low carb diet the way to go?

[Deleted member 33898]

I keep reading on here and online in general that a low carb diet is the best thing for diabetics. When I was diagnosed the clinic asked what I normally eat and told me how much carbs to have at each meal and stick to that. So its gone like this , breakfast 70g, lunch 70g, dinner 90g. I take bolus insulin before each main meal and basal once a day. I've tried to eat certain foods at each meal that are low in sugar and perhaps not as fast acting on glucose levels. I make sure there is some fibre and protein to slow things down. About half the time my post meal BG levels will hit between 11 and 12 around an hour after eating. They told me this is perfectly normal but why do I keep seeing these levels as dangerous on here? I have tried to increase pre meal insulin slowly for meals to combat this but have found that it works for a few days then those post meal highs will appear again. With the increased insulin brings sharp drops in BG levels when they peak after a meal, usually within 2 hours after eating. I try to keep from going into hypo levels but this cant be helped. I'll normally have a small snack when I see them drop to mid 4s to low 5s but they will just keep dropping until I have to take fast acting glucose which results in levels going high again. So I basically spend a whole day with my levels going up and down without really settling and generally I feel sick because of this. Breakfast and lunch seem to be the most problematic as I normally would be bit more active in the evening anyway after dinner. Any input on this would be really appreciated. Hope I am making sense

 

[Inka]

No, low carb most definitely isn’t the way to go IMO! It’s not necessary and means you’d miss out on nutrients. It also makes control harder and increases insulin resistance. It swaps one set of problems for another. The best diet for Type 1 IMO is moderate carbs. That’s the Goldilocks Zone.

You’re fairly recently diagnosed so I suspect your pancreas is doing what mine did - squirting out some insulin too late and too much. This will contribute to your lows and the ups and downs because this insulin is unpredictable.

Why are you testing an hour after eating? I don’t think that’s sensible, especially not in the early days.

Please, please don’t forget that Type 1 is a very different condition from Type 2! Different diet, different ‘spikes’, different targets.

 

[Deleted member 33898]

I've just been overwhelmed by information and generally obsessing( which I think I've mentioned in other posts) All I've been told is aim for pre meal levels of between 5 to 7 and its okay to hit the odd 8. In my recent clinic visit in writing it says a target level of 8 to 12(not sure if that's an average to aim for)My h1abc was 97 and then 55 on my 2nd clinic visit. I know they are professionals but nothing they say to me gives me confidence. It probably seems like I am just coming on this forum to complain but I do appreciate the opinion of other diabetics. I had my first eye screening today, I guess just hearing about the complications makes me want to get to a better place faster with any means.

As far as the testing goes, I have the libre sensor so I can see where I am at all the time.

 

[helli]

@jazzchicken I second the comment from @Inka that Type 1 is different from type 2 and needs to be managed differently.
Some people with Type 1 prefer to eat low carb because less carbs means less insulin so any error is smaller. A correct higher dose of insulin is not a problem - insulin is your friend not your enemy.

I have dabbled in low carb meals (but not a low carb diet) and found it more challenging because, when your body receives few or no carbs, it creates the necessary glucose by breaking down the protein. Different protein are broken down at different rates so you need to adjust the timing of your insulin and your insulin dose depending on whether you had salmon or nuts or egg or steak or prawns or ...

A prolonged blood sugar of 11 or 12 is not a good thing. A spike to that level and down again should not be a concern. This is why your clinic are not concerned .. because you should not be concerned.

Doing the job of a pancreas is difficult especially when you do not have tools as good as a real pancreas has - injected insulin does not work as fast as the stuff a healthy pancreas produces. A healthy pancreas produces insulin in response to food so can react to foods that are digested at different speeds whereas we have insulin that works at the same speed regardless what we eat. Ideally we want the peak of the insulin potency to hit at the same time as the peak of the carb absorption. If you are spiking and then returning to lower numbers, your insulin dose is correct but it is possible your insulin potency peak is after your carb absorption peak. So, if you want to reduce those spikes (which are NOT a big issue), you could try injecting a little earlier relative to your food. The advice is usually to move it by 5 minutes at a time.

There are other things to consider such as Libre often over reads when in double figures (so your 12 may be less if you checked with a finger prick), people without diabetes will have peaks in their levels and your mental health is as important as your diabetes levels.

An HbA1C of 55 is brilliant so you should be happy with yourself.
If the Libre readings are causing you anxiety, you can have a Libre break. You will still need to finger prick test before meals and when you drive but it could help stop the fixation on the momentary higher numbers.

Don't worry about complaining on the forum (I don't see that you are), we are here to help whether it is to offer advice, whether it is to have a rant to, whether it is to have a laugh ... we are here to help you.

Sorry - that ended up longer than I intended. I did not mean to waffle so much (although I am still waffling). I hope it is helpful.

