Is a low-carb diet a must?


#121

Helmut,

That’s amazing! Assuming you just do basal. Is that very low dose, too?

How do you know when you take Humalog if most days you need none? Must be scary to court lows since you need so little.


#122

Gerri & Anna,
Actually MDI, 10 u Lantus at night. My carb to Insulin ratio is 1 to 10. I have been eating about 45 g of carbs ( I use a about 1 unit extra in the morning for the dawn effect) I was taking up to 10 u Humalog per meal until cut carbs way back and added more exercise


#123

Inspiring!


#124

I take 30 units of 70/30 in the morning. My bg slides down all day long. When it reaches 70 I eat enough to get it up to 130. Before I had my CGM I did not have a good grip on my bg. I could not test over and over until the meter showed 70. When the meter showed 100 I took a guess that half an hour later my bg would be 70. Now the CGM tells me ‘100 going down’, ‘100 stable’ or ‘100 going up’. This makes a ton of difference. My bg variance has gone down from 60 to 30. It was a regular occurrence for my bg to be above 200 several times a week. This is when I used Humalog to get my bg down. I overdosed on Humalog to bring my bg down fast. Now I know that I used way to much Humalog. I always had to drink orange juice eventually to achieve a soft landing. Kind of crazy looking back. Now I have entire weeks where I don’t go above 160 even for 5 minutes. Thus no need for Humalog. Even being at 160 I don’t know what to do. Inject 1 unit and wait for 2 hours? Instead of Humalog I use exercise. A brisk walk or 10 minutes on the elliptical gets my bg below 130. No wait, no insulin tailing off, no injection. I have no idea why this option eluded me for my first 36 years of D.


#125

Figured you had to take insulin as a Type 1. Interesting the different regiments people are on. You must have a good endo helping you. My first & second endos were oblivious to my lows after meals. All they did was lower my doses, which didn’t help with highs later. Third endo changed me to Regular & that did the trick. I use Apidra to correct highs, but rapid is too fast for me & leaves too quickly.

Great that you’ve got this figured out!


#126

“You must have a good endo helping you.”

I guess I am different in this respect too. I have never seen an endo. I see my primary care physician once a year for a physical. My current doc did not want to accept me as a patient. She said “I don’t do diabetics.”. It took same convincing for her to say: “Let’s give it a try. I want to see your A1C below 6 and if it is ever above 6.5 you are out of here.” This was 5 years ago. I stopped by 3 months ago and petitioned her to sign the paperwork for my CGM. I can’t wait to tell her on Monday that I actually got it. This time I will petition for an OmniPod.


#127

“I don’t do diabetics.” Quite a statement considering how many of us there are. My PCP is quite knowledgeable because he has many patients with diabetes. I like him a lot. He was amazing when I first diagnosed & waiting for an endo appt.

Good she had the goal of a decent A1c. Seems that many doctors don’t think under 6 is possible & don’t encourage patients to aim for this.


#128

Great points as usual:) Would add that there are risks of using lots of insulin beyond immediate issues w/ blood sugar control. Years and years of hyperinsulinemia have been linked to weight gain, PCOS and cardiovascular risk, and hightened risk of cancer. When I was young, I ate what I wanted and covered it w/ insulin…now, 30 years later, I try to eat healthy/lowish CHO…to get the best control, lessen my longterm complications, and try to minimize other secondary diseases related to insulin usage. Have never had rock solid postpradials like I do w/ low CHO diet…just my experience, but again…longterm T1…w/ likely more insulin resistance and secondary autoimmune conditions than when I was young.


#129

OK Joe - that is really good - the amount of insulin you take each day! I just took a look at my history from over the past few days on my pump - and my total insulin intake varies from 21 u - up to ugh - 29 u yesterday. I pigged out on … carbs. Was alone in the house yesterday - and the little cheese fish crackers were calling me to release them from their bag where they can’t breath!! During the weekdays - I’m much better - w/e’s are evil for me!!


#130

I like my doc a lot. I think she is really good. She knows what my numbers should be. She said “For a normal person your blood pressure and cholesterol would be acceptable, but you are a D and thus are held to a higher standard.” I now take Diovan and Lipitor and agreed to cut down on pizza. My numbers now meet the higher standard. I understand her hesitation to deal with a patient who has problems getting the A1C below 6. She requires that her diabetic patients see an endo who deals with this aspect. I don’t think she cares why the A1C is below 6. She just has not dealt with a patient before who could do it by himself. After what I have learned in the past couple of months I am no longer content to be in the high 5s. I want to be in the low 5s or maybe even at 4.9 (no lows). Let’s see what happens.


#131

Many women have monthly hormone spikes that cause their blood sugars to rise dramatically at least twice a month, (during ovulation and PMS) and then to come crashing down after the hormone spike goes down. (these spikes may be sort of predictable, but you don’t really know for sure until it starts spiking, and then you have to chase the sugar down. And then you don’t know exactly when it’s going to be over, until you come crashing down really low.) It makes it difficult to do much better than a 7 for many women who have these extra blood sugar-hormonal challenges. As these women age, those difficult times of the month may start lengthening and become a greater percentage of their total days, and it is just rough. I don’t know if that is your situation at all, but we are ALL different and we all have different challenges. We all have to evaluate if what we are doing is the best we can do, and then accept our lives as best we can.

