High BG on LCHF...

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xjessica.rose

xjessica.rose

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Relationship to Diabetes
Type 1
Hi all,

I'm currently doing the DAFNE course which has left me a little confused after working with the DSN & dietician to sort out my BG levels.

I've been low-carbing for around 2-3 months (with a few cheat weekends) with daily carbs adding to around 40g from veg/salad mostly. According to the DAFNE carb counting my breakfast is 1.5CPs and all other meals are 0CPs, but although having a large dose of BI (levemir 31u split am/pm) I am constantly taking correction doses of Humalog at each mealtime because my levels are reading mostly between 11-16.

Today I was told this could be due to my body having 'no available carbs' and therefore my liver is pushing out its max limits of glucose instead. Due to this they're asking me to re-introduce carbs into my diet (so far I have refused) but just wanted to know if any other low-carb T1's have experienced this...?

Thanks in advance!

(Ps. My first post so apologies if I have missed anything!!)
 
Hi Jessica, welcome to the forum....

I'm T2 on LCHF & have pretty stable FBG at about 5.0 since starting LCHF. From what I see, the establishment really doesn't like low carbing so they will use any argument. Perhaps a T1 will be along to share their experience
 
Hello, and welcome to the forum. I try to restrict carbs, though I dont go as low as you, I eat around 50-100 per day. The thing I find is that, if I've had a zero carb meal, the body processes the protein, and eventually the fat, into glucose, so you will still need some Bolus insulin for these carb free meals. It takes longer to show up in the system, and I think around 50% of the protein is eventually turned into glucose,( not sure how much of the fat. Somewhere on here, I've seen a chart that tells you exactly how long the body takes to process protein and fat, but I can't remember where. I'll try looking in a mo.

So it may be a question of experimenting, and finding out how much insulin you need to cover your meals, looking at it as a Bolus to cover the glucose being produced by the food you are eating, rather than just as a correction dose to be done later when you're high.

Hope that makes sense. There are some very low carbers on here, who can probably explain it better.
 
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Sorry I can't help . Just wanted to say hi and welcome
 
Hi there! I have a similar experience sometimes with low carbing, mine is usually sky high after exercise too which is annoying as I was told exercise is good for controlling BG levels!
 
Hey everyone, thank you so much for taking the time to reply 🙂 All helpful so far and especially that chart from the other thread - I will likely bring this up in our dafne session tomorrow, probably only to be shot down but nevertheless! We shall see...
 
Carbohydrates are not all equal. There are vegetables that contain carbohydrate that are also high GI, but are low GL or in other words you have to eat them in large quantities to have an impact on blood sugar. Also these typically are more fibrous making the digestive system work harder to metabolise the glucose. LCHF can work but not for everyone. As a T1, eating a good balanced diet with low GL carbohydrates will be the fastest way to achieve good control. I typically eat 100ish grams of carbohydrate, mainly sourced from broccoli, Swede, carrots, porridge and similar. This combined with about 10 units of Novorapid and 8 units of Lantus has given me the best control ever.
 
Owen said:
Carbohydrates are not all equal. There are vegetables that contain carbohydrate that are also high GI, but are low GL or in other words you have to eat them in large quantities to have an impact on blood sugar. Also these typically are more fibrous making the digestive system work harder to metabolise the glucose. LCHF can work but not for everyone. As a T1, eating a good balanced diet with low GL carbohydrates will be the fastest way to achieve good control. I typically eat 100ish grams of carbohydrate, mainly sourced from broccoli, Swede, carrots, porridge and similar. This combined with about 10 units of Novorapid and 8 units of Lantus has given me the best control ever.
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Thanks Owen. As mentioned in my OP, I eat around 40g of carbs from broccoli, cauliflower, spinach, cabbage, yoghurt etc. but my diabetes team don't recognise these as 'carbs', there issue is with me only eating this amount, I'm still on 32u (now 34u actually) of Levemir and small correctional Humalog which is still leaving my BGs around 11ish throughout the day and night! I'm reluctant to eat more 'beige' carbs as surely I'm going to have to have so much more insulin??! or am I just totally confused :(
 
xjessica.rose said:
Thanks Owen. As mentioned in my OP, I eat around 40g of carbs from broccoli, cauliflower, spinach, cabbage, yoghurt etc. but my diabetes team don't recognise these as 'carbs', there issue is with me only eating this amount, I'm still on 32u (now 34u actually) of Levemir and small correctional Humalog which is still leaving my BGs around 11ish throughout the day and night! I'm reluctant to eat more 'beige' carbs as surely I'm going to have to have so much more insulin??! or am I just totally confused :(
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Not necessarily true, if your liver is pushing out more glucose to prevent starvation, but your pancreas cannot keep up. By adding more nuts, beans etc should help slow your liver down and reduce the competition with the insulin
 
It's nothing to do with 'the establishment'.

