Low carb breakfast (well low for me)

[Deleted member 33898]

So I've been trialling a lower carb breakfast. I've been looking for something to get close to the same amount of calories but less carbs. Normally I'd have rolled oats , milk , peanut butter and a piece of fruit for a total 60g of carbs. Came across chia pudding. I've been using no sugar soya milk, chia seeds, half a scoop of chocolate protein powder, peanut butter, peacan halves and then a some fruit. The fruit makes up the majority of the carbs. In total it's 30g of carb, 28g protein and 28g of fat. The protein and fat I'd normally have would be just under 20g each with the higher carb breakfast.

What I've found is I'm not getting any immediate peak instead I'll rise 2 hours later above my pre meal level. I'm taking 2 units upfront (insulin to carb ratio is 1 to 15), 15 mins before. I've read strategies in dealing with this ( protein and fat) but most involve a pump or regular bolus instead of rapid insulin (rapid bolus MDI is what I'm on) I just figured I'd try start the day with stable levels instead of spiking all the time. The higher carb breakfast normally spikes quickly and falls rapidly which never feels great but at least I level out until my next meal.

Anyone else like to share their experience with lower carb eating, particularly breakfast ?

Thanks

 

[rebrascora]

I've read strategies in dealing with this ( protein and fat) but most involve a pump or regular bolus instead of rapid insulin (rapid bolus MDI is what I'm on)

Hi. Not quite sure what you mean by regular bolus instead of rapid insulin. Do you mean something like Fiasp or Apidra or Lyumjev as oppose to NovoRapid?
I use Fiasp and for me a low carb breakfast would be full fat natural Greek style yoghurt with a few berries and seeds and a sprinkle of low carb granola. I always bolus for breakfast before I get out of bed and I usually need to add 1.5-2 units to cover (Foot on the Floor syndrome), so if I am not having breakfast or I'm having a very low carb breakfast like an omelette, I still need that 1.5-3 units up front.
For the yoghurt breakfast I usually need 30-45 mins prebolus time before I eat breakfast with Fiasp unless my levels are very low (ie low 4s when I wake up) and then it might just be 20 mins....it was 75 mins with NovoRapid. Otherwise I spike even with that low carb breakfast.
If I get the timing just right I don't get any rise at all. I tend to watch my Libre and eat when my levels get into the 5s and I can see the Fiasp is working... ie levels are starting to drop.
If I have a very low carb breakfast like an omelette with salad and coleslaw, I still inject the 1.5-2 units I need for FOTF before I get out of bed and then I have the omelette as soon as it is ready but I usually need a couple of units for the protein release about 2 hours later.... I watch out for it on my Libre and inject when I see it starting to drift upwards. The protein release is much slower than carb release so the insulin doesn't need a head start to keep pace with it like it does with carbs and you see an upward drift and decline rather than a spike..... graph looks more like gentle rolling hills rather than a mountain range.
That is how I handle it but I work on a 1:10 ratio and I know how much I need to correct protein and FOTF which may be different to yourself and also how long I need to prebolus for my body with Fiasp. Libre helps enormously with timings for prebolus and protein release.

 

[Deleted member 33898]

I take Novorapid, It's just something I read. Don't know the exact names of these slightly longer lasting insulins to take with meals. I have noticed the foot on the floor more since the start of the year, usually a jump of a few mmol. Normally letting the insulin work for bit longer brings it down before the meal kicks in, and I've only ever had to add a bit of extra insulin the odd time. This morning I had a small spike but didn't come down and then started to rise again so I took another shot of insulin, that's 3 units for 30g of carbs. Does seem strange that 4 units for 60g of carbs that I usually have will bring me back down and as I say the protein and fat content is lower but not significantly lower compared to the 30g meal. Just the main difference is how high ill spike on high carb meal compared to low carb meal.

I appreciate all the info on how you deal with low carb breakfast and I guess I could try a few things you have suggested. Just wonder is it even worth having to inject myself more than id like, I find the space I have limited already for injecting 3 times a day for meals. Though I could just do low carb for breakfast. My average is already being pushed up because I'm sitting up in the 7s morning through to lunch with this low carb breakfast. I thought maybe my basal was wrong but seems okay. I guess I could try 2 units upfront and 1 unit an hour later. I thought i'd trial lower carb with one meal for a while to see how I get on, breakfast seemed to make the most sense to experiment with. Just looking for an easier life really

 

[rebrascora]

I wonder if you are thinking of mixed insulins which are a combination of fast acting and slow release insulins in a particular ratio and mean you need to eat fixed amounts of carbs at set times of the day to keep your levels reasonably balanced. Those are not generally used by Type 1 diabetics so I would ignore anything you have read about those as it is not applicable in your situation.

