Dr Bernsteins Low Carb diet and UK Insulins

[kkapo18]

Hi all, jut great to have found this place of fellow diabetics!

I was curious for those following a low carb diet if you've been able to get a hold of Regular acting insulin? Currently I am taking Novorapid but noticing the effects of the slow BS rise couple hours after eating the meal, which I believe the Regular insulin would be better suited for.

I've read and asked a few people about Actarapid but don't believe they offer this in pen format?

Can anyone advise on their experience or if there is a equivalent type of insulin they use to help manage this diet type?

Thanks.

 

[EllieM]

Hi I can't help you with this particular question but have you tried asking on the Typeonegrit facebook group? (My understanding is that they follow Dr B's approach.)

How low carb are you going? When on less than 100g a day I didn't have too much trouble with insulins such as humalog or novorapid but am guessing you are much lower than that. Tagging @Antje77 who is LADA and I believe to be sugar surfing on very low carb.

 

[In Response]

I cannot comment on the regular insulins as I use Fiasp in an insulin pump which gives me the option to spread the dose out over a long period.
I want to mention that Dr B’s approach was designed before the modern options such as faster insulin, insulin pumps, etc were as popular as they are today. Therefore, his controversial low carb approach which increases insulin resistance is not necessary.
As you can tell, I am not a fan. Maybe I a biased due to his approach for women - we must all take the contraceptive pill because our hormones are too difficult to manage.
I guess if women with Type 1 are unable to have children, it will reduce the incidences of Type 1 in years to come.

 

[kkapo18]

I cannot comment on the regular insulins as I use Fiasp in an insulin pump which gives me the option to spread the dose out over a long period.
I want to mention that Dr B’s approach was designed before the modern options such as faster insulin, insulin pumps, etc were as popular as they are today. Therefore, his controversial low carb approach which increases insulin resistance is not necessary.
As you can tell, I am not a fan. Maybe I a biased due to his approach for women - we must all take the contraceptive pill because our hormones are too difficult to manage.
I guess if women with Type 1 are unable to have children, it will reduce the incidences of Type 1 in years to come.

Understood. Though I don't currently have a pump and the 'profile' of a less rapid acting insulin makes logical sense as it covers the spike we see from higher protein.

I know this method for those following very low carb in the US have readily and cheap access to R insulin, whereas it's much much less used here and the default insulin given is rapid, which for most people works, but for those going very low carb, high protein, it's effect is not as useful.

 

[hyponilla]

Hi, I follow the Bernstein diet and use Actrapid. It comes in penfills which I add to the novopen echo. It lets you dose half units of insulin and produces less plastic waste so double win. I am in the Czech Republic but as far as I know Actrapid penfills are available in the rest of Europe. You can use it to dose for carbs as well providing you pre-bolus.

 

[kkapo18]

Hi, I follow the Bernstein diet and use Actrapid. It comes in penfills which I add to the novopen echo. It lets you dose half units of insulin and produces less plastic waste so double win. I am in the Czech Republic but as far as I know Actrapid penfills are available in the rest of Europe. You can use it to dose for carbs as well providing you pre-bolus.

Great to know - i'm hoping given I know have the echo, I can readily access the penfills. I have my first appointment with a diabetes specialist next month but trying to push for getting Actarapid earlier as it just makes so much more sense.

How long before meals are you pre-bolusing? Also how long (hours) do you tend to find the insulin works over?

 

[Antje77]

but trying to push for getting Actarapid

Actrapid has the same action profile as NovoRapid, it's unlikely to make a difference.

I was curious for those following a low carb diet if you've been able to get a hold of Regular acting insulin? Currently I am taking Novorapid but noticing the effects of the slow BS rise couple hours after eating the meal, which I believe the Regular insulin would be better suited for.

I don't follow a particular type of diet but I do eat very little carbs, most of the time.
I use Fiasp in pens, and I'm happy with the quick action.
If I see a rise after food, I simply take some more insulin, usually before my BG hits 7, often even before this.

Like @EllieM said, I use a lot of Sugar Surfing techniques, you might like to look into this.