The main message is Look after all of yourself

 

[Deleted member 33898]

@helli thank you that is very helpful. Definitely will try some of those suggestions. I'm bit too dependent on the libre to be honest , definitely could do with less checks.

Thanks again

 

[Robert459]

Notes from a control freak: When first diagnosed, I panicked, researched cell respiration, etc and thought "I can beat this" and started on an Atkins style Zero carb diet. It did work, zero carbs = zero glucose so BG level stayed level for the year or so that I managed it. However it was VERY difficult, a sandwich was meat between 2 slices of cheese. Found we were adding ketones with alcohol so gave up eventually, I think it was the scent of a Dominos that eventually did for me. Since then I do eat low carb (less than 100 gms a day) but have the tools (tests, Libre, insulin) to help manage my body's response to fuel.

Maybe lucky that Libre pretty much matches test pricks, but before Libre was just guessing BG levels [between tests] edit

 

[Inka]

You’re not complaining at all @jazzchicken This is what the forum is for - questions, worries, rants. All good 🙂

Someone will probably leap on me here but I don’t think the Libre should be prescribed to the newly diagnosed. It causes unnecessary anxiety at a time when a) you’re probably going through your honeymoon and still figuring things out; and b) don’t have the experience needed. A Type 1 diagnosis is stressful enough and a lot to deal with by itself without unnecessary information and stress.

Your team are right. Brief spikes of 11 and 12 are fine. Really, they are. You need to pace yourself. You’ll drive yourself mad with worry else. I say that because I felt myself in that place too soon after diagnosis. Ease off a little. Be kind to yourself. You’re doing really well.

 

[Deleted member 33898]

@Robert459 thanks for the info. Can I ask about the alcohol adding ketones ?

 

[Robert459]

Can I ask about the alcohol adding ketones ?

It's been a while since we did cell respiration stuff but if I remember, energy is basically measured in ATP molecules (the brain/body works on ATP). Glucose via the Krebs cycle makes some ATP's while ketones make more. Alcohol is a source of ketones rather than glucose so consuming alcohol gives the brain/body more energy. I have a whole folder of print-outs upstairs but if you want to investigate yourself, look up cell respiration.

For a while, alcohol was giving us more "energy" but wasn't helping our overall health

 

[Deleted member 33898]

@Inka thank you.

Yes the libre was given to me because they could tell I'm a very anxious person but as much as it's been useful it has caused it's own share of anxiety. I think another issue is I may have lost my hypo awareness a bit or as the clinic said I'm probably not looking for the signs as well as I should. I feel reliant on the libre to tell me when I go low and so I use it alot. I do the odd spot check with finger prick test and most of the time it matches..issue is my hypos are probably averaging around 15 a week according to the libre. Not sure if this is an issue right now as I'm still up and down.

 

[Robert459]

issue is my hypos are probably averaging around 15 a week

Try a day without eating and watch what happens to your BG level overnight. With no glucose to consume, your BG level should be level overnight. If it isn't level, your basal insulin is either too high or too low.

If your basal gives you a flat curve, you can control your BG with bolus

 

[Inka]

@Inka thank you.

Yes the libre was given to me because they could tell I'm a very anxious person but as much as it's been useful it has caused it's own share of anxiety. I think another issue is I may have lost my hypo awareness a bit or as the clinic said I'm probably not looking for the signs as well as I should. I feel reliant on the libre to tell me when I go low and so I use it alot. I do the odd spot check with finger prick test and most of the time it matches..issue is my hypos are probably averaging around 15 a week according to the libre. Not sure if this is an issue right now as I'm still up and down.

If you’ve lost some hypo awareness, that’s not good @jazzchicken Its still such early days for you. Your hypo awareness should be razor-sharp. Don’t panic. You can easily improve it. I’ve had Type 1 almost 30 years and when I noticed my awareness had blunted a bit, I upped my minimum target to 5. That is, if I test and I’m in the 4s, I eat a small amount of carbs to push me into the 5s or 6s. Running too low will damage your hypo awareness - which is another reason not to aim to never be above 8.

Gradually you should get a feel for your blood sugar, but that’s much harder if you keep deferring to the Libre. When I was first diagnosed, I was told to only test before meals and at bedtime plus if I felt hypo. That worked well. It stopped me whacking insulin in and then having my own pancreas randomly add some too. It helped me relax and reduced the burden of diabetes. Despite testing less, my HbA1C was good. It’s simply not necessary to have all those readings from the Libre. During the honeymoon period it can be deceptive too because you panic at a brief 11 without realising your own insulin will kick in too and bring it down.

I know I keep saying this, but I can’t stress enough how Type 1 will take over your head and your life if you obsess too much about it. Balance is everything. I know it’s scary at first - really scary - but you need to go slowly and moderately and give yourself leeway. Set yourself realistic targets and take things slowly. Many, many Type 1s have managed fine without Libre over the decades, remember. In fact, many years ago they didn’t even have glucose meters!

