Type 1 advice

[Jess1D]

Hi
So have been a type 1 for 24 years
My control lately has been pretty bad, a lot of high sugars
My nurse has suggested giving bigger doses of insulin
Still not working, had a call with her in the week & she would like me to try Metformin
She does not like the idea of me going low carb- she tells me my body is screaming out for carbs- but when I have the carbs (which tends to be for breakfasts) I suffer with massive highs
Can I do low carb & use this Metformin?
Or will going strictly low carb be the answer?

Really appreciate some advice
Many thanks

 

[AndBreathe]

Hi
So have been a type 1 for 24 years
My control lately has been pretty bad, a lot of high sugars
My nurse has suggested giving bigger doses of insulin
Still not working, had a call with her in the week & she would like me to try Metformin
She does not like the idea of me going low carb- she tells me my body is screaming out for carbs- but when I have the carbs (which tends to be for breakfasts) I suffer with massive highs
Can I do low carb & use this Metformin?
Or will going strictly low carb be the answer?

Really appreciate some advice
Many thanks

Hi there Jess.

I'm not T1 so can't comment on your situation from an experienced perspective, but in observation, there are plenty T1 who live reduced carb lifestyles. Some even do keto (ultra low carb) without harm.

Metformin helps with insulin resistance, and many T2s take it whilst living low carb.

One of our Mods, @Antje77 is T1, takes Metformin and lives a reduced carb lifestyle. She might be able to help you.

 

[Antje77]

One of our Mods, @Antje77 is T1, takes Metformin and lives a reduced carb lifestyle. She might be able to help you.

Thanks for the tag, @AndBreathe .
@Jess1D , AndBreathe is correct, I eat lower carb and am on insulin and take metformin as well.
I'm having a rather busy day though, so I'll get back to you tomorrow at the latest!

 

[Jess1D]

Thanks for the tag, @AndBreathe .
@Jess1D , AndBreathe is correct, I eat lower carb and am on insulin and take metformin as well.
I'm having a rather busy day though, so I'll get back to you tomorrow at the latest!

Thank you, look forward to hearing from you

 

[Jaylee]

Hi
So have been a type 1 for 24 years
My control lately has been pretty bad, a lot of high sugars
My nurse has suggested giving bigger doses of insulin
Still not working, had a call with her in the week & she would like me to try Metformin
She does not like the idea of me going low carb- she tells me my body is screaming out for carbs- but when I have the carbs (which tends to be for breakfasts) I suffer with massive highs
Can I do low carb & use this Metformin?
Or will going strictly low carb be the answer?

Really appreciate some advice
Many thanks

Hi @Jess1D ,

From my experience with 46 years worth of DSNs & wot not. The train of thought with these guys are (to paraphrase.) "insulin only works with carbs." & "if you go low here, you need more carbs."

Now to be fair, I keep my carb count down cutting out the "usual suspects." That's mainly because I have a busy lifestyle with very little time to stop should I go low. (Unless I'm behind the wheel of a car.)
If things go wrong for me? Any corrections are minimal & swift.

The first thing I would look at first would be the basal dose? That is what it is, regardless of what you eat to a degree..
Basal testing is a great start to get the "foundation" right. (This you would need to consult with your HCP.)
https://www.mysugr.com/en/blog/basal-rate-testing/

Then you can work on the food you bolus for? Now there is the trick... It's all about the timing of the dose & your intended activity.. Some diabetic diatary recomendations don't always compliment an average insulin working profile..

Which could be why you struggle with breakfast?

Do you pump? Or on MDI?

 

[Ian DP]

T1 for 8.5 years. Very low carb (probably Keto) for 8 years. Fitter, healthier, stronger now than 15 years ago. My carb intake is around 24g per day, 12g for breakfast and 12g for dinner. No need for lunch, but will do on social occasions and skip evening meal. It’s so much easier to keep bg levels under control with low carb (in my opinion). I take 6 units fast acting for breakfast and 3 units for evening meal, with 6 units long acting morning and night. Because of the minimal insulin it’s easier to keep control. Hba1c has been regularly around 5.4% (34) for the last 8 years. No way would I change my diet. Happy.

 

[Hertfordshiremum]

Hi
So have been a type 1 for 24 years
My control lately has been pretty bad, a lot of high sugars
My nurse has suggested giving bigger doses of insulin
Still not working, had a call with her in the week & she would like me to try Metformin
She does not like the idea of me going low carb- she tells me my body is screaming out for carbs- but when I have the carbs (which tends to be for breakfasts) I suffer with massive highs
Can I do low carb & use this Metformin?
Or will going strictly low carb be the answer?

