I am a fairly newly diagnosed late onset Type 1 Diabetic. I am currently trying to learn all there is to basal-bolus, counting carbs, low carb eating, preserving beta cells and so forth. What I dont understand: I was told in a course for newly diagnosed at my hospital that I do not have to count the carbs in most vegetables, either because they are too low in carbs or their GI is so low. Since I am on a low carb diet, I obviously eat a lOT of veggies ;)
But I dont know how to count for them. If I have a salad with lots of tomatoes, red capsicum, pickles for example (not that that is a particularly yummy combination, just for the sake of argument) My BG definately rises afterwards, maybe by around 30-40 mg/dl.
I dont inject for it though, because my insulin requirements are still very low.. But I WANT to inject a little insulin if I can, just to get used to it and the possible benefits regarding preservation of beta cells.
So are the carbs in veggies to be counted or not? And how do I know how much is in those veggies, if my books tell me that there arent any carbs to be counted in them??? I would appreciate any advice..! Thank you.
If I posted this in the wrong category, I do apologise. I wasnt sure, but i thought since I m a LADA with remaining beta cell function it might be good to ask other LADAs about this? Also apologize for my english, if there are lots of mistakes!
I think this is an example of the practical side of adding carbs to every meal. The veggies will be converted slowly to glucose. By adding carbs you can inject for the carbs and to some degree for the vegies too. In some cases even the tail of the insulin is enough to cover the carbs from the vegies. For many diabetics insulins like NovoRapid/Log have a tail. This means there is little but noiceable insulin activity at the 3 to 4 hour mark - despite of the fact that this insulin is an analog insulin.
I count veggies. It's very handy to have a food scale to weigh them to get the count very precise, particularly if you are eating a lot of them. a cup of something like broccoli is sort of hard to measure unless you chop it up!
This is a great question. Often, when you are taught carb counting with an ADA style meal plan, you are told to eat 45-60 grams of carbs with each meal. And to simplify the process, you are told that you can consider a broad range of green and leafy veggies to be "free." And relative to a meal with a big ole serving of "healthy" rice, they are free.
But in truth, they aren't. And with a low carb diet, those smaller amounts add up and in fact may end up dominating your carb intake. And to properly adjust your mealtime insulin, you need to count them. So if you have a cup of cooked broccoli, you need to count that as about 12 g carbs, 6 g fiber. And a cup of cherry tomatoes is 6 g carbs, 2g fiber. And things get more complicated, if you eat lots of protein, as much as half the protein can convert to blood sugar over 3-5 hours. But for now, it is ok to just take small steps. A reasonable simple rule is that most non-starchy veggies are somewhere around 5 g carbs/cup. And then over time, you can learn which veggies have more or less carbs/fiber and make refinements.
ps. NutritionData is a good source of carb and fiber content.
pps. I think this question is of interest to everyone, and I'd encourage moving it to either the food or general areas. You can do this by selecting option and editing the original post, all comments will stay.
ppps. And only count the carbs that "matter." Counting all the fractions won't make a difference, only those things that clearly affect your dose calculation.
But to inject for just the vegies will reveal a problem I think. Todays analog insulins are faster than the conversion of vegies to glucose. With the good old Acctrapid the chances are much higher to find the right timing.
hi julez, i am honeymooning big time and never count veg as carbs. my lunch just now was a big salad with tuna and i didnt inject. i would go low if i did.
I bolus for vegetables as described above, and it has never given me a problem. For me, Apidra matches up well if taken immediately before eating them. Eating anything will cause the liver to dump glucose. There is no free food. You should be fine, as long as you don't over - bolus.
Also, someone should mention that some vegetable will make your BG rise only slightly, while others, like carrots, will make it go up a ton.
To my knowledge the liver will not change its release rate if there is insulin in the blood stream. This is why diabetics on insulin can not counter-regulate lows. The release can only happen if the insulin level is sinking below a certain threshold. It has to do with the orchestration of the digestion and the signaling role of the insulin. A rise in the insulin level is the signal that carbs and fat are being digested. Thus the liver does not have to release glucose and the fatty cells are starting to cumulate fat from the blood stream. Very helpful for healthy people but problematic for us because it impairs our ability to cope with lows.
The fructose of the vegies is digested slower than simpler carbs. This might be an individual factor but for me this means that I have to inject later. Otherwise the NovoRapid would easily overtake the digestion of the vegies.