 

[Inka]

Try a day without eating and watch what happens to your BG level overnight. With no glucose to consume, your BG level should be level overnight. If it isn't level, your basal insulin is either too high or too low.

If your basal gives you a flat curve, you can control your BG with bolus

Seriously, I’d starve!! There’s no need to do a basal test over a whole day. You can do it in segments. It’s not so good when you’re recently diagnosed anyway as things change so quickly. IMO, it’s easier to just adjust the insulin.

 

[ianf0ster]

Hi @jazzchicken You seem to have been given some Blood Glucose goals usually set for Type 2's as well as some slightly higher ones that are usually set for Type 1's. I can understand why that is confusing.

The vast majority of both Type 2's and of Type 1's are poorly controlled, so you appear to be doing much better than the average Type 1, though perhaps not better than those experienced ones in either this or in the 'red' forum. But you shouldn't be comparing yourself to those with vastly more experience of managing their conditions.

As has already been said, readings of 11 or 12 1hr after a meal aren't bad provided that the insulin continues to kick in and bring it down. But if a Type 2 was still getting those numbers 2 hrs after a meal, I would say that the carbs in the meal were a little too high. For a Type 1 there are both carbs and insulin to consider so to lower (or raise) a BG number it is all a question of balance between insulin (including which type and when and even where it was injected) against the carbs and to a lesser extent also the protein in the meal.

I feel that several forum members have thrown in some scare stories which I would like to correct:
1. Alcohol isn't actually good for anybody, however the problem for a Type 1 (or even a Type 2) diabetic is that it is processed at the highest priority which makes food digestion take longer and thus throws the insulin response out in time. So if injecting insulin for a meal and not compensating for alcohol consumption, the insulin will take effect before the time that the digestion throws the glucose into the blood stream.
So you can drink alcohol but be aware that it makes things trickier to manage.

2. Eating Low Carb doesn't increase Insulin Resistance, neither does it make you miss out on any nutrients. Of course you can design a nutrient deficient Low Carb menu just like you can with any other way of eating such as Low Fat or Vegan etc. And as @helli said some Type 1's prefer to eat Low Carb because lower carbs mean a lower insulin requirement, which means greater insulin dose accuracy. In fact there are thousands of Type 1's who eat Low Carb - just that @Inka isn't one of them.

 

[Inka]

Very true @ianf0ster I’m not one of the Type 1s who eat low carb - because I tried it and it doesn’t work. I’d eat my own d*mn arm if it helped! I’ve tried every diet over the years, including your beloved low carb. I still have low carb cookery books, including ones you’d probably recognise. I’ve also read a number of books about low carb. I had no prejudices for or against it before I tried it. The reason I don’t recommend it is because it’s not an ‘easy answer’ for Type 1 and it simply swaps one set of problems for another. It also makes handling illness difficult in Type 1s - because of the insulin resistance it causes.

You’re wrong - it does indeed cause insulin resistance. That might be useful if we were starving cave people but it’s a pain in the behind if you have diabetes.

It’s also completely unnecessary for Type 1s! My HbA1C is excellent. I eat bread, cereal, pasta, rice, chocolate, etc etc as part of a balanced diet. Carbs are the body’s preferred fuel. I’m sorry you can’t eat carbs. You obviously miss them.

 

[ianf0ster]

I wouldn't recognise any low carb cook books. We don't cook low carb recipes, we just eat low carb real food - no fancy ingredients Just proteins with their natural fats plus lots of low carb veg.
Are you confusing it with Keto? Low carb ranges from around 130gm of carbs per day down to around 20gms or whatever induces constant ketosis (if kept that low for every meal every day). It varies between being higher in protein with medium fat (e.g. how much fat I ate as a child over 60yrs ago) or higher in fat with medium protein (cheaper, but some fear that much fat).
In any case low carb for me is eat as much as you like in order to feel full until next meal or next day - no restrictions on quantities or on calories. No hunger, no diet books.
I can (and do) eat chocolate, I could eat a keto form of bread if I missed it. I have curries (but with 'cauliflower' rice), Lasagnas and pizzas (but with aubergine base). Linguini etc but using a bean based pasta.
I felt much more deprived when I ate Low Fat for 10yrs - at least now I can eat eggs, mature hard cheeses and other tasty foods again.

 

[Inka]

I know what low carb is @ianf0ster .You’ll see that I often reference the 130g figure myself - often in response to someone terrifying a newbie by telling then their diet is ‘very high in carbs blah blah’ when it’s clearly well below the 130g figure.