Really appreciate some advice
Many thanks

Hi T1 for 4 years. I was on insulin, low carb diet (30-40g per day) and metformin for almost the first year. I lost quite a bit of weight on this regime however the upset stomachs (metformin SR possible side effect) got worse not better so they kept telling me to eat more carbs to absorb the metformin, so I told them why not cut the metformin instead and eventually I came off the metformin but I do think it helped initially. I probably did have a degree of insulin resistance to start off but a year later this had gone especially as I had lost weight. Depends on your situation, I would say it’s worth a try. I got a lot of negative comments about eating low carb but read Dr Bernstein and decided I wanted to give it a good go. My HbA1c was 42 six months later, over 100 on diagnosis. The comments stopped after this!

 

[Ian DP]

Recommend Dr Bernstein ‘my solution’. A good read, and I still follow his recommendations 8 years after reading it. Not to expensive on kindle.

 

[Jess1D]

This morning 8am - woke & bm was 17.9-gave 5 units to correct- 1 unit brings me down 4ml
Now scanned & it’s showing 13 & bm is 13.7
Just seems my insulin isn’t having that much effect
I have Dr Bernstein book- very good
I’m just concerned will I still be having to give massive doses without the use of metformin

 

[Ian DP]

I need 1.5 units (rapid) to bring my GB levels down 1point. It takes 2 hours to kick in on my Libre (1.5hrs on BG metre).

 

[becca59]

This morning 8am - woke & bm was 17.9-gave 5 units to correct- 1 unit brings me down 4ml
Now scanned & it’s showing 13 & bm is 13.7
Just seems my insulin isn’t having that much effect
I have Dr Bernstein book- very good
I’m just concerned will I still be having to give massive doses without the use of metformin

Strikes me your basal is way off. The most important part of type 1 management.
If my numbers are very high I will always need a bigger amount than usual to bring them down. So when you have high numbers your ratio for reducing them will probably not be the usual 1 unit to 4mmol. That is a discussion for you and your team.

 

[Jess1D]

This is the problem my nurse just tells me give your usual correction dose- but I am giving way bigger doses, then as I say had the telephone call earlier in the week - she wants me to try metformin

 

[becca59]

Is the nurse from a hospital team or Gp?

 

[Patch13]

Type 1 for over 20 years. Best results I see are from low carb (I’ve never been offered metformin). With carbs my sugar goes up, down and all over the place. Low carb is more steady, but I still need to consider my basal rate etc. And I still sometimes get it wrong, but the highs are less high and lows easier to correct too (for me)

I think low carb would be worth a shot to see what happens to your BG, prior to metformin.

My old diabetes doctor never suggested low carb, but when I got good results she told me to keep doing what I am doing to keep blood sugars good.

 

[Jess1D]

Is the nurse from a hospital team or Gp?

The nurse is hospital based
I’ve been under her for 6/7 years
She had told me that I am focusing too much on the negatives & need to remember the positives - sorry but I don’t see what the positives are when I’m constantly in double figures!!
My hbac1 has gone from always in the 5s to now 7.6
I am concerned what damage is happening to my body

 

[Antje77]

Can I do low carb & use this Metformin?

You can eat any way which suits you on metformin, and metformin can be helpful for some T1's

However, from your other thread I get you're not on very high doses of insulin, and you use a ratio of 1 unit to 10 carbs all day.
There are a couple of things coming to mind.
I:C ratios are not static. For most they are different at different times of day, and most need more insulin in the morning than in the evening
Many of us even need some bolus insulin when waking, breakfast or not.

Ratios aren't static over the years either. The amount of insulin we need changes over the years, so what worked well a year ago doesn't have to work well now. It's normal.

And being female, it's likely your insulin needs vary throughout the month as well.

My nurse has suggested giving bigger doses of insulin

Makes sense to me.
But not just giving bigger doses in a random way, but trying to work out what your current ratios are.
Which is, like others have said, impossible if your basal dose isn't more or less right. So I guess that's the first thing to look at.

Some of us need only 6 units of basal, others need over a 100. It's not important how much you need, it's important to find the right dose for you!
The same goes for mealtime insulin.

As for the metformin, it's a very safe drug (if you're not having many side effects, for some it's a very uncomfortable drug) and there is no reason to not give it a try if you'd like to.
But I think the main thing is to work out how much insulin you need at the moment!