Keeping the weight off and low-carb vegetarian diets

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xwyfgotitall

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Type 1
Hello All,

I am 28, Male, and I have been Type 1 for about 7 years now. Things are all going well with regards to my Hba1c and all that but I am not sure if it because of being diabetic, me ageing or what not but I have been struggling to keep the weight off. I am 75% positive it is to do with the sheer amount of carbohydrates that I have in my diet (just to get by and to control my glucose levels) so I have been investigating the possibility of going on a low-carb diet for about 6 months to see how it goes.

This unfortunately is where i have hit a stumbling block! 1. I am diabetic 2. I exercise regularly (at least 20-30mins of intense cardio per day) 3. I am vegetarian 4. I have a highly intensive job where I am on my feet all day and my brain is going at 120% for the whole day which is exhausting.

I am not going to lie, I am pretty scared about trying a low-card diet due to the risks of going hypo at work, in the car and in meetings etc, but when I was under consultancy from a diabetic nurse at a local primary care centre they used to say that a low-carb diet is much easier to control and the amount of correctional doses would be much less than usual.

At the moment I eat a lot of Pasta, Pizza, Chilli, jacket potatoes/beans and stuff like that which have a huge amount of carbohydrates but I do not know what to replace these meals with at all.

Does anyone know of any resources on the internet or books that could help me lower my carbohydrate intake which can help me not go hypo and so I don't starve to death either?

many thanks,

Daniel
 
There's an interesting thread discussion on this forum about Low carbing/Low carb and exercise.
https://forum.diabetes.org.uk/boards/threads/low-carb-fat-or-fiction.56956/page-2
I'm not vegetarian, but I do limit my carbs ( not ultra low) and find it helps with control. It does become a bit of a guesstimate working out how much insulin to have to cover protein, which converts to glucose but much more slowly than carb. I fill up the calorie gap with nuts, seeds, avocado, and very slow carb release pulses like split peas and lentils, which don't cause any spikes in my blood sugars.
 
Hi Daniel, what insulin regime are you on? If you are on separate slow and fast-acting insulins then you should be able to adjust your insulin doses so you don't have hypos and don't need to eat so many carbs. Have you done carb counting course, e.g. DAFNE? I've been Type 1 for about 8 years, I'm also a runner and do at least an hour a day exercise, but consume about 150g carbs a day maximum, often less. I've actually lost around 6 kg since the start of the year after stopping drinking alcohol. There shouldn't be any need to overload yourself with carbs, and if you are gaining weight it's most likely you are having too much carbohydrate and too much insulin to deal with it - reduce the carbs and you reduce the insulin required, and the weight will probably also fall 🙂 I don't follow any particular diet, I eat bread, rice, pasta, potatoes - just in moderation and bulk up meals with other veg etc.
 
Hi Robin,

Thanks for the link I will have a good read.

Hi Northerner,

I am on slow and fast acting insulin as you say, and I have been on the carb counting course and I try my best to carb count even though I am usually taking a strict amount of 8-10 units for breakfast, 4 units at 11 for elevenses, 4-6 units at lunch and 8 units ish for dinner and then whatever i need to inbetween for correctional doses or snacks since my meals tend to just slot into those amounts. 150g seems so little, I probably eat that much before lunch time D:
 
xwyfgotitall said:
Hi Northerner,

I am on slow and fast acting insulin as you say, and I have been on the carb counting course and I try my best to carb count even though I am usually taking a strict amount of 8-10 units for breakfast, 4 units at 11 for elevenses, 4-6 units at lunch and 8 units ish for dinner and then whatever i need to inbetween for correctional doses or snacks since my meals tend to just slot into those amounts. 150g seems so little, I probably eat that much before lunch time D:
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I'd suggest starting a food diary and record the amount of carbs in everything you eat and drink each day. It's a bit tedious, but it will give you a true picture of your carb consumption, and also you will be able to spot areas where you might reduce or replace carbs with alternatives. If you want to share typical meals on here, people may be able to make suggestions for you 🙂 Bear in mind that 250g carbs per day is the recommended daily amount for non-diabetic adult males, so if you are eating well in excess of this then you are eating too much anyway! 😱 😉
 
There are two things to think about with this.

