The "right" amount of carbs

If you are a Type 1 (or otherwise not producing any insulin), how do you find out the “right” amount of carbs if you are eating low carb?



I have been trying to eat lower carb but no matter how low I go, it hasn’t seemed to make any difference in my daily blood sugars below about 150 or so a day. Above that I can see I spike higher after meals (into the teens), but below that I have not seen any significant difference even after a few weeks. I am nowhere CLOSE to being able to hit 7.8 or less after meals on a consistent basis, and I’m still having highs and/or lows every day.



For example, today I ate 86 grams of carbs and my blood sugars looked like this (which is pretty representative of my overall range each day, though today I had no lows):



6:28am - 4.7 (85)

8:18am - 3.9 (70) - Breakfast (25g)

10:22am - 7.5 (135)

12:34pm - 6.0 (108) - Lunch (28g)

2:18pm - 9.4 (169)

3:28pm - 11.7 (211) - Snack (8g), correction

5:44pm - 6.9 (124) - Dinner (25g)

7:49pm - 12.7 (229) - Correction



The blanks there mean I took no action (no food or insulin).



I understand that for a Type 2 who is still producing insulin, they can just test after a meal and if they are high they know they had too many carbs. But for a Type 1 there is also I:C ratio to take into account, plus a million other factors. For today I was also pre-bolusing by about 20 minutes for each meal, though this is much harder to do on days I’m out and about. Today I also weighed and measured everything as I was eating at home all day, so it was all accurate counting.



I did just lower my basal rate by 0.15 units an hour (about four units total) and my I:C ratio and ISF changed from 1:7 to 1:9 and 2.4 to 2.8, respectively, over the past two days. This is due to the monthly “drop” kicking in (I had five lows over the past two days and lots of borderline lows), so maybe I need to tweak them a bit more. Once I do they should hopefully be good for a few weeks before “the rise” kicks in.



But still, I find it crazy that I am still trying to stay between 70 - 200 each day (sorry, switching between Canadian and American here!). I don’t think that should be THAT hard of a goal. I don’t know if I just have particularly unstable diabetes or what, but I’d like to figure it out. Which brings up another question: has anyone here had trouble controlling their blood sugars even with a pump (NOT one of the older regimens) and found that low carb makes them dramatically more stable? Because … it’s just not happening for me. :frowning: Do I just need to give it a few more weeks?

Low carbing for me does not mean I will have better numbers, but it does mean that my highs come down faster and don’t stay high for as long, so for me that is worth something. I think it is quite impossible to have great numbers no matter what I try, due to exercise, stress, and hormones. I too have the extreme highs with increased hormones and then I bottom out with days of lows when my homone level drops, and it is hard to adjust insulin dosages to be in sync with hormones.

Hi Jen,
wondering what carbs you are eating rather than just quantity ?

I’m T1 and using MM insulin pump. Also using Dexcom CGMS.

I cut back my carbs earlier this year, with great success. But it was mostly the kind of carb. I eliminated the ‘white/grains’ carbs (breads, crackers, pasta, pizza, starchy vegetables, etc), and increased vegetables (broccolli, cauliflower, spinach, etc), dairy, fruits (limited), meats and proteins (including eggs). Currently I eat about 80-100 carbs/day, and can usually keep BG under 150.

I used to eat cereals, potatoes, rice, pasta, etc… whatever was ‘quick’ to prepare and consume. I would frequently spike to 200+ and take 3-5 hours to get back under 150.

Now I also wait longer after bolus, or square wave a ‘correction’ prior to meal. And I eat the meal more slowly, starting with the proteins/leafy vegetables first, giving the bolus even more time to work. I’m fortunate to have flexibility for this, I know this can be challenging.

The best advice I learned from this site was ‘eat to your meter’. At first, I was hesitant to eliminate certain carbs, but once I had CGMS and did more after meal BG checks, I learned quickly what did and didn’t spike my BG. If it caused spike, I would either delay longer, reduce serving size, make different combinations, or eliminate it !

It’s been months since I switched and I’m still learning ! Hope you stick with it a little longer, and try different types of carbs to see what works for you.

How many carbs do you eat a day? And how did you decide on that amount if it doesn’t really affect your BG range?

Thanks for your comments. I already typically stay away from bread (at least white bread, might have a slice of whole wheat bread, though, but rarely two at once), and potatoes were never a problem as I’m severely allergic to them. Rice and pasta I will eat in small sizes (like 1/2 cup), and same with starchy veggies.

Today for breakfast I had high-fibre cereal and almond milk, and coffee with cream.

For lunch I had a piece of whole-wheat bread (toasted) with peanut butter, and some cheese and pecans.

For my snack I had coffee with steamed milk.

For dinner I had 1/2 cup of rice, and chicken (no skin), and a salad.

