Advice for going low carb

[Charles Robin]

Hi all,

After much reading up on it, I have decided that I am going to try going low carb, and was looking for advice from others that have made the switch. I am 26, and was diagnosed with type 1 back in 1990 (I was three). I am 5'11" and weigh just under 11 stone 7. Therefore weight loss is not my goal here, it is totally orientated around blood sugar control. So far the only complication I have had was my last retinal scan, which said mild diabetic changes were found, requiring no treatment. This is obviously a sign that I need to get a handle on things before they are too late. My HBA1C tends to be 7 or under, but I have frequent highs and lows from trying to compensate for large carbohydrate meals. I'm tired of seeing the worry that I am putting my wife through, and something must be done. I am currently reading Dr Bernstein's book, and want to stick as closely to his 30g carb regime as I can. Thankfully I have always enjoyed vegetables, and a diet of meat and eggs is something I can adjust to. I will definitely miss the bread and fruit, but I would rather live healthily for a number of decades than die young for the sake of a sandwich.

SO here is my plan. I have been testing loads this week while eating the diet I am used to, and noting down all my results (thank you Microsoft excel). Next week I intend to do the same, but switch to the low carb diet. I currently use Lantus for my long acting insulin and Lispro for my short acting. I was taking 24 units of Lantus at 7.30pm, but have reduced that recently to 18 units to try and control the hypos. I intend to eat a low carb meal Sunday evening, and reduce my Lantus to 8 units, testing regularly to see the effect this will have. I will then have a 6g of carb meal for breakfast on Monday, and give myself one unit of Lispro to cover it. I will make a note of all my food and results for the next week and see how it compares. I will then go to my diabetic appointment on the 3rd of February, and push the idea of low carbing with my DSN. I have not discussed anything of this nature with my diabetes department before, so I am not sure whether they are for or against a regime of this nature. I have heard from a lot of other people that they have had trouble converting their doctors to their way of thinking, so if I already have some concrete proof that the regime is working, this may help me to get them on board.

So from anyone that has left high carbs behind, does my plan sound feasible/sensible? All comments, positive or critical are gratefully received. Many thanks for reading!

 

[robert72]

Hi Charles

You might find it easier to reduce your carbs over a longer period of time otherwise you will probably feel off colour for a couple of weeks while your body adapts to ketosis. Also you high-carb insulin : carb ratios will not work for low-carb, so a gradual descent will be less of a shock to the system.

Try starting at 150g/day for a couple of weeks and see how you get on. There is no rush.

 

[Charles Robin]

Thanks for the reply, that is a very good point. I was about to post and say I reckon I average 150 a day already, but I just counted and it's a lot higher than that! (A lot of that is to try and sort out hypos, but it still counts).

 

[Ambersilva]

I know you know this already. I am writing about the method that was recommended to me as a Type 1.

Going by your weight c.72kg, your total daily dose of insulin should be about 36 units. Half of the total dose should be long acting insulin. You need the long acting insulin to work in the background whether you eat or not. You then need the fast acting insulin to deal with the food you eat. If you cut back the slow acting insulin too much your blood sugar levels will rise to a constant but higher level.

You have already reduced the long acting considerably and if your waking and fasting level is at the correct level then I believe you do not need to reduce it further. Only reduce Lantus gradually and allow about three days for the change to take effect before reducing further. If you go to extreme low carb you still need to adjust the insulin to cover the protein and vegetables.

You have to be careful when cutting right back on insulin because your body needs insulin to provide the key to let the blood glucose into the cells for energy. I have made the mistake of not injecting enough insulin for a low carb meal and have ended up with absolutely no energy and found that even to remain standing was difficult. A bit inconvenient when you are one mile away from home with no bus to your destination and you've left your fast acting insulin at home with blood sugars rapidly rising.

 

[robert72]

Probably also a good idea to re-test your basal each time you make a big drop in daily carbs

 

[Dillinger]

Hi Charles,

I think you'll be pleased with the results you get.

I'd follow the steps that Bernstein suggests quite closely.

For your basal that seems quite a drop; don't forget your basal should be what you need if you didn't' eat anything all day; i.e. the bolus is intended to solely cover your meals.

I started splitting Lantus when I was on it and then moved to Levemir as it's acknowledged to be easier to split. Perhaps you could think about that?

