To low carb or not to low carb

Agreed. In my high school/college days I likely could have been taking in much more than I typically do now. I almost never paid any attention to what I ate until I was diagnosed though. I was active enough, with a good metabolism, good blood pressure and cholesterol scores so it didn't really seem to be an issue. Now, there's pretty much nothing that goes into my mouth before I know the carb count on it at the very least.

Thanks, Benjamin! It feels really good to know I've helped people. (Kind of built into my DNA to do that..lol). When I first came onto this website three years ago I was struggling to figure out my correct diagnosis and this was where it happened for me!

"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."

1. I'm going to postulate that this is true. That you have *good control* and do not have any difference in control no matter how big a meal you eat. (This is definitely not the case for me.)

Here's my take/understanding/not a doctor/I could be wrong:
Given (1) there is very little benefit other than the benefit that any person might derive. Type 1 is primarily the loss of an automatic mechanism that you must replace with a manual one. If you were theoretically able to maintain exactly the same glucose profile as the automatic mechanism, you would have no symptoms and be in the same boat as everyone else. The DCCT trial effectively established this. Having diabetes does not cause the complications. Diabetes causes loss of the automatic mechanism to regulate blood sugar. The resulting high blood sugar causes the complications.

However, even diabetics with "good control" can often have cumulative damage at some point that will affect them adversely. The degree of good control will essentially push that damage farther into the future. At this point, many of the things that affect other people (such as heart disease/etc...) are much more common in diabetics. So, the healthy things in life that reduce heart disease, etc..., will be that much more important for you (us). So, in this manner, even though your control was unaffected by your carb choice, it could be that a poor carb choice will still affect you disproportionately because of your diabetes.

Ultimately, you need to do what is right for you. If you are healthy and can maintain good A1c's with consistently low variance in daily blood sugar (not a lot of highs and lows that average out), don't sweat the low carb diet. The low carb diet can be a great tool for some of us. Same as insulin pumps. If it helps your control and you find it more convenient, fine. If you are doing great without it, more power to you. If someone is proselytizing low-carb, ignore it. But make sure you are honest to yourself about what good control is!

When I go on a low-carb diet, and it has amazingly great impact on my BG.
Here's one reason why:
My I:C is 1:5 and my ISF is 20.
Let's say i eat a 15 carb meal and my starting BG is 100. Even if I FORGET TO TAKE A SHOT, my after meal BG will be 160. The largest expected error to the high end is still within a postprandial range. Nice.

I think it comes down to 3 simple 'rules'.

1. Choose 'healthy' carbs that have higher nutritional value ('whole' foods / less processed, more veggies, etc). They tend to raise BG slowly, and can match the action of bolus insulin. Experiment with how long to wait after bolus to best match the BG rise.

2. Avoid carbs that spike your BG too quickly (different for everyone. some can eat cereal, potatoes, rice, pasta w/o spike, and others can't). This is the 'eat to your meter' concept. Combining carbs with fats/proteins will usually slow down the spike, so can take some experimentation before deciding to totally eliminate a certain carb. Decide what your BG goal is 2 hours after meal, and use your meter to help determine which carbs are ok for you to maintain your goals.

3. Refine and adjust over time. What works at one point for one person often changes as they get older, more or less active, stress, hormonal changes, illness etc.

By having goals for your BG, focusing on 'healthy foods', and using your BG meter (and CGMS) to 'evaluate' your food choices (and other factors), each person can find what's best for them. And when unable to meet goals, there's lots of help here to find what works for others !

The problem with your scenario of taking the right amount of insulin for 200 carbs or whatever number you choose is that it is very difficult to match the peak of the insulin with the digestion of the carbs. If I eat a lot of carbs, my blood sugar spikes high before the insuin peaks and then I end up crashing several hours later as the insulin continues to do its job. I try to bolus 10-20 minutes before meals, but I canā€™t bolus earlier than that without risking major lows.

So hypothetically it should be easy to eat anything you want as long as you bolus for the carbs. In reality, it doesnā€™t work very well for me because the timing just doesnā€™t work.

