Are you a T1 and low carbing did not work for you?

[cz_dave]

T1s: I would be interested in your opinion on low-carbing. Especially when eating less than 50g of carbs per day.

Have you tried it? Did it work for you? If not, why?

 

[robert72]

Works for me, but accept it might not work for all.

 

[catapillar]

Um, what does "work" mean in this context? Are you expecting low carb to achieve a certain specific result?

 

[sheepie123]

Its dangerous for T1D as it can cause a hypo better to use insulin and diet moderately ketoacidosis is also a real risk in T1D

 

[robert72]

Its dangerous for T1D as it can cause a hypo better to use insulin and diet moderately ketoacidosis is also a real risk in T1D

A low carb diet does NOT mean no insulin. Ketosis is not ketoacidosis, but I would suggest any T!s contemplating low-carbing should do their research beforehand.

 

[Jaylee]

Its dangerous for T1D as it can cause a hypo better to use insulin and diet moderately ketoacidosis is also a real risk in T1D

Hi,
Thanks for your concern.

The general objective (in short.) of low carbing as an insulin dependant is to lower the amount of insulin bolused for the carbohydrate. Certain carbs digest & breakdown differently so it's not always just a case of injecting before a meal... A correct bolus dose has its own working profile that may not match the digestive process of the carbs or the protein for that matter.
This can cause issue with "roller coastering" BS levels.

To counteract these issues briefly highlighted above.
Low carbing is adopted by some as a means of smoothing out BS & lowering A1c into the bargain!
If hypos occur? This can not only reduce the severity. But make them easier to treat & recover from... (From my own experience.)

I do agree that any insulin dependant embarking on low carb, researches & is clear on what they are doing..

 

[therower]

Hi @cz_dave . Tried low carb a few times over the years ( 50/60 g daily ) . Just couldn't get on with it.
Very active on a daily basis and found I couldn't function/ achieve what I needed to on LCHF. I need 150/ 180 g to feel comfortable/ able to get through the day.
LCHF didn't make any noticeable difference to 6 monthly HbA1C results.
Cholesterol levels slightly elevated after trying LCHF but not significant.
Ultimately I think LCHF works for many ( probably T2's more than T1's ), but on a personal level it doesn't suit my lifestyle.

 

[Snapsy]

Hi @cz_dave , I've been low carbing for around a year, starting with dabbling with it, and then after my Cornish holiday last June (I couldn't say no to a daily pasty) I've been low carbing in a fairly committed way.

I'm finding I take almost as much bolus insulin as before, as protein and fat in isolation from carbs, and quite a lot of veg, both mean rises in my BG levels.

I view my low carb lifestyle to be a hugely rewarding and positive state of affairs, because both my BG and my weight are very, very much more stable.

Carbs would often give me a huge spike followed by a rapid hypo. My lifestyle doesn't always allow me to pre-bolus way way in advance (which is something that would admittedly help with the spike -> hypo scenario) and actually I find basing my meals around veg, fat and protein works way better for me.

There isn't a right or wrong in any of this, just what works for you. I'm on a delicious culinary journey, and I'm doing well with my BGs and my weight.

 

[michita]

Hi cz_dave,

Low carb diet works very well for me. So far no problems. I make sure to get sufficient calories from fat and protein.

As I eat very small amount of carb, I inject small amount of insulin, my BS level stays stable and I rarely have hypo or hyper (usually 5s, rarely goes outside of 4.0 to 6.5 ).

 

[Jaylee]

Sorry! I shouldn't do this... But @Snapsy I'm a West Country boy.
Who can say no to a pasty?
Though it does cause me "pizza" havoc regarding bolus. (Whatever I try.)
A decent pork pie (for some reason.) on the other hand...

 

[Snapsy]

Meat and pastry in any combination has always rung my bell, @Jaylee !

Sausage roll, anyone?

 

[Snapsy]

PS That pasty holiday was a BS nightmare.......!

 

[therower]

Sorry! I shouldn't do this... But @Snapsy I'm a West Country boy.
Who can say no to a pasty?
Though it does cause me "pizza" havoc regarding bolus. (Whatever I try.)
A decent pork pie (for some reason.) on the other hand...

I'm hoping that's a Melton Mowbray pork pie @Jaylee . A local delicacy from around these parts.
Padstow pasty on the horizon come July and holiday time.

 

[catapillar]

I still don't really get what "works" means.

I've been eating 20-50g of carbs a day for about a year. It hasn't really changed what my blood sugar looks like, it's reduced severe spikes but I didn't get a lot of those with judicious pre bolusing, it hasn't reduced hypos.

It does mean that I now really struggle to deal with carbs and my pre-low carb I:C ratio would need to be dramatically increased to deal with a carb heavy meal.

It does mean that I now have to bolus for protein, frequently as a correction due to the delay of a protein rise. TDD is pretty similar to pre low carb.

So it works as in I'm alive, my blood sugars look vaugely alright ish. I'm fine with energy etc. I'm fairly active and most days I won't "carb up" for a work out but for long runs I'll usually have Bergen bread before hand. But there's more to think about in terms of the protein bolus and chasing that up and less flexibility because my body isn't used to having to deal with carbs. I wouldn't say it's particularly improved anything for me with blood sugar but I'm a bit scared to reintroduce because I know that will be painfull while I:C ratios are rejigged.

