Is a low-carb diet a must?


#41

#42

I’m not sure what I said that you thought was rude, Robyn, but if I said something to offend you, I do apologize. We all have opinions about how to eat, treat lows, etc. If I come on strongly about what I believe that isn’t meant at all to imply that anyone who believes something else is wrong or to put their views down.


#43

Hi Zoe: I personally really limit my refined sugar intake, I really was just giving an example of a reply that does tend to stop people who should mind their own business. Life is stressful enough without the diabetes police.


#44

Kelly, I can say with great certainty that 7.4 is good for me so far. Since I started on the OmniPod about 1.5 years ago, my A1c has come down a lot. I was at 9.3 right before I started. I did go up during the first quarter of this year but it was easy to see why. I wasn’t testing very often and there was a lot of stress in my life.

The lowest I’ve ever been is 7.2, which toward the end of last year.

Your comments are right on the mark for me.


#45

When I was first diagnosed, I worked with a great nutritionist who happened to be vegetarian herself. She helped me see that after a lifetime of counting fat grams and avoiding fat, adding fat back into my diet would help me from a diabetes standpoint.

Now I eat more foods like peanut butter, avocados, and almonds and feel more satisfied with fewer carbs.


#46

No…that was a really good analogy! I’m gonna use that when trying to explain this to the my family and friends. Thanks Pavlos!


#47

Got it, Melitta! My diabetic police tend to say it all in looks (which makes it harder to counter with snappy comebacks…lol)


#48

“Is a low-carb diet required to achieve great A1cs?” My answer is: YES.

I will make an attempt to quantify the difference.

For my little experiment I will either eat a 10g carb meal or a 50g carb meal of the exact same food. I assume that the 50g carb meal will try to raise my bg 5 times as much as the 10g carb meal. I will compensate for that by taking a bolus which is 5 times bigger. I know that with the 10g carb meal I can keep my bg in the range of 70-120. If I eat 5 times as much per meal and use a bolus 5 times bigger the range for my bg will also go up 5 times. This is because everything is linear. The 50g carb meal range with be 250 instead of 50. If I don’t want to play closer to the low end the 50g carb meal bg range will be 70-320. This assumes everything is the same except for the food amount and insulin amount. For the 10g carb meal my bg is centered around 95. For the 50g carb meal my bg is centered around 195. bg 95 corresponds to 4.9% A1C. bg 195 corresponds to 8.4% A1C. Of course, eating does not go on 24/7. If the effects of eating are limited to 12 hours a day my A1C would be about 1.8% higher when eating 50 carbs meals compared to 10g carb meals.

I used specific numbers because I like examples better than formulas. Change the numbers around. I bet that any study will find a strong correlation between amount of carbs per meal and A1C.


#49

And kudos for your hard work to get to your current level of control!


#50

Though numbers are by no means my forte, I believe there is a confound in that example. If carbs are 5x greater then insulin will be 5x greater. So far so good. What I fail to understand is where the idea that the range would be 5x greater comes from.
I aim for a BG of 100. My acceptable range is 80-120. My I/C is 1/8 and my I/BG is 1/50. In other words 1 unit of Humalog lowers my blood glucose by a factor of 50. 1 unit of Humalog also corresponds to 8 grams of carbs.

If I start with a BG of 100 and eat 10 grams my bolus would be 1.2 units. If I eat 50 grams it would be 6.2. In either case I would bring my BG down to 100 (I am purposefully excluding all other variables for the sake of this formula). In that scenario I was not using a range, but a solitary number (100).
Using a range would have the same consequences, however, since my target range will forever remain 80-120 regardless of carb consumption.

Just because something is linear doesn’t mean it’s causal. For example, shoe size and height are correlated (the taller the man the bigger the shoe size) but there is no causation (the man isn’t tall because his shoe size caused him to be so, also in reverse his shoe size isn’t caused by his height). Careful not to ignore the importance of the word “cause.”

I’m not trying to be argumentative, I simply want to understand and/or clarify.


#51

The problem is that larger units of insulin don’t always correspond to our ratios because absorption rate becomes less predictable in larger doses, aside from the many other variables we deal with.


