Type 1, low carbs and metformin

Hello all,
I was diagnosed as Type 1 in December at age 40. I’m over the shock and horror now and after a lot of internet research decided that the low carb approach is the way for me. I was diagnosed away from home and so only met with my nurse yesterday. She felt that my low bolus doses of about 4 units a day meant that I should try to do without bolus doses at all. She also wondered whether I should go on to Metformin instead. I take Levemir for my basel dose (after getting a full body rash and putting on 2 stone in 6 weeks with Lantus… one stone dropped over the last 6 weeks with the Levemir/low carb approach) and am currently on 16 units a day of that. My HBA1C was 5.8, which I was pleased with. I’m having about 4 hypos a week and no readings over 7mml, even when testing at one hour after eating. I may still be in the honeymoon period I guess. I get the impression from my nurse that she would prefer me to eat more carbs and bolus higher amounts of insulin but I feel quite stongly that less is more in this case. I am dreaming of flapjack sandwiches and pasta pie with mash but I guess my love of carbs will fade as time passes! Any comments or advice?

Wow. What led to your diagnosis? If it’s only been 4 months since diagnosis, I’m very surprised at how quickly you’ve been able to get your A1c down to 5.8% No matter when you were diagnosed, it is NOT easy to do, so congrats on that. As long as the rest of your vitals are good and you are not withholding essential vitamins from your diet, then low carbing is not a bad deal. I was a serious low carber before getting pregnant (now 7 months along) and I MISS it. :slight_smile: It was just easier.

There is no such thing as a Type 1 who is not on some form of insulin. If your Endo is suggesting you remove insulin injections from your lifestyle and replacing it with Metformin (I LOVE Metformin) then it’s possible she is suggesting you were maybe mis-diagnosed in December? There are thin Type 2s out there. I can’t remember right now, but I think the diagnosing test for Type 1s was searching for beta cells. Something like if you didnt have beta cells any longer, then you were Type 1. If you did have beta cells, but also ahd insulin resistance, then you were Type 2. Something like that- but I’m sure you’ll receive other responses to help with this. The only reason I’m questioning is because of your very rapid drop to a nearly PERFECT A1c within such a short period of time - coupled with your Endo’s suggestion to switch to pills. The reason this is important is because the treatment of these two diseases is different.

I am a high supporter of Metformin. I think it’s just a miracle drug. I was having major insulin resistance to my injections for years until I demanded to at least TRY Metformin (in addition to my injections). I was on it for 3 months last year and it reversed many of my diabetes complications. I put myself back on it earlier this month to help with my pregnancy insulin resistance and it has just been WONDERFUL.

So, I don’t really have any direct advice for you, but am looking to see if you were diagnosed correctly. A correct diagnosis is the first step to the proper treatment.

~ Type 1 for 13 years. Insulin + Metformin, split Levemir shots (60 units + 67 units currently), Apidra, A1c 6.5%

I agree with Marps perhaps misdiagnosed? Did they do a C Peptide test to confirm T 1

Either way I like the Metformin but would avoid any extreme diet - I preferm medium low carbs (80-120)not the extreme lo carb

Hi -

I am a big fan of bolus insulin. Your Levemir isn’t meant to cover meals and over time you’ll probably have to restrict your diet more and more as your insulin needs increase. I was diagnosed at age 57 and was on a dose similar to yours at 6 months (9 units of Lantus and about 3 units of Humalog per day) but now about 4 years later my total daily dose is around 25 units. I eat about 160 grams of net carbs per day and still maintain a good A1c.

Using real MDI (basal and bolus) is also very good preparation for a transition to the pump which is something you might be interested in down the road.

Congratulations on getting your A1c down so quickly and good luck!


The nurse was just suggesting Metformin instead of the bolus insulin, not removing the basal insulin. Doubtful that RacheEH has been misdiagnosed. I only use 6 units per day of bolus (15 of basal, in insulin pump) so 4 is not so out of range. Exogenous insulin, even at low doses, has enormous benefits for newly diagnosed T1s.

Hi RacheEH: Congrats on the great HbA1c, and really being your own best advocate. Maurie gave some excellent advice–bolus insulin is good to do, even while you are honeymooning (which you probably are). Going lower carb is also a good approach, I think. I don’t do extreme low carb by any means, but I have found that lower carb/high fiber is best for me. (And I still dream that I could just dive behind the counter of a good patisserie and eat away!!!) The amount of insulin you are using is pretty typical for honeymooning. Using the bolus insulin in addition to the basal is very important for preserving what remnant beta cells you have. The longer the honeymoon, prolonged via tight control as you are doing, the better your health outcomes. Best of luck to you!

