#glucose control

We’ve normalized the "afternoon slump." We accept the sudden irritability, the brain fog, and the intense, urgent cravings for something sweet as just a "busy life" side effect.

It’s not a busy life; it’s a glucose roller coaster. 🎢🚫

Frequent thirst, unexplained weakness, and that "heavy" feeling after meals are the body’s way of signaling that your internal frequency is off. Chronic high sugar doesn't just impact a lab test; it impacts your longevity and your daily sovereignty. To feel like yourself again, you don't need more caffeine—you need to stabilize the baseline.

आपके जागने से लेकर बिस्तर पर जाने तक, आपकी दैनिक आदतें आपके दिल को स्वस्थ रखने में प्रमुख भूमिका निभाती हैं। डॉ. संजय भोजराज, लॉन्गविटी मेडिसिन फिजिशियन और बोर्ड सर्टिफाइड इंटरवेंशनल कार्डियोलॉजिस्ट, ने अपने 9 मई के इंस्टाग्राम पोस्ट में सुबह 7 बजे से रात 9 बजे तक एक आसान दिनचर्या साझा की है, जिसमें जीवनशैली में छोटे बदलावों का खुलासा किया गया है जो हृदय स्वास्थ्य में सुधार कर सकते हैं, ऊर्जा…

Okay so first of all, the idea that excess fat itself causes diabetes is kinda half-baked. I'm assuming here you mean type 2 diabetes mellitus and not type 1 or diabetes insipidus. Visceral fat tissue plays a role- it can release inflammatory cytokines to contribute to insulin resistance- but it's not the sole cause of T2DM. There are people with large amounts of fat that don't develop T2DM and people who are lean that do. Aging, physical inactivity, high-sodium diets, and generally hypercaloric diets factor into it, even if adiposity is not considered "excessive," and there are variations or mutations in insulin receptor genes that can also cause resistance.

Let's talk about how our body handles glucose. Basically: our body likes to get some of our energy from glucose because it can be rapidly metabolized into energy, whereas fat and protein take longer. Our body wants to keep our glucose in a set range.

When you eat carbs, your gut breaks it down into glucose, its transported into your blood, and your pancreas releases insulin to help that glucose get into the cells (predominantly muscle) to be used for energy.

The liver can take in glucose without insulin. (Muscles can also take in some glucose without insulin, but this typically happens during exercise).

When muscles become insulin resistant, or when glucose is otherwise high, the liver takes in more glucose, which is turned into fatty acids for storage. Some fatty acids in the liver utlimate decreases insulin signaling.

When your body doesn't have enough dietary sugar, the liver will make it through a process called gluconeogenesis (gluco = glocuse, neo = new, genesis = formation- basically, fancy word for "process that makes new glucose"). One of insulin's roles is to tell the liver, "hey, stop making more glucose! We have enough right now!"

Thus with insulin resistance, you end up needing more insulin to get glucose into cells.

As you need more and more insulin, it gets harder and harder for your pancreas to keep up, and your blood sugar starts to go up, you start losing glucose in your pee, and your liver gets confused and thinks its needs to make more glucose.

But back to the "why do some diabetes drugs cause weight gain."

The treatment of T2DM is primariyl focused on reducing blood glucose levels, as the blood glucose itself can be quite harmful long-term. Diabetes drugs work in several different ways.

Some drugs called SGLT-2 inhibitors, eg empagliflozin or canagliflozin, help reduce blood sugar by helping you pee out more glucose (SGLT-2 is a transporter that reabsorbs glucose from urine back into your blood; if you block it, that sugar is peed out). Potential weight loss: if you pee out calories, they won't become stored as energy. Problem: more sugar in your pee feeds bacteria, can lead to UTIs.

Some drugs called alpha-glucosidase inhibitors, reduce blood sugar by delaying glucose absorption in your gut.

Metformin primarily reduces the amount of new glucose your liver makes.

