About 6 months ago, I went on a somewhat low carb diet, cutting out most grains and starches, eating limited fruits, and lots of protein and healthy fats. It’s based on what I have read regarding a “primal/paleo” diet, (mostly following guidelines on Marksdailyapple.com), as well as some advice from Dr. Bernstein.
As far as my A1c’s, weight maintenance, and energy levels are going, it’s been a lifesaver. My A1c has dropped from 8.0 (an all time high) in August '09 to a 6.6 just in April of this year. I have been Type 1 for 16 years and usually hover in the low 7’s.
I’m on injections of Lantus and Novolog, I take 10-12 units Lantus in the morning, and 6 units Lantus overnight, and take Novolog throughout the day based on my guesstimations of what I am eating. This is fairly severly decreased (Lantus-wise, anyway) from what I was on before.
Here’s my problem: when I was eating more carbohydrates, I didn’t have as hard of a time anticipating what to take for high-carb meals like pizza.
Now, I still occasionally partake in pizza or pasta, but cannot seem to control my blood sugars even with extra Novolog. It’s pretty frustrating, because there are certain social situations, etc, in my life in which I want to still be able to have some of these things once in awhile.
For example: last night a good friend came over - it was an emotional night and we decided to share a pizza. I took 8 Novolog around 7 p.m., ate some pizza (probably the equivalent to 2-3 large slices, which is a lot for me), took 4 Novolog about an hour after, checked my sugar at 10 p.m., and it was 85, so I figured I was doing great - a little worried about overnight lows so ate about 10g carb worth of a snack. I took my 6 Lantus, and woke up at 2 a.m. at 385!! I’m back to normal now but it took until 2 p.m. today to correct.
This is a much bigger swing than I ever used to have, so even though overall my A1c’s are much better and my general blood sugars stay in the “healthy” range of 80-150 for most of the day, I’d prefer that one single night of pizza not spiral me out of control like this.
Does anyone have any advice or has anyone experienced anything similar in learning to control Type 1 with a lower-carb diet? Do you think a pump would solve the problem? I’d prefer to stay on injections, but would be curious to hear from pumpers, too. I’d like to keep my current eating habits, but would love if pizza wasn’t the devil. 
Thanks!
See, that’s the thing about Pizza - you need the insulin 3, 4 hours later. Not at the time you eat, or an hour later.
For me, at least, this is about the same as any high protein or high fat meal.
Good old fashioned Regular insulin (remember that? Or are you too young and started off on Novolog) is IMHO such an excellent match to pizza. I had great A1C’s all through college, not because I was doing anything really clever, but because I was eating pizzas in mass quantities and matching with Regular insulin :-).
I don’t always agree with Dr. B’s “big plan” but he has lots of little tidbits that have great value, and his advice that Regular is a good match to high protein meals is exactly on the money.
Tim.
With a pump, you can do an extended bolus, which gives you a certain amount of insulin now, and spreads the rest out in little increments for the time period you specify. You would try 50/50 dosage extended over a couple of hours and see how that did for you. Next time you had pizza, you would adjust until you found your pizza “sweet spot.”
That’s all the knowledge I have to share about pizza and bolus. What I really wanted to tell you is that your control and the length of time you’ve been dx is admirable, and I am very impressed. Good job!
I have also found that since switching to a low carb diet that I am much more susceptible to spikes if I do eat any refined carbs. I haven’t yet tried pizza (which didn’t used to be a problem food for me when I was on higher basals) so I don’t have any specific advice, but I am also on injections, and I basically do what you do, count carbs and try to get it right. If I start trending a little low, 1/2-1 glucose tablet straightens me out, and if I cross 120 with an up/angled up arrow on my Dexcom, I do an intramuscular injection which tends to level it off within 5-10 minutes (I am also using Lantus, but I use humalog for meals)
Oh yes, I started on Regular as well. 
I agree with you in that the Dr. B “big plan” is a little much for me - doesn’t allow me to live enough of a normal life (no more than 1 slice of tomato, for goodness’ sake!!) - but I do think he has a lot of good tidbits.
Maybe I’ll talk to my doc next time about prescribing me with some Regular so I can sub once in awhile for special occasions. That’s a good idea.
Thanks so much! If they could only make the pump smaller and not weigh so much I would go for it. Oh well, I can dream…
That’s a pretty cool function though, I must say.
That sounds high to me, too, but even if it was 120g I did take 12 units of Novolog…so I was surprised it wasn’t covered even a little bit, and my bg rose 300 points, which is really significant. Thanks!
I think you did fine for the carbs in the pizza. I think what got you, 4 or 5 hours later, was all the proteins and fat getting converted into glucose.