SUGAR SURFING Frequently Asked Questions (FAQs)

What is Sugar Surfing?Sugar Surfing is a metaphor for Dynamic Diabetes Management, also known as “managing the moment”. It’s based on an awareness of one’s blood sugar trends using a continuous glucose monitoring system or by use of frequent blood glucose checks with a handheld meter. By viewing...

www.sugarsurfing.com

As you're newly diagnosed you can order the ebook for free too: https://www.sugarsurfing.com/new-diagnosed

 

[kkapo18]

Actrapid has the same action profile as NovoRapid, it's unlikely to make a difference.

I don't follow a particular type of diet but I do eat very little carbs, most of the time.
I use Fiasp in pens, and I'm happy with the quick action.
If I see a rise after food, I simply take some more insulin, usually before my BG hits 7, often even before this.

Like @EllieM said, I use a lot of Sugar Surfing techniques, you might like to look into this.

SUGAR SURFING Frequently Asked Questions (FAQs)

What is Sugar Surfing?Sugar Surfing is a metaphor for Dynamic Diabetes Management, also known as “managing the moment”. It’s based on an awareness of one’s blood sugar trends using a continuous glucose monitoring system or by use of frequent blood glucose checks with a handheld meter. By viewing...

www.sugarsurfing.com

As you're newly diagnosed you can order the ebook for free too: https://www.sugarsurfing.com/new-diagnosed

I was under the impression Actarapid is a longer
onset and works over a longer period? Novo onset is quicker and peaks earlier. Do you follow high protein as well as low carb?

Thanks for suggesting this book.

 

[Antje77]

Do you follow high protein as well as low carb?

I have no idea really, I only watch the carbs to have an idea on how much insulin to take, I don't even know what a 'normal' amount of protein to eat is, or how much protein is in different foods.
I do eat more cheese and eggs than before diabetes, and a little more meat.

This approach works very well for me, my hba1c has been solidly in the non diabetic range for the past 7 years with a high TIR so I don't feel the need to know exactly what I'm eating.

 

[hyponilla]

I pre-bolus carbs by 20 minutes, but I sometimes use novorapid and sometimes Actrapid depending on what pen I have at hand. Like Antje mentioned there isn't that much of a difference between the two, at least not in my experience, the profile curves look different but you can dose for protein with novorapid as well. I normally dose for protein 30 minutes after eating but I eat a lot of fatty meals so it's something you figure out from trial and error. Also, I like big salads so I eat more carbs than the 12g Bernstein recommends a lot of the time without spiking. I think you can have good control without adhering to it religiously, in my case the more carbs I eat the more unpredictable blood sugars become, but you need to balance life with diet. Non-diabetics go above the recommended 7.8 mmol/l quite a bit so I don't sweat the occasional highs the way I used to.

 

[remma]

T1 for 30ys, I'm 42 now.
I started following a low as possible carb diet just over 3 months ago.
My hgba1c went gradually from 56 to 38 and has plateaued there. (That's an average of 6.3mmol/l.) I want this lower but for that i do need better suiting insulins. I'm still on fiasp / levemir. The levemir only lasts for 10hours in my case so I'm left with filling the gaps with fiasp.
Unfortunately my diab nurse and endocrinologist doesn't seem to be interested in supporting my journey (yet?) by changing my prescription.
According to NHS UK website, there's 2 regular insulins available under NHS:
Actrapid which isn't available in prefilled nor penfill version, only in syringe+needle version! (That pains me as i like the simplicity of using the novopen6 smart pen as can be linked with the libre link app).
The other available regular insulin is Humulin S which does come in 3ml penfills. Need to research of the huma-pens. I have zero experience in my 30ys with Lilly products.
Plus on top of these all, I'd like to keep the fiasp on my repeat prescription as well to correct those occasional highs (mostly pre-period times as during illnesses).
Peace out X

 

[remma]