I don’t know if I’m eating the wrong food but I don’t think food is the only factor … I corrected the 12.7 and two hours later was only down to 11.9. I corrected that and will test in another hour and if it still hasn’t come down, maybe it’s my pump site … I have no idea. I don’t think I should be that high from just the food I ate at dinner, though.

Anyway, thanks for any other thoughts you have!

One method I tried which worked but which is hard to do on a daily basis, was to never eat more than 10g of carb (or equivalent in protein) in one sitting. The idea being, given a fasting BG in target, 10g of carb would never spike me more than 7.8/140. (We will leave aside the fact that BG can spike from non-food issues.)

And, it does work. In fact, I even once tried it out on thin-crust pizza. I ate one slice every two hours, and bolused for 20g of carbs each time. So yes, it took me two days to finish the whole pizza but the highest BG I had was 7.5 and the lowest was 3.9, which is not a bad flatline for eating pizza!

The downside, of course, is that it’s hard to fit into the practicalities of real life!

Jen,
Do you know if caffeine affects your bg? I know that 1 gram of caffeine raises my bg about 1 point. THere have been discussions here on TU, and some people are affected while others are not.

I try to somewhat follow Bernsteins model and eat fewer than 7 grams of carbs for breakfast and 15 or less after noon. That seems to work pretty well for me. I couldn’t keep my blood sugars flat unless I keep the carbs that low. Also, if I venture into the high fibre cereal, I tend to eat it with half and half. It keeps me full longer than almond milk, and has about the same number of carbs, maybe less.

It sounds like your carb counting is pretty accurate from which I’d suspect it might be a ratio? At lunch the post-parandial was in the 160s, which is ok but there’s room to knock it down a shade too so a bit of additional insulin would have done the trick I would think? I’d also think the 211 might be because the nuts would digest a bit more slowly than the other stuff? I’d probably skip the afternooon snack if my BG were up, although if I were stressed out, I’d bolus and wait like 1/2 hour or 45 minutes to eat it, until it was perceptably dropping.

I am aware that many health authorities are fond of “whole grain” bread but I seem to get decent results with storebought/ whitish bread, currently getting the Bimba Soft Wheat which is 11G of carbs/ slice, another way to carve it up? Although I’m having 2 pieces this am! A lot of times at breakfast, I just have eggs and some veggies and just skip the toast. The last 2 weeks have been a bit different as I jacked up the carbs before the race but skipping those carbs entirely in the AM I still sometimes will see a drift up, even when I eat eggs/ broccoli/ spinach and bolus for like 15G of carbs? If I have V8, I’ll bolus for 25. I dunno if it’s “TAG”, DP or what but it seems to come out ok.

oh it does effect my range, so less is best, usually 30 carbs at breakfast, about 60 at lunch and dinner varies. I am just saying that if I go high and stay high it is because I ate too many carbs, fat, etc. and then the high takes hours and hours to bring down. If I eat the same things for breakfast and lunch and not a ton of food like my standard breakfast and lunch and if I go high usually can bring it down rather quickly, because there are not other factors that will make it high again later, fats are killers later. Hope I am making sense.

I think that the primary reason that you lower carbs should be to help your blood sugar swings from eating. It won’t help you set your basal and it won’t help you choose the right basal or correction dose. So the primary purpose is to help control the after meal blood sugar swings.



Having only 25g of carbs for each meal is pretty low carb. For most people, each gram of carb will raise them 0.3 mmol/L (5 mg/dl). That means that a lunch like yours should have raised you to 13.5 mmol/l (250 mg/dl) if you took “no” basal. But you took your basal and it had almost no effect. Do you think you might have problems with wheat?



And I would also say that once you have gone high for the day (> 200-250 mg/dl), then you may be markedly more insulin resistant and then you will have more trouble. So don’t take your troubles at dinner as resulting from your eating or dosing, it is probably due to your high blood sugars earlier.



And always remember, tomorrow is another day.

ps. I find that wheat products (like bread and even crackers) often gives me a much higher blood sugar response. Twice what I would have expected from the carb count.

I don’t know about wheat (wouldn’t I spike from every meal then, as I pretty much always eat it?), but yesterday I think my infusion set was off. I corrected my 12.7 and two hours later was only down to 11.9, and an hour after that was up to 12.9, so I changed my site as it was also getting really itchy, and it was very red under the adhesive. Then I corrected again and this morning I woke up at 3.3. So I think for some of those meals it basically was like eating without bolusing. Next time I order infusion sets I’m going to try needle sets because I am really beginning to think I might be allergic to the cannula and/or the adhesive on the ones I’m using.

I’ll keep the insulin resistance thing in mind. I know that at the time you’re high you are insulin resistant, but didn’t realize it could continue to have an effect for the rest of the day.