I bolus for non-starchy veggies, as they cause a slow rise in my BG and they are one of the main components of my diet. I only strictly count carbs if I'm having something starchy or sweet. I did a lot of carb counting in the first few months of my diagnosis, and ultimately found that for me, most non-starchy veggies consistently affect my BG the same way (whereas my numbers are more variable when I eat starches). As long as I stick with non-starchy veggies and eat approximately the same amount at every meal, I take the same dose, whether I'm eating broccoli, kale, or mushrooms, for example. Other factors are involved, like exercise, hormone fluctuation, stress, and the amount of fat and protein I am eating, but I'm still figuring all of that out!
For more info on carb counting, I recommend checking out the Calorie King website. There are many others as well, and there have been discussions about them on this site that might be helpful to you.
I also found this confusing at time of dx (T2). At my dietician's suggestion, I started making kale chips--ate a whole batch, thinking they were "free" in terms of carbs. Then I looked up kale and found I had consumed 20-30g of carbs. I was despondent: what was I supposed to eat???? LOL
With time I familiarized myself with carb content from different veggies & learned which one had significant carbs : carrots, green beans, tomatoes. I eat those in small amounts. I now count a salad as half to a full carb exchange, depending on what's in it. I recommend looking up your favorite vegetables and concentrating on the lowest carb options.
I don't count most vegetables and I back out all fiber. Going low carb is not the only way to maintain tight control and preserve beta cell function. I eat around 150-170 counted carbs per day and still seem to be getting a little help from beta cells after 5+ years.
No matter what the doctors and nurses say, balancing insulin and food is more an art than a science even if you weigh and calculate everything.
This is very interesting. I often eat lettuce, only with olive oil and a small amount of lemon juice or ceasar dressing. I need to bolus double my normal carb ratio. It covers nicely, and still adds up to 1u at most. Probably not enough to prevent the liver from releasing glucose. If I eat vegetables as part of a meal, they do not raise my bg as much.
I would be very curious to know the insulin threshold at which the liver stops glycogenolysis, and to what extent?
i must count for everything edible i even look at. even pure protein requires insulin for me!!! i have been D for over 25yrs, am currently on the MMpump (11yrs) and i am still learning about how my body reacts to food and to insulin. it can even change during the course of the day. i have been learning that D is a tricky disease and doesnt always do what it "should" do, despite our every effort at maintaining excellent health.
so, to answer your question, YES, I BOLUS FOR CARBS IN VEGGIES!. usually 15grms of carb per 1/3 -1/2 a cup. You'll figure it all out. just pay attention and maybe start keeping a food journal.
This "threshold idea" comes originally from the discussion about the "somogyi effect". This is a supposed counter-reaction to lows at night that is leading to a high in the morning. Researchers ruled the possibility of a counter-regulation out for insulin dependend diabetics. I think they argued that you must be very short of basal insulin to get near the threshold of the liver. To argue the other way around insulin dependend diabetics always have too much insulin in their system. This is because the insulin release in healthy people happens continuously in very tiny micro releases. This excess of insulin is also responsible for a shortness in potassium we are all at risk of. I wrote about that here.
I do the same as Maurie....the only vegetables I count are the starchy ones. Given that I eat a mix of protein, carb, and vegetables at most meals, any errors from not counting the non-starchy vegetables get lumped into my I:C ratio . If were to go from 130 or so carbs a day down to 30, then I think I would have to be much more careful in counting the vegetables as proportionally their contribution would be much larger.
Thanks for the potassium info. I should probably get it checked out. I am fairly certain that I have never experienced the Somogyi effect, but many others here seem sure that they have. I am inclined to believe this would explain the relative rarity of extreme hypoglycemia. Not to mention the continuous release of glucose, despite the insulin we are taking to cover it.
What is an extreme hypo anyway? Seizure? Need for external help? Have you seen the campaign run by the JDRF that claims that 1 in 20 T1 diabetics will die from low blood sugar? Not that I am convinced about this figure but the term "relative rarity" is not appropriate in my opinion.
I would define any seizure or loss of of consciousness extreme hypo.
I am familiar with the JDRF ad. I would argue that if we accept their numbers; there are about 1,000,000 T1 diabetics in the US / 68 years life expectancy / 20 low bg mortality = 735 low bg deaths per year in the US. The real number is probably much lower. I'm sure we agree that it would still amount to 735 too many. But in a population 1,000,000 it is very small, considering how easily and quickly given that one's BG may fall for various reasons at any time.
I've gone into shock, often with convulsions about 20 times in my life. Mostly when I was a kid, and often in my sleep. It seems there are members who have lived with T1 35 years or more and never experienced an extreme hypo. I don't see how this would be possible without some sort intervention, which I believe could only come from the liver.
