I was also diagnosed as a T1 LADA only 7 months ago and have been a patient of Dr. Bernstein's since Sept. Eating 30g of carbs per meal is perfectly fine. I eat about 30g a day and went from an A1c of 8.8% in May to 5.1% in Nov and am in the best shape I've ever been in my life. In fact, any nutritionist who is pushing 150g of fast acting carbs on a diabetic should have their head checked.
If you were diagnosed with an A1c of 6.1% 10 months ago, you were unfortunately already solidly in the "pre-diabetic" range and well on your way to Diabetes. Are you certain about your LADA diagnosis? If you're T2, you might have the good fortune of being able to manage this insidious condition through diet changes and oral meds alone.
As others have posted, the reason you're gaining weight is that your body is finally able to absorb the nutrients you're eating due to your stabilization of your BG through injected insulin. Your weight will reach an equilibrium based on the level of carbs you decide to consume. The fewer you eat, the less insulin you'll need, and the less weight you will gain. Had you gone untreated, you would have continued to lose weight to the point of eventual death.
How many carbs you eat is really matter of choice. You can find comfort in the fact that you can cover all of your nutritional needs for carbs through the consumption of the healthy veggies alone that our mothers always told us to eat (broccoli, spinach, Brussels sprouts, asparagus, etc.). There is no nutritional need for breads, rice, potato products, pasta or any other fast acting carbs (and don't fall for the "whole grain" agribusiness spin either, it's about as credible as the "low-fat" labeling you see on so many products). Having said that, let's face it, fast acting carbs taste good, and when consumed in reasonable quantities by non-diabetics these foods will have no detrimental effects whatsoever. The challenge as a diabetic is trying to match insulin dosage to the dramatic effects fast acting carbs can have on our blood sugar. This is the crux of Dr. Bernstein's "law of small numbers" approach.
You will see there are members who can maintain good control eating much higher carb levels than others. My preference is 30g/day allowing me to cover my meals with negligible insulin doses and keep my BG in the same target range before and after meals. It's also allowed me to completely rid myself of the carb cravings I used to have during my non-diabetic days. You might achieve your desired BG control with higher carb consumption. It's all a matter of trial and error.
Good luck. You've come to a good community with a wealth of good advice.
Christopher, it is your personal choice to eat just 30g of carbs per day. However your body will turn down its metabolic rate as a reaction to this. This is to preserve energy for more important tasks like maintaining muscles and the brain. This is actually the last thing a T1 needs in my opinion. The metabolic rate and muscle mass are key elements for good control. With good I mean the ability to consume carbs WITHOUT severe spiking afterwards. Your path will lead to high carb sensitivity making it nearly impossible to cope with higher loads of carbs. I highly recommend moderate carb intake - no doubt about that. However the radical Bernstein approach is far too low in my opinion. Especially for young women there is a high risk of developing eating disorders like Diabulimia. Thus I think we as a community should take this into account too. We have enough statistical evidence that normal carb intake with correct insulin dosing can be done without complications. We also know that an A1c up to 6.0 is statistically sufficient to prevent complications. There is little value in bringing the A1c lower than 5.5 - at least for fully insulin dependend T1 diabetics.
The high carb sensitivity is a tricky thing to balance. Too few and you'll have yourself on a diet that won't be able to handle eating out anywhere. You'll feel like you're wearing a space suit.
But, too many carbs and the variance in your insulin effectiveness (as much as 30% I've heard - can anybody give me tested numbers?) can cause your BG to go all over the place. Your I:C ratios will change and you'll need more Insulin for each meal as well, which escalates the issue.
This is where logging your BG, carbs and insulin help out because you'll be able to find a happy medium (I have a slice of toast with breakfast, 1-2 with lunch and then a 30-50g carb portion with dinner) that will work for you.
Bernstein is brilliant, but his level of dietary control is far too intense for my liking.
Either way, it sounds like you're doing really well so far and are on the (sometimes bumpy) road to a long and healthy lifestyle.
As for being scared to eat carbs I think that’s normal at this stage. 30 g per meal is not an unreasonable place to start. There is a huge amount to learn about how you, as an individual react to different amounts and types of carbs. It’ll come over time, with much frustration and some lessons learned the hard way. But I can assure you everything you describe seems totally normal to me; as they could have been my own words a few months ago
Hi Holger, I am curious about your statements, but I certainly don't want to attack your ideas in any way. In fact, I think conventional wisdom concerning diet in large part agrees with what you wrote above. However, I was wondering if you based your thoughts on scholarly research or perhaps something else. If you do have scholarly references, would you be willing to share them for (1) low carb intake lowers metabolic rate, (2) low carb diets lead to carb sensitivity, and (3) low carb dieters, especially young women have an increased risk for developing eating disorders? I appreciate anything you can offer.
