Saying it is all about calorie deficit, or keto is magic, or exercise till you drop, are commonly dispersed and simplified “advice” tidbits that ignore individual differences and tolerances.
You are a fully mature adult male. Your adult metabolism is slowing just the same as your eyes are about to develop presbyopia. You will be experiencing more muscle loss after the age of 30, and therefore greater loss of mitochondrial ability to make energy. You may have a thyroid disorder — have you had it checked? You may have lower testosterone — some diabetic men see improvement in glucose after getting their hormones adjusted.
You indicate that you are Type 2, but that you are on both rapid insulin and basal insulin, and other medications. You seem to indicate that you go into DKA, also.
This is not the most typical situation for a Type 2 in their 30s, but again, people have different experiences. Have you been evaluated for autoimmune diabetes? Have you had insulin output done with a C-peptide test?
Assuming you are talking about excess, stored body fat, how much weight do you think you would need to lose to get to a healthy weight. 150 lbs might be easier to drop if you are obese, than “that last 15” which virtually everyone struggles with at some point.
Your diet does not seem crazy high in junk food as you describe it. Some low carb dieters do rely heavily on diet soda, cheese and almonds or other nuts — and I’m one of those people, too.
Diet soda is constantly up for debate as far as the physical and mental “tricks” it might be playing on the body. If it is caffeinated cola, that adds another mildly addictive element to the mix.
When I can stop munching on nuts and/or cheese, some of the weight will come off. That may or may not play into the caloric deficit argument, because the snacking can add excess energy but then it also requires more insulin more often. I know, it’s like, “Well, what the heck do I eat and drink then?”
One medical theory of metabolic chemistry is that insulin is a storage signaling hormone. In well-regulated bodies, you need enough energy in your circulatory system to keep your processes running immediately, and enough insulin to keep that energy going into cells. The beta cells seem to have glucose sensors associated with them that release insulin depending on the amount of glucose in the system. Inversely, the alpha cells release glucagon when glucose levels are dipping and this tells the liver to dump some stored glucose (glycogen). You have enough glycogen to last about a day before other metabolic processes kick in to rebalance the equation. Excess glucose gets stored as glycogen. And then the remaining excess glucose gets converted to lipids and fat stores. If you still have excess glucose, it keeps circulating till you get around 160-180 mg/dL and you will have measurable levels of glucose in your urine, too.
As was explained to me, insulin puts a break on certain metabolic processes. One of which is the metabolic conversion of stored lipids to energy. This energy is released as ketones. As you know, it’s possible to go into DKA — too many ketones, plus severe dehydration. It seems this is mostly due to insufficient levels of insulin — more common in Type 1 diabetics than Type 2.
So, you seem to need insulin, for some reason. It’s possible that your other medication caused the DKA, rather than your diabetic condition. You need to sort that possibility out, and decide if the 3rd/4th medication is worth that risk, if it induces such a reaction.
If you are not short of endogenous insulin and you can survive without the Jardiance or Invokana type medications, then you have to consider why do you need to be on insulin. Are you still at risk of DKA then? Maybe — some people with KPD would be.
But if you are trying to lose weight, then your insulin usage may be a big part of the problem. You might be dropping your circulating glucose, but also putting the brakes on emptying out fat cells — using lipids as ketones for energy instead of glucose. Some of your conditions for weight loss might be in place, but the insulin might be too high — putting you in storage mode rather than emptying mode.
Exercise does help to lower immediate glucose levels, requiring less rapid insulin. 1 unit might do if you go for a walk after a meal, whereas if you are sitting still after eating, you might need several units of insulin instead. This is because GLUT-4 insulin receptors in muscles are called to the surface of cells because of muscle contraction-stimulated pathways. This glucose uptake process is hypothesized to be independent of insulin-stimulated pathways. Also, exercise can build more muscles, which creates more mitochondrial factories to convert glucose to energy. Aging adults feel less like exercising, but perhaps are the ones who need to do more muscle building and activity. Younger people have it easy.
And then there are just genetic differences in people. My friend is very heavy, and so are her young daughters. They are tall but they all have wide legs — more so than other people. It’s just the way they are built, but no doubt that they eat a bunch of carby junk, too. Where it gets stored and how easily it gathers on them is different than most people. I’ve seen them slim down, and plump up again when times are stressful and less controlled. Basically the famous “Biggest Loser” type of effect. Luckily, they don’t have Type 2, but had relatives who did.
What does your physician say?