Do/can Type 1s have a lower carb diet?

[Inka]

@pawprint91 8.3 isn’t bad! Blimey - long-term Type 1s can get 8.3s at bedtime, and it’s still such early days for you. I know this will seem a million years away but burnout is a real thing. Pace yourself and set reasonable targets. 4 days on bolus and an 8.3 at bedtime is far, far from bad.

 

[Proud to be erratic]

The OP asked can T1s have low carb diets and there is lots in the information following the origin question that basically says yes, if you want to.

Gary Scheiner in his excellent book 'Think Like a Pancreas' points out that our brains only use glucose and if we eat very few carbs then the body will convert proteins and ultimately fats into glucose. As said earlier the conversion rates are not straightforward. But Gary Scheiner also points out that if any meal (not a snack) exceeds 30 gm CHO then the protein conversion doesn't occur. Accepting that the guideline is for adults and that we're all different so it could be +/- 30gms CHO, I make a point of trying to routinely keep above 30 per meal to avoid the protein conversion; I don't think he clarifies if one routinely only has 2 main meals daily whether those 60 gms CHO are sufficient - or 3 meals and 90 gms should be the target.

For your information (comparison if that helps), while I'm T3c following a total pancreatectomy, I'm broadly treated as T1 (without the honeymoon period confusion factor, but with missing hormones and digestive enzymes that went with the total panc'y). I started at a great weight for me, with BMI at 23 so not concerned about my weight but was concerned about obvious malabsorption; carb counting originally was totally distorted by that. I have settled into eating +/- 200gms CHO daily, starting my day with a breakfast of c.100gms; that large starting meal was (and still is) very balanced - including a small amount of cereal, but lots of milk, yoghurt, seeds and nuts (10gms), fresh fruit (3 or 4 varieties) and some prunes.

The issue for me until I got Libre and then much better stability, turned out to be not the amount of carbs but the bolus calculation:

the carb counting was straightforward;

correction for being high or pretty low (when necessary) has taken time to feel content with my ratio; my DSN and Endo each felt my 1:2 ratio was too aggressive and encouraged me to soften that - which I tried twice but have reverted to 1:2; so wasn't resolved promptly;

applying an 'activity' factor (how busy / full on was my day going to be?) still feels like guesswork, but I'm getting better with my guesses; initially I had no idea this was going to be such a big influencer and was definitely exacerbating my roller coaster graph;

pre-bolus timing is super critical for me. I'd found by trial and error (for breakfast) that I seemed to need 45 mins between taking the bolus and eating; but I hadn't appreciated that if I'd needed a correction for being too high that my insulin sensitivity meant that I MUST wait before starting to eat for my actual BG to be at least below 7.5. If I don't wait then invariably I end up high for hours, until I take a further correction. This has meant significant delay to my breakfast and that can become very unhelpful. I'm retired and can accept this consequence, but realise if I was working then I'd definitely need a different strategy and perhaps go for a lower carb different sort of breakfast, eg scrambled eggs and toast, but still getting a minimum of 30 gms CHO.

I use the prunes as a meal regulator (along with the benefits of getting a daily routine). I flash scan not only at the start of eating but at intervals during breakfast; my alarm is set at 5.6 and if this sounds during breakfast I immediately eat some or all the prunes, with their relatively high GI. Otherwise I eat them at the end if my flash scan suggests the insulin is dominating the carbs coming along; sometimes I don't eat them until much later if I'm edging above 8. Happened today.

Sometimes I reflect that it's all become more 'black art' than science - needing to use a high GI supplement to manage the theoretically highly calculated bolus! But the activity factor is necessary, yet part guesswork and the prebolus timing is very much influenced by what my body is doing on anyone day; some of that might be because of being T3c, particularly needing Creon to replace the non-existent digestive enzymes - did I take those at suitable intervals today?

Overall it has taken the best part of 18 months with Libre to find patterns and trends, along with so much help from this forum: some of that help very specific, some just 'background wash'. I did a fair amount of research and book reading, particularly to get a better understanding of my T3c; I do very little research nowadays.

