Type 1’s, how many carbs do you eat/day and what is your A1c?


#21

Aaaaahhhh. I wish a food allergy were that easy.

A food allergy means reading every ingredient label, often two or three times just to make sure, on every food or drink or medication you put in your mouth. Not being able to eat at many restaurants, parties, friend’s homes, bakeries, pre-made grocery store food, or foods from bulk bins due to cross-contamination concerns. Calling manufacturers of products to clarify ingredients. Worrying an entire year before your trip about what you’ll do if the person beside you orders a hot plane meal containing your allergen, because you react to steam. Wondering if that fork you want to use in the lunch room is really, truly allergen-level clean. Having to pack a food suitcase when you travel. Always having to decline food people offer you. More and more these days, wondering if that new fabric, plastic, packing material, car tire, or straw are made from your allergen. Having to leave when 30 people around you are eating your allergen and you’re starting to feel like you’re reacting.

In my experience, having mostly followed Bernstein and having lived with food allergies, eating low-carb is far easier than living with true food allergies. Which is a good thing, because if it were as hard as having a food allergy is, no one would ever choose to do it.

However, I do get what you’re saying about basically being able to forget about diabetes between meals. I was never able to really get that full benefit from low-carb, because protein was a huge issue as well as hormones, and any exercise, including running errands, would unpredictably send me low. But overall, eating low-carb and sugar-surfing are two opposite ends of the spectrum as far as being able to largely ignore diabetes versus having to pay attention to it constantly. I’ve tried both and at the moment land somewhere in the middle.


#22

About 200 grams carbs per day. A1c 4.9 - 5.1.


#23

150 carbs per day +/- with A1C ranging between 6.5 - 6.8 over past year.


#24

Up to 200-250g per day, but highly variable. This includes some bolusing for fats and protein though.
I’ve had 155 today but am still hungry. It’s nearly midnight. Sigh.
Last HbA1c was 5.5.
I suspect it’ll be better or similar next time.
I’m using DIY hybrid closed loop, which is a complete game changer. But only for 5 weeks so far. Previously I was a bit more wary of carbs. I’m now on much less overall insulin and am losing weight despite boosting my carb intake. Far fewer calories consumed for hypo snacks.


#25

You are doing yourself no favours by ignoring the consequences , You obviously don’t mind the prospect of kidney damage, atherosclerosis, neuropathy and of course the big one… amputation . Get your sugars under control or you will end up with some or all of the above.


#26

I don’t limit my carbs at all and I don’t eat anything close to low carb, but I don’t know for sure how many carbs I typically eat. As near as I can guess right now, it is probably right around 200 a day, sometimes a bit less, but most likely, more often than not, a bit more. My A1c’s since shortly after diagnosis 5 years ago have been right around 5, with the last two, as well as others, being 4.8. I haven’t had one lower than 4.8 and only had one as high as 5.4, but I had intentionally ran my levels higher to make my A1c be higher that time, which was dumb. The two after that one went been back to 4.8. I really prefer it to be as close to 5 as possible, am perfectly happy with the 4.8’s, but I didn’t like having the 5.4, lol.

Btw, I am not on a pump, I use MDI and have only had something like a CGM (Libre using Glimp) for a bit over 8 months, so those things really are not needed to have good control. I just try to keep my basal dose correct and bolus in a way to stay under 100 most of the time, even as much as possible, during the two hours after eating. I will correct if I am close to 120, which is rare, I don’t do a correction shot very often. I bolus for everything I eat and for many meals, I split my boluses so I am doing some a while after eating to cover the rise that comes later from the protein in my meal, or fats. I strive to mostly be in the 70’s and 80’s, and according to Glimp, I am only over 100, 9% of the time, over 110, 5% of the time, and over 120, 2% of the time, and never over 135. A low A1c really doesn’t need to mean one balances highs with lows like many people and docs seem to think. If one keeps their levels under 100 most of the time, they cannot have anything but a low A1c.


#27

Typical about 25 g / day and a1c consistently in the low 5s (I follow keto / Bernstein). Latest hba1c was 5.1. As long as I stick to low carb I don’t have to think too much about diabetes. I take about 20 units of long acting and 2 - 6 units of fast acting a day. Blood sugar events typically happen slowly and manageably.

