Call Out to Type 1 Low Carbers!

I am desperate to get my HbA1C down - it is still 7.8 and after 4 years of testing 10+ times a day, trying the pump, carb counting, etc for the last four years I am now convinced that the only thing that will work for me is low/no carbing. Thanks to the pump my basals are perfect but the post prandrials are awful. Small apples, for example, send me from 101 (5.0) to 222 (11.0). My ratio is correct -the insulin just doesn’t work fast enough for me. (On Humalog and tried Apidra but that was worse.)

My worries are that dietitians here in the UK strongly discourage this. Although I find it really hard, with low carbing my bloods are currently perfect throughout the day and I not only avoid the highs but also the lows :slight_smile: The dietitian’s main concern is ketones but this doesn’t make any sense to me - if my blood sugars are perfect and I have enough basal insulin to keep them this way, why then would I have ketones? They seem particularly worried about this if I become pregnant. Although I certainly recognize that avoiding an entire food group is bad for a growing baby, I worry even more that my super high postprandrial levels would be more damaging. (Low GI / less than 30g still rises me way too high.)

This week I have had 10-20g carbs a day and no ketones (I tested because of their advice.) When I was a child I had Professor Sonksen as the doctor at the hospital who looked after me - a leading specialist over here- who told me that I was the expert and with my experience I would know more than any doctor. As a kid I really didn’t know what he meant until now and with an accumulation of incorrect diabetes advice over the years, I think I might just be right in thinking the way I do about my individual diabetes carbs.

I would love to hear about your experiences low carbing /ketones and your opinions to see if anyone agrees with me or if there is something I am completely missing!

You’re right about ketones accompanying high BG. However, people who eat low carb (diabetics & non-diabetics) can have low ketones as a product of the body burning fat for energy in the absence of carbs. Many people, diabetic & non-diabetic, can also have mild ketones in the morning because of fasting overnight. This is completely normal & natural. So, your dietician is not really informed about the role of ketones as a natural process. The time to be concerned is when high ketones occur with high BG for an extended period.

Avoiding a food group is not unhealthy for a growing baby. What’s unhealthy is for the mom to have high BG when pregnant.

10-20 carbs for the day is exceedingly low. Dr. Bernstein recommends 30 carbs per day with a breakdown of 6 (breakfast because of dawn phenonmenon & when most people are more insulin resistant/carb sensitive), 12 for lunch & 12 for dinner.

I’m Type 1 & have been following Dr.Bernstein’s recommendations for over 1.5 years with great success by eating 30-35 carbs daily. I feel great.

Dieticians & CDEs in the US discourage low carb also. I heard nonsense from them about my brain starving on low carb & how I’d never be able to do this:) They think it’s better to take large doses of insulin & eat potatoes.

I am sooo new to this it is crazy for me to even answer you but…my son’s doc was saying that it would be helpful to give my son his insulin 20 minutes before he eats the carbs because the insulin is slower than the raise in bg levels. To me that seemed scary…and I told her not possible with a 15 yr. old boy so she just lowered his two big meal’s ratio. Maybe this technique would work for you if your ratio is correct but just doesn’t work fast enough for you??? Maybe it is a new “technique” I don’t know. Hope this helps.

Thanks so much Gerri- really nice to know someone else is having success with this. I bet in the future there will be different advice RE carbs! Perhaps potatoes works for some but not every diabetic.

I like your point about having ketones naturally…I’ve not had any yet but will test anyway.

I did read the Dr Bernstein diet but I think it is more hassle getting exactly 6/12/12 carbs for me. Thanks alot, Dee

Thanks Katsz, yes I have tried this and get much better results but not good enough for me. If I didn’t give a dose 20 mins before the apple at 101 I would end up sometimes as high as 252 instead of 222 so I would say your doc’s advice is good. I understand why it is scary with a 15 year old. A couple of months ago I dosed for chocolate before I walked to the shop - I ended up with a 39 reading!! Massive mistake to walk and dose at the same time! I figured I would have the chocolate sooner too but I bumped into someone. Life doesn’t always work like that, does it? Thanks, Dee

My son was just diagnosed in Nov. and one time he just wanted some meat at lunch…needed a 1u correction for his BG. and nothing for the meat and by the next reading he was a 94!!!

i do a low/no carb diet and im beginning to think that im not getting enough nutrients or something could this be true? i do a lantis shot in the am then stay somewhat active through out the day not doing anymore insulin and eating low/no carb meals.

Hi Dee,

I hope & bet future (near future) advice will be different, too. Ideas are slow to change.

