I agree with the premise of this diaTribe article. Low-card eating can help avoid extreme swings in BG. I also agree that the phrase,
“You can eat whatever you want, as long as you take insulin for it.”is horse manure.
But … how does one eat less than 30g per meal and still get 1200-1500 calories into a diet?
For me the key is to eat about 100g/day of protein, keep my carb intake in the 50-100g/day range and most importantly get plenty of fat. Key sources of fat for me are olive oil (I buy big jugs at Costco), butter, coconut oil as well as lots of cheese, meat and seafood. It really isn’t hard to get this fat. For instance, here is my recipe for Aoili. Split this recipe over two servings, put it on fish or veggies and you will get 100g of fat and nearly 1000 calories.
I don’t eat totally whatever I want, but I don’t restrict carbs. I have trouble staying above 110 pounds and can’t fathom taking the risk of losing weight by adding any more dietary restrictions than I already have in my life.
Worth noting hat my husband gets viscerally ill at the sight of milk (not dairy per se just milk itself) and had never met a veggie he can stand to put down his gullet other than lettuce on a sandwich or taco.
And it’s only the two of us, so meat, cheese and carbs it is in my house.
Add heavy cream. butter and sour cream to your diet that will boost calories quite a bit. I make a basic yogurt out of the sour cream by adding Stevia and various extracts to it, mix it up and enjoy. Could add a few blueberries if you need fruit in it. Heavy cream added to scrambled eggs, cooked in butter is a win also.
That becomes hard because my gut doesn’t like high fat. If I overdo fatty stuff in any one 24 hour period the system purges rather unprettily (read: I can’t leave the bathroom for a while).
I don’t think this is too difficult. Let’s say you eat 30 grams of carbs per meal and a small snack can round that up to 100 grams/day. At four calories per gram that’s 400 calories for carbs. If you’re targeting 1500 calories, then you need 1100 more.
If you eat 100 grams of protein per day, as @Brian_BSC suggests, then that’s another 400 calories and you’ll only need 700 calories from fat. Since fat packs nine calories per gram, that calculates to about 78 grams of fat per day to make up the difference.
I use heavy cream to make scrambled eggs. At 11 grams of fat per ounce, adding three ounces of heavy cream to scrambles eggs totals 33 grams of fat. Each large egg contains about 5 grams of fat, so two eggs equals 10 grams. Total for the scrambled eggs made with three ounces of heavy cream and two large eggs is 43 grams of fat, more than half of that 78 gram amount.
It’s easy to get enough fat in your diet if you think about it. Meat, cheese, butter, eggs, nuts, fish, sardines, yogurt, and cream all contain a great deal of fat. I find that fat (protein, too) satiates me to the point that I don’t need snacks in between meals. The biggest adjustment you need to make is to look past decades of Big Food’s demonization of fat.
I think it’s easy to get enough calories when limiting carbs. Good luck with changing your eating style to help with BG control. For me, carb limiting is one of the most effective tools I use to keep my BGs in range for a high percentage of time.
The idea of “carb-up, shoot-up” is a failure for most people’s BG control and is the quickest way to find yourself riding the gluco-coaster.
You may have some sort of digestive problem. There are enzymes such as lipase which you can take as a supplement to help fat digestion. You may also find that coconut oil which is an MCT is more digestible as it doesn’t need bile for digestion and absorption.
I know that many people have discovered that low-carb and high-fat works quite well. There is great advice in this thread already. Like lisa, I have some issues with fat digestion, and unfortunately taking really good enzymes doesn’t help that much. I also am physically active and lift weights, so I’m prone to losing weight if I don’t hit my calorie goals (which are relatively high: 2,500-3,500 calories per day, depending on routine). Low-carb definitely works for me, although for me it’s about 90-120g net carbs, with a minimum of 30g of fiber. So, if I struggle with fats, and restrict my carbs, what’s left?
Protein! Which, unfortunately, is expensive, doesn’t keep well, and is relatively difficult to find for snacks/on-the-go/quick foods. So, it requires some planning. For me, I sort of religiously use the following foods to get enough protein and calories (I eat 160-200g of protein per day, again depending on physical demands):
Why do you think that is not true? I eat whatever I want and insulin covers it. Just like for the non-diabetic. It just requires planning, timing, and proper dosing.
Sure I could do that too. I just would need 1 pen of humalog a day.
Diabetes is a dynamic disease. Although we can use various static formulas to guide insulin dosing such as insulin to carb ratio, insulin sensitivity, and insulin duration of action, many of us also observe that these metrics are not rock solid. They each, in turn, move within their own range.
