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


#41

I would agree with your statement here except for the word regardless. I recognize that people with diabetes can attain good to excellent A1c’s with a range of daily carbohydrate consumption.

I’m even aware more recently of people who maintain very good A1c’s consuming a low fat, high carbohydrate plant based diet. I’ve read accounts of people consuming 200-400 mg of carbohydrates per day with decent A1c’s. I think their game is more complicated than the one I play. I believe that they must pay strict attention to calculating their carb ingestion, carefully calculate an appropriate large insulin dose and timing, I also believe that these people usually adopt a very aggressive daily exercise regimen. I suspect that their average blood glucose is higher than mine with significantly more variability and hypoglycemia.

I’ve been reading more and more about hyperinsulinemia provoking inflammation and significantly contributing to atherosclerosis or coronary artery disease. I currently take about 30 units per day but in the past I’ve gone through periods of taking 80 units per day. In the case of insulin, I do think that less is more. I agree with the sentiment expressed by @IWannaBeABetaCellHea; larger and larger doses of insulin may come at a long-term health cost.

Medical textbooks estimate that the average gluco-normal person’s pancreas secretes about 0.5 units of insulin per kilogram of body weight. I think this evolutionary preference needs to be weighed when considering how much daily insulin is healthy in the long-term.

I don’t think that most people reporting in this thread would be able to eat unlimited carbohydrates per day and yet achieve respectable A1c’s. Again, we differ from each other but I believe we are spread across a spectrum.

For each of us, I think, there is a level of daily carbohydrate consumption where our control falls apart. For me, it is about 125 grams/day. Once I hit that level for a few days then my insulin doses just don’t seem to work dependably. My insulin to carb ratio, pump basal profile, and insulin sensitivity factor all cry for much more insulin. My blood glucose average and variability goes up. So does my time hypo.

So, yes the daily carb intake with still respectable A1c’s for members here run a spectrum but I still think, based on my limited personal experience, it is not without limit!


#42

That’s an unfamiliar subject to me but I gather it has to do with having a superabundance of insulin circulating in your system? One thing that my endo pointed out recently–one of those things that I probably should have known for decades but it came as news to me–is that you have to inject way more insulin than a gluco-normal person would have to produce endogenously to cover the same amount of carbs. It’s nothing like a one-to-one correspondence, due to the inefficiencies of subcutaneous absorption vs direct flow into the blood stream, the physical distance between the injection site and the liver and a lot of other factors.

This came up during a discussion of trying to get my TDD down in order to lose weight–another problem related to having to inject the stuff. I generally eat pretty low carb, in the realm of 50mg/day unless I’m going out to dinner, and I try to get out for an hour bike ride at least 5 x /week, but I still struggle to lose weight. Upshot of our discussion was that she started me on Jardiance, which has made a huge difference over the last couple of weeks I’ve been on it.

I started out for 20 years on the old R/N sliding-scale thing, so the idea of “eat what you want, just bolus for it” has always gone against the current of some pretty deeply ingrained programming, though I do indulge occasionally. But as a general rule, I go with “the less insulin you have to take, the easier it is to manage.” Jardiance has cut my TDD significantly and is a huge help with avoiding exercise lows and making it much easier to get out for a spontaneous ride without having to worry about having a high enough BG to start with.

ETA: I don’t mean to sound like an ad for Jardiance, but since it’s off-label for T1s I wasn’t aware that it might be so helpful, so thought it worth mentioning. Endo said she’s trying it with a couple of her other T1s with similar good results.


#43

I’m not on a HCLF diet, but most of the posts from true individuals eating plant-based HCLF seem to indicate that their insulin sensitivity is much higher.

It’d be interesting to start a thread to see if that’s true or not. I just feel like I read posts by vegans, and their insulin to carb ratios seem to be 1:15 or even more carbs per unit of insulin.

I find this especially interesting because it seems like those on a LCHF diet have the opposite experience. They seem to be incredibly carb sensitive with more insulin needed per gram of carb. Of course, if you’re not eating a lot of carbs, then your insulin needs still aren’t that high anyway.

These are all just observations and certainly not scientific facts. I mostly posted because I’m not at all convinced that a plant-based HCLF diet would result in hyperinsulinemia. I think we’d have to actually look at the amount of insulin these people are using in order to determine that. I had trouble finding a thread about this when i looked though.


#44

I agree. One of their main contentions is that dietary fat produces insulin resistance. I accept that, in a relative sense. I’ve observed my insulin sensitivity oscillate through each day. I am more insulin resistant in the morning than I am in the afternoon. But, am I insulin resistant? At 0.4 units of insulin per kilogram of my body weight, I conclude I am not.

