Switched to low carb! Not sure what is happening.

[aaronjunited]

So I moved to a lower carb diet since last week and I can't get my blood sugars to come down to range during the day at all. They only come down during the night then spike back up when I wake up and continue going up all day and night no matter what I eat or take for bolus.

I have mostly protein and fat plus very low carb veg for meals but I am still having some carbs in between as snacks with my coffee and my normal insulin dose isn't doing anything to budge anything.

My Lantus is 16 at 10pm and 8 at 6am.

Anyone know what could be going wrong here.

 

[Sally71]

I think that would suggest that you need to increase your daytime Lantus dose. Maybe your body has responded to the lack of carb by chucking more glucose reserves out of your liver. Also, protein turns to glucose when there is very little or no carb in the diet.

 

[rebrascora]

Hi

Are you aware that in he absence of enough carbs, the body will break down 40-50% of protein and about 10% of fat into glucose. This generally starts to release 2 hours after a meal and will then continue to slowly release glucose for several hours after that.
I follow a low carb way of eating and I need to inject meal time (bolus) insulin about 2 hours after my meal and sometimes another unit or two an hour or so after that to deal with protein release. I am generally guided by my Libre on this.

So a 2 egg omelette for instance with a big plate of salad and coleslaw will need 2 units for me about 2 hours after I ate it.

 

[aaronjunited]

I think that would suggest that you need to increase your daytime Lantus dose. Maybe your body has responded to the lack of carb by chucking more glucose reserves out of your liver. Also, protein turns to glucose when there is very little or no carb in the diet.

This is what I thought. And it looks like I may have to go up more. I hear Lantus doesn't last more than 8.5 hours and it's no where near the 24 hours as advertised.

 

[rebrascora]

Is there a reason why you have gone low carb and do you inject for the carby snacks between meal and why do you have the snacks?

 

[aaronjunited]

Hi

Are you aware that in he absence of enough carbs, the body will break down 40-50% of protein and about 10% of fat into glucose. This generally starts to release 2 hours after a meal and will then continue to slowly release glucose for several hours after that.
I follow a low carb way of eating and I need to inject meal time (bolus) insulin about 2 hours after my meal and sometimes another unit or two an hour or so after that to deal with protein release. I am generally guided by my Libre on this.

So a 2 egg omelette for instance with a big plate of salad and coleslaw will need 2 units for me about 2 hours after I ate it.

Yes I have been reading and researching this. I only just got my libre last month and have been trying low carb again since last week. I find it's a steady release also and my bloods creep up little by little like 1/2 mmol each hour.

So do you inject anything as you eat that meal? Or is it always onwards and after?

 

[aaronjunited]

Is there a reason why you have gone low carb and do you inject for the carby snacks between meal and why do you have the snacks?

Yea I have had poor control with the standard carb diet. The rollercoaster as they call it. I find it difficult to leave the snacks behind I guess as its like cutting carbs and everything I enjoy all together. It's not looking like I could get away with enjoying a few biscuits with my coffee at night.

It seems I need to get this basal addressed. I am on 16 units at 10pm and just started to add another 8 units when I wake up. I hear this can be inconsistent due to Lantus not lasting a full 24 hours and I find this is the case with myself.
I also had some lows during the night for a few nights in a row when i started the low carb. So a lot of dialling in with Lantus is what I need work on it seems before I can get to grips with anything else.

Right now my levels are steady high and they don't really budge much at all and I'm afraid to take extra novorapid to counter for fear of crashing hours later and putting too much insulin into my system.

 

[Inka]

If you eat too few carbs, you often find your insulin resistance goes up, which can cause stubborn highs. As said above, your body will get glucose from somewhere so if you don’t eat very many carbs at all, it will break down protein. In addition, eating more fat can also increase insulin resistance, as well as the physiological insulin resistance mentioned above.

The answer? Somewhere in the middle - the Goldilocks carb zone - enough to stop all that cr@p above but not so many carbs that your body can’t cope.

 

[rebrascora]

I think if you are going to go low carb then you probably need to commit to it rather than having carby snacks in between meals and in the evening ....... and you have to learn to inject for the protein. Personally I don't carb count or calculate insulin for the protein release, I just inject insulin according to what my Libre shows me my levels are doing. I certainly would not let my levels continue to rise throughout the day without doing something about it.

The rollercoaster on a normal diet is either because you are not timing your insulin correctly or your ratios are not right..... but that is assuming your basal insulin doses are correct and good diabetes management starts with the correct basal insulin even when you are following a low carb way of eating.