The best you can do is trial different strategies and see what works for you and fits in with your lifestyle. If you have Freestyle Libre sensors it makes it so much easier. Personally I don't find extra injections any problem at all. I am happy to inject where, when and whatever I happen to be doing.... With the exception of driving (obviously) or sitting on a horse probably and I doubt I could do it riding a bike or whilst sky diving 😱 but then probably wouldn't need to anyway. It only takes a second to whip out my pen and jab a unit or two when I need them, but then I have followed a low carb way of eating for about 3 years so I am into a routine of it.

 

[Deleted member 33898]

I tend to only use additional injections for corrections or takeaways. Try to eat meals I know don't need a split dose as I find it difficult to get it right. I've noticed since changing my breakfast I've been getting spikes up to 13 or 14 for lunch and dinner again, don't know if that's linked. Its tough to know what to do going forward. I've always preferred carby food and feel like I've already changed so much of my diet since diagnosis(limiting portions, no sweets or chocolate etc (well the odd square or two)). Even started to eat less pasta and rice, surprisingly potato works better with me than other heavy carbs.

I take it the only real benefit of fiasp is that it works quicker so you can bolus sooner to eating? It's not some miracle insulin to curb spikes? So instead of bolusing 20 mins before a meal I'd bolus 5 mins before and end up with the same spike is what i mean. Consultant mentioned to me going on fiasp to help spikes but I don't see how it would help, just convenience from being able to eat sooner.

Routine would be nice.

 

[rebrascora]

I found changing from NovoRapid to Fiasp really frustrating and it took me 2x 3 month trials before I got it to work for me but even then it isn't much quicker..... 45 mins prebolus as oppose to 75mins at breakfast which was the main factor in changing but still need 20 mins at other times of the day and if my levels get above 10 and I need a correction, it is like I injected water unless I do exercise as well, so I usually need to correct at 8 rather than 10. It also acts faster at low levels so if I am in the 4s it will kick in quickly but if I am 8-10 it takes ages. It isn't ideal for me but I am not ready to try anything else and risk another 3 months of frustration trying to figure out a different insulin for likely not much gain. I usually average 90% Time in range on Libre with Fiasp, so I have found a way of making it work well for me but I do have to be quite proactive and I need more of it than I did NR. It certainly wasn't a straight swap.

In your situation I would cautiously extend your prebolus time for breakfast by a few minutes each day. My situation is unusual at 45mins but many people need 30 mins at breakfast before they eat and the sooner they get it into themselves, ideally before getting out of bed, the better it works.

 

[nonethewiser]

Have same issue with low carb meals, need to bolus 2x for one meal, guess its body breaking down fat & protein in meal slowly.

Tried low carb diet once & was same for all meals as replaced carbs for higher % of fat & protein, was on injections then & needed to inject up to 3x each meal depending on what was on plate, not so much issue now as pump could handle that.

 

[Deleted member 33898]

@rebrascora
Oh wow, I couldn't put up with another change like that. Its enough work changing doses and times with novarapid at the moment.

Yes I have noticed corrections don't work as well the higher up I am, as you say some exercise helps. I find I'll go for a walk first to bring levels down a bit and get the correction working better. That TIR is fantastic. Regarding corrections, do you make them between meals? I was told at the start not to do that but have found myself correcting if its been at least 3 hours since my last dose, just hope I'm not being careless there.

Regarding pre bolus, I've found myself jumping between 15 and 30 mins depending on a few things like pre meal level. But its never that simple. A meal I've been used to having all of sudden is causing me to spike to 13 instead of 7. I extended the pre bolus as far as it can go without sending me into hypo territory and then it flies up. Cant understand it.

@nonethewiser

are you still following a low carb diet?

 

[nonethewiser]

@rebrascora
Oh wow, I couldn't put up with another change like that. Its enough work changing doses and times with novarapid at the moment.

Yes I have noticed corrections don't work as well the higher up I am, as you say some exercise helps. I find I'll go for a walk first to bring levels down a bit and get the correction working better. That TIR is fantastic. Regarding corrections, do you make them between meals? I was told at the start not to do that but have found myself correcting if its been at least 3 hours since my last dose, just hope I'm not being careless there.