#52

I keep on being tickled PEACH Dave…thanks for your kind words . PS I pray everyone is handling your family situation OK …my thoughts are with YOU


#53

If you could perfectly offset food with insulin your bg wouid be 100 all the time. Never lower, never higher.

Try to imagine how your bg would look like on a CGM if you eat without bolus. Then imagine your bg in response to a bolus without eating. Only if these two bg responses are exactly inverse they have the potential to offset each other. The shape must be the same, the magnitude must be the same, the timing must be perfect. Let’s assume the best case where you start out at 100 and after food and bolus have worn off end up at 100. There is no chance you will be exactly 100 for the entire time. Let’s assume you manage to be between 80-120 during this time. Now double carbs and bolus. All the imperfections will be multiplied by a factor of 2. Between start at 100 and finish at 100 the bg will vary between 60-140. Does this make sense?

I am not making up stories. This is what I see on my CGM every day.


#54

Um, it makes my head hurt. (That’s the curse of having diabetes in a body that’s strong on creative skills but weak in math).

I’m having trouble picturing this. Aren’t the units of insulin working simultaneously to lower the increase in blood glucose caused by the food?

Say that in this sample individual, there is an established insulin to carb ratio of 1 unit to 10 grams (which results in a curve that peaks at 140 mg/dl).

Why wouldn’t eating 20 grams of carbs with 2 units of insulin give more or less the same curve? Doesn’t the first unit of insulin “work” on the first 10 grams and the second unit of insulin work on the second 10 grams?


#55

In a noise free linear world you would be dead right Helmut but unfortunately it is not, starting with the 20% error in our meters and everything there after.


#56

rainbowgoddess, how many carbs do you eat per meal?


#57

> Doesn’t the first unit of insulin “work” on the first 10 grams and the second unit of insulin work on the second 10 grams?

Yes. Exactly. Let’s assume the first unit of insulin kicks in a little earlier than the first 10 grams of carbs cause the bg to rise and this causes a bg drop of 15. If injected at the same time the second unit of insulin will also kick in a little earlier than the second 10 grams of carbs and this causes an ADDITIONAL bg drop of 15. This adds up to a bg drop of 30.


#58

“We have a carb allergy.”

A carb alergy – not even close !! Might as well say we have a food alergy.

We need carbs to live. To suggest that diabetes is a carb alergy is over-simplifying the problem. We should be aiming at balancing carbs and insulin - not avoiding carbs and insulin


#59

Thanks!

OK, so I think I now get that the variance CAN POSSIBLY be greater when more units of rapid-acting are introduced.

But timing also matters, no matter how few the units or carbs.

How do you deal with the stretched out insulin needs that having an eating plan higher in protein and fats gives you (because eventually nearly half of that protein turns into glucose)?

Is the (about) 4-hour life span of the rapid-acting insulin enough to deal with the later increases in bg from metabolism of non-carb nutrients?

I guess it’s a little difficult to answer that for sure, because although your long-acting insulin should just act as a basal rate, it may contribute to lowering bg from eating.

Thanks for your patience with my questions!


#60

I say, “You must work hard at achieving those results and good for you! It’s nice to hear what works for you and see what of value I can apply to my own life.”

If a person’s A1C number, and blood pressure, and blood lipid, and weight numbers are on target and sensitivity and eye exams are conducted annually and that person is satisfied with his or her autonomy and abilities, why change what’s working?

But many of us are at various stages of the life journey with diabetes (I used to think, after 35+ years with type 1, that I would eventually reach a destination–cue the angelic music and shiny beams of light: DIABETES CONTROL. But, darn it, it seems to be a moving target.). Which is where information and feedback and thoughtful discussion comes in handy. Actually, ranting and raving and even grumpy discussion comes in handy, too.

More than the numbers, I like to applaud the effort that goes into living well with diabetes 'cause the effort is what’s worthy of recognition and praise. Just recognizing the easy-to-quantify numerical results fails to respect the person and his/her situation.

So, big round of applause for anyone reading this.