Yesterday I had some icecream with the kids (highly unusual occurrence) after skating, and took 3 units of insulin to cover it. 2 hours later I tested and was still considerably higher than I wanted so I did a correction. Next thing I know (about 30 minutes later), blood sugar is crashing and vision is narrowing tested at 48, and desperately looking for rapid acting carbs. Reminded me of why I don’t do carbs. Certainly there is a chance I would get better at blousing with more practice, but for me low carb is far easier. CGM is not in my budget - though it certainly would have saved the day if I had one.


#28

Who is they, and how do they feel about the 90% of the human population that lives happily into their 90s (assuming cancer doesn’t get them) with A1cs in the 4.0-5.0% range?


#29

In what way am I ignoring the consequences…? 7.5 isn’t a bad A1C, my endocrinologist is not concerned. My goal is to get in the 6s but 7.5 is not bad. Maybe you should redirect your life frustrations elsewhere.


#30

This friction between members often arises in A1c comparison threads. We need to be careful about how we think about the A1c number itself. I’ve found it to be more useful to compare my current A1c to ones of mine in the past, never with other members’ A1c’s. It is not good to think of the A1c as some rock solid standard that permits us to rank and judge each other.

Did you know that the A1c does not translate to one specific blood glucose average? Check out this diaTribe article for some interesting reading. Within this article is a table that shows, for example, that an A1c of 6.0% translates to a blood glucose that ranges from 100 mg/dL (5.6 mmol/L) to 152 mg/dL (8.4) with a median value at 126 mg/dL (7). Many of us think that an A1c translates narrowly to a discrete blood glucose number. I thought that for many years; it’s just not true!

I have first hand experience with this. My A1c is discordant with my average glucose exposure. My A1c overstates my glucose exposure by 0.5%. Continuous glucose monitor and fingerstick data indicate my A1c should be lower.

Having said that, I do believe that many doctors are just fine with higher A1c’s based solely on their over-reacting fear of hypoglycemia. I think they do this to the detriment of their patients. On the other hand, if a patient is experiencing wide fluctuations in blood glucose, a doctor would be well-advised to treat the glucose variability before counseling the patient to try and lower average blood glucose.

I do think the the standard of care A1c target of <7.0% is not nearly ambitious enough for many patients. It’s a tough call to set a standard for a whole population. Each person needs to ask themselves if they can do better. For me, carb limits provided a dependable way to focus my efforts toward a lower A1c. I think carb limitation as part of a larger effort should be considered for anyone who wants to lower their A1c. Experimentation is the mark of most people who do well with diabetes.

We are all here for each other’s support. Some of us can do better than others in managing blood glucose. Encouragement is more effective than criticism. Please be kind in your A1c comparisons!


#31

Since diabetes is so individual (just look at the ranges of A1c and carbs in this thread!), I think making broad-sweeping statements like “these tools aren’t needed for tight control” can be misleading.

I could not maintain an A1c below 7% for more than two decades despite really trying to do so. When I got a CGM, my A1c dropped by 1% to the low 6% range within two months. I have not been able to break into the 5% range even with pump, CGM, and eating low-carb.

There are some folks on here, mostly people who were diagnosed as adults and got tight control right away, who have never had an A1c above about 5.5% or so aside from diagnosis. But that is not the case for the vast majority of people with Type 1 diabetes. For many of us, the only reason we’re able to maintain an A1c of 6% or so is because of tools like pumps and CGMs.

I agree with @Terry4 that comparing A1c can be a hot topic. For someone who has never had an A1c above 5.5%, an A1c of 6.2% might seem horrible. But for someone who has never had an A1c below 7.1%, an A1c of 6.2% would seem great.

I used to continually feel like I was doing something wrong or missing something obvious when I got on these forums and found so many people with such low A1c numbers that I could not emulate no matter how hard I tried. I’ve since started comparing A1c results only with myself, and that has been much more successful.


#32

I know you premise this with “I think,” so I am certainly not arguing with you, but the answers in this thread suggest respectable A1c’s are achievable regardless of carb intake. And honestly, these results surprised me!

