T1. Trying low carb diet but still getting spikes in blood sugar.

[Doodlebug]

Hi all, or those in the know. I'm struggling to reach my diabetes nurse currently to discuss the above. A while ago I found carbohydrates were making my blood sugar soar and no amount of adjustments, water, slow-release carbs/insulin helped so I thought I'd cut back on my carb intake. I'm Type 1 by the way.

To begin with I cut back very slowly and opted for low GI options, then little by little I began to have meals with little or no carbs at all. The weight started to come off as was expected but just lately, my sugars have been spiking again after eating no-carb foods. I'm drinking plenty of water, making sure the protein intake is sufficient and any carbs I do have are little and slow release. I'm also fairly active. Can anyone give me a clue as to what's happening. I'm getting mixed information from all over the internet and a bit of guidance from someone with a bit of biological knowledge would be very useful. Many thanks.

 

[rebrascora]

Hi
I have been following a low carb higher fat way of eating since my diagnosis 3.5 years ago, so have a reasonable insight into it.
I wonder firstly if you always had these spikes but Libre has just recently allowed you to actually see them. Usually if levels come back down into range after the bolus has run it's course then the spike is down to timing of the bolus. I used to need t prebolus as much as 75 mins in advance of breakfast with Novorapid and now 45mins ahead of breakfast with Fiasp. Lunch and evening meal is usually just 15-30 mins depending upon my starting level.

Am I right in thinking that you are on a pump and therefore no separate basal insulin?
Can I ask what you are now considering a spike after eating low carb foods.... What will usually happen is that the body will break down protein in the absence of enough carbs but the protein releases slowly and usually starts about 2 hours after my meal and I see an upward drift...... which usually needs a 2 unit correction for me at that time. This is not what I would call a spike but there is certainly an increase that needs dealing with. Knowing that it will be coming and having Libre helps to head it off before levels drift out of range and I correct as soon as I hit 8 and I can see that it is rising, even if the trend arrow is horizontal indicating a very slow change. If it gets to 10 I find Fiasp becomes disinterested in dealing with it, so I really have to be quite proactive in catching it early.

I don't mean to be pedantic but I always feel uncomfortable when people say "no carb" or "zero carb". Even lettuce contains carbs but you would have to eat an unreasonably large amount to need to bolus for it. Most meals that I eat don't have potatoes or rice or pasta or bread or pulses etc but there will be carbs in tomato and onions and peppers and green beans and peas and dairy etc Short of eating just meat which would be pretty boring, no carb doesn't really exist. I really feel that it is important for people to understand this, particularly when you end up needing to bolus for the things that DAFNE would advise you to ignore. So a dish of ratatouille with a high meat content quarter pounder will need 2 units up front for me for the ratatouille and then 1-2 units 2 hours later for the protein release from the meat.

If you can give specific examples of the "spikes" you are getting and which meals caused them then it might be easier to comment on those rather than in general.

These days I tend to use my Libre to "Sugar Surf" which seems to work very well with low carb eating, rather than try to calculate how much bolus I need. I inject a token amount of insulin (usually 1-3 units) up front and then base my correction doses for protein (and any miscalculation on carbs) on the trend arrows and levels of my Libre after the meal rather than try to actually calculate anything. This takes a lot of strain off for me because I am not weighing and carb counting as such and it becomes quite intuitive after a while. I often find myself stacking corrections if my Libre doesn't respond appropriately after the first 45mins-an hour of the first correction. I know my consultant would be aghast but the protein release seems to need this. This works really well for me and I am currently averaging 94% TIR for the past 7 days on MDI with Levemir as my basal (I love Levemir!)

Anyway, happy to discuss low carb in more detail or "sugar surfing" or the specific problems you are seeing with your levels if you can give more detail. Just to clarify, it is believed that approx. 40% of protein and about 10% of fat will be broken down into glucose in the absence of enough carbs and will need to be bolused for but usually well after the meal. Obviously different types of meat and fish and legumes contain different concentrations of protein, so calculating it could be a right faff which is why using my Libre to guide me with corrections for the protein after the meal makes it all so much easier. With my stacked corrections I might occasionally need to steady the drop in levels with 5g carbs here or there with a JB or prune so that I level out gently where I want to be. I kind of see it like a pilot coming down off a steep descent for landing and then just lifting the nose a bit at the last minute to set it down gently.

Not sure if any of my drivel will make sense to you but feel free to ask for any clarification.

