To low carb or not to low carb

I've been reading a lot of the threads here and see a lot about a low carb diet. However, I have a question or series of questions. First let me start out on this premise: Let's say I am a type 1 diabetic (how about that, I am!) and I know my I:C ratio is 1:20 as an example. As long as I give myself proper insulin for the carbs I don't have a problem with my BG being out of control after meals regardless of whether I have 200 carbs a meal or 60. In this type of situation, what is the benefit to me as a diabetic, not just general health benefits anyone could get, from being on a low-carb diet? In essence, I'm doing what my pancreas would normally do and dose for the meal (although my pancreas was much more efficient and precise of course).

If this is a hot-button issue here then forgive me, I don't intend to open up a can of worms. My books from Dr. Bernstein and 'Think Like a Pancreas' are still on their way, so maybe they will answer this question. I've just seen a few people here who seem to feel very guilty that they were still "living like they didn't have diabetes and dosing for the meal." If you're BG's are in check and your otherwise healthy and doing okay, why is this a problem? Again, we're discounting the benefits anyone could get, and focusing on why it's beneficial specifically for diabetics.

NOTE: I DO count my carbs religiously (I don't see how that could be optional as a T1) and try, in general, to eat fewer than I did before I was diagnosed. Also, the ratios and scenario above do not fit me, they are just setting the stage for the discussion.

I'll chime in first. One benefit would be lower carbs would generally mean lower insulin doses and therefore if a mistake were made it would be less severe. Is that all there is though?

Yes this is true...also I would say the more insulin you use, the more sugar that is being pulled out of your blood stream, the more fat that insulin is going to pack on you. So if you are wanting to stay in decent shape, the low carb diet helps. I am new to this, but I feel like a healthy diabetic diet (type 1 that is) is EXACTLY like a healthy diet for someone without diabetes. Keep everything proportioned and you should be fine. If you are any kind of active, you NEED carbs, they are energy. If you are trying to lose weight, cut carbs, if you are trying to gain weight or are participating in activities that require a lot of physical exertion, increase protein and carbs.

Your thinking is correct though, IF you dose correctly, it shouldn't matter (as far as blood sugar is related, actual health is a total different story). In my opinion it's just like a person without diabetes. If they want to go eat 200 carbs per meal, go right on ahead! You just better be ready to run a half marathon per day or be prepared to gain quite a bit of weight.

That’s exactly it. Lower carbs decreases the results if you are off. I think that it’s easier to tell what your ratios are with smaller doses of food and insulin. I also think it’s easier to identify changes and make adjustments to rates and ratios. That being said, I also think that you can see a lot of that just by doing “less carb” rather than “low carb”

I don’t think there’s a huge correlation between running 1/2 marathons and not gaining weight though, or I’d be skinnier?

Excellent question, though I'm not sure why you wrote a hypothetical scenario instead of your own! But I'll suggest some answers. First of all if this hypothetical person was diagnosed as recently as you were, then there is a very good chance they are in their honeymoon and that things will change. Most Type 1's have some trouble in bolusing for their carbs and remaining in target after meals (I won't get into the discussion of "what is that target?".) Some people are more carb sensitive than others. I'll speak for myself. At breakfast my I:C ratio is 1:5, so I keep it to 20 carbs during the week and up to 33 on the weekend. The amounts of insulin I'd have to take for more carbs just feel like too much to me. But for many of us there is also a threshold above which we can not bolus with accuracy. At dinner my ratio is a lot better: 1:20, but I find once I go over the 50 carb level my results are not predictable or consistent. For many of us, in addition to numbers, we are not able to predictably bolus for certain foods, and they are, of course, the higher carb foods: My own are rice, cereal and to a lesser extent pasta and pizza.

Another reason to limit carbs is what Dr. Bernstein calls "the law of small numbers". I'm not a Bernstein follower - I just stay under about 100 a day. But I do like this law. It says, in effect, the more carbs, the more insulin needed, the more chance for error and for unforeseen consequences such as serious highs or serious lows.

Then there are two kind of longer term issues. You're right that this is a hot issue, and I've gotten indignation from some people when I say this, while others agree. If you "eat whatever you want and bolus for it" which is, of course, the extreme version of not limiting carbs, you are subject to both gain weight and develop insulin resistance. Insulin resistance combined with insulin deficiency is not a fun combination.