Many drugs either are insulin, help your body secrete more insulin, or help your body respond better to the insulin you are making. What happens when our body has more insulin or responds better to it? Blood glucose gets into tissues, where it can be stored as fat. Hence, weight gain.

The glitazones (eg, pioglizaone) also can cause weight gain by causing edema or water retention because, while they help your body respond to insulin better, they also increase sodium and water resoprtion in the kidneys.

GLP-1 receptor agonists (eg, Ozempic) mimic GLP-1 a hormone that increases insulin secretion when glucose is high. However, it also makes your stomach empty slower and works in the brain to increase satiety and reduce hunger, so you eat less when you're on them. The reduction in calories consumed drives the weight loss.

Reheated Rice & Potatoes Might Be Healthier Than Fresh 😳

Most people think fresh food is always better.

But when it comes to certain starchy foods, reheating them the next day may actually improve your gut health and blood sugar response.

I've been wanting to return to blogging for quite a while. I think the immediacy of social media overshadowed blogging and made long form writing feel passé. I've missed it for quite a long time, but couldn't even remember where I did my blogging in the past. I think tumblr was the last place I blogged, and I stumbled across my existing accounts in the past year or two and realized: "It's still alive! " I'm not sure who's still reading, but I figure I can share links to my posts with family and I also appreciate having a record of things for myself down the road. It's fun to see where you've been.

Ok, I'm going to start by giving a status update on my diabetes, and the tools and technologies I'm currently using. I might also give a chronology of where I have been since 2012. I should also note that, since I'm turning 53 this year, I've been T1 diabetic for over 40 years. I'm grateful for diabetes which as taught me to be curious, disciplined, and flexible.

Insulin: I'm taking Fiasp as my main insulin these days. It's a newer fast acting insulin with an action time starting within 15 minutes and lasting roughly 2-3 hours. It's been a good insulin to use with a pump because it can make corrections faster. I don't have to give lead time before meals. When I first started using it, I noticed that sometimes it noticeably stung at the infusion site. Lately, I haven't had that issue. It seemed like it also used to create inflammation at the infusion site, and absorption would be impacted, but that is also no longer an issue. I don't know if the insulin has changed, or if I've changed... but in the end, it's good.

CGM: I switched to Dexcom a few years ago (probably when I stopped using the Medtronic pump), and it has been great. I waited to go from G6 to G7 till the kinks were worked out, and that was maybe 6 months ago. I'm getting good results with it. One thing I didn't like about the G7 was the requirement that it be in line-of-sight with my Omnipod 5 pump to maintain connection. The G6 maintained a connection wherever it was on my body, but... with G7, I started having to keep the pump and sensor on the same side of my body. I ended up just placing them side-by-side for optimal results. However, I'm no longer using Omnipod 5, so that's no longer a limitation.

Pump: I'm currently using Omnipod DASH (older model) tubless pump pods as my delivery device. I started using Omnipods within the past year or so. They are fully disposable, and can be purchased via pharmacy benefits. Because of this, I was able to try them without a warranty/ contract situation. My endo mentioned that it's easy to give it a try, despite still having my previous pump under warranty. When I did, I was surprised how much I loved being tubeless. I had gotten so used to threading my tubing through my pants pockets, but it was surprisingly very freeing to be tubeless after many, many years (15?) being tethered. I first started with Omnipod 5, which allowed me to manage the pod from my phone and take insulin from my phone. I switched to DASH pods so I could start using LOOP, an open source algorithm that gets data from the sensor and controls the pump.

Automated Insulin Delivery Algorithm: I'm currently using DIY Loop to control the pump. It was developed by a cadre of open-source developers that wanted to "close the loop" and make an artificial pancreas available without waiting for the slow process of FDA approval, etc. It has been available, and constantly under improvement, for several years. They have been staying way ahead of the commercial offerings and have made some the most advanced algorithms available. The catch... is that, you have to build the app yourself using the resources they make available, so you are totally responsible for the settings and education about what you are doing. I built the app on December 20th, tested it with a DASH pod off-body, and then started using it on January 1st.

