce the amount of prednisolone I am on (down to 10 mg a day now) it has not enabled me to reduce my insulin requirements.

I take Insulin with breakfast and lunch. Take the prednisolone with breakfast. It actively increases insulin resistance starting about 3 hours after taking and lasting about 5 hours. Last year I was ok once the pred wore off and managed to keep the Blood Glucose low at other times, fasting BG was below 6.

Late last year a change occurred. Seeing my Endocrinologist in 2 weeks time. My fasting BG is now over 8 each morning and I have noticed it is harder to keep my post meal BG in the normal range even after the pred effect wears off.

About 4 weeks ago I started this low carb dieting. I am put myself on 20g of carbs a day. Which I have religiously stuck to. Initially I was able to lower my insulin but slowly it is creeping up again in an effort to keep my BG in the normal range. Up until now I have only needed the rapid insulin 2x day but I feel now I may need some kind of baseline insulin to lower the BG when fasting for instance.

Due to the Pred and the Insulin and pain making it difficult to exercise I put on a fair bit of weight which I want to lose.

However in the 4 weeks on the lowcarb eating plan I have not really lost any weight. Less than a kilo.

My next option is to stop drinking zero coke. I had thought that was 0 in carbs but maybe its upsetting things in other ways.

Other than that not sure what to do. Here is a sample days food:

8am : BG was 8.5 took 30 Units of Insulin (Novarapid)
Breakfast : 2 eggs scrambled with a bit of butter, covered with smoked salmon and some capers.
11am: BG 5.0 Had a hard boiled egg
12pm: Took 28 Units of Insulin (Novarapid)
1pm : lunch was some Roast Lamb with 1/4 roast Sweet potato 1 spoon of sour cream, Bowl of lettuce and 1/4 Avocado covered with Oil and Vinegar dressing.
4pm : BG was rising again to 6.5 so took another 5 Units of insulin to be safe
drank 1 cup of chicken bone broth
7pm : BG up again to 7.1 so took another 7 Units of Insulin
8 pm : supper : 2 hard boiled eggs with some mayo (0 carbs) and some smoked oysters.

I have to take the higher dose of Insulin before lunch due to the effect of the Prednisolone.

If anyone here has any suggestions would be greatly appreciated.

Hi welcome

Hi Inge and welcome. You have a tough job holding stable BG numbers for sure, I checked out Prednisone and found this article. Is there a chance your Doctor could change Prednisone for another drug that would make BG control less erratic. Just an initial thought.

All the best Eddie

Prednisone induces elevated glucose levels by stimulating glucose secretion by the liver as well as reducing glucose transport into adipose and muscle cells. The overall effect is a reduction in glucose clearance. Elevated glucose levels can lead to glucose toxicity further impairing insulin secretion. Prednisone can also impair GLUT-2 expression. GlUT-2 is a protein mediated glucose transporter that ferries glucose across cell membranes. That means that people with diabetes taking prednisone are likely to see a significant bump in their blood glucose numbers depending on the dose of steroid given.

One of the most difficult things about taking prednisone is that it doesn’t elevate glucose readings consistently throughout the day. Prednisone taken in the morning usually doesn’t cause glucose levels to start to rise until lunch time. Blood glucose readings usually stay high through the early evening hours and then decline over night. Many people have normal or low glucose readings in the morning while taking prednisone.

This type of action curve can make it difficult to use flat basal insulin such as Lantus® or Levemir ®to treat people taking prednisone. Sometimes the use of NPH can be helpful for people on prednisone as it has a peak mid-afternoon and if given in the morning its effects taper off toward the evening, mirroring the action of the prednisone. When using NPH the overall effect is a better balance between your glucose levels and your insulin throughout the day.

The good news about prednisone is that it is cleared from the system fairly rapidly and once you stop taking it, blood glucose levels return to normal fairly rapidly.

http://blog.joslin.org/2014/02/how-prednisone-affects-blood-sugar/

Thanks Eddie and Andy for the Welcome and the Info.

Unfortunately I am stuck with Prednisone. I have been tapering it. Started off on 40 mg a day but what upset me last year was that despite the prednisone going down the insulin was going up. I read elsewhere that longterm prednisolone usage can make the diabetes permanent and some people get it permanently after only 2 weeks on the stuff so I hate to think what a longterm use will do. Hence the statement above that blood glucose levels return to normal is I think a bit of wishful thinking.

