@blizzard2014 " I hope you get your numbers under better control."??? I don’t think we’ve talked about any one having bad control on this thread? So I’m not sure what you are referring to. I know @Marilyn6 and I are both vegans and not low carb and we both have excellent control.
mmm apples, applesauce…darn, wrong time of year. It is hard to get good apples this time of year here.
Marie, I am not sure who Blizzard2014 is speaking to. I also see some misunderstanding about plant based low fat diets from some members.
I have been a type 1 for 61 yrs. I have eaten every way possible since I was diagnosed in 1959. My doctor said that as long as my urine was free of sugar once a day I was in control. I didn’t even follow that rule during college or in my 20’s until I developed retinopathy.
I was fortunate because about then A1c testing became available. I quickly lowered my A1c to around 6.5 and my eyes cleared up.
After that I ate what I wanted and was pleased when I could start taking more than 1 shot a day. About 14 yrs ago I started following Bernstein and brought my A1c down to 4.7.
For the last 3 yrs I have been eating a low fat vegan diet of about 275 daily carbs. A low fat diet reduces insulin resistance. I usually use 23-24 total units of insulin. My A1c is 5.2. I weigh 106.
If I didn’t get 2 heart stents 10 yrs ago, I would probably not eat a diet that is this low in fat. I have no other diabetic complications.
I believe that low-fat is the best diet for my heart. My LDL isn’t terribly low at 114, but I am unable to keep it this low eating any other way. From all the reading I have been doing recently, I definitely believe that diabetics get more heart disease and that LDL probably matters.
Hi Marilyn,
I saw your posts on Google searches when I was trying to find people who had changed from LFHC to HCLF and I saw you had with success. I have been vegan 10 months and want to try the HCLF approach so I can eat a wider range of yummy vegan whole foods.
I started off ok in January but my sensitivity didn’t really pick up drastically and so I’ve gone off the wagon a bit, continuing, but now with high carbs and high fats. I had really great HBA1C’s these past years but my latest would be bad I think. Never as good as yours though!
I would like to try again and try to get it right. I think I didn’t work the exercise factor in well enough to help the sensitivity so I was wondering if I could ask some advise on this…could you let me know your weekly routine to help your insulin sensitivity?
Thank you so much for sharing your experience. It’s been very inspiring for me!
Best, Ros
Hi Ros, I also answered this under high carb, low fat vegan.
If I didn’t answer your questions there please let me know. I am very happy to help.
Hi @rozomon I am a vegan but I don’t follow anything other than I eat totally what I want as long as it’s strictly vegan. I am a very strict vegan. I do always prebolus, at least almost always. Though I don’t eat a lot as I’m retired.
I do not restrict my fats or carbs. Usually I do skip eating in the am as I have either dawn phenomenon or foot on the floor periodically and I find it easier to just not eat in the am.
So for example this morning I took an adjustment shot and it turned out to be a little too much, so I had a few grapes and some pineapple in the am. For lunch, my main meal of the day, I had a large bowl of veggies with seitan, cashews and some fake cheese on it and 2 vegan coconut mint cookies. For dinner I had a small bowl of fake turkey salad (Tofurkey, sweet relish and vegan mayo, vegenaise) with a slice of sprouted bread and jam. My snack at night was a piece of vegan dark chocolate.
My last A1C was 5.1%, I am usually TIR at 99% of between 65-160. I use a total of about 50 units of insulin daily in an insulin pump…
My biggest help is my CGM to let me know I am dosing right and if I need adjustments. My next biggest help is to prebolus so I don’t get any large spikes after I eat. I usually hardly ever go above 130-140. I also really count on an hour of exercise daily. I use my exercise bike after I eat and usually short my insulin a little or I will get on my bike if I see I am going up in numbers and it stalls it right away.
@Marilyn follows the HCLF way of eating so she can help you better with that. I just wanted to clear up that I am not HCLF. @Marilyn6 's diet is much better at making you more insulin sensitive.
Thank you Marie. That’s really wonderful of you sharing such detailed info. I love being vegan so I’m happy to be “in the club” with you.
I think I will try HCLF again and see if I can get the balance right and get my sensitivity back. It’s quite a mess right now.
On the exercise, do I understand right you do this once a day but after a meal? Do you find that positively affects your response to other meals as well? And when you prebolus, how long ahead is this of your meal do you shoot?
