Carb levels and choices in T1

[trophywench]

Well - neither would I, or Patti. I've never fathomed out either why 'folk' seem so keen on doughnuts - so boring. But there again I wasn't brought up eating stodge even though no doubt it was considerably cheaper than meat cheese fish and eggs just after the War when sis then I were born. Bread (and sweets!) was still rationed but no veg were. So we had meat, spuds and one other veg - 2 others on Sundays with the roast. Always a pudding, eg baked or steamed sponge, fruit pies and crumbles, and custard. I daresay the carbs in the pud filled up the corners - but all I know is, I've never wanted to be a carb monster and my belly isn't big enough to cram in more, even if my mouth is.

 

[Inka]

Luckily, there’s a middle way. The choice isn’t to either limit carbs or be a carb monster. Moderate carbs and better carbs (ie not junk food) is not only a sensible way, it’s the way most Type 1s eat.

 

[rebrascora]

But in this particular case where the OP is suffering erratic BG levels to the point that she feels she is not safe to drive, despite being on a pump, and doesn't mention eating junk food carbs, then trying low carb is a valid suggestion and the OP accepts that herself because she feels that she would be better with less or ideally no insulin, which might be possible if she is MODY, so I am really not sure why this thread has run off at such a tangent.

 

[Inka]

Neither am I sure why it’s run off at a tangent @rebrascora Rather than low carb, I would suggest the OP needs less insulin if she’s going hypo. As she hasn’t stated how many carbs she eats anyway, the push for low carb seems to have come out of nowhere. For all we know, she might be below 130g carbs per day anyway.

I also think it’s important to take into account different life stages. The needs of a 35 yr old might be quite different to those of a 70 yr old.

My issue wasn’t as such the suggestion that the OP could try low carb, it was the statements that low carb gave better control and that higher carb gave dreadful high sugars - which were later suggested to be due to a bad cannula anyway and nothing to do with the previous day’s lunch.

Any Type 1 with lots of hypos needs to look at their insulin first - basal and bolus, in that order. If that’s ok, then the next steps are possible conditions like coeliac disease, etc Hypos are a common symptom of that in Type 1s.

As a related aside, Dr Bernstein, a major proponent of very low carb diets has hypo unawareness. Reducing carbs to too low a level is potentially dangerous. Dr B isn’t the only one with hypo unawareness as can be seen on some of the shocking CGM graphs from children put on minimal carb diets. Many of those ‘feel fine’ cruising along at 2.8. Shocking.

We both know that low carb is anything under 130g carbs per day, but when you buy a low carb cookery book the recipes are mainly very low carb, keto or slightly above. I know neither you or Patti are recommending keto (I don’t think?) but ‘low carb’ has come to mean something quite different from the actual ‘under 130g’. So any casual reader could be misled.

 

[helli]

But in this particular case where the OP is suffering erratic BG levels to the point that she feels she is not safe to drive, despite being on a pump,

A pump does not stop hypos unless it is closed loop which the OP does not have.
Your basal can be too high with a pump just as it can be with MDI. You can miscalculate carbs with a pump, just as you can with MDI. Exercise (such as running around after small children) can cause a hypo, just as it can with MDI.
The fact the OP has a pump is only relevant if they are always hypoing at the same time of day.

 

[rebrascora]

A pump does not stop hypos unless it is closed loop which the OP does not have.
Your basal can be too high with a pump just as it can be with MDI. You can miscalculate carbs with a pump, just as you can with MDI. Exercise (such as running around after small children) can cause a hypo, just as it can with MDI.
The fact the OP has a pump is only relevant if they are always hypoing at the same time of day.

I appreciate that, but it does help compared to MDI. My point was that the OP is experienced with diabetes, has had educations courses and a pump and is still experiencing quite significant problems if she feels it isn't safe to drive. It is therefore worth trying a low carb diet although I appreciate that in her circumstances with young children, I would struggle if I wasn't already familiar and comfortable with low carb eating, because it does take some getting your head around initially. I don't personally find it more fiddly or time consuming to cook low carb because I just avoid high carb foods like bread and pasta and rice and breakfast cereals etc but it took some time to find low carb things that I liked to fill in the gaps.

I would point out that I mentioned education and basal testing before I suggested low carb, so I really don't feel like I was being excessively pushy about trying low carb, just offering possible solutions.

