I’m now two weeks into my adventures in low-carb-land, and I just thought I’d post an update and see if anyone has any words of wisdom or caution or whatever to share …
On the plus side, I’ve lost about 4 pounds (with, ideally, another 5-10 to go). So that’s working. My Ketostix are frequently showing “trace” to “small” amounts of ketones when my BG is normal, which I guess means ketosis is happening (though I’ll admit it’s very strange to be wanting ketones!).
On the whole, I’m feeling less “Atkins-flu-ish,” but I don’t think my exercise performance is quite what it is when I’m eating more carbs. It’s hard to tell, and part of the problem is newly unpredictable BG responses to exercise. Sometimes I find I need as many “ex-carbs” as I did before; other times, if I take in those ex-carbs, my BG will go up during exercise (which it never used to do, regardless of the type of exercise).
After a roughly ten-day honeymoon of great blood sugars, I’ve started having some difficulties in that area. Mostly frequent lows, but also some highs that don’t seem attributable to the usual suspects (carbs, hormones, equipment malfunctions …). For the most part, the highs are of a lower order than what I was experiencing before (9-11 mmol vs. 14-16 mmol), but my inability to figure them out is frustrating. Also, my old tendency to trend high in the morning and low in the afternoon has mysteriously flipped: lowish in the morning, highish in the afternoon.
I’m certainly going to persist with the program — I’m committed to giving it at least 3 months, and I suppose it would be unrealistic to expect a completely smooth transition! Anyway, I really appreciate the advice and encouragement I’ve had from you low-carb veterans and would welcome any further thoughts.
A couple of things come to mind. As your body becomes more used to eating less carbs & burning fat, the conversion of protein to glucose may become more efficient. I don’t know if there’s science to back this up, but that’s been my experience. I didn’t need to bolus for protein until I went low carb. This may also account for your flip to afternoon highs, if you’re eating a lot of slow digesting protein/fat for breakfast. Improved protein conversion may account for the exercise highs. I’ve found it helpful to keep protein pretty consistent day to day to get more predictable results.
Hi, Gerri … The protein issue was something that did occur to me, so it’s helpful to hear about your experience. I’ve heard the argument that protein is more unpredictable than carb in terms of its effect on BG, and for that reason some people would rather stick to carbs. I guess I’m finding them equally unpredictable right now, but your hypotheses about breakfast and exercise make sense. So many variables to consider … but of course that’s one of those things that’s always true in this biz! Thanks!
You are doing great. I generally found that being in ketosis did not always mean being positive on the Ketostix, once your body adapts, you only produce the amount of ketones that you need, fewer excess ketones are dumped in your urine. On the exercise thing, what I found was that much of my aerobic exercise could be fueled by fat, and that I essentially got to the point where I needed no carbs to sustain blood sugars during exercise. But everyone is different, and you will have to see.
It sounds like things are going very well, thanx for the update.
I think protein may be more unpredictable because it’s harder to judge since there’s usually fat & protein in protein & the type of protein effects how quickly it’s digested. Fish/poultry/eggs digest quicker for me than red meat. When I was weighing everything, I weighed protein after cooking.
It may be protein as others mention but i also wondered if it is glucose related? By low carbing you (paradoxically!) increase (muscle) insulin resistance [but it is ‘physiological’ insulin resistance which is “good” (like say ketosis you describe here is “good”) rather than ‘pathological’ insulin resistance (which is “bad” and causes type 2 DM) (like ketoacidosis is “bad”)], Basically physiological insulin resistance is your brain saying hey we don’t get so much glucose around here any more so it tells the muscles to lay off it and run on ketones / fats instead so it can reserve all the glucose for itself. This means glucose that you take has much more effect on blood sugar as the muscles are not taking it up as they are being told not to! Before low carbs I would take 4 g of glucose (1 glucotab) to raise me 1mmol (18mg/dl). Low carbing led to halving my requirements or more (in other words to get 18mg/dl (1mmol) rise in blood sugar I now bite off less than half a glucotab (less than 2g glucose). I dunno if this is true or not but certainly I now need minimal sugar to correct things and I think I read read this on hyperlipids blog [google hyperlipid and once you find his blog (another really cool site - he thinks a lot!) search for “insulin resistance” and you should find it there but I believe the above is what he said]. Anyhow, true or not, I personally found the above increased sensitivity to carbs to be the case.