Remember early in the movie "The Patriot" when the Mel Gibson father character gives his young son a rifle to attack the British military group that had just murdered his second oldest son... He tells him, "Aim small, miss small" as in aim for a button, hit the guy. But aim for the guy, miss entirely. That's what low carb means to me.

I previewed some of Dr. Bernstein's book on Amazon. I will say that it is not for me and leave it at that.

I will also say that there are more calories per gram of fat than per gram of carbohydrate. (Try 9 calories vs. 4 calories.)

I will further add that it's not a good idea for me to eat more than 60g of carbs in one meal because it makes the results extremely unpredictable, even if I follow my I:C ratio to a T. My CDE told me I could eat whatever I wanted, but that if I was looking for a 'safe zone' that 40 to 60g per meal was fine.

And lastly... there is the glycemic index (GI). Some people don't agree with GI, some people do, some people just don't care. I did research on establishing GI's for horses when I was in undergrad... so perhaps I am biased... but the basic premise is that certain carbs spike your sugars more than others. Simply reducing the amount of carbs you eat seems straightforward and easy, but I think it would be wise for a person to also consider the types of carbs they are consuming. Carbs are not inherently evil.. making good choices about which carbs you do eat can make a difference. If you are interested, there is a book entitled The New Glucose Revolution which discusses the GI in people..

And as an addendum... if I personally did a truly 'low carb' diet, all I would actually want to eat are nuts, meat and cheese, probably. Given the inherent risk of heart disease in my family and how really good my lipid panel is right now- I'm going to nom me some carby veggies and be really content with that. However, I have seen people on here report that they are doing low carb and have stellar lipid panels as well.

It's all really what you want to do... Maybe it's 'cause I'm a Libra, but I think balance is the key to nearly everything.. :)

I think any time that someone keeps a food diary or somehow watches what they're eating, they will lose weight... I think it forces you to watch your portions, etc... just my humble opinion..

I have only gained a couple of pounds since diagnosis, which has occurred in the past couple of weeks; and I'm now eating about 150g of carbohydrates per day (I was keeping it less than 100). But I stay active, and am making healthier carb choices than I did prior to diagnosis.

I believe the reason I've gained a couple NOW is because I love Easter candy. Yes, I did eat that Cadbury egg with 25g of carbs in it. And it was totally worth the 2 units I gave!

Err... okay... so I may have eaten like 3 of those in the past couple weeks... and a bunch of Reese's peanut butter eggs...

I have no guilt!

You know that person that gets real grumpy without their morning coffee? That's me without chocolate. :)

I've been low carb eating 30-35 carbs for over 3.5 years. I've never experienced any of negatives on that list. Sorry, but have to eye roll at that article. Plenty of fiber on low carb diets from vegetables, nuts & nut flours. Grains are believed to be high fiber because that's what the marketing & cereal commercials promote. For example, two slices of whole wheat bread has 24 grams carbs & 3.8 grams fiber. A cup of rolled oats has 55.4 grams carbs & only 8.3 grams fiber. One avocado 17 grams carbs & 13.59 carbs fiber. Guess which one has more vitamins, minerals & healthy fats:)

There's not a carb deficiency on low carb because about 58% of protein is converted to glucose & a small percentage of fat. Other biochemical processes also contribute glucose, such as cells dying.

I have more energy eating low carb & feel much better than I did on my former high carb diet.

I think this is a very personal issue. There is a lot of evidence that reduing carbs can help with blood sugar control and weight. And "good" blood sugar control can be obtained when eating carbs. But "good" blood sugar control is a personal issue. Some are happy with a good A1c of 7%, but others really want an A1c in the 5s. If you want an A1c in the 5s, a low carb diet is not just an arbitrary choice, but for most it is a thing that you "must" do to safely attain that level.

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A1C is not an end all beat all number to base everything upon... In current studies that are going on involving diabetics who have lived over 50 years with their disease, the biggest predictor of longevity is what age your ancestors died. If they died of heart disease at an early age, then that puts you at a higher risk for the same issue.

