I am an insulin-dependent diabetic for the last 7 years. I have been using a conventional treatment of two injections: one in the morning (40 units) and one before dinner (28 units) of mixture insulin (70/30).
During the first 4 years my glycemic control was excelent (average HbA1c: 6.5%), but in the last 3 years I began having some problems (the average is about 7.6%). While wondering the cause of this problem, I realized that it happened when I started consuming more alcohol than before. In the begining, alcohol provoked mild hypoglycemias, which I prevented by eating before alcohol consumption (2 or 3 beers - I am not a heavy drinker). But in the last year, when I drink beer or wine, I have mild hypoglycemias in the next 2 hours, and hyperglycemias and insulin resistance for the next 2 days! I even started having the dawn fenomenon much more frequently than before.
I also realized that when I eat a lot in one day, I develop insulin resistance and dawn fenomenon for the following week, unless I exercise vigorously (3-4 joggs/week) or reduce insulin dosage and food intake for one or two days.
I believe that these alterations in my metabolism are somehow related with the amount of energy reserves in my body (fat and glycogen). When I drink or eat a lot, these reserves increase to the point that gluconeogenesis becomes uncontroled and the insulin I take is unable to inhibit it.
1. Is my theory correct?
2. Why did these metabolic changes occured in the last 3 years?
3. How can I prevent this? Augment insulin dosage?
Nice to hear your voice again. As you know we're volunteers here, so be sure to review your results and our suggestions to your endocrinologist. My "answer" won't directly answer your 3 specific questions, because I am not qualified to do so. I hope the information I provide is useful to you, nonetheless.
Just with the simple aging process, our metabolism changes - whether one has diabetes or not, so it is not unusual that our response to foods changes over time. As you know, our responses to different types of food can explain sustained higher blood sugars, too. For example, a stronger, fuller bodied beer will have a more potent impact than a lighter beer with fewer carbs and less alcohol.
The foods we choose to eat with alcohol can impact our blood sugar -- foods with high fat & carbo typically result in a sustained blood sugar rise that's longer and higher than the same amount of carbo without the fat.
If you have gained weight in recent years (alcohol has "empty" calories -- they are stored but give us no nutritional value), that alone could explain increased insulin resistance.
You might consider a personal experiment to avoid all alcohol for a week while you keep your other activities and foods constant. That way you might be able to isolate alcohol-related effects from those related to other aspects of your lifestyle.
While I've been a light drinker (perhaps 1-2 drinks every 7-10 days) I have found that I am more sluggish the morning if I have one drink with dinner or in the evening. Feeling sluggish in the morning was new for me and so I tried the personal experiment I suggested to you. I haven't tried to figure out the physiology and yet the pattern was so clear, I drink even less now so that I can enjoy each day.
LRS has given you some good suggestions. I, too, would suggest that you look carefully at whether you have gained any weight in the past few years. Fat cells are more insulin-resistant than muscle cells, and any increase in body fat would explain insulin resistance. As for the high glucose levels the day or two after you drink, you might want to look closely at the fat content of the foods you eat before you drink. If they contain lots of fats, your body may not be digesting them fully until long after foods normally digest. I find that when I eat foods high in fat, such as pizza or french fries, my glucose will drop low at first because those foods are not digesting yet when my quick-acting insulin is peaking. Later on, I tend to find my glucose levels rising as those fatty foods digest. If you drink and nibble, I might suggest that you test more often, say, every 2 hours, and adjust both insulin and/or food as needed to avoid having glucose levels staying high or low for very long. That will help you lower your a1c numbers.
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