Regarding pre bolus, I've found myself jumping between 15 and 30 mins depending on a few things like pre meal level. But its never that simple. A meal I've been used to having all of sudden is causing me to spike to 13 instead of 7. I extended the pre bolus as far as it can go without sending me into hypo territory and then it flies up. Cant understand it.

@nonethewiser

are you still following a low carb diet?

I don't follow low carb diet now, it was only brief experiment about 14 years ago, did it for 3 months or thereabouts.

Still have occasional meal that's low in carbs, say like omelette with side salad & slice of sourdough bread.

 

[rebrascora]

Regarding corrections, do you make them between meals? I was told at the start not to do that but have found myself correcting if its been at least 3 hours since my last dose, just hope I'm not being careless there.

I think it is only careless if it is causing you to hypo regularly. I break all the "rules" with my diabetes management , but I get good results so they can't criticize me and I shouldn't be answerable in that regard to the clinic staff unless I am doing something detrimental, which would show on my Libre.
I regularly stack corrections, sometimes with as little as an hour between them if my Libre shows my levels are continuing to rise, despite the previous correction. My low carb way of eating lends itself to managing my levels by responding to my Libre rather than trying to carb count and protein count.
I scan an average of 30 times a day, so I have a very good feel for how my body is responding and when I need more insulin. The "rules" or guidance about such things were made pre Libre so you only knew what your levels were doing maybe 5-8 times a day when you finger pricked and it was to keep you safe. With Libre you can check whenever you need or want to and of course Libre 2 has alarms so again it is mitigating some of the risk.

I am not advocating that people should do as I do and stack corrections because on a normal diet that might be more risky. Protein and fat have quite a damping effect on BG levels because they release so slowly so they don't peak and drop so dramatically. What I think is important is that people are not restricted by "rules" and should be encouraged to experiment to see what works for them (with one eye firmly on keeping safe of course) rather than being worried about what their DSN will say if they find out they have "pushed the boundaries" or "broken the rules". We are all different and we should become the experts in our own diabetes and the nurses and consultants should be there to support us with that, not dictate to us.

 

[Deleted member 33898]

@rebrascora sounds almost like sugar surfing. I put off reading about it until recently. It suggested by my consultant the last time I was at the clinic. Using the libre is essential to that style of diabetes management. I thought I was scanning too much until I read about sugar surfing. I do think my current diet is closer to a normal diet although I pack bit more protein and fat into each meal to get the calories up instead of having too many carbs, still not gained weight back lost though. I got into a habit of making sure every meal had protein and fat in a certain range otherwise I'd expect huge spikes after. I convinced myself this was a winning formula. But now my average is up to levels not seen since just after diagnosis so I suspect maybe my honey moon period is ending, perhaps it was not only helping with the spikes but clearing up the slow rise from protein after meals. Only good thing is I haven't had a hypo for 4 days which is a record for me ! =/

I felt at the start the diabetic team were strict with what I could and couldn't do. But after a while they told me to keep doing what I am doing. Maybe that will change but you are right in saying that we should become the experts. Just wish I could skip forward to becoming qualified.

 

[rebrascora]

Not heard of the term "sugar surfing".... Off to investigate that.... although I don't like the use of the word sugar in regards to diabetes as it is too misleading/blinkered in my opinion.

Congrats on going 4 days without a hypo! I have never thought to keep an eye on that sort of stat. I average almost one a day according to Libre but it exaggerates 🙄 and the ones I have are generally very mild and only involve one or 2 JBs at most and I can usually carry on with what I am doing, so they are more of an inconvenience (and a red blot on my stats ) than anything worse. I try to keep my TIR hypo % to less than 4. I got it down to 1% once but it was hard work and not something I could maintain.
I bounced my attitude to hypos and the frequency of them off my consultant at my last appointment and he is fine with it at the moment. I think it is important to seek external input to assess whether you may be becoming complacent so I find it useful to discuss things like that with him. Personally I think having slightly more regular hypos can boost your confidence in dealing with them and make you less afraid of them.... as the fear can be far more debilitating that a hypo in my opinion.... but I know it is a fine line to walk and losing hypo awareness is a potential risk.

Anyway, off to do some research...

 

[rebrascora]

Thanks so much for that suggestion.....

