After an A1C of 13, and 17 yrs as a Type 1, denial is not working as a treatment anymore :-). I have done a tonne of research, read a bunch of studies, talked to/argued with both my GP and my endo, and have decided to switch to my own blend of Dr. Bernstein and Paleo as a diet. The key here is that there is less than 35 g/day of carbohydrates in my diet, I only eat twice a day (except/unless lows), my only dairy comes from 2 tbsp full fat cream in my 1 cup of coffee, and full fat greek yogurt, and cheese as a garnish. No grains, legumes, processed food, starches, etc. I made the switch about a week ago, and for 3 days, I maintained some of the best numbers I have seen in the last decade. Then, yesterday, my sugars started climbing, and I haven't been able to get them under 7 mmol/l (126.1 mg/dl) and they have been as high as 13 mmol/L (216 mg/dl). I am bolusing my regular correction, and even adding 1-2 U, and still it won't come down. Not cheating on the diet, no sneaks, nothing. Thoughts? Anyone else have experience with this? Thanks!
Once you stop eating a higher amount of carbs you need to start blousing for the protein in your meal. You add in about half the number of grams of protein to your meal carb count. This could be one reason why. Are you waking up with good numbers?
Caffeine raises BG. I've found that not eating doesn't help with dawn phenomenon.
No, it's not your liver compensating. Could you be getting sick, insulin is nearing expiration, or a bad pump site? Try correcting using injections.
It looks like you've made some major changes to your way of eating. Going with a high fat, normal protein, low carb diet will take your body some time to adapt to this new regimen. You've switched your metabolism from primarily burning sugar to hopefully primarily burning fat. This may take more time than one week. I say, stay the course and make sure you add some daily exercise, like one hour of walking each day.
Be patient, keep track of everything and let nature take its course. You're on the right track.
I don't know what is going on, but it could be a combo of any of the suggestions made. I don't think it's soon enough for you to need to bolus more for protein maybe. I would try it for a while longer for sure and see what happens, and I would still eat vegetables too. There are many things you can substitute for grains etc. I'm finding new recipes all the time. You may also find you need more than 35g per day. I switched from that to around 50-70 per day, some days more if I go hypo more or I'm exercising. My dp is often is worse when I don't eat. Or any change to my schedule which is usually nocturnal and it can change also.
IMO there is no reason to just eat twice a day on Bernstein's diet. Just dump all the garbage carbs, get down to 35 a day, and get some exercise. Then I think you'll lose a lot of the weight and your numbers should fall in line. With Bernstein's approach you have to bolus for protein as well, but the big advantage for me was that BG isn't going up and down quickly. It slowly rises and falls for me. With dawn phenomenon, taking a small dose of regular metformin before bed can sometimes cover it. The Metformin kicks in at about 4 hours and maybe peaks at 6-7 (YMMV).
Great responses, as usual, from TuD. I'm 7 years into Dr. B. We called him Crazy Bernie at first because it seemed impossible. But "Perseverance furthers and the superior man triumphs" (the I Ching). It takes time for our so vey complex bodily systems to process these changes. Hang in there. Pay close attention to everything. You'll find your way. I know you can!
Stay in touch...Judith in Portland
Changing to a low carb diet can be a significant change and it could affect lots of things, including your basal levels. There is no reason to expect that your basal levels will be the same when following a low carb diet. Perhaps it would help to look at a tune up on your basal levels.
And I know that when I have bad morning Darn Phenomenon (DP) it will thrown my whole day off. I think bad DP can make you insulin resistant and send out of control signals to your liver to dump glucose. These problems may not as evident always eating in the morning, but as others have mentioned, not eating can really make it worse. If I don't aggressively correct a bad DP I will also rise further in the morning if I don't eat.
Just shoot whatever you need. I wouldn't ask myself too many question changing diet like that and going into ketosis.
Do some basal testing to be sure you are on track with that and then correct the boluses!
I've been on lo-carb for more than 6 months. Best choice of my entire diabetic career ;)
Hey RTW! I made a similar change back in Nov. I struggled for the first 3 weeks and then everything just got better. My blood sugars are more normalized and I'm feeling like a million bucks! I wish more diabetics were encouraged to live this kind of lifestyle. my doctor hasn't been very helpful in this process so I have been going at it alone and figuring things out as I go. For a while I had lots of unexplained highs but they always came down. it looks like you are on the pump... maybe there is an issue there. I would call Medtronic and get it replaced just to be safe. Then you might want to try an injection instead of the pump to see if that brings your bs's down. Also, I had to take greek yogurt out of my diet because it royally messed with my bloodsugars. It was like eating fruit- unpredictable. You might want to try no yogurt for awhile. Congrats on living the Paleo lifestyle- go Paleo!
very true, brian about DP, it's so dang frustrating and sets the morning, day off to a bad start and can certainly cause insulin resistance for a long timeframe. also, fast acting insulins were designed to work with CARBS, not protein. If you're eating protein late at night, it could be digesting slowly overnight. I have to bolus for protein, especially if majority of meal is without carbs. I tend to do better with eating carbs, myself. Protein is a hit and miss with me. I tend to need MORE bolus so what's the point?
I agree that the action profile of the rapid acting insulin analogs much more closely matches the metabolic absorption of a meal comprised mostly of carbs. I have had a lot of success, however, using a pump-delivered square wave of insulin to match the absorption of protein and fat. In fact my extended boluses to cover protein and fat are more consistently successful than the immediate boluses intended to cover carbs.
I realize that this is not available to those that use MDI. If I were forced to switch to MDI, I would experiment with using rapid acting analog insulin together with old-fashioned Regular to simulate what I'm now doing with my pump.
For example, to cover my breakfast this morning of a two-egg omelette made with whole cream, ham, salsa and cheddar cheese, I delivered 2.2 units to cover 8.7 carbs and 7 units over 6 hours to cover the protein and fat. This dose is, of course, customized to my metabolism and others would need to use trial and error to figure out what's best for them.
I find protein much easier to deal with than carbs.
Personally I cover CHO with humalog (analog) a few mins before eating and protein with insuman (regular) a few secs before eating.
Every time I eat the same amount of cho, protein, and possibly fat and that give me some stability too.
In my opinion if you someone doesn't have anything against pumps that should be the choice!
I know I might sound like ms.obvious considering u are diabetic for years but any chance u might me missing a hypo somewhere in between ur bg readings? That also easily can throw bg off. Btw I have never heard of low-carb diet do u maybe have some useful links? What is your main course if not carbs? Is it proteins? Do you feel you are eating normally or u are hungry all the time cuz 35 grams seem crazy, even though I am always around 120 grams.
It's ok to skip breakfast if you don't particularly enjoy it. Ultimately, it just cuts down on total daily calories and can result in weight loss.
Essentially, you just decrease the carbohydrates you are eating to a very, very low carbohydrate diet (FYI - 120 is already pretty low). You increase the amount of protein and fat you are eating as a percentage of your total calories. This is Dr. Bernstein's method for helping control blood sugar. Many people (including myself) think this method is kind of extreme, but a lot of people report great success with controlling blood sugars. It is still a matter of debate whether very low carbohydrate diets, in addition to using insulin, should be used as a method to treat diabetes.
Here is Dr. Bernstein's book: http://www.diabetes-book.com/. You can read many of his chapters for free on the website.
Another common low-carbohydrate diet is Atkins. Just google that one.
Do you already have good control? If your A1C's are good and your BG readings do not have large swings, I wouldn't worry too much about lowering your carbohydrate intake further. 120 is already pretty low.