How do you eat to maintain your best control?


#1

As a Type 1, I’ve had I’d say decent control since being diagnosed. However, I’ve been really struggling lately.

I’ve tried eating low carb high fat, high carb low fat, vegetarian, pescetarian, vegan; I’ve tried it all. Right now I’d say I’m balancing it all, and that’s because I just can’t figure out what works best to control my blood sugar.

So I’ve come to ask, what way of eating works the best for you in gaining good control?

There are so many things that work for different people, and I’m open to everything. I definitely have done my research on what’s “best” or “healthiest” but I honestly think everyone has to do what works best for them.

My main goal is to have more steady control, and better numbers. I’m tired of spiking to 250-300 on daily basis. Some has to do with switching basal insulin and still adjusting, but eating has a lot to do with it too.

So I’m just curious how you eat, if it’s special, if you just eat what you want and bolus for it; let’s just talk! :slight_smile:


#2

I mostly eat what I want. I tend to eat lower carb things while I’m at work because I can maintain tighter control. I would still be willing to eat 30-40 carbs for lunch though.

I’ve found that the diet matters less than the way you dose for the food you eat. When eating high glycemic index foods, prebolus by 30 minutes or so. When eating low glycemic index foods, dose when you start to eat them. When eating foods with lots of protein/fat, you may want to dose again 2 hours later. The timing varies quite a bit from person to person, but I’d say that the timing and the amount of insulin is the most critical.

Also, Sometimes I might find myself wanting to eat a high glycemic index food and I don’t have the time to prebolus. In these cases, I might dose extra to limit the spike, and then have some sugar nearby for 2-3 hours later when I’d drop low. I think this is a little easier to track with a cgm. Do you use a cgm?


#3

I can’t just “eat what I want” and maintain my preferred weight, and avoid highs and lows. So now I low carb. Luckily for me, my wife is an excellent cook and makes tasty meals that aren’t high in carbs. I eat meat, fish, chicken, veggies, fruits mostly. She makes a killer minestrone which is often my lunch. I avoid the white foods now.


#4

I also eat what I want and also agree it’s all about the dosing. How long is the pre bolus? How many carbs and what kinds? And I agree a CGM can help tremendously with this post meal spike issues. There are many here who do the low carb and have great success with it. And yes the reality here is the less carbs the better the blood sugar. But I like my carbs and have learned pre bolus is my friend. And have also learned those high protein, no carb meals also need insulin. I have learned that the hard way, love a big juicy steak, but blood sugars 6 hours later don’t!


#5

I use a low-carb, high-fat way of eating. I’ve been at it for six years now. Prior to that I bought into the idea to eat what I want and just dose for it. I really liked this idea! I tried for years, decades really, to make that work.

Since managing using a carb limited diet for the last six years, I’ve discovered that insulin doses, food, and my BGs behaved in relatively predictable ways if I consumed under 75 or 100 grams of carbs per day. Once I exceeded that level, all my diabetes formulas just stopped working. It was like pushing rope; it just couldn’t get the job done in any predictable way. Your diabetes may vary, of course.

I eat two main meals per day, a late breakfast and an early dinner. This incorporates up to a 16-hours per day fast. I think this eating style and rhythm helps keep my insulin sensitivity in place. I eat eggs, cheese, nuts, low carb veggies, berries, heavy cream, beef, pork, lamb, and fish. I limit bread, potatoes, noodles, and rice.

I often spend greater than 90% of my time-in-range 65-140 mg/dL (3.6-7.8 mmol/L) with low BG variability. Here’s a 24-hour trace of a good day, not typical, but not too far off.

While I need to note that I use an automated insulin dosing system, I give my way of eating at least 80% of the credit for the control I enjoy. I’m not a Bernstein style low-carber as I eat about 50-75 grams of carbs per day. I have good control, take less insulin, and feel more energy every day.

I considered going low-carb for about two years before I found sufficient persistence to make it stick. I’ve never looked back. It was one of the best things I’ve done for my diabetes in 34 years. YDMV!


