Type 1 & low carb

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Evergreen

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Type 1.5 LADA
Hello everyone!

I am just looking for some opinions/advice on low carb eating with type 1 diabetes.

I tend to eat low carb, have done for years (even before my diagnosis), like the foods and as I find it incredibly difficult to find the right ratios for insulin low carb eating makes this much easier. Now some of the nurses in my team aren’t phased by this and some don’t like it.

Can someone tell me whether I should start to eat more carbs (and try and figure out my ratios), or whether it’s ok to eat low carb with type 1? And if ok, are there things I should watch out for? I’m aware of DKA, is the risk of getting DKA higher with low carb eating?

Hope someone could shed some light on this for me!
 
I see no reason at all why you shouldn't have low-carb like I do. As always you just need to keep your BS under reasonable control and I find it easier with lower peaks and troughs.
 
We have some T1s on the forum who prefer a low-moderate carb approach, while others are happy with a higher carb menu.

I guess it depends on how low carb you are meaning? I would imagine things would get more complex if you were aiming for ketosis (because the speeds of analogue insulins are based more on a mixed diet with carbs present).

I probably average 120-150g of carbs most days in meals, which gives me good flexibility, but occasionally I can have 100+ in a single meal! And I don’t really intentionally limit carbs, so if I fancy cake, biscuits, or whatever, then they are on the menu.

I think a flexible and varied approach is more workable personally.
 
It depends on how few carbs you’re eating @Evergreen Too few and you’ll get insulin resistance. You’ll also have to count protein and work out a way to cover it. I’ve tried loads of diets and would almost literally eat my own arm if it was the magic answer to Type 1. Th only answer I’ve found is to eat well, including moderate carbs and use your insulin appropriately. Reducing carbs too low makes things harder not easier IMO. It will also mess up your response to carbs if you eat too few. As with most things, the answer is a happy medium.
 
How low carb is your diet?
I found insulin ratios with very low carb challenging because in the absence of carbs, our body breaks down protein to glucose. Therefore, In addition to an insulin to carb ratio, you need to consider an insulin to protein ratio. It is often suggested this is half the carb ratio. However, I found I needed a different insulin to protein ratio for different types of protein. In addition, protein is converted to glucose slower than carbs so the insulin for the protein needs to be taken later than the insulin for carbs.
Some people with Type 1, including @rebrascora and @DaveB , successfully manage a low carb diet and find these complexities worth it. It took up too much of my mind to gain value from it.
 
@Tdm Changed from low carb I think because it messed up their ratios. I tried to link to the post but will just copy it instead:

“I tried low carb, and just ended up with rubbish carb/ insulin ratios as i became insulin resistant (1 to 3) I went to higher carb. My rations is now back to 1 to 20 and i can enjoy bread, biscuits etc and eat less fat, and also I am no longer verging on underweight. My control is just as good as when i was low carb”

That was pretty much my experience too. Having experienced temporary insulin resistance in pregnancy, I spotted it starting during low carb when I ate too few carbs. My blood sugar went up, I had to do far more corrections, and my basal forever needed fiddling with. My TIR is better on moderate carbs and I feel better too.
 
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If a low carb approach is working for you and you know how to manage it, then I don’t see why you shouldn’t continue. It depends how low carb you are going, but in the absence of carbs your body will burn up fat instead which creates ketones as a byproduct. So you may see some ketones in your blood, these should not build up to dangerous levels though if you are taking your insulin correctly. As others have said, you may find that you need insulin for protein as well if you are very low carb. If you are managing this though, or are eating enough carbs for this not to be necessary, then carry on!

Why exactly are the nurses not pleased, have they given a reason? If they are quoting the darned Eatwell plate at you, which says all meals have to consist of 40% carbs, that approach is very outdated now. If they have other concerns though, it might be worth at least listening to them and seeing what they think. If they can’t give a sensible explanation of why they think it’s a bad idea then don’t listen!

Basically if you are happy with your diet, and you aren’t losing or gaining weight (unless you want to), and if your blood sugars are under control, then you must be doing something right. Everyone is different, you have to find what works for you and then stick with it.
 
Thank you for your answers!

I’m not super strict and will eat a slice of pizza or a bagel or similar if I fancy it, I just then never seem to get my BS right!

I think I probably average around 50 carbs a day sometimes less sometimes more, so I suppose that is pretty low carb! It doesn’t seem like it though, but that’s maybe because I can see my blood sugar on my Libre…

I’m now wondering if I’m struggling with the ratios partly because of the low carb and might try to go up to about 100 grams of carbs a day.
 
I’m now wondering if I’m struggling with the ratios partly because of the low carb and might try to go up to about 100 grams of carbs a day.

