For me I am interested in IR and what to help it.

whitelaw714 wrote: »

I'm actually a pharmacy student and a type 1 diabetic trying to improve my insulin sensitivity, so I took great interest in your plight Dragonwolf, and as a pharmacy student, I actually may have a suggestion. Have you tried pioglitazone ( brand name Actos), or just the metformin? Actos functions similarly to metformin, but it also increases insulin sensitivity and has an off-label use for PCOS. I'm not sure if you've talked to your doctor about this, but it sounds like a viable option for your condition. A common side effect of the medication is weight gain, however this is caused by water retention. Another effect is increased fertility, and since this drug has the same harmful effects on developing fetuses as metformin, effective birth control is necessary while on this medication. Feel free to disregard my information, after all, I'm not actually a doctor, but after hearing about what you're going through, I felt the need to share what I'm learning.

Metformin is a class B medication and not harmful to humans either in utero or after they are born according to the med info I get with my metformin From the pharmacy. When I went into the ER with my last pregnancy they told me met was fine to take during the whole pregnancy Along with a print out of a NIH study that says there is no risk to the fetus at all. So it being harmful is news to me.

But it's great to know there is another med out there that can work like met for those that can use birth control or are past that point in their lives.

Actually, if you read studies, weight gain is common with many anti-diabetic drugs, metformin included. You should consider the fact that the purpose of anti-diabetic drugs aren't taken to lose weight. It's taken to promote cellular metabolism by increasing glucose uptake, decreasing hepatic glycogen release, and increasing insulin sensitivity. When insulin sensitivity is an issue, wouldn't it make sense to use a drug that increases insulin sensitivity? Taking metformin or glipizide for example won't solve the actual issue, even if it doesn't have weight gain as a reported side effect. I may not be in my later years of pharmacy school, but I have a large understanding of physiology, and knowing that Actos stimulates a receptor in already existing cells to increase metabolism within those cells means that the cells may grow in size, but it doesn't cause cell proliferation. Any weight gain (assuming the patient is maintaining a lifestyle that does not change their weight significantly) is caused by water retention. This is further supported by the fact that this drug can cause sodium retention in the kidneys, which would promote water retention to balance osmotic pressure within the body.

As for your source, I don't trust it. For one, it has a medication with just a single side effect apparently reported. That is completely untrue. I haven't heard of that drug, but I know that you can't effect something (especially in the endocrine system) without having the potential for multiple side effects. It's completely unrealistic when you understand physiology. It also presents all side effects as though they have a similar rate of occurence when in reality, that isn't the case at all. Severe side effects are rare; it wouldn't still be on the market if they weren't rare. The FDA would have prevented the drug from coming to the market or staying on the market if these severe side effects weren't rare. This "dangerous" class of anti-diabetics, while they admittedly have rare side effects that are more severe than other anti-diabetics on the market, have the potential to be just as dangerous any other drugs that effect the endocrine system, which is to be expected if you consider that your endocrine system plays a large role in homeostasis.

The second article seems more reliable as it posts many valid sources, but it mostly talks about the dangers of avandia, not Actos. Patients taking Actos are supposed to be closely monitored for signs of water retention, which is part of what leads to cardiovascular issues while taking this drug. Having water retention while on this drug doesn't mean you'll end up with heart failure. Water retention is actually a very common side effect with hormonal contraceptives, so it would be very clear if there was a strong correlation between water retention and heart failure. Typically, low doses of a drug have far fewer side effects than larger doses. Perhaps a low dose of Actos has a better benefit vs risk comparison in most people's eyes than the typical dose does. However, you can't disregard the fact that Actos is an effective anti-diabetic and is currently being researched to formulate drugs similar in structure that have less of an effect, essentially decreasing the therapeutic effect but also eliminating some of the risk associated with the drug.

Dragonwolf wrote: »

(...)

Finally, I've started lifting and walking again. (...)

Now, I know it's going to take time to see results, but what I don't know is how long is a reasonable amount of time to allow for changes in insulin sensitivity. (...)

So, for those that have been able to manage their blood sugar/insulin issues with similar diet/lifestyle changes, how long did it take for you to see results? What tweaks did you have to make to get things to fall into place (if any)?

First off, I'm skipping the drama. No need to get personal in a discussion that's supposed to be about a topic.

