Hi Xanthe
I was diagnosed less than a month ago with T1. I was taught something similar to the DAFNE method but with an emphasis on keeping carbs between 45-75 per meal( I do splurge once in a a while). I take 1 unit of insulin for every 15 grams of carbs. I was also told that by keeping my meals roughly the same size in carbs I would be able to better manage my blood sugar. My typical breakfast is; 2 whole grain waffles, 2 hard boiled eggs, piece of fruit, and either milk or coffee with sugar. I’m not really in a position to offer advice but I have noticed the closer in size all my meals are, the more stable my blood sugar seems.
Cheers,
Mike
Hi Mike,
thanks for the advice- interesting as I was always taught 1 unit for 10g of carbs… and have found that’s worked… I do sometimes wish that my insulin pen did half units too though! For the six years that I’ve been diagonosed, I also ate pretty much those quantities of carbs-I would never hesitate injecting 5/6 units for pasta, pizza, cake etc… and it’s great if your’re good at judging the amount of insulin and blood sugars are happy with that, but mine were just everywhere… The general pattern would be one extreme or the other- I’d inject a couple of units too little and end up bit a crazy high blood sugar a few hours later… or I’d over compensate and have a hypo just half an hour later… and then have to eat more,., and then end up with another high…! The pattern just went on like that… As of last weekend, I cut my carb intake to about a third of what it was before and my sugars have been amazing… I’ve really noticed the difference in only injecting one or two units per meal… I don’t want to suggest this is what will happen to you - I really think that what diabetics can and can’t do varies so much from one to another. If it’s only been a month, there’s also a chance your body is still producing some insulin though… so you may have to adjust your doses after a while. Good luck with it though, sounds like you’re already doing really well.
X
I:C ratios differ for everyone, Xanthe, and for many of us they differ at different times of day. Mine for example before I started Symlin were 1:6, 1:7 and 1:18. On Symlin they are 1:12, 1:14, and 1:30. 1:15 is sometimes quoted as a starting point because it’s average. You can start from that and then depending on your resulting blood sugars two hours after a meal you tweak it one way or another until you are in target range more of the time.
Yes, you’ve discovered what Dr. Bernstein calls the “law of small numbers”. Even though I don’t eat as low carb as Dr. Bernstein suggests, I really believe that rule is true. The more carbs you eat the higher the insulin dose you need and the more unpredictable the results - too little you go high, too much you go low, etc. For me if I get in the neighborhood of 50 carbs (for dinner, I could never tolerate that for breakfast) the results are unpredictable using my usual I:C ratio.
I follow an approach similar to yours, I eat mostly what I want, when I want and give the appropriate amounts of insulin. I typically eat 200 - 300 g of carb in a day. This approach can work, but in order to maintain good control it does require much more diligent carb counting and understanding of how food and insulin are handled by your body. The whole challenge to this approach is that by taking a large amount of carb and a large amount of insulin, if you don’t get it right, you end up with a large error in your BG, the low carb option is very valid way of improving your BG numbers, since a small amount of carb and a small amount of insulin will result in a much smaller error if your don’t get it right. My approach is that if I know a certain food will spike my BG I try to have smaller portions of it (potatoes, white rice, watermellon, juice, sugary deserts, etc), also if I have no idea of the carb content of a certain food I will also limit myself to a smaller portion of it and take an eductated guess on the carbs. When I am at home I try to weigh out my food whenever possible and calculate the carbs, doing this is also a good practice because it makes you better at guessing the carb content of those same foods when you are not able to weigh them. One rule that I follow with no exceptions is that I do not play competitive sports or hard excercise within 3 hours of a meal (4 hours if possible). I have also been trying a cgm for the past 2 weeks and this is an amazing tool, which I would recomend to anyone. CGM allows me to learn a tremendous amount about how certain foods and activities affect my BG trends, plus I can be more aggressive with my insulin doses and can see the BG dropping and prevent almost all of the lows from happening. My A1Cs are typically in the mid 6 range and do not have problems with serious lows, but I do put a lot of work into achieving these numbers.
In the end you need to find an approach that fits your goals and lifestyle, the more research and learning that you do the better your results will be, lowering your carb content will give better results, but can be very restrictive to your lifestyle, getting a CGM or pump will improve your results and confidence, but may not fit everyone’s budget.
I used to do REALLY low carb intake, but I have adjusted. I used to set a goal to be at 90 - 120 every day. That would make me crazy for carbs and I would end up “falling off the wagon.” Lots of guilt, blah blah blah. Now I just try to temper carbs with veggies and protein. Like I might have eggs and veggies and cheese in an omlelet and some whole wheat toast or a piece of fruit. That is balanced. Snacks aren’t just carbs - I have to eat some nuts or have some cheese. Things like yoghurt are difficult because they are healthy but carby. I would rather eat something I like more - like toast! Or popcorn! So I skip the yoghurt. (I really dislike yoghurt) Good luck!
My approach: Eat like I’m a healthy non-diabetic. Avoid junk food. Keep the carbs reasonable - unless doing lots of exercise. (then I eat a LOT of carbs). Be fanatical about counting and dosing correctly. Keep records for your favorite/routine foods. Keep an eating schedule if possible.
It is possible for some people to eat higher carb and have low A1cs. I can do this, but I have to know VERY well how foods affect me and how to use my pump and all it’s fancy features to do this (ie: combo boluses are used quite often). Also, I use the TAG approach, meaning I bolus not only for carbs, but for a portion of the fat and protein content in my food as well. I have an A1c of 5.6% and consume anywhere from 100 to 250g of carbs a day.
I don’t restrict myself personally, but I do try to eat healthy. And I try not to eat things that don’t come with a carb count. Guessing sends by BG all over the place. That’s not to say that I never guess, but I try not to make it a habit. Also, I try to keep the carbs somewhat low because more insulin can sometimes equal excess weight. Also you mentioned cereal, and for me personally, cereal makes my BG spike. I usually extend my bolus when I eat cereal.