You need to be absolutely hot on adjusting your insulin relative to your carb intake

You need to forget everything you think you know about fat.

Firstly, I'm going to say that you might not even need to go on a low-carb diet. You say you eat a lot of carbohydrates 'just to get by and control my glucose levels'. That to me tells me that you're probably taking too much insulin.

If you are on a two-injection system, you are unfortunately stuck with how you manage your diabetes. You need to be on either a basal-bolus injection system or a pump for this to work.

Assuming you are on one of these.....

Let me guess, is this a fair description of how diabetes management is for you at the moment?

You do your injection according to what you feel is the right amount. You then eat a carby meal because you don't want to have hypos, and then your blood sugar rockets up, and then starts to trickle down and keeps dropping throughout the day until your next meal or you have a snack to stop you 'going low'...where you repeat the whole process.

Is this correct?

You are doing what is commonly called 'feeding the insulin', where you eat things to offset the impact of insulin.

My gut feeling is you are, in the first instance, simply taking too much insulin. If you are constantly having to eat carby meals to avoid hypos, there is too much insulin circulating in your system. Too much basal, or too much bolus, or more probably, a complicated combination of both. So before you do ANYTHING to adjust your diet, you need to make sure your basal is set correctly, and your bolus ratios are also correct.

With a correctly set basal, your blood sugar when not eating should remain static. It should not be dropping. That means if you wake at 6am and then don't eat until 12pm (or any other long period), your blood sugar should stay broadly the same throughout. If you're already saying to yourself 'but if I don't eat, I'll have a hypo', then that probably already tells you you're taking too much.

Once you've got this stuff sorted, you may find that you don't actually need to eat loads of pasta, beans and pizza (which, if we're being honest, aren't exactly healthy foods whichever way you slice it) to keep your blood sugar up, which may in itself lead to weight loss.

You need to get into different mindset of how you see insulin. The biggest myth in diabetes is that you take insulin to lower your blood sugar. You don't. You take insulin to prevent your blood sugar from rising. It's a subtle but very important difference. Once you've got your head round that, things could get a lot easier. Once you can tell us a bit more about your insulin regime (all the above might be a completely incorrect assumption about your control), then we can start talking about fat, insulin and adjustments.
 
Ok, just seen your above post about fixed doses. There's the problem right there. You MUST carb-count. It's essential. Otherwise you're feeding your insulin, not you.

It's very bad to feed insulin. Why? Because insulin is the hormone that makes you store fat. No other hormone does this. And the way insulin stores fat is by converting glucose in your blood into fat, while preventing your body from burning fat cells.

And this is the secret at the heart of everything. What you eat turns into something different once it's inside you. Fat doesn't become body fat. Cholesterol doesn't become blood cholesterol. Starches don't become starches inside you. Protein doesn't become protein inside you (or at least, not the same protein). The only substance that doesn't really change is glucose.

The equation is simple - unmetabolised blood sugar + insulin = body fat.

Why am I telling you this? Because you need to not fear fat. Because you are going to need fat if you are to make up the calorie deficit from reducing your carbs to prevent you from feeling hungry. It is perfectly possible - I tend to eat less than 50g of carbs a day with few hypos and I rarely, if ever, feel hungry. I probably have wider options than you because I'm not vegetarian, so for breakfast I will have scrambled egg with bacon (and on weekends, a big ham and cheese omelette which keeps me full until about 4pm), lunch will be salads with plenty of chicken, some kind of cheese, olive oil. My evening meal will be a good steak with steamed broccoli, or sausages with mashed cauliflower, or lasagne with leek sheets instead of the pasta. Once you start looking at carbs, you'll start to see that in almost all meals they're either there as a bulking agent (rice, pasta etc). or a delivery mechanism for what you actually want to eat (the bread in pizza or sandwiches). The trick is to find alternatives that work just as well for those functions (eg. grated and fried cauliflower perfectly replaces rice, spiralised courgette replaces pasta and noodles), or simply have more of whatever it was you are actually looking to eat.

