Dietician/Nurse say not to low carb

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Hi everyone,

I am new to the forum but have been diabetic for 12 years after being diagnosed when I was 21.

My blood sugars have never been very well controlled despite my very best efforts and my HbA1c is 9. I have been carb counting for about 18 months and my control is still erratic - I tend to go very high and very low. I don't exercise as am too scared about what it will do to my bloodsugar (more hypos).

I recently read Dr Bernsteins book and decided to give low carbing a go (having 30 - 50g carbs per day), however after a meeting with the dietician and Diabetes Nurse I have been told that I shouldn't be low carbing as a type 1 and risk making myself ketoacidoic. I have been ketotic while low carbing but only in urine, not in blood. I was also told that I was eating too many calories when low carbing.

My BS was still too high (8- 12) while low carbing but seemed less erratic, I have been back on carbs for a week now and have had 5 hypos!

Low carbing was a last resort to try and get my HbA1c to 6 so that I can conceive and now I don't know what to do for the best. I am very frustrated! Any advice from Type 1's low carbing would be greatly received!

BTW I am also insulin resistant and taking 4 x Glucophage with evening meal.
 

diabetesmum

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Hi,
I'll start by saying I'm not a Dr or a scientist, just a well read mum to 2 Type 1 daughters, one of whom regularly, if some what erratically, low carbs.

My understanding is that so long as you are having sufficient basal insulin you will not develop ketoacidosis. You may produce some ketones (as anyone, diabetic or not might) but the presence of sufficient basal insulin will stop your blood becoming acidic. I am surprised you nurse doesn't know that - perhaps she is just trying to scare you off low carbing. You have read Bernstein so you have all the info. I would say do what you feel is best for you, as an adult you don't even have to tell your nurse or consultant what you are doing/eating/not eating. Just enjoy their amazement as your HbA1c drops and your hypos improve.

If you are worried, have a few more than 30-50gms, and then as you get your confidence back, drop it down again - do what suits you and what you feel happy with, that's my advice, for what it's worth!
Best wishes,
Sue
 

MrsPugwash

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Hi citrusgirl

Can I suggest you get in touch with our own Fergus who is a T1 and has been extremely successful in controlling his BS by low-carbing for many years. He is extremely knowledgeable and helpful and I am sure will be able to give you plenty of advice and guidance.

Good luck!
 

alaska

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I'm relatively new to the low-carb regime. I'm still yet to have a clinic meeting since staerting so i have no idea what I'll be told by my consultant when my next appointment comes around in a couple of months.

Take this with a pinch of salt as I'm no physiologist
At 30 - 50g of carbohydrates, if you spread them out amongst the day - as most people generally would - you have enough sugar in your blood to (a) keep your cells supplied with energy and (b) enough to build up glycogen stores in your liver.

Point (b) appears to be the case as whenever I exercise for short periods, there appears to be a corresponding rise in blood glucose despite not eating beforehand. This, I presume, is because my liver is releasing it's stores of glycogen it has built up, but I don't claim to know this for certain.

I don't find myself worried about ketones or ketosis. Perhaps there is a bit of low level ketosis happening but I can't say I really notice it. I felt tired in my legs, particularly when I started but now I feel like how I was before - except that my levels are better and therefore I feel, more consistently, better.

It's a great benefit to be less worried about what number range you're going to be in at any time in the day. Even when you're testing four or so times a day, on a high carb regime, I still felt like I had no certyainty that a number would be in the right range. When it was it was a relief but when it wasn't it was quite unpleasant to not always know why.

On low carbs I still find myself going high from time to time, but when I do, it's not half as bad as it would be if I was on a high carb diet. I still forget to injections every once in a while but it's a lot easier to come back down from say 12 mmols/l than it is to come down from about 16 or 17+, which would often be the case after the NHS recommended high carb meal.

Also, one of the other best things about the low carb diet is that when it comes to your levels between meals, they're going to be a lot better on low carbs than on a high carbs.

You may have been shown graphs of how sugar levels respond to eating meals. These are typically shown as a hill shaped curve. The higher and steeper the hill, the more sugar your blood is coming into contact with.

Say your pre-meal levels are between 5 and 6 mmols/l. On a high carb diet, the level the hill will rise to can often be anywhere between around 9 and 12 (this will vary for different of course). On a low-carb diet, however, the hill will usually peak at a much lower level. For myself, the levels would rarely get above 7 mmols/l if they started at between 5 or 6.

The size of this 'hill' is essentially a measure of the damage you do to yourself long term. The larger the size of the area under this curve, the more damage you're doing to yourself. A low carb diet leads to a significantly smaller 'hill' between meals, as a result it is a lot better for you long term than a high carb diet.