#6

I agree with and do much the same as previous posts. Having CGMS was eye-opening for me to really help me make changes to my food choices, insulin dosing and timing.

Generally I do lower carb, and when I find my BGs are trending higher, that’s the first thing I cut back on.

I also started metformin last year, and found it helped keep the spikes not so spikey (lower, slower peaks after meals). I have been T1 for 50+ years, but metformin is now being used more often for T1s.


#7

@Terry4, question, is there a correlation between spiking and A1C. I’m talking spiking to say 200-250 but not for a long period, say back to safe zone after 2-3 hours? Hence, despite the high spikes, the daily BG average still remain in the safe zone 80-120? My concern is, during the high spikes, will there be complication damage?


#8

For me, low carb is the best way to maintain the tight control. There is just too much variability eating a high carb load. I’d give myself a 1 in 10 chance of nailing the timing and amount of bolus with a high carb meal.

I’ve been on a very low carb stretch the last 11 days and my highest reading was 170, and that was because my pump malfunctioned. I keep an Excel log each day from my Dexcom of running 7 day averages and by giving myself a regular metric to watch it helps a lot with motivation. I have crude formula in there as well so I can see ballpark a1c, which helps me to see as it drops.


Insulin effectiveness
#9

The A1c number can mislead with regard to high and low excursions. People with the exact same A1c can live through a much different glucose experience. Check out this graphic from diaTribe:

I’ve read studies that suggest that BG variability can cause health damage. Anecdotally, I know I feel better when my blood glucose doesn’t jump around as much. I feel more rested when I sleep with steady blood sugar, even if it’s slightly elevated.

You can’t draw any firm conclusions about blood glucose and complications except to say that better glucose control reduces the risk of complications. There are no absolute guarantees. But when you think about it, gluco-normals don’t have health guarantees, either!

I place more value in the time-in-range number than I do in the A1c number.


#10

My ideal food for stable BSLs is unfortunately (or maybe fortunately?) chocolate. Clearly less than ideal compared to eggs, vegetables, meat and cheese (which rarely cause me any BSL blip at all). But for carbs, chocolate is my preferred source. I can simply bolus when I eat, no preplanning, and maintain a stable, useful level. I use Libre rather than CGMS, but the patterns are still there.
I don’t eat high carb anyway, as I’m quite a small individual with a smallish appetite. I eat the insides of hamburger/chicken burgers, avoid the bread, and don’t eat chips.
I do love pasta though, and that is still a struggle to manage correctly, after 40 years of D. Prebolusing helps, but I almost always underestimate the carbs in it.


#11

I gotta admit that there isn’t one thing that works consistently well all the time. I mix it up. The same food might be fine one year, then its no good the following year. Three months ago, I could eat breakfast and not take any insulin at all. Now, I don’t eat breakfast because it sends me high (but, I’m not hungry then these days). I think my body is putting out a lot on energy, on its own, in the AM, because I might not eat until 3pm. That wasn’t true some months ago when I was quite hungry in the AM.

Consistent postprandial spikes like that would lead me to believe this is a basal issue…at least that we would hope that altering the basal might allow you to eat at some point during the day, without bad results. Have you eaten anything lately that didn’t cause a goofy spike? That might give us some clues on what to recommend. You could also post some record of your numbers and let us all fight it out over whats going on. We never agree, but it might help to bounce some ideas around.


#12

I find low-carb eating to be essential to my BG control. I simply can’t eat high-carb foods and expect to stay in range, inevitably I end up on a rollercoaster of highs and lows. I typically eat under 50 grams a day and often it’s around the 20-30 grams mark.

While eating low-carb helps, I also manage my BG throughout the day and night. There are many, many factors besides food that affect BG levels (exercise, stress, medication, illness, hormones, weather…). Low-carb alone is not enough to keep my BG stable without me actively managing it, but it does make the highs and lows much less severe. I’d say I check my CGM at least every 30-60 minutes, and often more than that. If I go several hours without checking it, I’m prone to drifting out of range.


