Type 1 and a Low Carb-High Fat Diet

I think the actual goals are increased Time in Range, better A1Cs and fewer diabetic complications. If achieving those items results in less insulin, then that is all the better.

Why?

Because a large TDD on a long-term basis might lead to developing insulin resistance, and that can become a bad spiral to get into (really bad, IMO!).

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I’ve found I have to restrain my initial reaction to my downtrending Dex numbers. It’s especially concerning when, like in your case, it occurs with significant insulin on board following a meal. Like you observed, the Dex can switch from a down-trending arrow to a sideways arrow relatively quickly while it keeps the same BG number. If you had your fingerstick meter with you then you could have verified the actual BG and treated accordingly.

Without additional fingerstick data, I’ve often over-reacted to the Dex’s downtrend warning and over-treated and get an unneeded bounce to the upside. I usually walk without my meter and try to treat trending lows with small carb doses spaced out over time. I like Tic-Tac mints since they only contain about 1 carb for two pieces. I also try to walk after a meal when the Dex trend is moving up. I like to watch the Dex level out and start to trend slowly down and back in my preferred range.

We’ve all been caught out without back-up sugar. I place a high level of importance on always having a source of glucose with me, even if my BG is high and I’m trying to knock down with a walk. Better to have it and not need it than the other way around.

If you’re meeting your BG goals (90-140 or 80-130) a high percentage of time, you’re doing a great job. I don’t think that there’s any specific number of carb grams that’s ideal for everybody when your’e talking about 60 grams per day or so. You know what’s working for you. My only suggestion is to continue to watch your BGs, both fingerstick and Dex, and learn what your body is telling you. You are in a good range; keep it up.

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Terry4, thanks so much for the encouragement.

" I also try to walk after a meal when the Dex trend is moving up." This makes alot of sense. My Dex reading was 112 horizontal and I was expecting it to rise either horizontally or angle arrow like it often does after a meal. Boy was I surprised! and I panicked.
My recent a1c was 6.9. Is it likely that I’m spending more time in the higher range closer to 130 rather than closer to 90? My “nighttime”~ midnight to 6am is usually 100. Perhaps too much time is spent in the higher BG range rather than the lower BG range? My fasting is most often around 100 +/- 10; sometimes mid 80’s. Late dinners, or a high post dinner BG leads to higher fasting numbers. I’m hesitant to increase my basal Lantus for fear of going low during sleep. Would going on the pump help address some/many of these fine tuning issues? late dinners, unexpected high dinner BG numbers?

An insulin pump allows fine tuning basal needs, especially if you need an aggressive early morning basal profile to offset significant dawn phenomena. Here’s my current basal profile:

I probably could reduce the number of basal rates I’ve programmed to eliminate some of those smaller steps, but you get the idea. I have a larger need for basal insulin in the first half of the day with a lower need in the afternoon and then a step up in the evening following my dinner. It’s difficult to get a long acting insulin like Lantus to do this. Having said that, I know many people make their MDI program work well.

Overall, a pump will allow more freedom to adjust.

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@ Terry4 - Which pump do you use? I’m very seriously considering the omnipod. I am concerned that I’ll be a mess of tangled tubes with the others.

@lh378 - I use an Animas Ping pump. Here’s a link to a recent comment that summarizes my experience and feelings about choosing a pump.

I agree with u 100% …I am T1 and took my A1c from 10 to 5.6 by following LCHF

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I"m not terry4 but I don’t find it a big deal to have tubing. once in a while it can be a pain, but I will never lose my pump (do to the tethering) and I don’t have to worry about some of the issues that Omnipod users have to contend with (reliability, excess insulin usage, etc). I also don’t like the idea of such a large device placed on my skin. I wear the smallest possible sets, which are the Sure-T’s. they are quite flat and only the connector, located 4" away from the set, sticks up a little, but is still very low-profile compared to an Omnipod (as in a few orders of magnitude)

I went on low carb inMay and my A1C went from 12 to 8.
It has been better all around health wise.
I find the lows still come but much easier to fix and regain control.
When it goes high it feels so much worse now. My energy goes right out of me.
But the lo carb, better bg is so much smoother and I hope 8 will slide down to 6 in 3 more months. I use a pump but no CGM.