Then, weirdly, you will find that if you are reducing your insulin (because you can, because you've got less 'stuff' going in that raises blood sugar), you will find your fat metabolism is no longer blocked and your body has less 'stuff' to store as fat in the first place and less of the hormone to help you store it.

A good start for recipe ideas will be http://www.ditchthecarbs.com/recipes/ - but you do need to be comfortable with matching your insulin to your carb intake first.
 
Hello DeusXM,

Lots of great information there, thanks! I have never actually heard of spiralised courgette or grated and fried cauliflower. Definitely a new one to me, if I do end up liking the taste I will definitely consider it as a permanent replacement as pasta and rice are a massive part of my diet and the cut down in my daily carbs would be massive. Might do some tester meals sometime this week 🙂

Most of your assumptions are correct, however I don't really guess what my carbohydrate content is in my food as I have a very structured diet during the week so I tend to eat the same foods everyday so I know what the carbohydrate content is, and that is why my injections are so fixed. The varying factor is my job really, it can be very hit and miss one moment i can just be sitting in my office doing nothing and others I could be literately running about for hours on end, and that is where I need to keep my glucose levels up. Unfortunately it isn't something you can forecast so I need to be reactive in my approach i.e. "feeding the insulin"?.

Considering what you have said about the long acting insulin, by your statement saying that my blood sugar levels should be staying the same from 6am until 12 then mine must definitely be too high. (I thought it was only natural that your glucose levels drop during the day due to work, temperature, etc.). reflecting on this, the above paragraph could be the cause of high long lasting insulin?.

I am currently doing a food diary today which mirrors all of the weekdays bar my evening meal so I can find out exactly what I am eating during the week.

thanks again everyone for your responses.
 
I'm at a loss how you can have stable BG with your current diet.
most would suggest you start with a basal test
https://mysugr.com/basal-rate-testing/

This set of UK workbooks is worth reading and practising working examples of carbs, doses and correction. Don't change without nurse approval.
An Introduction to Carbohydrate Counting ,
The Next Steps

USA http://www.bd.com/us/diabetes/download/insulin_adjustment_workbook_complete.pdf

get the book think like a pancreas
and
http://www.diabetes-book.com/laws-small-numbers/
 
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Considering what you have said about the long acting insulin, by your statement saying that my blood sugar levels should be staying the same from 6am until 12 then mine must definitely be too high. (I thought it was only natural that your glucose levels drop during the day due to work, temperature, etc.). reflecting on this, the above paragraph could be the cause of high long lasting insulin?.
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Definitely sounds like a basal issue. Your insulins serve two different purpose.

Your bolus is there to offset the impact of the carbs you eat, so the idea is that your blood sugar, two hours after eating, is roughly back where it was when you started eating. The reality is slightly more complex than that, but I think we need to park that for now as it overly complicates things.

Your basal is there to offset the glucose released from your liver throughout the day and meet your basal metabolic needs. Therefore the theory goes that you take precisely the amount of basal insulin to stop this glucose coming out of your liver from raising your blood sugar. Again, the reality is a bit more complex (particularly as many people find their liver outputs different amounts of glucose depending on the time of day). But the fundamental idea behind your basal is that theoretically, you could eat nothing all day and not suffer any hypos. If your blood sugar levels are constantly heading downwards, then by definition you are going to have to keep eating to keep them up, which of course is adding in empty calories.

I get what you're saying about the flexibility of your day but as a general rule, your basal requirements will not dramatically alter on a day to day basis, so once you've got it 'right', you can (mostly) then start to leave this out of the equation. Your bolus insulin requires you to think ahead a little, but no more than maybe 4 hours. So for instance, say at lunchtime you get wind that you may have more activity than you would normally expect in a couple of hours time - in that situation, I would take less bolus insulin than normal, rather than take the same amount and then eat more food. As a general rule, it should always be your insulin that's altered whenever there's concerns about low blood sugar.

