For the past 7+ years since my diagnosis, I’ve been trying to get my carb counting and insulin/carb ratios down so that I can control my BG. My diet is lower in carbs than it used to be, but I’m not trying to follow a low-carb diet. (As a vegetarian, low carb can be a challenge.)
Now it occurs to me that perhaps there is no way to “get it right” if I’m not following a low-carb diet. Many of you have much better A1cs than mine (7.4) so I’m wondering if you have to follow a low-carb diet to get there.
Is a low-carb diet required to achieve great A1cs?
I am an average of 190 grams of carbs daily …considered NOT low ; am a pumper and my last A1C was 6.9 ( at age 68 plus ) ; am slim and excercise as in 1/2 marathon training at the present …I consider myself LUCKY, HAPPY and healthy
My niece has had A1cs in the low sixes, a few mid sixes, very rarely high sixes since diagnosis four years ago. However, we cannot control high blood sugars after eating so she is still out of range a good portion of the day. Will go to the low to mid 200s after each meal and drop into range by hour four, or we can give her more insulin, she drops to the 160s or lower, then we feed the insulin. Still out of range after eating regardless. Her A1cs are still fairly good. We do everything most parents or caretakers do and some have higher A1cs so, yes, a lot of hard work, but I think a lot of it is luck. Up until recently, she would have three meals a day weekends and three meals plus afternoon snack when in school. She is now snacking a bit more. Curious to see how this effects A1c. Would not go low carb for a child, but I think adults could get better control if you had a low carb meal for one meal a day, i.e., breakfast or lunch. I personally would not go low carb all the time because it is just too restrictive. By low carbing one meal, you can stretch out the time you are in range. P.S. Niece eats anywhere from 160 to 225 grams a day, definitely not low carb, but she doesn’t overeat either.
Personally my A1C was 5.2 just last week!!! While I am only 22 and I am very active, I can eat anything that my non-D friends would eat. It is all about knowing portion sizes and not overdoing… Basically I think about what foods I am eating for a healthy lifestyle and do not owrry too much about how many carbs… Look at it this way… Should anyone have a blizzard everynight for dessert? No! So one here and there, when you feel like it won’t hurt you!
These discussions seem to be loaded, but here goes anyway.
I couldn’t control my BG being a vegetarian. Gave it my best shot after decades of eating no animal protein, but it didn’t work for me after diagnosis. Others appear to pull this off, but I was all over the place.
I eat low carb, 30-40 per day, & my A1c greatly improved. My last was 5.2 on MDIs, no CGMS. Not preaching, but my goal is to take as little insulin as needed in order to limit the high/low swings. Still have lows when I’m more active, but it’s far less frequent & my previous highs are very infrequent. I haven’t had a problem eating low carb, am never hungry & cravings for the things I used to eat went away. I still eat lots of veggies, just low carb ones.
You could try low carb & see if it helps you. Would be the only way to know.
You can actually achieve a great A1c even if you have massive blood sugar swings (a lot of highs and a lot of lows). Think about it…if half the time you’re 250 and the other half you’re 50 then you’ll have an average blood sugar of 150 and an A1c of around 6.5 right?
Great A1c?..yes. Terrible control?..absolutely. It’s funny how we tend to congratulate people on great A1c’s without considering that it is often achieved with constant sugar swings. Believe me, I know because this was me for many years.
So the key is to get the good A1c without swinging constantly, and IMHO, this is much easier when restricting carbs. Also, another bonus of lowering carbs is taking less insulin…which usually means fat loss and less insulin resistance.
BTW- I’m not trying to preach here. I’ve also got a long way to go before I can say I’ve “got it right.” You can do it Janet!
An A1c of 7.4 is not very good. You can compare the post by Gerri and Nel Peach and you have your answer. How can someone with it a peanut allergy get it right by eating peanuts. We have a carb allergy. With that said if I eat much less than 100 grams a day I go carb crazy. Have never been able to suppress that, I know they are bad. Again does depend which ones.
Thanks for all of the answers. I sure learn a lot here – and can see that as always there are different answers for each of us.
