I had an appointment on Monday and she made some slight changes. I increased my Lantus by 1/2 unit and increased my Humalog to 1 unit:10 grams carbs. It’s improved it, but it could be better.
Many times I exercise in the evening, and this really helps. Your situation sounds a lot like mine. After my lower carb lunch today, my sugars have been totally stable. Getting caught in those cycles of chasing highs is no fun, and it’s so hard to maintain normal sugars.
So, I’m completely shocked. 
After I ate a lower carb lunch, my sugars are completely stable. There was a 20mg/dl increase, but then it came back down within an hour or so. I’m just in disbelief right now. I never knew that eating low carb could have this impact. I think this is something that I might need to pursue.
joeynicole, thanks for the examples. I will definitely have to check out your blog. Are you taking insulin with meals when you eat eggs and bacon or steak and asparagus? Also, does eating like that impact your cholesterol or triglycerides? I’m a cheese-o-holic, but I eat very limited fatty foods in my diet, so that would have to be an adjustment for me. However, 4-7 slices of bacon sounds like a dream, lol.
I am really happy joeynicole was able to help you on this. But I am also a bit sad and a little bit angry. You were diagnosed 18 years ago. The “medical establishment” has had a billion chances to help you with this and you were let down by the system. What you just found is called the “law of small numbers” by Bernstein. Eat smaller amounts of carbs, you require less insulin for cover/correction and you have less errors/variability. You don’t have to go extreme, you just have to apply the principles. I have followed a low carb diet since 2006. I no longer eat a very low carb diet, but I do find that if I keep things about 20g/meal, I can easily meet all my blood sugar targets. And I do bolus for protein.
some notes:
- adjust your bolus timing to the carb profile of your meal. pre-bolus, delay it, split it, or do what you have to do.
- spread out your carb intake. i’m not a low-carber but i try to keep most meals in the 30-45 carb range at most. i think this matters more than your total intake of carbs/day.
- if you want to eat more carbs some days than others, do it on your most intense exercise days (the exception to the 30-45 carb rule is that if i just did a bunch of kettlebell swings and crossfit-type stuff i’m going to eat 60-75 grams of carbs, along with a lot of protein and fat).
- hypos happen, so don’t beat yourself up. 60 is not even that bad.
- your doctor is not in charge. you are. if she’s going to make you promise to do this, tell her you can’t make that promise unless she finds a way to help you avoid having to correct in the first place.
- sounds like your basal might need tweaking?
Yay! So glad you got to see it for yourself! I personally do not have to bolus for protein/fat meals. I do bolus for the amount of carbs in the veggies I eat. I do know some type 1s have to bolus for protein.
I am not concerned about a high fat diet (from proper fats). When you remove grains from your diet, your body changes over from running off of carbs for energy to running off of fat for energy. I get my fats from animal fats (bacon grease & grass-fed heavy whipping cream mainly) and some avocado, some coconut.
Without grains in your diet you reduce inflammation. Inflammation is the big danger when it comes to heart disease and so many other diseases and conditions.
To know that grains make you fat, and fat makes you skinny (and healthy), is a bit of a whirlwind for people to wrap their heads around. The information is out there, it’s just not popular. Books like Good Calories, Bad Calories break it down nicely.
Also check out the book “Fat and Cholesterol Are Good For You” by Uffe Ravnskov, MD,PhD here:
http://www.ravnskov.nu/cholesterol.htm
More info here: http://www.marksdailyapple.com/cholesterol/
bsc - I am so with you on this. After learning more about the benefits of protein/fat/veggie diets and all the scary facts about what grains to do us, I became so, so angry… even sad. Years of struggling to keep my blood sugars in check and then wham, here’s the answer - and it’s so simple… I’m still a bit angry, in fact. I am so grateful for pioneers like Dr. Bernstein and his lovely law of small numbers. What an “oh duh” moment I had when I read that in his book.
What are your favorite non-starchy veggies? I just pulled a spaghetti squash out of the oven. It’s one of my standby favorites.
I agree with you. When I know I am eating a meal with higher carbs that tends to act quicker on my blood sugar, I’ll either bolus part of it 10-15 minutes before and take the rest with my meal. For that meal in particular, I would have skipped the apple. Those I usually have for a snack with some cheese. They spike me a lot. You could have carrot sticks or some other crunchy vegi. You could also eat half the sandwich and add a little more protein to the half you are eating. I am one of those people that bolus just a little more for my protein. The other thing you can consider is the amount of insulin that is still active in your system 2 hours after eating and give a correction that is a little more conservative. Wish you the best of luck.
