Increased Carbohydrate Sensitivity with Low-Carb Diet

For some background info: I'm a type weird, possibly MODY 3 but possibly really, really atypical T2, on 2.4 mg of Cycloset (Bromocriptine Mesylate, max dose 4.8 mg per day) in the mornings. A1c never above 5.4, normal fastings, but really bad responses to small amounts of carbohydrates at meals (hovering in the low 200's for hours after having one 15g-slice of whole wheat bread). Started off as reactive hypoglycemic, just like my father, and progressed to high BG after taking Januvia. My father has also progressed to high BG, but I'm more careful with carbohydrates so my A1c is lower than his. I'm also extremely sensitive to BG fluctuations, so by the time I get to ~150 I need a nap and anything above 180 generally puts me out of commission for a few hours. The last time I tried a very low-carb diet I wasn't on any meds at all, but I started off on metformin after a 4-month trial of essentially eating nothing.

Partially because of the paper I posted here last week and partially because I've had enough of not being able to do schoolwork when I'm high, I've decided to go back on a very low-carb diet. Though I was restricting carbs before, I gave allowance for things like fruit or sweet potatoes or (small amounts of) brown rice. I was probably eating about 80-100 carbs per day, but that only works sometimes. I've had enough.

The problem is, I remember from the last time I did this that I had increased sensitivity to carbohydrates after I did it for about a month--and the fewer carbs I ate, the lower my tolerance. Ordinarily, even an entire cup of milk will barely budge my blood sugar (especially if it's 2% or whole milk), but I was easily hitting the 160's from small sugar free lattes (and caffeine usually isn't an issue for me, either). It got to the point where I couldn't have one apple or I spiked.

I'm doing a lower-carbohydrate version of what I did the last time, but I do need to be able to eat some carbs (like the ~3/4 cup of milk I have in my two coffees in the morning). Does anyone have any ideas? Has this even happened to anyone else?

Well I sure know what you mean about blood sugars > 150 wiping you out, I too need a nap. I know the insulin users on this site will find this odd but since I try to never go over 140 by the time I get to 150 my body is in very unfamiliar territory and rebels. I work in IT so it is imperative I keep out of the 150+ range, my brain simply shuts down.

For me the source of the carb is just as important as the absolute number of carbs. 15g from broccoli and other veggies is not equivalent to 15g from whole wheat toast. I have been low carbing for 5.5 years and my daily carb count is the same as it was back when I started, I need to keep < 50g, so I don't think my sensitivity has changed.

I arrived at my diet by eating to my meter. I have found I cannot tolerate any grain but there is another group of foods that I just have to watch quantity on, tomatoes and peppers for instance. I eat a small tomato in salad every day but avoid concentrated tomatoes like tomato paste. Since I have been eating one small tomato daily for 5.5 years I don't think my sensitivity has changed.

For me milk is a problem and so I would have trouble with the milk in the coffee. Since I have always drunk my coffee black it hasn't been a problem for me. I use unsweetened almond milk as a milk substitute, perhaps that would work for you.

I don't know if you've ever seen the Low Carb Dietician blog, you might find it interesting reading. She too has an atypical type of diabetes. She has experimented with diet starting out with moderate carb. Over the years she has gradually cut her carbs due to unwanted spikes, and found that < 50g is the best level for her.

I also have a worse time with grains than with non-grain sources. I spike higher and faster from grains than from, say, a sweet potato. Tomatoes and starchy vegetables are also an issue, but less so (except tomato paste--that one's a killer).

Milk is a necessity because I can't stand the "other" milks (except nut milks, because I'm allergic). The truth is, it takes up so many carbs that I'm considering switching to tea in the mornings.

I'll take a look at that blog. Thank you!

What about using half and half in your coffee in the morning? I don't think that has any carbs, or if it does they are minimal. Though I can totally relate to having only one thing that works in coffee - otherwise the "texture" is just wrong! (I can't drink milk due to an allergy so have gone through pretty much *all* the alternatives.) I've largely quit caffeine and find tea much easier to deal with since I can often drink it black or with just a bit of stevia or alternative milk if it's black tea.

I think grains are the primary culprit for a lot of us… I don’t think that it’s the grain itself that’s the problem it’s the journey it goes through before landing on your plate that’s to blame— being ground into a pulp (as almost all grains are in processing) makes them digest far faster than nature ever intended… Go eat a handful of wheat you just pulled out of the ground and I don’t think it’d spike anyone… But grind it down into flour and then bake it into bread or pasta or whatever-- different story

Cream is lower carb than whole milk, could you try a couple of teaspoons of cream in your coffee?

You might give hemp milk a try. I can't handle soy or almond either. My daughter got me some hemp milk and it works great. In fact, It tastes better than anything else I have ever tried, including cow.

It is true that when you follow a low carb diet you become carb intolerant. In fact you are advised to "carb up" for a few days before taking an oral glucose tolerance test.

Not familiar with MODY and how it plays with the whole IC ratio, bolus insulin treatment regimen. Does this type of D work the same as T1 and T2? I.e. you can pretty reliably calculate insulin via an IC, bolus with meals, and have the carbs "covered"...

If so, have you considered talking to your endo about trying a fast-acting insulin and bolusing when you eat?

It's the only way I know of to get those lingering highs down. I'm T2, but I wouldn't give up my Humalog for a wild night with a Victoria's Secret model... it's the ONLY way I can control this disease, feel healthy, and have a life at the same time.

Okay, the jury's out on the Humalog vs. Victoria's Secret model. I gotta be honest :-)

It's a good theory, and it might be a combination of both, but I have just as much of an issue with brown rice as I do with bread and pasta.

I like the half and half/cream idea. It tastes better in milk, anyway! (I love half and half in my coffee, but I never use it because it's so high in fat.) I like the idea of tea just fine but it just doesn't have as much caffeine as coffee does.

Interesting point. Good thing it isn't an issue for me--I had one IGTT and I'll never do it again (and my endo knows what it'll show, anyway).

You should be able to calculate the insulin correctly for MODY the same as for T1 and T2, but the doses are significantly smaller than either. I have brought up the insulin idea and have always had it shot down so fast that I don't know if I'll try again.

I think the idea of insulin makes a lot of sense for me--why am I medicating myself for a whole day when I only eat carbs twice (maybe three times) in a day? And there are times I need more "coverage" than others, like when I eat more or exercise less or am really stressed. It's obvious that orals aren't working well for me, and I'd be thrilled if he recommended insulin. I'm trying invokana now, but if that doesn't work out I think I'll bring up insulin again and try to argue it out with him.

Yeah but the brown rice on your plate has had the “hull” mechanically removed and then been boiled to the verge of disintegration before being served-- making it digest far faster than any human being evolved to be capable of. At least that’s my theory. Go grab a handful of rice out of a rice paddy and eat it raw I don’t think it’d spike your bg levels that way either