I guess it comes down to a couple of issues. First, eating fewer carbs seems to result in fewer BGs extremes. What I don’t understand is why that’s the case if I’m counting carbs correctly and bolusing right. While I can see that fewer carbs = a reduced chance of going high, why isn’t it possible to bolus to cover any number of carbs? Why can’t I have a Blizzard every day if I use the right amount of insulin to cover the carbs? Other than the fact that I’ll get fat, I mean.
Second, why are BG swings “bad” if my A1c is 6 or below? I don’t like the feeling of going high/low but what is the downside from a health standpoint?
Originally I became a vegetarian because I felt so much better physically. After 15 years, animal protein doesn’t appeal to me any more – but that wouldn’t stop me from adding it back in so I can feel better physically and be healthier.
I’ve added fish to my diet from time to time since becoming diabetic to see how it affected my BG and it does help curb highs.
I appreciate you sharing your experience, Gerri. I wasn’t expecting an answer from a former vegetarian and your story gives me good food for thought, so to speak.
I have found the debate about low carb dieting very interesting, mainly because it’s something that I have never heard of in my diabetic clinic yet the internet is a mine of information about it. I was only introduced to carb counting when I got my pump a few months ago, and at that stage I was told that with carb counting, I could eat whatever I want. I didn’t buy that for a second and don’t follow this, but at the same time I am far from being on a low carb diet although it is something I would consider trying.
I am working as a research assistant for the summer, and spoke to a woman carrying out research on women with T1 diabetes. She said that she had a group following a low carb diet, and group following low fat. After a number of months, they were tested and it was found that while all of them had decreased insulin resistance and improved their A1c, there was no significant difference between the group following a low carb diet and the group following low fat, except that there was a small increase in weight gain in the low carb diet. That has made me wonder if maybe the type of diet depends more on the individual than being universal? Of course, this is just one study of thousands that are probably being carried out, but I thought it was pretty interesting…
Dino’s post is the most important one here. Good A1C caused by massive BG swings is far worse that a slightly bad A1C with a constant high.
I don’t really follow or care about the low carb debate so I I’m not going to preach for either side. Having said that, we are not allergic to carbs. I have a cousin who has been involved in at least 15 motorcycle accidents (that I can count or remember) but that doesn’t mean he’s allergic to motorcycles.
Low carb, high carb, “normal” carb, it all makes no difference (if we are talking purely about BG control). As long as you know how to correct for the carbs you eat you will be fine.
The reason why you can’t have a Blizzard everyday and have good BG control is because you lack the same perfection of the human body we all do. You can bolus what you think is the correct amount for the Blizzard, but there are so many variables involved that chances are you will get it wrong. The non-diabetic body can auto-adjust for all of these instantly. We can’t. I guess the easy way to deal with this would be to avoid carbs, but IMO that’s going against nature and that’s always a bad idea.
So why does it matter whether I’m on a high carb, daily Blizzard diet or a low carb diet since there are so many variables? Is it because the chances of a big effect on BG for getting it “wrong” with high carb foods are greater? That making a “mistake” on a 70 carb bolus has more consequences than making one on a 20 carb bolus?
Also, why is it that a good A1c caused by massive BG swings is worse than a slightly higher A1c caused by constant highs?
I’m full of “whys” today and hope that I’m not coming across as argumentative. I’m genuinely interested in your response.
You’ve nailed it exactly right! Higher carb requires higher insulin doses & the chances of getting the ratio correct are less. The larger the dose, the greater chance for miscalculation. As we all experience, it’s far from an exact science. Smaller numbers, smaller mistakes, which are easier to correct with less harm to our bodies. On low carb, my numbers are more level. My highs aren’t as high & the lows aren’t as low. In addition to BG over 140 causes damage, it’s also the huge swings from high to low, low to high which are damaging, Also, they make you feel terrible.
Good A1cs can be had with huge swings & that’s not the goal. Standard deviation is more important. Keeping BG as level as possible, as close to normal as possible.
Insulin in high doses behaves more unpredictably, perhaps due to problems being absorbed.
Low carb lessens the variables & improves the odds.
Like Gerri said you got it exactly right. By the way, “whys” are the driving force of civilization. Without “why” we (diabetics) would still be stuck in some primitive thinking about our condition and we wouldn’t have all the life saving technology we use on a daily basis. If there is one type of question I will never refuse to answer (as long as I can) it’s the one that includes “why.”