Your different responses to exercise can depend also on when you exercise. Dr B in his book says if you exercise in the morning blood sugar will almost always go up so this may be a factor too. I think it would be worth getting his book (of course you probably already have it!) as he describes how to adjust glucose for exercise / effects of morning exercise in some detail. (His book is the best £20 I ever spent- totally life changing / saving as I guess many here agree!). Another thought - when you exercise you produce more GLUT4 channels - temporary channels to allow glucose into the muscle cell just produced during the exrcise really. These however only work when insulin around to activate them (actually they can work a bit without insulin so heavy exercise my reduce blood sugar a bit via increased GLUT4 channels even with no insulin but basically they need insulin to activate them I think). If you take some insulin and then exercise hard soon after (say within the first 1-1.5 hours) the exercise increases the number of GLUT4 channels and insulin is there to activate them and so glucose pours through them into the working muscle and blood sugar (BS) drops fast! If you exercise a while after you bolus (say 4 hours after a meal so just your basal insulin is working and there is no bolus dose left) the drop is much less as, tho you still get the increase in number of GLUT4 channels, there is much less insulin to activate them so not the dramatic drop described earlier. (I use basal bolus technique with syringes rather than a pump so if you pump I guess this will be different for you but basically the more insulin you have on board when you exercise, the more blood sugar may drop - for me at least - for otherwise same exercise). Finally blood sugar drops depend on type of exercise: anaerobic (weights etc) will not drop sugar much (may slightly increase it) for me where as aerobic (endurance) activity will drop it quite rapidly after say 10 mins (tho again more important for me is amount of insulin on board - if I take a dose and do weights 20 mins after I can drop quite fast). If I am going to cycle straight after a meal I will take say half my dose to account for the drop from cycling caused by the increased numbers of GLUT4 channels created by the bike ride. (I may then take another small insulin correction after the ride (as the GLUT4’s start dissappearing again when I stop but the remnants of my breakfast will still be digesting so may spike me once the extra GLUT4’s have closed). (Anyway as it is a low carb (6g) meal, my bolus dose is quite low anyway - perhaps 3-3.5 units bolus injection (this is a single syringe dose not a pump bolus which I think is different??) so the changes are in the order of 1-2 units in my syringe. Again an advantage as if i get it wrong the changes are relatively minor - again what Dr B calls the law of “small doses having small effects” the main advantage of low carbing in controlling BS I think…
Usually low carbing (by reducing the amount of insulin you require) will massively improve your highs and lows (Dr B calls it getting off the roller coaster and that was so the case for me!) so I hope things will continue to go well for you. Asyou say the transition has ups and downs (like all of this!). I am still trying to work out things after over a year of basically no carbs! Best wishes to you for it!
Hi, Ralph ~ Thanks so much for all that great info! Re. the “good insulin resistance” effect, I’ve also noticed that I seem to be getting more bang for my buck with glucotabs, and I was wondering what may be going on there … interesting to know it’s not a random or imagined thing.
I do indeed have the Bernstein book and refer back to it regularly. I recently learned about GLUT4 channels from another book, so it’s great to have that info presented again in different words.
I notice that you’re in the UK, and I have a question for you about CGMS availability, but I’ll send that in a separate message.
Well, I spent some 5 years on low carbs and experienced elevated fasting blood sugars the whole time. I would have been pleased to reach 115 mg/dl like Peter. In the end, I had an A1c of 6-6.5% no matter what I did with low carb. I was very likely carb intolerant because of my low carb.
Does following a very low carb diet result in insulin resistance? Yes, you become unaccustomed to processing carbs. Does it “give” you diabetes? Hardly
I’m curious, bsc … are you no longer low-carbing? If not, what made you go off (or modify)?
I must confess – I’m starting to feel like my own science experiment, and it’s hard to know if I’m doing the right things … so much conflicting info out there.
Over the past couple of days, I’ve been feeling the way I did right before I was diagnosed 24 years ago: thirsty all the time, drinking/peeing all the time, losing weight, showing ketones … I suppose the crucial difference is my blood sugars aren’t sky-high (but they’re not superb either – my basal needs seem to be increasing daily). On the plus side, I don’t seem to need extra carbs for exercise right now, and my BGs have been fairly flat (if highish). But … given the other stuff, I’m having a hard time just now thinking of this regimen as a positive thing.
I’ve been eating about 45g of carb per day (compared to about 120-150 before), but I’m wondering if I should increase that amount – I’m a bit concerned about dehydration, as well as various other nasty-sounding things that I’ve read are associated with a rapid drop in carb intake.
I am still low carb, over the years I’ve gone up and down, but generally been between 50-100 g/day. I tried much lower levels, but saw no improvement in blood sugars from lower readings.
I have to tell you, during the adaptation phase to a low carb diet, your body can go through some changes. One of these changes is that as you move to fat burning, it can have a significant diuretic effect. Atkins himself never mentioned this, but in the recent book, New Atkins for You, they recognize this effect and suggest you increase your electrolytes and salt. Some recommend drinking boullion (not the low sodium kind). You should try some increased salt intake and see if that helps. Why don’t you try taking about a 1/2 tsp of salt three times a day. Losing weight and showing ketones are all positive things.
As to the whole carbs for exercise thing, if it makes you feel better fueling your exercise, then just do it. On the blood sugar side, you may find that you are eating more protein than before, and I found that half of my protein converted to blood sugar and that conversion took place over hours, leading to mildly elevated blood sugars.
I would suggest you try to the whole salt thing andsee how it goes. I’ve not heard any nasty sounding things associated with rapid carb drops. What are they and do you have pictures?
I've not heard any nasty sounding things associated with rapid carb drops. What are they and do you have pictures?
Thankfully, no. I’ve read so much lately that I’m losing track of it all, but I think heart arhythmias were mentioned somewhere, as well as flare-ups of other (non-diabetes) autoimmune conditions.
Re. exercise, I’m quite happy to wait and see if I can perform as well without ex-carbs; I’m less happy about the extra insulin I seem to be needing, whether from protein consumption or carb intolerance … or whatever it is. My TDD seems to be creeping back up to pre-low-carb levels, which doesn’t bode well for weight loss!
Anyway, thank you for the info about the diuretic effect (I hope it’s temporary!) and the salt suggestion. I shall prepare some bouillon anon!
Ketones are the natural biochemical by-product of burning fat for energy. The purpose of fat stores is for energy. So, the presence of mild ketones shows you’re using fat & losing weight.
I’ve read so much lately that I’m losing track of it all, but I think heart arhythmias were mentioned somewhere, as well as flare-ups of other (non-diabetes) autoimmune conditions.