First and foremost, I’m not trying to start a war with the low-carb people. I think that low-carb is an excellent approach for almost all type 2’s and for a lot of type 1’s. I’m a big believer in “if it ain’t broke, don’t fix it” and that goes for every approach.
That said, there are lots of type 1s on this site who maintain excellent control while eating lots of carbs, and I think there’s a lack of resources/discussion on this site about how to do it. I think it’s especially important to have this discussion to give those who just don’t want to make the transition to low-carb some tools to keep better control. So, for the high-carbers out there, I’m curious if there’s anything you do to keep your control good. Bolus timing? Exercise/food timing? TIps for accurate carb counting (especially ones that don’t involve weighing things? Anything is helpful, especially stuff you found out through trial and error.
for me it’s the timing and tons of cardio stuff. If I run like 30 miles/ week, and I’m looking to push that up a bit, I am sort of chasing the dragon all the time. I think my settings may be a bit gunked up as my pump just blew up but I usually eat pretty conservatively during the day and then splurge @ night. There was a diabetes psych video that referred to this as “Werewolf” behavior but I sort of load up on exercise and then just have a large bolus to cover the evening splurging. I’m old so it’s not like I’m out on the town too much, I’m out in the sunroom with my book and some popcorn/ chips/ beer/ etc.
Great topic. I am eating around 200 carbs per day and scored a 5.6 on my last quarterly exam (A1C). I stick to a somewhat rigid schedule and try to eat foods that have a low glycemic index. Every workday (5 days a week) I have the same breakfast (protein bar 17 g carb) and a very similar lunch (meat sandwich, apple, peanuts = 60 g carbs) at very similar times. Dinner and night snack vary a bit but I almost always stay under 60 grams per meal. I do measure the high carb items (like noodles or rice) and eyeball the lowcarb items (broccoli).
I pre-bolus everymeal and by 8-15 minutes usually. Lunch is my most challenging meal as I return to my desk job where I get no exercise (largest bolus of the day). Through trial and error I have found that my work lunch (meat sandwich, apple, peanuts) starts to raise my CGM at 70 to 80 minutes after lunch. I time my bolus so that (hopefully) my CGM starts to dip down to 75 to 80 right before the PP spike from the meal kicks in. There seams to be a magic time and bolus amount for high carb meals where if you do it just right you, then you can flatline like a dream.
Great topic, and I salute your friendly spirit of enquiry.
I’m currently being nagged incessantly to eat a minimum 100g of carb a day. It’s because I’m pregnant. My diabetes team doesn’t care how much or little carb I eat when not pregnant, but insist that I need at least 100g a day when pregnant.
There are the following structural difficulties:
from day 1 of pregnancy I have needed twice my pre-pregnancy insulin dosage
mornings, I need three times my pre-pregnancy insulin dosage. Furthermore I need 1 unit of Apidra for plain old oxygen, 2 units of Apidra per cup of tea with no sugar. I cannot eat any carb before noon unless I pre-bolus three times my normal insulin dosage, 1 hour before eating.
having to meet tight post-prandial targets, which for pregnancy are 1 hour after eating.
my system can’t deal with more than 20-30g carb in one sitting
So here is my coping strategy:
pre-bolusing. Depending on the time of day and type of insulin, up to 2 hours in advance
shooting bonus amounts of insulin because the higher the carb content (and for me anything over 30g in one sitting is high), the less effective the insulin
being prepared for the inevitable lows. If I am within target 1 hour after eating, I am guaranteed a hypo at the 2.5-3 hour mark. Luckily, being so glucose sensitive means that I can use fruit (which I would otherwise have to bolus for) to catch the lows.
I was afraid that using so much insulin would mean a lot of weight gain. But my weight gain after my first trimester has been 100 grams. Nevertheless, I am looking forward to going back to low-carb.
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I am definitely lower carb than I was before dx, but just as definitely not low carb – I eat probably 100-150g a day.
Tips:
I exercise too, but not as much as acidrock!
Typically I keep it to 30-40 max at a time. I never eat more than 70g at a sitting, and that is a total carb blowout for me (big bean burrito, etc.)
No fast, pure sugar carbs, unless I’m low.
Not many carbs in the AM: a slice of low carb bread with peanut butter is ~10 or 12.
I find small quantities of dessert in the evening not to be a problem. You just need the fat to slow down the spike. So ice cream, cake, these things are not a real problem. Fruit desserts are worse for me.
Pre-bolusing by at least a few minutes, up to 25 for an anticipated high carb, not super fatty meal. I’m still experimenting with this. Whether to pre-bolus, and by how much, depends not just on the carbs, but also on the fat. Do not pre-bolus for pizza!!
Out to dinner – I do lots of small boluses. Maybe for 15 g before I see my food (small pre-bolus to lay the groundwork), then top up to what I actually need once I see the plate. Then if I decide to have dessert, I bolus more. Once I’ve got some going, I find I don’t need to bolus early for the later “top-ups”.
Good discussion! I eat about 100 grams of carbs per day. I can eat whole grains and fruit without much difficulty. I try to go the “South Beach Diet” route, which a Type 2 friend said his endo recommends (I have Type 1 diabetes). I have definitely been influenced by the low-carbers here on TuD, but I am just not going to do the super low carb thing. First, I exercise a lot (yes, I do a temp basal, but for extreme exercise you need to carb up to prevent a hypo). Second, I love food. Third, I once tried to do the Phase 1 of the South Beach Diet, and I became crazed–I had headaches, I was REALLY hungry, and it was just a bad thing for me.
That is certainly good for me!! Book + music is an essential part of the equation too. Quite often, I will tailor the music/ booze to go along w/ the book…although the popcorn seems to go w/ all of the above!
Thanks y’all. Since I started this thing I’ll add one tip that I’ve found helpful:
When I go out to restaurants, I tend to splurge, but I always freaked out about pre-bolusing because I was worried I’d mis-count the carbs if I didn’t see the meal in front of me. I find that a good fix to this is to pre-bolus about 2/3 of the carb amount I expect to eat when I order and then to bump another small bolus when I actually get my food. This has let me smooth out restaurant numbers a lot, not only because my carb counts are more accurate, but because I find that restaurant meals are usually sort of heavy and have plenty of fat, and I find that doing the last 1/3 of my bolus 20-30 minutes later helps deal with the delayed BG rise you sometimes get from that sort of food.
I’ve recently cut down a bit on my carb consumption, but I’m still ‘high’ by most diabetics standards, I think. At my last A1c I was at 5.6…5.9 before that. That was while eating about 250-300g carbs a day.
The keys for me:
Continually ensuring that my I:C ratios were spot on for all times of the day.
Using TAG (total available glucose)…basically not only bolusing for carbs, but also for a smaller percentage of fat and protein.
Using combo boluses.
Making sure I was also getting a lot of fiber (I typically consume 30-50g of fiber a day, recommendation for a woman is only about 25g)
If I ate simple carbs…I spaced them out or ate them in smaller amounts with a majority of my carbs being complex.
