= first, what is meant by "control"?  it seems as though everybody
=has a different definition of it.  by the way, i am overweight,
=type 2, very insulin resistant;  never get as low as 200, even with
=a total of 150 units a day.  don’t often get to 400.

Control means keeping your blood sugar levels closer to normal than they would
be absent treatment.  The closer to normal the blood sugar levels, the better
the control.  Your control is rather poor.

=Dwhat is meant by "multiple injections"?  i guess that’s what i may be
=on.  60 nph at bedtime, 35r in am, 25 or more r before each other meal.
=still working to get enough insulin to lower bg.

That is a multiple injection regimen.

=why does insulin make a person gain weight?

It doesn’t, at least not all by itself.

=it seems as though food has become much more fattening since i started insulin
=8 months ago.

Insulin allows the body to use sugar.  Carbohydrates are converted into sugar
by the digestive process.  If you don’t have enough insulin, then your body
can’t use carbohydrates effectively, and the much of the sugar that’s produced
by digesting carbohydrates is excreted by the kidneys.  Basically, without
enough insulin, carbohydrate calories in your meals don’t count.  When you
began using insulin, suddenly some of the calories from your carbohydrates
started being used by your body.  I.e., your effective caloric intake
increased.  And it’s that effective increase in caloric intake that makes the
food more fattening.  As your ability to use glucose increases, you have to eat
less.

=is it possible to see further improvement.  it seems as though i start
=getting hungry, weak, trembly, etc., when my bg drops close to 200.

Basically, your body’s gotten used to being quite hyperglycemic.  It now
considers something considerably higher than 200 mg/dL "normal" for it.  That
is NOT a situation you want to perpetuate.  As your control improves, the blood
sugar level at which you begin to feel hypoglycemic will slowly drop.  This
will, among other things, mean that you won’t start feeling hungry when your
blood sugar levels get anywhere close to normal, which means you’ll be less
likely to eat and raise your blood sugar levels again at that point, which will
result in improved control, giving us a self-reinforcing feedback loop:  As
your control improves, it’s very likely that you’ll find it easierr to maintain
control.
—————————————————————————
I  try  very  hard  to say exactly what I mean.  I’d appreciate it if you’d
bear that in mind and not try to "interpret"  my  posts  to  fit  your  own
preconceived notions if I’m posting in a serious thread.  Remember:  If you
throw a strawman into a heated debate, flames are likely to be the result.

About some questions regarding insulin and control, and Steve Kirchoefer
wrote a wonderful answer! I’d just like to add a little more:

Barbara, as a Type II, your biggest bugaboo is going to be food, hunger
and weight. Insulin is often not a very good solution for people who are
so insulin resistant. You need to talk to your doctor about what other
choices are available to you, either alone or in combination with the
insulin to get your blood sugars down, and to at least keep your weight
stable. (If you can lose, GREAT, but that’s not the first concern. Your
BG’s are! )

Some people have experienced a lot of success with Metformin (Glucophage)
— have you tried it? Also, some people have had some success with
various antidepressants such as Prozac, which act as appetite suppressants.
In addition, there is a new drug, called Acarbose coming out soon, which
slows down the absorption of carbohydrates, and helps smooth out the BG
peaks which many Type II’s experience.

I, not being a doctor, am not recommending WHAT you should do, but
advocating that you be a well-informed consumer. Find out about
EVERYTHING, and then make choices (and if one choice doesn’t work, try
another!) It’s YOUR body, and YOUR future that you are working with; and
you need to be the one in control!

Good luck!

Smiles,

._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c-

Natalie A. Sera, AKA Dr. Quack, with all her ducks in a row!!!!  
       ___
Type \/ 3, MI 4x (3Rs and an N) a year and a half!

Proud mother of Josh, age 21                      

._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._(` ._c- ._c- ._c- ._c- ._c-

                                         Can YOU find the Ugly Duckling?

Barbara Noble <no…@emba-news.uvm.edu> wrote:

>hi,

>Bplease let me ask a few quesions.  

> first, what is meant by "control"?  it seems as though everybody
>has a different definition of it.  by the way, i am overweight,
>type 2, very insulin resistant;  never get as low as 200, even with
>a total of 150 units a day.  don’t often get to 400.

Tight control is maintaining bG’s to as close to the normal range of 80 to
120 mg/dl as possible.  The best that most of us can do is some kind of
approximation to that standard.  Having bG’s in excess of 200 mg/dl all of
the time is *not* OK, by any current standards.  Regardless of what your
present symptoms are, you are not in good control at this point.  You need
take more aggressive measures to bring you bG down.

>Dwhat is meant by "multiple injections"?  i guess that’s what i may be
>on.  60 nph at bedtime, 35r in am, 25 or more r before each other meal.

>still working to get enough insulin to lower bg.

You are on multiple injections if you are taking insulin with each meal.
Multiple injections is one method of achieving tight control, but by no
means do multiple injections guarantee better control than other regimens.

>why does insulin make a person gain weight?  it seems as though food
>has become much more fattening since i started insulin 8 months
>ago.

>is it possible to see further improvement.  it seems as though i start
>getting hungry, weak, trembly, etc., when my bg drops close to 200.

