Hi everyone,
I was diagnosed last September with Lada. I am on shots(novorapid and lantus, using insulinx monitor trying to dose as I eat. My educators have told me to eat small meals a day, which I do and rarely feel hungry. But yesterday I had my first endocrinologist appointment and she said that I will always be chasing my tale if I continue to eat like that, that 3 bigger meals a day would be better. What do you guys do? I have also been told to eat 12 serves of carbs a day, for health brain functioning. which I probably sit around 10-12. When you guys talk about low carb diets are you talking lower than this? Has anyone done the Daphne Course, I cant get in to September, do they suggest any particular do's and don'ts for dosing for normal eating.
thanks
Like a lot of people here @ Tu, I use a ratio, G of carbs/ unit of insulin (7.8 or 8.0g/U...). I cheat on the math with a pump but count. I don't really have a "plan" to eat this much. I eat the same thing for breakfast and lunch most of the time during the week and just splurge in the evenings.
By "low carb," I think a lot of people would consider that around 40G/ day. Gary Taubes' "Why We Get Fat" (not D oriented but very interesting...) notes that studies have shown the benefits of low carb at up to 75G of carbs/ day. I run about 120-140 most of the time.
Good primers for this are "Your Diabetes Science Experiment" by Ginger Vieira, "Think Like a Pancreas" by Gary Scheiner and "Using Insulin" by John Walsh. You might want to check them out as they are sort of like diabetes "owners manuals" that will tell you how to run your own show successfully.
I admit I don’t understand your endo’s comment. I was told that the benefit to eating several small meals is to keep spikes to a minimum.
thanks acidrock and ren, what she was trying to tell me is that, in the evenings when i eat more often im not giving the insulin enough time to bring down my glucose before it goes up again. But once she gets my carb to insulin ratio right it shouldn't matter. is that right. Or do people on a pump add there snacks(insulin) to their meals or just dial it in as they eat it. Or leave 3 hours before eating again, when you are back down to a reasonable level. thanks
The evenings are challenging, I eat, then I eat some more, all the while tossing some brewskis down the hatch. With a ratio, I can sort of figure my "long-term" (until bedtime...) plan out and just take a big shot but I do the best when I keep track of everything. Another beer? Bolus for 10G of carbs (Guinness...) or 6G of carbs (Miller Lite...) or the 9% Lagunitas IPA seems to be 20-25G, I haven't quite got it yet but I'll keep trying until the sixer is gone...
Haaaahaa!! thanks
Hi Nel71,
I think the Daphne Course is a good idea, if nothing else you will learn about nutrition. The one thing I find helpful is when a nutritionist learns what YOU enjoy eating and what YOUR habits are, and can help design an eating plan based on that. If eating small meals works for you then that is okay! Be prepared though, that may not be true forever.
I eat two big meals a day, and I am not hungry. If I do get hungry, I know that something is amiss...so I take care of it. My education on eating came from the old exchange diet recommendation from another time period. I still follow that advice today and make changes as needed for age, and stuff. I prefer foods from nature, but don't mind a can of soup when I'm cold and tired and don't feel like prep or am in a hurry. Like acid, I like a cold one or two as well.
Just so ya know, there is no "normal eating" so if a door to that bus opens, walk away :)
Hi Nel - One thing I've discovered is that people have very strong emotions connected to their eating style. I've also discovered that when it comes to good dietary advice for controlling BGs, it's less likely that you'll get good advice from doctors, nurses, and dietitians.
I use a low carb diet, about 50-70 grams of carbs per day. I don't know what your "12 serves of carb per day" translates to but I suspect that each serving translates to many grams of carb per serving. Maybe 15g/serving or about 180 grams per day? If I eat that many grams of carbs per day, I lose control of my BGs and the insulin doses do not act in a predictable fashion.
I eat two main meals per day plus an occasional afternoon snack, usually nuts. My diet can best be described as low carb, normal protein, and high fat. Don't expect to get any positive feedback on this eating style from traditional medical professionals.
One of the best pieces of dietary advice often given on this board is "eat to your meter." That means check your post-meal BG, 2 hours is a good time, and adjust your eating content, amount, and bolus timing to bring the 2 hour post meal check to less than 140 mg/dL (7.8 mmol/L) and your 4 or 5 hour check to your pre-meal BG. Hopefully that's under 100 mg/dL (5.6 mmol/L).
I always pre-bolus (amount of time between insulin dose and starting to eat) at least 15 minutes. Sometimes I push it as far as one hour -- in those cases I keep a steady watch on my CGM and start to eat when I observe a downward BG trend.
I believe that it's helpful to allow three to four hours, at least, pass between eating. That gives your system some time to process the previous meal and benefit from some downtime. I also make a practice of not eating for three hours before bedtime. I find I sleep better if I can do this.