That's way too much waffle now and everyone's probably fallen asleep upon reading this. But to summarise, I personally wouldn't let the doctors/nurses put me off unless they came up with something convincing. As diabetesmum (I think?) pointed out, there's a big difference between a bit of ketosis going on and ketoacidosis. And yes, listen to Fergus as he has a welath of good advice to give.
 

hanadr

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Hi citrusgirl
They have no scientific evidence against low carb. It's all based on supposittion. They've given up telling me off, but one of them told my daughter that my diet is dangerous. They can't find anything wrong with me, so why try to scare my daughter, who has still to lose her post baby weight?( after 13 months)
If you've been reading Bernstein, you'll understand that he's a T1 and has reversed the few complications he had and prevented any further ones. The only thing he says that hasn't reversed is that the hair on his legs hasn't regrown.
Compare that with my husband, who followed the high carb instructions for 35 years and has kidney disease, retinopahy, neuropathy, Charcot feet, diabetic ulcers and severe anaemia
He's doing better than might have been expected, because he now has TIGHT BGs on much reduced carbs and insulin.
 

Trinkwasser

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MrsPugwash said:
Hi citrusgirl

Can I suggest you get in touch with our own Fergus who is a T1 and has been extremely successful in controlling his BS by low-carbing for many years. He is extremely knowledgeable and helpful and I am sure will be able to give you plenty of advice and guidance.

Good luck!

You're a bit late, Fergus was asked to leave. You can still read some of his posts in the Success Stories thread and elsewhere.

However Katharine who is a doctor with a Type 1 son has written a lot of good stuff here

http://www.dsolve.com/

she also posts/posted here

IMO the nurse and dietician are confused between ketoacidosis, which is dangerous but only occurs with a lack of insulin, and ketosis which is a natural function of fat metabolism
 

the_anticarb

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Why was Fergus asked to leave? I thought he was the number one dude on the low carb forum!
 

Doczoc

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the_anticarb said:
Why was Fergus asked to leave? I thought he was the number one dude on the low carb forum!

Bloody hell only been off here a few weeks, Fergus was a cornerstone of this forum, what happened?
 

MrsPugwash

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I am somewhat astounded that Fergus was asked to leave given the breadth of his experience, extremely knowedgeable postings and also his very calm and well thought out style. What a great loss to this forum.
 

fergus

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Hello again!
Well, to the relief of a few, the downright despair of a few more and the completete indifference of the majority, I'm still here.
Just to clear up a small point before I go on - I was never actually asked to leave the forum. Let's just say the welcome mat went missing for a wee while.
Now it seems most of the disruptive members have built themselves their own little forum so let's hope that sanity prevails here once more.
Thanks for the kind words though - on this thread and others - not a bad idea getting to proof read your own obituary!
Well, judging from alaska's post, the relative newbies are quickly getting a more thorough understanding of low carb principles here then they're likely to find from some health professionals. Great stuff.

All the best,

fergus
 

MrsPugwash

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Hurrah, Fergus lives! Think I'll hoist the Jolly Roger in celebration and take The Black Pig out for a celebratory cruise .......
 

timo2

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It would appear that reports of Fergus' demise have been greatly exaggerated. :D

Welcome back, Fergus.
 

cugila

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Welcome back Fergus.
 

Katharine

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The nurse and dietician are just rolling out the old dietary ketosis is the same as diabetic ketoacidosis. This is a myth. You get dietary ketosis when there is a relative lack of carb in the diet and you get diabetic ketoacidosis when you have a relative lack of insulin in the blood/tissues.
Dietary ketosis does not cause or lead to diabetic ketoacidosis.

So, what do you do with this information?

Since you would like to get your sugars in control and have a healthy, happy little baby, I would recommend that you look up some of Lois Jovanovich's material. She is now a professor who looks after diabetic women who are pregnant or who are planning a pregnancy in the Sansum Research Center Santa Barbara.

She recommends a maximum of 30g a day for the three main meals and if you really want them, three optional snacks of up to 15g of carb a day. Thus you could be on 90-125g of carb a day and depending on your preferences and blood sugar goals you could be on less than 90g a day.

The limit of 30g for each meal is pretty doable.

Lois wrote an article (which is out of print) called "Lets not be ketone cops". I have copy in my files. In this she explains that less than normal blood sugars is what the does the damage in pregnancy NOT the issue of ketones in the urine. Many non diabetic women get ketones in their urine after an overnight sleep.

I hope you can feel reassured about your sensible plans to restrict your carb intake.