Hi -
If you are currently using 2units of rapid per meal you should start by eating maybe 30-45 grams of carbs per meal. It is ok to start on a fixed dose but that doesn’t mean that you don’t have to match your insulin to your carbs. The usual starting point for an insulin to carb ratio is 15 grams per unit. Your endo is probably planning to increase your dose to bring you down slowly but if you eat 75 grams of carbs on 2 units of insulin, you are likely to stay very high.
Maurie
Do you mean 6 units basal and 2 units bolus per meal? I agree with Maurie that you can approach it by using that dose and seeing how it works with the number of carbs you eat, but you do want to start thinking more in terms of Insulin to carb ratios, rather than a set dose.
Ok. That makes sense. Thanks.
You might also want to track down “Using Insulin” or “Think Like a Pancreas”, both of which are sort of like owner’s manuals that have good directions to calculate ratios and basal rates and all of that? If you are just starting out and your numbers are coming out well for you, you might ‘reverse engineer’’ a ratio by just figuring “if I ate 50G of carbs and my numbers are good, I can eat 75G of carbs and take 1.5x as much insulin”? Your mileage may very and, as people have indicated, as you push the carb envelope, you can run into issues with differing rates of insulin absorption for larger doses of carbs.
I am usually inclined to eat bigger in the evenings (one doctor in a video referred to this as being a “werewolf”!) but I don’t run my carbs as tightly as a lot of people. It is definitely a long term thing that kind of requires constant supervision?
peeks @ page ah, 042511 dx. Welcome to the club!!
Theresa, there are many low carbers on this forum who were diagnosed as adults. Some may be Type 2 diabetics or LADAs, who have never had experience with being a child with diabetes. Your endo and diabetes team are correct. A lot of the adults are biased and misinformed. Low carb eating is not for children and certainly not for teen boys who are growing at a phenomenal rate. I would be more inclined to limit carbs amounts at each meal but eat more meals, than limit carbs per day if I were having a problem with handling the large bolus doses. Our tiny, thin (in the 20th percentile) girl, was eating up to 250 grams when growing. Her growth seems to have slowed down, along with her appetite, and she now eats anywhere from 100 grams to 180 and 200grams. There is no need for her to eat very low carb. Many highs are not even due to postprandials. Or lows. I can see adults that follow a low carb diet do have more stable blood sugars, or at least they claim here that they do. This may be an option for her when she is grown. Or not. It will be her choice.
Do you have an endo, CDE and nutritionist? The nutritionist (but it should be one that works with our endo’s office) will actually create a diet for you with a meal plan. Our eight year old was given a meal plan of 60 grams for 3 meals a day and two 15 gram snacks. The low carb amounts I have seen some eat on this board… I’m not sure how you would maintain weight/energy on that, but if you want to go low carb, they could probably advise you. I think 50 to 60 grams at a time is sensible. I would not go over 60 grams at a time at first, even if I had to eat more meals a day. That is because you will need more insulin to cover large carb amounts and a large dose is stronger than a smaller dose. Get “Using Insulin” by John Walsh, “Think Like a Pancreas” by Gary Scheiner and “Type 1 Diabetes” by Ragnar Hanas. You need to count carbs, basal test, etc. It’s more complicated than a paragraph here can explain.
My plan is 100 grams of carbs per day. I divie it up into three meals, and dinner being the last meal often gets only whats left in the budget. With that and my drugs I am able to keep my BGs below 140 most of the time. If I have an active day my BG will be a little less.
Thanks Jan!
I have to say that over time, I have developed a serious mistrust of the advice being given out by CDEs and so called nutritionists. Despite claims, you won’t “die” from lowering carbs. Everyone seems to accept that carbs raise your blood sugar. It only seems natural to only eat an amount of carbs that enables you to maintain your target glycemic control and keep a healthy weight. If you are a member of the Flatliners Club and have 12% bodyfat, then you are doing great.
But that need not be low carb! I meet the two goals on 160 net carbs per day.
I eat 75 grams of carbs for dinner and take 4 units of humalog. I am content and sometimes full after supper, but just like anyone else on a crave for anything carby, I am still hungry after dinner, but that is VERY rare!
Everyone is different. I’m glad you are doing well on 160 g/day. But note that is a level far below the 250-300g/day I was advised by my CDE.
250-300 per day for a Type 2? I can see why that might lead you to lose trust in your CDE. I agree that we’re all different and was just reacting against a “low carb” fundamentalism that appears from time to time on these boards. If adults want to use a low carb diet to manage their blood sugar, I say go for it. But I have grave doubts that approach is appropriate for growing children and teens and don’t believe that not going low carb automatically means that they won’t have reasonably controlled blood sugars.
Maurie
The current dietary advice (from the ADtA) for all diabetics and specifically for all T1 diabetics is to obtain 45-65% of calories from carbs. That is what you will be told by a CDE or an RD. This was a question from Inch, who is 35 years old, not a child or a pregnant woman. If you are having difficulty with glycemic control, particularly having large blood sugar excursions around your meals, then a really effective strategy to deal with this issue is to reduce and control your carb intake. I don’t think that is really contentious.
Why don’t you drop by the Flatliners club. There are some of the members who actually follow what most of us would consider a moderate or even (OMG!) high carb diet.
As an RD and new CDE, I would never advise you to eat so many carbs! I truly don’t think most people, whether they have diabetes or not, do best with such a high-carb diet. I try to individualize eating plans based on preferences, weight, and glycemic control. I generally recommend 130-150 grams for most people with Type 2 and eventually hope to be given the authority to present low-carb (<100 grams/day) diets as an option for people with all types of diabetes 
Thank you Franzi. I want you to be my CDE.
ps. Given that you should be very up to date on the latest dietary guidance, what is the “official” word on what a T1 should eat in terms of carbs?
The last time I received nutrition advice at Joslin, the word was that T1s need at least 125 carbs per day. My experience is that RD/CDEs haven’t been that dogmatic about eating large numbers of carbs.
I went to the DOIT program (Diabetic Outpatient Intensive Therapy) at Joslin about 6 months after diagnosis and was given a meal plan of 275 carbs per day. I wasn’t able to eat that much and didn’t. When I spoke to the RD/CDE a couple months later and told her she asked how much I was eating and she said fine.
My wife went to a RD at a local hospital for borderline diabetes and she was told to spread about 130 carbs out over the course of a day. That is way less than 45% of her daily calorie needs.
I am glad you got that advice. My experience is different. I have a local diabetes center staffed with CDEs and RDs. It runs an AADE accredited diabetes education program. I run a diabetes support group that meets at their offices and I know most of the staff quite well. I have constant discussions with them concerning low carb diets. Their current dietary guidance is 45% of calories from carbs. The best I can tell, they cannot teach outside the guidance without risking their accredidation.
Maybe one day I can be your CDE if I decide to go into private practice…
This is about as “official” an ADtA stance as I can find on carb intake: Individualized, match carbs to insulin using C:I rations, and no less than 130 grams per day in order to protect brain function. Nothing new, huh?
Hi Franzi - I couldn’t reply to your response below about the guidelines - too many indents - but do they cite any clinical studies about impaired brain function in adults with fewer than 130 carbs per day? There is quite a bit of anecdotal evidence on this site that it’s not the case
Maurie