@Inka I have seen you mention this before about Dr Bernstein. Obviously I know of him but I don't follow him or know a great deal about him. I don't know if the information you quote about him not having hypo awareness is current or just a phase he went through or misreported, but I am sure there are people who eat a high carb diet who also have no hypo awareness. We are all different. It may be an age thing which is affecting his awareness. There are so many factors which influence our levels. I haven't found that a low carb diet has affected my awareness so far and if going low carb also causes insulin resistance (or lack of insulin sensitivity) as you often suggest then there should be little concern about hypos if you are using minimal insulin. There is no harm in giving it a try.... other than the effort involved. I agree with Patti that it can make managing diabetes with insulin easier for some people but it depends on the individual, just like everything else with diabetes, we all react differently and have to find what works for us, but we do that by experimenting and trying different things.
If you want an example which doesn't involve failing cannulas, I have had 4 attempts (experiments) at eating a sweet mince pie in the last 4 weeks and despite pre-bolusing a significant length of time in advance and injecting both a normal amount of insulin for it and an increased amount of insulin to see if the carb info is wrong, because personally I think 38g carbs for a mince pie is a little low although they are smalliish, I have ended up spiking to mid teens every time and then needed a correction later to bring me down. 7 units of insulin for 1 mince pie with a normal ratio of 1:10 is ridiculous and my Time in Range stats are trashed. So my 4 attempts to get it right, tell me just to stick with my low carb way of eating. And I ate cream or cream cheese with it on each occasion to try to slow it down! I appreciate that a mince pie isn't the healthiest option but a few pieces of sweet potato usually work fine and they are part of my low carb diet, a mince pie most definitely isn't. I just prefer to stick to just 20-30g carbs at a time and find that works well for me and still provides a lot of variety in my diet.

 

[trophywench]

Mince pies are tricky! It's not only the mincemeat carbs, but the pastry has quite a lot to answer for in terms of fat - and obviously if you slosh cream on it - more fat to slow the carbs down. Hence much like eg pizza - it's never a just bolus for the carbs and all will be AOK. Plus because it's a mega hit of both sugar and starch, the BG shoots up quickly to more than is wanted and I reckon, needs more insulin than normal, to deal with it. I do like one though - so only eat eg one out of a box of 6, instead of one each 3 days running.

Not all foods are worth puzzling over dosing and corrections. To me - dried fruit confections are.

 

[nonethewiser]

I appreciate that, but it does help compared to MDI. My point was that the OP is experienced with diabetes, has had educations courses and a pump and is still experiencing quite significant problems if she feels it isn't safe to drive. It is therefore worth trying a low carb diet although I appreciate that in her circumstances with young children, I would struggle if I wasn't already familiar and comfortable with low carb eating, because it does take some getting your head around initially. I don't personally find it more fiddly or time consuming to cook low carb because I just avoid high carb foods like bread and pasta and rice and breakfast cereals etc but it took some time to find low carb things that I liked to fill in the gaps.

I would point out that I mentioned education and basal testing before I suggested low carb, so I really don't feel like I was being excessively pushy about trying low carb, just offering possible solutions.

@Inka I have seen you mention this before about Dr Bernstein. Obviously I know of him but I don't follow him or know a great deal about him. I don't know if the information you quote about him not having hypo awareness is current or just a phase he went through or misreported, but I am sure there are people who eat a high carb diet who also have no hypo awareness. We are all different. It may be an age thing which is affecting his awareness. There are so many factors which influence our levels. I haven't found that a low carb diet has affected my awareness so far and if going low carb also causes insulin resistance (or lack of insulin sensitivity) as you often suggest then there should be little concern about hypos if you are using minimal insulin. There is no harm in giving it a try.... other than the effort involved. I agree with Patti that it can make managing diabetes with insulin easier for some people but it depends on the individual, just like everything else with diabetes, we all react differently and have to find what works for us, but we do that by experimenting and trying different things.
If you want an example which doesn't involve failing cannulas, I have had 4 attempts (experiments) at eating a sweet mince pie in the last 4 weeks and despite pre-bolusing a significant length of time in advance and injecting both a normal amount of insulin for it and an increased amount of insulin to see if the carb info is wrong, because personally I think 38g carbs for a mince pie is a little low although they are smalliish, I have ended up spiking to mid teens every time and then needed a correction later to bring me down. 7 units of insulin for 1 mince pie with a normal ratio of 1:10 is ridiculous and my Time in Range stats are trashed. So my 4 attempts to get it right, tell me just to stick with my low carb way of eating. And I ate cream or cream cheese with it on each occasion to try to slow it down! I appreciate that a mince pie isn't the healthiest option but a few pieces of sweet potato usually work fine and they are part of my low carb diet, a mince pie most definitely isn't. I just prefer to stick to just 20-30g carbs at a time and find that works well for me and still provides a lot of variety in my diet.