Yes, "sugar surfing" is exactly what I do. It was really interesting to see it broken down and explained in such detail, as I was just doing it instinctively, but the thought processes I use and the things that I consider when I take action are exactly as he describes. It's good to know that this is a recognized strategy for managing Type 1 and that it works with a regular diet as well as low carb, although it was my low carbing which led me to develop it because the protein release is just too complex to try to calculate it. I think my change to Fiasp was also a catalyst in me altering my management to this strategy.

 

[rayray119]

@rebrascora
Oh wow, I couldn't put up with another change like that. Its enough work changing doses and times with novarapid at the moment.

Yes I have noticed corrections don't work as well the higher up I am, as you say some exercise helps. I find I'll go for a walk first to bring levels down a bit and get the correction working better. That TIR is fantastic. Regarding corrections, do you make them between meals? I was told at the start not to do that but have found myself correcting if its been at least 3 hours since my last dose, just hope I'm not being careless there.

Regarding pre bolus, I've found myself jumping between 15 and 30 mins depending on a few things like pre meal level. But its never that simple. A meal I've been used to having all of sudden is causing me to spike to 13 instead of 7. I extended the pre bolus as far as it can go without sending me into hypo territory and then it flies up. Cant understand it.

@nonethewiser

are you still following a low carb diet?

I'm now wording about the 4 hour rule myself I'm planing to speak to my team next time and i say thiers are points where i know i'm not going be down to normal in next 4 hours and speak to them about correcting before the 4 hours are up). they always told me to be mindfull about correcting before bed but i do if I'm above ten because i know on day when i haven't been a work if i'm high at bed and don't do a correction i'm gernally not going to come back down(i've learnt this)

 

[Benny G]

A few years ago I asked my diabetes consultant if I could try 'regular' insulin (as recommended by Dr Bernstein) to help investigate the full potential of the high protein, very low carb way of eating.
Long story short, consultant said 'No regular.'
The workaround using humalog, of course, is to stack.

Once you have learned the rules, you can break them as required.

 

[Deleted member 33898]

Not heard of the term "sugar surfing".... Off to investigate that.... although I don't like the use of the word sugar in regards to diabetes as it is too misleading/blinkered in my opinion.

Congrats on going 4 days without a hypo! I have never thought to keep an eye on that sort of stat. I average almost one a day according to Libre but it exaggerates 🙄 and the ones I have are generally very mild and only involve one or 2 JBs at most and I can usually carry on with what I am doing, so they are more of an inconvenience (and a red blot on my stats ) than anything worse. I try to keep my TIR hypo % to less than 4. I got it down to 1% once but it was hard work and not something I could maintain.
I bounced my attitude to hypos and the frequency of them off my consultant at my last appointment and he is fine with it at the moment. I think it is important to seek external input to assess whether you may be becoming complacent so I find it useful to discuss things like that with him. Personally I think having slightly more regular hypos can boost your confidence in dealing with them and make you less afraid of them.... as the fear can be far more debilitating that a hypo in my opinion.... but I know it is a fine line to walk and losing hypo awareness is a potential risk.

Anyway, off to do some research...

I generally hypo one or two times day and the TIR at me at 4% and sometimes 5%. Its frustrating because it takes me a while to come back round after them, I can't concentrate at all for a few hours which makes work difficult. Of course after that run without them they are back again today, clearly missing something. I actually fear highs more than lows. I know I should be just as concerned with the lows because as you say losing hypo awareness isn't great but I still can't get the thought of complications out of my head even if they are years down the line. Its all I think about everyday.

Thanks so much for that suggestion.....

Yes, "sugar surfing" is exactly what I do. It was really interesting to see it broken down and explained in such detail, as I was just doing it instinctively, but the thought processes I use and the things that I consider when I take action are exactly as he describes. It's good to know that this is a recognized strategy for managing Type 1 and that it works with a regular diet as well as low carb, although it was my low carbing which led me to develop it because the protein release is just too complex to try to calculate it. I think my change to Fiasp was also a catalyst in me altering my management to this strategy.

After all the diets and methods I've read its the one that seems to make sense to me. I just need to create a good foundation before trying it by sorting my basal out and knowing my correction factor for bolus etc. That's good you found a strategy that works for you.