@rozomon For most common meals I prebolus half a half hour before I eat and the rest when I eat. I try to be around 85-105 most of the day. But if I am under 90 I prebolus half 20 minutes before I eat and the rest when I eat. Higher fats or very high carbs I need some more sometimes a half hour after I eat. Although most of my meals if very high carb end up having more fat which is why I probably need some later. (Amy’s Vegan pizza for example)
I eat one larger meal a day with either smaller meals or snacks once or twice.
Usually I will take less for my larger meal and about a hour after will get on my exercise bike. My aim is 10 miles which is about 1 hour at one sitting. But sometimes I drop too much or stay too low in which case I will try again later I still aim for the 10 miles though. It also helps get rid of the spike with FOTF I sometimes have in the am.
I also use it to help control or stop any spike that I have once I reach about 125-130. It almost instantly stops any climb and I consider it good for me. I have my alert set at 130. So usually once a day of 10 miles and throw in a 2-4 mile extra to stop any spike or forget to dose for a few chunks of pineapple eaten!
I know when I hurt my back again before Christmas I couldn’t exercise for quite a few weeks and had to be more precise in my dosing and had a tendency to stay at higher levels longer. I didn’t like it and couldn’t wait to be able to get back too it. I listen to music and I also will do my email and play games to mix it up.
Thanks Marie. Ah so you are eating a similar way to I have for some time with a bigger meal and snacks! Could I ask, are you doing this to lose weight or do you find the calories are enough to maintain?
The information on how you exercise is great. I am suspecting this has been my missing key and am excited for feed day tomorrow to test it out (today is fasting day)
@rozomon I only ever fast to do basal testing, but I do know I am always super sensitive the next day to insulin when I have.
I lose about a pound a month and I do have weight to lose. But I am not trying to lose weight. I am happy at what weight I am at, but another 10 pounds and I will be at a weight I was at 30 years ago although not as trim because I did a lot of weight lifting back then. So I am not against the slow loss.
I am 63 now and have been a vegan for 35 years and a vegetarian for over 50 years. I put on weight when I was misdiagnosed with all the different medications they tried on me and when I first went on insulin. And while I stopped gaining I could never lose until I got a CGM and a pump and could keep track of my levels and take my insulin more appropriately. My goal was never to lose weight it just started happening with better dosing. I take less than half by switching. A pump was within 2 months of a cgm so I expect both played a part. I was very haphazard on mdi and I suspect I did a lot of eating to my insulin dosing versus dosing to my eating.
But I am retired now and not as active and if I am hungry I eat. I am not trying to diet, it just seems to fall into place with the better track of blood sugars and dosing, albeit very slowly.
Thank you for the detailed information, Marie. Very helpful.
I have talked with two other vegans who have been vegan for a long time and both also have excellent sensitivity and seem to be able to eat higher quantities of fat and maintain excellent HBA1C’s. It’s very inspiring and I’m looking forward to seeing more results as I continue the vegan diet. I am healthy and slim but since my 20s have had slightly elevated cholesterol - probably my genes. Since. going vegan, I’ve gone off the statins I was put on and my CHO is perfect!
I want to lose 10lb that I’ve gained in the past year and I suspect my insulin dosage plays a big role in it. I’ve been doing alternate day fasting this past week fasting for 36 hours and then eating normally. It’s been great but my weight has barely shifted and I suspect the higher doses of insulin on my feeding days are affecting that.
On days I eat, my sugars are currently pretty wild as the sensitivity doesn’t seem to be right so first things first, I hope to sort that out following the HCLF approach.
Slow and steady, right? We are always learning something new with diabetes.
Looks Good! I wish my last 24 hours looked like that!!! I’m dealing with a bunch of highs right now…still think my basal dosage is off by A LOT on my pump…but we’ll tweak it on Tuesday when she looks everything over Im sure.
That’s a 2 week average? My daily’s look a little more zig zaggy. Although I don’t go above 140 that often. My alerts on my Dexcom are set for between 80-130 so I can make sure I stay TIR.
I was misdiagnosed for years! One of the best things you can do is to learn your pump adjustments as fast as you can! The endo has general guidelines that work for most people and we can be so different!
Thank you @Jimi63!