Incidentally, A1C is only 4th on the list of prognostic indicators at this point. It's a great tool, but should never be the only thing that someone focuses on. Having a much lower A1C typically increases risk for hypoglycemic episodes. If you are willing to take the risk and feel that it is worth it, then go for it.

But just as there is damage with prolonged periods of hyperglycemia, there is also damage with hypoglycemia. Acute and severe hypoglycemia can result in death if bad enough... your brain needs glucose to function, and if it doesn't have enough, it can get you into trouble very quickly.

I just feel that all sides should be looked at and weighed before making a decision.

Editing to add that ultimately, it's whatever helps you sleep at night knowing that you've done and are doing all you can.

I agree with you that tight glycemic control is about lowering your average readings and reducing the swings. That is why I said "safely attain that level."

I actually place little faith in my A1c, my meter is the golden measure of my progress and actually for me the fructosamine is much more accurate than the A1c.

Sorry- it's probably my own irrational fear of hypoglycemia that makes me want to point out that 'this is what can happen' every time someone mentions a really low A1C.

I would prefer it if they ran a fructosamine... we use that in animals.. my GP mentioned the research seems to say that it is better than A1C, but he didn't say anything more.

Hell, why not do both?

Oh- because insurance rules all. :/

As a side note here, Dove makes some really good sugar-free chocolate peanut butter candy! I was very surprised when I had it for the first time how good it was. Not necessarily low carb (23g per 3 pieces I think), but very tasty. I don't really have much of a sweet tooth thankfully, but a good peanut butter/chocolate combo is my weakness. That along with chocolate milkshakes/malts.

I found out the hard way that the sugar free stuff makes my stomach very angry if I have too much! But the little Reeseā€™s eggs are like 9g of carbs each, which I feel is reasonable. :slight_smile:

Ugh. Milkshakes. Love those too, but not sure itā€™s worth what would happen after with BGā€¦

Frozen yogurt is supposed to be an okay alternativeā€¦ I havenā€™t yet explored it though.

I'm fairly certain something else will get me before I die of the D. With a history of congestive heart failure, stroke, heart disease, and a degenerative brain disease (sorry, don't recall the name of it, but it's not Alzheimer's) between both sides of my family I'd say it's a safe bet.

I have to agree here that A1c is not a great measure for us. As many have pointed out, and as some on here have admitted, if you balance out your highs with an equal amount of lows then you can still have a good A1c. Your standard deviation is going to be all over the place, and I can't imagine one would feel all that great but you could "fake" a good A1c that way.

The gist of what I'm picking up here is that low carbing is one tool available to us to help manage our BG (among other things). Whether you want to use that tool or prefer a different one is a matter of choice an opinion. One might prefer to draw with charcoal, rather than paint with oils, or like the color pink over green, or like the Xbox over Playstation, Chevy over Ford. Each side of these have their merits, but one is not inherently "right" or "better" for everyone. So it is with low carbing, while there are merits to it, it's not going to be for everyone and they are no more wrong for not doing it than other are right for doing it. Neither side should be made to feel bad, or feel superior, for the choice they make about it.

Breyers has a pretty good low carb ice cream. It's 4g net carbs per 1/2 cup serving, but if it's the splenda/truvia type stuff that angers your tummy you may not want to try it. I haven't tried to make any milkshakes with it, but I can tell you I'm not a big fan of the Hershey's sugar free chocolate syrup.

I don't low-carb, though I've been trying (without much success) to reduce them a bit. The reason is this: post-prandial highs. At my last endo appointment, he told me that those PPD high blood sugars are what makes my A1C higher than I'd like. If I could smooth, or even eliminate, that spike, I'd be better overall.

As for the weight issue, I could actually afford to PUT ON a few pounds! I'm not quite sure how to go about doing that. Fatty, unhealthy stuff doesn't seem quite right, nor does a low-carb diet.

I have read this discussion with interest, because I low carb, sort of. I try to watch my carbs by not intentionally eating carbed foods, and snacking on protein rich foods, such as nuts and meat. I have virtually eliminated breads and starches. What it has done for me is eliminated the need for high doses of insulin at meal time, and increased energy levels and endurance. I have seen a dramatic improvement in my A1-c as well.