Please don’t worry about mild ketones. Really is nothing.

Did you read Dr. Bernstein’s book Diabetes Solution? You don’t need to get 6/12/12 exactly. Do what works best for you. If you lose too much weight eating low carb, slowly add more protein to your diet.

Gerri really speaks the truth. While many aspire to the ideals in Bernsteins dietary plan, few really achieve it and stick to it over the long term. But many have adapted his concepts very successfully. The key thing is the ‘principle,’ the so called ‘law of small numbers.’ Your blood sugar is controlled by doing two things, getting your average down and decreasing the variability. Diabetics are so often taught the first and not the second, but in fact in order to effectively reduce your average blood sugar without risking hypos, you reduce your swings. That is in truth the Bernstein principle of small numbers.

I’ve followed Bernstein for some years and although I’m a type 2 I can tell you it does work. At the peak, some two years ago, I had my standard deviation of my postprandial numbers down to 7 mg/dl, 95% of my postprandial readings were between 93-121. If you follow his methods to the limit some patients can get their average down into the 80s with a very small standard deviation, achieving an HbA1c of less than 5% and not have hypos. But understand, for most people, eating that strict a diet over a long period of time involves monastic levels of devotion and you just don’ need that.

Practically, you can apply his principles with more lenient levels of carbs and still achieve outstanding HbA1cs (like 5.5%). The key is the food. I found nutritionists and other advisors to not be useful. In the end, I became successful by buying and preparing the vast majority of my own food. Bernstein also has a complimentary book “The Diabetes Diet: Dr. Bernstein’s Low-Carbohydrate Solution.” I also have and would recommend cookbooks from Dana Carpenter, Michael Eads and George Stella. There are also quite a few low carb website. Gerri has some great recommendations.

In the end, I basically never achieved 6/12/12. I got below 50g carbs/day and at that level I was in constant ketosis (ketostix showing trace and marginal ketones). I was able to gain 25lbs of muscle over the years with a modified Bernstein diet. Bernstein recommends modest levels of protein, I always ate large amounts.

Berstein is often criticized for being so strict and harsh that nobody can be successful. That is not true. You need to look at his ideas and adapt them to be succesfull for you as an individual. Most Bernstein fans would likely tell that is what they have done.

I was going to give the same idea as Katsz! Maybe try waiting 25-30 minutes (that’s what I need to wait to avoid going over 200 mg/dl).

I’m with Danny as I consider myself a carb-restricted individual, but not as strict as Dr. Bernstein suggests we should be. I started this lifestyle almost two years ago with the following results:

-I’ve decreased my Lantus intake by about 50%, from 20u a day to around 9u - 11u, depending on my activity level.
-I’ve lost about tewnty pounds of body weight since cutting back on insulin, but since I’m eating a high amount of protein, I’ve put on lean muscle mass. Body fat % from 21% to about 10%
-I have no kidney problems as of my last lab results
-My cholesterol has improved
-My A1c used to be atrocious, now it’s much improved (but still not perfect by any means)
-I have more energy now than I’ve ever had in my ENTIRE life. I workout and play competitive sports almost everyday…I’m like a kid again.

-If you go low carb, those “once in a while” high carb meals could destroy your blood sugars…I think because your body will develop a low tolerance for such meals. It’s hit or miss with me, so I try to avoid.
-Other Type 1’s and even doctors will try to tell you that it’s not a balanced diet and it’s an unsustainable lifestyle over a long period of time. Simply rubbish! I get my veggies in, my lean meats, some fruit in moderation. A lot of people out there are still in denial about how to eat as a type 1, so don’t let their discouragement affect your lifestyle decision…a great decision at that!

Want to echo what Dino said about the occasional high carb indulgence. Good point! I’ve experienced this & my reaction was way higher than expected. Maybe this is why Dr. Bernstein stresses keeping carbs & protein fairly consistent from day to day, aside from the obvious reason of consistency in knowing what to do regarding doses. Perhaps our bodies get “set” to a certain amount & go haywire when we veer. A carb loaded diet is relatively recent in human history.

My diet is far more nutritious now than the ridiculous “diabetic” meal plan I was given. A dietician told me I wouldn’t get adequate fiber. HA! Though I think the high fiber craze is over the top, there’s plenty of fiber in vegetables & I eat a lot of veggies.

I didn’t find Dr. Bernstein’s The Diabetes Diet: Dr. Bernstein’s Low-Carbohydrate Solution worthwhile.

