Since I've been reading so many posts recently related to low-carb and I've put on a few pounds this winter, I thought I'd start my annual experiment with going really low carb. My normal carb intake is around 100-120, but even at that level, I have a lot of roller coaster BG readings.
Starting yesterday, I am eating just vegetables, cheese, meat and a few nuts. Very typically I am struggling in the morning with BG rising up to the high 100's and needing a lot of insulin to come down. Once it gets down late morning, then my BG readings are incredibly level. Overnight, my Dexcom and meter readings were flatlined from 85-95.
Without a breakfast bolus, I know that I will have to increase my morning basals by a huge amount and probably just take a wake-up bolus although I'm not eating carbs. I don't have dawn phenomenon in the traditional sense, but like many Type 1's, my BG starts rising once I get up. Unfortunately it doesn't do it all of the time, just some of the time. When I eat carbs, I eat breakfast soon after I get up and then exercise immediately after breakfast. This usually stops post-breakfast spikes, but does open me up to lows mid-morning.
My question though is: For those of you who low-carb, did you have to re-do your insulin regimen from scratch when you started low-carbing, especially your basals? And how do you cover your meals? Normally I don't bother dosing for protein and fat, although you could argue that some of that is built into my basals and bolus ratios. But obviously I need to do something if I'm not eating many carbs.
Basal adjustment has to come before bolus adjustment whether low carbing or not, so your BG are stable round the clock within 30 points. The basal should be taking care of your cellular activity only. I highly recommend doing a 3 day basal test. The timing of your basal insulin may be creating some problems. Take the results of your testing every hour to a CDE. Read Walsh's Using Insulin. Maybe 2 doses of basal are needed to get your BG stable.
To answer your question: no, I didn't have to redo my insulin regimen. I simply got a better hold on what bolus needed to be given for different types of foods, using small numbers of grams. I always bolus for protein. I bolus for every meal's number of grams, same as ever.
I am on a pump, so my basals aware set pretty well for the most part. It’s just the morning after I get up that is problematic. I’m on my 3rd day of super low carb, and the morning spike today was only about to 140 vs the 180 the first two days. I think it’s a matter of figuring out whether a basal increase would prevent it or whether it should be a bolus unrelated to food, or a bolus taking into account the protein at breakfast. It may be a combination of all three.
Do you use the TAG approach or do you just bolus for carbs and protein? I don’t know whether you pump, but how long do you feel it takes the protein to affect your BG? How much do you bolus for protein grams compared to carb grams?
I pretty much use TAG for protein and tweak for fat. Protein takes 1.5 to 2 hours.
I bolus 50-60% for protein.
I know pumps tho I don't use one. On a pump if one's BG around the clock, not counting after eating, is not stable, one can't bolus and have the BG return to where it started.
I ensure I eat some protein every meal. It keeps away hunger when low carbing. And that means I don't go around snacking all day or even have a desire to. I can either lose weight or not lose weight on low carb! So set a goal! And don't over-insulinize yourself or you can gain that weight! :)
Since you are on a pump, have you tried a tempy basal rate increase in the mornings? Alternatively, you might have a different I:C ratio in the morning.
FWIW, the only way I have lost weight "successfully" is by increasing my activity AND reducing my total daily calories (especially smaller dinners).
I’d recommend taking a bolus, even if it’s for “just” meat and nuts? I am too lazy to do math most mornings so I count egg beaters, brocolli & spinach as 17 G of carbs (trial & error…) & chase it w/ skim milk if it runs a shade low. I have observed that when I have really flat BG days, DP seems to be stronger too?
I’m not really doing this to lose weight except for 2-3 pounds that I put on this winter. I am actually quite thin and have been at about the same weight for at least ten years. But I have to laugh that my endo will mention it if I’ve gained 2 or 3 pounds, so I thought I’d avoid that conversation. Also it makes the clothes loose again around the waist.
Today I had the exact same breakfast and activity level as Monday when my BG went up to 180 with no carbs. Today I bolused for the protein in 3 eggs which only calculated to 3.3 grams of protein, so only a .2 bolus. A few hours later now I’ve crept up to 110 from 75 at awakening, but obviously I would have been on trouble had I taken a lot more insulin.
So I’m still in a learning curve of what happens with extreme low carbing. I’m extremely sensitive to insulin and only had a TDD of about 20 when I was eating 120 carbs per day. Yesterday my total was 11 units (basals of about 8.5 and the rest bolus). The lows are definitely diminished when you’re hardly taking any insulin.
