Sunday, September 16, 2012

status as I start GAPS

Insulin by Sprogz, on Flickr
Insulin by Sprogz, on Flickr

I didn't realize it was this close and I hadn't yet gotten my current status up here. IME, this is the sort of thing that is VERY easy to lose track of if you don't write it down at the time.

I am currently controlling my bG with metformin, a MDI regimen of Lantus and Novolog, controlling the side effects of the insulin with K-dur, supporting my liver with silymarin, taking FiveLac as my probiotic, and treating my heart disease with Niaspan, CoEnzymeQ10 and fish oil.


I currently take a generic extended release metformin, 1000 mg twice a day. Metformin is a drug that reduces the production of glucose by the liver, reduces insulin resistance (IR) ad hence increase peripheral glucose uptake, lowers bG and thus reduces diabetic complications, lowers cardiovascular risk (slightly lowering both LDL and triglyceride levels) and reduces mortality around 40%. It's been around a long time, and it's the only non-insulin diabetic drug I really approve of.

Lantus is a basal insulin, which means you take it to handle the glucose produced by the liver throughout the day. It is the insulin you take to cover your fasting needs. Lantus lasts in the body about 20-24 hours, so is usually prescribed daily at bedtime. I am one of those closer to 20 hours than 24, so I take two shots a day. And since I have never remembered to take a bedtime medication more than twice in a row, I take Lantus at breakfast and dinner. In the morning, I take 15 units and at dinner 30 units.

Novolog is a fast-acting insulin, and I take it with the following rules:

  • measure preprandial bG and for every 10 mg/dL over 100, add 1 unit Novolog
  • calculate carbohydrate in meal and for every 4 grams, add 1 unit Novolog
  • calculate protein in meal and for every 8 grams, add 1 unit Novolog
  • for breakfast, add 4 units Novolog (I have a bad case of Dawn Phenomenon)
  • add up all the above to decide size of shot, but do not take more than 30 units at one time

The Lantus and Novolog regimen keeps my fasting and preprandials bG under 100 mg/dL and my highest postprandials under 140 mg/dL - if I eat properly, where properly is defined as <20 grams carbohydrate at breakfast and < 40 grams carbohydrate at lunch and dinner.

If I eat more carb than that, my postprandials go higher, generally returning to normal before the next meal. But if I'm VERY naughty, my next preprandial will be high again, and it may even take 2-3 meals to get my bG down again.

If you think this sounds like a lot of aggravation, you're right. I have to decide what I'm going to eat before I take the shot, and have to know how much carb and protein is in it.

If I decide halfway through that I'm full, too bad, I have to eat cause I took the insulin for the whole meal.

If I decide I am still hungry and want seconds, I have to think hard about whether to take more insulin or not... the previous Novolog shot is still working, so it's really simpler to just wait 4-5 hours so I can get a new preprandial reading and go from there.

Finally, insulin causes potassium loss, it being one of the physiological things that insulin does. I have had a lot of problem with edema in my feet, which I can control to a large extent by taking potassium. I also sleep with my feet elevated, and they are usually relatively normal in the morning, and increase throughout the day. Recently, I have been mostly controlling edema with two 20 mEq K-dur at breakfast and dinner.

It's not perfect by a long shot, but much more K-dur is not feasible. Because rapid changes in serum potassium can be fatal, prescription potassium is supplied in a microencapsulated form, in which every little bit of potassium is wrapped in a matrix, so very little enters the bloodstream at any one time. This is handy for not killing you, but is annoying because the pills wind up HUGE. There was a point about a year ago, where I was up to 10-12 K-durs a day, and just wound up quitting insulin cause swallowing those pills was just such a pain. However, I'm currently on four and hopefully won't need to increase as 4 is doable.

Potassium is also the reason I won't take more than 30 units of Novolog at one time, no matter what I'm eating or how high my preprandial is. I took more than that ONCE, and after the several hours of rolling around on the floor with the worst cramps I'd ever experienced, I decided not to do that again! So for me, living with elevated bG temporarily beats the heck out of taking enough Novolog to bring it down fast.

Insulin dosing is measured by a total daily dose (TDD), the sum in units of all types of insulin. My TDD varies day-to-day, as my eating varies a lot. I wind up taking between 30-40 units of Novolog daily, so my TDD varies from 78-83 daily.

The general rule is that half your insulin should be basal and half fast-acting, but I find I need to err on the side of a bit more basal generally.

Reducing insulin use is not a goal, per se. In stage one of the intro diet, the diet will be rather low-carb, though I'm aiming for it not to be too low-carb and will be able to raise carbohydrate rapidly as I move through the stages.

Reducing carbohydrate intake will reduce insulin needs, but this will not in itself mean I'm improving. Even if I reduce my basal dose to be closer to half TDD as I reduce my Novolog dose, that will not be indicative of much either.

What will excite me will be if the ratios, the rules I use for dosing Novolog, change. If that occurs, it will mean my IR is improving.

If GAPS is wildly successful at treating T2, reducing insulin will mean reducing K-dur as well, which will also please me as I hate those monster pills.

And I hate to dare to admit it, but my real hope is getting off insulin. I don't mind the metformin, but the insulin is a pain.

Not the shots themselves, I barely feel those. Testing bG is much more painful than the shots, the shots are easy. It's the whole regimen. I lived as a T2 for a couple decades just eating low-carb, and until my pancreatitis that worked well for me. It it is SO much easier to just pass on the bread and potatoes than to measure everything you eat to calculate shots for it.

It goes... prepare food (from recipe you've previously calculated the carb and protein content for), sit down at table and measure preprandial, calculate shot, take shot, then eat your now-cold dinner. Someday, I'd like to eat hot food again!

Finally, I've been taking 150 mg silymarin at breakfast to support my liver.


I am currently taking FiveLac.

heart disease

I currently take 1000 mg Niaspan with dinner every night. Niaspan is a slow-release niacin preparation that reduces LDL and raises HDL. SloNiacin is the equivalent over-the-counter supplement.

It can cause some annoying flushing of the skin, itching and redness. However, the non-flushing niacin does nothing, so one sucks up the side effects. Actually, a glass or two of water stops the flushing anyway, so it's not a big deal.

I am also currently taking fish oil, 1000 mg at breakfast and dinner. I could do better with more, but the fact of the matter is, it's better to take 2000 mg/daily on a regular basis than to get tired of swallowing pills and give up.

I take 100 mg CoQ10 at both breakfast and dinner also.

I've also been taking 10,000 IU vitamin D3 with breakfast because I badly failed my last blood test and I have a history of having a hard time raising it.

changes for the GAPS protocol

Of course, the largest change will be the diet. And the largest change to the diet will be losing the caffeine. I expect to be rather miserable for a few days over that. Hubby and my HHA keep asking what do I want before I start, will I miss pasta, french fries, etc. Honestly, none of that matters compared to my coffee and Diet Pepsi.

Since I will be adding cod liver oil, I will be dropping the D3. I will also be adding a nut/seed oil as part of the protocol. And I'll be adding a BetaineHCl / pepsin supplement with each meal.

Once I'm low on Fivelac, I'll be ordering GutPro as I think Biokult is too expensive.

I've setup to do the detox baths, one day Epsom salt, the next baking soda.

Disclosure: Affiliate