Hi @kkapo18 , i was happy for your message! I tried but cannot send you private message. You asked how i bolus for protein.
The reality is, there's not much connection between my eatings and when i give the fiasp. I just give fiasp when my bg is heading higher and on a low carb diet this isn't necessarily linked to eating. I always need to give fiasp early morning to prevent the dawn ph. And most days i need to give another time in the morning to support the slowly kicking in levemir.
It really feels like the levemis is running the show and fiasp just pops in when levemir doesn't bear to level the bg.
Most dinners i give fiasp approx 2hours post meal and that's max 2units.(most days chicken/mushroom or fish meal and at times a stake). Tonight i gave 1unit 2 hous post chicken/mushroom (nil carbs) but shouldn't have as again 2 hours later I was low. Its bed time now. Night times i tend to go low.
I'm thinking to go with novo-rapid. Would be already a step towards the good direction and hoping the endocrinologist would be more open for that.
And really wondering what to do with the levemir. I tried all sorts during this 3 months. Gave it at 4am and 4pm for weeks (dr b gives his basal at 4am so i tried). Now returned to give it at 7am - 7pm. Similar enough results really but at least less overnight wakes.
I should really try giving it every 9-10hours so it would be a constant presence in the system. But gives me a headache to keep track of when the next dose due. Maybe some alarm system of some sort. Argh. So what's your regimen with the novorapid? And what's your basal? Are you in uk? Is your endo/DN on board?

 

[kkapo18]

Hi @kkapo18 , i was happy for your message! I tried but cannot send you private message. You asked how i bolus for protein.
The reality is, there's not much connection between my eatings and when i give the fiasp. I just give fiasp when my bg is heading higher and on a low carb diet this isn't necessarily linked to eating. I always need to give fiasp early morning to prevent the dawn ph. And most days i need to give another time in the morning to support the slowly kicking in levemir.
It really feels like the levemis is running the show and fiasp just pops in when levemir doesn't bear to level the bg.
Most dinners i give fiasp approx 2hours post meal and that's max 2units.(most days chicken/mushroom or fish meal and at times a stake). Tonight i gave 1unit 2 hous post chicken/mushroom (nil carbs) but shouldn't have as again 2 hours later I was low. Its bed time now. Night times i tend to go low.
I'm thinking to go with novo-rapid. Would be already a step towards the good direction and hoping the endocrinologist would be more open for that.
And really wondering what to do with the levemir. I tried all sorts during this 3 months. Gave it at 4am and 4pm for weeks (dr b gives his basal at 4am so i tried). Now returned to give it at 7am - 7pm. Similar enough results really but at least less overnight wakes.
I should really try giving it every 9-10hours so it would be a constant presence in the system. But gives me a headache to keep track of when the next dose due. Maybe some alarm system of some sort. Argh. So what's your regimen with the novorapid? And what's your basal? Are you in uk? Is your endo/DN on board?

Thanks for the info - very interesting to see you managing with fiasp and dosing 2 hours post meal. My idea is that on low carb, i rise very slowly so i can afford to let it rise and then allow my novorapid to kick in once the protein starts to break down into sugar. This is why I take the shot anything between 15-40 minutes after the meal (depends on the profile of the meat - the fattier the protein the longer it takes to break down).

My basal is Lantus. I take 12 units before bed and 1 unit of Novo before meals.

I will eventually also ask for Fiasp (for corrections) it's great to have as an option if I do on the rare occassion go very high (which really is hardly ever. I barely ever spike above 7 post meal).

 

[hyponilla]

T1 for 30ys, I'm 42 now.
I started following a low as possible carb diet just over 3 months ago.
My hgba1c went gradually from 56 to 38 and has plateaued there. (That's an average of 6.3mmol/l.) I want this lower but for that i do need better suiting insulins. I'm still on fiasp / levemir. The levemir only lasts for 10hours in my case so I'm left with filling the gaps with fiasp.
Unfortunately my diab nurse and endocrinologist doesn't seem to be interested in supporting my journey (yet?) by changing my prescription.
According to NHS UK website, there's 2 regular insulins available under NHS:
Actrapid which isn't available in prefilled nor penfill version, only in syringe+needle version! (That pains me as i like the simplicity of using the novopen6 smart pen as can be linked with the libre link app).
The other available regular insulin is Humulin S which does come in 3ml penfills. Need to research of the huma-pens. I have zero experience in my 30ys with Lilly products.
Plus on top of these all, I'd like to keep the fiasp on my repeat prescription as well to correct those occasional highs (mostly pre-period times as during illnesses).
Peace out X