#13

I try to have the same or very similar breakfast (high protein) and lunch (more carby) every day, helps me keep things reasonably predictable for the morning and afternoon. Dinners vary a lot but I generally weight it towards high protein. I love to barbecue and would have a 14 oz. steak and salad for dinner every night if I could afford it and if the weather would cooperate. On nights when I play hockey in the evening, I have 2.75 oz. (dry) of spaghetti with meat sauce about 3-4 hours before games, followed by an after dinner bolus and an apple about 1+ hour before the game.

My total daily carbs is in the 175-200 grams range. This might seem high to some, but it seems to work for me. I’m satisfied that my diet keeps me at my ideal weight. I keep my BG in range by using a food scale for portion control, diligently carb counting (or in a pinch, carb guessing), pre-bolussing (usually 30 minutes for me) and being pretty aggressive with correction bolusses when needed after meals.


#14

No I don’t use a cgm, I can’t afford one although I’d like one! I’ve tried pre-bolusing and still haven’t figured out a way to make it work for me. I either end up dropping too low while I’m still eating, or it doesn’t work and I still spike. I’ve tried with different foods too with no luck. :confused:


#15

It’s really hard for me to tell honestly! I have posted previously about just starting Tresiba, but having a hard time finding the right dose because I keep fighting off small colds and what not. I just increased it another unit tonight because my evening numbers from dinner on are running 200’s even with corrections it seems. My morning numbers are running anywhere between 80-115, daytime 100-160 ish, but evenings and night until I’d say midnight or so (I take Tresiba at 11pm) are just horrid!


#16

Could you take 10 blood sugars a day? Or, as close to hourly, as possible, and post? Its a pain, but someone might be able to help fix this.


#17

Do you know how many calories you are eating in a day? I eat low carb but if I go above about 1500 calories I start getting high BGs like right now my BG is in the 200’s because I ate 1800+ calories today and my corrections are having a hard time knocking that much food back down.
There are several free Apps out there that will help you track your food, meds and BG’s so you could start seeing some patterns. For me eating whatever I want whenever I want just doesn’t work. Eating after 8 or so in the evening sets me up for high BG’s at night and I can eat all day but if I go over that 1500 calorie limit I pay for it. In addition, it’s not like I need the extra food I’m usually just snacking for no reason. You could try eating the same amount of calories every day for a week give or take and see if that provides some answers.


#18

I try to eat low carb/high fat more time than not, and especially in the morning, which is so helpful. My rule re: higher carb foods is that I can have them if a.) I REALLY want them, or b.) it would be super inconvenient or rude not to eat them. This tends to particularly include travel/vacations, when I usually say screw it and manage as well as I can (which often is somewhat canceled out by increased low intensity activity all day). Also, in terms of determining if a food qualifies for really wanting it, I try to do a one bite test when I can, especially if I’m at a party or event with trays of tempting sweets or such—take one bite of the carb-y thing and then pause and really think about if I want more, and give myself permission to throw out the rest of the cookie or whatever if it’s not in fact as awesome as it looked (which ends up being a lot of the time).

Also, if my diabetes control has gotten out of whack, I will sometimes do a reset by eating stricter LCHF/keto for a little bit to just remove the carb variance entirely—it’s not a diet I find sustainable longterm for myself, but it can be helpful as a calibration of sorts.


#19

I was lucky in the same way, Dave. When I went super low carb, my husband had just retired and discovered that he loved puttering about the kitchen—voila—lots of creative low carb food appeared!

I follow Bernstein with my own variations—20-35 carbs/day has worked great for me for over a decade. And I never feel deprived, having figured out low carb versions of old family faves!


#20

We even eat home-made delicious pizza. A pizza will give us about 3 meals, as now that we are watching my diet carefully, I only eat 2 or 2.5 pieces at a meal. My bg doesn’t go up much and I don’t have to bolus much, as I’m not eating lots of food each day. It’s kinda cool to eat pizza and not gain weight or have to take a ton of insulin to cover it.

In months past, I’d eat about 1/2 of the pizza in one sitting. LOL! (I shouldn’t laugh, as it made for a roller coaster out of my bg’s and packed on lbs)