@Dragon, I relate to your problems and I can literally hear the pain from trying to do "everything" without hard results. I think maybe you jumped the gun here, because 3 weeks of exercise is not enough time to repair the hormonal balance. Anyway, even hearing about other's experience can only give you an idea of timeline/measures that may or may not work for YOUR body.

I tried talking about Jason Fung in this group last fall, he really inspired me and made me understand a lot of how the body processes nutrients. I highly recommend watching his series "Aetiology on Obesity", although most of it may be old news for you, his compilation is very thorough and comprehensible.

Here's my playlist for his series.

As I understand it, a big part of his treatment for diabetes patients is fasting in some form. I suggest you do some digging on his excellent blog It's not very structured, but there are nuggets of info if you dig there even in the QA below posts.

LCHF explains some of the question of “What to Eat” but does not address the question of “When to Eat”. This is an entirely separate but equally important part of the equation. If you are eating continuously “grazing”, then that will undo some of the benefits of the LCHF diet. I suggest trying to reduce eating ‘window’.

I think it's important for people like us with complex issues to not limit ourselves to only one "box" of thinking.

Personally, I've found that I have to stack methods for both fat loss and healing body. It sucks, but I'm practical, I'll do whatever it takes both for the short game of losing fat and the long game to repair metabolism.

Following is what I do, just to throw out some ideas. Disclaimer: It might not work for somebody else.

1. LCHF: I allow myself more carbs on hard workout days.
2. I workout a lot: Last months I'm doing 1.5-2 hours almost daily brisk hilly walks/runs. I eat to power my workouts. Sometimes I do long endurance stuff like hours of cycling.
3. Limit stress: I consciously try to limit what I stress about. Modern life is sometimes absurd and a lot of the things that seems "very important" are not in a bigger picture. Elevated cortisol is something I must address. A lot of foamrolling is great too:)
4. Intermittent fasting: I do daily leangains style fasting and calorie cycling. In practice I start to eat somewhere around 12-8. I don't stress about meeting an amount of fasted hours, but tailor it to my schedule. By doing this naturally, I'm up to PR 22 hours. On some resting days I force myself to do low kcal days, in effect zig zagging intake. For fat loss I need to reach an average/week that is below my BMR. Yay, spreadsheet.
5. Keeping/gaining LBM: Last 3 months or so I've tried to have at least 30g protein per serving, after seeing this doctor's interesting lecture about protein intake. I've noob gained muscle many places, mostly in thighs.
6. Supplementation: I cautiously supplement with things I suspect I'm low on: Tyrosine, selenium, zinc, chrome, iodine, manganese, potassium, magnesium, omega 3, fiber, astaxhantin, bcaa. It's in the form of foods: parsley, brazil nut, pickled ginger, kelp/sea weed, fish etc or in capsules/powder.
7. Keep researching and experimenting: I keep an open mind about what can be tweaked or improved according to my goals. Lately I've understood a lot more by broadening the research to include other fields namely biochemistry and endocrinology and also professor Sapolsky's series on Human Behavioral Biology
8. Having compassion and patience with myself: None of us are perfect. Striving for it is fruitless and frustrating. Owning my mistakes, forgive them and move on is a mindset that helped me a lot. Here's two extremely powerful and inspirational videos on willpower and living in truth

So what are the effects of all these experiments ? Purely anecdotal: I used to carb crash into "coma" 15 mins after dinner and have high symptoms of systemic inflammation. I can now eat 200g boiled sushi rice (sweetened with erythritol) without any problems. Haven't tested upper limit yet. I still avoid gluten products, though. My bad knees are much better, I can train harder and much longer. Inflammation is better, but not gone. I still have all the effects of being in FA despite sometimes higher carbs. I think that eating LCHF and training body work synergistic versus IR. I'm just guessing here, but I think that it has to do with repairing glucose metabolism via depleting muscle glycogen on a regular basis. I need to do more strength though... Doing a 30 minute slow walk has little effect for me. It needs to have some intensity and volume.