Additionally, many women are responsible in a very personal way for the care of other people, such as children and elders, which makes it more of a challenge to pay the kind of constant, analytical attention to their own blood sugars which would be required in order to get a very low A1C. Not that it cannot be done… but there are seasons of life in which self care is more difficult than others.


#132

It is for me - I simply must have my steak and lobster!


#133

low carbs is not a must.
I found out I can eat ice cream sometimes, french fries and dark chocolate.


#134

The problems with just calculating carbs correctly and dosing insulin accordingly are several:-

  1. Injected insulin cannot easily match the insulin that your body would make. Thus it is quite hard to match the injection to the absorption of carbs/protein/fat that comes with each different meal (and absorption can vary depending on the proportions of c/p/f as well). This can be addressed to some extent by techniques such prebolusing, splitting bolus doses.

  2. When eating large amounts of carbs it can be quite hard to accurately determine exactly how much carbs (and protein) are being eaten. Eating 100g of carbs and being off by 20% could mean you are getting too little or too much insulin.

  3. There are also errors in dosing insulin / how well it is absorbed from any particular site etc.

Thus I am a low carber. Small amounts of carbs means less error margin to play with. Smaller doses of insulin are safer too. If I am out by 1/2 to 1 unit of bolus insulin when dosing say 2 units to cover my meal, my sugar levels might go a bit low, but its unlikely to go dangerously low. I may go high, but again, not terribly high. If instead I have dosed 10 units to cover a cup of rice and veges… and my measurements are off, I can be at risk of a serious low. Bernstein calls this “law of small numbers”. Small inputs mean smaller risk of errors.

If you did decide to go lower carb, there are vegetarians who do this… can find online support and ideas, I am sure.

High variability in blood sugars are linked with complications as well (vascular, nerve, cardiac). There has been some research that highs of say over 200 cause tissue glycalation (I saw some research on a keto forum - low carb downunder, I think). This glycalation is cumulative over time… and the body has to try to recover from it. Thus targets would be “tight control”, with reduced variability. Highs cause damage over time… lows can cause immediate major issues if you become unconscious / get in an accident, etc.


#135

Dino,

That was very nicely stated. You are so right and still very kind in how you stated it.

Thank you. Too often, too much emphasis is placed on an A1C number rather than how that average is derived.

I am personally much more concerned with the number at the top of a spike’s peak than the before and after numbers.


#136

While Bernstein’s law of small numbers has aged well over the last nine years since this thread started, low carb discussions still provoke controversy in our community. Back in 2009, I read many TuD threads, probably this one, but did not post comments. I learned a lot from discussions like this and eventually conceded that low carb was an effective way of controlling BGs and I should adopt this tactic. I was reluctant to give up my comforting carbs and It took me a few years but the wisdom finally sunk in. In 2012 I adopted a low carb way of eating and never looked back.


#137

I believe that each of us juvenile onset/type 1 diabetics have to find what works for you. Then STICK with it. Don’t let another juvenile onset/type 1 or any other diabetic tell you what you’re doing is wrong. Sure you can listen and find out what others are doing, but our bodies all act differently to the different foods.

There are also simple and complex carbohydrates. Most people refer to rice, potato, bread, cake, cookies as carbohydrates. These are what I call starches. And people seem to forget, that everything we eat does break down into sugar.

I don’t have a set number of how many carbohydrates I eat in a single day. If I want pizza, I can have it. It doesn’t spike me like it does a like of juvenile onset/type 1’s. I’ve learned I’m an atypical juvenile onset/type 1. Or maybe it’s just I know how much insulin to have and how to have my t:slim 64 extended bolus set.


#138

Type 1 dx 1959
Followed Bernstein’s low carb way of eating for 11 yrs. My A1c was usually 5. I took 17 units of insulin, For the past 2 yrs I have been on a low fat plant based diet.
Now I eat 325 carbs daily and my A1c is 5.5. I now take 23 units of insulin,
I dropped 10 lbs eating this way, feel better and have more energy.


#139

I am also a veggie - have been my whole life, so that’s not going to change because of diabetes. I’m pretty high energy and certainly eat a higher carb diet than even the non-low-carb-ers. What tech are you using? That will help us target a good solution. But, in general, I need my basals set correctly. If the basals aren’t good, then I will notice first in my post-pranial numbers. A1c=6.1, which is as low as I’m comfortable going (possibly a little lower than I feel comfortable with). I currently view < 6.3 as me not taking care of the numbers…but, thats me.

My Doc just got me experimenting with extended bolus (Omnipod pump). But, I tend to go low post meal because I haven’t figured it out yet. I need to play with it more, but it makes me kinda nervous because I have dropped like a rock a couple times. The way my basals are set right now, I dont think I currently have a need for extended bolus, but I’m sure a time will come when it is useful.

I think that I am currently in a physiological sweet spot where my basals are set pretty accurately, AND I’m able to eat almost anything (even golden grahms cereal) without high post-pranials. Thats not always the case.


#140

I just posted about this in another thread.

In my case, I tried a very low-carb diet for a year. For various reasons (primarily other chronic conditions I live with) it started to not work for me. So I’m currently eating a higher carb diet and am happy sticking with this. My control has worsened a bit, but my control even eating low-carb was not the kind of control many people manage to get (I was never able to break into the 5% range for A1c, and still had daily highs and lows). I may return to low-carb eating at some point in the future, but for now, I’m happy sticking with eating more carbs.