Let’s say that someone eating HCLF consumes a meal with 150 grams of carbs with a 1:15 insulin to carb ratio. They would inject 10 units of insulin. If I eat a 20 grams of carbs meal and use my 1:4 insulin to carb ratio, I would dose 5 units of insulin. If post-meal BG control is equally good (I’ve yet to see that it is.), I still think that less insulin is better. Larger doses of insulin have a greater potential to go awry due in part to the 42 things that affect blood glucose. Less insulin = smaller mistakes.

I posted in a thread that celebrated the HCLF way of eating and asked for continuous glucose monitor traces to be posted. I accept their reported glucose control at face value but would sure like to see, for example, a 14-day ambulatory glucose profile (AGP), to see what their control looks like. I have not had anyone accept my challenge and post their graph.

The 14-day AGP is available in Dexcom’s Clarity program. If anyone reading this uses a HCLF plant-based way of eating and also uses a CGM, I’d love to see this report posted. Maybe I need to expand my thoughts on acceptable dietary habits with diabetes!


#45

I’m a little confused by this measurement. It seems like we can’t isolate carb intake from insulin requirements when defining insulin resistance.

If I were to not eat for two days, I would need significantly less insulin/day and insulin/kg, but that wouldn’t say anything about my insulin resistance. Or at least, I wouldn’t think that it would say anything. Maybe someone can clarify this?

Is this the standard that is generally used to define insulin resistance? If so, is it valid with every diet?

I’m not really advocating for a plant-based HCLF diet, but I’ve read posts from individuals who follow this diet who have a ratio of 1:30. In that case, they’d be using the exact same amount of insulin as you are. I have no idea if their glucose varies more than yours does. However, if they’re maintaining a standard deviation of around 40 mg/dl, not having frequent severe lows and highs, and have a good A1c then I don’t think we’re in any position to say that the way their managing their diabetes is not as good as any other.

Research has yet to demonstrate that variability correlates with long-term complication risk. As you’ve posted in the past, reducing variability protects you from the short-term risk of severe hypos. However, A1c is by far the strongest indicator of long-term complication risk. According to the DCCT, an A1c of 6% correlates with a nearly negligible complication risk. So if people want to use HCLF to get there, then I really don’t think we’re in a position to say that it’s a bad way to do it.


#46

I just realized I never responded to the original post.

My A1c tends to be much lower than my average glucose would predict it to be. My average glucose correlates with an A1c between 5.6-6.0%, depending on the time of the month. My last actual A1c was 5.1%. I don’t know why there’s such a large discrepancy, but I think my control is pretty good either way.

I vary my carb intake quite a bit, and I certainly don’t adhere to any kind of prescribed number. I’d guess it ranges between 100-150, but somedays it’s less or more. I don’t track it. I eat a lot of veggies and plant-proteins, but I also eat animal protein when I want to eat it. When I eat it, I tend to prefer eggs, fish, and occasionally meat. I love cheese but I’m now trying to eat it sparingly because of the saturated fat content. The recent study regarding increased cardiovascular risk as well as a study @Eddie2 posted recently convinced me that this is something I need to be watching. I splurge on weekends though :slight_smile:, and I think I probably drink more than I should. I suppose we all have our vices.

I found that I was hungry on a plant-based diet when i tried it, so I stopped eating that way. Maybe I was hungry because I didn’t add enough carbs or eat often enough. I don’t think I’d try it again though.


#47

This is true across a population, not true for any individual.


#48

I am a vegan and have been for over 30 years and a vegetarian for over 50 years. I eat on average about 120 grams of carbs a day, But I eat what I want to, If I choose to eat a higher carb meal, I do. I just generally will keep that to once a day.

My last A1C was 6.4. I have dawn syndrome and generally have taken to not eating in the mornings, it’s just too hard to control and keep my BG down in the morning, especially if I eat. I usually am not hungry in the mornings anyway. If I do eat, it’s a very small carb amount or pure protein or fat like an avocado. I also pre bolus which helps a lot in controlling BG and eating any higher carb meal.

My ratio is 1 unit per 3 carbs in the afternoon, to 1 unit per 5 carbs by night. By night sometimes 1 unit per 5 carbs is too much.

Generally I am happy and if I’m hungry I eat. But I love nuts, avocados and soy meats and if my BG is higher than I want I generally stick to low carb foods.

