Following blood tests for weight loss, I was rushed to hospital 4 weeks ago ( blood sugar 38, ketones plus 4) &'shocked to learn I haveType 1 diabetes. I am 54, very slim, fit & have always eaten very healthily. I'm really struggling to get the insulin dosage right and as my usual diet is quite low carb ( but high in fresh fruit) the nova rapid injected with food has been sending my blood sugar levels plummeting 3 hours after eating & I've really struggled having to cram carb heavy foods in me almost constantly to keep my levels up. The diabetes nurse reduced my daily Lantus to 6 and my novo rapid with meals to 2 but I've still been suddenly dropping to 4 and below (& also during the night). I was told not to inject if my meal had minimal carbs and this week told not to inject with food at all ( & when my blood sugar has then gone high - between 7 and 10 - I've managed to bring it down with exercise, but I'm exhausted). I can see the logic in the LCHF diet which I've been trying as it means I don't need to inject with meals but I reeally can't afford to loose any weight and as I've had high cholesterol in the past I need to have 'good' fats ( so lots of avocados and nuts). If anyone can give any suggestions for healthy low carb eating that won't make me loose weight I'd be really grateful - am really struggling ....and longing for a bowl of fresh fruit....
Newly diagnosed Type 1: LCHF - how do I NOT loose weight?
- Thread starter Jane!
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Hi. Weight loss when T1 is due to body not having enough insulin to metabolise the carbs i.e. you are starved unless you have enough protein and fats to go into ketosis which burns these for energy. Injecting insulin enables the body to use carbs. It sounds like your nurse hasn't told you about carb counting which is essential for good control. First you must get the Basal right and hopefully the changes advised by the nurse will do this. If you are on one Basal per day then aim for a fasting blood sugar level of between 5 - 7 mmol. This is the advice from my DN also from NICE and makes sense. You should be adjusting your Bolus to match the mealtime carbs and the carb to Bolus ratio varies from person to person. Most DNs start you on 1 unit of Bolus to 10gm carb but this may need to be varied so you don't hypo of have elevated blood sugar. Keep in touch with the DN but carb-counting is essential and simple and my DN started me that way the day I started insulin. Keep measuring frequently while you are making changes and make the changes slowly bit by bit.
Thankyou. I'd been injecting for 2 weeks before the nurse gave me the Carbs & Cals book but she didn't explain how many units of insulin to grams of carbs. She said I'm still producing some insulin so it's difficult to work out how much bolus insulin I need to inject & that as 2 units seems to be too much for most of my meals, not to inject with meals at all and especially not to if I'm active ( just trying to mow the lawn for 5 mins brought me crashing down ). Dropping the basal dosage to 6 has stopped me getting too low in the night but I think my fasting level (8) is now too high. My blood sugar's been dropping to 4 so often that she said I needed to have slightly higher levels for a while but it's worrying me that they're now too high.
teacher123
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Hello @Jane! and welcome to the forum 
Yes, you will be experiencing the honeymoon period - your partially working pancreas is still secreting insulin and therefore you have too much insulin on board if crashing very quickly. For exercise at this stage, and eating low carb you probably won't need any insulin on board as you will hypo. Again, it's all about testing and seeing how your body responds to it.
It will take time for your levels to fully settle so don't tinker with them too much on a daily basis. Try and find a routine with your basal dosage as it takes more than one night for it to show its full affect on levels.
Have a look in the Low-Carb section of the forum for ideas, guidelines for eating that way. Greek Yoghurt (high fat) with some nuts or berries is a nice breakfast idea. It's all about finding foods that you can tolerate, eat to your meter and most of all enjoy your food
Yes, you will be experiencing the honeymoon period - your partially working pancreas is still secreting insulin and therefore you have too much insulin on board if crashing very quickly. For exercise at this stage, and eating low carb you probably won't need any insulin on board as you will hypo. Again, it's all about testing and seeing how your body responds to it.
It will take time for your levels to fully settle so don't tinker with them too much on a daily basis. Try and find a routine with your basal dosage as it takes more than one night for it to show its full affect on levels.
Have a look in the Low-Carb section of the forum for ideas, guidelines for eating that way. Greek Yoghurt (high fat) with some nuts or berries is a nice breakfast idea. It's all about finding foods that you can tolerate, eat to your meter and most of all enjoy your food
Spiker
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Your DSN said you are still producing insulin so it's hard to work out your ratios - true - but then thinks it's sensible to prescribe a fixed dose for meals - makes no sense at all. A fixed dose is going to conflict with your own insulin production much more than a variable dose, based on the carbs in the meal.
If you are going hypo then the right response is that the basal dose should be reduced further, and the bolus (carb) ratio should be reduced, not to keep the basal constant and skip the meal bolus. When you go high you should use a corrective insulin injection, not exercise - it's actually dangerous to exercise with high blood sugar.
As was said above, start carb counting. Even if you continue on the fixed per meal dose, find out how many carbs you need in a meal to stop going hypo on that dose. Then if that's more than you are comfortable eating, reduce the insulin per meal and reduce the carbs per meal in the same proportion.