Some here, especially low-carbers, talk about proteins as if they are (to use the old ADA exchange diet terminology) “free foods” but they aren’t. Maybe they’re free if you have some super-easy-to-control diabetes with some remaining insulin production, or just “glucose intolerance”. But for T1’s like you and me, they get converted to glucose many many hours later, and pizza is the textbook example of this happening. It’s called “pizza effect”.
Dr. B’s advice about low-carbing and regular being a better match for meals with lots of proteins, is exactly right IMHO. All the docs and drug-sellers might tell you how these new fast-acting insulin analogs are perfect but they just get absorbed too quickly for high-protein meals. Then pump manufacturers invent “dual wave bolus” to make the action of the new fancy-pants fast-acting insulins look exactly like what I started on a good chunk of a century ago - Regular insulin.
Novolog/Humalog is great for fast-acting corrections, don’t get me wrong.
Talking about diets and carbs reminded me of something. My aunt is on this new diet that is according to her blood type. Such as Type A can have coffee, but no cheese or red meat etc. She says she feels awesome since starting it, and has already lost some weight. Has anyone ever heard of or tried something similiar? My aunt is bringing the book over today and I would love some input
You certainly have strong opinions of this world we live in, dont you Tom?
Actually, another factor that may have affected you is that on a low carb diet, you build up what is essentially a carb intolerance. In fact, low carb patients are advised to “carb up” 2-3 days before taking an oral glucose tolerance test. Your sustained low carb diet has perhaps left your body ill-adapted to handle carbs, particularly a large unanticipated meal.
To properly handle your splurge, perhaps you should have gone into training 2-3 days before, raising your carb levels in anticipation.
I’m curious what you mean by “somewhat low carb”. What’s an average number of carbs per day for you? I think the reason Bernstein strictly limits it to 30 is that it keeps someone burning the fat they consume since there isn’t enough carb to fuel their body for the day. (Disclaimer - I haven’t read his books, only looked at some of his stuff online).
That’s correct, fats anyway,slow the workings of the insulin, that’s why you need the fast acting later.
Pizza seems to require a combo bolus or dual wave bolus if on a pump, in differing amounts for everybody… it’s indiidual. I have also read, but have no experience personally, that Regular insulin works well for Pizza. Don’t know how to dose using Regular… I have another suggestion, if you want to enjoy Pizza but yet stay on your low carb diet. Had a friend who was doing Atkins who used to order pizza with everything on it. She would eat the cheese and toppings and leave the crust. This satisfied her pizza craving and she said it was pretty good. In our case we combo bolus 60/40 for 1.5 hours. If still high at the three hour mark, we will just correct that as E doesn’t do too well with long, extended dual wave boluses. Since she will only eat one slice, the combo bolus alone will usually do the trick and she does not go high. P.S. Note the friend who did Atkins was not diabetic so I do not know if all that fat/protein will spike BG.
Hi Jag - I mean that I’m following a diet that essentially eliminates grains and starches (corn, rice, legumes). I sometimes slip up and have a bite of rice or pasta or bread if I am out at a restaurant or at a friend’s house, but when I cook for myself I do pretty well. I eat mostly veggies, meats, some nuts and some fruits (mostly low sugar fruits). I’d say on a day I’m planning/cooking I usually average about 50-75g of carbohydrate.
Hello Sarah:
We are ALL facing this @()#@*#&@#@ problem. Injections, pump, pills, does not matter in the least. The trick has always been the same one, did we GUESS correctly!
We balance things, weigh them by our experiences, modify them accordingly, but when the number is provided… did we get it right, OR does the number reflect a screw up, a bounce from a low, or merely a high that we need to attack again with all the forces within our power to destroy it. Sometimes the numbers defy cause and effect. Hey I sent 10 (@)#@#@#* units at that number, two hours ago but got zilch for it. What the heck is going on ???
Are you honestly out of control, because you have a couple numbers that are not textbook, or what you want them to be? We’re not talking 579 here. We’re talking about something in the mid 300 range which if you factor in potential distortion of 20-30 percent meters possess… that 385 could easily have been 320 or lower instead.
You are allowed a night off, or we risk becoming obsessed. Doing so, our “mental springs” get wound tighter, and that leads to other bad stuff. Enjoy the pizza, make your best guess… don’t make yourself crazy over numbers, they aren’t that blessed accurate…
In your place I’d have skipped the snack. Pizza loves to drag the process out… and trys to make us unhappy at the end anyway. And you do realize the only SURE way to fix this “problem” is to eat more pizza and conduct the necessary experiments tweaking things, right (weak grin)?
Any signs the 385 number was a low, hiding behind the pizza?
Stuart