Diet and Insulin matching for TIDs

From Australia with 52 years on insulin and seen just about every diabetic diet under the sun. From diagnosis at age 13 I found that the best way to manage growth spurts and manage the inevitable insulin increases (based on urine tests and hypo awareness only) was to eat more protein and reduce carbs and whist I have only recently adopted a very low carb regime my previous diets were at the 60 to 80 g carb per day level because accepting BSL > 7 mmol/l (>125 mg/dl) and HBAIcs > 6 % still allows complications to happen. See the DDCT.
My question then is related to the following studies:
https://www.liebertpub.com/doi/full/10.1089/dia.20180384. This is a US study looking at things like HBA1Cs and CGM and insulin pump use in TIDs 2011 -2012 vs 2016-2018. ages < 6 to > 50 years of age.
HBAIc is up (average 7.8%) and so is CGM use and to a lesser extent insulin pumps use.
So more technology in use but worse results and I am not trying to single out the USA. For example, according to the National Australian Diabetes Audit 2016 the average HBAIC of Type One Diabetics in Australia for 2016 was 8.4% +/-1.7% The range was 5% to 19%. I was not able to find Australian statistics about cgm and pump use as the site (NDSS) was undergoing maintenance.
Also according to papers such as Obesity in Type One Diabetes: Pathophysiology, Clinical Implications and Mechanisms 27 July 2018 author: Corbin et al. and Weight Management in Patients with Type One Diabetes and Obesity in Curr. Diab Rep. 2017 17 (10): 92 Author: Mottalib.obesity in TIDs is increasing faster than in the general population.
Where are things going wrong to lead to such unsatisfactory results ?
? Blood sugar limits too high? ? Diet and insulin regimes not right? Exercise vs food intake imbalance and the less known one: the effect of the gut biome on insulin sensitivity?
https://wis-wander.weizmann.ac.il/lifesciences/blood-sugar-levels-response-foods-are-highly-individual is a study of non-diabetics whose BSL response to various foods is found to correlate with their individual gut biome. Does it apply to TIDs and T2Ds? Does the ability of an individual’s gut biome to influence insulin sensitivity make it easier to gain or lose weight?? Or is it a combination of diet, gut biome, better BSL targets and less variation in BSL with the most sensible insulin regime??

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Like you I have had T1D for 52 years. Tons of complications, most recently kidney transplant and very little blood going to the feet. Believe it or not after 50 years I have begun to control my diabetes and my AIC is now 5.9 and std deviation around 15. I’m hoping better control or even excellent control might reduce all the calcification that is throughout my body. My keys to recent success are: know the basic rules and attempt to fine tune basal insulin (nothing more discouraging than to have good outcomes and then find out after food is gone you BG keeps going up or down, low carbs (I probably limit myself to 40 carbs per day), sugar surfing (now that many have CGMs it is relatively easy to take add’l bolus if BG moving too high or have a quick acting carb if it is moving too low and pre-bolus (the most underrated tool in the shed). Never stop experimenting on yourself but do it safely.

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For me low carb was the norm right from the start.

Never wanted an ice cream Sunday or fish and chips (mostly a big pile of french frys) bad enough to do all these calculations followed by an injection.

Quickly learned low carb meant lower sugar and fewer injections.

I am over the needle phobia that started it but to me its still to much of a hassle for the “reward” of munching out on stuff I should not.

Half an apple pie and the real cool whip, would be nice but no.

Actually that fast acting stuff, humalog, still scares me. Do my best to minimize it.

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At 60 yrs with diabetes type 1, I too have eaten many different ways. I think that the low carb diet is great in many ways for most folks. I starting low carbing 30 carbs a day before it was popular,
and ate that way for 11 yrs. Unfortunately for me and several others that I am aware of my LDL became very high and I ended up with heart stents. My HDL was very high, my Trigs were very low and my A1c was in the 4’s. When I received stents, I had had type 1 for 50 yrs, with no other complications of any consequence. No neuropathies. I found out that a grandfather died of a heart attack in his 60’s, and I was hypothyroid.