 

[pawprint91]

@pawprint91 8.3 isn’t bad! Blimey - long-term Type 1s can get 8.3s at bedtime, and it’s still such early days for you. I know this will seem a million years away but burnout is a real thing. Pace yourself and set reasonable targets. 4 days on bolus and an 8.3 at bedtime is far, far from bad.

Thank you. I am just happy with a single figure to be honest I know that 8.3 is okay - I think I was more frustrated that on Day 1 I was pretty much back where I started with my pre-meal reading before bed, and then Day 2 I started on a 5 but was an 8- but yes, I appreciate your advice that I probably need to calm down and be patient with myself!! (Something I am not always the best at!)

 

[pawprint91]

applying an 'activity' factor (how busy / full on was my day going to be?) still feels like guesswork, but I'm getting better with my guesses; initially I had no idea this was going to be such a big influencer and was definitely exacerbating my roller coaster graph;

Thank you again for taking the time to write another thorough and helpful reply to one of my posts. Activity seems to affect me quite a lot at the moment - after lunch with a friend yesterday (I started at 9 because I made the mistake of having a snack), I spiked at 14. My friend seemed a bit concerned, until I reassured her that after an intensive uphill walk home plus some shopping on the way I would be fine. Sure enough, 3 hours later, I was a 5.8.

Sometimes I reflect that it's all become more 'black art' than science - needing to use a high GI supplement to manage the theoretically highly calculated bolus! But the activity factor is necessary, yet part guesswork and the prebolus timing is very much influenced by what my body is doing on anyone day; some of that might be because of being T3c, particularly needing Creon to replace the non-existent digestive enzymes - did I take those at suitable intervals today?

Overall it has taken the best part of 18 months with Libre to find patterns and trends, along with so much help from this forum: some of that help very specific, some just 'background wash'. I did a fair amount of research and book reading, particularly to get a better understanding of my T3c; I do very little research nowadays.

I feel like I have a lot to learn - but as @Inka has so kindly said, I think I need to pace myself a bit. I don't know if I'll learn more in my upcoming DAFNE course, but I feel like the nurses make it seem far more straightforward than perhaps it actually is when we are living with it! (But perhaps to begin with, that's a good thing!)

 

[Inka]

Thank you. I am just happy with a single figure to be honest I know that 8.3 is okay - I think I was more frustrated that on Day 1 I was pretty much back where I started with my pre-meal reading before bed, and then Day 2 I started on a 5 but was an 8- but yes, I appreciate your advice that I probably need to calm down and be patient with myself!! (Something I am not always the best at!)

But that all makes sense. When you first start insulin/bolusing, you always err on the side of caution, so your ratio will probably be slightly off. That is good. Your priority should be to avoid hypos. More than that, many Type 1s are advised to be at least 8 before bed, so your result wasn’t out of the ordinary anyway 🙂

The target levels for Type 1 are very different to those for diet-only Type 2s. We don’t have a 2hrs after-meal target, for example.

The biggest things to get your head around - and I speak from experience here - is that perfection is impossible, and there is no ‘answer’. You could spend hours a day calculating carbs, GI, micronutrients, ratios, digestive speed, calories burnt through exercise or whatever, think you’ve got the answer - and then things change again a few weeks later! Or the next day!! It’s that relentless changing that’s a big part of the burden. If we just had to take 5 injections of X amount of insulin a day and eat X amount of carbs, that would be a walk in the park! But it’s not like that. It’s a pretty constant process of tweaking, changing, things going well, things going badly (even though you’ve done exactly the same thing), getting things ok only to see them all go wrong again. It’s a pain in the bum, frankly, but accepting that does reduce the stress and pressure.

 

[DeeM]

But that all makes sense. When you first start insulin/bolusing, you always err on the side of caution, so your ratio will probably be slightly off. That is good. Your priority should be to avoid hypos. More than that, many Type 1s are advised to be at least 8 before bed, so your result wasn’t out of the ordinary anyway 🙂

The target levels for Type 1 are very different to those for diet-only Type 2s. We don’t have a 2hrs after-meal target, for example.