Interesting rebrassco, wonder if spike was due to you low carb diet, remember following low carb for 3 months & would spike badly when eating heavier carb load.

Not big fan of mince pies anyway, do like scones & often have one when out for day, that & americano. Dont tend to spike into teens but have had plenty of practice over years to bolus for it.

 

[Inka]

Mince pies are usually very sweet if they’re shop-bought @rebrascora I much prefer home-made - so much tastier and with nice crispy pastry not that weird soft biscuity stuff. I agree with @nonethewiser that it could well be your low carb diet that’s affecting your response to a higher, more difficult carb load. It does mess with things if you go too low carb. Filo pastry is a good alternative if you want to try.

Dr B has mentioned his hypo unawareness himself. Yes, obviously anyone can develop hypo unawareness, but my point was that even for the maestro of very low carb diets, going to an extreme can cause hypo unawareness, which is dangerous.

People on pumps often underestimate how varied their insulin needs can be throughout 24 hours. For a couple of hours during the night I have no insulin going in, then a tiny amount which gradually climbs to deal with my DP. However, I’ve seen pump users with much flatter basal profiles that really don’t suit them. In addition, pump basals and ratios often need adjusting numerous times through the year, and that requires a little more thought and effort than when you’re on pens. So as @helli says, if the pump settings are incorrect, things can go pretty wrong - either too high or too low, or swinging about from high to low.

Therefore the OP would be best talking to a DSN and going through all her settings. Hopefully this will improve the hypos.

 

[helli]

I gave up reading about low carb when I realised the "maestro of low carb" suggested all women should go on the pill because our hormones affect our levels too much. That may be one way to reduce the number of people with T1 if we can't procreate. But also a defeatist attitude towards trying to live a normal life - for a woman there is little more normal than our monthly cycle.

 

[Pattidevans]

Of course I am aware of Dr B, but some early reading easily convinced me that he was far too extreme for me. However, you can't blame his low carbing for his hypo-unawareness as has been said, anyone can get through running consistently too low, or suffering multiple hypos.

I choose my bread carefully @Pattidevans I find good sourdough blood-sugar friendly, and proper rye bread is excellent (and filling too). I do sometimes eat normal bread eg 2 or 3 slices of garlic bread, and I find that ok as part of a meal. I think I’d probably stick with the sourdough and rye bread even if I didn’t have Type 1 as I’m not really a fan of the ultra-processed bread we get so much now. Ideally, I’d make my own, of course, but I don’t have time.

I find that a touch patronising @Inka. I do know the difference between choosing good bread such as sourdough or rye, but it all tends to spike me, whilst I can eat potatoes with little problem. I do realise you don't know my background, but I am in fact well versed in nutrition and different foods. I travelled the world full time for 20 years during the 70s and 80s due to my job and ate pretty much every cuisine at a time when few Britons had ventured past Spain. Subsequently my husband and I owned a hotel and restaurant for 12 years where I was relief chef. In order to have credibility with the chefs we employed I gained professional chef qualifications level 1 and 2 (few chefs did level 3). After we sold the business I ended up working at a government funded children's centre where one of the things I did was to devise healthy cookery courses for young mums which were featured in a Government South West video production. So I do have a very good handle on nutrition. I'm still a passionate cook and love experimenting with different and exciting ingredients and am happy to tweak them to suit my style of eating.

To be clear, I have always said "lower carb". I find a level of somewhere between 70g and 100g per day suits me and makes it easier to control my BGs. I am glad you don't have a problem and rarely go above 9, which illustrates that your body can handle carbs in a way mine can't.

Anyway, this is off the subject entirely, though I do need to mention that I do not think the high BGs the other day were entirely due to a faulty cannula, I don't think that kicked in until much later during the night or early morning. The thing is that there are so many many things that can influence our blood sugars that it is often hard to pin down exactly what is causing any particular problem. It would be hard for any of us to suggest what might help the OP (aside from a possible mis-diagnosis) given the small amount of information we have been given by her.