I think that you need to reduce the peak to valleys. When it is raising and dropping so fast, its nearly impossible to determibe how much to correct. When I do use a correction bolus, I always look at the insulin on board. Most people use an insulin duration that is too short and humalog needs to be at least 5 hours. So if three hours after eting and you are 230 and if there is 4 units remaining and youi have a correction factor of 40, you could espect to end up at 230 - (4*40) = 70 and no correction would be required. A couple things that I have found to reduce the peaks are
Metformin
Low Glycemis Index
Using Lemon Juice and Water w a lil sweetnerto reduce the glycemic index
Good Luck
Yes you can - look up the glycemis index! it really works and I eat english muffins (extra fibre) make muffins with carbolese flour, Sweet Potatoes and baked potatoes long grain rice - all in moderation. Stick white rice, White bread and mashed potatoes are no nos
Totally agree with BSC…so frustrating that the medical establishment continually ignores this. It’s really hard for me to keep my mouth shut when med professionals continue to push my teen in the wrong direction with their nutrition talks. There seems to be so much more that needs to be studied and documented about T1.
I am really happy joeynicole was able to help you on this. But I am also a bit sad and a little bit angry. You were diagnosed 18 years ago. The "medical establishment" has had a billion chances to help you with this and you were let down by the system. What you just found is called the "law of small numbers" by Bernstein. Eat smaller amounts of carbs, you require less insulin for cover/correction and you have less errors/variability. You don't have to go extreme, you just have to apply the principles. I have followed a low carb diet since 2006. I no longer eat a very low carb diet, but I do find that if I keep things about 20g/meal, I can easily meet all my blood sugar targets. And I do bolus for protein.
My 12 year old daughter , who was diagnosed this past year was taught that we had to wait at least 3 hours after giving rapid acting insulin to “correct” .
We were told this by 2 different diabetic Centers/Endo’s
Everyone corrects after 2 hours?
When you give MDI’s how do you actually know what your Insulin on Board is?
Hi -
I was taught to correct after 3 hours at the Joslin and I usually wait until the third hour to correct although if I’m way off at 2 hours, I’ll correct then.
My pump calculates insulin on board as a straight line over 4 hours but my experience is that if I’m 2 hours+, my insulin on board is only half that and if I’m close to 4 hours my insulin on board is a trace.
Waiting the third hour is much safer for your daughter - especially if she is on MDI - because she probably won’t have appreciable insulin on board at that point. Things are hard enough for a young teen without trying to cut things too close.
Maurie
Thanks everyone for the encouraging words and advice. I’m almost emberassed to admit this, but I work in the healthcare industry, and I never even gave the low carb diet any thought. Everything I’ve ever heard in classes or from my doctors is that eating carbs is acceptable with insulin coverage. I haven’t had any spikes at all today. For dinner, I had some ground turkey with sharp cheddar sprinkled on top of it along with a decent side of broccoli. Then for a snack tonight I had a salad and some berries. My readings increase slightly after I eat, but then go back down. For some reason though, I’ve noticed a slow, steady increase throughout the day, which I can’t explain. However, I didn’t want to overcorrect, especially since I’m not 100% sure on how much to dose with meals. I’d rather be a little conservative while I’m learning rather than get myself in trouble. I went shopping tonight so that I’d have a little more variety. I’m thinking spaghetti squash for tomorrow. Yum! I also looked for Berstein’s book today, but unfortunately they didn’t have it at Barnes and Noble. I’ll have to order it online.
Why do you think most endo resist this diet if it works so well? Are there any risks involved?
bsc, Do you mind if I ask how you bolus for protien only? How do you calculate how much insulin to take?
not to worry the treatment plan is simple: " sugar high - take more insulin sugar low; eat more candy or fruit juice; what is wrong with you anyhow can’t you follow directions". And for this they make hundreds of thousands of dollars. Aside from a few folks in the business, this really is a self education disease and we each need to learn what works for us - no doctor is going to fix us. I really wish I found this site a long time ago.
It does sound like your basals are too high if sugars drop over 100 points during the night. I always treat and correct at bedtime.
Moderation in all things is the key - I really dont think ultra low or no carb is good for you. With practice and timing moderate doses of carbs (15 to 50 per meal) can be effectively used without spikes. I have been working on this for over 30 years and only recently am starting to figure it out. The CGM is a key enabler to teach us how much and when we need insulin.
We all need to be careful on giving timing recommendations - there are so many variables. I find that Humalog has at least a 5 hour duration and as many have pointed out, corrections can be dangerous. I find the real key is to work to eliminate the spike so that there is nothing to correct for. The 4 or 5 hour correction is much safer.
WOW - one suggestion is that you could talk to your doctor about switching to Novolog. I’ve used both, and Novolog is a “rapid-acting” insulin so it takes care of your food more quickly and has a short period of time before it peaks! I check within one hour of a meal to know if I got the insulin I need. Only when I’m eating large, drawn-out meals like Thanksgiving do I have more trouble with post-meal corrections.
Tiffany, I am glad you are finding ways to reduce your PP spikes. If you are interested in learning about protein/fat bolusing I would recomend reviewing the TAG group (Total Available Glucose). Bolusing for protein/fat seems to vary by diabetic and is likely more difficult for MDI, but possible.
Basic ideas of TAG: About 10% of the fat is converted into glucose and 40-60% of protein is converted into glucose. This conversion of fat/protein to glucose of course takes longer than carbs, maybe 2-5 hours . Your explanation of a slow steady BG increase throughout the day sounds like it may be a TAG issue. If you are interested, I would suggest reading some posts in the TAG group and asking other MDIers how they TAG.