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July 2024
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A complex picture when it comes to determining insulin doses

Being a type 1 diabetic for 44 years and 8 months has given me a unique view on how insulin works in the body. But it’s not the same as studying the subject in a lab.

One thing I learnt 4 years ago was that insulin binds to potassium. I was aware insulin was used in the treatment of hyperkalemia or high potassium levels in the blood as a vague background piece of information but it never occurred to me until I described how some of my hypos (low blood sugar) were making me feel: my heart would speed up and feel jittery for want of a better term. It wasn’t a heart attack or anything but definitely, things were not happening they way they had been.

Insulin binds to glucose and helps it pass through cell walls to provide energy. It also binds to potassium: but potassium is the mineral that helps the heart to function well – so if insulin binds to potassium in the blood, it is depriving the heart of the fuel it needs to keep its rhythm.

But that explains a few things – why bananas, despite not being hugely sweet have such a large insulin requirement. Insulin is not clever, it will bind to glucose but it doesn’t do that in preference to anything else, so if there is potassium, it’s 50:50 where the action is happening. Potatoes have a similar issue.

Cut the potassium then?

No, as I said, this is a vital mineral, not just for the heart. Nerves like to be bathed in it to help repair them and keep them healthy. Bones are stronger and muscles repair better – the heart is effectively a muscle. Many foods with potassium have other useful vitamins and minerals, promoting great nutrition.

However, for the type 1 diabetic body, insulin doses possibly need to include consideration of the potassium in the food.

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