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nowlistenhereboy t1_j1fzxkm wrote

Reply to comment by muinamir in Despite improvements in insulin formulations and delivery over the last 30 years, diabetes control has not improved among US adults, and disparities for minority and uninsured adults worsens by Ordinarymangodoctor

> I wish we'd stop trying to pin this solely on diet

You can perfectly manage your glucose levels by meticulously testing and administering yourself extra insulin to cover but all of that extra insulin is not without its own cost to your body. Having all of that extra exogenous insulin creates its own set of side effects because insulin does a lot more in your body than just allow glucose into cells. Insulin facilitates growth of adipose tissue and can lead to hypertension, atherosclerosis/heart disease among other things.

Getting exercise and reducing your caloric intake to more closely match your caloric expenditure is the MAIN thing EVERYONE should be doing.

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RigilNebula t1_j1gbn9f wrote

>Having all of that extra exogenous insulin

For type 1 diabetics, all insulin is exogenous. It's not "extra", it's simply insulin.

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nowlistenhereboy t1_j1gkn7d wrote

That totally depends on how much they eat. If they eat enough to the point they are administering more insulin than their body would normally produce if they did not have diabetes, then it's absolutely excess insulin.

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drugihparrukava t1_j1gmvj6 wrote

We (type 1's) don't take insulin just for food. We can fast and need insulin because we don't produce it. Several hours if you're pumping, or a days/a few days if you're MDI, of no basal,(background insulin) and we're in DKA. Nothing to do with food.

It's a never ending balance of working out levels, as we have over 42 known factors that we do calculations for. Getting it exactly right isn't even possible with existing closed loop pumps.

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nowlistenhereboy t1_j1gnd4n wrote

Yea, not getting it absolutely perfect is not what I'm talking about. What I'm saying is that you can potentially eat a very large amount of calories, cover it with a bunch of insulin, and your sugar will appear to be fine. But all the negative effects of that over consumption and excessive insulin will manifest in the same way it would affect a type 2 or even someone who doesn't have diabetes.

This issue is way more pertinent to type 2 diabetics. But even a type 1 could develop insulin resistance in this way as well as the negative side effects of hyperinsulinemia.

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drugihparrukava t1_j1gof55 wrote

Hyperinsulinemia is when the pancreas releases large amounts of insulin so that doesn't happen in a T1 body. Insulin resistance can occur in T1 for several reasons, but it's not the same as hyperinsulinemia which is one of the possible causes of T2. So we generally use the term IR which can happen temporarily in a type 1 (due to one's period, ovulation, or many other hormonal changes, illness, scarring causing bad sites etc) or from having T1 for decades on its own can cause some resistance.

If a T1 does choose to eat large amounts of calories, of course that's not healthy for anyone, diabetes or not. But no the glucose (or "sugar will appear to be fine") isn't necessarily the case. It's a struggle to work out boluses and we dose differently for carbs, proteins and for many other reasons.

TLDR: yes no one should be eating excessive quantities anyway with that I agree. T1, however, and insulin dosing is very complicated and not caused by diet.

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Just an FYi if anyone's interested; it's understandable if you don't live with T1D to know just how much of a mental load this disease is. We have an additional 180 decisions to be made per day while acting as our own pancreas 24 hours per day. This is a rather simple chart of the 42 factors that affect blood glucose, and not all are listed here either: https://diatribe.org/42-factors-affect-blood-glucose-surprising-update

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RigilNebula t1_j1j0v05 wrote

The things that you're saying are just the consequences of overeating in general though. If a non diabetic eats too much food, they'll see a growth of adipose tissue, and this can lead to hypertension and heart disease.

Unlike non-diabetics, if a type 1 diabetic overeats without taking 'exogenous' insulin, they will not gain weight, and there's no risk of a growth of adipose tissue. (There are, however, significant other risks, including death.) However, if they take insulin for the food they ate, they'll see the risk of weight gain and excess fat that non diabetics would see from overeating.

So you may be arguing that there are health risks to overeating. And this is true, but it's not specific to type 1 diabetics.

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