Probably exactly that @Evergreen Eating that few carbs will almost certainly mess up your sensitivity. You don’t have to eat loads of carbs. The answer is somewhere in the middle 🙂
 
Sally71 said:
If a low carb approach is working for you and you know how to manage it, then I don’t see why you shouldn’t continue. It depends how low carb you are going, but in the absence of carbs your body will burn up fat instead which creates ketones as a byproduct. So you may see some ketones in your blood, these should not build up to dangerous levels though if you are taking your insulin correctly. As others have said, you may find that you need insulin for protein as well if you are very low carb. If you are managing this though, or are eating enough carbs for this not to be necessary, then carry on!

Why exactly are the nurses not pleased, have they given a reason? If they are quoting the darned Eatwell plate at you, which says all meals have to consist of 40% carbs, that approach is very outdated now. If they have other concerns though, it might be worth at least listening to them and seeing what they think. If they can’t give a sensible explanation of why they think it’s a bad idea then don’t listen!

Basically if you are happy with your diet, and you aren’t losing or gaining weight (unless you want to), and if your blood sugars are under control, then you must be doing something right. Everyone is different, you have to find what works for you and then stick with it.
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This helps a lot actually! The nurses who haven’t been happy haven’t really given me a clear answer as to why (and to be honest I’ve somehow never queried it either…I set out to eat more carbs but then just somehow don’t. I like salads etc and don’t really eat that much so I suppose it just happens!)

I’m happy to hear that as long as I take my insulin and keep BS in check (I still go up and down but hba1c is 54 which is ok I think?). Might try and eat a little more carbs though as I wonder if that’s going to help figure out my ratios!
 
Inka said:
I’m now wondering if I’m struggling with the ratios partly because of the low carb and might try to go up to about 100 grams of carbs a day.

Probably exactly that @Evergreen Eating that few carbs will almost certainly mess up your sensitivity. You don’t have to eat loads of carbs. The answer is somewhere in the middle 🙂
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Thank you! I’ll try and eat more! Does aiming for 100 grams a day sound about right?
 
Evergreen said:
This helps a lot actually! The nurses who haven’t been happy haven’t really given me a clear answer as to why (and to be honest I’ve somehow never queried it either…I set out to eat more carbs but then just somehow don’t. I like salads etc and don’t really eat that much so I suppose it just happens!)

I’m happy to hear that as long as I take my insulin and keep BS in check (I still go up and down but hba1c is 54 which is ok I think?). Might try and eat a little more carbs though as I wonder if that’s going to help figure out my ratios!
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I’m not T1 so have no lived experience to share, but if your natural/comfortable way of eating is low carb, then, in your shoes, I would resent having to eat more carbs than I felt comfortable with.

There are a number of low carb T1 groups, like Type 1 Grit, on Facebook, where you might find others enjoying a low carb way of living.

Just a thought …l
 
There are a number of groups full of people with eating disorders and extreme, obsessive behaviour, not to mention hypo unawareness. That’s one very good reason to avoid very low carb groups @Evergreen It attracts them like flies…

Yes, if you eat about 50g a day now, then I’d probably increase that gradually up to the 100g you said. You might well want more than 100g and that’s fine. You’ll find a good number that works for you, depending on your age, sex, lifestyle, etc. I eat anything from 120 to 200g per day. I like maintaining my insulin sensitivity and I like being able to eat a piece of cake out knowing I haven’t messed up my response to carbs so can deal with it without some kind of mega bolus to counteract resistance. Mainly, I like moderate carb because it’s just easier. There’s a reason most Type 1s eat moderate carbs - it works.
 
Yes, that makes so much sense. I’ll try and do that!

I think the reason I keep coming back to low carb is because it’s easier. It takes the thinking out of it, especially as I’m struggling with the ratios. I find that often my blood sugars only come down after 3 hours and if I want to eat again then I struggle with how much insulin to take. So low carb takes that stress away…but I suppose I need to look at the bigger picture here!

Appreciate your advice as always!
 