I can attest to improved energy also, despite the warnings from dieticians & CDEs that I’d be out of fuel eating low carb. Gone are the days of feeling sleepy after meals & dragging. My huisband, not diabetic, feels better as well.

It’s not easy to go against conventional wisdom from authoritative sources like doctors, so stick to your guns. I refuse to it discuss with doctors any more.

I love low carb. Don’t worry about those ketones. You are the expert. Keep it up. Start looking at low gluten recipes and use some of the flour substitutes in recipes: blanched almond flour, flaxseed meal, protein whey. And, of course, DaVinci and Splenda.
I’m T1. I can’t take a small apple. It sends me into the mid 200s with insulin 20-25 min ahead. The most fruit I eat is a strawberry or two with every 3-4 suppers. A piece of pineapple in a blue moon.
I can eat 10-15 per meal without going above 140, so 4 meals a day. I choose meat/protein every meal. I’m convinced it’s a way to lower sugars.
I have good unsweetened dark chocolate bars in the frig and 1 gram CHO cookies setting in the glass cake dish all the time. It’s nice to see BG doesn’t vary. My only problem is that my husband eats my goodies. My A1c is in the 5 range. I’m staying there.

If you can’t handle super low-carb, talk to your doc about getting on Symlin. It specifically helps to lower post-prandial readings.

Hi Everybody,

THANKS SOOOOO MUCH for your help. It is really encouraging to that see other people are doing this and I feel so much better now for trusting my own data and instincts! My dietitian won’t be happy but I think we are the experts.

I am so grateful to all the posters and really think Tu is amazing - for the first time in a long time I really don’t feel like I am on my own with this diabetes.

I am going to try to continue working with a low carb diet (Symlin not available here in the UK yet) and who knows, maybe it could slow down the complications.

Thanks again,

Where do you get the 1 CHO cookies? :slight_smile:

Is it just untrue that eating a lot of protein will raise your HDL levels? I’m battling high bad cholesterol and trying to stick to low carb. I rarely eat carbs either, except for my morning coffee. I eat a lot of meats and veggies (but carbs hide in veggies too sometimes) but I’m trying to lower my carb intake even more. My BG have been much better since I started restricting my carbs and I, too, am reading Dr Bernstein’s diet (tho I’m modifying his suggestions to fit my lifestyle)

I’m still waiting to have more energy, but… I’m sure it will come.

So, please just confirm:
Eating a lot of protein for meals (meats specifically) doesn’t trend a higher cholesterol level for you guys?

I’ve never heard any relationship between protein and HDL. My recipe for raising your HDL is to eat lots of healthy fats, take lots of fish oil, drink medicinal red wine and exercise. I actually buy my fish oil at costco and take 8-10 1.2g fish oil gelcaps a day, and my preferred wine is an Australian Shiraz. Who said your treatment had to be unpleasant (and I’m not talking about the fish oil).


Dee, one question I haven’t seen anyone ask is the biggie: HOW DO YOU KNOW? How do you know that you dosed “properly” for that “small” apple that sent you over 200 mg/dl? Your eyes and brain can play tricks on you, you know. For instance, I bought a bag of oranges the last time I went to the store. The oranges looked “small” to me, especially when compared to the other oranges in other bags. When I opened up the bag, I picked the smallest orange I could find from the bag. It seemed kind of large in my hand, but I thought that was just because I have small hands. At least that’s what I thought until I put it on my scale and found out that it weighed 218 grams – 7.65 ounces!! Then I put that amount into the serving amount at and found out that an orange that weighs that much has 25 grams of carbs – about 10 grams of carbs more carbs than what I would normally have for my morning fruit. Even those of us who are aware of this all-too-human tendency are susceptible to it!! The best investment/Christmas-Birthday gift I got last year was a digital food scale; it’s become my favorite kitchen “appliance”!

If you haven’t already done so, I also recommend logging your food for at least a week, along side of your bgs, your activities and any “events” (e.g. a cold, your period, etc). A month would be better. Use either the dm management software that is compatible with your favorite meter or use one of those online dm management services, such as SugarStats or SweetSpot to help you keep track of all of that data (and yeah, it’s A LOT of data!!) and to give you visual feedback (i.e. pie charts and line graphs) to help you more easily see trends. Having the computer do that work for you can really help you pinpoint at what time you’re having difficulties and can help you make better decisions.

Yes, I know it’s a PITA to weigh and measure your food and to have to track boatloads of data. Think of it like this, though: You’ll be in control of your dm, rather than it trying to control you.


awesome post.