I'm not in the UK so I can't comment on the DAFNE course. I understand that it's based on calculating your insulin dose based on your expected meal. I know that I can't consume meals with a large carbohydrate content and still remain in a good BG range. Large carb consumption leads to large insulin doses which in turn leads to large dosing errors and the inevitable hypo- and hyper-glycemia. Large doses of insulin do not act as dependably as small doses of insulin. The only way you'll know is to eat to your meter.
At this point, most comments point out the obvious that "your diabetes may vary." While I understand the truth of that sentiment, what brings you here is trying to understand what you share with others similarly situated.
I was dx'd at age 30 with Type 1 diabetes. I didn't have the requisite antibody tests but I suspect that I would also be characterized as LADA. My last A1c was 5.9%, my BG variability as measured by standard deviation, is around 30, and I rarely have lows less than 60 mg/dL (3.3 mmol/L).
thankyou for your feedback Karen and Terry, it has been most helpful.
Terry you use CGM. They are not common here. How much are they, approx? Do you still have to prick your finger with these devices?
Nel - I found this UK website that appears to answer your question about the DexCom G4 cost. I've never used the Medtronic CGM system and don't have any actual costs but I would assume that they are comparable.
Yes you do have to prick your finger with a CGM. CGMs require a minimum 2x/day calibration. The CGM protocol specifies that one should always do a finger stick before treating a hypo with carbs or a hyper with a correction insulin dose. The CGMs are not yet accurate enough to confidently base treatment decisions. That being said, I find my Dex CGM to be accurate enough to be extremely useful.
Many CGM users report using fewer strips once they start on a CGM. I prefer the continued check and balance of doing 10-15 fingersticks/day. I am probably not typical!
Whenever a new sensor session starts, there is a two hour blackout period. I hate losing sight of my BGs during even this short period. Once you get used to living with this data-stream, it's hard to live without it!
Nel - You may want to read this 2012 Swedish study done by Nielsen JV, et al. One arm of the study T1 participants limited their carb intake to 75 grams per day.
Dr. John Briffa, a London physician, wrote this about the Swedish study:
For what it’s worth, some Swedish researchers recently published a study in which a low carbohydrate diet was tested in a group of type 1 diabetics [2]. The study subjects were asked to limit their carbohydrate intake to no more than 75 grams a day. Blood sugar control was assessed with a test known as the HbA1c, which provides a measure of overall control in the preceding three months or so. The HbA1c is usually expressed as a percentage, with less than 5 per cent generally being taken to show very good blood sugar control (typically seen in non-diabetics). The average HbA1c in the study subjects was 7.6 at the start of the study. The HbA1c was retested at 3 months and 4 years.As with all things, some stuck with the advice regarding carbohydrate restriction, and some did not. Those who did not comply with the advice saw no significant change in their HbA1c levels over time. On the other hand, the subjects who went with the advice saw their HbA1c levels drop to an average of 6.0 per cent. Clinically, this would be seen as a very significant drop clinically, and signal generally much improved blood sugar control.
I agree with Terry on the 'eat to your meter' suggestion. It was an eye opener for me, since previously my doctors had only allowed BG strips for testing 4 times/day, to calculate meal time bolus.
Many health care providers make it sound like a carb is a carb, and that it affects everyone in a similar way. This is so not true ! 15G carb by itself, vs 15G carb + 15G protein will also have a different impact in how fast/high your BG may spike after a meal.
Also, as a LADA, with some insulin production, you may find you can eat soon after bolus. But when you rely totally on injected insulin, often have to wait 15-30 minutes, especially if BG is initially 'high'. So just when you think you have it all worked out, sooner or later it will change, and 'eat to your meter' will again be your best weapon.
Some comments are not true for everyone. I have been T1 for decades, and if I waited 15-30 minutes for my meal I would need an ambulance to serve it up.
The eat to your meter advice is excellent, but the reality of eating anything is dependent on your own eating habits, situations, lifestye, whatever they may be. Carbs, protein, fat, whatever will need to be considered.
Good for you for reaching out for information Nel. I think you will find some real help at the class, it can be suited to your own situation there :)
I pump and I do try to space my meals so that I'm not always dealing with a lot of insulin on board when trying to calculate my next bolus. Small meals may be better for avoiding spikes - especially for T2s - but I don't think the advantage outweighs the importance of being able to calculate the correct insulin dose and if you hate needles the way I do, fewer meals means fewer shots means less unhappiness.
I eat more carbs than many here (about 160 net carbs a day on average) but I don't think the science supports the need to eat 12 servings of carbs per day to support brain health.
Maurie
Thanks Karen, that is so true. It is nice to know what works for other people though, but I and everyone else new to diabetes should understand that what works for some might not work for others.