Marie, this is all great and inspiring, thank you. But it can be also misleading for people newer to the condition. Frankly, your defining strength, and a most admirable one, is the discipline in treatment. The kind of daily exercise you’re doing is remarkable and I would say it carries a big part in the bg management. I cannot help wonder if you have many external factors or family in your daily life as that would make that sort of discipline even more remarkable.
Having said that, to put forth on every occasion that you eat whatever you want whenever you want, and the kind of relatively very high carbs you do, is wrong advice, I dare to say. You manage so well because you’re experienced, highly disciplined, and wonderfully in tune with your system. A newbie trying to do this would probably have terrible a1c’s.
Again, you’re an inspiration, but, for most, an unfeasible target of near-perfection due to that unusual level of discipline and exercise and, perhaps, time/resources to manage this. I feel that a safer approach is lower carbs and more rigor in the meals.
I am retired, so I do have more time than when I worked to respond to my BG level. I have always made it plain that being retired has helped me. My past work schedule, I couldn’t even count on having a meal during the day or if I did what I would get to finish eating. So there never could be any prebolusing on days I worked. Although I still managed an A1c of between 6.8-7.0. That was also before a pump or a CGM.
However, I know plenty of people that aren’t vegans that have good control that eat what they want to and work. In fact I know more type 1’s that eat what they want to, that do not low carb at all and have good control. I belong to a group of 14 type 1’s that only two are low carbers and one that limits carbs. Only 3 of us are retired and all have control A1C’s of between 5-7.
So I think it’s completely safe for a newbie to learn that you can control your BG levels and keep eating what you want too. You do not have to low carb. You have to learn how to dose appropriately for the carbs.
There is so much to learn in the first few years after diagnosis.
Here’s my background before I share my thoughts and opinion:
I have very well managed diabetes. My A1c has been sub 6 for years and dropped below 5 last year with the help of Afrezza. Unlike Marie, I’m not vegan though I have considered trying it out again.
When I think about managing a meal that has a ton of carbs, some of my first thoughts are:
These all go through my mind in the blink of an eye with very little actual thinking involved on my part. It’s practically second nature. I’ve had diabetes for 25 years.
If I make a mistake and dose way too much, I have a cgm to show me my trend and alert me to the low. I also have the experience of knowing that in the past, x happened when I last felt this way as I was trending low.
As I’m describing this, it sounds exhausting. But it isn’t really for me anymore. It’s become just a regular part of my daily life.
However, I remember how bad and scary the lows could be in my first few years after diagnosis. That isn’t to say I don’t have lows now, but I don’t tend to find them scary unless there’s something that is really alarming about them- like if I’m snorkeling in the ocean when I drop low or if I don’t have glucose on hand. Even those scenarios I’ve figured out how to avoid or manage by running a bit higher while snorkeling (it’s only for a few hours anyway!) and keeping very small glucose gel packs in my pocket.
So here’s my point:
A HUGE part of all of that being second nature is experience. However, you won’t gain that experience unless you do things that will give it to you. If you’re new to diabetes, then I think trying things out incrementally and really paying attention to how you feel and what happens. Some people write everything down and review it later. Whatever works best for your brain! Eventually, I genuinely believe you can find ways to mostly eat what you want.
Even people without diabetes have limitations on what they can eat to maintain their weight or cholesterol levels for example.
Thank you for sharing. We are very interested in Afrezza but stories abound on its potentially carcinogenic or other effects to the lungs. Our endo expressed that too and cut short our hopes for this needle-less intake. We were otherwise willing to deal with the less precise dosage and all. You have no such worries at all?
This is what the package insert for Afrezza says:
“In clinical trials, two cases of lung cancer, one in controlled trials and one in uncontrolled trials (2 cases in 2,750 patient-years of exposure), were observed in participants exposed to AFREZZA while no cases of lung cancer were observed in comparators (0 cases in 2,169 patient-years of exposure). In both cases, a prior history of heavy tobacco use was identified as a risk factor for lung cancer. Two additional cases of lung cancer (squamous cell) occurred in non-smokers exposed to AFREZZA and were reported by investigators after clinical trial completion. These data are insufficient to determine whether AFREZZA has an effect on lung or respiratory tract tumors. In patients with active lung cancer, a prior history of lung cancer, or in patients at risk for lung cancer, consider whether the benefits of AFREZZA use outweigh this potential risk.”
