June 29, 2006
Insulin, Meal Planning, Food and Diet
Question from Virginia Beach, Virginia, USA:
I’m a type one diabetic. Once, I sat next to a type one, CDE, who chowed down on six donuts and insisted that type one’s who adjust their insulin properly for their food can eat junk food without repercussions. I hear this a lot from type ones. They insist that if you count carbohydrates and adjust your insulin, you can eat anything you want. Aside from the potential to gain weight from consuming too many calories and nutritional deficiencies for consuming empty calories, are there diabetic specific health reasons a diabetic should watch their consumption of sweets and high carbohydrate foods in general?
For instance, does injectable insulin really work as well inside the body, as the natural insulin produced in a healthy individual to counteract the rise in blood sugar from eating a dessert? Personally, I find it harder for my insulin to keep my blood sugar within my goal range if I consume a food made of concentrated fast acting carbohydrates. Is this because I’m not using my insulin properly? Or, is it too much to expect NovoLog to keep up with a death by chocolate sundae? Also, if I develop a habit for sweets, and my TDD of insulin increases as a result, are their healthy ramifications for that? Can diabetics on insulin pig out on desserts without consequence? I feel like I’d have more difficulty controlling my weight if I started eating lots of sweets and increased my TDD of insulin. But, I’ve been told by another type one that this is a ridiculous idea. They said everyone has insulin in their bodies, and produces it after eating carbohydrates, so, us taking insulin doesn’t cause any more weight gain than it would in someone with a pancreas that produces it on their own. Is that true?
My second question is about insulin use in type 2 diabetes. I want to learn more about it because I wonder if type 2 diabetics on insulin are unfairly judged as being in poor control of their diabetes. I’ve heard that type two diabetes is progressive and regardless of how much a type 2 exercises and eats they may eventually need insulin. But, how often does that occur? And, is it more common for a type 2 diabetic to be on insulin, simply because they are overweight and not following diet and exercise guidelines to control their diabetes? Once, I heard a doctor say that if a diabetic is overweight, they simply aren’t doing their part to control their diabetes. He also said he didn’t prescribe pumps for type 2s who were overweight because, he said, there was no way of knowing if they really needed insulin until they lost weight. He told me laziness was the reason most type 2’s took insulin. Is that true or is it an unfair criticism? A lot of type 2’s I meet say they feel discriminated against and judged unfairly for their insulin use.
It is true that one of the principles of diabetes management in type 1 diabetes is to match the insulin for the food that is eaten. However, it cannot be good nutrition for someone with diabetes to eat too many calories and gain weight. This adds to insulin resistance, requires more insulin, and makes it more difficult to lose weight. If high-glucose meals are eaten intermittently, and not regularly, it might be reasonable to talk about making corrections for exceptions, but not a regular habit. Remember that insulin therapy, in the form of intermittent injections or given through a pump, is used in place of the normal secretion of insulin from the normal pancreas. Insulin is secreted in a pulsatile fashion and a minimum of insulin is secreted for the job. With injections, large boluses of insulin that do not mirror usual insulin secretion are given. I would say that the insulin is just as potent, but is unable to approach the efficiency of delivery that the normal secretory process provides.
Patients with type 2 diabetes have both insulin resistance and a lack of appropriate insulin secretion. The natural history of type 2 diabetes is such that progressively more therapy is required to treat the diabetes. It is like a plot line that changes over time. What once was adequate to treat patients with diabetes may not be adequate over time. More than 50% of patients with type 2 diabetes end up being treated with insulin at some point in their life. It is also true that not all patients with type 2 diabetes are lazy. It is true that blood sugar control is helped by weight loss and exercise. It is also true that patients with type 2 diabetes are discriminated against. I would urge you consider looking into the advocacy program through the American Diabetes Association if you are interested in fighting the discrimination.