For the past six days (today is day six) I've been eating around 50g of carbs per day. It's actually pretty easy once I decide beforehand what I'm going to eat, and I am determined to stick to this long-term!
I've lost a bit more weight but am not freaking out, slowly is better as long as I keep going down. :)
Blood sugars have been pretty awesome ... 63% of readings have been between 4-7 (70-125)! I have only had three readings above 10 (180), however I've had seven lows in the past six days which is way too many ... The problem is I don't feel lows in the 3s at all so I'm not finding them until I test. I don't mind lows in the 3s (though my endo would freak out), but it makes me nervous that 3s could turn to 2s and then we'd have a problem. Most of the lows are after exercise or after corrections.
One of the times I'm going high is after breakfast. I cannot figure it out. I tried lowering the carbs to almost nothing, I still go high. In fact even when I don't eat, I still go high, except when I sleep in, in which case I'm perfect. So I tried upping the basal around the time I wake up yesterday, but then this morning I woke up low, and we'll see what I am after breakfast. It's like I've got a mini dawn phenomenon when I wake up but not if I sleep in, this is in addition to the rather massive "normal" dawn phenomenon I usually have regardless ...
The one other area I have trouble with is exercise, but nothing's new there. I exercise after dinner and I try cutting back my dinner bolus so I start out a bit high, but I either have to start out fairly high and end up in range, or else I start out only a bit high and end up low ... This is for only 30-35 minutes of exercise which I am trying to gradually up to an hour.
Also, I am a bit nervous about the whole ketones thing. I know when you go below a certain number of carbs per day it's normal for your body to switch over to burning ketones. But being on the pump, this makes me nervous. Last night I checked ketones using the Precision Xtra and they were 0.6 mmol/L (normal is <0.5 mmol/L), and this morning I checked again and they were 0.5 mmol/L after eating breakfast. I've only been doing this for just over five days so am guessing this might build up more over time. I used to use ketones as a way of deciding whether an infusion set might be bad (and never had anything over 0.1 unless I was high), but I am guessing I can't use that anymore. I am also nervous if I DID have a bad site/or bad insulin levels of ketones would build up really fast because all it takes is 2-3 hours of interrupted delivery for me to start getting ketones from no insulin. Anyway, any thoughts from Type 1 pumpers or others who know about this stuff would be appreciated! I want to stick to this but I also want to be safe about it.
Congratulations, Jen! It sounds like you're doing a great job.
I'm the most insulin resistant in the morning, too, and prone to going high after breakfast. I have to calculate the total available glucose in whatever I eat at breakfast and cover that with insulin to avoid going high. Since 58% of protein and 10% of fat metabolizes as glucose, I look up the protein and fat content of what I'm going to eat. Four strips of bacon have 7.73 grams of protein and 18.3 grams of fat. Calculating the amount of glucose, divided by my I:C ratio meant that I needed to add 1.3 units to my correction dosage this morning. I didn't eat any carbohydrate, so I didn't have anything to cover for that.
I'm not on a pump and so I can't say anything about ketones, pumping and T1. I am always in ketosis, but only mildly to moderately, with no spikes as far as I know. A low carbohydrate diet (of 50g or less) is "ketogenic." It switches our bodies to burning fat rather than burning glucose because there just isn't enough glucose to serve as the main fuel source. Ketone bodies are produced by burning fat, but I don't know what happens when a person with T1 becomes ketogenic. I do know that Dr. Bernstein recommends a daily diet of no more than 30 grams of carbohydrate, though, which must result in ketosis for most of his patients.
Welcome to low carb and I think you’ll be happy with the results. I know that I have!
My suggestion is that you get a copy of Living Low Carb by Jonny Bowden which will answer most of your questions, especially those you didn’t yet know you have!
Some thought on your specific issues:
Your basal rates were presumably set for when you were on a higher carb intake, so you are going to need to keep an eye on your levels and adjust your basal rates. Also, when you lose weight your basal rate will be affected. Wear pur CGM if you have on, and test often. Stock up on Dex tabs as well.
Your look sugar will also be affected by protein, so in a low carb meal you have to figure that out as well. Read Bernstein’s book for great details as he is a type 1 doc who advocates very low carb. The Diabetic Solution, I think it’s called. Protein can be a real pain to calculate as I am finding out.
I presume you have a food logging program, if not try myfitnesspal.com which has web and phone access (iPhone/droid) and is free. I have yet to find something missing from their database. Also, with low carb for our purposes remember that it is being low carb at each meal, and not for the day. So you can’t hoard carbs from one meal to another. The goal, as Bernstein discusses (and invented, as far as I can tell) is to get to the point where you eliminate phase 1 insulin as much as possible, so you avoid having your blood sugar ever rise after a meal. Great goal.