Are you sure that you have your current basal correctly set up? If not I'd sort that out before moving to low carb. You can do that by fasting (which is I guess the ultimate low-carb approach..?) have a google about correcting basal doses. But basically one day fast at breakfast and see what your bloods do, a couple of days later fast at lunch and a couple of days later fast at supper. Test during those periods and after and in particular the evening/night after the evening fast to see what you bloods are doing.

If you think your basal is right then I wouldn't reduce it too much; I would reduce it by say 2-4 units and test, but realise that it might have to go back up as it may well be the right amount.

Use your current ratios to start but as Robert says you may need to totally rework them. I find it is very noticeable that my sensitivity to insulin increases during the day; so my morning ratios are much higher than my evening.

Make sure you drink lots of water but don't drink any booze for the first couple of weeks as that always complicates matters I find.

I don't find the low-carb diet (I try and eat around 30 grams a day) to be just meat and eggs; there are a lot of things that you can eat and there are some really good low-carb recipes here.

Your DSN will, odds on, freak out and you will be told you must eat plenty of carbohydrates. So, either be prepared to ignore all that or keep your experiment to yourself until you have a better chunk of time under your belt to see the affect on your HbA1c.

Good luck and welcome to the low-carb world!

Best

Dillinger

 

[Charles Robin]

Cheers, that's really helpful. I did have one other question though regarding exercise. I have been trying to get a handle on my control for a while now, and I thought I could keep my current diet and add exercise into the mix and it would be fine. I took up cycling again, which I really enjoy. I am discussing doing some long distance rides with some friends later in the year. If you exercise, what do you do with your insulin/ carb intake? I'm reading Dr Bernstein's book at the moment, and am getting close to the exercise chapter, but I would like to know what works for others too.

 

[Dillinger]

Hi Charles,

If you are doing consistent exercising you will probably need to lower your basal and refine your bolus ratios. You insulin sensitivity will improve so you'll need to inject less.

That's one of the reasons why exercise is so good for us.

The other thing by the way, which I'm sure goes without saying is that low-carbing never applies to hypo corrections; for that you have to carb! You may have to correct hypos whilst you sort out your insulin amounts if you swap from not much exercise to lots.

Best

Dillinger

 

[Charles Robin]

Hi Charles,

If you are doing consistent exercising you will probably need to lower your basal and refine your bolus ratios. You insulin sensitivity will improve so you'll need to inject less.

That's one of the reasons why exercise is so good for us.

The other thing by the way, which I'm sure goes without saying is that low-carbing never applies to hypo corrections; for that you have to carb! You may have to correct hypos whilst you sort out your insulin amounts if you swap from not much exercise to lots.

Best

Dillinger

All good tips, thanks for the insight! Hopefully the more info I have, the smoother the transition will be.

 

[SamJB]

Yeah don't expect your DSN to endorse this. Down to advice I took about low carbing from Dillinger and xyzzy around 18 months ago, my HbA1c has been at 6.1% for a year; I now get on average a couple of mild hypos per month (I've actually not had one for 6 weeks at the mo) and I've not been in the 2s since I started it; and I have a double figure reading on average once every two weeks. Going low carb was the best decision I've ever made in my life.

Anyway... As Dillinger said, you probably dont need to reduce your basal so much, mine had stayed the same. Your basal insulin is used to cover the gentle trickle of glucose produced by your liver throughout the day. This shouldn't change by much. You may also find that for low carb meals you need to bolus for portion size. Have a Google (or search this forum) for "Chinese Restaurant Effect Richard Bernstein", it explains why in there.

Edit: fixed typos

 

[Patch13]

Hi. I'm a type 1 too and I decided to low carb last January as my sugars were swinging up and down despite having an ok(ish) hba1c in the 7-8% range. However I felt grumpy, very hungry and generally miserable and tired!

I wanted to try out low carbing after reading the bernstein book to see if I could feel any better. I'm definitely glad I did. I eat less than 30g carbs a day and my sugar levels are very much improved. I rarely have high levels, but I do have a few hypos - although I can always feel them (this is also partly due to changing requirements when working etc and needing to adjust my pump to accommodate this). My basal rate didn't go down a lot, but my bolus has significantly.

I would describe my diet as low carb, moderate protein and high fat. This means I count carbs, protein and fat and work how much insulin to take based on these. The annoying thing about it is I need to perform calculations before eating, but the positives far outweigh my annoyance at this.

My DSN and consultant were somewhat supportive of my low carb choice as they saw my HBA1c is now much better (around 5%).

I know low carbing isn't always for everyone, but I think it's worth a try at least!