For the last 3 yrs, I have eaten about 275 carbs a day on a low fat plant based plan. This works beautifully for me. My A1c is 5.4 and I usually stay in the 60-140 range. My body reacts to this way of eating much better than it did to low carbing. I take 20 -22 units of insulin daily and weigh 108.

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I am a type 1/LADA and I am a vegan. I have been a vegan for over 30 years. I do well with eating what I want, and for me that means it has to be vegan. I truly believe in the benefits of whole grains, veggies and fruits. And yes I eat a cookie off and on! I have no other health issues going on other than a bad back.

But the best way to control BG’S is to keep track and dose appropriately. for me that means prebolusing and that keeps in check any unwanted increases. For me that reacts like a “normal” persons would in that it is ready to go when I eat.

I think everyone needs to pick what diet works best for them. But I do not believe there is only one right way.

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It is well known that underactive thyroid can be associated strongly with heart disease (e.g. see mayoclinic.org) and that cholesterol does not cause heart disease. The statin companies are using false, misleading interpretations of data for their profit and doctors are sucked in by the fake statistics. The low triglycerides obtained on a low carb diet are good news for heart and liver. The oxidation of tissues caused by thyroid disease and the glycation caused by raised BSLs lead to damage of blood vessels ( see Fat Emporer podcasts, Dr Paul Mason 1 -> 5. I am very surprised that you need so little insulin on a plant-based diet, and the high carbs involved are a known risk for heart disease.(as per Dr Mason above) This plant based push is a food industry mantra lacking in true and accurate scientific basis.
Kidney problems can be a cause of low insulin requirements and dyes used for stenting procedures etc can damage kidney function. ( search radiographic dyes and renal function)Also if you eat no meat you are at risk of B12 deficiency. (mayoclinic.org, B12 deficiency)Good luck but I believe you are not basing your health on sound science. Just my take on things not medical opinion or advice and I bet your are experiencing lots of hypos. Additionally on low carb diets sodium. magnesium and potassium losses are greater than on low carb diets and unless adjusted for can make people feel unwell and upset BSLs. ON high crab diets sodium retention increases the risk of high BOP (see dietdoctor.com).

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Thanks for the encouraging reply. I must admit though that I find sugar surfing useless, because it takes so long for any fiddling about with multiple doses to have an effect hours down the line and this just complicates things and increases the risk of hypos and rebound high BSLs even with cgms. And is likely to increase the variation in BSLs not decrease it. But we have to not accept old dogma from conservative doctors!!!

Kite doc,

I am a reader and a researcher and I know that many doctors do believe that cholesterol is important when it comes to heart disease. I have read some of the arguments against cholesterol being the cause of heart disease. I am familiar with both sides of the argument.
The doctors I follow do not like statins and don’t use them unless all else fails. I agree with you on your take on the makers of statins. You are talking to someone who Is smart and well read, so I don’t really appreciate the lecture. My kidney function is excellent. I do not have any more lows than I did on the low carb diet. My triglycerides are still low. It sounds like you have not educated yourself about the low fat plant based diet. I would suggest that you read the information on the Mastering Diabetes website to start with. The two men with type 1 who run the site also have several YouTube videos which explain why the diet works. Dr. Khambatta has degrees from Stanford and Berkeley. I would suggest that you educate yourself about the diet before you start criticizing.

At 68 yrs old, I have never felt as well as I do now. Gone are the migraines that I had when eating very low carb, and I no longer pass out from low blood pressure when I get out of bed. My energy levels are much improved and I spend an hour daily at the gym and love it. My body clearly did not like the very low carb diet and I don’t understand why that bother you. I am not suggesting that everyone follow my way of eating.

If you are trying to warn me then please don’t. I know what I am doing.

