- This topic has 1,924 replies, 78 voices, and was last updated 10 years, 6 months ago by .
-
Posts
-
do any of you fast on fast days? i only do on yom kippur, and its so hard..a little high-and i’m dead thirsty, and once i’m low, i have to take the shiurim….
I do, on both Yom Kippur and Tisha B’Av. Yom Kippur is much more challenging cause of both the whole shul/davening thing and cause I’m not so comfortable checking real often and playing around with the pump temp basal etc. (chilul yom tov on yom kippur doesn’t feel that great)
On the other hand, Tisha B’av is more relaxing, not obligated to do anything and I can play with the pump/check BG often. In addition, in back of my mind I know I can break the fast at any time…
Your getting me nervous for Tisha B’av though, anyone have any good ideas? Anyone else fasting?
Remember technically if you don’t eat glucose, you don’t need insulin. Yea I know about gluconeogenesis, but you won’t need as much insulin as usual.
health, you’re really making me nervous with your statements. Everybody knows that basal has nothing to do with food, so if your basal is programmed as it should be, it has to stay like this for a fastday.
rebbetsin, once you’re low, you take shiurim?are you crazy? once you’re low you eat as much as needed! The shiurim are for example, when you’re pregnant and rav weismandl doesn’t let you fast in such circumstances, than you eat shiurim, because there is no imediate sakune, and btw, rav weismandl doesn’t let a type 1 fast on tisha b’ov
Diabetics (Type 1 only) should technically lower their intake of insulin during a fast. After the body runs out of carb intake -the next step is glycogenlysis (converting glycogen to glucose). In order for this to occur two things happen in the body -1. insulin drops, 2. glucogen increases. Discuss this with your med practioner before actually doing it. Mod 80- Any comments Doc?
Health, you are technically wrong. The body needs insulin to survive, even w/o eating carbs. That is the basal insulin tralala is referring to.
tralala, she was talking abt Yom Kippur, you can’t eat more than shiurim then. and everybody has their own diyan/doctor to ask if they should or shouldn’t fast on Tisha B’Av, I fasted all the yrs…
Health- the problem with fasting is not about hyperglycemia, its about getting hypoglycemia. Nothing will happen if for a day or two a diabetic will have high blood sugars the problem is if the sugars get too LOW!! Gluconeogenis generates glucose from amino acids. Such being the case, gluconeogenises will prove to help a diabetic who is fasting by stabilizing sugars and protecting from lows. Besides, gluconeogenesis is a cycle that kicks in during starvation mode, not during a regular one day fast!! Also, the only time gluconeogenis is activated is when there is low insulin (ie no carbs) so you obviously dont need insulin to block out the glucose that is produced by gluconeogenesis!! check your facts before you post!!:) We know you mean well but its hard to hear wrong information from someone who doesnt live with this every day!!
As a type 1 diabetic I only fast on tisha ba’av and yom kippur. (I used to fast on other fasts too but then i realized that my numbers were out of control for about 2 weeks after the fast.) The way i fast now is by beginnig my day with higher numbers(somewhere around 200-250) this way by the end of the day I am around 130 and still feel fine. btw I am not on the pump so i cant adjust basal rates…
i’m pretty sure poskim agreed on only fasting yom kippur..i could be wrong, but why do more than you have to?
because how can you not fast on tisha ba’av? I never actually asked a shaalah but I bh always fasted okay so why not? Its so hard to feel the taanis feeling if your not fasting!! no?
allsg8- That’s exactly what I said -what facts do I have to check? What wrong information did I post? I’ll say it again -it’s better to have a lower insulin level for those that give themselves insulin- so glycogenlysis can occur. In your pump language -less or no boluses.
Forever 1- I never mentioned basal, someone else did. Plus, you don’t need insulin to survive technically. People die from DKA, not from too much sugar. The by-product of anaerobic respiration is acid which makes the body go into metabolic acidosis. They also die from dehydration. So technically it’s not the insulin you can’t live without, it’s all the complications that are caused by sugar not getting into the cells for its energy.
Don’t think we ever asked a shaalah but we did discuss with our doctor. I never had any major issues BH.
I once saw an interesting study where they actually made Type1’s fast an entire day in order to test their basal. I don’t understand how that could be accurate though.
yea..but it’s not our mitzva! just like its no mitzva to fast on an ordinary day…You’re actually doing a mitzva of vinishmartem meod when not fasting..
Following is a different study analyzing prolonged fasting in general:
Type 1 diabetes and prolonged fasting.
Reiter J, Wexler ID, Shehadeh N, Tzur A, Zangen D.
Division of Paediatric Endocrinology, Department of Paediatrics, Mt Scopus Canpus, Hadassah Hebrew University Medical Centre, Jerusalem, Israel.