Hi there,
Congratulations on your HbA1c! 38 is great for a type 1 and your curves look really good, so I got curious, why do you want it lower? I ask because I used to be quite obsessive in my diabetes management and had my HbA1c in the low 30s (it's now in the high 30s). It came at the price of hypoglycemia unawareness because I spent a lot of time hovering around 4 mmol/l. Hypos didn't bother me much because on a low-carb diet, as you've probably noticed, they become quite easy to correct with less than 5g of carbs. Then one day I was eating out and got a salad caked in honey and balsamic vinegar so I miscalculated the insulin dose by a mile and passed out from a hypo. It taught me a new respect for hypos which are pretty dangerous if you have poor hypoglycemia awareness, so it's worth keeping in mind if you aim for an HbA1c in the low 30s.

 

[In Response]

I started following a low as possible carb diet just over 3 months ago.
My hgba1c went gradually from 56 to 38 and has plateaued there.

An HbA1C that has gradually gone down over 3 months?
interesting consider HbA1C is taken every 3 months.
I assume you are referring to Libre’s estimated HbA1C.
That’s the measurement that other CGM manufactures have decide not to call HbA1C because it doesn’t measure the same thing.
For me, the Libre estimated HbA1C is more than 20% lower than my real HbA1C.

i am glad you have found a way to manage you diabetes. It is not for me but given my real HbA1C is 40, I am happy to eat a lesss restricted diet and learn to dose my insulin to avoid highs and lows.

 

[Jaylee]

Libre estimated HbA1C is more than 20% lower than my real HbA1C.

Fascinating. Because my estimated A1c on the Libre & BG meter logs has romped in at approx 15% higher than my lab result.
Am I right in remembering you are also a Pescatarian on diet choice?

 

[becca59]

Fascinating. Because my estimated A1c on the Libre & BG meter logs has romped in at approx 15% higher than my lab result.
Am I right in remembering you are also a Pescatarian on diet choice?

Yes up to now my estimate has always been higher. Hoping the same occurs for the yearly test I had done yesterday. I know it’s gone up. The big reason for me has been stress.
Having said that I had it done at Gp yesterday as I have a consultant phone appointment coming up. It wasn’t requested I have one done though as the interest for the consultant is TIR not HbA1c. And that I am very happy with.

 

[HSSS]

Therefore, his controversial low carb approach which increases insulin resistance

Not a type 1 but am low carb. I’m curious about this statement why you believe low carb increases insulin resistance?

Or are you referring to the very short term physiological insulin resistance (aka adapative glucose sparing) that’s seen on very low carb and disappears within days of adding more carbs (seen sometimes in type 2 as a result of less demand = less production and ramping back up takes a moment) but I’ve no idea in type 1 with only exogenous insulin.

 

[In Response]

Not a type 1 but am low carb. I’m curious about this statement why you believe low carb increases insulin resistance?

Or are you referring to the very short term physiological insulin resistance (aka adapative glucose sparing) that’s seen on very low carb and disappears within days of adding more carbs (seen sometimes in type 2 as a result of less demand = less production and ramping back up takes a moment) but I’ve no idea in type 1 with only exogenous insulin.

People with Type 1 need more insulin per gram of carb if they eat a low carb diet.

 

[HSSS]

People with Type 1 need more insulin per gram of carb if they eat a low carb diet.

Can you explain or direct me to an explanation of why that would be?

In a non diabetic or type 2, insulin is released in response to carbs. Less carbs = less need for insulin, less circulating insulin = less resistance to it. How does type 1 fip that around?

I’m surprised to read this as it contradicts everything I’ve previously read that low carb in type one meant less insulin and that’s exactly the reason it’s done, to reduce the effects of dosing errors and reduce the likelihood of developing insulin resistance from higher doses.