Everyone makes their choices as far as how many carbs (and what kind) we eat or don't eat. I have chosen not to low carb (I consider myself "moderate/low" although we have had endless debates about terms. To me Bernstein is 30 carbs per day - that is "low carb". I've made my choice for various reasons but I still have utmost respect for people who low carb and the results they get doing it.

I low carb as a T1. But I don't follow Bernstein per se. I make my own low carb rules that I know work for ME. During the first year I definitely limited my carb intake but I still ate regular bread, potatoes on occasion, ice cream etc. Once my pancreas went kaput and my insulin needs increased, I was concerned about the amount of insulin I intake daily. I am not weight obsessed but I have been thin all my life and I like the way I feel and look. But that is really not the main reason I low carb. I do it because for ME I have found that my blood sugars are very consistent when I eat this way. I pretty much make all my own food and I love the things I make and eat. I have had a blast learning to bake and cook this way. I read many different food blogs and have found that the food I make and eat is delicious and really satisfying. Plus, I feel like I eat more healthfully this way. When I go to the market I pretty much shop the periphery...fruits, veggies, dairy, meat and cheese. I just don't eat things out of a box anymore. When I read the ingredients it seems they invariably slip things in that for ME raise my sugars.

So in the end I think it's a personal choice of what you like,can tolerate and feel the best in doing for you overall health. There is no right way only YOUR way.

This is all very good information. I was assuming that awg was exaggerating (or at least I hope he is) when he said 200 carbs per MEAL, therefore I might have exaggerated a bit on the half-marathon. However, I would love (or hate) to see a diabetic try one of those diet plans. I seriously doubt that at 600+ carbs a day (unless you are Michael Phelps) a type 1 diabetic would be able to maintain weight. Maybe I'm wrong, but I don't want to test it!

I certainly agree, if you're physically active and involved in athletics you need those carbs to keep your body going. Let's face it, carbs are one of major energy sources our bodies use.

I don't know that I'd say the more insulin you take the more sugar it's going to pull out and fat it'll pack on. If I were to order a baked potato as a side instead of cooked broccoli (we'll assume they're both naked to make it easy) then I just about tripled the amount of carbs compared to the broccoli, but didn't increase the fat. My insulin needs go up, but there's no extra fat to be absorbed. DV amounts for broccoliand potatoin those links. High carb doesn't necessarily equal high fat. However, when it does this may actually be the case. I couldn't really say.

The little (very little) bit of research I did before asking this also showed that typically people lose about the same amount of weight going low carb as when they go low fat. But I'd also agree that a healthy diet in general for a diabetic is going to be the same as a healthy diet for a non-D. Such a balancing act to be healthy in general!

Just to clarify, I'm not trying to attack you here at all, so please accept my apologies if it has come across as such. I know things can come across worse when typed out than when you can actually hear the person say it.

True, but that totally depends on your activity level. I see carbs as things that float out there for awhile. Carbs turn into glucose, and glucose is energy. If you eat more carbs, which make more glucose, and you do NOT exercise, what is that glucose going to do? It is going to be stored as fat. Carbs are great for highly active people. But if you don't plan on exercising or moving around, and you eat a lot of carbs, you won't use all those carbs, and they then will be stored. If they are not used, where do they go?

This is why when you want to lose weight you go low carb. Now you burn all the little amount of carbs that are fresh, and when there is no more, the body goes to the "old" carbs, which are stored as fat, and burns them, hence the weight loss. I am not advocating low carb, but just like insulin and anything else, it is a balance.

Zoe, I've come to enjoy reading your posts! Anyway, I didn't use my actual numbers because I am new to this and I'm still getting honed in on them. I just picked fictitious ones so we'd all have a baseline in case someone wanted to get fancy and start doing some math!

That's great to know that, for some, if they go above a certain level the results are less predictable! If I get nothing else out of this then I'm glad I asked because I learned that. Hopefully I'll learn more though. I'm watching my carbs pretty well right now, so I don't know if I fall into that category or not yet. I can definitely see why one would want to limit their carb intake if that were the case for them though. Makes perfect sense! Does that seem to be the case for a lot of you here?