The interesting thing is, once you start cutting out carbs, you start getting into something that's the law of small numbers.

Say, for argument's sake, your insulin ratio is 1:10g, but when you are more active, it actually drops to 1:5g.

At lunch, you have a pasta meal that's 80g of carbs.
You therefore take 8u of bolus insulin to offset it.

Then you're more active than you were expecting. Your ratio then technically means you're at 1:5, which means you now really only need 4u of insulin.
Unfortunately, you've got 8u on board.
That means there are 4u of insulin excessively in your system.
That means, to stave off a hypo, you need to find another 40g of carbs somewhere.
One gram of carbs contains 4 calories, so that's now an additional 160 calories you need to stay level, which your body probably doesn't need - plus, the majority of those calories are going to be turned into fat.

Now let's take another option.
For lunch, you have an awesome avocado, feta and halloumi salad, drizzled with olive oil. For argument's sake, call it 10g of carbs in total.
You then bolus 1u, because it's got 10g of carbs in it.
Then you're more active than normal, which means technically you only need half a unit of insulin.
So now, instead of being 4u 'overdrawn' on your insulin, you're only 0.5u overdrawn.
That means you only need an additional 5g of carbs. Not only is that far easier to make up than 40g, but that is only 20 additional calories you need. You also don't have 4u of insulin working to inflate your fat cells while stopping you from metabolising fat.

Do you see how by reducing the carbs, you reduce the insulin, and you reduce the margin of error - even if you can't forecast what's coming up?

It's exactly like driving and encountering an obstacle in the road - if you are tootling along at 20mph, you can gently steer past it. When you're hurtling down the motorway at 70mph, it's much easier to oversteer and veer all over the place. Eating a lot of carbs and a lot of insulin is like driving at high speed while jolting the steering to the left and right - it makes it much harder to stay in line and you've a much higher probability of having a nasty accident.
 
Deus, have you got the ratios wrong way round? Surely needing 4 units of insulin for 80 carbs is 1:20 not 1:5?
 
Yeah, you're right, it's 1:20. The numbers still add up though - in the first scenario, you're still 4u overdrawn and need to make up the deficit. In fact, I might be getting slightly lost in the maths here but then I think that actually means you need an additional 80g of carbs to offset the excess (and therefore 10g in the second scenario).

I suppose the simplest way of explaining all of this is if you take a lot of insulin, and then find the amount you've taken is double what you need, that's a lot more of a problem than if you take a small amount of insulin and then find you've taken double.
 
DeusXM said:
I suppose the simplest way of explaining all of this is if you take a lot of insulin, and then find the amount you've taken is double what you need, that's a lot more of a problem than if you take a small amount of insulin and then find you've taken double.
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Makes a lot of sense, I'd never really thought about it in these terms 🙂
 
Northerner said:
Makes a lot of sense, I'd never really thought about it in these terms 🙂
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It makes a lot of sense, Deus. It probably explains why I always find it so hard to treat a gardening hypo.
 
Cauliflower "rice" and courgetti have often been mentioned on these forums, but this thread is the first I've ever heard of leeksagne. 🙂 One learns something new every time here. 😉
 
I picked up a spiralizer a couple of days ago from Argos for about £12.50 and it made spaghetti from courgettes super easily, I was actually quite suprised how easy it came out. link: http://www.argos.co.uk/static/Product/partNumber/4454580.htm

Had my first low carb meal yesterday which was the Leek Lasagne, it didn't turn out the greatest and ended up being a big pile of mush but damn it was tasty! I think I need to add a few more layers of leeks to give it more structure? some pics: https://imgur.com/a/6jMPJ . I don't know what it is, but only taking 2 units of insulin for an evening meal seems wrong D: and even though there was nothing "heavy" in the food I didn't feel hungry all last night and this morning.