Your DSN is going against the new (August 2015) NICE guidelines by not putting you straight onto proper basal-bolus regime. A fixed dose per meal, regardless of the meal content, does not deserve to be called basal-bolus - in my view anyway.
Also as a personal opinion, as a Type 1 I would not embark on LCHF until you get a full understanding of carb counting, dose adjustment, and how to set a correct basal dose. All this you get from a DAFNE course or equivalent such as the BDEC Online course. Apart from anything else few DSNs will support you low carbing, particularly not right after diagnosis. So you would be on your own (apart from us here helping you!).
If you are going hypo then the right response is that the basal dose should be reduced further, and the bolus (carb) ratio should be reduced, not to keep the basal constant and skip the meal bolus. When you go high you should use a corrective insulin injection, not exercise - it's actually dangerous to exercise with high blood sugar.
As was said above, start carb counting. Even if you continue on the fixed per meal dose, find out how many carbs you need in a meal to stop going hypo on that dose. Then if that's more than you are comfortable eating, reduce the insulin per meal and reduce the carbs per meal in the same proportion.
Your DSN is going against the new (August 2015) NICE guidelines by not putting you straight onto proper basal-bolus regime. A fixed dose per meal, regardless of the meal content, does not deserve to be called basal-bolus - in my view anyway.
Also as a personal opinion, as a Type 1 I would not embark on LCHF until you get a full understanding of carb counting, dose adjustment, and how to set a correct basal dose. All this you get from a DAFNE course or equivalent such as the BDEC Online course. Apart from anything else few DSNs will support you low carbing, particularly not right after diagnosis. So you would be on your own (apart from us here helping you!).
Spiker
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Your high cholesterol is probably because of the high proportion of fruit in your diet. It's nothing to do with 'good' fats. Apart from the evil fats (hydrogenated) and the truly evil fats (trans-fats), there are no bad fats. This is a myth and there's no good data supporting the "animal fats bad, vegetable fats good" myth. Quite the opposite. Dietary fat doesn't increase cholesterol. Carbs increase cholesterol and fructose is particularly bad. Total cholesterol, what doctors normally mean by 'high cholesterol', is statistically meaningless. It has no negative health consequences (and actually is associated with longer lifespan). What's relevant to health is more specific lipid levels such as LDL/HDL ratio and triglycerides. If you successfully do LCHF your lipid profile will improve dramatically and you won't ever have to worry about what kind of fats you are eating. Just eat the ones you like and that fill you up.
teacher123
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Excellent posts @Spiker. I'm diagnosed five months and still in honeymoon period. I've been doing LCHF for three and half weeks now, only need 6 units of lantus each night to keep my glucose levels within the 4.5-7 range throughout the day (done +4 hours tests etc). I just was eating carbohydrates for the sake of it to keep up the bolus insulin injections and then going hypo.
Hi @Jane! I'm in a very similar position to you. Started insulin beginning of June, very underweight, and experience rapid blood sugar drops often going hypo, often at night, I'm told because of the honeymoon period. Now managed to stop losing weight but cant actually put any on, but my situation is made worse that I can't eat fats as my diabetes is due to necrosis/PEI/malabsorption. I am only on basal insulin no short acting because the consultant considers it too high risk to start me yet because of the night hypos. This does mean that I have to be extra careful with my carb intake and I'm permently running high especially in the evenings (but I'm also steroid dependant). Not a pleasant situation at all and at first I was really frustrated but with hind sight it has been the right regime for me. I've accepted I can't increase my weight at the moment, and I'm carb careful as I can't LCHF. Got my next appointment on Friday when they may start introducing a bolus. I suppose my point is, I'm learning I can't sort this quickly because my body is still changing, and once it's finally stopped producing insulin I will be able to get some kind of control back in my meds/diet/exercise/weight. Till then I'm abit like long term suck it and see! Sue x
Hi. I find it strange that the consultant would avoid adding Bolus due to nightime hypos. Nightime hypos are normally caused by the Basal being a bit too high and not really affected by a Bolus which only lasts 4-5 hours. Hopefully the consultant will add the Bolus next time you see him. As Spiker says, the latest NICE guidelines encourage the use of full Basal/Bolus for any T1. During a honeymoon period or when new to insulin you do need to only make small changes at a time and measure often so you can learn what is right for you
Hi. Your DN is right than 2 units is very low and not really worth injecting when the meal only has average carbs but if you want to have a special high-carb meal then you will need to have a Bolus and that's when carb-counting is important. I don't normally Bolus for breakfast as it's low-carb and not worth injecting 2-3 units; also my overnight Levemir is still quite high which compensates. If I'm on holiday and having a full hotel breakfast then I will proably inject 4-5 units.
Believe me @diabell its been an ongoing discussion!!! I probably wasn't good at explaining, worse hypos at night but I have rapid rises/drop at anytime. For example yesterday afternoon my bs went from 6 to 18.7 in about 45 minutes. Then to 3.2 about an hour later. It doesn't seem to bear any correlation to when or what I eat, exercise, sleep. I'm told that it's the combination of the steroids and the honeymoon period (???) Sue xx