T1 is simply NOT the universal panacea for diabetes that T2s assume it to be.

In the first instance, it sounds like your basal simply isn't enough. 31u a day is not necessarily 'high' and it sounds to me that perhaps when you were eating more carbs, the additional bolus you were taking was making up the shortfall.

Secondly, for T1s, low-carbing introduces two new levels of unpredictability. Almost all T2s have residual insulin production, which means that for foods that release glucose out slower than carbs, their pancreases can keep up. Unfortunately, we don't have that option. If you are low-carbing as a T1, your body increases its conversion of protein to glucose, and typically, most people on a low-carb diet increase their protein intake. This creates a wildly unpredictable glucose profile - protein starts converting to glucose around 2-3 hours after eating which makes it incredibly hard to bolus for. As a T1, you need to bolus for protein too, which T2s generally don't need to factor in.

Thirdly (and this is where it gets controversial)....low-carbing can actually increase your insulin resistance, which means that you proportionally need more insulin (sometimes a lot more) and can actually end up taking more insulin in total. Seriously. After trying out low-carbing, I've completely wrecked my insulin ratios to the point that I can't actually eat carbs at lunchtime full stop, even if I inject according to a 1:2 ratio - yes, 1u per 2g of carbs. If I want a sandwich for lunch, I will generally have to take about 20u of Novorapid - I'm on just 26u of Lantus per day and that will keep my BG levels rock steady if I don't eat, so that should illustrate just how badly low-carbing can potentially affect your future ability to metabolise carbs. Correction doses are even more of a nightmare where 1u will only reduce my BG by about 0.2mmol/l. When things have gone wrong (eg. you misjudged your bolus earlier), that can cause major issues and I find that on average once a month I have to do a highly dangerous IV injection of insulin just to get back on track. This is likely to horrify people but if my BG starts getting into the high teens, I will literally mainline 10-12u of Novorapid as it is the only way to get back on track. I am aware this is PHENOMENALLY dangerous but it's the only choice I am left with and I've learned how to manage this effectively.

Low-carbing can work for some T1s very effectively but it is not 'fire and forget'. By reducing my carb intake I've managed to get my A1C down to 43 (yay!) but I'm now sorta stuck with a reduction in flexibility and have to occasionally resort to some practices which are highly dangerous.
 
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I am a Type 2 but what I have gleaned from being on this forum for a number of years, we are all different, and where some can survive and do well on very few carbs, some need to have more!
 
@DeusXM as a relative newbie T1 your current state sounds pretty horrific to me and it's something I'd like to avoid if I'm honest.
After looking at many of your posts I know you have been a keen supporter of low carb diet to aid BG control.
How much (or how little) carb were you eating to "completely wreck your insulin ratios"?
Is this something that others have also experienced?

I am at about 100-150g carbs per day which isn't super low by any means but my control appears to be OK and my diet seems sustainable.
 
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zx10pilot said:
@DeusXM as a relative newbie T1 your current state sounds pretty horrific and it's something I'd like to avoid if I'm honest.
After looking at many of your posts I know you have been a keen supporter of low carb diet to aid BG control.
How much (or how little) carb were you eating to "completely wreck your insulin ratios"?
Is this something that others have also experienced?

I am at about 100-150g carbs per day which isn't super low by any means but my control appears to be OK and my diet seems sustainable.
Click to expand...

Don't get me wrong, low-carbing can work for T1s, but it comes at a price which you have to be prepared to pay, and as you might be able tell from my post, no-one really told how much it would be. I don't know if my experience is atypical. It could well be. The benefits I get from low-carbing is I spike less (which has a beneficial effect on my overall control), and my cholesterol ratio has improved. I haven't seen any weight loss benefits although possibly it's helping for weight maintenance.

Generally, I aim for less than 30g of carbs a day - I now start to run into difficulty once I go above 50g. Worth noting that some carbs affect me far less than others too - for instance, basmati rice actually has very little impact on my BG but bread is a complete disaster zone for me.
 
In that case I am quite happy to stay at the level I'm currently consuming as it seems to be a happy medium (for me at least).
Good luck with your situation though.
And apologies for hijacking the thread.
Regards
zx
 
Does low carbing really increase insulin resistance? I sometimes wish I was more resistant, i have an ISF of 5 which can make correction doses interesting! Luckily this is something I don't need to do often (maybe due to restricting the amount of carbs in my diet?) I don't find protein really affects my BG levels much, having said that I very rarely have a completely carb free meal so I guess I've probably always got a bit of bolus on board to handle it.
 