They can vary from day to day or even by time of day. They may change due to exercise intensity and duration and for many women by their current position in their monthly hormonal cycle. Simply counting nutrition carefully and dosing accordingly does not insure an optimal insulin dose each and every time.
So we are faced with a system with inherent elasticity in the major factors that determine the best dose size and timing. Bernstein has written about his law of small numbers. It basically says that fewer carbs drives taking less insulin which in turn means smaller mistakes.
Making a 10% error on a calculated insulin dose of five units means missing your target by +/- 0.5 units of insulin. A 10% error on a dose of 20 units equates to a possible dose error of +/- 2.0 units of insulin. You can easily see that as the possible dose error, as measured in units of insulin, goes up, so does the risk.
Now, it’s possible that a person with diabetes can get very good at dosing for high carb meals. But, with all the moving parts in glucose metabolism, it’s highly likely, due to the sheer number of insulin dosing decisions, they will, over time, face a significant under- or over-dose of insulin.
That is a high stakes game I played for many years. Due to a robust habit of fingersticking up to 12-20 times per day before the days of the CGM, I was pretty good a catching errant insulin doses – until I didn’t. Unfortunately the consequences of overdosing insulin can be severe. I am lucky to be alive considering the two or three dicey situations I found myself during my 33 years of living with T1D.
Once I discovered the beauty of a carb-limited way of eating together with its inherently safer nature, I will never go back to playing that high-stakes game. Getting the higher insulin dose calculation right 999 times out of 1000 is not good enough in my book because it only takes one unlucky instance to expose the real risk since the consequence can be terminal.
I tend to agree that being told in my mid-20s that I could eat whatever I wanted and just cover it with insulin was terrible advice that has negatively impacted my life.
I did eat whatever I wanted for a few years. My A1c, while it didn’t rise, also didn’t improve at all with the switch from NPH to Lantus, when I think it could have. And, more importantly, I gained a ton of weight. I am still trying to lose that weight ten years later.
A couple of years ago I was able to hit an A1c of 6.0% - 6.2%, and I would say that I did it without limiting carbohydrates too much, but I was eating about 90 grams total per day, which is low-carb. After a couple of years of eating more carbohydrates and having a higher A1c, I suspect I will be back to those low levels when I get it checked next month, but only because I’ve gone back to eating an even lower-carb diet at about 40-60 total grams per day.
Due to a variety of factors (being overweight, taking medication that causes weight gain, having blood sugars that are somewhat difficult to control, needing to take a lot of insulin if I eat high-carb, maybe the fact that I am female) I can’t eat whatever I want unless I want to gain more weight and live on the blood sugar roller-coaster. A low-carb diet is the only way for me to lose weight and keep my blood sugar under tight control. Eating low-carb and minimizing the insulin I bolus also helps my infusion sets last a full two days instead of dying after 12-24 hours, and having a steady blood sugar also helps CGM sensors last longer than they do with widely variable blood sugar levels, so those are two very nice side effects for me.
What the phrase should be is, “You can eat the same diet approved by nutritionists for non-diabetics, as long as you take insulin for it.”
I can’t eat anything I want. I’m still middle-aged AND skinny, but I didn’t stay skinny by eating whatever I wanted. I have a diet that gives me enough energy and doesn’t put extra weight on my body. Admittedly, the most difficult part is taking the right amount of insulin. But that is true of every Type 1 or insulin-dependent Type 2.
If I didn’t develop Type 1, I probably would have continued to eat “whatever I want.” My family are generally lean and I NEVER had any weight issues (and I still don’t).
But I am unique. I think the best advice I would give a Type 1 on food is eat what meets your needs. Whatever that may be. I would never insist on telling someone to eat a certain way. “Your diabetes may vary” because “your body may vary.”
When I was diagnosed as an 11 yr old in 82, I was told about all the things I was never supposed to eat again. Big bummer for a kid. So I was sneaky with candy and guilty with high BS. Bad cycle.
So when a pivotal clicinical trial showed that MMDI was a better way to manage diabetes and that you could use sliding scale to cover food intake. That was revelatory for us T1s. It made us closer to normal.
Lastly, saying “I can eat anything I want,” is great for non-diabetics questions about “can you eat that?”
So those of us diagnosed before the era of the sliding scale, being told you could eat normally and adjust insulin for it was a huge sea change.
