Type 1: A good HbA1C without hypos?

[azure]

I'd agree, Dillinger, but add an "excessive" to your sentence before the word "carbs"

I eat 180g carbs and the vast majority of my tests are between 4.0 and 7,0. I've found that having an advance bolus (different times for different meals) means I can often reduce my bolus and spike in the 6s.

It took me time to work out that out, but it means smoother sugars and less thought. I do have a pump though, and that makes it easier in that I know my basal dose pretty closely matches my needs. However, intelligent bolusing (well, as intelligent as I can get it : D ) has been what I've found most useful.

 

[novorapidboi26]

I too don't get as good a result in the 5 - 6 range but I know what I would need to do to get there I just choose not to do it....

maybe thats wrong, maybe its not, but testing 10+ times a day and restricting my diet to include almost no carbs for me is a lower quality of life....so its a fine line to walk which is different for all....

 

[Kristin251]

The problem I had with carb counting wasn't counting carbs. It was what OTHER foods were in the meal. How much protein? How much fat? They all either speed up or delay digestion and I could never get my insulin there at the same time as my food with random meals. Now I eat the same amount of veggies and protein at each meal and add a hunk of avocado. I tested my dose and timing of my dose until I got each one right. Now very few surprises on my meter.
My half unit novolog pen is invaluable!!! Wish they had a half unit lantus here!! Sure could use that

 

[Kristin251]

@azure taught me how important timing your bolus is !! Even with very few carbs I still take insulin 10 min before I eat. If I'm a little higher waiting 20-30 works and sometime doesn't require extra insulin. Seems just the act of chewing starts my rise so making sure some insulin is there first is important for me. If I miss timing, I miss the meeting of insulin and food.

I'm not ready for a pump at this time but I have a system that acts like a pump especially in the morning. I bolus 1/2 unit novolog, wait 10 min eat my silly avocado, set the timer for one hour, take another 1/2 unit anencephaly then another 2.5 hours later. I've tested many many times to see when I start spiking and I know I start the rise after one hour always. If I don't take the 1/2 around noon I start rising again. If I take a larger dose with my food I drop then spike. These small doses spread out keep me very level from 8-3 when I eat lunch. Then it's one unit with lunch and one with dinner and all is well. It took loads of testing to figure this out and recently things changed for no reason so this is where I am now. I didn't used to need the noon dose and lunch and dinner went from 1/2 unit to 1 but I'm sure I'm out of my honeymoon now.

 

[GBS_82_]

High Carbs=High Insulin Doses=High miscalculations=High corrections=High A1C

In short, if you maintain the mindset "I can eat whatever I want I just need insulin," you are setting yourself up for failure.

As someone with an a1c in the 30s, I actually have more hypos when my average blood sugar increases. The main reason is because of the equation I typed above. When I eat more carbs, that means I have to give myself more insulin for those carbs. That makes it easier to miscalculate which can then lead to very high or low numbers. Sometimes you can overcorrect for those very high/low numbers and find yourself in the totally opposite place you were before.

Simply put: I try to avoid the blood sugar rollercoaster as much as possible. On most days, I limit my carbs to somewhere 10-20% of my total caloric intake and I try not to eat too many in one sitting. That doesn't make me immune to highs and lows, but it certainly reduces the chances of them happening.

I totally agree with this although it took me a while to accept. I love the theory of 'we type 1s can eat what we want when we want' but - for me at least - the reality is different. I'm a few weeks into a low carb diet and am pretty much in range all the time. As a result I have much more energy and far less fear of hypos.

 

[Kristin251]

I totally agree with this although it took me a while to accept. I love the theory of 'we type 1s can eat what we want when we want' but - for me at least - the reality is different. I'm a few weeks into a low carb diet and am pretty much in range all the time. As a result I have much more energy and far less fear of hypos.

The reality is much different for me too. Great thing I love low carbing and fatty foods!!! I also love taking lower doses of insulin and not fearing thenhypos I used to have. The anxiety was just too much for me. I envy people who can stay rock steady eating what they want when they want but at the end of the day lchf also keeps my tummy issues and weight in check. There are foods I miss like pizza and sweet potato ( and many others) but one small bite of sweet potato or the toppings off a sample piece of pizza is enough for me. A small bolus for a chocolate covered strawberry on my birthday and Mother's Day is good enough for me. I actually split the strawberry with my hubby. I don't need it all. Just a bite.

 

[GBS_82_]

The reality is much different for me too. Great thing I love low carbing and fatty foods!!! I also love taking lower doses of insulin and not fearing thenhypos I used to have. The anxiety was just too much for me. I envy people who can stay rock steady eating what they want when they want but at the end of the day lchf also keeps my tummy issues and weight in check. There are foods I miss like pizza and sweet potato ( and many others) but one small bite of sweet potato or the toppings off a sample piece of pizza is enough for me. A small bolus for a chocolate covered strawberry on my birthday and Mother's Day is good enough for me. I actually split the strawberry with my hubby. I don't need it all. Just a bite.