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Back in the 1990s when I first was diagnosed with Type 2, the low carb approach to managing diabetes was making a comeback after years in ‘hibernation’. For the record, low carb or even starvation diets as a way of managing diabetes type 1 or 2 is nothing new, that trend has come and gone numerous times of the past centuries. Anyhow, back to the nineties, my support team at the St. Pauls hospital diabetes center here in Vancouver Canada strongly advised against the low or no carb approach, citing that the most common cause of complications and death in diabetics is not from high blood sugar and neuropathy, though that can be serious enough, but from kidney failure and heart disease attributed in large part to a diet high in fat and protein and low in carbohydrates. I took those warnings seriously and have been happy with my low GI carb since. Now that the pendulum has swung back in favour of high fat and protein and low carb, with several studies citing at least the short term benefits of those dietary models, I haven’t noticed any of the usual warnings that were so prevalent in the past, including how a diet very high in protein could easily lead to someone ending up in a kidney dialysis machine in their final days and about the many diabetics who succumbed to heart attacks in their 40s or 50s after a lifetime of low carb and high fat. Has the science changed here or has the wind gone out of the dietitians?

There never was any science behind these claims about low carb diets. One study of nurses found that patients with kidney failure had an association of accelerated kidney decline with high protein in their diet. But it turns out that there is no association when you have normal kidney function and guess what low carb diets are not high protein diets, they are high fat. This was basically scaremongering.

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i significantly cut down on my carbs once i got my Dexcom. when i was able to see the trends i realized how frequently i was spiking and then slowly going back down to a more “normal” range. so, i cut out the carbs to as little as possible and started eating mostly protein (which i need to bolus for; usually 1 unit per serving) and fat, like peanut butter and cheese. i am very skinny now. lost about 10 pounds, which i certainly didn’t need to lose, and more importantly, screwed up my belly fat making it difficult to attach my sensor. but, i went from an 8.9 A1c to a 6.5 A1c. so the diet has definitely improved my health w/ regard to my D. my solution: high protein and high fat, lowest carbs possible. my typical insulin/day is about 20 units.

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With LCHF, You can have normal protein and replace the carbs with fat. The mix can be about 70% fat, 20% protein (10-30%) and 10% carb, it isn’t normally a high protein diet.

I would suggest any T1 watch Bernstein’s video or even buy his book

the other thing is TAG total available glucose, when T1’s bolus for protein as well.

I think, if your weight is fine, you don’t need to reduce carbs, if your A1C is in range and you don’t go too high or low much, you also don’t need to reduce your carbs. going by the obesity in the general community about 2/3 of us have trouble metabolizing carbs

I agree, Jack. There is another diabetes website where all members, including type 1’s, are advised to follow a LCHF diet. So many people with diabetes do not seem to realize that some of us can eat higher amounts of carbs and still have good A1c’s, and not be overweight.

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I agree, Richard. And those same some of us can rock a flat line bg’s most of the time. I wonder why this truth receives so much rejection and can’t be suggested without argument. I have been enjoying peaches and watermelon lately…summertime fruits are the best carbs!!

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karen57 and Richard157, I hope to be able to manage moderate carb and BG. I tried the LCHF. It has been too difficult for me. My family eat “traditionally” healthy. Veggies, fruits, protein (meats)…and well, some/moderate amounts of ice cream and some cakes/sweets (once or twice a week)

Would a total daily carb intake of about 100g +/- 20 considered to be moderate carb? If anyone takes in about 100g daily, do you count the protein conversion to carb when you bolus?

The only carbs I count are carbs. I don’t add in anything else from protein, and that works for me. YMMV. Life is complicated enough without more conversions and besides, I don’t need to do that.

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@phoenixbound, I thought so too. (I had been ignoring proteins and broccoli! until I looked at the numbers.) I started to notice that I was habitually getting high after about 3 to 4 hours after insulin injection for meals. When I reworked the numbers taking into consideration protein and even green vegetables…the numbers made a little more sense. But it isn’t an exact science.

So far it’s “close” when I bolus about 3-4 units for a meal and may have to correct at about 2 hours after the meal.

it’s all about timing, getting the right I:C ratio, the type of food eaten, the activity level, and the phases of the moon. When I am very active my insulin acts as if it is turbocharged. :slight_smile: When I spend too many days doing little physical activity, it’s like having insulin resistance. If I eat too much fatty foods, I become resistant for a period of time. EVERYTHING we do affects our fasting and our PP bg readings when we are T1. Other types don’t have the same issues–they have their own set of issues with bg control.

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