Abstract
AIMS: Fasting is common in several religions. The aims of this study were to determine if prolonged fasting (> 25 h) is safe for individuals with Type 1 diabetes and to identify factors associated with success. METHODS: Patients intending to fast were instructed on insulin dose adjustments, frequent glucose monitoring and when to terminate the fast using a standard protocol. Clinical and epidemiological factors were recorded and a comparison was made between successful and unsuccessful fasters. RESULTS: Of 56 subjects who intended to fast, 37 (65%) were successful. Individuals terminated their fast in the presence of either hypoglycaemia or hyperglycaemia and adherence to the protocol was high. There were no serious side-effects of fasting. Successful fasters had greater reductions in insulin dosage and higher HbA(1c). There were no differences between individuals taking intermittent insulin injections and those with continuous infusion pumps. CONCLUSIONS: Persons with Type 1 diabetes can participate safely in prolonged fasts provided they reduce their usual insulin dose significantly and adhere to guidelines regarding glucose monitoring and indications for terminating fasting.
Health- Sorry, I know your probably older than I am but I have to disagree! Firstly- No! One cannot survive without insulin. Lack of insulin is what causes all other complications you listed to to occur in the body!!! Your using fancy terms but the root of the problem is LACK OF INSULIN!!
Furthermore, all mechanisms that occur in a healthy non diabetic person DO NOT occur regularly in someone with diabetes. Meaning, that low insulin will not cause high glucagon and hence glycogenolysis and gluconeogenesis. The mechanisms are all either slower or almost lacking in diabetics. Proof- every diabetic (at least type 1) is given an emergency glucagon kit. Why would we need to inject glucagon if our body knows to produce it on its own when were low? also, why would we ever go low if our bodies would be able to control the glucose on its own??
One more point, the correct spellings are as follows:
Glycogenolysis and Glycogen!!
I dont mean to sound harsh sorry if i do!
Rebetzin- I dont see fasting as lack of veneshmartem meod because its not impossible for me to fast. I just need to be very vigilent about my numbers and activites while fasting. thats all!I would really fast all other fasts but that i think is going too far!
Allsgr8- I might not be the best health sciences student out there, but when I post I usually know what I’m talking about.
From the Diabetes Journal: “We conclude that in type 1 diabetes acute regulation of EGP by insulin is mainly via changes in GL while GNG changes little during the early hours of acute insulin excess or deficiency.” In English -lack of insulin causes Glucagon to increase to make more Glucose. Sorry, but I know a lot of medicine. Like I said before Insulin by itself isn’t necessary for life -it’s just easier to live with it. Acc. to you every patient that goes into DKA should die, but we do manage to control the DKA most of the time and then we give the insulin. We can control DKA without insulin, but insulin is what Hashem put in our bodies and that’s what we want to use -the natural hormone. A person who goes into hypoglycemia -the first thing we do is give glucose. If not available, an injection of Glucagon is given to release a lot of glycogen to glucose. It’s not that Diabetics can’t do it- it’s just that the process takes a long time in everyone. Giving a large dose of Glucagon releases a lot of glucose pretty rapidly, which is what they need in an emergency. Hypoglycemia is an emergency because the brain can’t function without sugar.
~it’s just easier to live with it.~
Then why did people die from Type 1 before the invention of inuslin?
~Acc. to you every patient that goes into DKA should die, but we do manage to control the DKA most of the time and then we give the insulin.~
How would you control DKA without insulin??
Like allgr8 mentioned the root of all the complications you listed above is from a lack of insulin!
and to clarify the “pump language” bolus is insulin given when eating or correcting (I don’t bolus when I fast) basal is the background insulin needed even w/o food, and this is REQUIRED when fasting.
Like I said before Insulin by itself isn’t necessary for life -it’s just easier to live with it.
How in the world is insulin NOT necessary for life? I’m sorry, but I don’t understand what you’re saying at all.
I’m not following this but this post jumped out to me. Most of our medical knowledge is much shakier than physicians think. But if there are some things we know with as much certainty as possible, among them is that insulin is necessary for life. There is no question about this. Glucose cannot enter cells without insulin. Living without insulin would be like driving your car without putting any fuel into it.
allsgr8, who are you to decide what’s going too far, and what’s just right? That’s why we have poskim, whom you said you haven’t asked…
Type 1 Diabetes 101.
What is insulin?
Insulin is a hormone. It makes our body’s cells absorb glucose from the blood. The glucose is stored in the liver and muscle as glycogen and stops the body from using fat as a source of energy.
When there is very little insulin in the blood, or none at all, glucose is not taken up by most body cells. When this happens our body uses fat as a source of energy. Insulin is also a control signal to other body systems, such as amino acid uptake by body cells.
