Hello everyone, Can I pick your brains as am freaking out quite a lot!! Just finished a Dafne course which I found generally really good. I think they have isolated the problem of my consistently raising BG throughout the day (probably due to not enough Lantus in the system). I take 16 units at night but have started adding in an extra shot in the am which so far hasnt worked but apparently it takes a few days. Im going to take this up to 8 units in the morning. Over the past few years I suppose I have been keeping a lid on my raised BG by a strict lo carb diet but have been frustrated when sugars have still not been under control enough despite all attempts to maintain it with zero sugar, (max 30 / 40 gcarbs per day). Long story short the dietician on the course was horrified by what I was doing and I felt singled out in the group. She allowed some of the others to 'try a low carb lunch' for one day just to check their background but would seriously not recommend it any longer than that. I allowed her to pick my lunch on the last day and she encouraged me to order a plate of chips and a sandwich so we could measure the carbs. I never eat this kind of food. As I predicted my blood sugar was up to 23 by the evening!!! I dont know why I cant seem to eat this stuff and others in the group were managing perfectly and counting carbs but she was adament that carbs were essential with every meal - but how on earth are chips even healthy??. It caused me to question everything. Then we had a session on DKA. Everyone was given a ketone meter and advised to check for ketones of BG goes above 13. Mine regularly goes above that which is why I'm completely freaking out now. I thought ketones were a natural of a low carb diet so assumed I would have some present in the urine. But the dietician tells us they are very very dangerous and will lead to coma and death. Is there a difference between the ketones Ive got and the ones that lead to coma and death or should I be calling an ambulance now?? I feel fine and perfectly btw! apart from when I ate the chips!!! thanks all!
Ketosis or Ketoacidosis???
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mrman
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There is a big difference. ketosis, as u said many low carbers go in when dieting. These things burn the body fat. This is ok as long as the sugar level is normal and enough insulin present to feed the body . Dka, diabetic ketoacidosis is caused by not having enough insulin in the body so the body will go In this state to burn anything it can to use for energy. Can cause serious damage to all organs, as well as extreme weight loss and can lead to a diabetic coma. If u have high sugars and ketones u need.to seek medical advice. Usually having a correction dose will bring sugar level down and ketones down. Sometimes of levels are too high it won't! And urgent medical treatment needed.
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They do say with lantus to allow up to 3 days before making adjustments again, from my own experience this advice is spot on as it takes 2 days for any changes I make to show results.
It can never be said enough how important it is to get the basal dose right, without it everything else fails and you will never get any consistent bg control, once you get the dose right you can then look at your insulin to carb ratio's.
It's a shame you were made to feel singled out on the course for following a low-carb diet, how anybody eats is nobody's business and if they had concerns for your well-being this should have been discussed in private, most HCP's will say that carbohydrates are an important part of a healthy diet and shouldn't be excluded or severely restricted, on my DAFNE course I was low-carbing and eating between 90-120g of carbs a day, when I asked the Endocrinologist in the Q & A session about the minimum amount of carbs per day to stay healthy the reply was 130g, the figure 130g is one that has often quoted on the forum when members have asked the same question from their HCP's.
As for dietary ketosis, my HCP's give the same reply when I asked about very low-carb diets but wouldn't go as far as to say it would lead to coma or death, the opinion is it puts an added strain on the kidneys and as diabetics we are already susceptible to kidney disease this is something we shouldn't do, whether this is right or wrong I don't wouldn't like to say.
Gary Scheiner in his book Think Like a Pancreas when talking about a lack of carbohydrates in the diet says ''Ketone production is unhealthy for anyone, particularly those with diabetes. Maintaining at least a modest level of carbohydrate intake throughout the day should prevent ketosis.''
As for the chips, well as everyone knows its not a healthy option and certainly not something you should eat everyday, I'd imagine your huge bg swing was due to you following a VLC diet over a period of time, often I have read posts on the forum that those who VLC become sensitive to carbs the longer they follow the diet, I'll be having home-made chips tonight and my postprandial bg readings will hardly move for the first few hours due to the fat content of the meal, as with most people who don't restrict carbs the bg rise will come much later in the evening.....hence why I have to split dose on such occasions.