Thankyou for your input everyone.
Hey Nel71
Like you, I'm a T1 LADA and I was also diagnosed last year just a little before you (May). I eat three meals a day and it's proved very successful in BG control. The rationale is that it gives your previous dose more time to clear and you minimize the risk of insulin "stacking."
One thing you might of found is that people get very passionate around the "low carb" topic. It seems to get as contentious as religion or politics. Suffice it to say I will start with the disclaimer of what works for me.
I'm a patient of Dr. Bernstein and follow the methodology he outlines in his book very closely. My carb intake is around 30g/day. Breakfast is usually some variant of 3 eggs with ham or bacon, often with salsa cheese and sour cream. Lunch and dinner is 1/3 of a plate of meat (chicken/fish/beef) with half a plate of green veggies (broccoli, Brussels sprouts, spinach, etc). Snacks are usually between lunch and dinner (rarely after dinner) and are things like nuts (almonds/pistacios/walnuts) or a boiled egg or two, or half an avocado with salt and pepper, for example.
I consume no fast acting carbs - bread, cereal, oats, pasta, rice, sugar, milk, etc. There is absolutely no nutritional need for these, by the way.
Regardless of what I choose to eat, I try to keep the protein/carb/fat intake consistent across meals. This limits the glucose variability in my diet and allows me to fine tune my mealtime insulin to achieve a nearly flat BG curve for the entire day.
I have no "energy" issues. In fact, I find that my energy across the day is very consistent. My brain works just fine. I'm still stunned by the fact that there are medical professionals out there that perpetuate the myth that carbs, and even fast acting carbs are required to maintain "brain function."
Your body is extremely clever in converting food to energy and taking the path of least resistance. The easiest to convert are fast acting carbs, of course. But these can be disastrous for a T1 trying to maintain good BG control due to their fast spikes and unpredictability. Deprive the body of fast acting carbs and most carbs overall, and you force it into a process of gluco-genisis, whereby it begins to convert proteins and fats into the glucose it needs. As long as you are consuming sufficient fats and proteins, you'll have enough energy. In fact, the upside of this process is that it delivers much more stable and consistent energy than the spikes and troughs from fast acting carbs. Hence, no 3PM crash, for example, that many people suffer after a typical high-carb starchy lunch. Also, as a T1, it requires much lower insulin dosing and your risk of over/under dosing is greatly diminished.
With this approach I've reached sub 5% A1c's, and I'm in better health than I've ever been in my life.
And again, let me finish with the disclaimer that this is what works for me. There are others in this forum who achieve excellent control with a higher carb intake and different meal timings. There is no one "right" or "wrong" way, however with more meals and higher carbs comes higher variability, which then makes BG control more complex.
Good luck and I hope this helps.
Christopher
Hi Nel,
Well, sorry to hear you had to join the type 1 club..ugh! As mentioned, eating is very individualized...we all do things differently. I'm not sure if you're still honeymooning and have some beta cells left; we'd be able to tell if you mentioned your insulin doses, regimes? It's my experience that once the honeymoon phase wears off and we're no longer producing insulin, low carbing (extreme low carbing) becomes a challenge too. Low carbs may work well for type 2's but eventually, as the autoimmune destruction continues, as a type 1, our bodies will eventually turn everything into glucose and we end up having to bolus for protein or a plate of veggies or nearly everything. So, it's a lot of trial and error, we become our own science projects..ha! I can spike sky high if I eat the above plate of veggies and protein if I don't bolus and our analog fast acting insulins are designed to work on carbs not really protein, etc.. I can spike sky high on on anything if my insulin doses aren't correct. I eat about 60 carbs a day but eat bread, yogurt, fruits, etc...a healthy diet and if my insulin doses are correct, I usually have no problems. I do prebolus if on MDI's, if on pump I don't have to prebolus so much (not sure why). Also, i have a treat and snack too, I'd actually like to gain some weight so i'm trying to eat more. We're in this for the long haul (unfortunately), so find an eating pattern(s) which fits with your lifestyle and just keep tweeking your doses, that's really what it's about.
Another trick for eating is to consider that about 50% of the protein (grams) will be converted to carbs, so if you eat a 1/2 a chicken, like the one in the pic, it might be 30G of protein (that's a total guess...Calorie King doesn't have 1/2 chicken...) so bolusing for 15G of carbs might balance things out about evenly.
But you have to be careful about the timing on the insulin. If your entire regime is based on medium to high carbs and you have a one-off high protein low carb meal and dose for the protein, you're may have trouble with the insulin hitting before the protein. This sort of issue is a major reason that finding a program that works and sticking rather closely to it is safer than going back and forth between higher and low carb.
Maurie