The illness I am being treated for has no cure. Steroids and immune suppressive drugs are used to help with the inflammation and to calm down the immune system which is attacking the body. Nothing else around that will do it. Prior to steroid usage people had an average life expectancy of 6 months after diagnosis. So I can be thankful that we have the horrible stuff even though it causes other issues.

Anyway I decided my number one focus is to get BG levels to normal with the help of the LC diet and insulin if needs be. Maybe it takes a bit longer for my body to catch up. Also not sure how my Endocrinologist will feel about the LC diet. Have yet to cross that bridge when I see him I had hoped to impress him with some fantastic BG levels lol

oh my GP is quite happy with everything as my HbA1c results were 6.1 las time round. So he reckons all is normal. That was before I started the low carb diet and just about the time the fasting BG started to play up.

Hi Inge and welcome.  

I have just read your posts and clearly things have not been easy for you.

However, your A1c results last time were very good so I hope that if you can continue the LCHF 'lifestyle' things will steady and improve.

Look forward to reading more of your posts, and wish you .......

All the best Jan

Sounds like your trying so hard, I wished I had something useful to help you but I'm pretty useless with the clever stuff

sorry

Thanks Jan and Andy. I guess I am hoping someone else has had experience with steroid induced diabetes. Or others have had to wait over a month for the LCHF diet to kick in and show results. But even our Endocrinologists here don't have much experience with this kind of diabetes so it's a trial and error thing. I started off on pre-mixed insulin but that was constantly giving me hypos and I was eating around the clock to avoid them. Also made sleeping a dangerous thing. so when I changed Endo's the new one swapped me to rapid acting insulin and last year it worked fine. Its just that I didn't expect the diabetes to become so nasty all of a sudden My diabetic nurse/educator didn't seem to think the 8 + BG in the morning was anything to worry about but she is not into LCHF. I read Dr. Bernstein's book and that showed me to avoid complications it's very important to keep BG below the 6 i.e. as "normal" as possible.

Hi, welcome from me too

I'm sorry I can't help you with your insulin requirements. I hope someone else can help you with that soon.

As regards weightloss. It will be difficult for you because of the need for prednisolone. ( I have seen the effects of this drug on my Mum and son) Difficult, not impossible though. I think you are right to give up diet coke. I am convinced diet coke helped me on my way to becoming insulin resistant. The more natural the diet the better.

The only things I can suggest re weight loss are....

Are you drinking enough water? When I drank more, I lost more weight.

Are you having enough fat? This can be tricky to get right because of the high calorie content in fat. I can only tell you what happened with me. When I started to put butter on almost everything I lost a bit more weight, even though I was consuming more calories. I'm not saying this will work for you, but you could maybe add a little fat and see what happens. Your menu above is brilliant as far as I can see.

Good luck, I hope you will find what works for you soon.

Oh I forgot to say.....

Have you had your thyroid checked?

Have you had your vitamin D level checked?

Problems with both of these can make weight loss difficult.

Now I'm hoping a clever person will come along to help you

Inge checking further I reckon you are doing a great job in controlling you BG numbers. Most of the members here are what I call bog standard type two diabetics and have it very easy compared to you. Controlling your diabetes is very important, but I appreciate you are having to do a balancing act. You say Wegener's Granulomatosis cannot be cured, does it ever cure itself? if not does that mean you will be on Prednisone for life?

Hi and welcome to the forum Inge - from a fellow Australian.

Have you heard of the Paleo autoimmune protocol and/or the Wahls Protocol? Many people with autoimmune conditions seem to be having great improvements to their conditions by following variations of the diet. The story of Dr Terry Wahls is particularly inspiring and she is now conducting a number of research studies into various autoimmune conditions.

Here's a couple of links you may find useful:

Paleo autoimmune protocol:
https://www.google.com.au/webhp?sourceid=chrome-instant&rlz=1C1AFAB_enAU497AU517&ion=1&espv=2&ie=UTF-8#q=paleo%20autoimmune%20protocol

Dr Wahls:
https://www.google.com.au/webhp?sourceid=chrome-instant&rlz=1C1AFAB_enAU497AU517&ion=1&espv=2&ie=UTF-8#q=terry%20wahls

Welcome to the forum Inge, not much more I can add that hasn't been said already. Control of your BG levels will be tough but you're making some good choices so far.

eddie1 wrote:Inge checking further I reckon you are doing a great job in controlling you BG numbers. Most of the members here are what I call bog standard type two diabetics and have it very easy compared to you. Controlling your diabetes is very important, but I appreciate you are having to do a balancing act. You say Wegener's Granulomatosis cannot be cured, does it ever cure itself? if not does that mean you will be on Prednisone for life?