helli said:
including @rebrascora and @DaveB , successfully manage a low carb diet and find these complexities worth it.
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I don't find it a complexity at all. I find my diabetes management much less taxing thanks to Libre. I don't carb count or protein count, I just inject a bit of guessed insulin up front and correct later according to what Libre shows my levels doing.
I have never had DKA not do I consider it a risk on a low carb way of eating because I actively keep my levels in range.
I average about 70-80g carbs a day. I do have to be aware of protein release and inject for it, but I certainly don't calculate it, I just inject a couple of units when my Libre alarm goes off at 9.2 and if my levels continue to rise I will inject another couple of units an hour later. This works really well for me and dramatically reduces the head space I need to devote to my diabetes. No weighing or measuring, just a very rough estimate of carbs and then keep an eye on Libre after that and inject accordingly.
I consider my ratio roughly 1:10 for all meals with an extra 2 units added on at breakfast to deal with foot on the floor, and this works OK for the small amount of carbs I have, but as I said, I do need to inject a correction or two 2+ hours later for protein. Extra injections don't bother me, so it is no big deal and I would rather be injecting just a couple of units at a time as larger doses. In the honeymoon period, my own insulin production was able to mop up the protein release so I didn't notice it initially, but when my honeymoon came to an end, I have had to learn to deal with it and for me, being confident and proactive around correcting in the 9s at 2 hours post meal has been key to my success and ease of managing it. I am not recommending other people do this, but it is what I have found works well for me on low carb.
I go off piste occasionally with a beige buffet at family gatherings or an organized group meal where there is little choice but it usually ends in frustration and I no longer really enjoy that food anymore, so quite happy to continue low carb for the rest of my life and there have been so many health benefits to eating low carb for me that it just makes sense all round to continue and that includes less calculating/mental strain.
 
Evergreen said:
Thank you for your answers!

I’m not super strict and will eat a slice of pizza or a bagel or similar if I fancy it, I just then never seem to get my BS right!
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Hello, from what I’ve seen with type one discussions on & from my own experience with pizza, a lot of people struggle with it. (With the standard bolus up front for the carb content.)
Don’t beat yourself over it.
With regards to basal. If you have the dosage right for you. Then this should make the “detective work” easier with what you bolus for.
Nurses & salad; I’ve heard a lot of viewpoints from these professionals over the decades which don’t seem to have changed? My assessment spending more time listening to them than the HCP gaining a broader understanding of me. In short, the mantra I have heard from them. “Insulin only works with carbs.” Apparently, I “need the carbs or the insulin injected is ineffective?” There also seems commonly a mix up with calorific intake for carb counting. Recommending banana over bacon. (As one interesting example.)
Of course with protein, there is the “gluconeogenesis” to take care of. But that is also why we take insulin.

Good luck figuring out your ratios. Telling you mine would do no service, but I can say my insulin sensitivity has increased by 50%. But that’s just my personal metabolism. Nobody is “superhuman” with a “one size” that fits all.
Never feel disparaged by the views on a salad. 🙂 I certainly enjoy my “grub.”
 
This all is really helpful advice! I’m honestly so happy I found this forum as it’s more useful than my diabetes team sometimes!

I was worried about DKA as I’ve just been in hospital with it a month ago and no one could give me a proper answer as to why that happened. I’m now pretty convinced it was just a virus and had nothing to do with low carb eating, so that is reassuring.

I think I’m still in the honeymoon phase and working out my basal is a complete pain, with differences every couple of days which isn’t helping me feel reassured or comfortable. I’m changing diabetes teams as I have been quite unhappy with my current one (especially after my experience in hospital which is another story), the new team is keen to get my on a closed loop pump to help with my basal requirements and I’m hoping this will in turn make it slightly easier to deal with my bolus.

Thanks again for all your advice!
 
Evergreen said:
This all is really helpful advice! I’m honestly so happy I found this forum as it’s more useful than my diabetes team sometimes!

I was worried about DKA as I’ve just been in hospital with it a month ago and no one could give me a proper answer as to why that happened. I’m now pretty convinced it was just a virus and had nothing to do with low carb eating, so that is reassuring.

I think I’m still in the honeymoon phase and working out my basal is a complete pain, with differences every couple of days which isn’t helping me feel reassured or comfortable. I’m changing diabetes teams as I have been quite unhappy with my current one (especially after my experience in hospital which is another story), the new team is keen to get my on a closed loop pump to help with my basal requirements and I’m hoping this will in turn make it slightly easier to deal with my bolus.

Thanks again for all your advice!
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If you’re still in the honeymoon phase? Changing the menu you are used to might be unwise. Till things have settled down for you.
Good luck with a team & regime that works for you.
 
I am pretty sure that I am out of the honeymoon period but I still need to tweak my basal doses on a regular, sometimes daily basis due to variation in activity levels and stress and hormones and a host of other things, but I am happy to do that and it is one of the things I love about Levemir, as it allows that daily (or in my case nightly) adjustment if necessary.

Sorry to hear that you have been in hospital with DKA. I guess because I have never had it, it is not something I worry about, but I think being prepared to stack corrections if my levels keep going up is a saving grace with this and now that we all should have CGM, I think there is much less risk from stacked corrections because we can monitor our levels closely. I find hypos or near hypos much quicker and easier to fix than high levels so I am not frightened to inject correction after correction until levels come down. It might be that I need a JB or two at some point later but that is no great hardship in the scheme of things compared to levels continuing to rise and ketones developing. That is my logic anyway.

Wishing you lots of luck with your new team and possibly getting a closed loop if that is what you would like.
 
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