No weight loss Is this due to too much injected insulin??

sarahtrust

I have been trying really hard 1200 calories and 90 carbs per day for three months with no weight loss
The endocrinologist bumped my insulin up over a few months to 34 basal twice a day and meal time novorapid 20 each meal Is this too much insulin and should I cut it down? Am I being overdosed on insulin which prevents glucagon from being used? Please help

BarneyRubbleMD

@sarahtrust ,

Too much injected insulin could halt weight loss and drive blood sugars down--are your blood sugars getting low 2 hours after meals?

About a year ago, I was injecting about the amounts of insulin you are (both basal & meal time) but I lost weight each month while injecting that amount of insulin since I knew my diet was in a calorie deficit based on the results of my RMR (Resting Metabolic Rate) test I had done at my local dietitians office. I had that RMR test so I could plan my diet around that RMR # since it's very specific to just me and not some generic equation telling me how many calories I should be able to eat each day (MyFitnessPal's calorie estimates for me are quite a bit off). Also, during this time I was trying to lower my insulin dosages (due to the cost) by observing how different foods affected my blood sugars & sense of fullness so I could make better food choices that would help me lower my insulin dosage. For example: I like hard sourdough pretzels but could barely have 2 of them (that's like nothing--I use to eat a dozen) with a meal before my carb count would get too high along with my blood sugar but if I substituted out those 2 pretzels for a large Red Delicious apple (that has the same # of carbs), I noticed I'd be way more full from that, stay full longer from that & my blood sugar wouldn't get nearly as high even though the net carbs were the same (note: the sliced apple was weighed just like the pretzels were). Finding food substitutions that work for you to keep you full for longer can help with reaching a daily deficit that's needed for weight loss, even when injecting insulin.

sarahtrust

Are you in USA What is the RMR test? Thanks for response

nvmomketo

RMR = resting metabolic rate

If you do bring down insulin, you'll probably need to bring down your carbs too. Right now you are at 90g, which is about 360 calories - almost a third of your daily calories. You could easily cut your carbs by half or more of you wished.

Exercising or walking after eating may lower your insulin needs a it too.

Is it possible that you are accidentally eating more calories than you think? Are you weighing all of your foods? Simply eyeballing can lead to eating more than you think.

And are you logging all food? All cream in your coffee, the small handful of nuts, butter or jam on a muffin, oil on veggies? Could you be eating more by grazing?

sarahtrust

Thanks for full and thoughtful respponse
1. Seeing endocrinologist tomorrow with 3 months of myfitness pal's diaries and reports, Thinking of trying to see a nutritionist or naturopath to look at diet because need calcium, iron ,protein from diary and report information
2. I will look at cutting carbs more ( 18 in an orange alone which I have everyday!) Thanks
3. Starting exercise today ( have had two back fusion ops and degenerative spine in neck impacting on spinal cord so even walking is difficult but trying to plan programme of exercise at home currently, waiting for further neck op so calcium important, lots of carbs in yoghurt. Milk etc.
4. I must be eating more than I think, though I cut out snacks, going with Byron Richard's book on Leptin, says 5 hours between meals to reset insulin cycle and nothing after dinner, mostly rigorous about this
5. I do weigh most foods, can tighten up here too
6. Grazing is a disaster for me so I try hard not to eat anything between meals, usually not hungry anyway,
7. Today woke at 4 am ( yesterday's bedtime BG 5.6 (100) with BG 4.6 (82) which is low for me and often I start to have hypo symptoms if it is below 5 so had 1 biscuit stayed up for 2 hours as could not sleep (hard to sleep with "normal" blood sugars) then woke at 9am with BG 6.7(120) should I now miss breakfast until BG is down, have basal insulin or not, have how much meal insulin? Finding it all hard to understand even after so many years and micromanage
8. But take your point of need for more diligent ,rigorous, recording/weighig/exercising as far as possibleThanks

BarneyRubbleMD

@sarahtrust ,

To answer your prior questions--yes, I'm in the United States & like @nvmomketo mentioned, the RMR is a Resting Metabolic Rate test. I had that done at my local dietitians office (a 10 minute test breathing into a tube that I believe is measuring oxygen & carbon dioxide and calculates a metabolic rate specifically for you when at rest. For sedentary lifestyle, they multiply that # by 1.3 to get your maintenance calories. From that #, I figured my diet calories based on a 500 calorie deficit from that maintenance calorie #.