So, perhaps the first thing to do would be to do some basal testing and get your basal doses sorted if you are currently not too sure if they are right. You need to be confident they are holding you steady in the absence of food (including low carb food) To do this, skip meals (and snacks) in rotation over a few days and see what happens and keep the meals in between the basal testing periods, simple meals where dosing for them is easy and straight forward. ie. a sandwich that you know the insulin dose and timing of, rather than more challenging meals like pasta with a creamy sauce or pizza.

Out of curiosity, have you ever done a DAFNE course or whatever your local equivalent is? This is an intensive 5 day course, sometimes a whole week in one go or other places do it one day a week over several weeks. The beauty of the course is that you get to spend time with other Type 1s and learn from each other and how to problem solve for each other as well as yourself. You also get a very experienced and non judgmental DSN and dietician pick over your readings and help you make sense of it all and help you adjust your basal doses or even change your basal insulin if they feel that the one you currently use is not helping you but also teaches you to recognize when your basal insulin needs adjusting
DAFNE stands for Dose Adjustment For Normal Eating but it was helpful to me on a low carb diet because I learned how to recognize when my basal insulin needed adjusting and it gave me confidence to make those adjustments to cope with exercise and illness and seasonal changes and stress..... all the things which affect our basal needs.

I don't personally follow the DAFNE guidance or any other guidance on dosing anymore because I follow a low carb way of eating but the course was really helpful for my understanding of how the insulins work and how my body works and boosting my confidence to manage my diabetes.
I would say the DAFNE course was the third most helpful source of information on diabetes management I have had. The number one slot goes to the wonderful people here on this forum and No. 2 being the amazing data benefit from technology ie. Libre. My nurse and Consultant are probably in 4th place mostly because I see/speak to them so rarely, whereas I can come on the forum every day if I need to, plus the practical knowledge of people who live with diabetes is massively broader than medical staff who just now the theory.

 

[Lucyr]

So I moved to a lower carb diet since last week and I can't get my blood sugars to come down to range during the day at all. They only come down during the night then spike back up when I wake up and continue going up all day and night no matter what I eat or take for bolus.

I have mostly protein and fat plus very low carb veg for meals but I am still having some carbs in between as snacks with my coffee and my normal insulin dose isn't doing anything to budge anything.

My Lantus is 16 at 10pm and 8 at 6am.

Anyone know what could be going wrong here.

Low carb doesn’t suit everyone, doesn’t work for me either. What was your motivation for trying it? If it was to improve BGs then it might be a more moderate approach works for you best. If it was for another reason, you might need to adjust your insulin doses or types to work with your new diet.

 

[nonethewiser]

. I hear Lantus doesn't last more than 8.5 hours and it's no where near the 24 hours as advertised.

Don't know who told you that as it's simply not true mate, was using lantus before switching to pump, would have used it good 10 years or more & only injected lantus once daily, early evening around teatime found was best time for me.

 

[Bloden]

Don't know who told you that as it's simply not true mate, was using lantus before switching to pump, would have used it good 10 years or more & only injected lantus once daily, early evening around teatime found was best time for me.

I switched from Lantus to Tresiba because Lantus was only lasting for 16 hours by my estimation. But only lasting 8.5 hours? I've never heard of that @aaronjunited. Good luck finding the carb amount sweet spot.

 

[Pumper_Sue]

So I moved to a lower carb diet since last week and I can't get my blood sugars to come down to range during the day at all. They only come down during the night then spike back up when I wake up and continue going up all day and night no matter what I eat or take for bolus.

I have mostly protein and fat plus very low carb veg for meals but I am still having some carbs in between as snacks with my coffee and my normal insulin dose isn't doing anything to budge anything.

My Lantus is 16 at 10pm and 8 at 6am.

Anyone know what could be going wrong here.

If you eat a lot of fat and protein you will need a lot more basal insulin and also probably will need to split your bolus insulin as well.

 

[Tdm]

I did low carb but, as people have said, started to become insulin resistant. Now i do normal carb with a 15 min prebolus, a 20 min walk after, and get pretty much the same result as on low carb. I do still do a low carb dinner on work days when i can't go for a walk, and low carb/keto snacks between meals. My insulin sensitivity is good and i can eat bread. I missed the bread so much.

 

[aaronjunited]

Thank you everyone for the replies. It seems I need to get my basal correct first and foremost. And I've seen others say I should get my insulin changed to match the diet I am on. R-Insulin was suggested to me as it is slower release to match protein eaten. Then Levimere was suggested as it would last a full 12 hour period if split in two doses.

The reason I am wanting to try low carb is because of blood sugar control and to eat more healthy. The more carbs I eat, the more I want and this isn't good for A1C in the long run. Done heaps of research on diets and what types of foods to eat that will give me more satiety. This change is about the numbers and getting tighter control. Lowering carbs is also good to help rule out complications later down line. Most of our "carbs" are processed foods and aren't healthy in the long run.

