Low Carb for Type 1?

Type 1 and LADA
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Low carb for type 1?
I am type 1, diagnosed in 1945. I knew nothing about an appropriate way of eating. My doctor told me to take my insulin before breakfast and to avoid sugar, but there was no other advice given back then. I could eat anything I wanted, and as much as I wanted, if it did not contain sugar. I lived on a farm, and there was soooo much to eat. I drank milk from our own cows with every meal. We had an orchard with many kinds of fruit, and an acre of garden space. I ate tons of carbs every day, but I did not eat sugar, so my parents thought that was OK.
There was no device for testing my blood sugar until the mid 1980’s. I survived and thrived that way for 50 years until the 1990’s. I started testing my blood sugar with a glucometer, and before the dawn of the 21’st century, I was counting carbs and using a fast acting insulin. I began gaining weight. I had never been overweight until then. I was diagnosed with insulin resistance in 1998. Yes, type 1 diabetics can have insulin resistance. I started taking oral meds for the insulin resistance. With Metformin, eating an average of 130 carbs per day, and getting a lot of exercise, I lost all of the extra weight. My A1c’s were in the high 5’s and everything seemed good, but then I started having diabetes complications. Retinopathy and neuropathy were diagnosed. The roller coaster control, with too many highs and lows gave me a good BG average and A1c, but the complications were there.
I started using a pump in 2007. There were fewer highs and lows. My diabetes management improved so much that the retinopathy disappeared, and the neuropathy was not much of a problem at that time. My A1c’s have remained in the 5.4-6.4 range for about 15 years. I am averaging 150 carbs per day, and I am not overweight. I am obviously not following a low carb diet, but my diabetes management is good. I am using a pump and a CGM, and my complications are under good control. Why should I follow an even lower carb diet? There are many type 1 people following a very low carb diet but I don’t think a low carb is necessary for all diabetics.

What do YOU think?

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This is like everything else having to do with diabetes management: individual. Cases differ, responses differ, optimal strategies differ.

That said, low carb has certain builtin advantages that apply across the board. One of them is what Bernstein calls “the laws of small numbers”. Briefly, it just means that the less carbohydrate you eat, the less insulin you need, and the lower the dose, the less the danger of something going badly off the rails. That’s certainly a desirable profile to aim for, but as with every other aspect of diabetes (and as mentioned above), it has to be factored into your own individual pattern to see what makes sense, and to what degree.

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@Richard157, while I have not lived as long as you with T1D, I have lived with it for a long time. I respect the spectrum of personal treatment philosophies as well as the range of biologic experience.

For me, however, when I cut back on my dietary carbs to a relatively low level (< 60 grams/day or so), I proved to myself that Bernstein’s law of small numbers that @David_dns describes is a real thing. The biggest observation I’ve made with consuming a limited carb diet was that my blood glucose variability improved dramatically. Lower variability enabled a lower BG average without any increase in hypoglycemia risk.

I found a dramatic improvement in my glucose control accompanied by a large increase in my quality of life. Getting off of the glucose roller coaster made me feel much better. While I felt much better physically, my emotional aspect benefitted too. I also felt more energetic.

Cutting daily carbs provided a whole constellation of direct benefits to me. I lost weight, took much less insulin, slowed down the progression of gastroparesis symptoms, brightened my mood, and most importantly restored my sense of controlling diabetes rather than diabetes controlling me.

While I use all the latest diabetes tech, my adoption of a carb limited way of eating is the single best tactic I employ. Now I know the resistance most people experience when it comes to reducing carbs. I believe carbs have an addictive quality, but my addiction was quickly broken within a matter of weeks. The effort required for me to limit carbs in my diet pales in comparison to the sustained exertion of willpower I needed to give up cigarettes.

Having said that, the prospect of limiting carbs was something I considered and resisted for a few years. When I was diagnosed with gastroparesis in 2012 I took the plunge and have never looked back. If I had adopted this way of eating 33 years ago when I was diagnosed, I would have prevented a lot of damage that high blood glucose did to me over the first 28 years of diabetes. In fact, when I found how effective carb limiting was for me, I harbored resentment and anger toward the health care professionals I interacted with over my long career with diabetes. Not one of them even hinted at the idea that carb limitation can help people like me.

Oh well, live and learn. In summary, I don’t see my experience as definitive for all people with diabetes, but my experience was so positive for me and many others, both T1D and T2D, that I think everyone with diabetes should at least give it serious consideration. I’m also aware of people with diabetes who can consume more carbs than I do yet still enjoy the benefits I do. “Your diabetes may vary” also applies to the daily threshold of dietary carb where loss of control and highly increased variability occurs.

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Hi @Terry4, at this time I did not see a need to lower my carb intake, but I will keep your reply in mind. I may need to make a change in the future if I also have gastroparesis, or some other complication. I have several physical handicaps that are not diabetes related, I don’t think low carb would help them. lol

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Richard, the last part of your sentence is what is most important, YOUR diabetes management is good with the diet and other other choices you make.

According to this, you are on the ‘low’ end of the 2010 recommended guideline.

