I’m a recently diagnosed Type 1. I’ve been following Dr. Bernstein’s low carb guidelines (eating about 36-40 carbs–ok, not quite as strict as Dr. B). Problem is that I’ve lost weight & need to gain weight. How to stay low carb, which has really helped control BG with low doses of insulin (Lantus & Apidra), & gain some needed pounds?
Grateful for advice!
I lost about 30 pounds when I started the low carb diet which I actually think was to do with the added insulin I had been producing in response to my high BG before diagnosis. I was thin to start with and now weigh 115 pounds (I’m 5’7"). I worried about it for a while but after about 3 months I stabilized and am now resigned to staying this weight. It was a good excuse to buy some new clothes 
If you continue to lose weight after you get your BG down and get used to the diet you could try upping your calories by eating more fat, which is fine to do on the low carb diet. I eat a lot of nuts, cheese and dairy such as whole milk yogurt and cream. I do also eat more fruit than Bernstein recommends, especially berries, and probably eat 20-25g per meal, but since it is all from fruits and veggies I find that my BG stays normal and my last A1C was 5.3. I use 4 U levemir and 2-4 U Novolog if I am having more than 12g carbs in a meal.
Thanks, Libby. My doctor, though supportive of the low carb approach, is urging me to gain weight… I’m short (5’2") & small boned. I weigh about 96 lbs, the thinnest I’ve ever been. Honestly, I’m afraid to get on the scale in case I’ve lost more weight! Glad to know it levels off.
I’ve been staying low on carbs, but my BG soars at night. Just took a reading & it’s 118 (135 using a different meter). I haven’t eaten a thing since dinner 4.5 hours ago. After dinner reading was a lovely 84. I’m wondering if I’m eating too much protein, it’s usually around 30 grams (5 ounces) & I may also need to up my Lantus. If I take more Apidra, I get too low.
I agree with Libby…nuts and cheese…peanutbutter is high in fat but low in carbs but you also need to see how your insulin reacts. I find my insulin peaks faster than the foods high in fat so you may need to delay your bolus; you will just have to see what works for you. I often add cheese to everything and I have a minor peanutbutter addiction LOL…I lay off of it when I want to drop a few pounds…
I love peanut butter, too! I could eat an entire jar. Think delaying my bolus until after I eat, may be the trick–thanks! How long after? I’ve never done that before & am new to this.
Sorry if this is a stupid question… Know that protein raises BG, but more slowly than carbs. Does fat also raise BG? Asking because my dinner was high in fat with cheese & cream & wondering why my BG went up so high so long after eating. Thanks.
Gerri,
Typically protien has a minimal effect on BG but the fat slows the conversion process of carbs to glucose therefore your insulin may peak at 2 1/2 - 3 hours and the fat may cause the carbs to peak at 3-4 hours so your insulin is finished working before the carbs have turned to glucose…I find I have good results if I take my injection when I finish eating a high fat meal ~ some people will also take half the dose of insulin with the meal (or right before) and the other half in about an hour. I always seem to go high if I take my insulin (Humalog) at the recommended 10 min prior to a meal if it contains quite a bit of fat. I personally try not to delay more than 20-30 minutes…
It takes a while to get your BG numbers where you want them and there will probably be many adjustments to your insulin/carb ratio…just try to log everything…at least for the first few weeks… you’ll see patterns in the foods you eat. I know this may sound boring, but I also found it helpful to eat the same foods at the same time for a few days… think of it as introducing new foods to a baby…so you see how your BG responds. It’s no guarantee though; I have done this with some foods and go high one day and hypo the next. (sigh) It’s a learning process so at this point try not to strive for perfection, just decent control…
Great advice–really appreciate it! Based on some things I’ve read, I’ve started taking a reading 1 hour after eating instead of the usual two. So, after a low-carb dinner (12 grams), the reading after 1 hour was 58! I take Apidra about 15-20 minutes before meals. I usually only need 1 unit with lunch & dinner & 2 units with breakfast because I have dawn phenonmenon regularly. 2.5 hours after dinner it was 84. Now, it’s still hovering around 120 after eating dinner at 7:30. Is this odd?
Do you also take a long acting (basal) insulin? I think I would be more concerned about the 58 than the 120. Typically, your food starts to digest at about 20 min…insulin starts to work in about 30 min so it sounds like the hypo of 58 happened because your insulin started to work first…then the carbs kicked in. I don’t think the 120 is odd if you didn’t eat anything again after dinner. If you can, try eating the same thing tomorrow but take your insulin 10 min before or even with your meal and see what happens when you test at the same intervals.