Hi Diabeetusista: Welcome to the club, although that always sounds weird to say. You are doing so great, lowering your A1c in such a short span of time. Congrats! I wrote a Top 10 Tips for the newly diagnosed that I hope you will find useful. Best of luck, and use TuD to get the support and answers that you need!
It's a bit of a "side note," but I have to completely agree with Holger about developing eating disorders. I would go so far as to say that Type 1 diabetes is a recipe for disaster for women, leading often to eating disorders. It is a complex thing. Thankfully, there are lots of great groups and support here on TuD and elsewhere (Diabulimia Helpline, for example).
There are certainly different opinions on some of these matters. I actually find that lowered carb intake in itself has no effect on metabolic rate. Many people adopting a low carb diet report boosts in energy. There are some who think that very low carb diets can lead to a downregulation of your thyroid and a lowering of your metabolic rate, but most people won't reach that level.
As to low carb diets leading to carb sensitivity, I think a better term would be carb intolerance. Having run on a low carb diet for a long time, my body burns fat efficiently, but is not used to carbs. I don't have the gut flora and my body is oriented towards taking up only small amounts of glucose.
And I really don't think it is fair to focus on low carb diets as increasing risk for eating disorders. Low carb diets, many of which don't restrict caloric intake are probably my better than the calorie restriction diets that often lead to feelings of starvation and binging.
I agree with Brian vis-a-vis eating disorders. Low carb diets per se do not increase risk for eating disorders. Obsessing about and restricting food can be risk factors, but we all (must) obsess about food to some degree. Weight gain which is a risk of higher carb eating is more of a trigger. In addition there are many factors which put one at risk for eating disorders, many of them psychological/emotional and having nothing to do with food and eating, some of them cultural.
30 carbs per meal is reasonable. Yes being on insulin makes you gain weight which is why we limit our carbs. Listen to the experts but keep in the back of your mind that everyone is different and everyones' diabetes is different. You figure out what works best for you and your body. I suggest keeping a detailed log of what you eat,test,what time, any activities you do, do this for about 3 months and then you will soon see what works and what doesn't.
I did this myself and although it was a pain in the butt, it sure gave me insight as to how my body reacts to different foods and I also noticed that the time of day makes a difference, as the weather does, hormone cycles... it never ends!!!
There is a much higher rate of eating disorders amongst women with Type 1 diabetes (maybe men, too, but I have just seen studies on women), which was my point in my earlier post. Then, for me, a very low carb diet a la Bernstein did in fact lead to feelings of starvation/crazed hunger, no matter how much I ate, and I know this has been others' experience as well. By taking a more moderate carb approach, I don't have the problem of crazed hunger.
Hi, Melitta! I wasn't disagreeing that there is a higher rate of eating disorders among women with Type 1. I just was just disagreeing that a low carb diet is an automatic set-up for an ED. Low carb diets are not for everyone. It certainly sounds like it didn't work for you and for others the feelings of deprivation are counter productive. For me and for many others, though, eating low(er) carb allows me to maintain my weight and I feel very satisfied and happy with the food I eat (a requirement for someone with an ED). After 18 years recovery from an ED (pre-D) beginning to slowly but steadily gain weight was a trigger that made my recovery feel shaky until I lowered my carbs.
As I said we're all different, (which is why discussions about "low carb vs medium or high carb" are meaningless.) The need to "obsess" about food can definitely be a trigger for eating disordered behavior of one degree or another. But the counter to that is to find a level of carb intake that works for you both in terms of BG control and satisfaction and to make this your "new normal", a normal with which you feel satisfied. In addition, many people think of eating disorders as being entirely about food and weight and they are not. There are many psychological and emotional factors that determine who develops an ED and who either eats normally or has minimal eating disordered behavior. For many of us, recovery from an ED comes when we realize it is not just about food and weight.
I sort of suspect that diabetes might fuel eating disorders because it's challenging to find balance and also is infused with a vocabulary of success vs. failure. If you are struggling, it seems very natural to feel bad. Really, it's a struggle all the time and, even though I do ok, sometimes, it's pretty burdensome and quite a bit of it eminates from my head while I think "I need to do this to do that or that to do this..." in endless loops in my brain all day long. If I didn't get ok results, it would be much more difficult to "resolve" the loops and not end up getting involved in beating myself up.
I think that a lot of my more recent progress has been from realizing that I feel better when I look for things that will make me feel good and that those are green, leafy vegetables that have more vitamins in them. If it's good, I will just eat a serving of it and feel good that I'm fueling something else that will be fun and I'll be able to do another thing faster because I feel less creaky eating a lot of veggies. Which, in turn, leads to less carbs, shiny hair, etc.
The one thing I find frustrating about the low-carb dialogue is that it's hard to get a ruling from science about where to draw the low-carb line? is it 30/ day, 30/ meal, 75/ day? They all might have something to recommend them but having a "target" for carbs, would be almost as helpful as targets for BG!
I was diagnosed about 8 mos. ago and have been figuring out my diet since then.