 

[Deleted member 33898]

I'm now wording about the 4 hour rule myself I'm planing to speak to my team next time and i say thiers are points where i know i'm not going be down to normal in next 4 hours and speak to them about correcting before the 4 hours are up). they always told me to be mindfull about correcting before bed but i do if I'm above ten because i know on day when i haven't been a work if i'm high at bed and don't do a correction i'm gernally not going to come back down(i've learnt this)

I've corrected before bed a few times as well. It just makes sense to not be sitting high all night. I guess it is risky but I think if you see it working and its safe then why not

 

[rebrascora]

For me, getting my basal dose right is key and it needs tweaking quite often to keep it right as my needs change frequently due to not having a regular routine. Some days I can be very active and doing manual physical work and other days more sedentary although still a basic level of activity mucking out four horses.
I don't have a set routine with meals either. Some days I graze on low carb snacks all day and that gives me a great opportunity to assess my basal dose. Other days I might have 3 meals a day, or two or just one.... again, useful for seeing how level my basal is keeping me in the absence of food and bolus insulin. I guess that is another reason why the Sugar Surfing works so well for me.

Learning to eat low carb is difficult to begin with because we have bulked out our plates with carbs pretty well all our lives and indeed there was an element of guilt in eating just the tasty bits like curry with no rice, when I first started. And "how do you eat without bread?" was an impossible question in those early days, as it is a carrier for so many foods either as a sandwich or on toast, but I have now developed a whole range of interesting recipes and snacks and treats which are low carb that I really enjoy and despite being a bread and tatties lover, I don't miss or crave them now. I might occasionally eat a small portion to be sociable when eating out but they are often not as good as I remember and not worth the BG upheaval. Eating more fat (cheese, cream in my morning coffee, full fat coleslaw and creamy Greek natural yoghurt and full fat mayonnaise and fatty cuts of meat) and discovering lots of different low carb veggies has been the key to making it enjoyable and sustainable. Last night I had a plate of ratatouille cooked in plenty of olive oil and balsamic and a splash of port and herbs with a couple of slices of smoked bacon as my evening meal. It wasn't a huge plateful but it was incredibly tasty and filling. I had a couple of boiled eggs and a packet of pork scratchings and some olives and a bottle of water at lunchtime as a snack type lunch as we were out with the horses. These things might not appeal to you, but there are other things to try which might suit you better.

 

[trophywench]

I find having several hypos a day as utterly unacceptable to any Type 1.

Consider your brain cells.

You may well consider you have more than enough of them at the moment but perhaps when you get early onset Alzheimer's by killing too many of them, you may change your mind.

Anyone who considers a BG of 7 is too high is clearly already stark raving bonkers.

 

[rebrascora]

I find having several hypos a day as utterly unacceptable to any Type 1.

Consider your brain cells.

You may well consider you have more than enough of them at the moment but perhaps when you get early onset Alzheimer's by killing too many of them, you may change your mind.

Anyone who considers a BG of 7 is too high is clearly already stark raving bonkers.

According to Libre I had 4 hypos yesterday but Libre exaggerates and they were all very minor ones that were extremely short lived. Didn't test them all but 1 JB was easily enough to do the trick. Some days I might have non, somedays 1. I average just under one a day over 90 days and my consultant is happy with that as I am still meeting the < 4% below range which is the target for Libre and they are all very minor ones.

You have to remember that many of us are not on a pump and have lifestyles where our activity levels can vary quite a lot, so whatever basal insulin goes in, is there for the duration. I don't consider those "hypos" a problem as they are not below a level where a normal person might naturally drop to. I am quite sure some of them will not even be below 4, but I see no point in wasting a test strip to check most of the time, I just treat and get on with life. I also reduce my basal dose the next day if that happens, so this morning I knocked 2 units off my Levemir dose. I have still had a couple today so I might need to do a further reduction tonight of 1 unit but I have had a less active day today, so may be fine on my current dose. The important things is to recognize what the problem is and address it.

Personally I don't worry too much about the long term implications of being high but I find it very difficult to bring my levels down once they are high and I can be in double figures for hours and inject correction after correction trying to get them down and it is a lot of effort and frustration, so it is easier to keep them lower. If I go a bit too low, a jelly baby brings me up in 10 mins as easy as can be, so that is one of the reasons I would rather be towards the lower end of the range in the 4s and 5s rather than 7-8s. I also often start to feel sluggish once I get above 8 and it can be harder to yomp up the hill and muck out the horses at that level.