 

[travellor]

This is an interesting thread as a type 2.
It's a common effect of a low carb diet to become ultra sensitive to carbs, -"adaptive insulin resistance".
One theory was the pancreas becomes "sluggish" after a low carb diet, and then takes time to ramp back up to full insulin response again.
It seems it must be a lot more involved than that.

 

[nonethewiser]

This is an interesting thread as a type 2.
It's a common effect of a low carb diet to become ultra sensitive to carbs, -"adaptive insulin resistance".
One theory was the pancreas becomes "sluggish" after a low carb diet, and then takes time to ramp back up to full insulin response again.
It seems it must be a lot more involved than that.

My pancreas is shot mate, have to look for another explanation.

 

[travellor]

My pancreas is shot mate, have to look for another explanation.

My point exactly.
Blows a massive hole straight through that theory.

 

[trophywench]

@travellor - you would be quite amazed how much insulin your body needs literally ALL the time - so if it were sluggish - you'd, err, gradually die.

 

[travellor]

@travellor - you would be quite amazed how much insulin your body needs literally ALL the time - so if it were sluggish - you'd, err, gradually die.

Erm, it's not a permanent response. If it was every type 2 low carber would need insulin, so clearly the response recovers.
And obviously, as you are aware, less carbs do need less insulin.
So.......
The usual explanation is if you low carb, for a type 2, the pancreas ramps down insulin production, then a high carb meal takes its by surprise, so it takes time to ramp back up.
It's recommended to switch back to a high carb diet for the days before an oral glucose tolerance test for example.
However, that theory seems to be at odds with this thread, as the same results appear to be happening with injected insulin, which suggests the type 2 theory is rubbish.
Hope that's clearer.

 

[Inka]

I find that a touch patronising @Inka.

Then that would be the way you read it @Pattidevans I was simply explaining how I choose my bread, how it affects my blood sugar and what I’ve found works. That was as part of a discussion about carbs eg I agreed with you that “cr*p carbs* as I called them were a very different matter than healthy carbs; you told me you had bulgar wheat and zaatar in your cupboard too; I explained I would never have eaten a big plate of macaroni cheese and a whole baguette of garlic bread even before I got Type 1, etc Nowhere did I suggest you didn’t know what sourdough bread was or had never eaten it before.

I think from memory you eat Nimble bread? If you were to tell me you ate Nimble bread for lunch and it worked for you, I wouldn’t take that as you thinking I didn’t know Nimble bread existed or patronising me about it. I would take your statement at face value - ie you telling me what bread you eat.

 

[Pattidevans]

No, I did buy some Nimble but it's horrible stuff. I think we ought to put this discussion to bed now. I'm tired of it and I think we have to agree that what works for some doesn't work for others. I've never been one to say "my way is the highway".

 

[Jennyninja]

Hi there everyone, I've not visited the forum for a while as I've been on the Month of Miles chats for a while. (Really supportive and interesting like this group by the way ). Carbs/exercise and T1 are constantly on my mind and the last few months have been a bit of a rollercoaster. Now c6 months from start of insulin T1 diagnosis. This thread is so interesting. Having been a misdiagnosed T2 for nearly 13 years I had been living on a very low carb diet to survive. The transition to eating more carbs has been an uneasy one for me so I recognise the arguments for low carb very well. However I'm now convinced that healthy carbs and correct dosing is the answer especially as I am a runner. I would like to transition to a more veggie diet for health and the environment. (I'm sure most of us have seen the Prince William /David Attenborough Earrh Shot prog). Veggies have carbs so I expect my carb intake to increase. I'm hoping it's all going to go smoothly. I'll keep you posted

 

[travellor]

Further thoughts on this.
I was remembering @ianf0ster was saying he was "fat adapted" from eating his grandmothers diet, and could easily switch.
That rang a bell, as I used to believe I could easily switch from eating to not eating, (intermittent fasting), and switching to using fat reserves in some way.
I could happily work all day, and not need to eat from morning to night.
So, either using the stored reserves, or switching to breaking down fat as ketones at the drop of a hat, as Ian said.

In adaptive insulin resistance, the body is used to having minimal carbs, and is set up to use fat.
So when BG rises from eating carbs, the muscles simply aren't set up to use the BG.

I wonder if my poor eating cycle set me up to have the insulin resistance I eventually developed, and my "normalisation" of my weight and eating habits reset it?

Hopefully one day, this will be better understood.