One of the reasons that I felt the need to start using a non-commercial algorithm was because I noticed my Omnipod 5 not being able to control my BG after I started using a GLP-1. My insulin needs went down dramatically and the pump no longer delivered the appropriate corrections when my glucose drifted up. I found that my BG was hanging out around 150 mg/dL all the time, while I was very sensitive to insulin and using a lot less.The reason this was happening is because the Omnipod 5 uses your Total Daily Dose (TDD) to decide how sensitive you are, and it downgrades how aggressive your corrections are. With some searching online, I found a lot of people who were frustrated with this, and many of them were tricking the pump into being more aggressive or they were just using manual mode to override this issue. I found that a lot of people were getting better control with Loop, so I planned to try it if I could get the DASH pods, which are hack-able.

Non-insulin Meds: I started taking Metformin a few years ago in an attempt to push back on insulin-resistance. At one time I was taking the max dose, and when I would take less or stop taking it, I would notice a difference. In the online communities for T1 diabetics I had heard that Type 1s were using Metformin and it was helping to stabilize blood sugars by slowing down the glucose being released by the liver. It also has been shown to provide some longevity benefits in cardio and kidney health overall. Sidenote: my T1 dad (60+ years T1) started to notice some brain fog that he associated with metformin, and discontinued it. I haven't noticed anything like that for myself, so far.

This past August I saw my endo and I told her that I'd been a bit frustrated because I'd been noticing insulin resistance that I couldn't seem to counter with eating differently or exercising more. I had spent a summer walking a ton and eating low-carb, and I found my blood sugars hovering high for periods of 6 hours or more. As soon as I ate again, I'd be chasing a 200 for a while. At night my BG wasn't coming down with the help of auto-mode on the pump. It didn't make sense, and in the past I had good results from my interventions. I also noticed that I was using more insulin and slowly gaining weight despite increased physical activity. I had decided to start taking Metformin again to see if it would help with insulin sensitivity.

My endo offered the idea of using a GLP-1. She said that it is like metformin on steroids. I didn't really know what GLP-1s were, but after looking into it I recalled a lot of coverage of a class of weight-loss drugs (Wegovy, Ozempic, etc) that had been adapted from Type 2 diabeles to clinical weight-loss for obesity. I was nervous about taking something that seemed quite powerful and unkown. As I looked into other Type 1 diabetics that had been using GLP-1s, I realized that it addressed some issues that are often unaddressed in T1 care (constant hunger, rapid stomach emptying, liver glucose release, insulin resistance). *I had previously used injected Symilin at mealtimes for similar purported benefits, but the hassles outweighed the benefits. I was seeing many T1s talk about their insulin use going down, and blood sugars stabilizing. Many T1s were only using the lowest doses for these benefits. I decided to give it a try.

My endo said that insurance might not approve it since I wasn't obese, but said there were different channels for getting it (compounded, self-pay). Since I have a sleep apnea diagnosis it was approved on 2nd try, otherwise I might not have pursued it. It's an expensive drug.

In early-September, I started Zepbound. Normally, you up your dose every month as long as you can tolerate the side-effects. Your body has to adapt to it. I noticed lots of benefits on the first dose, with blood sugar stabilizing and my insulin use going down to about 50-60% of my previous dose. At the time, I was using the Omnipod 5 in auto-mode and it beautifully adapted to my changing insulin needs. I didn't have lows and just observed that my daily insulin use was going down, along with very flat blood sugar graphs. When month 2 came, my insurance balked at keeping me at the introductory dose, I guess no one is supposed to stay there... but, many T1s do, with good results. I acquiesced and went up to 5mg, which is still considered a introductory dose. I have stayed on that amount for 4 months and plan to stay there till further notice. I'll write up another post with more granular detail about how it works and the nuances of using it.