I usually go by my premeal readings…for instance if I’m 85-95 before breakfast, I expect (or hope) my pre- lunch will be between 80-110.
Have you seen an endo or &/or a certified diabetes educator? If not, please do; they will help you understand your carbs & insulin. I am no expert so personally I believe the strict low carb is best suited for type 2’s …and if you want to gain weight you should increase your carb intake. I find (for me) 30-45 grams per meal and 15-20 for snacks works well. Most T1’s seem to be under weight at diagnosis and you can always cut back on carbs later.
Just know we are all different…what works for me or even Dr. Bernstein may not work for you. There is another book called “Using Insulin” by John Walsh that you may find helpful. It can also be found on the Diabetes Mall website HERE.(for some reason this link isn’t working for me right now but hopefully it will for you)
You’re doing great! Just keep reading and learning…
Thanks again for the encouragement & advice! Yep, I take Lantus as basal (usually 4 units), but think I may need to up the dosage. I cut back because it was giving me evening hypo.
I’ve been to one endo & didn’t like him at all. Have an appt to see another. Am taking a course with diabetic educators (I’m assuming they’re certified) given through my local hospital. I’ve been to two sessions & it’s been pretty useless. It’s l geared toward Type 2s & I’m the only Type 1 in the class.
My internist has been great & more informative than the endo, but of course he’s no diabetic specialist.
When I did eat 30-40 carbs per meal (I went haywire with the 45-60 ADA diet given to me), I felt terrible. Soon as I started cutting down on the carbs, I felt much better.
Will get that book–thanks!
Please keep us posted on your progress…and get with a good endo~ could be you need to take your lantus at bedtime. If you adjust the lantus I would only do so by 1 unit (up or down)every other day.
BTW, welcome to the community/family. I’m glad you were able to find TuDiabetes so soon after you were diagnosed.
Take Care!
Will do on all counts. Took the Lantus this morning & will try at night tomorrow, or will split the dose between morning & evening–guess that can be done as long as it’s around 12 hours apart or so, right?
Feel very fortunate to have found TuDiabetes. Knowledgeable & kind people willing to share sure helps!
Thank you.
Gerri, Here’s another thought. I take 4 or 5 Units basal and find that if I do a very low carb meal- say a salad with an apple - about 15g carbs, I don’t need any fast acting insulin. Bernstein is mistaken about regular folks never going above 100, but the ADA are wrong that it’s ever OK to be up at 180. There is a really interesting website that shows that normal people go up briefly to about 120 after eating (130 after breakfast) and in fact spend 3 1/2 hours a day between 100-120, about an hour between 120 and 140, ten minutes above 140 and only one minute over 160. Since I read this research I am less restrictive than Bernstein in what I eat and in my numbers. I aim for under 120 at an hour but if it’s a little higher I don’t worry. I try to be back under 100 at two hours which is very close to normal BG numbers.
The reserach also shows that risk of complications and death go up after 140 so I think 118 after a high fat meal is just fine. In fact, this happened to me yesterday. I had tempura and was up at 120 for about 3 hours instead of back down to 100 after two.
Here’s a link to the website: http://www.diabetes-symposium.org/index.php?menu=view&chart=22&…
Dr. B said in one of his teleconferences to up the fat to gain, but given that I was able to maintain a weight loss for a long time eating a lot of fat and a Bernstein type diet and that I can usually gain weight without trying on a non-low carb diet, I am not sure that really would work.
You might cautiously raise your carbs and Apidra. Apidra is, in my experience, so fast that you can get very good blood sugars while using it to cover a bit more carb than what Bernstein believes to be possible.He only uses humalog and R and they are much slower than Apidra.
I am NOT trying to gain weight, but after maintaining within 2 lbs for 4 years I packed on ten pounds last December after starting Lantus and getting such good control that I was able to eat a lot more carbs and hit all my blood sugar targets. The blood sugar stayed pretty but not the waistine!
Unfortunately, if you put on weight by using more insulin you are likely to get the classic apple shape weight gain around the tummy. So I’m not sure how advisable it is.
It is possible that if you just keep watching your blood sugar and eating excess calories from fat your body may get back to its set point weight. Most of us do.
Jenny, glad you wrote because I wanted to thank you for your wonderful site! I’ve been reading & researching, sifting through a lot of conflicting info trying to find the information that felt “right.” Your site lit the lightbulb I’ve been searching for. I’m grateful for what I’ve learned from you & it’s given me the focus & direction to see how much more I need to learn. Intellligent, straight forward, well researched, well written–thank you for everyone you’ve helped through your site & book.