Hi Eddie. It's early morning here down under hence only now having a chance to reply to your question. Wegener's doesn't cure itself but for many it goes into remission even sometimes for many years. Some manage drug free remission which means they are off the prednisone and immunosuppressive drugs. I have so far supposedly reached drug induced remission and we are now trying to get me off the prednisone and then if that works off the Methotrexate as well. If successful I may be drug for for years even but eventually the disease flares and then the drug cycle begins again I had hoped remission would happen within a few months but I have now been on the treatment a year and it will take at least another year to ditch the drugs. But I found out many others have a lot of trouble the first two years and then suddenly things improve. so I need to be patient but I simply can't afford to put on any more weight.

According to my scales this morning I seem to have lost 1.6 kg in the 4 weeks since starting LCHF dieting. Guess i was expecting the weight to simply fall off Well at least it is going down.

My fasting blood glucose jumped to 9 this morning so looks like I urgently need to get some base level insulin.

Indy51 wrote:Hi and welcome to the forum Inge - from a fellow Australian.

Have you heard of the Paleo autoimmune protocol and/or the Wahls Protocol? Many people with autoimmune conditions seem to be having great improvements to their conditions by following variations of the diet. The story of Dr Terry Wahls is particularly inspiring and she is now conducting a number of research studies into various autoimmune conditions.

Here's a couple of links you may find useful:

Paleo autoimmune protocol:
https://www.google.com.au/webhp?sourceid=chrome-instant&rlz=1C1AFAB_enAU497AU517&ion=1&espv=2&ie=UTF-8#q=paleo%20autoimmune%20protocol

Dr Wahls:
https://www.google.com.au/webhp?sourceid=chrome-instant&rlz=1C1AFAB_enAU497AU517&ion=1&espv=2&ie=UTF-8#q=terry%20wahls

Thanks for the Welcome Indy and the info. I will check those links out. It has taken me 4 weeks to get my mind around the LFHC diet and I have been reading non stop. If I can achieve some results lowering the insulin needs I think this LCHF diet will also improve my immune system in the long run. So I am committed to stick with it as nothing else seemed to be working in any case.

zand wrote:Hi, welcome from me too

I'm sorry I can't help you with your insulin requirements.  I hope someone else can help you with that soon.

As regards weightloss.  It will be difficult for you because of the need for prednisolone.  ( I have seen the effects of this drug on my Mum and son) Difficult, not impossible though.  I think you are right to give up diet coke.  I am convinced diet coke helped me on my way to becoming insulin resistant.  The more natural the diet the better.

The only things I can suggest re weight loss are....

Are you drinking enough water?  When I drank more, I lost more weight.

Are you having enough fat?  This can be tricky to get right because of the high calorie content in fat.  I can only tell you what happened with me.  When I started to put butter on almost everything I lost a bit more weight, even though I was consuming more calories.  I'm not saying this will work for you, but you could maybe add a little fat and see what happens.  Your menu above is brilliant as far as I can see.

Good luck, I hope you will find what works for you soon.  

Hi Zand. Thanks for your reply and your information. I will increase the water which I need to do in any case when I stop the diet coke. Probably that is making me dehydrated as it works as a diuretic. The caffeine is probably bad too. When I first started I think I was overdosing with protein but then I read that too much protein and the liver converts it to glucose so I reduced protein and increased fat. However I should probably increase the fat a bit more but as this illness has affected my digestive system I quickly get indigestion from fatty food, despite being on high dose meds to reduce the acid. Anyway will see how much I can tolerate. Just dumped a bit of sour cream onto my breakfast
As to Thyroid. I would have to check. I was tested for every imaginable disease last year when they were trying to work out what was wrong so I am assuming that was flushed out too. As Wegeners is rare and as very case seems to present differently I was actually very lucky to be diagnosed in weeks not months

Hi Inge welcome to the forum, I'm afraid I've nothing to add to what's already been said I'd just like to wish you well and hope things work out for you.

Graham

Hi Inge - good to see you posting your replies. I think with the time difference UK to Australia there may well be a delay in others making their reply to you. But it is important to keep talking.

Take Care, I wish you well, and from the links and advice people have posted it looks like you have some reading / research to do.

All the best Jan

Inge Danaher wrote:

eddie1 wrote:Inge checking further I reckon you are doing a great job in controlling you BG numbers. Most of the members here are what I call bog standard type two diabetics and have it very easy compared to you. Controlling your diabetes is very important, but I appreciate you are having to do a balancing act. You say Wegener's Granulomatosis cannot be cured, does it ever cure itself? if not does that mean you will be on Prednisone for life?

