Low Carb for Type 1? Not Me!

Type 1 and LADA
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Low Carb for Type 1? Not me!!

I have read that many type 1 people eat very healthy, low carb meals. That certainly helps with the control of blood sugar levels, but I do not find that to be necessary. For so many years, starting in 1945 when I was diagnosed, I ate anything I wanted as long as it did not contain sugar. My portions could be as large as I wanted. Not eating sugar was the only limitation made by my doctor. My typical day saw me eat hundreds of carbs, many of which were very fast acting. That was poor diabetes management, but my parents and I did not know any better. I lived on a farm, and there was a lot of exercise. My doctors knew very little about diabetes back then. I was very fortunate that my diet did not cause any diabetes complications.

In 1988 I read an article in a magazine that mentioned carbohydrates. I saw that carbs were very much involved with blood sugar management.That was the first time I had that knowledge. I was still using injections with animal insulin, so knowing about carbs did not help me very much. I did, however, start eating smaller portions of food that had fast acting carbs.
In the mid 1990s Humalog was introduced. That was my first fast acting insulin. I started carb counting. Trial and error showed that I needed one unit of insulin for every 10 carbs I ate. Before breakfast my carb sensitivity was greater, and I needed 1 unit of insulin for every 7 carbs, but only for that meal. Carb counting, and eating only small portions of carbs with fast acting foods greatly improved my blood sugar control. My A1c’s began dropping, as you can see in the graph below.

I began using a pump in 2007. Programming my insulin:carb ratios, and my variable basal rates at different times of the day on the pump gave me so much improvement in my control. Fluctuations did occur because of scar tissue, and occasionally forgetting to bolus at the right time, but my management was very good. I started using a Dexcom CGM in 2015. I have set my CGM to alarm when my BG reaches a high of 170, or a low of 70. That has resulted in my staying in my 70-170 range 90% of the time.

At the present time I eat an average of 130-140 carbs per day, and my A1c’s have been in the 5.4-6.4 range for more than 20 years. Here is a typical day in my current schedule:

8:30 AM…A slice of toasted bread (9 carbs), a slice of ham, berries (16), one egg, and coffee…total…25 carbs
12:00 noon…A medium size baked potato (30), a pork chop…total…30 carbs
2:00 PM…Before going to the gym for a one hour workout…one half cup of ice cream with sugar…(25)…only a 1.5 unit bolus since I was going to get a lot of exercise
5:00 PM…Five corn chips with salsa, and coffee (10)
7:00 PM…Pastrami sandwich with mayonnaise, slice of cheese, and slice of tomato… only one slice of bread, 9 carbs per slice…(12)…cottage cheese (6)…strawberries (10)…total…28 carbs
10:00 PM…My BG was 79 so I needed a small snack…peanut butter and crackers (12)
TOTAL for the day…130 carbs

I never eat anything with sugar (table sugar) unless I am going to get exercise afterwards, or I have a low. I carry a small ziplock bag of skittles with me when I am away from home.

Note: My meals vary a lot, but the carb counts and the times that I eat are very stable. I do like a lot of variety in my food choices, so no two days are the same. As long as my diabetes management is stable, I see nothing wrong with that. My A1c is good, and I am not overweight. My BMI is 23.6.
I like variety in food, TV programs, movies, activities,
exercises, and most all things…but not women. My wife is wonderful and I do not need variety there. :wink:12744137_10153491991847098_8513033092537783968_n

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I am definitely not low carb, but my basic policy is that as long as I know how many carbs I am eating, I can do the appropriate bolus, so everything should be good. Is this appropriate? I think it is. Obviously I still need to eat healthy foods, but that applies to everybody. Am I the healthiest person in the world? Definitely no, in fact, I’m probably not even as healthy as I could be, but that is not due to how many carbs I eat. And if everything you claim is true (and I believe it probably is), then I would consider you a role model for diabetics! Congratulations!

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I am definitely not a low carb person. As a cane farmer and a fisherman my physical activity can be extreme for several days and protein can not supply enough carbs to keep up with my work load.

On the rare occasions that I have reset irrigation pipes at night, I have to be careful not to Hypo. Replacing carbs with protein for the night meal causes problems through the night. I may go to bed at 4.5 but wake with a reading of 12.2.

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We all suffer from the lack of any standard as to what the definition of “low carb” is. I do eat a low carb diet that consists fo less than 30 grams of net carbs per day. While some may consider this “extreme,” I see this way of eating as “moderate,” in that it leads to moderate glucose excursions and an easy to live with glucose variability.

I’m not evangelical about my way of eating and fully respect each person’s individual choice. @Richard157, you have markedly improved your glucose metabolism over many years of consistent effort.

While I would not characterize your way of eating as low carb, I do see it as “limited carbs” as most people easily consume about twice that many grams of carbs per day as you. You have found an important balance between good nutrition, reasonable glucose control, and the social pleasures of eating. Congrats on your continued success!

That line chart A1c graph tells an important story.

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I never leave the house without either 2 or 3 pill bottles filled with Wild Berry skittles. They don’t melt; they don’t leak, and they taste good enough w/o being a temptation. Gone are the days when I’d foolishly be far away from carbs. It’s a wonder I didn’t end up face down on the ground a number of times–but I came close.

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Should be, but for me, the more carbs I eat the more likely I’ll over/under bolus and by a greater margin.

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Bernstein’s often quoted “law of small numbers”:

The fewer carbs you eat, the more unlikely it is that you’ll make a colossal dosing error :+1:t3:

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I’ve made some doozies in my time. :slight_smile:

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I’m not following a low-carb diet currently, but am more moderate carb (most meals are around 20-30 grams). My health has improved greatly in recent months and I think because of that my blood sugar control has been extremely good and relatively easy.