But it's not all sunshine, there's still some lingering problems: Frequent and daily neuropathy, eczema, hard to lose fat (probably more due to close to GW and too high carb and kcal intake). So I'm far from the careless intake of 3000-4000 daily kcal when I used to be skinny, but it's steps in the right direction

Here's what I suggest for you:
1. Do one thing at a time and add on more methods after a sensible time frame.
2. Keep lifting heavy with progressive load, be mindful of your back though. Listen to body, take it slow. Organic growth. Have good variation in your sessions. Walking is great for rest days.
3. Experiment with fasting protocols. Especially 1 day of VLCD a week on quieter days. I find that my body really likes big contrasts. So a really low day is followed by high day.
4. Experiment with TDEE/creep down intake: As mentioned somewhere above, people with PCOS and or IR have very low BMR, due to hormonal dysregulation. So it's logic that the TDEE calculators for people with normal, functioning metabolisms DON'T work for people like us. All calcs are just a starting point, an estimate. Confer with doctor if you feel you need a medically supervised eating plan.
5. Make sure you get enough good quality sleep.
6. Have patience.

I wish you well

TL;DR: The body is a biochemistry facility. Metabolism is the process where the nutrients we feed the body are translated into chemical compounds it can use for energy and repair/generate tissue. Macro composition of meals, timing of meals and proper exercise can help greatly on fat loss and insulin resistance, in my experience. Carb thresholds are individual and can be changed, experiment to find yours!

Edit: Clarity and spelling. Btw, muscle glycogen are never fully depleted, only reduced. Maybe it's the process of glycogen replenishment that is the health benefit in regards to IR.

whitelaw714, I don't care if you trust my source or not. I will take my personal experience of living with PCOS for 30 years, my own education (PhD in endocrinology and postdoc in pharmacology, I also worked at a pharmacy school for almost 5 years) along with the understanding that the healthcare system which you are becoming a part of is built not for optimal health but for management of disease states. Please, as you are learning during pharmacy school, keep a skeptical eye out and dig for more information. I know you need to spit back info on the exams, but your education does not need to end there. And also learn from your patients. Many of us have found metformin actually helps with weight loss, and is recommended for women with PCOS during pregnancy, for example, while you are claiming the opposite.

My BS today and I did have breakfast . 1/4 cup of oat bran - cooks up to 1/2 cup, 4 tablespoons of egg whites and 1 table spoon of organic natural peanut butter

Guess it's safe to say Surclose spikes my insulin . Two days without injesting and my numbers are getting back to my normal range .

Here's another study for you. They give results at 1, 10, and 24 weeks on a ketogenic diet.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1334192/

In summary, in this pilot study, a LCKD led to significant reductions in weight, percent free testosterone, LH/FSH ratio, and fasting serum insulin in women with obesity and PCOS over a six-month period.

Dragonwolf, I've spent my life struggling with my tendency to give sarcastic answers to people asking serious questions. If there were a meter to measure social awkwardness I would peg the needle. Dilbert could teach me social skills. That said, I think you are asking a question that cannot be answered by anyone not living inside your skin. My answer would be that if you have reached the point of asking the question, you have waited a reasonable amount of time. But that is my answer. I don't know if your level of frustration is blocking your way forward but I suspect that it is.

The question then becomes do you tweak what you are doing or blow it up and start over. My approach would be to look at the data, try to find things that moved numbers in the right direction and build from there. Others may make intuitive leaps that I don't see . In any case keep trying, keep reporting and maybe some smart person will spot a way forward.
https://www.youtube.com/watch?v=3WJ1cf3nrLE

DittoDan wrote: »

Ya know what come to mind for me? Making a Mountain out of a molehill.

In 1979, I saw this movie called, "The Main Event" and it had a scene in it that I have never forgot. I googled it and someone wrote about it, I will post it below. I feel like the boxer that had his lip snipped off and that Dragon has a paper cut. I am dumbfounded.



I mean, lets say she has a valid concern and I am wrong, so what? Diabetes is NOT a death sentence. She is in the right groups and doing the right diet. All her post can do is scare other people, make them stress, worry, lose sleep. I am here to counter her phobia so that others don't share in her phobia and make matters worse for themselves.

@robert65ferguson‌ did you see my glucose chart? Did you see her glucose chart? which one would you rather have? (an answer of "neither" would be a cop out).

In other words, some may take my post as offensive, but I can claim the same. Lets worry when worrying is warranted... paper cuts are not fatal....

Dan the Man from Michigan

I think you've been hanging out with Fit_Goat too much. Your post was maybe offensive, maybe not, but your tone is nothing short of rude and very dismissive.