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tim.culhane

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Hi All,

My name is Tim and I live in Dublin.
Have been diabetic for 28 years.
I use a dexcom G7 continuous glucose monitor.

I'm blind and have a profound hearing loss but neither of these are related to my diabetes.

One of main reasons for joining the group is to get ideas for maintaining a low carb diet.
I have gone low carb for brief periods in the past and rally noticed the benefits.
I want to get back to it but need advice on online resources to help plan meals and come up with meals and recipes with low or no carb alternatives.

Lookiing forward to getting to know everybody.

Tim
 
Hi @tim.culhane and welcome to the forum,
I eat low carb, mainly meat, fish, eggs, cheese, above ground veg, berries.
From what I have heard, getting meals for which the insulin dosing is straightforward tends to be of more importance for a Type 1 such as yourself.
So I'm tagging @rebrascora who is a low carbing Type 1.
 
Hey,

I just think that if I can eat low carb most the time then I lower the amount of insulin required. Hence I get less wild swings in my blood glucose levels.

I did low carb last year for a few weeks and then results were positive and almost immediate.

I just need the motivation to get back to it and handy ideas and meal plans to get started.

Like all things just starting is the difficult bit.

Would be interested in other people's experience on low carb diets.

Tim
 
Hi Tim and welcome.

Sorry to read that you have sensory loss issues as well as diabetes. I imagine that must be quite challenging. Good that you have Dexcom G6. Are you on MDI or a pump and if MDI which insulins do you use?

As Ian says I follow a low carb way of eating. For me it started because I was initially though to be Type 2.... I was diagnosed with diabetes at the age of 55 and I was a bit of a sugar addict, so it was a reasonable assumption, but it became clear quite quickly that I was actually Type 1, however in the 6 short weeks of low carbing to try to reverse the Type 2 I found numerous benefits to this way of eating not least that it helped me control my sweet tooth and and comfort eating but also improvements in gut health and reduced joint pain and a very noticeable cessation of chronic migraine, so there were lots of unforeseen benefits and whilst I was encouraged by nurses and diabetes dietician to eat normally, I have mostly stuck with low carb as I feel it is beneficial for my general physical and mental health. I am not really strict but generally don't eat the big hitters like bread and pasta and rice and potatoes on a regular basis. I don't specifically follow a meal plan, I just substitute other veg for those elements of a meal. So I will have mashed cauli instead of mashed potato and I serve chilli or curry on a bed of cooked shredded cabbage and bolognaise on a bed of cooked broccoli or courgette. Most veg is cooked with a knob of butter or a dollop of cream cheese or served with sour cream and chive dip from the chilled counter. I use celeriac for chips instead of potatoes and have them with steak or chops. I very occasionally have konjac noodles/rice but I am trying to use less processed foods so they are a rare feature in my diet these days, but I do have a couple of packets in the back of the cupboard as a quick option if I need them.
I fry a lot of stuff and I microwave most of my veg as it is quick and energy efficient and I can cook 4 leaves of cabbage shredded with a knob of butter in 2 mins which isn't much longer than the konjac noodles. I also eat quite a lot of pickles like beetroot and gherkins. Yesterday I had a couple of rounds of black pudding with fried mushrooms and pickled beetroot, with a fried egg on a bed of shredded savoy cabbage cooked with a knob of butter. It was a nice plateful of tasty food and put together in about 15 mns. I also like stir fries. Tonight I am making a cauliflower and halloumi curry which I will have on a bed of savoy cabbage and broccoli spears.