Insulin is produced in the pancreas. When protein is ingested insulin is released.
Insulin is also released when glucose is present in the blood. After eating carbohydrates, blood glucose levels rise.
Insulin makes it possible for glucose to enter our body’s cells – without glucose in our cells they would not be able to function. Without insulin the glucose cannot enter our cells.
And as Mod-80 stated, cells with no glucose is like a car with no gasoline. Your body doesnt work, especially after it starts burning fat and the resulting byproduct cause high levels of acid to be found in the blood, leading to what is called DKA (forgive the spelling…diabetic ketonic acedocis).
Regarding fasting, Rabbi Meisels over at FWD (friends with diabetes, or as he calls his group – rayim mesukim)has all sorts of tips for fasting including many pre fast tips.
health- In an earlier posting on this page you metioned metabolic acidosis caused from anaerobic respiration.. the Diabetic ketoacedosis that Diabetics can fall into is not from anaerobic respiration-that’s called Lactic acidosis. Ketoacedosis is the build up of KETONES in the body, hence ketoacidosis. ketones have a very low ph and therefor when they build up in the blood they make the blood ph too low. Acetone is the ketone that builds up and in some patients with DKA you can smell it in their breath as a fruity odor.
Another thing, Yes people do die from DKA if it isnt caught in time. when i was diagnosed the drs said i only had another few minutes until____ baruch hashem hashem spared my life in the last minute literally! (The Dr’s in ER told my parents that a boy had come into ER a couple of hours before me and hadnt made it unfortunately.) So yes ppl do die from DKA which is caused from LACK OF INSULIN! btw, you metioned that we could control DKA without insulin..how is that?? please explain!!
Hope you understand things a bit clearer this time.
btw if your a health sciences student you should take a medical biochemistry course-it might help you understand all these concepts. 🙂
Rebetzin- When i say going too far- I mean for myself. like i mentioned before, Im fine during the fast but for about 2 weeks after the fast I cant get my numbers under control. Therefor I only fast on tisha ba’av and yom kippur! maybe ask your husband the Rav what he thinks!! lol
Allsgr8 -Oh I do understand Bio-chem. My mistake was that I thought everybody here did too. After reading all these posts, I understand why nobody understands me. I’m like talking Bio-chem 101 and you’re talking Bio-chem 1. But you are correct in that one thing (I must have been half asleep when I wrote it)- It’s not anaerobic respiration that causes the metabolic acidosis, it’s the ketones. Ketones from the breakdown of fat and other acids cause the metabolic acidosis found in diabetics. Also one thing I’ll try to explain, but after this please read up on your Bio-Chem before you respond to me. People do die from DKA; but what I was saying was- we have other treatments for DKA besides for insulin. So I was using this as a proof that insulin isn’t actually needed to sustain life.
Either you understand my point or you don’t, but it IS logical.
So I was using this as a proof that insulin isn’t actually needed to sustain life.
Either you understand my point or you don’t, but it IS logical.
In the same sense the heart is not needed to sustain life because someone could be put on a heart-lung machine. I suppose drinking and eating aren’t necessary. Heck even someones head isn’t necessary for life. Yes insulin is not necessary for life, for a little while I suppose.
Like I said before Insulin by itself isn’t necessary for life -it’s just easier to live with it
Ask your local endocrinologist who knows biochem 1001 what he thinks of this statement.
Mod -80: Like I said before -“We can control DKA without insulin, but insulin is what Hashem put in our bodies and that’s what we want to use -the natural hormone.” Even though you’re being sarcastic, it’s true -you definitely can survive with a heart-lung machine without a heart. I personally haven’t witnessed long term survival on it, but that yungerman who had H1N1, I think was on it for awhile & B”H he is alive and well. Parental nutrition is given all the time and people live for extended time and they don’t drink or eat. As far as living without a head, we haven’t yet figured that one out in modern medicine, but I do think the Gemorah says that a person can live with their head cut off as long as there is no wind. Don’t ask me to explain this Gemorah.
Parental? Like in nursing a baby? Or did you, perhaps, mean parenteral? –77
We can control DKA without insulin
1. How well and for how long?
2. How do you propose getting glucose into the cells without Insulin, a necessity to sustain life?
Mod 80- 1. We obviously aren’t going to experiment on a patient to find out, but it can be done. You can try it on yours’. 2. A. We start using fat for cellular metabolism. B. Glucose enters the cells through Glut 1- 14. Only Glut 4 responds to insulin to bring the Gluts to the membrane which are only in adipose and skeletal muscles.
health- INSULIN is the hormone that causes more Glut 4 transporters to appear on the membrane!! without insulin there are no glucose transporters (Glut 4)on the membrane to allow the glucose into the cells…btw you said its possible to stop DKA without insulin but your still not telling us how???? Where’s the logic in that one exactly?
whats the difference between biochem 101 and biochem 1? if you really want to understand biochem i can refer you to an excellent course you might not want to contribute to this forum until then in order to spare yourself some embarassmant and harasment!
health, so let’s say you’re right, “a person can live without insuline” (you didn’t prove it yet…), what do you want with that? do you just want to show us that you know something more than us, or do you want us putting the pump on the table for the entire fast?