I think you’re right that I definitely need to bolus for nuts. I’ve always eaten a ton of nuts and usually use a square wave over several hours for them. Cashews are an exception. They cause a significant increase in BG. That’s because they’re so yummy.
I do think that the fewer carbs you eat the murkier the distinction between basal and bolus becomes. And it really doesn’t matter as long as somehow you give yourself the right amount of insulin. So even if your breakfast doesn’t have 17 grams of carbs, that bolus amount works.
I’ve never eaten vegetables at breakfast, but I’ll need to do that because just eggs is starting to be a bit gross after only 4 days. Maybe some low-carb toast also.
I accidentally bought 13 ounces of cilantro (don't ask- it's hysterical yet embarrassing).. then made a cilantro pesto of the excess. I then decided to mix that in with my morning eggs for a variation, and it was pretty awesome (though it made them green)..
Sometimes I just vary the cheese I use in the eggs too..
And sometimes I eat yogurt and/or strawberries too... I can't do veggies at breakfast, seems odd. :)
The path to DKA is through insulin deficiency. DKA only occurs with high blood sugars, not exactly something caused by low carb. Low carb diets can cause your body to burn fat, which involves the generation of ketone bodies and trace to moderate levels of ketones. But these levels are "natural" and occur in everyone, particularly as you fast overnight. But fat burning and the generation of ketones does not "cause" DKA. DKA is caused by insulin deficiency which results in your body overproducing glucose and ketones. If you aren't overproducing glucose, then you aren't overproducing ketones and you don't have DKA. And this is important because it is this overproduction which causes high ketones levels and the acidosis which is the hallmark of DKA.
ps. These claims about low carb causing DKA go back years and I believe have been part of a deliberate misinformation campaign. Just because you repeat a lie over and over again, it doesn't make it true.
I've never had green Tabasco, so might have to give it a try. Yesterday I hard-boiled all the eggs I had left in the house, so will go to the store today to get more. I think I'll definitely try an omelet or just scrambled eggs mixed with spinach and other vegies.
For all of you who use egg beaters instead of eggs, is it for health reasons are just because it's easier and faster?
Green Tabasco is a wonderful substance that makes eggs and many other things quite delicious without doing anything bad to them nutritionally. It is not as hot as regular tabasco and has a different flavor. My non-diabetic kids also love it, so it is endlessly running out at our house.
When I started doing low-carb, I found that I had to change a few things:
I had to increase my overall amount of basal insulin. I think was hovering around 9 units per day on a more typical diet for my basal needs and ended up needing between 10 and 12 units per day on a low-carb diet (albeit one that consists of more protein and fat).
I had to decrease my bolus amounts. My I:C ratio went from 1:10 to 1:15.
I had to bolus closer to mealtime (not 15 minutes before, but more like right as I sat down to eat).
I think all these changes were needed because when I low-carb it, I definitely eat way more fats and proteins, which digest more slowly and can cause my BG to go up far longer after eating. That said, my BGs are definitely more stable overall when I can keep the cards down under 100 g/day (and I'm pretty active; on days when I'm less active, I try to stay around 70 grams total).
I think what you're doing makes sense based on what I'm seeing right now. I'm five days into this still eating super low-carb. I need to start planning how to add back a few carbs while being comfortable that what I'm doing has reasonably adequate nutrition.
I'm going to read Dr. Bernstein again. I haven't read it in years and I know I'll never follow his WOE completely. I'll probably read some old Tu posts to see what others are eating.
Usually when I go really low carb I don't feel great, but actually I've felt really good this week. The flat lines on my Dex are truly awesome. I can join the Flatliners Group now which I could never do honestly when eating 100-150 carbs per day. But I'm waiting to see if my commitment continues. It never has before, but every day is a new day.
I think that you're right that a basal increase probably covers the slower digestion from protein and fat. Right now I'm doing well with my current basals with just an occasional 0.1 or 0.2 correction nudge.
I fully understood dka until I started researching low carb diets which have always dropped my bs and my a1c..I came across a page that told everyone to go out and buy their keton strips and enjoy ketosis!! Obviously as a T1 it freaked me out a little...thanks for clearing that up!
Did anyone else had to increase their basal on low carb? I had 8 -10 units total but now I feel like it is not enough, Tried 12 today. Can anyone explain why this is happening, physiologically wise I mean :)