Hope you get the basal dose right soon and get those bg readings down!
It can never be said enough how important it is to get the basal dose right, without it everything else fails and you will never get any consistent bg control, once you get the dose right you can then look at your insulin to carb ratio's.
It's a shame you were made to feel singled out on the course for following a low-carb diet, how anybody eats is nobody's business and if they had concerns for your well-being this should have been discussed in private, most HCP's will say that carbohydrates are an important part of a healthy diet and shouldn't be excluded or severely restricted, on my DAFNE course I was low-carbing and eating between 90-120g of carbs a day, when I asked the Endocrinologist in the Q & A session about the minimum amount of carbs per day to stay healthy the reply was 130g, the figure 130g is one that has often quoted on the forum when members have asked the same question from their HCP's.
As for dietary ketosis, my HCP's give the same reply when I asked about very low-carb diets but wouldn't go as far as to say it would lead to coma or death, the opinion is it puts an added strain on the kidneys and as diabetics we are already susceptible to kidney disease this is something we shouldn't do, whether this is right or wrong I don't wouldn't like to say.
Gary Scheiner in his book Think Like a Pancreas when talking about a lack of carbohydrates in the diet says ''Ketone production is unhealthy for anyone, particularly those with diabetes. Maintaining at least a modest level of carbohydrate intake throughout the day should prevent ketosis.''
As for the chips, well as everyone knows its not a healthy option and certainly not something you should eat everyday, I'd imagine your huge bg swing was due to you following a VLC diet over a period of time, often I have read posts on the forum that those who VLC become sensitive to carbs the longer they follow the diet, I'll be having home-made chips tonight and my postprandial bg readings will hardly move for the first few hours due to the fat content of the meal, as with most people who don't restrict carbs the bg rise will come much later in the evening.....hence why I have to split dose on such occasions.
Hope you get the basal dose right soon and get those bg readings down!
mon
please ask this dietician what the specific deficiency symptoms are. I'll check back in my memory to see if I've ever experienced them in my several years of low carbing. Actually dietary carbs are NOT necessary at all. It's been known since 1926 and the Steffanson experiment. It's all bunkum!
Hana
please ask this dietician what the specific deficiency symptoms are. I'll check back in my memory to see if I've ever experienced them in my several years of low carbing. Actually dietary carbs are NOT necessary at all. It's been known since 1926 and the Steffanson experiment. It's all bunkum!
Hana
ElyDave
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hanadr said:
For most people, absolutely not necessary at all, although the body metabolises carbs, they can be effectively generated from stored glycogen.
The exception I would give is endurance athletes, where gluconeogenesis (think I've got the right term here) and the breakdown of glycogen is not as quick as utilisation in the muscles. ALthough the free fatty acid mechanism is also there, some level of glucose in the bloodstream is also necessary, and may need to come from dietary sources.
I find I need about 15g every 15 mins on a long bike ride, but nothing for weight training.
Hi,
Like Brett said I wouldn't worry too much about ketones UNLESS your sugar levels are high as well. This means that if you are running on a low carb diet then you need to be even more obsessive about your sugar levels as soon as they rise you could run into trouble. I would say try to keep them max at 8 if you are going high ketone period too. But that's just from my own experiences. Also if you are exercising, as we all should without fail, maintaining sugar balance can become very tricky so checking often and adapting to the readings is key even if that means having some dextrose.
Now for the need some carbs argument I'm afraid I'd say we do, yes the body can metabolise the glycogens but the brain is an altogether different matter it's glucogen stores are much smaller and it is not only way way more demanding in terms of glucose requirement but is also far more sensitive to lack of glucose. This doesn't mean you can't low carb but I certainly would not go as far as going no carb for any length of time. The main problem is we don't notice the brain troubles until they become major issues and by then it's probably already crisis mode. Just a thought.