I think one of the key things about eating low carb when you are insulin dependent is to be aware that your body will break down protein and to a lesser extent fat, in the absence of enough carbs in the meal, The protein and fat release is much slower and tends to start 2 hours after a meal in my experience and rather than spiking BG like carbs do (usually in the first or two hour after eating) you get an upward drift from about 2 hours post meal for up to 8 hours afterwards. I tend to find that I need to inject a small bolus to cover the carbs from things like onions and tomatoes and veg before the meal, usually a couple of units and then I will need a correction or 2 starting at about 2 hours after the meal but I might need 2 units at 2 hours post meal and another 1-2 units an hour or two after that. I don't try to calculate the protein and fat release, I just keep a close eye on my Libre and when my levels hit 8 and are slowly drifting upwards I inject the first correction and if they are still heading upwards an hour later and my levels are in the 9s I will hit it with another 2 units. I use Fiasp which is one of the quickest acting insulins and I find works best for me on a low carb diet if I stack corrections like this but it is frowned upon by HCPs because of the danger of causing a hypo, so you have to keep a close eye on your CGM . With the protein release being slow and sustained over a period of several hours, it buffers the effect of the stacked corrections, so I rarely see a sharp drop unless I do exercise with stacked corrections on board.

I should say that I use a reader for my Libre and I scan approx 30-35 times a day so I keep a very close eye on my levels and I have been using Fiasp for several years now and I understand pretty well how it works for me and I am not sure I could use this same strategy with NovoRapid and I certainly don't recommend it without lots of testing to see how your body rersponds. Low carbing with insulin is nopt easier as people sometimes expect because of the protein release, but I have found a system for myself with Fiasp, where I no longer carb count as such, I just inject a small bolus in advance of the meal and then inject corrections as I feel necessary depending upon what I see on my Libre and what experience tells me I need. A decent size low carb meal will likely still need about 5-6 units of Fiasp for me delivered in 3 injections, 1 before and 2 stacked corrections afterwards depending upon what Libre shows me. I have my high alarm set at 9.2 and when the alarm goes off I jab 2 units. I don't weigh or measure anything particularly and I don't really carb count any more, I just inject according to my Libre. Similarly if my levels are getting a bit low a nudge them back up with a very small carb rich food... A single dried fig is my current choice at about 7-8g carbs each. Sometimes I use dried apricots or prunes which are 5g carbs each and 1 is usually enough to stop the drop and levels things out. If I am dropping fast then i have a Jelly Baby, to stop the drop and then perhaps a prune or apricot. Mostly this works for me pretty well and I basically just use my Libre as a long running computer game and use insulin and carbs as my controls to keep in range and I use as much or as little as I need to do that. I don't worry about ratios or calculating doses, I just respond to my Libre data. This takes a lot of the mental strain out of my diabetes for me. It is very much something that has evolved as I have gained experience with Libre and Fiasp (which I hated when I first tried it) but find it works well for me now that I understand it's quirks and how my body responds to it.

Sorry that is a lot of info and not all specifically covering what you asked about, but I find going low carb as a Type 1 needs an unconventional approach to make it work for me. Whether my system would work for others I don't know but diabetes is surprisingly individual and you have to find what works for you and your diabetes. The important thing is to keep yourself safe, and particularly if you are tempted to experiment with stacking corrections as I have outlined and to keep records so that you can look back and see roughly how much active insulin you have on board. I log all my insulin doses on Libre. I occasionally log carbs but I find that much less useful.

A typical day's food intake for me would be

Breakfast:- coffee with real cream, creamy Greek style natural yoghurt with a few berries or other seasonal low carb fruit like rhubarb or apricot, mixed seeds, cinnamon and a sprinkle of nutty granola.

Lunch:- half a green apple with a chunk of nice cheese or some olives and cheese and some nuts or some homemade vegetable soup. Occasionally I will have a ryvita with butter and Marmite with the soup.

Evening Meal:- Curry or chilli or steak and celeriac chips or high meat content bangers and cauli mash with whatever other veg or salad I can fit onto the plate and always a big dollop of coleslaw if I have salad and usually a balsamic vinegar dressing. Personally not a huge fan of fish.... mostly because I don't like handling it, but particularly fishy fish which is a shame as it is so good, but I will eat tinned tuna and salmon and sardines occasionally.

I eat a lot of nice cheeses and coleslaw and olives and I try to compete with myself for how many different veg I can introduce onto my plate in the evening. I find pickled veg really handy for adding a bit of extra bite and the acidity/vinegar seems to really help with stabilizing my BG levels and it is quick and easy to open a jar and counts for another veg on my plate!