Just wondering if anyone else besides me experiences a raise in BGL after eating scrambled eggs (or any form of eggs) It took me a while to figure out what was causing the high BGL but once i figured it out I started injecting 1 unit of novolog per egg. THat keeps everything clear but I still dont understand why protein would raise my bgl? THanks!
Allsgr8 -For someone who knows his Bio-chem -you should tell us why your BG goes up. I know why, but you’re telling me that I’m embarrassed about my knowledge of Bio-chem. Btw, DKA can be treated with Sodium bicarb., fluids amongst others.
Tralala -How about lowering your boluses?
I’m not taking boluses at all on a fast(only if I go high), maybe you mean basal?
But I’ll repeat, a basal is not for food, so why should I have to lower it?
Health- so whats the answer? dont try telling me its because of gluconeogenesis!!! cuz its not!
Health- I just looked up what you said about treating DKA. It could be treated with INSULIN and other fluids through IV.Not fluids alone.
I meant boluses, not basal. Why do you go high on a fast day?
it can happen in the begining of the fast, or if the basal is not correct
Allsgr8 -We were discussing if you can treat DKA without insulin, not if insulin is part of the treatment. Fluids, potassium,
Na bicarb., Phosphate are all treatments. Don’t embarrass yourself by admitting you don’t know Bio-chem. Of course it’s gluconeogenesis.
Alpha-ketoacids (derived from glucogenic amino-acids) is part of the citric acid cycle which converts to Oxaloacetate. Oxaloacetate is a direct precursor of PEP. PEP then goes through a series of steps to produce Glucose as the end result. In other words -protein can be converted to sugar.
Health- I am trying to tell you that NO! there is no way to treat DKA without insulin. the treatment is FLUIDS PLUS INSULIN! Trust me I went through this!
And about the gluconeogenesis which you love to talk about; that takes about 16 hours to kick in so a high BGL an hour after eating eggs would not be from gluconeogensis!
Allsgr8 -This is the last time I’m responding to you. You seem to have a hard time listening to someone other than yourself. I know what the treatment is for DKA, but the discussion was -are there other treatment options? And the answer is in the affirmative.
The body will produce glucose from its’ own proteins during a fast after a certain amount of time of fasting (gluconeogenisis). The body can also use proteins that you injest to produce glucose (Also gluconeogenisis). (See previous post how this works biochemically.)
Health:I meant boluses, not basal. Why do you go high on a fast day?
Why would one go high on a fast? Looks like you know better than us, what would be your answer??
Forever 1 -The first question I would ask is -Do you eat/drink (even a little) on the fast days?
Health- You dont have to respond to me if you dont want to.. but, you keep saying there’s a way to treat DKA but you say that without telling us what the method is (other than “fluids”). And, like i stressed more than once in my posts, gluconeogenesis only kicks in strongly after about 16 hours of fasting. the glucose that is produced from ingesting proteins is very miniscule and isnt enough to raise a diabetic’s BGL or anyones BGL. Let me challenge you with this question: how come when I eat fish or chicken by BGL dont change by even one number but when I eat EGGS they do change by a lot?? There’s something to it but both myself and my doc dont know what it is.. Maybe you know more than my endo? You seem to think so at least… Oh and btw Im REALLY curious as to what field of health sciences your going into.
Sorry if I came across harsh in my previous postings… its just that your saying things that arent accurate that I (and many others) have experienced first hand and have more knowledge about. (besides which, I am a health science student in addition to being type 1 diabetic so i really have to admit that i do bh know a lot about these things.. Double wammy:)
Health, no, I don’t eat or drink when I fast.
Allsgr8 – I did answer you, but the whole post was deleted. Maybe YWN can start editing the posts instead of deleting all of it.
I am interested in hearing what you have to say so maybe find a nice way of saying it and they’ll post it. (Not to say that ur not nice…I just assume that’s why it was deleted)
Allsgr8 – I had a very long post, but with one not so nice line in it. They deleted the whole thing. Maybe if you ask them -they can edit it and put it up. If not I’ll answer you in a few days when I have time.
did anyone here have a hard time with shidduchim because of the diabetes? was it kept a secret? how and when did you tell?
- You must be logged in to reply to this topic.