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Question:

From Los Alamos, New Mexico, USA:

I became clinically diabetic at the age of 27, with fasting blood glucose at 160. At the time the doctor made no mention of this, and it wasn't until several years later that other symptoms led me back to take a physical. At this point my fasting blood glucose was 285, and my BMI [body mass index] was 26. The doctor diagnosed me with Type 2 diabetes and put me on Glucotrol [a pill for Type 2 diabetes]. The results were immediate, but after a while my blood glucose started to rise anyway. Finally, in spite of all efforts, the oral medications (Glucotrol and Glucophage [another pill for Type 2 diabetes]) failed.

I also exercise every day and with or without medication began having moderate (in the 50s) hypoglycemia. I found that the only way I could keep the blood glucose levels under control was by further restricting my diet, and eventually became very thin for my build (175 pounds and muscular).

The doctor suggested a GTT with insulin measurements, and we obtained the following results:

 Fasting1hr2hr3hr
blood glucose145210250200
insulin5182327

The insulin units are in microunits per ml, I think.

This led to a referral to an endocrinologist who said that I don't have Type 2, but am slowly developing Type 1. I have searched the web, and have found many references to insulin levels in test subjects. However, I have found none that relate specific data to hyperinsulinemia or hypoinsulinemia. I am curious about what the insulin numbers mean and what degree of beta cell loss they relate to.

Insulin therapy has done wonders. My endocrinologist says that I also have counterregulatory problems, which are responsible for the lows during workouts. I am curious as well as to whether this is a problem with Type 1 or 2.

Answer:

I don't think that there is any doubt that your present endocrinologist is correct in saying that you have now developed clinical Type 1 autoimmune diabetes. The slow destruction of the insulin producing cells in your pancreas almost certainly started many years ago and has been gradually eroding beta cell function ever since.

You cannot extrapolate insulin levels in an glucose tolerance test to give any idea of remaining beta cell mass. But it is now likely to be less than 5% of what was available before the autoimmune process started. Whether all endogenous insulin will go remains to be seen, that is the usual course; but sometimes some residual insulin production remains, if not for always at least for a year or two. Whilst this doesn't allow of coming off insulin it may make for better control.

There is nothing unique in getting hypoglycemic in relation to vigorous exercise. It is usually explained as muscle action promoting the release of insulin from the injection site. This clearly isn't the whole story because some people like you get low blood sugars during the activity, some after an hour or two and some several hours later sometimes causing nocturnal hypoglycemia. In any one person the pattern is usually consistent and you are going to have to learn to adapt your insulin and diet plans on the days you take vigorous exercise. The solution may be as simple as a timely extra snack or it may need some reduction in the nearest preceding insulin dose. In children who are on three or four shots a day this is usually in the lunchtime lispro insulin [Humalog®] dose for an afternoon sport of some kind.

A burden yes; but you seem to be doing well and good control really does pay off.

DO'B

Original posting 7 Apr 1998
Posted to Exercise and Sports and Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:08:58
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