 

[Winnie53]

If you're a member of Diet Doctor, there's a newer video by a type 1 diabetic who shares his pre- and post- low carb diet experiences...

Improve Type 1 Diabetes with Low Carb - an interview with Dr. Kieth Runyan, M.D. and type 1 diabetic - (log in on Diet Doctor before clicking on this link)...

https://www.dietdoctor.com/member/interviews/runyan

It was recorded in May 2015, published in January 2017.

We have one type 1.5 diabetic in our diabetes group. With low carb, she was able to significantly reduce her insulin usage.

 

[phdiabetic]

I'm a type 1 who found no benefits and many disadvantages to a low carb diet. Currently I eat almost anything I want at any time, with just a couple of limitations (no more than 60g carbs at one time, no "guessing" - I must know exactly how many carbs I'm eating, no carbs if my blood sugar is too high). This diet works well for me - no significant blood sugar spikes at meal times (blood sugar usually remains 6's or below), I maintain a healthy weight and I am usually not hungry.

The reason that low carb didn't work for me is that the assumption that less mealtime insulin = more stable blood sugars simply wasn't true. The most variability in my blood sugars came from basal. I am in the honeymoon period and my basal needs are constantly changing, so I found that when I was too low it was almost always because of basal, and when I was too high it was either rebounding from a low, or not enough basal. The amount of food I ate seemed to make very little difference. I also felt hungry all the time (yes I ate lots of salad, nuts, etc but it didn't help much) to the point that I felt shaky, weak and sweaty, like I was having a hypo. While being unpleasant, it was also dangerous since it impaired my ability to recognise a real hypo.

So that's my personal experience, but my opinion on low carb (as stated in your post, <50g/day) for type 1's in general is that it is unnecessarily dangerous, as glucagon may work much slower, or not be effective at all. Even though I've never needed glucagon, I still wouldn't take the risk, and I think that all type 1's should make the ability to recover from hypos their top priority. As such, I would suggest that a moderately low carb diet (100g/day) is much safer for type 1's than a low carb or keto diet.

 

[Steve14]

Wish I could try it. AFAIK you replace the extra carbs with high fat. My liver doesn't tolerate meals with high fat such as olive oil. I tried digestive enzymes, but no difference. Guess it's genetics.

 

[tim2000s]

I'm a type 1 who found no benefits and many disadvantages to a low carb diet. Currently I eat almost anything I want at any time, with just a couple of limitations (no more than 60g carbs at one time, no "guessing" - I must know exactly how many carbs I'm eating, no carbs if my blood sugar is too high). This diet works well for me - no significant blood sugar spikes at meal times (blood sugar usually remains 6's or below), I maintain a healthy weight and I am usually not hungry.

The reason that low carb didn't work for me is that the assumption that less mealtime insulin = more stable blood sugars simply wasn't true. The most variability in my blood sugars came from basal. I am in the honeymoon period and my basal needs are constantly changing, so I found that when I was too low it was almost always because of basal, and when I was too high it was either rebounding from a low, or not enough basal. The amount of food I ate seemed to make very little difference. I also felt hungry all the time (yes I ate lots of salad, nuts, etc but it didn't help much) to the point that I felt shaky, weak and sweaty, like I was having a hypo. While being unpleasant, it was also dangerous since it impaired my ability to recognise a real hypo.

So that's my personal experience, but my opinion on low carb (as stated in your post, <50g/day) for type 1's in general is that it is unnecessarily dangerous, as glucagon may work much slower, or not be effective at all. Even though I've never needed glucagon, I still wouldn't take the risk, and I think that all type 1's should make the ability to recover from hypos their top priority. As such, I would suggest that a moderately low carb diet (100g/day) is much safer for type 1's than a low carb or keto diet.

An interesting point of view @phdiabetic and as someone who is in the honeymoon phase, yes, I can understand that you'd struggle a little with variations in your background insulin production, however I'd also add that when you're through the honeymoon period, and have no endogenous insulin having any kind of effect, exogenous insulin amounts generally increase in respect of amounts of carbs ingested and thus swings in blood glucose are much greater.

As you've said, your mealtimes are currently not causing huge spikes. That's more than likely because, with the exogenous insulin, your beta cells are somewhat relieved and able to produce insulin alongside that which you inject, ameliorating your ups. Once you've lost that and insulin amounts have increased, needing to take less insulin with food is beneficial in reducing the risk of fluctuations and miscounting.

With regard to glycogen, typically when eating low carb, your glycogen stores remain at around 60%, so the use of Glucagon generally still works, however it's also worth bearing in mind that signalling between alphe and beta cells as one becomes longer term T1 becomes less adept and for many people, the body's own ability to recover from a hypo is impaired, so you end up in a risk assessment situation, where for most people, it's safer to take less insulin and run a lower risk of a crashing low than it is to allow the body to recover from a hypo via a mechanism that may not function correctly.

Ultimately, it's up to each person alone to determine their path.

 

[TheBigNewt]

I never thought it was a good idea for Type 1's. It might be better for Type 2's. I tend to avoid high glycemic carbs like white potatoes, white rice and pasta and breads, but it's not unusual for me to have a meal with 40-80g of carbs.

 

[lizdeluz]

PS That pasty holiday was a BS nightmare.......!

Legendary pasties at Praze-an-Beeble! Dim and distant summer holidays before T1.