I am a very strict vegan and would never change that! There are vegan cookies, cake etc but I honestly just don’t feel good if I were to eat more than a cookie or a couple of bites of cake. My higher carb meals are usually because of pasta , potatoes, beans, pizza or bread. I eat whole wheat pastas or sprouted breads if I am making items at home.


#49

I think that’s probably also true for any measurement we have available.

My understanding is that the A1c is a good indicator because it’s a measurement of how much glucose has attached to a protein, hemoglobin.

I also understand that complications resulting from diabetes are a result of a combination of things, but they generally begin with the creation of advanced glycation end products which occur when glucose attaches to proteins in our body in an unhealthy way.

While the A1c isn’t perfect, I think it’s the absolute best measurement we can use to minimize our risk of complications.

If you are aware of studies that demonstrate a different measurement as a better indicator, please post them.


#50

Do you mean, not true for every individual?

Because from all the research I have reviewed, I am pretty sure it is true for me.


#51

I find low carb less work and that I feel better most of the time because I’m less likely to swing high or low. It is also less expensive for those like myself who are self-funding, since I can maintain good numbers with a Libre or glucometer, but can’t when eating higher carb without a Dexcom. Also insulin requirements drop significantly. I have no idea if it helps with complications though, I just know I feel awful anytime my BG starts climbing above 9 and almost incapacitated mentally when it hits the teens, but that some people don’t experience this.


#52

I also found when I was eating low-carb that my Dexcom sensors would last on average a month. I think because of lack of sharp variability in my blood sugar (I still had variability, but it was slow up or down for the most part). Since going to a higher-carb diet, my average sensor life has dropped to two to three weeks.


#53

Yes, I think everyone is a bit different in what works for them. I don’t think I said anything negative in this thread about the LCHF diet. I apologize if it came across that way.

I’m glad it works for you!

I also don’t feel well when I hit above 160 for a sustained period of time. It doesn’t seem to bother me much to hit 160-180 if it’s a brief excursion though.


#54

I think A1c is a great goal when comparing to past results. Maybe people run into limitations once they get into a very low A1c range and find getting lower challenging. But for an individual, dropping their A1c from 9% to 7% to 6% is a tangible goal that their control has (mostly likely) improved. The one exception being that having too many hypoglycemic episodes can’t be measured with A1c, of course.

I think where A1c gets frustrating is when insurance companies use it as an eligibility criteria for certain technologies. For example, my plan covers the Libre, but one of the eligibility criteria that must be met every year is an A1c >7%. So therefore I don’t qualify (although I will still be applying and fighting). It’s frustrating because I and my doctor both agree that I benefit from a continuous/flash glucose monitor even with a lower A1c, and in fact my argument with my insurance company will be that the only reason my A1c is below 7% is becasue I self-fund the Dexcom. But if I have to maintain an A1c over 7% just to qualify each year, that sort of defeats the purpose of even using a CGM.


#55

Oh, you definitely didn’t say anything negative, was just pointing out what I think is a benefit of it regardless of complication risk. It’s not like I’m perfect anyway, it was Thanksgiving in Canada this weekend and I definitely ate too much pumpkin pie!


#56

I find my pump sites last longer and are more predictable, especially if using Fiasp. I’m not sure about Dexcom for me, but usually 2 weeks is the best I can do. What really annoys me about it is the transmitter cost. Even though I can get 6 months using xDrip instead of 3, it’s still a lot of money compared to the Libre if the sensors last the same amount of time or less.


#57

Yes, better stated.


#58

The insurance stuff is sometimes maddening. Not sure if you have the option for insurance appeals in Canada, but one thing that was pointed out to me by an endo was that a CGM can save you from a life-threatening hypo event, regardless of how low or high your A1C is!

Maybe that is something you can use for an appeal. There is really no argument against that!

In a previous insurance appeal, I illustrated that a single visit to the emergency room would cost the insurance company more than an entire year of CGM or pump supplies.


#59

That’s just really rotten that if you have bad control you qualify for a sensor, but if you have good control you don’t? That just motivates people to not be as well controlled so they qualify. Which in the long run will cost them more with the complications of poor control.

And some kind of CGM is a huge help with controlling your sugars.

Because mine is considered well controlled my endo needed to document the lows to qualify me when I decided to go ahead and get a pump. I think Eddie2 might be right to see if you can appeal because of lows.


#60

So their theory is that CGMs should only be used in alternating years?

One of those rare instances where the expression “Catch-22” in its strictest sense actually fits. In the novel, you couldn’t get the insanity deferment unless you applied for it, but applying for it proved you were sane and thus ineligible. In this case, if you use a CGM to get the result it’s intended to provide, you don’t qualify for it. Nuts!