SlowRunner said:
Does low carbing really increase insulin resistance? I sometimes wish I was more resistant, i have an ISF of 5 which can make correction doses interesting! Luckily this is something I don't need to do often (maybe due to restricting the amount of carbs in my diet?) I don't find protein really affects my BG levels much, having said that I very rarely have a completely carb free meal so I guess I've probably always got a bit of bolus on board to handle it.
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After the day I've had even Trump and Moon seem to effect insulin levels. I'm not too sure on low carbing having this effect. Don't get me wrong, it might in some people. I would say your fitness regime is the biggest contributor to a low insulin resistance, hence the encouragement to increase levels of exercise in T2. As a T1, you need to match your exercise with carbohydrate, in the same way as very active people and athletes do. As you are clearly not storing fat, then your insulin is easily covering your current dietary needs.
 
DeusXM said:
It's nothing to do with 'the establishment'.

T1 is simply NOT the universal panacea for diabetes that T2s assume it to be.

In the first instance, it sounds like your basal simply isn't enough. 31u a day is not necessarily 'high' and it sounds to me that perhaps when you were eating more carbs, the additional bolus you were taking was making up the shortfall.

Secondly, for T1s, low-carbing introduces two new levels of unpredictability. Almost all T2s have residual insulin production, which means that for foods that release glucose out slower than carbs, their pancreases can keep up. Unfortunately, we don't have that option. If you are low-carbing as a T1, your body increases its conversion of protein to glucose, and typically, most people on a low-carb diet increase their protein intake. This creates a wildly unpredictable glucose profile - protein starts converting to glucose around 2-3 hours after eating which makes it incredibly hard to bolus for. As a T1, you need to bolus for protein too, which T2s generally don't need to factor in.

Thirdly (and this is where it gets controversial)....low-carbing can actually increase your insulin resistance, which means that you proportionally need more insulin (sometimes a lot more) and can actually end up taking more insulin in total. Seriously. After trying out low-carbing, I've completely wrecked my insulin ratios to the point that I can't actually eat carbs at lunchtime full stop, even if I inject according to a 1:2 ratio - yes, 1u per 2g of carbs. If I want a sandwich for lunch, I will generally have to take about 20u of Novorapid - I'm on just 26u of Lantus per day and that will keep my BG levels rock steady if I don't eat, so that should illustrate just how badly low-carbing can potentially affect your future ability to metabolise carbs. Correction doses are even more of a nightmare where 1u will only reduce my BG by about 0.2mmol/l. When things have gone wrong (eg. you misjudged your bolus earlier), that can cause major issues and I find that on average once a month I have to do a highly dangerous IV injection of insulin just to get back on track. This is likely to horrify people but if my BG starts getting into the high teens, I will literally mainline 10-12u of Novorapid as it is the only way to get back on track. I am aware this is PHENOMENALLY dangerous but it's the only choice I am left with and I've learned how to manage this effectively.

Low-carbing can work for some T1s very effectively but it is not 'fire and forget'. By reducing my carb intake I've managed to get my A1C down to 43 (yay!) but I'm now sorta stuck with a reduction in flexibility and have to occasionally resort to some practices which are highly dangerous.
Click to expand...

I take it from this you regret doing it? One of the first things I can remember being told at diagnosis was control the carbs. If you don't it's not long before you find out why. I've done that ever since and typically have between 120-200g a day although it is more when I'm exercising. I'm not sure if that's considered high or low. Ratios are 1:10, 1:12 and 1:10 with 20 units of Tresiba. Corrections are 1u to 3 mmol/l. (No need for IV 😱). These ratios haven't changed much in 30 years, in fact sensitivity has increased with the 1:12 at lunchtime. So I'm almost on fewer units of insulin than you but 4 to 7 times the carbs. Control is okay and my last HbA1c was 48. Hopefully when I go on the pump this will improve. Compared to your experience, most of all I find my quality of life is fine as I don't consider what I do too restrictive.
 
Matt Cycle said:
I take it from this you regret doing it? One of the first things I can remember being told at diagnosis was control the carbs. If you don't it's not long before you find out why. I've done that ever since and typically have between 120-200g a day although it is more when I'm exercising. I'm not sure if that's considered high or low. Ratios are 1:10, 1:12 and 1:10 with 20 units of Tresiba. Corrections are 1u to 3 mmol/l. (No need for IV 😱). These ratios haven't changed much in 30 years, in fact sensitivity has increased with the 1:12 at lunchtime. So I'm almost on fewer units of insulin than you but 4 to 7 times the carbs. Control is okay and my last HbA1c was 48. Hopefully when I go on the pump this will improve. Compared to your experience, most of all I find my quality of life is fine as I don't consider what I do too restrictive.
Click to expand...
Sounds sensible to me.
 
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