Just for me, Jen, two of the things you list - cereal and rice are things I find I can’t eat at all (even in reasonable amounts) without spiking.

I noticed you said when you tweaked your basal, you did it across the board .15 per hour. When I make basal changes I usually only do .025 changes so I don’t ping pong in the other direction (I have a Ping - not sure which pump you have and what number changes you can make - but anyway the minimum). Also, it looks like you might have particular “time zones” that need tweaking, while others don’t rather than just making it all the same rate.

Perhaps your lunch and dinner I:C’s need tweaking a bit? You said you had raised them, so perhaps they need to come back down? Btw I also have “drifts” of needing to lower rates a bit then awhile later having to raise them, and I’m post-menopausal. Whenever I have asked on here several other type 1’s chimed in that they also had “drifts”.

Finally, I would have corrected the 169. I always correct post prandial highs unless I see I still have IOB which will handle it.

Yeah, I’m not sure I could follow that and actually stick to it … LOL.

One thing I’m trying to find are snacks which are very portable (can be stuck in a purse, basically) and low-carb and don’t require any kind of temperature control (and are also not nuts). I am going to try and start carrying something around with me so if I go for coffee with friends or something and they get a treat, I’ll have something to eat that isn’t 60g of high-GI carbs from behind the counter. By far my weakest time for sticking to low carb is on days I’m out and about, so I think this would help.

I don’t think caffeine affects me, but I guess to test that I’d have to drink some caffeine that didn’t involve any other carbs.

Right now for the carbs I am sticking to <30 a meal which is still challenging although I’m making it more often than I’m not. Once I find it each I may go lower, but I’m also not sure I’d be willing to go even lower, but we’ll see. There was a time I thought I would never go as low as I’m eating now, so who knows!

I am pretty sure my changes are from hormones because they happen every two weeks or so and do follow the pattern of my cycle, but they are not totally predictable. I wouldn’t really call it a drift, more like a sudden dramatic change! It usually goes where I am fine and then suddenly without warning ALL my readings will be above 200 for no reason (I even caught this when I did a CGM for a week a few years ago!) and I have to raise everything a few notches, and even with that for the remaining two weeks I tend to have way more highs than lows. Then two weeks later I’ll be going along fine and maybe notice a day or two where I am in range a lot rather than having highs, and then all of a sudden will have a day where I just can’t get my blood sugar to stay up, and that’s when I need to lower everything again, and then for the remaining two weeks it’s like I can do no wrong as far as highs are concerned. Then it starts all over again. I do think there is a bit of adjustment (overshooting the settings) sometimes, but I have learned (at least for the “rise” part) that the faster I jack things up higher the easier it is to get things under control. If I only change things by the smallest amount I end up going two or three days running either really high or having constant lows, which is why I’ve started changing settings every 12h or so till my blood sugars seem more level. Usually I have to change my basal rates 0.15 to 0.2 units an hour and have to change my I:C ratio up or two 3 or 4 points, and I change my ISF a corresponding amount (up or two 0.2 mmol/L for every point I change my I:C, if that makes sense).

I actually think yesterday my infusion set was being rejected (I’m beginning to think I have an allergy to the adhesive or cannula as they barely last two days and often get very itchy and red by the end), because in the evening I could not get down below 200 even with repeated corrections, so I eventually changed it. This morning I woke up at 59, so my settings may need a bit more lowering, we will see what the day brings …

I have been being cautious about correcting post-prandial readings because I had been really stacking insulin before. I really do NOT like the way the Ping handles IOB and it seems to allow me to stack insulin in a way that my Cozmo previously did not. I don’t always remember to look at the IOB (the pump screen is a huge effort for me to see so I only read what I “have to” and sometimes forget to look at the IOB when I’m correcting) so sometimes I will just not correct rather than have to figure out the correction and take off the IOB that the pump doesn’t subtract properly! Anyway, that is the one frustration I have with Ping, but otherwise it’s a great pump.

That must be frustrating not being able to see the pump screen easily. Was your previous pump screen easier for you to read? I assume you’ve tried messing with the contrast to see if that helps.

It sounds like you pretty much know your patterns, but that doesn’t make them any less frustrating! I eat about 80-100 carbs a day. I’ve found that it isn’t the total that helps manage so much as the individual meals. Occasionally I have a dinner that is 50 carbs and when I get to that level my regular I:C ratios don’t work. But I do agree with others that it isn’t as much the amount of carbs as the type of carbs. As a vegetarian I always ate a lot of pasta and rice. And my favorite breakfast was granola yogurt and fruit. I tried every type cereal in my (extensive) market, including “healthy” ones and finally had to accept I couldn’t eat any cereal. Ditto rice. Gone. Pasta I can bolus for when I eat it occasionally when I go out and it’s the only vegetarian option, though it still is somewhat unpredictable.