Apologies for rabbiting on quite so much but it isn't exactly a subject that you can cover in 2 sentences, because of the complications of insulin dosing for low carb. Sometimes you can get away with increasing your daytime basal to cover some of the protein and fat release, but even with a high morning Levemir dose (22units) I usually need corrections after meals for protein release.
 
I personally don't find that I need less insulin, but I do find that eating low carb makes my BG levels more stable, so they drift up and down more than spiking and dropping.
 
I found when i went low carb i became more insulin resistant. So i still needed the same amount of insulin.
Whilst it was true my control was good, i found i could get just as good control with higher carbs, and it meant i didn't miss out on bread, cakes etc
I still do the occasional low carb meal when i need a low drama meal
 
Thanks for all that info.

I'm on novarapid for fast acting and Tresiba for my long lasting insulin, which I always inject around 10pm each night.

From what you say going low carb isn't quite as simple as people make out.
The idea would be that if you cut out the carbs then you automatically need less insulin.
Less insulin results in less yoyoing of your readings throughout the day.
I guess it depends on how much fat you are eating.
Presumably if you had a more protein/veg diet then levels would not creep up again as the fat is broken down.

I have gone low carb for several weeks at a time last year and did see pretty dramatic improvements.
Biggest thing was that my readings became much steadier and were much more closely grouped together.
My period in my desired range increased a lot.

As you say, everybody is different and not only that, our bodies behave differently from day to day.

I'll definitely take on board what you say about the effect of fat on glucose levels.

Tim
 
It isn't so much the fat but mostly the protein that releases glucose in the absence of enough carbs. If your meal doesn't contain about 30-40g carbs, the body will break down approx 40% of protein and about 10% of fat to get glucose, so the protein in your meal is going to release 4x more glucose that fat will, therefore unless you are eating a block of butter or lard, it is mostly the protein which counts. Fat slows down the release of glucose from carbs but that is different altogether. ie the Pizza effect.... but pizza is not low carb so not relevant in this situation.
 
So how do you feel about the diets such as Bernstein, which seem to promote high protein intake?

It almost seems that cutting out carbs and maintaining or increasing protein levels results in the same end result.
Perhaps you take smaller more frequent insulin doses but your overall insulin use doesn't drop much.
 
I have mixed feelings about Bernstein. I think he is incredible but I also think he is a bit extreme in some of his views, although I have not read a lot of his work.

What I know is that we are all different and what suits one person, may not suit another for a whole variety of reasons, so I am much more interested in experimenting on myself and finding what works for me. I think it is important to understand the mechanisms involved, so that you can relate what you see with your BG levels to those processes.

I don't have a problem with eating more protein, although I personally feel better eating more fat and more vegetables. I believe Bernstein exercises quite rigorously and this may well deal with the glucose release from the protein he eats, so he may not need to inject for it because he burns it off. I too can do this but often I don't have the time or the inclination. I have recently been experimenting with running up and down stairs 20 times and that is effective at dropping me about 2mmols, which is the equivalent of almost 1 unit of insulin for about 10 mins of quite intense activity, but to me that is exercise lowering my insulin needs not eating more protein and less carbs.

What you have to understand is that there are lots of factors at play wit managing BG levels, not just the food we eat and exercise and insulin but there are about 40 other factors, some we have some control over, some we do not. You have to learn to look at the bigger picture over the longer term to figure out which ones are having the most effect.

Many people will actually tell you that eating low carb causes insulin resistance which means you need more insulin rather than less. My gut feeling is that this is not the case but that your body gets into a routine of breaking down proteins and fats and it is the glucose release from them which makes it look like you are insulin resistant. If you eat 30g of carbs or more per meal, your body may not break down protein, so it depends how low carb you go and what you count. After all even lettuce contains carbs, just only a tiny amount per 100g so you would have to eat a very large portion for it to count for anything. On the DAFNE course they tell you not to count the carbs from beans and sweetcorn and sausages and even carrots, but all these foods contain carbs, so even if you avoid the big hitters like bread and potatoes and rice and pasta etc, it is still quite easy to clock up 30g carbs per meal if you count everything.
 
Yes, I'm well aware that many factors are at play when it comes to determining blood glucose levels.
I have been diabetic 28 years and have had pretty good control insofar as my a1c looks good.
However I would like my levels to be in a smaller range than they have been lately.