My other comments are embedded in your list below...in italics

sarahtrust wrote: »

Thanks for full and thoughtful respponse
...1. Seeing endocrinologist tomorrow with 3 months of myfitness pal's diaries and reports, Thinking of trying to see a nutritionist or naturopath to look at diet because need calcium, iron ,protein from diary and report information.

Seeing a registered dietitian helped me, especially with the nutritional stuff after finding out I was deficient in some nutrients after getting the results back from my nutrition testing.

...2. I will look at cutting carbs more ( 18 in an orange alone which I have everyday!) Thanks

I ran into the same issue with oranges, which were huge at the time (like the size of grapefruit). I substituted with Halos (which I think are mandarins) which are smaller only having about 10 carbs each and are still easy to peel and divide in half (if needed) to split across meals).

...3. Starting exercise today ( have had two back fusion ops and degenerative spine in neck impacting on spinal cord so even walking is difficult but trying to plan programme of exercise at home currently, waiting for further neck op so calcium important, lots of carbs in yoghurt. Milk etc.

Every little bit helps

...4. I must be eating more than I think, though I cut out snacks, going with Byron Richard's book on Leptin, says 5 hours between meals to reset insulin cycle and nothing after dinner, mostly rigorous about this.

I've done my best with 4 hours between meals and no snacking between meals and nothing after dinner but allow myself a 1 hour slip in that time but if I let my meal time get much more delayed than that, I can get too hungry and end up binge eating a bunch and that really messes up my blood sugars. My not eating after dinner was also to eliminate my acid reflux issues by being able to go to bed on an empty stomach

...5. I do weigh most foods, can tighten up here too.

This is good. I'm still amazed at how "off" I can be when I try to "guess" and how much that adds up to by the end of the day. I still don't weigh my protein powder (just use the scoop) for my morning shake or measure my coffee creamer (I use a ready-made GNC Total Lean 25 protein shake for this--swiss chocolate flavor & "eyeball" the 2 tbls) but if my weight loss stalls, my "crappy" logging areas will be the first thing I'll tighten up on.

...6. Grazing is a disaster for me so I try hard not to eat anything between meals, usually not hungry anyway,

I think this is good and it's what I do. I tried using snacks between meals too but it just messed with stabilizing my blood sugars. With having about 4 hours between my meals and my meal insulin dosage "adjusted" so that my BG doesn't go too low or high, that meal should last me until the next meal when I'll be ready to eat again (hungry but not starving). Grazing was a disaster for me too.

...7. Today woke at 4 am ( yesterday's bedtime BG 5.6 (100) with BG 4.6 (82) which is low for me and often I start to have hypo symptoms if it is below 5 so had 1 biscuit stayed up for 2 hours as could not sleep (hard to sleep with "normal" blood sugars) then woke at 9am with BG 6.7(120) should I now miss breakfast until BG is down, have basal insulin or not, have how much meal insulin? Finding it all hard to understand even after so many years and micromanage.

It takes time. When my blood sugars were ranging from 250-350 mg/dl, if I injected enough meal insulin to bring my blood sugar down to about 120 mg/dl in 2 hours (about 30-50 units at that time), I'd have "hypo" symptoms! My body just wasn't use to such a quick change in blood sugar. Now that my blood sugars are pretty good, having #'s in the low 80's feels fine but that certainly wasn't the case a year ago and I had trouble sleeping too when I got down in the 80's (but not now).

Also, be careful of the insulin-injecting "yoyo" effect of injecting too much meal insulin and having blood sugar drop too much and having to eat something to bring the blood sugar back up when you know you had enough to eat for the diet if it wasn't for the hypo thing happening. As you make better "diabetic" food choices you'll probably find that you'll need to lower your insulin dosages to compensate to keep your blood sugars stable which will also help with sticking to a diet as hypos tend to make people hungry. Your endocrinologist (or their staff) should be able to give you some guidance or instruction on making these adjustments with insulin dosing, especially meal insulin dosing based on pre-meal BG and net carb content of the meal.

...8. But take your point of need for more diligent ,rigorous, recording/weighig/exercising as far as possibleThanks

It really is a "pain" to do with all the logging, pre-planning, weighing & recording stuff (BG & insulin) but, for me, the "data" I gathered from doing this was very helpful, especially when I included my meal times, pre-meal and post-meal blood sugars and meal insulin dosages within my MFP Food Diary (at each meal) to help me monitor what's going on when I eat different things or larger/smaller meals and the "adjustments" and/or "substitutions" that were needed (and that I could look back at this at a later date to see what I had done previously).