Back on the wagon with a new question

Hi, everyone ...

Last year I tried going LC and ended up reverting to moderate carb — ironically, after having quite a bit of difficulty controlling my blood sugars (despite some early success). In the meantime, I've read more about the non-blood-sugar-related benefits of a ketogenic diet, and I'm giving LC another go. So far, the best thing has been a sharp reduction in chronic hunger (one of the benefits I was hoping for), but I'm again having problems with persistent highs. I'm aware that I need to account for protein in my boluses (I've been keeping my protein consumption pretty moderate), but it seems that my basal rates are no longer sufficient.

I'm about 10 days into this (keeping carbs =/< 30g/day). Has anyone else experienced these kinds of difficulties? If so, was there improvement over time?


P.S. On a side note, does the new edition of Bernstein's book (2011) ever explicitly address ketosis? As I recall, the 2007 edition never mentions the word, which strikes me as odd, given the persistent confusion between nutritional ketosis and diabetic ketoacidosis.

Welcome back! Adjusting your insulin regime to a very low carb diet can take some time. Protein is certainly an issue. I bolus for half my protein, so if I have 20g of protein in a meal, I count that as 10g of equivalent carbs. Dr. B seems to variously uses between half and 66%. The real issue is that protein is digested over a period of 3-5 hours, so a regular bolus may miss the blood sugar rise leading to highs between meals. This can be worse if you have gastroparesis. A solution is to use a dual wave or extended bolus.

Now, does a very low carb diet raise your basal requirements? On this, Dr. B doesn't really say anything, but I believe it may be partly true for two reasons. First, previously during the day your carb boluses may have actually contributed to meeting your basal requirements. And second, a low carb diet increases certain hormones like cortisol that are used to control your body's natural production of glucose and ketones. This may cause a rise in basal requirements. Mostly, people see a similar basal requirements after moving to a low carb diet, but a dramatic drop in bolus requirments, you may need a basal/bolus ratio of 80/20 or so.

As to ketosis, Dr. B doesn't say much. He considers confusion of DKA and nutritional ketosis sheer "stupidity." A good reference for ketosis and how low carb diets affect your body is "The New Atkins for You" or if you like more of the science, "The Art and Science of Low Carb Living."

ps. And don't forget to increase your sodium intake. Low carb markedly improves your sodium regulation, your kidneys dump sodum, particularly in the first two weeks.

Although I'm sure it has nothing to do with insulin requirements, I would second Brian's advice about salt/sodium. I got this advice from "The Art and Science of Low Carb Living." and it has made a difference in how I feel generally, and has not adversely affected my blood pressure, as I feared. The authors of "The Art and Science of Low Carb Living." have a new book out concerning athletic training and low carb called "The Art and Science of Low Carbohydrate Performance" I know you're an athlete, Heather, and thought I would pass it along.

Thanks for the blurb, Shawnmarie! Nice to see that he's using the K-word in this edition. :) I have the book on hold at the library and am looking forward to comparing it to my older edition.

Thanks, Brian! Great info, as always. And great to see you're now on the TuD Admin list ... where you belong! :)

I have ordered the Volek/Phinney book and am very excited to read it. I've seen video clips of Phinney and was very intrigued/impressed.

Re. sodium, I'm quite a saltaholic, so I'd be pretty surprised if I need to add more sodium, but I'll check the specific recommendations.

Thanks, BadMoon! And thanks for remembering my athletic pursuits. :) In addition to the Art & Science main volume, I've also ordered the Performance one. Can't wait!

I haven't read the performance book and may not bother as my athletic pursuits are in the distant past:) But the Art and Science book is one is of my favorite low carb books, because it's all based on solid research. Like you I've watched or listened to several interviews with Phinney and came away very impressed.

I am presently reading "Diet 101: The Truth About Low Carb Diets" by Jenny Ruhl. Her bloodsugar101 website and it's "eat to your meter approach" was key in getting my T2 under control. It's also research based and while not strictly about diabetes the topic is discussed extensively, since she herself is diabetic. What I really appreciate is Jenny's ability to analyze studies and critique their design and conclusions. When there is a question that has not been studied, she simply says "we don't know". She also says low carb is not for everyone, as some peoples metabolisms handle carbs in any quantity with no problem. Very refreshing in a world where diet books tend to claim their diet is the solution to all problems for all people.