Though it’s slower acting, what’s your opinion of R insulin? Seems that insulin in a natural state would be better. My mother’s hypothyroid (jury is still out on the condition of my thyroid since it’s borderline low) & she’s had far better results using Armour thyroid than the synthesized forms.
Thanks, Libby. Seeing those numbers makes me feel better & encouraged. I also take 4-5 units of Lantus. Some days I’ve not had to take any fast acting Apidra for lunch or dinner with no problem, but I always need to take before breakfast. The last two weeks I’ve had to take fast acting before every meal, though keeping the carbs consistently low. As soon as my bg goes up, my head starts pounding.
Gerri,
I’m glad that you are feeling better. I saw from your profile that you were only diagnosed at the end of May and that you had a really high A1C. The changes you are making are amazing and will make you so much healthier. I am amazed and impressed that you figured everything out so quickly. It took me several months before I realized what was happening. I was testing at two hours and eating the recommended 250g carbs a day and didn’t know that my BG was swinging wildly. I just knew I felt terrible so I started testing earlier. I gradually dropped all the foods that made my BG go high and now feel better than I have in years. It’s really not hard for me to eat this way because I am full of energy. And the weight did stabilize- I’m just a size 8 instead of a 12
Don’t feel like I’ve figured anything out at all:)
I was near comatose when my husband took me to the ER. I just thought I was sick with the flu. My bg was 809! I was in intensive care for two days on IV’s & a heart monitor & then two more days on a regular ward. My bg was checked every 30 minutes, around the clock for two days. No exaggeration, I was beginning to hallucinate from sleep deprivation.
I feel like such an idiot that I was dying from thirst, vomiting & urinating constantly & had no clue I was diabetic. Duh–could it have been clearer? I was drinking fruit juice & eating watermelon for two days prior to going to the ER. Amazing I didn’t die.
Every meal they gave me in the hospital made me feel sicker. Breakfast was a huge piece of French toast, cereal, milk… Lunch was grilled cheese on white bread, fruit cocktail & soup. Dinner was meat, potatoes (or another starchy veg) or pasta with meat sauce, salad & a roll. I was shot up with huge doses of insulin, but I kept soaring. No surprise, huh, given what they gave me to eat. I kept asking “this is a diabetic meal?” & was assured it was within 60 carb ADA recommendations. Told my husband if he didn’t get me out of there pronto I was going to die from the food. I begged him to bring me food I could handle. The nurses had to be convinced that it was ok for me to eat something other than was prescribed. Yeah, better for me to eat their mashed potatoes & white bread. I love sushi & my sweet husband got me some. As soon as I ate it, I felt better & I had a much better bg reading. Of course, anything tastes better than hospital food:)
Like everyone else, I was given the usual ADA diet plan to follow & my bg swings were huge. I felt cranky & out of it. I called my doctor every day & almost every day he changed my dosages. It scared me taking such high doses.
Prior to being diagnosed, I ate huge amounts of carbs–big bowls of pasta, Indian food, any Asian food with lots of rice. I could eat a whole loaf of bread at once & did. Can’t even imagine what my bg was eating like this.
Hi. I am very new to this. My boyfriend has just recently been diagnosed with Type 1 after losing 15 lbs in 3 weeks. He is 5’8" and dropped to 118 lbs. Now after 4 weeks he has only gained 2 lbs back and can’t seem to get enough to eat. He has also had very high cholesterol, so we have to watch out for that. Loves peanut butter, mixed nuts, veggies, oatmeal and has switched from eggs to egg substitute. He is on Lantus- 10mg- and takes it at nite. His BG is normally doing ok, but occasionally hits 71 when he needs to eat or 326 when it wasn’t the right food he just ate. Help!
Hi Kathy,
Your boyfriend is very fortunate to have you.
Eating protein is the best way to gain weight for Type 1s. If he’s staying away from saturated fats because of his cholesterol (though there’s lots of new info that strongly suggests that this isn’t the cause of it), then have him check out protein shakes, in addition to eating lean protein. Whey isolate powder is high in protein & low in fat. If he avoids the flavored ones, whey protein isolate has only 1-2 grams of carbs per serving. You have to check the labels. He can mix this in a blender with unsweetened almond milk (also low carb, low fat). It’s filling. I add cold decaf coffee, stevia (a natural sugar substitute) & sometimes peanut butter. I love peanut butter, too!
Have his doctors started him on counting carbs & are they beginning to figure out what his carb/insulin ratio is? Know you said recently diagnosd, but how recent? In case he doesn’t know this, eating low carb is the best way to control those numbers.
One thing to take into consideration when adding more protein, is that it takes longer to digest (except for protein shakes) than carbs & 50% of the protein turns to glucose.
Most people take two doses of Lantus–morning & night.