Hi Eddie. It's early morning here down under hence only now having a chance to reply to your question. Wegener's doesn't cure itself but for many it goes into remission even sometimes for many years. Some manage drug free remission which means they are off the prednisone and immunosuppressive drugs. I have so far supposedly reached drug induced remission and we are now trying to get me off the prednisone and then if that works off the Methotrexate as well. If successful I may be drug for for years even but eventually the disease flares and then the drug cycle begins again I had hoped remission would happen within a few months but I have now been on the treatment a year and it will take at least another year to ditch the drugs. But I found out many others have a lot of trouble the first two years and then suddenly things improve. so I need to be patient but I simply can't afford to put on any more weight.

According to my scales this morning I seem to have lost 1.6 kg in the 4 weeks since starting LCHF dieting. Guess i was expecting the weight to simply fall off Well at least it is going down.

My fasting blood glucose jumped to 9 this morning so looks like I urgently need to get some base level insulin.

Hi Inge

Thanks for coming back to me. Let's hope your condition goes into remission soon and completely for ever. Diabetes is a tough gig, and other health complications can make it very hard to control BG numbers. You are doing a fantastic job, and clearly very clued up.

Have you seen our modest food and recipe blog? very basic but some great ideas without blowing your bank account or spending hours in the kitchen. http://www.lowcarbdietsandrecipes.blogspot.co.uk/

Please stay in touch and keep posting. All the best Eddie

Thanks Graham, Jan and Eddie. It's good to hang out with a group of people all trying the same thing, keep their diabetes in check using low carb. I have had to put my novarapid insulin injections up to 30 with breakfast and 30 with lunch. That seems to have done the trick during the day. Also added a bit more fat to the diet. So now my remaining issue is the high fasting bg. One way to deal with it is get up at 2an and take some insulin but I would prefer not to have to do that. So hopefully my specialist will give me some base line insulin when I see him next Tuesday. It will be interesting to see his reaction to the LCHF diet approach. Still unsure if I will let him in on it. I was thinking I may say that I have reduced my carbs drastically.
TODAY is DAY ONE of DIET COKE AVOIDANCE. Wish me luck. Funny enough yesterday something appeared on my FB page damming diet coke and blaming it for causing diabetes. Guess if there is even only a hint of truth in that I would be mad to continue drinking it. So .... mineral water is my substitute. I think that's it for the GIVING UP BAD STUFF efforts. Well I managed the CAKES, the ICE CREAM, the CHOCOLATES, the PASTA, the RICE , the POTATOES. Funny how the very things we love are bad for us So ... the coke should not be impossible now that I know how dangerous it can be.

Good luck

Good advice so far Inge. LCHF will certainly help with the control of your BG levels. As for your doc, some are slowly accepting the idea whilst others will shun it. Whatever advice you get, stick with the LCHF, it works. I was a little confused when I read about you possibly getting up at 2am to inject ? You mentioned you may ask for "base line insulin " ? Do you currently use a basal ( background ) insulin ?

mo1905 wrote:Good advice so far Inge. LCHF will certainly help with the control of your BG levels. As for your doc, some are slowly accepting the idea whilst others will shun it. Whatever advice you get, stick with the LCHF, it works. I was a little confused when I read about you possibly getting up at 2am to inject ? You mentioned you may ask for "base line insulin " ? Do you currently use a basal ( background ) insulin ?

Thanks mo1905 No that's the insulin I am after basal. I just forgot the term. I have not needed it in the past. Only this year my fasting blood glucose has risen so high

I think basal will make a big difference to your overall control. Good luck Inge and please keep us updated with your progress. Please feel free to ask any questions you may have. If you've got no questions, stick around anyway :-)

mo1905 wrote:I think basal will make a big difference to your overall control. Good luck Inge and please keep us updated with your progress. Please feel free to ask any questions you may have. If you've got no questions, stick around anyway :-)

When I first started they put me on Novamix which had a mixture of fast and slow acting insulin. However that kept giving me hypos so last year the Novarapid was all I needed. Then late in December I noticed my fasting BG rise over 6 then 7 then 8 and the other day it reached 9. Hence I feel my diabetes has become more severe and I need the basal now

Steady rising BG levels doesn't really mean your diabetes is getting more severe, it just means your current regime for maintaining control needs adjusting. Going onto basal/bolus still needs adjusting and carb counting but the advantage is your control and freedom is much greater. Look on this as a plus, not a negative.