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Thank you for your reply and for the references. I am not going to spend money on a Mastering Diabetes course and am not happy that the basics of it are kept hidden by these means. And they seem happy to criticise meat without producing any unbiased science about their claim. I find the plant-based research I have looked at or what I have read from reviewers has been biased, statistically manipulated and invariably linked to the food industry in some way.
And on the surface no explanation of how B12 needs are met on a plant-based diet is given as a reassurance that the diet course is worthwhile undertaking (at cost). And how does one avoid Vitamin A,D,E and K deficiency? Noting that Vitamin K 2 deficiency is a worry regarding bone and heart problems.So I find your wish for me to spend money to “educate themself” a little disingenuous when by contrast the literature and know-how on low carb diet is open or at low cost by contrast.
Perhaps we could agree that any diet whether plant-based or low carb, which causes weight loss can influence BSLs although low carb produces lowering of BSL before weight loss begins. Does the same apply to your diet?
I am glad that you are achieving good control, triglycerides and whatever you mean by no change in hypo rate but I wonder how the results of low carb diets such as in the quoted Pediatric study compare to your own, particularly about BSL variability. Your reasons for not being happy with the low carb diet such as dizziness and migraines could be explained by readily available literature and thus do not necessarily preclude persons from such a diet once they recognise the biochemical changes of undertaking such a diet and using natural means to correct them. .Claiming the diet does not suit you without qualifying it with the fact that you may not been made aware of the biochemical issues and how to correct them would be perhaps a more accurate statement. Finally, who funds the research for the founders of Mastering Diabetes and others in plant-based nutrition, and do they or others declare any conflicts of interest in this process?

Let it go Kite doc. It seems to me that you enjoy arguing with people who don’t follow low carb diets. I am a perfectly healthy 68 yr old woman who has lived with type 1 diabetes well for 60 yrs. To me that says a lot about the way I choose to live my life. I enjoy being a vegan for many reasons. A B12 supplement is inexpensive and works well. I keep an eye on my other vitamin levels and all are within range. My protein levels are higher now than they were when eating low carb. My body is happy. I lost 10 lbs quickly when I switched to eating low fat plant based. Many folks with type 2 lose weight and are able to stop taking all of their meds. They are very pleased. They are no longer considered to have diabetes as long as they continue this healthy way of eating. I enjoy a very healthful lifestyle full of fresh organic fruits and vegetables with plenty of legumes, potatoes, rice and quinoa. I stay away from food with preservatives. I exercise.

For breakfast yesterday I ate a 1/4 cup cooked oat groats, a banana, a medjool date and a cup of fresh berries. I took 3 units of insulin and my blood sugar was down to 80 two hrs after eating. I had to eat more fruit before going to the gym. Because the diet is very low fat, insulin resistance drops. My insulin resistance was not measurable when last tested because the level was too low. I make none of my own insulin. Information about this eating plan can be obtained free of charge, but I don’t really think that you are interested in learning anything about this way of eating. You have found what works for you and that is wonderful, but you seem to be threatened by anything but the low carb way of eating. At the Mastering Diabetes website pages of scientific studies are listed.

The low carb diet works beautifully for most people, but it didn’t for me. I am very happy for you, but I choose to not argue with you and don’t want to continue to read your unfounded arguments and suppositions.

Other than that, welcome to the board. We try to be a very friendly helpful group of people.

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Seems my diabetes duration of 35 years doesn’t rank me highly in this thread! I just want to add a few thoughts here since I think it’s possible to reconcile our personal diabetes eating choices with others who make very different choices.

I eat a low carb, high fat diet, often < 30 grams of carbs per day but I longer count carbs. I eat no grains and no added sugars except for treating the occasional hypo. I avoid all processed foods and favor whole foods including meat and dairy. I believe that this way of eating, now in its 8th year for me, has contributed a lot to my health.

Like you @kitedoc, I was highly skeptical of @Marilyn6’s reports of good glucose control with eating so many carbs. What I learned over time was that her glucose success was real. While it challenged the basis of how my diet is formulated, it taught me that there is more than one dietary path to good glucose control.