I kind of alluded to "the law of small numbers", just didn't know what to call it. But yeah, definitely another good reason to limit the carbs. Miscalculation on 30 carbs would be a lot less severe than on 300 for sure. Also wouldn't want to develop insulin resistance. Is this a common problem for type 1's who have been using large amounts of insulin throughout their lives?

Like you, I have the utmost respect for people who adhere to a low carb (or any serious diet plan for that matter) diet. It takes a lot of discipline to do so. I guess I'm also trying to understand why people seem to feel guilty for dosing to the carbs when that's what their pancreas would've been doing anyway had they been a non-D.

I have a theory that it works better to have smaller portions of carbs during a long run than to load up beforehand a lot. I always have some but have had several 30+ mile weeks fueled by maybe 15G of carbs at breakfast and maybe another 20 while I’m running? It’s always a work in progress but I seem to do ok w/ fairly light carbs, although I’m not Michael Phelps!

I second that! Zoe, reading your experiences and info has really helped me out these past 2 months. You, along with the other great members of this sight have helped me more than any medical website out there. Thanks!

Hey, thanks! I have something to say about (almost)

I would venture a guess that there are a lot more Type 1's who have developed insulin resistance than actually talk about it, especially those who were diagnosed in the days before the DOC and before an awareness of low carb options. I think there is a culture of low carb on this board (which is a good thing) but perhaps it makes some people who eat a lot of carbs be a bit reluctant to admit it. (not so good).There are some regulars though who eat a fair amount of carbs and seem to have good control. I do think that is easier for some than others to accomplish though.

Yeah, well as far as distance running goes, you definitely have more experience than me. I just thought of a hard exercise, and half marathon it was! Being a football player my whole life, all of our workouts and games require very short burst of high intensity, which is the exact opposite of you distance runners. My diet transition once I stop playing, (which is happening this summer, finally hanging up the cleats!) is going to be a challenge. Finding out the amount of carbs I need for my "new" exercises and daily activity was going to be hard before, now add diabetes to that transition and I feel like I am having to completely start over. LIke everything else with this disease, I guess I am in for a lot of trial and error....

Hi awg0681,

You'll learn a great deal from Dr. Bernstein's book whether you choose to follow his approach or not. And in case you haven't seen references to it already, I also learned a lot from Jenny Ruhl's book, Blood Sugar 101, and website I would recommend her book as a great place to start for anyone new to diabetes.

Best wishes


Yeah, the 200 a meal was definitely an exaggeration! It was just to get across the point for the scenario that no matter the carb intake, dosing properly keeps BG in range. 200 a meal would be a wee bit on the excessive side. ;-)

Ive been trying to cut carbs too, ive lost like 20 pounds, my carb ratio is I:C is 1:4, I go threw 300 units in about 2 1/2 days. I wish my body didnt require so much insulin. Im a type one but i didnt carb count before the pump now i do, I would just do 25 units for breakfeast, lunch, 30 to 35 for dinner. For stuff like the chinese buffet i would do like 45 to 50 units.

Thanks for the resource, Marty. I'll take all the information I can get. If what Zoe is saying about Dr. Bernstein (anyone else always think Berenstain when they see that name or is it just me?) and keeping carbs to 30 or so a day is true then I don't think I'll be following that to the letter. Going that low begs the question as to what side effects there would be to that diet. I read an article where they talk about the common side effects from low carb dieting. Short excerpt on side effects:

"The most frequent complaints with low-carb diets are constipation and headache, which are readily explained by the lack of fruit, vegetables and whole grains, Astrup said.
Also, bad breath, muscle cramps, diarrhea, general weakness and rashes are more often reported on low-carb diets than on low-fat diets, Astrup found.
"The majority had some of these side effects in the Atkins group. In the control group, almost nothing," he said.
These side effects are consistent with carbohydrate deficiency, because the brain and muscle do not get enough sugar from carbohydrates to maintain their normal function, Astrup said." (Full Text Here)

None of that sounds too fun either! Now, that is a news article and not a medical article/journal, so take it as you will.

As crazy as it sounds...I bet in my college playing days, I was eating around 400-500 carbs a day. I never carb counted back then, just thinking back to how I used to eat. I never considered myself an unhealthy eater, I just was a carb loader with our workout regiment.