So can i take 16 units of lantus at midnight as I don't head to bed until after 1am most nights.

 

[aaronjunited]

If you eat a lot of fat and protein you will need a lot more basal insulin and also probably will need to split your bolus insulin as well.

I think if you are going to go low carb then you probably need to commit to it rather than having carby snacks in between meals and in the evening ....... and you have to learn to inject for the protein. Personally I don't carb count or calculate insulin for the protein release, I just inject insulin according to what my Libre shows me my levels are doing. I certainly would not let my levels continue to rise throughout the day without doing something about it.

The rollercoaster on a normal diet is either because you are not timing your insulin correctly or your ratios are not right..... but that is assuming your basal insulin doses are correct and good diabetes management starts with the correct basal insulin even when you are following a low carb way of eating.

So, perhaps the first thing to do would be to do some basal testing and get your basal doses sorted if you are currently not too sure if they are right. You need to be confident they are holding you steady in the absence of food (including low carb food) To do this, skip meals (and snacks) in rotation over a few days and see what happens and keep the meals in between the basal testing periods, simple meals where dosing for them is easy and straight forward. ie. a sandwich that you know the insulin dose and timing of, rather than more challenging meals like pasta with a creamy sauce or pizza.

Out of curiosity, have you ever done a DAFNE course or whatever your local equivalent is? This is an intensive 5 day course, sometimes a whole week in one go or other places do it one day a week over several weeks. The beauty of the course is that you get to spend time with other Type 1s and learn from each other and how to problem solve for each other as well as yourself. You also get a very experienced and non judgmental DSN and dietician pick over your readings and help you make sense of it all and help you adjust your basal doses or even change your basal insulin if they feel that the one you currently use is not helping you but also teaches you to recognize when your basal insulin needs adjusting
DAFNE stands for Dose Adjustment For Normal Eating but it was helpful to me on a low carb diet because I learned how to recognize when my basal insulin needed adjusting and it gave me confidence to make those adjustments to cope with exercise and illness and seasonal changes and stress..... all the things which affect our basal needs.

I don't personally follow the DAFNE guidance or any other guidance on dosing anymore because I follow a low carb way of eating but the course was really helpful for my understanding of how the insulins work and how my body works and boosting my confidence to manage my diabetes.
I would say the DAFNE course was the third most helpful source of information on diabetes management I have had. The number one slot goes to the wonderful people here on this forum and No. 2 being the amazing data benefit from technology ie. Libre. My nurse and Consultant are probably in 4th place mostly because I see/speak to them so rarely, whereas I can come on the forum every day if I need to, plus the practical knowledge of people who live with diabetes is massively broader than medical staff who just now the theory.

With the rollercoaster i think you are right in terms of not timing doses correctly and the basal/bolus not being the correct amount which leads to everything being all over the show.

I've done the basics on carb counting and can do it very well.

Thank you for your detailed response and the guidance is inspiring! Thank you!

 

[aaronjunited]

If you eat a lot of fat and protein you will need a lot more basal insulin and also probably will need to split your bolus insulin as well.

Are you on low carb? What type of long acting do you use and how often? And same question for your food insulin?

 

[aaronjunited]

I did low carb but, as people have said, started to become insulin resistant. Now i do normal carb with a 15 min prebolus, a 20 min walk after, and get pretty much the same result as on low carb. I do still do a low carb dinner on work days when i can't go for a walk, and low carb/keto snacks between meals. My insulin sensitivity is good and i can eat bread. I missed the bread so much.

This sounds interesting so it does. I think sugar is my killer as it's so addictive and I have that type of personality.

 

[aaronjunited]

Don't know who told you that as it's simply not true mate, was using lantus before switching to pump, would have used it good 10 years or more & only injected lantus once daily, early evening around teatime found was best time for me.

Dr Bernstein said this. He's had diabetes since he was 12 and is now 89 without any complications along with his patients all being under 5% HBA1C.

He states he has experimented with Lantus since it first was released and has no doubt it doesn't last more than 8 hours for many type 1's.

 

[nonethewiser]

Dr Bernstein said this. He's had diabetes since he was 12 and is now 89 without any complications along with his patients all being under 5% HBA1C.

He states he has experimented with Lantus since it first was released and has no doubt it doesn't last more than 8 hours for many type 1's.

Well perhaps myself & @Bloden & other forum members here are exception to the rule.

Anyway stick to what your drs told you as they know you best, was just pointing out that lantus lasts much longer than 8 hours in my experience of using it over many many years.