Happy Saturday! Welcome back to Ask D'Mine, our weekly advice column hosted by veteran type 1, diabetes author and community educator Wil Dubois. This week, Wil offers thoughts on sugar absorption in people with diabetes (not quite what you might think of) and how not every mix of insulin is a good idea ;)

{Got your own questions? Email us at AskDMine@diabetesmine.com}

Valeri, type 2 from Texas, writes: I was diagnosed with type 2 diabetes two years ago and was terrified since my type 1 brother died at age 52. Getting my blood sugar under control was easy for me — I totally lost my appetite and lost 20 pounds in a very short time, and now my sugar tests normal. But I have not been able to find out about the long-term effects of the cells not being able to absorb sugar which, as I understand it, is needed for energy and cell reproduction. Has any research been done on the matter? I eat no sugar and little carbs other than veggies and fruit. Before diabetes I was a hyper-energetic person, but not so now.

News nuggets from around the diabetes community

NEWSFLASH: FDA Clears Dexcom Share Direct
Dexcom gets regulatory approval of its 'on-the-go' mobile apps for CGM data-sharing.
State of the Union: It's Time to Cure Diabetes
President launching new precision medicine initiative to better treat, cure diseases like diabetes.
'Robotic Pancreas' Appears On American Idol
Carlos Santana's nephew Adam Lasher shows off Dexcom G4 during live performance.

closing banner

Wil@Ask D'Mine answers: I'm so sorry about your brother. Siente mucho. I'll light a blue candle for him. But, in happier news, I'm glad to hear you've lost so much weight. Of course, I can't in good conscience recommend your fear-and-grief diet to others, and I doubt it'll join the ranks of New York Times best-selling diets.

As to your question, no research at all. Because you've been misinformed about how diabetes works. Your cells are just fine and dandy. They still love feasting on sugar. And they never had a problem absorbing it. They just couldn't get to it. Sugar is moved from your blood into your cells by the hormone insulin, and type 2 diabetes is a disease of insulin resistance.

The analogy commonly used to explain this (which I hate, but I've yet to come up with something better) is to imagine that each and every cell in your body is a little house with a locked door. Insulin is the key that unlocks the door to let the sugar in. With type 2, insulin leaves your pancreas with the wrong set of keys so it can't get the door open.

While insulin resistance isn't 100% understood, we do know that the more you weigh, the greater your resistance; and the less you weigh, the less your resistance. That's why your grief diet fixed your blood sugar. The weight loss changed your insulin resistance picture. The insulin is leaving your pancreas with the house keys again, instead of the car keys.

There's no long-term damage to your cell's ability to absorb sugar because that was never the problem to start with. In terms of feeding your cells, everything that you eat is converted to glucose. Even bacon. So I doubt that your new low energy is due to your diet change. In fact, with 20 pounds less of you, I would have expected you to have more energy. And I think if something else had triggered your weight loss, you absolutely would have more energy.

Valeri, remember I'm only the janitor at my clinic, but I think you're depressed. Depression is probably the leading energy-sucker in the world. And Lord knows losing your brother at such a young age is a perfectly appropriate thing to get depressed over.

It may pass on its own. Or you may need some help. That help might mean counseling, or anti-depressants, or both. Check in with your medical team, OK? Grief and depression look a lot alike, so you need to let the experts sort it out. Grief passes with time (but can be helped along with some expert assistance), while depression is a disease.

And like any other disease, depression needs to be treated.

 

Kathi, type 2 from New York, writes: I hope you can answer a question, but if "Hi, you need to speak with your MD," is all you can say, I understand.  If someone is on Humulin 70/30 using 16 units before meals and Levemir 48 units at bedtime... And on a pretty strict, non-varied diet (no way I could eat a taco salad without ending in the 300's) ... How do I learn to adjust my insulin for an occasional variation with more carbs? Without shooting up gallons more insulin? Can that only be done with a pump? Is there a more concentrated insulin? Will my MD get to that lesson? (I don't really expect you to know that, I'm just venting.) OK, that's 5 questions...