Diabetic ketoacidosis and ketosis are two different things. The first occurs when your blood sugar is too high and your body starts to use fat as its fuel because it is not able to access the glucose in your system. The danger there is not the ketones (by product of fat burning) but the uncontrolled blood sugar. I have found that a few weeks after being low carb, I feel “high” when I start to reach 150.
Hi Jen. I'm no expert by any means and I am on MDI so don't know about the pump. But I do follow low carb and find it works very well for me. It does take a little more planning. Especially while you figure out what to do for exercise. Most of the carbs I eat are complex and after 9 or 10 in the morning. I have found that a minimal amount of carb in the morning helps me so I usually add a little baked sweet potato to my eggs and cheese.
It is difficult to eat low carb without planning ahead. Most LC food is not easy to grab and go unless you already have it prepped. Every week (usually on the weekend) I roast a whole chicken (in my smoker, but the oven works too). This makes Sunday dinner and lunches for the week. I bake a couple sweet potatos until just tender and then slice them into 1/2 inch plus thick slices. Cube up a pound of cheese and mix some strawberries into Greek yogart. The cheese amd the yogart usually last more than the week, so I do those as needed. I also nuke a bag of veggies every day or two for dinner and lunches. I also keep things like cottage cheese, fresh veggies and almonds around for snacking.
Here is a typical daily menu for me;
Breakfast: 6-7 a.m. 3 eggs, 1 slice sweet potato (I let it cook a little further, break it up then add the eggs), 2oz cheese Snack; 9-10 a.m. 1 slice whole wheat toast w/peanut butter, 1 "Diabeteze" protein bar and a small cup of coffee.
Lunch; 1-2 p.m. 4-6 oz chicken and a pile of veggies
Snack; 4:30-5:30 1-2 oz cheese, 1 1/2 - 2 cups popcorn and usually 1 beer
Dinner; 7:30-8:30 4-6 oz meat (varies) and a pile of veggies
Snack; Maybe or maybe not. Depends on BG, time andf how I feel about it, usually a couple spoons of peanut butter or maybe a protein bar or yogart.
This seems to work pretty well and seems very consistant for me. I do change things up a little from time to time, buut this is about 80% of my days. I don't know if I am lucky or what, but I rarely go above 145 or below 65 and my A1c has been in the mid 5's for the last year.
Thanks for the book recommendations, I've put a bunch of books on hold at the library and bought a bunch that aren't available even on interlibrary loan.
I do know that ketosis and DKA are different ... I guess my concern is that if the "baseline" is raised already, it might make the development of DKA more rapid than it would otherwise be. And it is already pretty rapid (hours) on a pump if something goes awry. Maybe I am wrong on that, though.
I checked urine ketones today and the strip turned instantly to the darkest colour purple (large). Blood ketones at the same time were 0.6 mmol/L. So am not sure if that's bad or not. Blood sugar at the time was at 8.2 (148 mg/dl) an hour after eating.
I just put my pump settings down as I've been low all day today (till now). My blood sugar still spikes after eating to the lows 8s (150 mg/dl) at an hour. Then by two hours it is around 5 or 6 (100-120 mg/dl). So that is pretty good. I am only eating around 15g of carbs per meal and I know some people can eat that and stay perfectly flat! Might look into bolusing for protein a little later.
So far I am trying to take everything slowly and monitor closely so I don't end up in any bad situations with highs/lows/ketones.
Jen, did I miss a mention of bolusing ahead of your meals? That has helped me a great deal in keeping my numbers steady, regardless of carb intake. Bolusing for fat and protein takes a lot of study to get down exactly, I think, but adding a few more grams to my carb count bolus and extending it helps...not exact science on my part, but helps keep me in range. I liken it to cooking...you do it sort of intuitively after a while. Congrats on the low carb commitment. So many arguments in favor, but it is not easy to maintain for all of us.
Exercise can be tough. Intense exercise, weights or hard intervals, can raise my numbers. If I am doing basic cardio for over 1/2 hour, to keep from going low, I either eat a 7 or 8 carb treat, such as a piece of candy, cookie, piece of banana, or few sips of juice, before hand, or I just suspend my insulin delivery for the first 1/2 hour...don't know if all pumps offer that option. Experimenting will tell you if that works for you.
Good luck. Sounds like you are motivated and doing things properly. keep us posted....we can all use the motivation.
Great work Jen! I've recently gone back to super low carb (I let myself ease up there for a while) and find that my sugars are MUCH easier to control! I of course am trying to balance exercise (lows) etc, etc, but at least feel good about better numbers! I too have the rise in the am, unless I sleep in, and have been working to increase my basal a few hours prior by just a tiny bit at a time, which has helped. Then of course there are mornings that make no sense :) Keep up the good work!