Going to try the rice alternative with grated, fried cauliflower and have a chilli tonight (this is the one I am most apprehensive about, as I don't really like cauliflower!)

one thing that has been extremely apparent during this thread is that my background insulin is wayyyyyyyyy too high, i went to bed with a glucose level of 11.5 at 11:30pm and i woke up this morning with it at 2.6 at 5:20am
 
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I've been reading two books - 'Reverse Your Diabetes' and Reverse your Diabetes Diet', both by Dr David Cavan, and following the guidelines

My blood sugars are slightly lower and more stable/constant, and I've lost a bit of weight
As far as I can judge, the advice and diet is basically low carbohydrate. there are some interesting ideas in them, and they're worth reading

XWYFGOTITALL; A friend is not too keen on cauliflower. He adds a few fennel seeds to the water when he boils it, and only cooks it till it's softish, and not competely mushy
 
I don't know what it is, but only taking 2 units of insulin for an evening meal seems wrong D:
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I know, it's quite a hard leap to make in your head because most diabetes specialists seem to equate insulin with more than carb control. Just wait till you get to the situation where if you're very lucky, you don't actually take any bolus insulin during the day!

Going to try the rice alternative with grated, fried cauliflower and have a chilli tonight (this is the one I am most apprehensive about, as I don't really like cauliflower!)
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I can't eat cauliflower in its natural form. I hate the texture, I hate the smell, I hate the colour.

However, I can eat as much cauli-rice and mashed cauliflower (particularly if the mash is stuffed with butter, cheese and bacon bits) as you can throw at me. Cauli-rice also doesn't work in dishes where the rice performs a flavour absorption role ie. don't use it for paellas and risottos.It's great for fried rice dishes and any meal where you would typically have a 'thing' in sauce with either rice or cous-cous on the side eg. curries, tagines

The courgetti works well in stir-fries too as noodles - just cook it right at the end as it only needs 30 seconds or so.

If you REALLY want to go through the keyhole, take a look at this - https://www.buzzfeed.com/christinebyrne/cauliflower-not-carbs

The bacon cheddar cauliflower chowder ranks up there as one of the tastiest dishes I've ever cooked. And again, I say this as someone who HATES cauliflower.

one thing that has been extremely apparent during this thread is that my background insulin is wayyyyyyyyy too high, i went to bed with a glucose level of 11.5 at 11:30pm and i woke up this morning with it at 2.6 at 5:20am
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Definitely - assuming you had no bolus on board, you should have woken up with a reading of somewhere between 10 and 12. If your basal alone can lower your BGs by 10mmol/l in 6 hours, it's set too high.

You may find that tweaking your basal will in itself do a lot for preventing weight gain and avoiding the fear of going low without having to make any significant dietary adjustments.
 
DeusXM said:
Definitely - assuming you had no bolus on board, you should have woken up with a reading of somewhere between 10 and 12. If your basal alone can lower your BGs by 10mmol/l in 6 hours, it's set too high.

You may find that tweaking your basal will in itself do a lot for preventing weight gain and avoiding the fear of going low without having to make any significant dietary adjustments.
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I have decided to lower my background insulin by 2 units every night to see how it goes, It started off at 28 units and last night it was 26. when it starts stablising out a little more I will probably keep it the same for a number of days to see if I got the balance right. should be all OK in a couple of weeks and then I can crack down on the carbohydrate malarkey 🙂

does this unit vary on the persons diet or is it like a body size/gender variable? i.e. if i crack down on my diet would the amount of background change or would it generally stay the same?
 
DeusXM said:
Just wait till you get to the situation where if you're very lucky, you don't actually take any bolus insulin during the day!
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I do this on my working days (personal choice, I prefer not to have the risks of insulin on days I am working/driving). So I have carb free lunches, and it suits me fine. BUT I am careful to 'skip' over that part of my D-management when it comes to discussing with the consultant - I tell him about my non-working day lunches instead...cos carb free meals for a T1 can't be right, can they? 😉
 
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