The Dietary Guidelines for Americans released in 2010 recommend that Americans get most of their calories, or between 45 and 65 percent, from carbohydrates. This corresponds to a daily intake between 170 and 244 grams if you eat 1,500 calories a day, and between 281 and 406 grams if you eat 2,500 calories a day.

The term ‘low carb’ can mean so many things, and unfortunately can cause over-reaction since there is no clear definition of what it means.

I think it is also important on the timing of insulin, type of carbs, and what is eaten in combination with the carbs. When I eat a piece of fruit, I often combine it with or after a serving of peanut butter or cottage cheese. Or when I choose higher carb meals, I can use Afrezza. It’s all about balance and achieving the BG ranges/goals we choose for ourselves, not just the number of carbs.

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What works works, and we need to be able to live with it!

So I am low carb / keto mostly. It works for me. It may not work for others.

I like eating in a way that means I don’t need to spend much time thinking about or managing my diabetes.

I dare say most people will do better avoided added sugars and highly proceed foods (diabetic or not), but after that take and run with your own plan on how much you restrict them.

The only real issue I have is that people newly diagnosed with diabetes should be given the option / knowledge about low carb as a valid management tool, at the beginning of their journey, rather than the eat what you want and cover it with insulin spiel.

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Yes, I certainly agree newly diagnosed diabetics need to be told about low carb, not just low GI. And here they need to be taught how to dose for insulin, not just cover their food with insulin and hope it works.
There is no one size fits all in diabetes, I am very carb sensitive and so I eat low carb. Eating this way also impacts my blood pressure and cholesterol as well as blood sugars and keeps me in a good range.

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Hi,
My son was diagnosed more than a year with type 1 at the age of 2,5 years. After a complete rollercoaster for the first months we adopted a moderate low carb diet (60-90g of carbs daily) with lots of veggies and some fruits. It stabilized his bloodsugar significantly and his A1c came down to 5,6 without major lows.
Then two months ago I watched an online summit about whole food plant based eating. Many of the doctors there said low carb studies are only short term and that eating animal protein will lead to heart disease and other diesases in the long term. And that a Whole Foods plant based diet will lead to insulin sensitivity and reduction of insulin in T1D.
I am really confused now. The doctors who advocate a wfpb diet said, that studies which advocate the consumption of animal products were sponsored by the meat and dairy industry. I saw the movie “what the health” today were doctors and other professionals explain that eating fat and animal protein leads to insulin resistance and arteries- heart disease.
I am really confused now. My son just turned 4 - so he will live with diabetes his whole life. I don’t want him to have complications within the next 50 years…

Does anyone experienced insulin resistance and the need for more insulin after many years of eating low carb? Or has anyone switched from one to the other?

Richard, how does your diet look like? Do you eat starchy vegetables like potatoes, or grains? Do you eat lots of meat?

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@Nija, I experienced insulin resistance after having type 1 for 50 years. It happened when I switched from animal insulin to synthetic insulin (Humalog). I average 150 carbs per day, including some grains. My bread is seven grain, only 9 grams per slice. No more than two slices per day. If I have potatoes or pasta, I do not have more than a half cup, and no more than once per day.
I do eat some meat with each meal, but not large portions. I have eaten this way for many years, and my heart is in great shape at age 78.

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The whole “animal products are bad for you” mantra is based on the traditional diet/cholesterol/CVD model that has been recited as holy writ for the past half century or so and generally treated as received wisdom. Nearly every health care professional in the world buys into because it was presented to them in school as settled gospel. In point of fact it’s essentially politics, not science. Propaganda, in other words, not to put too fine a point on it.

If you want to discover the reality behind the sound bites, there are some excellent sources available. A really good place to start is the book Good Calories, Bad Calories by Gary Taubes. Thoroughly researched and extensively footnoted, it’s one of the first (and best) serious looks at the issue. And there is more where that came from.

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I experienced significant insulin resistance after eating a relatively high carb diet after 23 years with diabetes. Unknown to me, my insulin resistance ramped up and I gained about 20 pounds over 20 years. I wasn’t aware of the concept of insulin resistance at the time and none of my doctors raised the issue.

What I did know is that I started taking more and more insulin and it just didn’t work as well. I would calculate an insulin dose to correct, say a 250 mg/dL high, and my glucose level would not move, at all! My A1c crept up from the low 6% range to as high as 8.5%.

When I finally started to eat low carb (< 60 grams/day), my insulin resistance totally rolled back. I lost weight with little effort, reduced my total daily insulin dose by half, and felt more energy. My blood glucose variability fell by a lot as did my average blood glucose (meter and CGM).

So my experience is contrary to what the whole foods plant based advocates may contend. Based on my experience, I don’t agree that eating fats and animal proteins leads to insulin resistance. My current insulin dose is about 0.4 units per kilogram of body weight, a dose that suggests good sensitivity to insulin.

I eat beef, pork, fish, cheese, eggs, heavy cream as well as berries and low carb vegetables. I like fat and protein. Fat and protein satiates; carby meals often need to be followed up with a snack two hours later. Yet, I can eat two hard boiled eggs and two breakfast sausages and enjoy great after-meal BGs without hunger pangs for five or six hours after.