Afrezza was developed by a person with type 1 diabetes, Al Mannkind. Mannkind Corporation is not affiliated with all of the large other pharmaceutical companies, so when Afrezza came out, those companies did everything they could to suppress it. It is difficult to weed through the information online and that doctor’s provide to determine how safe Afrezza is because there were so many parties that wanted Afrezza to do poorly. In addition, there appear to be issues with people shorting the stocks- basically betting that they would do poorly, and then those people did everything they could to make that happen. This is what I’ve heard anyway, I didn’t learn of Afrezza until well after Afrezza was first released. Most doctor’s have no experience prescribing it, so they’re only repeating what they’ve been told by others.
I can’t say whether there are carcinogenic effects or not, but honestly, I’m more worried about the pollution in my home city impacting my lungs than Afrezza.
When I asked my doctor if I could try it, he said that they’re still learning about the effects of Afrezza. He was willing to prescribe it to me but wanted me to understand that there were some unknowns. He has two patients that use it, but both patients came to him first asking about it. I’ve been using it for about 2 years, and I seem to be doing fine. My follow-up spirometry test was in the same range as the one I did before I started using Afrezza. The clinical trials mentioned above were published in 2014, and performed even in the early 2000s. I haven’t seen any other reports of possible carcinogenic effects since.
I came across this paper recently which is quite dense and long, but it describes in-depth the 4 cancer cases on the Afrezza insert. It seems that many people in the trial were from other countries - eastern Europe specifically.
Page 82 has the following text:
"Dr. Pai-Scherf stated “Lung cancer is the most common cancer in the world and the leading cause of cancer-related mortality. According to the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) statistics, the overall age-adjusted lung and bronchogenic cancer incidence rate during 2006-2010 was 61.4 per 100,000 men and women per year in United States. This rate corresponds to an annual incidence rate of 0.06%. The median age at diagnosis was 73 years. The incidence of lung and bronchus cancer increases rapidly after the age of 55 and is highest between the ages of 65-74. The Afrezza pooled safety population is based on trials conducted internationally. Based on World Health Organization (WHO), the age-standardized incidence rate of lung cancer is highest in Eastern Europe and Eastern Asia compared to North America.’
‘A close examination of the four cases of lung cancer reported in the Afrezza TI program indicates that demographics and the available characteristics are consistent with what would be expected in this population. However, the current available evidence does not allow a meaningful analysis regarding the risk of lung cancer in patients exposed to Afrezza TI because of small numbers and confounding factors.'"
This has actually not been a problem for me at all. The dosing is very different, but I personally wouldn’t use the term imprecise. I remember when I only used Humalog that when I was trending upwards fast, I had two choices: give a heavy dose of insulin now and then head off the low that happens a couple of hours later, or give the right dose and have to wait hours to get back in range.
Now I can get back in range quickly without the same worries about a low. Which means that my body is spending more time in a healthy range, reducing the probability of my developing complications long-term.
I could talk all day about why I love Afrezza, but it being needle-less would not be the focus of that discussion. I adjusted to giving myself shots when I was young. So the main benefit of it being needle-less is that I don’t have to do them in front of others when I’m out being social. That’s nice, but I can see why people might not think Afrezza is worth it if that is the only benefit they’re perceiving. Afrezza takes some getting used to, but the option to bring my blood glucose in range within an hour without having to worry about lows - it is really hard to describe to someone who hasn’t used it before.
Afrezza has made some aspects of diabetes a lot easier- primarily exercise. It’s out of my system within 1.5-2 hours, so I can go swimming or hiking without having insulin on board. I use Lantus 2x a day in the morning and evening, and that is less affected by exercise than Humalog or Novolog. So I don’t end up plummeting after a hard workout in the way I would if I had active fast-acting insulin on board.
Let me be clear though: I still use Humalog sometimes. Afrezza works best when my basal is strong. As a woman in my thirties, I have to adjust my basal throughout my monthly hormone cycle 20-25%. I am less sensitive to insulin right before my period, and more sensitive around a week afterward, but the patterns are not absolute. I tend to favor Humalog when I suspect my lantus dose is insufficient and should’ve been increased.
I also use Humalog when I’m about to have a meal that I think will take longer to digest. The benefit of having Afrezza on hand is that if I realize my dose was not enough, I can give a little Afrezza and see the effects within minutes.
Anyway, there’s a long answer to your short question 
Happy Birthday!! 