I am also a LADA Type 1, eat low carb, and use very small amounts of bolus insulin. I stopped taking Levemir and take no basal insulin at all, because I was getting some hypos, especially when I was more active. I was only taking 6 units of Levemir, however, and even that was causing some hypos.
What is your fasting BG level? If it’s not too high, you might want to cut back on the basal insulin, rather than the bolus. Many new LADA Type 1s have an initial problem with Phase 1 insulin response which affects post meal numbers. Have you checked before an hour? I was spiking to 10 mml (180+) at about 30-45 minutes and then quickly coming down to normal levels. If you are having a response to tiny amounts of insulin, you aren’t insulin resistant and are definitely not Type 2.
It’s been over 4 years for me and I am still taking only 4-6 units of Novolog per day, fasting levels around 90 (5 mml) and one hour levels around 7 (120). Whenever I think it’s all a dream and I’m not diabetic, I check myself at an hour without the 2-3 units of insulin and am at 180 (or 10).
Good luck!

Thanks everyone for your replies. I’m definately Type 1, as confirmed by what they call a GAD blood test. I was diagnosed after my sight went, my thirst got out of control and I couldn’t stop weeing. These symptoms had been going on for months as I’m someone who tends to think things will sort themselves out if I don’t make a fuss! Weirdly one of my brothers was diagnosed just 2 days after me. Could someone tell me what will happen if I am honeymooning now and then stop? What will I notice? When is this likely to happen? Also, I lost all symptoms of hypos. Will they come back or am I going to be someone who just has to test a lot?

UHMMM Honeymoon or not, if you are type 1, yes you will need to test a lot. Welcome to the club. Doses will change over the years as your body changes. In my humble opinion the only alternative to frequent tests (which includes CGM) is to be prepared for lots of complications. I lost my sister to this disease in the days before we could test. So feel blessed that we now have the tools to help manage this disease!

The frequent testing will not go away until there is a cure and no one knows when that will be. So… all we can do is try and stay as healthy as we can so that when the cure is available, we are healthy candidates for it

So to understand you correctly…Type 1’s can take Metformin to help with insulin resistance? Will Metformin have any affect on the pancreas of a Type 1? So the pancreas of a Type 1 is a non functioning organ much like tonsils? Just curious…

Although the doctors say that you can eat carbs (just remember to bolus!) I believe otherwise! I think that when you eat less carbs, your sugars seem to be more controlled. although, eating no carbs would be dangerous and run the risk of constant hypos.

I think the bottom line is to keep your blood sugars under control (with as few highs or lows as possible). How you do that is ultimately up to you.

I hate to be harsh about this, but you need to just accept the need to bolus for meals. Low carb or no low carb you should bolus. Yesterday, I tried to skip my lunch insulin, after all how many carbs can there be in rotisserie chicken and veggies? Well enough that I was still above 140 mg/dl at 2 hrs. That is not acceptable.

You can choose to low carb. I agree it can really help you control your blood sugars. But don’t use low carb as an excuse to evade having to bolus.

The veggies have carbs; i find that nearly 1/2 my carbs are now veggies!

Yes, veggies have carbs, as do eggs and I count them. In this case, it was a green giant frozen veggie pack with a specific carb content, 17.5g. I rise 2-3 mg/dl for each g of carb. Based on exact counting of the carbs, I should never have peaked above 140 mg/dl, but I did. The plain fact is I must also count protein and the protein load from this meal probably exceeded the carbs in the veggies and I experience a blood sugar rise from simply eating And in the end, I should have bolused for the meal.

one theory is the basal is too high if you can take the 8 grams without a bolus that is only 1/4 unit so perhaps decreasing basal 0.05 for starters

Lynn, If you were sweating you may have experienced a low - The body’s natural reaction is to secrete glucose from ther liver (I think its the liver anyhow) to counteract the low. So instead of treating the hi you may need to trweat the low that caused the hi. It is a vicious roller coaster ride are you using long acting insulin? or was the 7.5 u a bolus for bedtime snack - I guess I just assumed you were on a pump. Maybe you could get a several day trial of a CGM (or better yet a full time one!

I fought the roller coaster until i was able to fine tune things with a CGM. Good Luck

Lynne, the last few lines of your message keep resonating with me - particularly about being sick and weak. I don’t know how much help I can be, but I’ll try.

First off, I don’t do low-carb (quite the opposite; my endo says many patients insulin is equal for basal and bolus, while my daily bolus can be double the basal!). Food is not evil. Remember, you need food for energy; feeling weak may have nothing to do with diabetes, maybe you’re just starving yourself.

The hospital visit for a few days may be good if you’re in imminent danger, but overall I don’t believe it will get you back on track. You get poor food choices in the hospital, and activity is nearly nil; it doesn’t help you prepare for “life”. Was your 187 reading when you woke up at 4am or was it when you woke up after a full night’s sleep?

One thing I’ve learned is not to set your targets too tightly. If you test before a meal, and then are 40 points higher than that two hours later, there’s nothing to worry about. I used to constantly fight the post-prandial highs and the inevitable lows that follow. It drives you crazy, both physically and emotionally.

Unfortunately I don’t have enough background information to help you further, nor am I qualified to do so. It sounds like you still may have a lot to learn – how long have you had diabetes? A visit with a CDE (certified diabetes educator) may help; they generally have more time than a doctor, and often have more patience as well. I wish you luck and good health.