At times when I end up eating say more than 30 grams of carbs per meal, my blood glucose spikes and becomes difficult to pull back down.

Your diabetes (your son’s in this case) may vary and I respect that. I just don’t buy the beliefs of the whole foods plant based diet when it comes to people without a functioning pancreas. I might find it an attractive option if I were a gluco-normal.

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The low-carb practitioners correctly point out that their approach makes insulin dosing much easier, because the errors in dosing are smaller, and so huge spikes and crashes are less likely. But I really like carb food, and I usually eat 150 to 200 g carb daily, but it varies greatly, although usually between 100 and 250. It works ok for me — not as well as Terry4 but I’m satisfied with an A1C 5.8, 70% of my time between 80 and 130, standard deviation 29. Over the last 30 days I did spike up to 250 on 5 separate occasions, so I’m no flatliner. To handle my medium-high carb diet I use the sugar surfing approach with Dexcom CGM, which enables me to correct early and often to mitigate initial errors in meal bolusing.

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Your numbers are impressive, particularly your 70% time in range! I would likely eat more carbs if I could get away with it, but I can’t. I’ve tried. As we all know, diabetes tactics are not a one-size-fits-all thing. I feel that the most important philosophy is to dynamically shift when things change. For too long, in the past, I stuck with the static formulas and needed to make large corrections far too often. Gluco-coasters R us!

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As a biologist, I can say that film is poor at best, and pseudo-science at worst. Just because there are a few doctors featured doesn’t mean much. Different things work for different people, however, and some people do really well on plant-based and high-carb diets.

As for myself, my insulin resistance is directly related to how many carbs I eat and how much I exercise. Not my weight (which is now fairly stable), but carbs and exercise. When I eat low-carb and exercise frequently at high intensity, my insulin resistance (and thus requirements) are minimal.

I think it’s best not to rely on “position” movies, papers, or editorials. Try some different ways of eating and lifestyle choices, and then choose what works best for you.

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That’s sounds very reasonable. We ate the same way last year but I called this way of eating kind of a moderate low carb diet.
Do you eat lots of food or do you also have to restrict them?
For my son potatoes, white rice and wheat will rise highs if he eats more than 12g of carbs of it for one meal. Good to hear that your heart is in good health.

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Yes, you are right. The film wasn’t scientific-still it made me choose eating less animal protein and exchanging some with legumes and beans.
But when it comes to science in the nutrition topic it gets very confusing because there are thousands of studies and they seem to say the exact opposite- so it is true that everybody has to find his own way which is very frustrating sometimes, when trying to find out what’s best and getting very conflicting results- some people are doing great on lowcarb some are doing great on wfpb diet some switch from one to the other. My conclusion is that we will try to stick to some things that they have in common, like: little or no processed food and avoiding the combination of higher amounts of carbs and fat.

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Hi,
I would say the most important thing for your son is maintaining blood sugars as close to normal as possible. Eating a diet based mainly on real unprocessed foods, as you are doing, would be the most rational.

The movie “what the health” has been roundly criticized by many. Food industry is highly political. As are the mainstream dietary recommendations.

The latest research (check out Tim Noakes among others), is that high insulin and high sugar levels (both related to carbs) are the bigger culprits in health problems and inflammation.

Btw, kids need more protein than adults for growth. Bernstein quotes requirement of 3 - 5 g of protein per kg of body weight for children. I would not restrict meat / animal protein for a child.

Bottom line, keep doing what you are doing, which is working.

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I eat an average of 150 carbs per day. I like to snack on raw carrots and other raw veggies. I also like nuts and cheese.

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Hi Nija, like you I have a son who was diagnosed young at age 2 and he is now 6 yo. I think the situation for kids differs a little from adults. One the one hand, there are long term complications that are mentioned here, but on the other hand, the brain’s preferred source of energy is carbohydrate and most kids tend to be more active than older adults. I am in healthcare and would suggest calculating your child’s basal energy expenditure (BEE) or his individual caloric requirements to get an idea that his body needs are being met. There are online calculators that can assist with this calculation-- the total number of kcal your son needs everyday based on his demographics. If the user inputs actual weight then you may need to consider adjusting for his being over/under weight when you figure out how many calories he needs everyday. It is possible to then convert the grams of carb/fat/protein eaten in one day to total kcal to get an estimate if he is meeting his approximate BEE. I think children must get a variety of foods, but a lot of children (not all) will not be as interested in consuming the same low carb health foods that some adult fitness experts advocate and we also do not want them to lose weight (unless told to do so by the MD). My personal opinion is that it is best to eat a variety of foods while minimizing table sugar and salt-- while eating more organic than not organic. Finally I wanted to mention that while it is possible to reduce total insulin doses for each meal by eating low carb all the time, one must keep in mind that if the BEE is not being met, the body will start burning fat to meet its BEE (thus producing ketones from burned fat). So perhaps consider checking ketones along the way to be sure that they are in range–everyone gets sick from time to time and the ketones will only increase further during illness.

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Thank you, yes I will keep doing what we are doing, just increasing the variety in consuming more protein from lentils etc. than before.