The biggest things to get your head around - and I speak from experience here - is that perfection is impossible, and there is no ‘answer’. You could spend hours a day calculating carbs, GI, micronutrients, ratios, digestive speed, calories burnt through exercise or whatever, think you’ve got the answer - and then things change again a few weeks later! Or the next day!! It’s that relentless changing that’s a big part of the burden. If we just had to take 5 injections of X amount of insulin a day and eat X amount of carbs, that would be a walk in the park! But it’s not like that. It’s a pretty constant process of tweaking, changing, things going well, things going badly (even though you’ve done exactly the same thing), getting things ok only to see them all go wrong again. It’s a pain in the bum, frankly, but accepting that does reduce the stress and pressure.

Again, this thread is so helpful - I am learning such a lot from everyone on here with so much more experience. The bit @Inka has said about the priority being to avoid the hypos - I don’t think I have fully understood that before, but this was also a key point in another article I read recently from a diabetes consultant. It seems obvious now, but because I haven’t yet experienced a severe hypo but had experienced the ketoacidosis I guess I was just focusing on that side of things more.

 

[DeeM]

But that all makes sense. When you first start insulin/bolusing, you always err on the side of caution, so your ratio will probably be slightly off. That is good. Your priority should be to avoid hypos. More than that, many Type 1s are advised to be at least 8 before bed, so your result wasn’t out of the ordinary anyway 🙂

The target levels for Type 1 are very different to those for diet-only Type 2s. We don’t have a 2hrs after-meal target, for example.

The biggest things to get your head around - and I speak from experience here - is that perfection is impossible, and there is no ‘answer’. You could spend hours a day calculating carbs, GI, micronutrients, ratios, digestive speed, calories burnt through exercise or whatever, think you’ve got the answer - and then things change again a few weeks later! Or the next day!! It’s that relentless changing that’s a big part of the burden. If we just had to take 5 injections of X amount of insulin a day and eat X amount of carbs, that would be a walk in the park! But it’s not like that. It’s a pretty constant process of tweaking, changing, things going well, things going badly (even though you’ve done exactly the same thing), getting things ok only to see them all go wrong again. It’s a pain in the bum, frankly, but accepting that does reduce the stress and pressure.

I also so appreciate the advice about not aiming for perfection, with all the complex variables and algorithms to take into account.

 

[Inka]

I also so appreciate the advice about not aiming for perfection, with all the complex variables and algorithms to take into account.

It’s not just the complexity, it’s the extremely annoying change-ability too. It’s so frustrating! Knowing things can change helps you deal with it and be as ready as you can be.

Severe hypos are awful, and best avoided as much as possible. Because our target range is so close to hypo territory, it does make it hard. I try to have a buffer zone so I’m a bit further away from a hypo, but even then s**t happens so it’s hard to avoid them completely. Always err on the side of caution and always be prepared for a hypo by having treatment with you.

 

[DeeM]

It’s not just the complexity, it’s the extremely annoying change-ability too. It’s so frustrating! Knowing things can change helps you deal with it and be as ready as you can be.

Severe hypos are awful, and best avoided as much as possible. Because our target range is so close to hypo territory, it does make it hard. I try to have a buffer zone so I’m a bit further away from a hypo, but even then s**t happens so it’s hard to avoid them completely. Always err on the side of caution and always be prepared for a hypo by having treatment with you.

Thank you. It does all sound and feel like walking a tightrope in the wind!
It feels especially annoying that something that could be so helpful - exercise - is also such a tricky complicating factor in all the calculations.

 

[Inka]

Absolutely! And it can be off-putting too, worrying about having a hypo if you exercise ‘too much’. In this hot weather, I’ve cut my exercise back because my blood sugar is dropping super-fast, but even in normal times it can make exercise seem like a major chore because of the diabetes.