 

[Thebearcametoo]

Your body runs off glucose. Without it your cells don’t work. So as @rebrascora says in the absence of sufficient carbs from your diet the protein and fat will be broken down to glucose - our bodies will take easy to get carbs first as it’s less effort.

A spike in and of itself is not necessarily bad as long as you come back into target and it depends what you call a spike. Time in range is more helpful than trying to stop all spikes but being able to see increases help to fine tune when to take insulin.

 

[Doodlebug]

Hi Barbara,

Thanks for your reply. You're correct, I do use a pump (Novorapid alone) and when I mention spikes, I'm talking about upwards of 14 mmol/l.

Thank you for the information re. protein breakdown. This makes complete sense and so I'll try a bolus just before and after eating, depending on how long it takes me to metabolise it. I digest quickly so it might hit my sugars a little faster. I can set the pump to release slowly over time as well so it might catch the spike and give a gentle 'bump' instead.

Don't worry, I do understand that all foods contain carbohydrates I just didn't want to be too particular about terminology. Once you've had type 1 for 39 years, you realise everyone has a different understanding of it; patients and non-patients alike.

I'm very grateful for the advice.
Best wishes
D xx

 

[helli]

Bear in mid the insulin to protein ratio can vary for different types of protein. When I tried very low carb, I needed a different ratio for prawns, cheese, nuts, eggs, salmon, … I don’t eat meat so never tried the ratios for that.
I also found the absorption rates varied hugely - some protein needed a pre bolus, some needed a bolus when eating and some needed a bolus over an hour after eating.
I found it all far too challenging with too many ratios and absorption rates to remember and went back to a “normal” diet.
The biggest benefit came for me when I learnt how long in advance I needed to pre-bolus with NovoRapid and switched to Fiasp.

 

[Doodlebug]

Bear in mid the insulin to protein ratio can vary for different types of protein. When I tried very low carb, I needed a different ratio for prawns, cheese, nuts, eggs, salmon, … I don’t eat meat so never tried the ratios for that.
I also found the absorption rates varied hugely - some protein needed a pre bolus, some needed a bolus when eating and some needed a bolus over an hour after eating.
I found it all far too challenging with too many ratios and absorption rates to remember and went back to a “normal” diet.
The biggest benefit came for me when I learnt how long in advance I needed to pre-bolus with NovoRapid and switched to Fiasp.

Thanks for this also. Is there any literature available about this or did you find this out for yourself?

 

[rebrascora]

Thanks for this also. Is there any literature available about this or did you find this out for yourself?

Everyone's digestive system is different so you really need to experiment and find how your body responds. I think this is why using your Libre or other CGM readings to decide what you need insulin wise for protein rather than trying to calculate it is the easier option, in my opinion.

 

[Doodlebug]

Everyone's digestive system is different so you really need to experiment and find how your body responds. I think this is why using your Libre or other CGM readings to decide what you need insulin wise for protein rather than trying to calculate it is the easier option, in my opinion.

Thanks Barbara and everyone for your advice. I use a CGM anyway and so will begin a food journal to log the BG response times with different proteins. I'll have a look through some medical journals also.

Best wishes
D xx

 

[helli]

Thanks for this also. Is there any literature available about this or did you find this out for yourself?

I found this out myself but, on other fora, I see I am not alone.

 

[Thebearcametoo]

Think Like a Pancreas has some stuff in it about protein and fat but i don’t remember how much detail.

 

[Doodlebug]

Ooh thanks, I'll have a look.
Xx

 

[trophywench]

Food falls into 3 basic groups - Protein, Fat and Carbohydrate. The body can make glucose out of all of them - however the fact is it is less difficult for it to convert the carbohydrate and so, if it is getting enough carb to produce as much glucose as it needs, it either doesn't bother converting either the fat or the protein at all, or otherwise doesn't convert all of it. As most adults fall into the 'gets enough carb' category, hence neither DAFNE nor BERTIE (or similar carb counting and dose adjustment courses) tell us anything about their conversion. Anyway if we take the question as 'how much glucose can the body get from protein or fat, in comparison to what it can get from carbohydrate?' the answer is 40% from protein and 20% from fat, hence if we do need to 'jab for protein' and need 1u of insulin for 10g of carb, we'd need 0.4u for 10g of protein and ergo 0.2u for 10g fat.

 

[rebrascora]

I believe it is only 10% of fat gets broken down not 20%, so of all 3 macro nutrients, fat has by far the least impact on BG levels