I totally agree. I am planning to have the occasional treat - i.e. I have a friends wedding next month and will probably drink beer. But I know it will need careful management and there will be consequences. To start with it will mean an alarm set for six hours after I finish eating / drinking to check my levels aren't sky high in the night. Happy to do that occasionally but not every day

 

[Kristin251]

I totally agree. I am planning to have the occasional treat - i.e. I have a friends wedding next month and will probably drink beer. But I know it will need careful management and there will be consequences. To start with it will mean an alarm set for six hours after I finish eating / drinking to check my levels aren't sky high in the night. Happy to do that occasionally but not every day

My daughters wedding is coming up and I'm already nervous haha. Stupid I know but rollercoastering makes me feel awful so it's really not a treat. I'm thinking I'd rather be in control and not make food an issue. She is having a gluten free cake but obviously not sure free and her husband to be loves key lime pie so they'll have that as well. Maybe just a small swipe on my finger haha. If I eat sugar the cravings follow immediately. I'm going to drill into my head it's JUST FOOD before I get there. I will have my cocktails too haha. But mine has zero carbs so actually helps me out.

Enjoy your beer and wedding !!!

 

[drahawkins_1973]

I agree with a lot of what has already been said.
For me low carbs and timing of bolus is key. I'm fortunate to have a libre which I find helps.

 

[tim2000s]

I think it's fair to say that @Kristin251 , your diet and way of diabetes is very, very close to the Bernstein approach to living with Diabetes, which I and many others find a little too rigid and stringent.

What I've found interesting since starting to use a closed loop (artificial pancreas) system is that it does make eating less stringently easier, and the commercial products from iLet and Bigfoot have similar capabilities to OpenAPS in their "food" algorithms, helping to manage higher carb "treats".

Aside from this, it's fair to say that you achieve a good Hba1C without Hypos by paying attention and managing your diabetes more carefully. As my consultant also said, the majority of people she sees that have Hba1Cs below 6.5% also eat lower carb, and that was typically less than 100g a day.

 

[Soplewis12]

Avoid carbohydrates and the highs and the lows will go (you need to adjust your insulin appropriately).

I seem to be seeing a lot of people trying the low carbs at the moment, I might consider it but would rather have carbs than proteins to be honest, but definitely worth thinking about.

 

[Kristin251]

Yes Tim, it is very bernsteinish but I was that way before I even read his book. I was more a healthy Atkins induction for 25+ years. More for weight and stomach issues as I wasn't diabetic then to the best of my knowledge. Carbs bloat me and exhaust me. I can completely see where this would bore lots of people. Having a happy tummy is just as important to me so these two things work in tandem quite well for me. And if I screw up one, the other gets screwed up. Not to say that's never happened but I do try to avoid it. I actually wish my stomach would allow me more veggies.

 

[Dillinger]

I seem to be seeing a lot of people trying the low carbs at the moment, I might consider it but would rather have carbs than proteins to be honest, but definitely worth thinking about.

Well the problem for diabetics is glucose and all digestible carbohydrate is converted into glucose. As you don't need to eat carbohydrates at all (there are for instance no deficiency diseases associated with carbohydrates) then the more you can remove them from your diet the better it is for controlling blood sugars. Carbohydrates are the key to managing your blood sugars, and by that I mean getting rid of them is the key.

Is there a particular reason why protein is a problem for you?

 

[Garr]

You can eat a "normal diet" and have a good Hba1c without having hypos. Read "Think like a Pancreas", keep a detailed log you can always refer to, exercise daily and always leave at least 4 hours between carbs and 4 hours between last carbs and bed. I eat the same diet as before diagnosis ( 200-250 ish carbs a day) and my last few readings have been 40, 39, 36, 36, 39 and 40. Without hypos. Timing of bolus before and/or exercise after meals help to strike the spike. Getting your basal correct is critical though. Low carb is great for some but became too boring for me. It's just finding what works for you. Self-discipline is the real key though.

 

[azure]

I agree @Garr Eating a moderate level of carbs can give you a great HbA1C as long as you apply yourself. That way you also avoid the physiological insulin resistance that so,often comes with cutting out carbs and ketosis. You also usually don't need to bolus for protein when you have carbs with it.

It's a total fallacy to say that LCHF is the only way to get good results. Controlling carbs, yes, but that doesn't mean you have to cut them out completely.

 

[Dillinger]

It's a total fallacy to say that LCHF is the only way to get good results.

Well, there are couple of problems with that; we know from the annual National Diabetes Audits that the vast majority of Type 1's fail to get below the NICE recommended HbA1c levels; (lower than 58 mmol/ml which is 7.5% in old money; a pretty high level in light of the evidence of complications see the DCCD trial that our treatment is based upon - https://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/GetPdf.cgi?id=phd000390)

Here is the most recent audit - the current figure is that only 29% of us get below that (low) target (page 24):

http://content.digital.nhs.uk/catalogue/PUB19900/nati-diab-rep1-audi-2013-15.pdf

Note, by the way how they no longer list Type 1's getting below 47.5 mmol/ml (6.5%). The last one I saw had only 6.9% getting below that which is not very good.