As for your question about massive swings: There was a discussion here earlier (a few weeks ago) about low BGs being life threatening or not. I did a quick search to answer the question and found that studies have shown that the constant fluctuation of BG causes more damage to your body than a constant high. I don’t remember the technical aspect of the whole thing, but you can google it if you want. You can also find the info in that book everybody here is calling the “diabetic bible” (I can’t remember the name of it now for some reason but it’s by Walsh).
Also, two days ago I had my last A1C and my doc was telling me the same thing. I still need to drop it, but he warned me not to do it too fast because there is a strong correlation between big drops (and raises) in A1Cs and death.
I love to use examples when explaining myself so here goes my example with regards to your question/observation (the one Gerri and I agree you got exactly right).
Imagine you are on a motorcycle. Driving at 20 mph you still have to think about all the variables on the road (traffic, animals, laws, road signs, bad drivers, weather, your abilities, the bikes capabilities, road conditions etc). Should something go wrong while you are riding at 20 mph you have a greater chance of avoiding it or even surviving it. You don’t have to be as alert when driving slow because your natural reactions are adequate. Increase your speed to 120 mph and it’s a different story. Suddenly that car that pulls out in front of you without looking is life threatening. At high speeds you don’t see him fast enough, you can’t react fast enough, and the consequences are more severe.
I think that example kind of went down hill, but I hope you get what I’m saying.
I eat mostly fish, eggs, cheese & some poultry. I still can’t eat much red meat. I think after so many years of not eating animal protein, red meat throws my system for a loop. Maybe it’s because of the higher fat content. I basically eat protein & vegetables. I’m a small person, so I don’t need a lot of protein to feel full. The lower carb veggies are the ones I like the best, thankfully. Some people feel deprived eating low carb, but I don’t. For baking, I use almond flour, golden flaxseed meal & coconut flour for pancakes, muffins, etc. I don’t like cow’s milk & the lactose sends me soaring, so I use unsweetened almond milk. It’s a great low carb substitute.
Thanks for the suggestions. I’ve been considering going low-carb for a while now to get my BG in controll for once. My mind changes a lot about low carb, though- But your suggestions for cooking substitutes have helped to open my eyes.
I love veggies anyway - and usually eat a small portion of meat for dinner, not much else. We’ll see what happens. I’ve been slowly substituting wheat bread instead of white- carrots instead of starchy corn, etc. Small things like that. No ice cream for the past few months. Which sucks in the hot summertime! But, no cravings for it anymore.
I wish someone could explain this to the entire WORLD. The other day I got yelled at by someone because I ate a piece of fried dough. Now, I’m not saying a huge piece- more like just ONE BITE of it… then I got a lecture about how high in carbs it is and how dangerous it is for diabetics to eat foods like that. It didn’t even have any sugar on it! And my BG was still 126 afterwards!
(sigh) It’s so aggravating when people think they know everything just because of ONE story they’ve read and/or ONE diabetic they knew.
Great questions, Janet! I think everyone covered the idea of why swings are bad, as well as the “principals of small numbers”. (loved your motorcycle analogy, Pavlos). In addition, the “eating Blizzard’s daily” idea and then bolusing for it not only would lead to weight gain and “feeding the insulin” (having to do more insulin to cover the large number of carbs) but to insulin resistance down the road and then your diabetes management gets a lot more complex.
I’m also a vegetarian. I was pretty much in denial for the first year of my diagnosis (I was mis-diagnosed as Type II which doesn’t help). I thought “I eat healthy, I like how I eat, I don’t need to change much”. But I was eating very high carb (lots of pasta and rice). It’s taken a bit of scrambling to come up with a diet I like that is more diabetes friendly but also makes me happy. I love food and cooking and interesting restaurants, and I like a lot of variety. With a bit more work I have managed to continue eating vegetarian. I’m partly retired so I have the extra time to put in on shopping and cooking that it retires. Also I recently moved back to the San Francisco Bay Area (from Guatemala) so I have excellent access to varied ingredients. I eat moderate carb, usually around 100. I probably couldn’t take it much lower and stay vegetarian. I think all these things are about choices we make that balance out our blood sugar results and our quality of life.