You have Type 2. You have insulin resistance. You don’t take insulin. You don’t have Type 1. I stand by my comments. Carbs are part of a healthy diet and a moderate amount makes control of Type 1 easier.

 

[Deleted member 33898]

@Robert459 I think if I was to try something like that id probably check with the clinic first. I get the idea but I'd rather see what they think about it

@Inka thanks.based on what you are saying my plan at minute is to 1. Stop me checking the libre soo much and 2. To keep away from hypos is to set my libre low glucose alarm to 5 mmol so that I can address this with a small carb snack to keep them topped up , because normally once I'm in the 4s a hypo is usually hard to avoid . It's probably an adjustment of bolus or basal needed but I'm not quite sure yet . Alarm also means I don't have to keep checking unless I'm warned. I'll obviously still need to scan every few hours to pick up sensor data.

I'm also going to accept these highs post meal, least until the clinic feels I need to change them. I hit around 11.5 this morning post meal.i just took a deep breath and said it's all good and it quickly came down.

@ianf0ster thanks for the info. I may stick to the higher carbs for now but will speak to the dietician on my next appointment to discuss my options. I do still drink alcohol . I had never really been much of a drinker anyway, had the odd night I'd go over the top and regret it the next day so I wouldn't miss that. I do find if I have half glass of red wine and piece of dark chocolate in the evening my levels are quite stable the next day, though I don't do this often.

Just wondering something else. So my post meal peak of say 11 will come down but sometimes quite fast. Within 2 hours I'm into the 4s majority of the time, for instance I had all bran and a banana this morning for breakfast. Is this a bolus adjustment more than basal? As basal would only need adjusted for levels when bolus isn't onboard ? surely if I lower the bolus I'll see the glucose peak higher though? Maybe thinking about this too much.

 

[Robin]

Just wondering something else. So my post meal peak of say 11 will come down but sometimes quite fast. Within 2 hours I'm into the 4s majority of the time, for instance I had all bran and a banana this morning for breakfast. Is this a bolus adjustment more than basal? As basal would only need adjusted for levels when bolus isn't onboard ? surely if I lower the bolus I'll see the glucose peak higher though? Maybe thinking about this too much.

You could be falling into the trap of taking too much bolus, in the attempt to avoid a spike. This doesn’t work (as you've found out!) as you then have too much bolus still floating around in the system after the 2hr mark. Bolus Insulin has a profile, it starts working slowly, builds to a peak, and then tails off, all over a 4-5 hour period. I find the best way of coping with that is to try to tailor what I'm eating to what I'm injecting, in terms of timings as well as quantity of insulin. If I’m having a carb heavy meal that I think might get glucose into my system quicker than the insulin, then provided I'm not starting off from too low a point, I will bring my insulin dose forward,(ie, inject a bit earlier) perhaps 10 minutes at a time, until I find the 'sweet spot' for injecting for that meal. (This is particularly true at breakfast, when my morning readings tend to rise as my liver chucks out a bit of extra glucose to gear me up for the day).
Basically, to cut to the chase, there are two arms to injecting bolus. Amount, but also Timing.

 

[rebrascora]

Just wondering something else. So my post meal peak of say 11 will come down but sometimes quite fast. Within 2 hours I'm into the 4s majority of the time, for instance I had all bran and a banana this morning for breakfast. Is this a bolus adjustment more than basal? As basal would only need adjusted for levels when bolus isn't onboard ? surely if I lower the bolus I'll see the glucose peak higher though? Maybe thinking about this too much

It's the timing of when you inject your insulin which is the problem as I think @helli mentioned. How far in advance of eating do you inject your insulin? I used to spike up to 14-15 most days after breakfast and then come crashing back down to 5 an hour or 2 later and it really wasn't pleasant. I started experimenting with extending the pre-bolus time. I started with the recommended 15-20mins and increased it by about 5mins every day and did lots of testing (I was finger pricking at the time) What I found was that if I injected my NovoRapid an hour and 15mins before eating breakfast I could stop my levels spiking and crashing, but I would get distracted during that time or try to fit stuff into it and lose track of time and I had a few hypos where I left the with that insulin on board and no breakfast. I changed to Fiasp which is a bit quicker and 40-45mins seems to work pretty well with that at breakfast time and 15-20mins at other times of day. I now inject my breakfast bolus as soon as I wake up, before I get out of bed and then I potter on with my morning routine and I can manage to keep things nicely in range by keep checking my Libre (readings and arrows) to see when the Fiasp is kicking in and I can eat my breakfast. This is an extreme length of time and my consultant was very shocked but you can see on my Libre graph that it works for me. Carefully experimenting with the timing of insulin and breakfast is key to sorting the problem. Other times of day, it seems to be less of an issue for most people but breakfast time is challenging for many as the insulin is having to fight against a tide of Dawn Phenomenon/Foot on the Floor syndrome glucose release from the liver.