As for chips and sandwitches they should be ashamed, chips I would have said ok passable but sandwitches too boot! omg are they intentionally trying to make you fat? bread is a bit no no in my books
Hope that helps,
Frankie
Like Brett said I wouldn't worry too much about ketones UNLESS your sugar levels are high as well. This means that if you are running on a low carb diet then you need to be even more obsessive about your sugar levels as soon as they rise you could run into trouble. I would say try to keep them max at 8 if you are going high ketone period too. But that's just from my own experiences. Also if you are exercising, as we all should without fail, maintaining sugar balance can become very tricky so checking often and adapting to the readings is key even if that means having some dextrose.
Now for the need some carbs argument I'm afraid I'd say we do, yes the body can metabolise the glycogens but the brain is an altogether different matter it's glucogen stores are much smaller and it is not only way way more demanding in terms of glucose requirement but is also far more sensitive to lack of glucose. This doesn't mean you can't low carb but I certainly would not go as far as going no carb for any length of time. The main problem is we don't notice the brain troubles until they become major issues and by then it's probably already crisis mode. Just a thought.
As for chips and sandwitches they should be ashamed, chips I would have said ok passable but sandwitches too boot! omg are they intentionally trying to make you fat? bread is a bit no no in my books
Hope that helps,
Frankie
Hi guys thank you all for your detailed replies! Noblehead I had no clue how vital background insulin was to the whole affair and have spent so long focusing on QA doses it never occurred to me! I can tell Lantus is kicking in now after four days as have woken up hypo last two days so am thinking maybe I need to bring down the night time one and up the day one so they are equal? I wonder if anyone else takes two Lantus shots rather than one per 24 hours?
Hanadr the dietician tells us our bodies obtain energy from carbohydrates hence why they are essential. Personally for me it's been the opposite tho. I'm basically guaranteed to fall asleep after a hi carb meal... but that could be due to lack of the right background doing its work I guess? On your diet do u ever find ketones?
Thanks again
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Hanadr the dietician tells us our bodies obtain energy from carbohydrates hence why they are essential. Personally for me it's been the opposite tho. I'm basically guaranteed to fall asleep after a hi carb meal... but that could be due to lack of the right background doing its work I guess? On your diet do u ever find ketones?
Thanks again
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Noblehead you mentioned you split the dose for your chips. Does that mean you take half before eating and half after the meal? Is that only for certain foods? I've also noticed BG steadily increasing into the evening after dinner and wonder if this would help?
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mon said:
No not immediately after eating otherwise I'd be hypo in no time. I split the dose by injecting just before eating a high fat meal and again 3 hours after the food, as you no doubt know a meal that is high fat slows down the absorption of carbohydrates and you get a delayed effect many hours later, Gary Scheiner talks about a Secondary bg rise in his book which explains it much better than I can, I'll try and look for it later and post what he says.
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Here's an extract of a article that is taken from another site where Scheiner talks about the delayed effect:
''It has long been known that adding fat to a meal will slow down the digestion/absorption of carbohydrates. This is due to a slowdown in gastric emptying the rate at which food passes from the stomach into the intestines, where the nutrients (such as glucose) are absorbed into the bloodstream. This is why the carbohydrates in high-fat meals tend to take longer to raise the blood glucose level. But the difference is generally an hour or two: Whereas a low-fat meal will raise the blood glucose level quickly (usually within an hour), a high-fat meal may take two to four hours to produce a blood sugar peak.
So what about after the carbohydrates are finished doing their thing? That's when the fat itself begins to exert its effects. The process goes something like this:
You eat a high-fat meal or snack (this is the fun part).
In a few hours, the fat begins to digest; this continues for several hours.
The level of fat in the bloodstream (triglycerides) rises.
High triglycerides in the bloodstream cause the liver to become resistant to insulin.
When the liver is insulin resistant, it produces and secretes more glucose than usual.
The blood glucose rises steadily as the livers glucose output goes up.
This is what causes the gradual, delayed blood glucose rise after consumption of large amounts of fat. The response seems to be dose-dependent the more fat you consume, the more insulin resistant the liver becomes, and the more glucose it produces. The type of fat also appears to play a role. Saturated fats (the type found in dairy and animal products) seem to cause more insulin resistance than monounsaturated and polyunsaturated fats (the type found in vegetable products).''
