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For doctorsWould you ever put people with type 2 diabetes on insulin?
, medical content by Dr. Jason Fung, MD
in Diabetes, Insulin, Intermittent fasting, Q&A 
How can a person with type 2 diabetes lower their HbA1c? Would you ever put a person with type 2 diabetes on insulin? What is a normal insulin level? And, can you have celery, radishes and lettuce during a fast?
It’s time for this week’s Q&A about intermittent fasting and low carb with Dr. Jason Fung:
Low serum insulin + High HbA1c
Dear Dr. Fung,
Have you come across a situation in which a person on LCHF and IF has been able to bring fasting insulin levels down but HbA1c stays high? If T2D for 20 years; after 3.5 years of LCHF and IF, fasting serum insulin is 3.8, but HbA1c remains at 8-9. I would like to understand the science behind this and how to reduce HbA1c. Thank you.
Ranny
We’ve seen every possible combination. Latent onset type 1 diabetes is a situation where fasting insulin may fall over time and blood glucose remains high.
Dr. Jason Fung
Would you ever put T2D on insulin?
If you had a patient who was strictly keto for a month but after removing meds such as gliclazide, due to the stress it puts on the pancreas, but was still taking maximum metformin but waking on 12-17 would you introduce insulin? How long would you give the body to rid itself of sugar naturally? I would be interested in your approach. Hypothetically of course. Thanks.
Caroline
Every situation is unique, and I treat patients on an individual basis, but yes, I’ve put many people with type 2 diabetes on insulin. Other than that, I can’t answer specific cases.
Dr. Jason Fung
What is normal insulin levels?
Dr Fung,
I read your book the Diabetes Code about reversing type 2 diabetes and you talked about insulin toxicity in T2DM patients. On page 58, a diagram shows fasting insulin levels in obese people. Can you tell me in general what is the normal insulin range (pmol/L) for diabetics who are not over weight or obese, but have a diagnosis of T2DM? Thank you.
Fathuma
You need to check with your own lab. Each lab has different levels that they consider normal.
Dr. Jason Fung
Can I eat celery, radishes and lettuce during my fast?
Hi Dr Fung,
I was thinking that as these are extremely low in carbs, they would no affect the fat-burning that occurs during a fast? They also help with the cravings and chewing on them seems to help me.
Laurie
Fasting is classically just water and no food. You can do a variation of fasting that allows celery, radishes, and lettuce, and that may certainly be successful for weight loss.
Dr. Jason Fung
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I am a regular IF proponent for the last year and a half and have been at my ideal weight for my body type and age (68 yrs) for some time. I quit drinking coffee and drink "Pero" instead and I am wondering if the 1 g carb-0 g sugar per serving will break my fast. I am using the 18/6 or 20/4 protocol 6 days a week. Thank you for your work!
That may affect different people differently. It appears to be barley based, so may not be a good option if you are eating keto/very strict low carb in conjunction with your fasting.