Insulin helps your body to use more of the food that you consume.  You will
gain weight if insulin therapy is not supported with proper control of diet
and exercise as well.  There are three components to control – diet,
exercise, and medication.  You need to find the correct balance of all
three components.  You should be able to improve significantly from where
you are now.  Unfortunately, it will not be easy, but the rewards of doing
so will be worth the effort.

–
Steve Kirchoefer
Naval Research Laboratory
Washington, DC  20375-5347

<no…@emba-news.uvm.edu> writes:
>everybody
> has a different definition of it.  by the way, i am overweight,
> type 2, very insulin resistant;  never get as low as 200, even
with
> a total of 150 units a day.  don’t often get to 400.

Those are scary numbers all around.  I hate to say it, but the way
to get BG down without increasing insulin intake is to eat less.  

No way to avoid that.

> Dwhat is meant by "multiple injections"?  i guess that’s what i
may be
> on.  60 nph at bedtime, 35r in am, 25 or more r before each

other meal.

Sounds like multiple injections to me.

> still working to get enough insulin to lower bg.

> why does insulin make a person gain weight?  it seems as though
food
> has become much more fattening since i started insulin 8 months
> ago.

Yes, the injected insulin will allow you to metabolize sugar that
was formerly going out in urine.  And one way to metabolize sugar
is to turn it into fat.  (And at a BG of 400, a lot of sugar
should still be going out in the urine.  It’s just wasted food.  

At lower BG levels, you lose less sugar, and if you get those
lower levels by just shooting insulin without reducing food
intake, you’ll gain weight even while eating no more food.)

> is it possible to see further improvement.

I’d certainly hope so.

 it seems as though i start
> getting hungry, weak, trembly, etc., when my bg drops close to

200.

I get those same symptoms, but not until the BG drops a bit below
50.  Apparently one can change the threshold at which one feels
symptoms of hypoglycemia.  At least that seems to be the drift of
one thread on this group.  If you’re living at an average of 400
mg/dl and drop to 200, you may feel hypoglycemic, even though your
BG is about twice the normal level.  But if you gradually reduce
your average BG level — let’s say for argument to 275 — then
you’ll eventually find that levels that previously made you feel
hypoglycemic will feel okay.  Then you can work on getting lower
still. (That’s the drift of others’ arguments; I have no direct
experience to support it, but I suspect it’s true).  Once you feel
good at 200, you can work on getting lower still, and presumably
you’ll eventually feel okay with a BG below 100 (Which is normal).

Another matter to keep in mind is that as body weight drops, so
does insulin resistance. As I understand it, the concentration of
insulin receptors is inversely related to the percentage of body
fat.  So if someone loses a lot of weight, they have to decrease
the amount of insulin they inject even more than one would expect.
For example, if one went from 200 pounds to 100 pounds, one’s
insulin requirement wouldn’t be half of what it was at 200 pounds,
but less than half because the higher level of insulin receptors
would let that person use insulin more efficiently.  If that
person, having gotten down to 100 pounds tried to get by on half
as much insulin as he/she used at 200 pounds, he/she would
 either go hypoglycemic or eat too much and gain weight again.
(And if I ever got down to 100 pounds I’d be dead.  These are just
easy numbers to work with).

I’m sure others will elaborate on all this — and take me to task
if they think I’m wrong.  I *will* give a little medical advice,
though.  Talk to your doctor, and if he/she is content with BG
levels of 200 -400, get another doctor.  A good dietician might be
useful, too.  BG levels way over 200 all but guarantee serious and
nasty complications.  Nobody needs that.

Best of luck

John Carroll
pp001…@interramp.com

Barbara Noble <no…@emba-news.uvm.edu> wrote:

> first, what is meant by "control"?  it seems as though everybody
>has a different definition of it.  by the way, i am overweight,
>type 2, very insulin resistant;  never get as low as 200, even with
>a total of 150 units a day.  don’t often get to 400.

Well, "control" isn’t a binary thing, it’s a continuum.  200-400 is not
ideal control, but it’s better than 600.  Same goes for, say, 30-200.  
The "ideal" ranges most often cited center on about 100 or 110.

>why does insulin make a person gain weight?  it seems as though food
>has become much more fattening since i started insulin 8 months
>ago.

Well, when you don’t have enough insulin in your system, you can’t use
your blood glucose properly, so a lot of the calories are "wasted" —
flushed out of the body through sugar spillage in the urine and ketones.

>is it possible to see further improvement.  it seems as though i start
>getting hungry, weak, trembly, etc., when my bg drops close to 200.

My vague understanding:

Your body gets used to the blood sugar level it is most frequently at.  
When your blood sugar level gets below the level your body is accustomed
to, you start getting the symptoms of hypoglycemia.  As you get your bg
under better control, your treshold for hypoglycemic symptoms will go
down.  There is an absolute aspect to hypoglycemia; at some level, my
guess is someplace around 40, *nobody* can accustom themselves to it
enough to be unimpaired, because there’s just not enough sugar there.

                                                Rachel
—
Rachel Meredith Kadel or, for the adventurously inclined, Bean-na-Sidhe
rka…@fas.harvard.edu
Honorary Fellow of Brad’s School of Piano Tuning and Bible Technology