''It has long been known that adding fat to a meal will slow down the digestion/absorption of carbohydrates. This is due to a slowdown in gastric emptying the rate at which food passes from the stomach into the intestines, where the nutrients (such as glucose) are absorbed into the bloodstream. This is why the carbohydrates in high-fat meals tend to take longer to raise the blood glucose level. But the difference is generally an hour or two: Whereas a low-fat meal will raise the blood glucose level quickly (usually within an hour), a high-fat meal may take two to four hours to produce a blood sugar peak.
So what about after the carbohydrates are finished doing their thing? That's when the fat itself begins to exert its effects. The process goes something like this:
You eat a high-fat meal or snack (this is the fun part).
In a few hours, the fat begins to digest; this continues for several hours.
The level of fat in the bloodstream (triglycerides) rises.
High triglycerides in the bloodstream cause the liver to become resistant to insulin.
When the liver is insulin resistant, it produces and secretes more glucose than usual.
The blood glucose rises steadily as the livers glucose output goes up.
This is what causes the gradual, delayed blood glucose rise after consumption of large amounts of fat. The response seems to be dose-dependent the more fat you consume, the more insulin resistant the liver becomes, and the more glucose it produces. The type of fat also appears to play a role. Saturated fats (the type found in dairy and animal products) seem to cause more insulin resistance than monounsaturated and polyunsaturated fats (the type found in vegetable products).''
Sid Bonkers
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What a great explanation of fat digestion that is Nigel, I never realised the part about trigs in the blood affecting the liver in that way before. I had been under the misapprehension that it was just the fat delaying digestion that led to a delay in the bg peak.
I know you have often recommended the Gary Scheiner book in the past but I had not considered it before, being a T2, but if its full of information like that I shall have to reconsider and get a copy :thumbup:
Although I still have the last two Game Of Thrones books to get through yet :lol:
I know you have often recommended the Gary Scheiner book in the past but I had not considered it before, being a T2, but if its full of information like that I shall have to reconsider and get a copy :thumbup:
Although I still have the last two Game Of Thrones books to get through yet :lol:
mrman
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Very interesting read noblehead. Also thought it was just fat delaying digestion of carbs. Trig bit does make sense. Thanks
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Sid Bonkers
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Stefano
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Noblehead thanks for your explanation. That makes so much sense to me and explain why just carbscounting sometimes is not enough.
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Hi guys. I've not been on here for a while but after doing a DAFNE style course myself about 6 months ago, I experienced the exact same response as you, Mon. I used to keep to max 50g carbs per day and had near perfect control. Was made to feel I should eat Carbs so introduced them and increased insulin dose to compensate. End result? Put on 2 dress sizes and HbA1c has gone up to 8.6 from 6.4. Currently on holiday and gone back to low carb. Ketones are fine, as long as you're not suffering with high sugar levels. Also, low carb means any dose miscalculations are going to be minimal so hypos are a lot less likely, once you have background levels right. :smile:
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mrman
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hit the nail on the head there so to speak, as to making sure basal insulin dosage is correct. I personally struggled to do this on mdi. That its why I'm now pumping and since I sorted by basal out, things are so much easier. That is why I feel pxxxxcd off at the nhs for refusing others the pump. Surely if they are given the pump, with adequate support to get basal doses right and bolus doses right there would be alot less complications cause of it, instead of just leaving people to get on with it themselves often with misguided and harmful advice.
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Brett I had no idea that finding the perfect background insulin dose was such an art form. I can feel the extra am dose of Lantus is kicking in now four days later! But have had consecutive hypos in the morning so now thinking I need to reduce my pm BI as I start increasing the morning one. Is it common to split a Lantus dose half and half in that way?
Claire thanks for your post it has reassured me so much!! Out of interest when you were on 50g carbs how much QA did u take? Is it possible that if your BI is perfect and you ate a zero carb diet that you would not need to take any QA insulin at all? Does anyone do that or is it dangerous?
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Claire thanks for your post it has reassured me so much!! Out of interest when you were on 50g carbs how much QA did u take? Is it possible that if your BI is perfect and you ate a zero carb diet that you would not need to take any QA insulin at all? Does anyone do that or is it dangerous?
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