I went through that too when I switched to basal-bolus MDI after 20 yrs on R/N. “Either you can’t or you gotta” had been the rule for hi carb foods for so long, and for a while there I relished not being strapped into that straightjacket. But I guess I’d been in it long enough that I retained most of my habitual avoidance. Bigger deal for me was just not having to adhere to such a rigid schedule in order to avoid the nasty hypos always waiting around the corner–being able to eat when I wanted to with the Lantus was a much bigger deal than eating what I wanted to with the Novolog. Over time I began to try being more free about the “what,” too, but I eventually arrived at my own version of Bernstein’s principle–fewer carbs drives taking less insulin which in turn means smaller mistakes --that @Terry4 cites above. It’s just so much easier to stay off the damn roller coaster if I just Don’t Go There. It’s nice to at least have the option to stray from the straight-and-narrow every once in a while, but I generally find it a lot easier if I constrain even those indulgences to things that aren’t so hard to rein in. Beer, yes occasionally. Pastries, french fries, Chinese food? Not so much. Time of day also plays a role. Indulging in carbs at mid day gives you lots of time to make sure you haven’t over or under-compensated. Making that same educated guess (which is essentially what carb-counting boils down to, at least for me) an hour before bed time is a much scarier proposition.
Exactly. I think this is a big part of my inability to switch my mindset. I was on R and N for my first 12 years of T1. I can still, to this day, having been pumping for the same amount of time, quote you my last R/N dosages (2 and 21 in the morning, 5 and 11 at night). I think it was just so drilled into me “you HAVE to get all your carbs!!!” that to this day I often use the fact that T1’s HAVE to eat carbs to balance the insulin we take as an explanation when people ask me why I’m eating pasta. It’s like trying to overcome brainwashing LOL
Interesting thread. i just finished reading brighspots and landmines --promoting the 30 carb per meal plan. I do question however the idea of eating so much fat to compensate --especially the high saturated fats in dairy and meat. My goal is to get thru each day with good control and to eat healthy for the long run. I’ve been eating primarily heart healthy diet for ten years and I’m not willing to give all that up especially considering some of the complications that may appear in the years to come. So keeping heart healthy --good diet and exercise , and trying to manage the 30-40 carbs per meal diet --and maintain a good weight – its a real balancing act. Some non t1 friends and family really don’t understand why I pit so much work into this ………
One of the interesting things about fat consumption is that it really does affect people differently. Pre-diagnosis, I was a typical “healthy American eater.” I ate lots of whole grains, brown rice, very little dairy or saturated fats, most chicken or venison if I was eating meat, and plenty of fish. I avoided beef, bacon, ribs, butter, etc. And I ended up diagnosed as diabetic and with high cholesterol. Turns out the diabetes was Type 1, but before I learned that I’d already discovered that low-carb, high fat diets were really good for controlling BG in Type 2s (which I thought I was).
Anyhow, I now eat moderate amounts of carbs, and a ton of protein, but my fat consumption (and saturated fat in particular) is through the roof compared to what it’s been my entire life. The results? My lipid profile is almost too low: low LDL, low VLDL, borderline non-existent triglycerides (thanks low-carb!), and very high HDL. My computed “cardiac risk” dropped below 1.0%. Why? Doctor thinks I’m one of those people that responds very well to a high-saturated fat diet so long as I exercise intensely.
I’ve always been into training, but fueling it with carbs didn’t work. Now that I primarily subsist on protein and fats (many of which are saturated fats), my body is responding ridiculously well. I genuinely believe that people respond differently to different kinds of diets. Some people are primed to work on high carb, low-fat diets. Some people (like myself) do best on high protein, high fat diets. Where we go wrong with nutrition is suggesting that one size fits all: the best advice for a diabetic (or anyone else for that matter) isn’t “eat 30g of carbs per meal” or “avoid saturated fats” or “eat a ton of protein.” The only sensible advice is to experiment with eating different combinations of macros and use data to decide what works best (glucometer readings, A1c, and lipid panels).
Thanks for your perspective David. Like you , I was diagonosed as type 2 (at 56) after being told I was pre diabetic 6 months earlier. I fully controlled all for about a year with diet (dr Bernard-vegan–high carb low fat) for 1 yer, then with meds for 1 year. When they wanted to add 1 more med to control–I decided to seek out another doctor. Confirmed type 1–and started insulin–and changed my diet from vegan to eating fish/limited dairy/no gluten. So yes it’s a process to figure it out. Good control so far [5.9] and just started using a cgm which I fought doing but now I love. I wish there was a one size fits all aproach but learning it’s about experimentation/logging/testing and trying to see what works. I agree that exercise is key – and I ‘try’ to do something everyday --thanks again for your thoughts
YEP!