Last night I skipped dinner but then decided at the last minute to have some cereal because I was worried otherwise I’d wake up at three in the morning starving. So I had some and bolused, knowing it was a risk before bed. I extended the bolus by an hour with the thought that I could cancel it if I seemed to be crashing. Well, my BG flatlined for an hour, so I went to bed…and an hour or two later woke up to my Dexcom alarming and my BG at LOW. I didn’t even bother to test because I nearly fell over when I stood up, so I knew I was definitely low. I overtreated because I felt so close to collapsing, of course rebounded, took a two-unit bolus a couple hours later, and finally woke up in range.

Reminds me why in general I stick to lower carb and lower GI foods! Eating high carb stuff is just not worth the rollercoaster, and while sometimes we can get the bolus right, it doesn’t take much of a mistake to get dangerously off track.

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Followed Dr, Bernstein for 11 yrs eating 30 carbs a day. For many reasons I switched to low fat plant based eating and became much more insulin sensitive. I eat 300 carbs daily and give 23 units of insulin as compared to 17 low carbing. I have no working beta cells. I have been eating this way for 2 1/2 yrs and am very healthy. Type 1 dx 1959.

In the last almost 20 yrs, my A1c’s have ranged from 4.7 to 5.5. Besides heart stents which I acquired while on the very low carb diet and which I have no idea if my very high LDL while low carbing caused, I have no diabetic complications that I am aware of including no neuropathy.

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I am doing well as a vegan, I do not low carb, I probably average about 120 carbs a day. But I don’t limit myself, if I want pizza, I eat pizza (vegan pizza, I am a very strict vegan). The only thing I do is, I don’t eat or don’t eat high carbs in the morning as I have dawn phenomenon and it’s too hard to control blood sugars in the morning with eating on top of it.

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Richard, Your 35 year chart of A1C is fantastic!

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Marie,

I too am vegan T1 50 years. Eat roughly 200 carbs/day. Was always high after breakfast, but have made some progress that may help yu too. I temp basal 120% for coffee for 1 hour. Coffee would drive me sky high. Steel cut oats with bolus 1/2 hour before eating. I add a little flax or hemp or tahini and it is going well.
I try to eat lower fat as the heart disease is is upon me at 50 years T1.

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Love that you kept a record of your a1c’s. Kudos for having done so well! What it shows is that even with an a1c around 6 complications are likely. Mild nerve damage is pretty good, but people do respond differently, and other people may get more serious complications even with an average a1c of 6. The average a1c’s out there are much higher and complications are on the rise in spite of great technology.

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I too practice low carb and don’t see it as a limitation in the slightest. Being fat adapted has some amazing additional advantages such as being able to go all day without food. I am a little evangelical about low carb - not because I care if others follow the same woe, but because there is much misinformation out there and for that reason so many people dismiss low carb as a viable alternative. The myth that people, and in particular kids require carb to grow is pervasive. Doctors and endocrinologists put the fear of life into parents whilst omitting to explain the devastating effects of elevated glucose levels.

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I eat around 130-150 net carbs a day. This is many fewer than I ate before diabetes and it certainly isn’t a high number but I like beans, and bread and fruit. I would be very unhappy on a low carb diet.

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Same here, lower than before diabetes, but I do eat what I want, It’s just no longer would I eat a potato and pasta say at the same time. But I do love beans, whole grain bread and fruit too! Kauai Sugarloaf Pineapples just became available after about 2 months of the farmer not having any to harvest, so I am enjoying them! They made me love pineapples again!

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If you wouldn’t mind, could you share what a days worth of meals looks like for you? I’m really curious how you get 300 carbs in a day on a low fat plant based diet. This whole discussion is very interesting to me and I don’t think there is a one size fits all diet plan when it comes to anyone, not just those of us with diabetes.

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At your 130-140g per day, Richard, I think any NORMAL person or doc would call that low carb.

A typical NORMAL non-diabetic’s consumption is 250-350g of carbohydrates per day.

However it is not low-carb by MILITANT LOW-CARB advocates at all, who often are aiming for 15-50g of carb per day - if not less.

Richard, I think it is important that you not get too distracted by the MILITANT LOW-CARB advocates who are very vocal in this group. You are in fact low-carb already.

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Hi Riley, I really liked the very low carb way of eating and was a big supporter of that woe for many years, but for me it eventually caused me many health difficulties.

Here is a typical day of eating for me now. You have to remember that I am quite petite, so I don’t eat a huge amount.

For breakfast I always eat 1/4 cup of cooked oat grouts, 1 banana, 1 cup of blueberries, and a large date with flax and chia seeds and cinnamon.

Today for lunch I will have a large bowl of potato and leek soup with pumpkin seed kernels. Some kale or spinach and 2 garbanzo bean chocolate chip cookies.

Right now I am at the gym and have already had to eat some dried fruit. I eat it whenever my glucose level drops.

In the afternoon I drink about 6 oz of beet juice made with beets, apples, ginger, lemon,and parsley. It is really good tasting and helps control my blood pressure without taking meds.

Dinner tonight will be a large piece of shepherds pie made with lentils, baking potatoes, vegetables, onions etc. Topped with nutritional yeast and more pumpkin seed kernels. With that
I will either have a green salad, or carrot and celery sticks etc. For dessert I will have two more garbanzo bean cookies. Everything is non processed and most is organic.

The lowest A1c I had while low carbing was 4.7 and the highest while eating low fat, plant based is 5.5. I feel sooooo much better and I am in great shape.

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