So, your statement above is only applicable to the unknown but probably very small population of Type 1's who eat carbohydrate and get decent HbA1cs (by which I mean under 47.5 mmol/ml - as detailed in the DCCD trial). I bet a large number of them are newly diagnosed honeymooning diabetics as well.

Which leads to the second problem; those well controlled carby diabetics are probably not reading a self help forum on how to control their diabetes; they are already controlling it.

You should consider the needs to the majority of Type 1s who are struggling to maintain good HbA1cs and their needs are categorically best met by cutting out carbohydrates. It's not rocket science.

 

[Soplewis12]

Well the problem for diabetics is glucose and all digestible carbohydrate is converted into glucose. As you don't need to eat carbohydrates at all (there are for instance no deficiency diseases associated with carbohydrates) then the more you can remove them from your diet the better it is for controlling blood sugars. Carbohydrates are the key to managing your blood sugars, and by that I mean getting rid of them is the key.

Is there a particular reason why protein is a problem for you?

No, just a personal preference.

 

[noblehead]

Which leads to the second problem; those well controlled carby diabetics are probably not reading a self help forum on how to control their diabetes; they are already controlling it.

I don't know @Dillinger , as you know there's plenty of type 1's on this and the DUK forum who are well controlled and eat carbs in moderation, and by doing so they are still keeping their insulin usage down (TDD) as per Dr Bernstein's law of small numbers (can't remember how it goes, is it low doses less mistakes) or something along those lines...........

You should consider the needs to the majority of Type 1s who are struggling to maintain good HbA1cs and their needs are categorically best met by cutting out carbohydrates. It's not rocket science.

But only if managing type 1 diabetes successfully was as easy as cutting out carbohydrates, as you know you have to factor in protein and fat when calculating insulin doses and this in itself can create more problems than it solves (for example having to split-dose for lchf meals where a meal with some carbs would just require one injection), we have seen first-hand that some type 1 members here have experienced insulin resistance when their diet is too high in fat which has meant them having to take additional meds like the drug Metformin, so very low-carb diets like LCHF are not the answer for everyone.

 

[azure]

Well, there are couple of problems with that; we know from the annual National Diabetes Audits that the vast majority of Type 1's fail to get below the NICE recommended HbA1c levels; (lower than 58 mmol/ml which is 7.5% in old money; a pretty high level in light of the evidence of complications see the DCCD trial that our treatment is based upon - https://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/GetPdf.cgi?id=phd000390)

Here is the most recent audit - the current figure is that only 29% of us get below that (low) target (page 24):

http://content.digital.nhs.uk/catalogue/PUB19900/nati-diab-rep1-audi-2013-15.pdf

Note, by the way how they no longer list Type 1's getting below 47.5 mmol/ml (6.5%). The last one I saw had only 6.9% getting below that which is not very good.

So, your statement above is only applicable to the unknown but probably very small population of Type 1's who eat carbohydrate and get decent HbA1cs (by which I mean under 47.5 mmol/ml - as detailed in the DCCD trial). I bet a large number of them are newly diagnosed honeymooning diabetics as well.

Which leads to the second problem; those well controlled carby diabetics are probably not reading a self help forum on how to control their diabetes; they are already controlling it.

You should consider the needs to the majority of Type 1s who are struggling to maintain good HbA1cs and their needs are categorically best met by cutting out carbohydrates. It's not rocket science.

I agree that it's both shocking and upsetting that so many Type 1s aren't achieving ideal HbA1Cs. In my opinion, the answer to that is better education. For example, I personally think it's ridiculous that some Type 1s are sent on their merry way after diagnosis with set bolus doses and no mention of carb counting at all. They eat a tuna salad and a bread roll one day and have a hypo, the next they eat a baked potato and baked beans and a banana for dessert and have high postprandial readings, and feel completely confused and disheartened. I'm not suggesting every newly diagnosed Type 1 should be given a full-on DAFNE experience before they leave hospital, but a short explanation of carb counting would make a big difference.

Your post seems to have a number of non sequiturs. The poor control of some Type 1s doesn't in any way prove LCHF is the answer. As I said, it is more likely to,prove they haven't been given the education and support they need to manage their condition.

With appropriate knowledge, many, many Type 1s could eat moderate levels of carbs and get HbA1Cs in range.

I am obsessed with diet - looking for the perfect diet for Type 1. Nothing I've read suggests that LCHF is that diet. Controlling carbs is most certainly the answer as eating excessive carbs makes control much harder, but just because excessive carbs is bad, doesn't mean zero/minimal carbs is automatically good.

 

[Wurst]

Strenuous exercise is the key for me , without it my control goes off a bit.
I've maintained my HBA1C in the high 4%'s for around 2 years now with minimal hypos, until recently. I decided to go back a strict low carb diet for the new year but have had 3 hypo's this week already :-( Not a big drama as my hypo awareness is intact, a simple basal adjustment is needed.