I started out with a very strict low-carb diet (at least by my standards) and was able to get a good A1C on my first follow-up with my diabetic educator. I’ve tried almost all my favorite foods since then - with the exception of big desserts or super-high sugar foods that are quick to spike BG in almost anyone - and have come to a good understanding of how to dose for particular carbs. As I learned from these forums, everyone will have a different response to different foods, but I found that researching different carbs and how they typically affect BG in people was the best place to start (beans, etc. Digest more slowly and most people won’t see a fast spike, whereas white flour will spike most people mo quickly, for example). I’m lucky in that almost every response i have to various carbs falls in the “typical” category, but it was reassuring to have some type of info about a particular food before trying it for the first time since my diagnosis.
It really is trial and error for everyone with diabetes, but having some background on different carbs should help you to anticipate their effect on your BG - the other element, and the best advice I’ve received on this site, is to test, test, test - especially as you’re learning how your BG responds to all the different factors from food to exercise. It takes a while to get used to testing as part of your daily routine but it’s given me a lot more confidence as I go through my first year with diabetes and have had to try things for the first time since my diagnosis that I used to do without any thought (going for a bike ride, skiing, eating).
I am a LADA type (I think I am a full on one now. Unless I restrict carbs altogether my BG's spike) as well and recently started a bolus regimen. I love it! My BG's are so pretty now. With that said...
You will gain weight with Insulin but it seems like you have a crappy nutritionist like I did at first.
She was telling me to eat all of these carbs but I kept walking away with these HUGE numbers on my meter.
I got my best information from this website.
I don't eat more than 70 carbs a day...and when I do eat them I bolus for them ALL. The only carbs I eat are fruits and vegetables. And since fruit has natural sugar a five milligram bolus insulin works very well for me.
Definitely cut back on your carbs and you will stop gaining the weight.
Wow, it’s interesting for me to read so many similarities in your ‘story’ to mine. I was diagnosed just over a year ago, joined TuDiabetes last summer and I think this might be the first time I’m responding to someone else’s questions in a post with something like reassurance. Obviously, everyone’s situation and management with their diabetes is going to be different, but I found reassurance when people with similar ‘numbers’ had positive experiences to report.
So, here goes: diagnosed at 28 years old my A1C was 9.5; my latest was 5.6. I take 7 units of Lantus in the morning and only bolus with meals that are greater than 30g of carbs. This isn’t very often, but it’s been handy to have figured out a rough 1u Humalog : 15g carb ratio when eating out and also now being on holidays where tropical fruits are so plentiful! The nurse educators and dieticians I’ve seen are pretty uncomfortable about my max being around 150g / day. They similarly urge this be the number I shoot for (I’m roughly your height/weight). For me lately, it’s more like 120g. Anyways, I gained weight immediately after starting insulin (it was less than 10 lbs for me to get back to my usual body weight) and I’ve been steady at this weight for nearly a year. So my experience was that there was gain and then a levelling out once back at (what I consider) my healthy weight.
I want to echo a comment earlier in this thread commending your early ‘aggressive’ research into diabetes management. I took a similar approach and am grateful now, one year in, for the crash course I embarked on to catch up with foundational knowledge. There’s always so much more out there to read and learn about - establishing general working knowledge of diabetes and diabetes management helped me feel less fear and anxiety about potential outcomes/complications and allowed me to find and apply control in the places I can while I manage my (honeymooning) T1 diabetes.
As for your last question about ‘experience with carbs when new to this’ - that’s a whole other story! A year in, I’m still feeling ‘new to this’ when it comes to my attitude towards carbs. I’ve experimented with so many different approaches on the carb front and I’m trying to find the middle ground. For me right now, I’m motivated to continue to restrict carbs, but I’m also wanting to find patterns that will be reasonable to adopt for the long-term. It’s felt like a lot of work to get the 5.6%.
Hi! I am Lada too! You do need to count your carbs and use the ratio as Zoe said, but I have been able to find a stable baseline and just take a couple units more when I am eating a higher carb meal or a beer.
You will gain a little weight back. When you were running that high, your body was burning your muscle and fat as it wasn't getting enough sugar as there was no insulin to convert your carbs to energy. Now you actually have insulin to convert the carbs you consume to energy, instead of your body eating itself so to say.
Insulin needs to act on carbs recommended about 45g per meal to function, so don't eliminate completely. But as anyone should stick to the whole grain/wheat ones and not white ones and no pure sugar. This is important for anyone.
I lost about 25 pounds then put on insulin in December I gained about 5 pounds and have not really gained or lost any more weight ( it may go up or down 2 or 3 pounds is all)
It's also important to consider the type of carbs. Avoid heavy carb foods with lots of fat as they are more difficult to gauge their effect on your blood sugar, at least to begin with (i.e giant plate of pasta or pizza). As you get more and more comfortable with carb counting as others have suggested, you're food options will increase! Good Luck! Always feel welcome to come back with any questions.