I think the important thing is to come up with a diet that works for you and that you enjoy and can stick too.
If it feels like hard work, boring or otherwise problematic then you are very unlikely to stick to it.
 
I agree although a good HbA1c can be misleading which is why the Time in Range feature on CGMs is a much better guide to diabetes management. I found going low carb really challenging at first because I was culturally in the habit of filling my plate with bread and potatoes particularly, other cultures it might be pasta or rice or beans and it is surprisingly difficult to break from those traditions, so I do think that going low carb involves a certain amount of effort at least initially. Plus of course our society is full of advertising for cheap high carb and very attractive and addictive foods, so there is a lot of temptation certainly initially when you are trying to eat ore cleanly and reduce the carbs and eating out can be quite challenging until you get the hang of it, again because the profit is in serving people cheap tasty high carb foods. Asking for a steak with no chips or onion rings but a big salad, doesn't seem like much of a treat when you are paying for a meal out.... so it isn't always easy and you do have to be quite committed to it to push through these challenges. For me the health benefits have been worth it, but I am not a social eater and I mostly live on my own and cook for myself. My partner has his own house which is full of cakes and biscuits and sweets and he eats high carb foods and takeaways quite often. I used to cook for both of us, but he doesn't want to eat low carb so it is easier if he sorts his own meals and I sort mine. So, there are a lot of aspects which have made it tricky and definitely not easy but for me the health benefits have been worthwhile, and I can manage my BG levels better being low carb, but it is not in any way simple and it has taken several years to find ways to make it sustainable.
 
Welcome to the forum @tim.culhane

Hope you manage to find a balance of carbs and insulin which works for you.

Are you thinking of moderate-low, low, or very low? As I understand it ‘low carb’ is usually thought to start at below 130g of carbs a day.

Have you got a rough idea of daily carbs that you think would be workable/flexible enough to work for you long-term? 🙂
 
tim.culhane said:
The idea would be that if you cut out the carbs then you automatically need less insulin
Click to expand...
Hi Tim
I have reduced my carbs in order to reduce the size of the spikes after meals. We aim for 30g carbs in each meal, but it is only a target and we flex around that. I don’t think that that qualifies as ‘low carb’.

On the odd occasions where I have had a very low carb meal I have been surprised at the rise in glucose, but found out that in the absence of carbs I need to take account of the glucose produced from the protein. In my mind I have enough to think about with the carbs, and don’t want to have to think about calculations with the protein too, so just stick to around 30 g. This enables me, with appropriate timing of my bolus before the meal, to have hills in my graphs from my sensor, rather than peaks and troughs.
 
rebrascora said:
Hi Tim and welcome.



I should say that I use a reader for my Libre and I scan approx 30-35 times a day so I keep a very close eye on my levels and I have been using Fiasp for several years now and I understand pretty well how it works for me and I am not sure I could use this same strategy with NovoRapid and I certainly don't recommend it without lots of testing to see how your body rersponds. Low carbing with insulin is nopt easier as people sometimes ....or steak and celeriac chips or high meat content bangers and cauli mash with whatever other veg or salad I can fit onto the plate and always a big dollop of coleslaw if I have salad and usually a balsamic vinegar dressing. Personally not a huge fan of fish.... mostly because I don't like handling it, but particularly fishy fish which is a shame as it is so good, but I will eat tinned tuna and salmon and sardines occasionally.

I eat a lot of nice cheeses and coleslaw and olives and I try to compete with myself for how many different veg I can introduce onto my plate in the evening. I find pickled veg really handy for adding a bit of extra bite and the acidity/vinegar seems to really help with stabilizing my BG levels and it is quick and easy to open a jar and counts for another veg on my plate!

Apologies for rabbiting on quite so much but it isn't exactly a subject that you can cover in 2 sentences, because of the complications of insulin dosing for low carb. Sometimes you can get away with increasing your daytime basal to cover some of the protein and fat release, but even with a high morning Levemir dose (22units) I usually need corrections after meals for protein release.
Click to expand...
An incredibly useful post - thank you
 
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