It also taught me that the typical way of eating combining high carbs with high fat was likely at the root of obesity and type 2 diabetes pandemics. You and I limit carbs and consume abundant fat while Marilyn eats very low fat and abundant whole food carbs. Both of these ways of eating eliminate processed foods and neither chooses the deadly combination of processed high carbs and high fat.

One of the long-time proponents of low carb eating to control glucose in diabetes is Dr. Bernstein. He maintains that, “what works, works.” Now that may seem an obvious statement of fact, but I think it holds true in this discussion of contrasting values. Any person with diabetes who can control their blood sugar and report A1c’s in the 5% range without undue hypos is likely making a good choice for their health.

There is more than one legitimate dietary path to good health. The human body has evolved to flexibly respond to a variety of the conditions around food availability, seasonal changes, and especially geographical variations from tropical to arctic. It makes sense that our genes have responded to this variety of challenges by giving us a range of healthy eating styles.

We are here to support each other in our common struggle with diabetes. In some cases we must tolerate other’s divergence from our dearly held beliefs. We don’t always know what we don’t know. The science of nutrition is still emerging and we need to stay flexible.

None of us is fully informed on this topic because of the limits of current scientific knowledge. So, in the situation where we can’t know the full truth, we each need to make a leap of faith as we decide today’s best diet.

I accept that there is more than one dietary path to good health and someone choosing a path other than one I’ve chosen does not threaten my choice or make it invalid.

@kitedoc, I am squarely in your philosophical camp about eating with diabetes but I think our community benefits from people who make alternate choices like @Marilyn6.

I think closely held personal beliefs are best honed with some uncertainty.

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I must say, I am very happy for those who find happiness with their low carb diets! Because over the years I have learn, when you find something that works for you, great and go for it!
But sadness to this thread is it sounds like those of us who do not follow this type of diet are doing it wrong and doing damage to themselves and to others who are doing things incorrectly.
I am all for voicing your insights to what works well for you but the wording of these conversations can be a little better. I have been so turned off by the way some people on other sites preacher their way or death, that I left. I don’t want this site to do that to others who might be coming help for help, support, ideas.
The ideas are great but we must remember that what works for you will not work for everyone.
My treatment plan has changed many, many times over the years. And with each change I have learned what works and what doesn’t work. And I have also learned that giving a previously tried treatment, might work better this time (CGM before-hated everything about it, but now with all the advancements couldn’t live without it). And thankfully my exchange diet went away and learned how to count carbs. And than learned with a CGM what foods do what to my blood sugars. And yes, I am not a low carb person. And yes, I may not be a “good” as some with my numbers but they are my numbers, my goals and have stopped beating myself up when I miscalculate a prebolus. I do find most times a good pre-bolus can solve most carb issues. But that is me and that is years of experimentation. Yes, I have pizza nailed now!
So my sad little rant here, is wording matters. And to please remember there are many people lurking here who might be afraid to jump in for fear of getting the talking to. Words matter, tone matters and remembering YDMV (your diabetes may vary)!

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@kitedoc On this site we have spoken up about our beliefs but have always accepted that others eat differently and that’s okay. We have always just tried to help each other and give support when it’s needed. It has created a forum when someone wants to discuss a problem and then we try help each other. Or even just to share happiness!

The right way is the way that works for each person and we all have our own beliefs as to why we follow it.

Marilyn is to be admired for how successful she has been in controlling her blood sugars.

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I am so skeptical too. Not of the subject here in particular but any of it. Before I buy anything I pull it apart usually starting with who funded it and conflicts of interest.

Here is a tool you might enjoy.
Has Your Doctor Received Drug or Device Company Money? https://projects.propublica.org/docdollars/

The best tool for finding those conflicts of interest. See a doctors name on a study or wrote a book ? That website will tell you if they are taking money from the pharmaceutical industry. It lists all the doctors taking those bribes.