Wil@Ask D'Mine answers: Hi, Kathi. You need to speak with your MD. But that doesn't mean I won't answer your five questions.

So, you're using a 70/30-mix and Levemir? Really? Now that's odd. Mix has both basal and fast-acting insulin in it, so you don't often see it used with another basal insulin like Levemir, because doing so gives you two kinds of basal insulin. You're also on an unusual mix of old-school and new-school. Humulin mix is a blend of NPH and R, so it's a pretty old-fashioned insulin. Wait a sec... Did I say old-fashioned? I meant to say "primitive." Mix is a bit old school to start with, but your formulation of mix is the oldest of the old school. I didn't even know they still sold it in the USA. Levemir, on the other hand is the newest of the basal insulins. But, hey, if the combination works...

Oh. Wait. It's not really working, is it? The problem with mix, whether or not your doc has shaken up the recipe with some bonus basal, is that it requires, in your words "a pretty strict, non-varried diet." Both in timing of the meals, and the size of the meals. Personally, I think it's perfect for retired Marine Corps drill sergeants who really want their meals on the table at exactly the same time every day, and always eat the same thing. (Attention retired Marine Corps drill sergeants: no offense intended. We thank you for your service to our country. Hoorah!)

So mix works great for people who don't have much variation in what they eat. But mix is not for people who mix it up.

Now to your five questions:

1.) How do you learn to adjust your insulin for larger meals? That's a real problem with a mix insulin. Only 30% of your 70/30 mix is the rapid-acting insulin that's appropriate for carb-killing. The other 70% is the longer-acting stuff. If you increase your mix for a bigger meal, you just upped your NPH for the next half-day, too. All that upping usually results in a downer, in the form of a low blood sugar somewhere down the road. To make matters worse, you're taking a second basal insulin in the form of the Levemir, so upping the mix will "stack" more NPH on top of the all-day long action of the Levemir. So there's really no way to learn to do this with the meds you take, because it can't realistically be done. (But don't give up hope, see answer #3.)

2.) Gallons of insulin? Oh, please. Your mix is only 16 units. A gallon of insulin would be 378,541 units. No shit, but the copay on a gallon of insulin is the real killer.

3.) Can that only be done with a pump? No. Not at all. If, instead of a mix, you used a pure rapid or fast-acting insulin, you could infinitely vary the amount you took to match the size of the meal. This is generally done by calculating the number of carbs in the meal, then using a formula from your MD to determine how big or small a dose you need to "cover" the meal. A diabetes educator is probably the best person to teach you how to do this. It's not super-simple, but it's not rocket science, either. The insulin itself could be in a pump. But it could also be in a pen. Or even a good ol' fashioned syringe. The delivery mechanism doesn't much matter; it's what you are delivering that counts. Unlike the mix, which can't be increased dramatically because increasing the fast part also increases the slow part, a fast insulin can be taken in any size of dose needed for the meal in question.

4.) Is there a more concentrated insulin? Yes, there is. But you don't need it. Since you asked, most insulin in the USA is U-100, meaning that there are 100 units in a milliliter. That's its concentration. But Lilly also makes a U-500, five times as strong per drop. It's generally used for people who need more than 250 units of U-100 insulin per day. Interestingly, or horrifyingly, depending on your perspective, a U-300 is being evaluated by the FDA now. Insulin resistance increases with weight and Americans are... um... increasing in weight, so the Pharma companies see a new market for concentrated insulin. I'll call it Fluffy Insulin. For what it's worth, in the old days we had U-20, U-40, U-80, and U-100—and taking your insulin with the wrong syringe was common and dangerous. As today's FDA is danger-adverse, I wouldn't hold your breath on the U-300. It has a steep hill to climb.

5.) When will your MD start teaching you the advanced lessons? I have no way of knowing, so I asked an "expert" in these kinds of things. According to my Ouija Board, your doctor will get to that next year. Maybe.

So in summary: yep. You do need to speak to an MD, ideally a good one who's prepared to teach you the tougher stuff. And when you do, I think you should ask for "taco salad insulin" ...

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.