Having Type 1 definitely improves our frustration tolerance.

It does sound like you might have some kind of allergy. I don’t get itchy sites, but yesterday I saw some blood under the canula and got my paper towel ready because I knew I’d have a gusher when I removed it. I use Viva, a very thick paper towel, and it still drenched it.

I agree with the others that it is the quality of the carbs you eat. I am not a big cereal eater but I know other people have complained about cereal and BS. Interestingly though, I don’t have the same issues with rice that other people do as long as I eat it in small quantities. I also bolus more for it than I would a different food though. I had some yesterday as a “bad day” splurge and I ended up going low, not high (guess I over-bolused!).

I have the most problems with carbs in the morning. I drink some Gatorade everyday because I have issues with dehydration – the one I buy has 7 grams of carbs in. I can have it with lunch or dinner without a problem but if I have it in the mornings, I shoot up to over 200. I have seen other people say that they are able to manage cereal by having it in the evenings and not mornings. Sometimes it isn’t the food but what time you eat it.

Another thought is that some people find when they go lower carb, they now have to account for the protein and fat that they eat. Danny started a TAG group here. TAG stands for Total Available Glucose. You bolus for your protein & fat using an extended bolus. It is kind of like carb counting – you have a ratio that you use but count the protein & fat grams instead of carbs. You would bolus for it on your pump like a carb but if you came up with needing 2 extra units, you would extend those units over a period of a couple hours. If you want to learn more about TAG, here is the link to the group. Like carbs, you have to play with the percents to come up with what works for you, but it really does help.

http://www.tudiabetes.org/group/tagers

My previous pump was the Cozmo and its screen was impossible to see. I used a 12x (very strong) magnifier with it and even then couldn’t read some of the print. The Ping screen I can just barely see without a magnifier if I put it as close to my eye as I can and squint at it (the only numbers I have trouble with are 0, 6, and 8), but it’s still not easy. I have it set to the highest contrast setting it allows. What I really wish it had was a font size setting and/or some sort of speech output option! I should probably be using a magnifier to see it, and I often put it under my video magnifier when I’m at home, but when I’m out and about that’s just one more “thing” I need to carry around and one more “step” in the process (and also requires two hands) and so, if I can see it without one, I tend to not use one.

I searched forever for a cereal that would work for me and eventually found one, then they took it off the market so I searched around until I found another (actually recommended on this site), and I’m not sure what I’ll do if they take it off the market. I love cereal in the morning, but for a while was having eggs with one piece of toast, but went back to the cereal when the post-prandial readings were just as varied …

I think that is what drives me crazy, too. If I ate the same food and was always at least in the same ballpark with readings afterwards I’d know whether it was okay to eat, but I get such different readings. Yesterday I was 7.5 (135) after breakfast and today I am 11.9 (214 mg/dl). Maybe it is my I:C ratio and I’ll change it if I’m high after lunch, but I bet I could keep it exactly the same and end up in range tomorrow after the same breakfast … It is the same with basal testing, completely different results each time. I look at the “modal day” graph in my pump software and it’s chaos even eating the same foods each day and having the same schedule. Even my endocrinologist says he can’t spot any patterns if given a week or two of my readings (although, yes, I am looking for a new endocrinologist!).

Anyway, sorry for the rant! I just get so completely frustrated sometimes and wonder if I’ll ever figure this stupid disease out.

I think some food spikes most of us and some is very individual. For awhile I was just shooting and eating. Then I realized I was causing some Insulin resistance and gained 5 lbs. My A1c went from 7.0 to 6.5 so my endo doesn’t care but I did. So I cut back on carbs and am much more insulin sensitive again. I don’t think I’ll ever be a real low carber but I have given up cereal, potato, eat small amounts of rice and pasta and I agree the squishy wheat bread at 12 carbs per slice work a lot better than whole grain, at least for me.
I don’t understand why pump makers don’t have products for visually impaired, since that can also link to diabetes. It sounds like you should stick to the needles. Do the cannulas have latex? That’s a common allergy.

Jen - the monthly changes you’re noticing are completely normal for us women. I have to change my lantus (long-acting) dose all month long based on where I am in my cycle. Once I ovulate, I need more lantus until I start my period, the I go back down to my “normal” dose. I also eat less than 30 grams of carbs per day, and my “carbs” only come from non-starchy vegetables - never grains. This keeps my blood sugar in great control. I also only do dairy in the form of heavy cream and cheeses - never milk or half and half, as they will cause a spike. Low carb and good amounts of fat and protein are the key. Have you read Dr. Bernstein’s book, The Diabetes Solution? I know it’s already been mentioned here but it really is spectacular. I also used to use the pump, but went off of it due to skin irritation as well. I now use novolog and lantus on injections and do great. Best of luck.