It is sad the way things are… Sad to turn on the TV and see ads for “Prevogen” that memory pill sold with lies to defraud the elderly.

I just cant fall into the trap that everything is a scam.

Very low carb did not work for me, I eat 100 or so per day not including lows. No amount of adjustments to basal etc have worked. My bg is very variable. It is a very difficult disease to manage and we must each do our best.

That said most do better on some form of lower carbs. And recommendations to eat 60g per meal is bad for most. I had to eliminate gluten and all grains and starchy veggies.

Thank you for your answer and the information about disclosure of MDs earning from sponsors etc. And it is chastening as I read about them. In Australia we lag behind and no such law exists here yet to be able to reveal this information about doctors here.
I have read though that University funding in USA and here by various interest groups may not be detected.
of course not all studies are biased but there are plenty that have been shown up by the persons accomplished in various fields and well versed in statistical analysis.

Yes. it is about non-diabetics being tested with use of CGM and the wide variety of BSL responses found and the correlation with gut biome.
If you have the right gut biome your insulin works better if would appear. Of course the number truly successful in each type of diet would be needed I suppose in a study to see how this matches up in TIDs.
Best Wishes

I agree about food choice in general and keeping below 150 g carbs per day. And it appears difficult to find doctors and diabetes nurses who have the time and experience with helping TIDs to adapt to low carb diets (at least in Australia).

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Thank you for your reply and I agree that it is often trial and error when it comes to diets and the fashions which may accompany them. My push is against fake and falsified science and there is evidence of the biased parties involved in many but not all cases. That leads to the question of do we wish to remain blind to these as we have been in some instances in the past or do we wish to learn why a diet works, which may be due to sound scientific principles or for completely other reasons. As an example, if you wish to obtain a small perspective: perhaps see The Fat Emporer podcast:
Dr Gary and Belinda Fettke. This gives an Australian perspective of influences of the food industry on us. You can decide to watch it or not and /or see if it applies in USA, UK and elsewhere in some form as well.
A further Fat Emporer podcast is E 25 Dr Lustig ( US MD) Processed Food.
Best Wishes

Thank you for your thoughtful reply. As you may have gathered I am concerned where biased science is used to promulgate a particular treatment,. diet ect. And when western diets were influenced by the work of Keys and the Framingham study etc the recommendations led to a low fat crusade. To achieve caloric sufficiency my understanding is that the % of carbohydrates in diets increased, and whilst the following is an association not statistically I am told that the rate of obesity and metabolic syndrome and type 2 diabetes rose in all populations exposed to this dietary change. Fat intake went down. Keys argued for saturated fat as the demon and won out in the popularity debate over excessive carbs intake as the underlying cause of these changes. Yet Keys thought the Meditarrean diet was heart healthy (yet olive oil weight for weight has more saturated fat in it than pork. And see the reference to lipid hypothesis in Jennifer Elliott vs DAA.
When it comes to things like the GI index, low carb and higher carb plant based diets there is a possible elephant in the room.
Yes a study on non-diabetics using CGM but showing the wide variation in BSL responses and correlating these with variation in gut biome between participants. We would need to see how many of each type of diet e.g. planted based high carb vs low carb high protein vs GI/GL have gut biomes which predicate success. We have some idea about what % benefits from supported low carb diet support, ( but not how many fail for lack of support or whatever), but no success rate etc for those on planted based high carb and for GI/GL I am uncertain of the reliability of the results.
Best Wishes

Thank you for pointing out the references supposedly supporting Mastering Diabetes diet. I will not belabour the problems with this reference list and instead just point out that there maybe factors not fully recognised for why some diets work for some TIDs and not for others.

Perhaps gut biome is a factor.
Of course further research is needed and some comparisons of actual success rate and why the diet in question did not work: between the various diets e.g.high carb plant-based vs low carb high protein vs GI/GL etc.
see wis-wander.weizmann.ac.il/life-sciences/blood-sugar-levels-response-foods-are-highly-individual