I’m starting a new thread from the To Low Carb or Not to Low Carb just because it is already so many pages and it’s hard to navigate.
From reading your posts in that thread, it sounds as though you keep your BG daily between 65-140, have a standard of about 25, and eat moderate carbs of about net 160.
If this isn’t too nosey, I’d love to know your thoughts on how you manage to do that. I can’t even imagine a universe where I could do that. What kind of carbs are you eating and what’s your insulin regimen?
I think that my biggest obstacle is that my short-acting insulin (Novolog, but I’ve also tried Humalog and Apidra) has discernible action 4 hours out. Any bolus that prevents spikes above 140 will ultimately cause a low, even with meals of about 25-35 carbs. Although my snacks are smaller than in the NPH days, I still have to snack mid-morning and mid-afternoon.
I have good A1c’s (in the 5’s), have the pump and Dex, limit carbs to about 100-120 per day, etc. But I am not close to obtaining the type of stability you talk about.
So Maurie, if you have time to respond, what’s the magic?
Well. First, I'm usually between 65-140. But I've spent the past couple days trying to knock down 160s so I wouldn't want you to think that I live in diabetic shanga-la.
If I had to guess the reason my blood sugars are as stable as they are is that I'm only 5 years in with an initial diagnosis at th age of 57. I assume there are at least a few beta cells hiding out and doing some heavy lifting.
I eat a lot of fat and fiber to slow the initial spike. My breakfast is 2 egg beaters, 2 slices of sprouted grain bread with about 60 grams of peanut butter, a cup of tea, 8 oz of 1% milk and a medium apple. That comes out to around 65-70 net carbs. I dose that total minus 10 (for 65 grams I dose for 55). Two hours later I dose for 16 grams of carbs and correct back to 95.
For lunch I usually eat a salad dressed with lemon juice and olive oil topped with about 110 grams of chickpeas, a couple of high fiber crackers, 4 oz of Greek yogurt, a small square of chocolate and an apple. I count and dose this meal. My goal is to be around 120 about 3 hours later which is when I exercise.
I have more variety for dinner and simply count and dose.
I take a long time to eat so that if I dose right before I eat, the bulk of carbs are eaten about 20-30 minutes later.
I don't know why this works. It does and I feel lucky.
That does seem like a ton of food, but maybe it is the mix of fat and fiber that make it work.
And it’s always interesting to wonder if you are still producing insulin. Although “brittle” is a outdated and much maligned term, there is no doubt that some of us react with larger swings to fairly minute changes or mistakes. On the other hand, there are many who think that residual insulin production makes their control more difficult and unpredictable.
Thanks for responding. This is crazy stuff we deal with every day.
I eat about 70-80 carbs per day (I am almost 60 years of age.) My last A1C was 5.1. I control tightly, but still fling! I had 80 carbs today, and Chinese food (with a square wave bolus).
The "magic" is understanding how food affects you. I truly admit it is hard to understand all this, and I truly do not. I know the "Ps" are bad and I can't always control my reaction to them: pizza, pasta, and peanut butter. Also, a great love for me: oriental food--Chinese, Thai, Korean, sushi...Sometimes I do great with the Ps a nd sometimes not. I absolutely do not believe nutritional labels--often very inaccurate.
I feel like I am often in a cr*pshoot with carbs--what number do I play?
I have experimented with net carbs, and it never works--60 carbs is 60--carbs for me, no matter the fiber and "net" numbers. I think it takes awhile for the "fiber" to affect the net numbers....
I think knowing how food affects you is one piece of the “magic”. For me the difficult piece is matching insulin to the carbs. I am definitely one who can’t wait for the faster-acting insulins that are rumored to be under development. To see someone like Maurie who can eat that many carbs and still be under 140 at 2 hours without crashing lows at 3-4 hours is just not part of my experience.
I’m on my third day of super-low carbs, but I know this is not a level of carbs that I can sustain long term. However, except for mornings which are still a bit screwy, my BG is amazingly stable with most readings between 85-95. I’m almost starting to be motivated to work out a sustainable diet that is probably at the level of 60-70 carbs. Don’t know if I have the willpower to do that, but it sure does make life easier. I don’t need to lose weight except for a pound or two, so I need to embrace a lower carb diet with sufficient nutrition and calories not to lose weight. Also when adding back carbs then it gets harder to resist more of those tasty, junky carbs…
I haven't put much effort into low carb dosing but I often get poor results with a high protein, low carb meal. It took me four years to gain back 9 very needed pounds on the diet I eat now. I'm not sure I could even maintain my weight on low carb. There's just so much fat I can eat and I'm not really that fond of meat and other high protein foods.
Do you pump or are you on MDI? You must have a short insulin duration if you can avoid the spike at 2 hours and not crash at 3-4 hours. I know that I continue to have action from my boluses at least 4 hours out, although many people feel that they don’t see much action after about 2.5 hours.
John Walsh has an article at diabetesnet.com about insulin duration in pumps and claims that most people set their insulin duration way too low on pumps and that there is actually some action 6 hours out. But he also says that this is extremely variable from person to person.
Sometimes I wonder if I am driving myself crazy for no real reason. I’ve had Type 1 for 35 years and have probably spiked to 180 after many/most of my meals. The thing is that I don’t stay at that level for very long. I don’t have any eye, kidney or neuropathy complications and no indication that they are around the corner. Will I be healthier if I only spike to 140? Maybe. Maybe not.
The one thing I will say is that when I low carb, I definitely have fewer lows. Or just in general that when I avoid the highs, the lows seem to diminish also. It’s the lows that are probably my biggest threat, although my pump and Dexcom give me a lot of protection.
Maurie, you are really a voice of reason and I enjoy your posts a lot.
I pump with a Cozmo, set my duration at four hours and reduce the pump's insulin on board calculation by 50% after 2 hours. The Cozmo calculates IOB straight line. I don't tend to get much downward action after about two hours. In fact , I'm higher at four hours than I am at two hours a fair percentage of the time. It may be that my basal is set a bit too low and my bolus a bit too high. I haven't put the effort into sorting that all out.
Don't drive yourself crazy. You have excellent control and the small improvements that you continue to make will probably have a positive but relatively small impact on your health. I have only admiration for you and others who have been at this for decades. To work at this for 35, 50 or 60 years is an incredible slog.