Six people eating from “about 25” and up to 90 g carb report A1c’s ranging from 4.8 to 7.1.

Nine people eating from 90 up to 200 g carb report A1c’s ranging from 5.3 to 7.5.

Four people eating “about 200” and “up to 260” g carb report A1c’s ranging from 4.8 to 5.8.

If this were a rigorously scientific experiment, the conclusion would have to be that a higher-carb diet results in a better A1c!

My own conclusion is that other factors must obviously be at work. How much are people exercising, for instance, or how balanced and healthy is their diet as a whole? How much do their BGs fluctuate? What I see from the responses here is that whether people are eating about 25 g carb a day or 10 times that amount, their A1c’s fall into the same range, and no group is achieving noticeably lower numbers than another.


#33

I have been doing diabetes for along time and realize everyone is different. And what target works for one, is not going to work for the next. I have always been very happy if I can keep my A1C under 7.5. My endo is happy with that also but would like it better at 7.0. But we work well with each other and have a good understanding. I have no complications, work full time in a pretty physical job, have 2 A1C. But I will also say, my endo doesn’t really worry a whole lot about my A1C any longer. It’s time in range and my standard deviation. I think we need to keep in mind that everyone has a different goal in our management plan.

And I will say, this question is like the one I get every time a see a new doctor. How much insulin do you take? I hate that question!!! I always say, it depends! Am I exercising, am I eating heavy carb or light carb, am I sitting all day or walking all day, a, I sick. I mean come on, everyday if you look at my pump, the daily number is never the same as I don’t do the same thing everyday. I have some carb days as low as 20 and as high as 200. I call it life, my life and I am going to try and enjoy it. Especially since I was told way back when I would not make it past 30! Everyday is a celebration!


#34

I don’t have any frustrations but as a previously undiagnosed t1 diabetic with sugars in that range, I was, within three years of diagnosis , undergoing a quadruple bypass at the ripe old age of 55. All was trying, poorly it seems, was to say that the damage is unseen and often, in my case certainly, unfelt. I worked fourteen hour days, on my feet, volunteered as a Cub Scout and Scout leader, and got regular exercise but still suffered pretty catastrophic consequences from thinking that I didn’t have to change my life. Five years on I’m semi retired but still do volunteer work, walk my dog and enjoy my life and, god willing, will live to see grandchildren. I wish you the best.


#35

I eat between 20 and 20 grams of carbs per day–90% from vegetables. A1c 5.9–6.0 since I started this path in 2015. By the way, I am a vegetarian… get protein from seeds, nuts, sheep or goat cheese, and occasional non fertile eggs.


#36

I think this is key, it seems to be a dramatically easier disease to manage the older you are at diagnosis, for many reasons. Also my bad about the food allergy comparison, I made the mistake non-diabetics make when they think they know something about this disease!


#37

I think you should keep in mind that your experience is unique, as @Jen pointed out. I do pretty well on pump or MDI, but it would be near-impossible for me to never go over 135, and basal doses are always changing due to stress, the weather, being a Toronto sports fan, etc.


#38

I do keep in mind that my experience is just that, and that is what I commented on, my experience. My experience is that I have maintained that level of control without using a pump or CGM, so, in my experience, those things are not always necessary to maintain that level of control. I did not mean to imply that those things are not needed by everyone, just that not everyone needs those things. There is a difference, I just didn’t realize I had to clarify that, which was my mistake. I thought it was obvious that I was talking about my experience, but I guess it wasn’t, so again, my mistake. I apologize to anyone my mistakes offended, I meant no offense whatsoever.


#39

Typically eat between 20-50 grams of carbs a day with A1c’s in the 5’s using only 11-12 units of Tresiba long acting basal. Most recent was 5.3

But remember a1c is only half of the battle. You also need to minimize insulin. I’d you are using tons of exogenous insultin to keep uiurbA1c down I don’t think you are doing many favors.

Low carb & low insulin = healthier


#40

I usually stick to fewer than 80g carbs per day. But I also like @Dmitry2’s approach: high carb, but only with very familiar foods. I’m trying to adopt that slowly. Oh, and my last HbA1c was 5.2%, with 98% time in range (70-150 mg/dL).