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[Charles Robin]

Thanks Patch, your experience is more reinforcement that I am doing the right thing! I'm already surprised by the variety of food I can have. Just been to nandos and kept the carbs to 12g. My blood sugars since 8pm have stayed in the 4.3 to 4.8 range, which I am dead chuffed with. If I was a baker, I would be worried about my business with the amount of evidence that we will be healthier without the bread and bagels!

 

[JustDomUK]

Luckily I was put on a low carb programme by my health care team however my advice to you is this. I'm type 1 and if you have illness while on this regime you will probably find it a little harder to maintain the low blood sugars regardless of the number of carbs you eat.

I'm not entirely sure what happens should you switch from ketosis to ketoacidosis

Secondly, make sure you drink plenty. I was not a good person for drinking water but if you don't want to put added strain on your kidneys then ensure you drink at least 8 glasses a day. I can't stress this enough.


Good luck. I've lost five kilos since being on it although I'm on it to lose weight. Three weeks so far.


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[SamJB]

Thanks Patch, your experience is more reinforcement that I am doing the right thing! I'm already surprised by the variety of food I can have. Just been to nandos and kept the carbs to 12g. My blood sugars since 8pm have stayed in the 4.3 to 4.8 range, which I am dead chuffed with. If I was a baker, I would be worried about my business with the amount of evidence that we will be healthier without the bread and bagels!

Nandos is brilliant for low carbing. Half an extra hot chicken, coleslaw and peas for me!

 

[SamJB]

Luckily I was put on a low carb programme by my health care team however my advice to you is this. I'm type 1 and if you have illness while on this regime you will probably find it a little harder to maintain the low blood sugars regardless of the number of carbs you eat.

I'm not entirely sure what happens should you switch from ketosis to ketoacidosis

Secondly, make sure you drink plenty. I was not a good person for drinking water but if you don't want to put added strain on your kidneys then ensure you drink at least 8 glasses a day. I can't stress this enough.


Good luck. I've lost five kilos since being on it although I'm on it to lose weight. Three weeks so far.


Sent from my iPhone using Tapatalk

Wow! Not heard of a health care team being this progressive and recommending low carb. What were the circumstances of the recommending it for you?

 

[JustDomUK]

I wanted to lose weight and have good control. I asked my specialist what I could do. He went through the benefits of Atkins and 5:2 and LCHF explaining what they can do. He prefers low carb. He took me through how insulin works (thoroughly) and I left well informed and on LCHF. My GP is the same. Very supportive and progressive. I think you can tell a good GP surgery from a bad one by the investment they put into the surgery itself. The computerised touch screen ones tend to be ahead of the game. Shop around and don't be afraid to swap


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[SamJB]

That's great. If only there were more places like that.

 

[Charles Robin]

Well, I had my diabetic clinic yesterday. My DSN told me low carb was unnecessary, and the only thing I need to worry about is the large amount of hypos I have had. I pointed out I was yoyoing while eating high carbs, and he told me if I got rid of the lows, the highs would disappear too. When I pointed out I was constantly hungry, and that this had disappeared for the last week on a low carb diet he said it was still unnecessary. He then went on to tell me that I could relax my control, and as long as the hypos disappeared he was not worried. I mentioned my fear of high blood sugars and complications, and he told me I was unlikely to develop anything in the next ten years. I pointed out that my last retinal scan reported mild changes, and he said that was nothing to worry about.

So what I have learned is that high carbing is fine, I can eat whatever I want, and that anyone over the age of 40 does not mind getting complications at all, because it's only important if I get them in the next ten years.

As a child, I once spent an hour riding on a roundabout at a playground. I got a similar sensation from the conversation in my appointment going round and round. In the end he grudgingly said I could follow a low carb diet if I don't get many hypos, and agreed to book me an appointment with the dietician. It's very nice to know what my taxpayer's money is funding when it comes to healthcare!

 

[Patch13]

'So what I have learned is that high carbing is fine, I can eat whatever I want, and that anyone over the age of 40 does not mind getting complications at all, because it's only important if I get them in the next ten years.' - This bit did make me laugh. I just can't believe how short sighted this is. He should be delighted you are trying to take care of your health and avoid complications!

It sounds like you are happy with the low carbing at the mo so it is worth carrying it on and seeing what improvements you can make.

Be warned that I can't imagine the dietician will appreciate your diet either - the last one I saw told me to up the carbs, but I ignored the advise as I'm happy with my sugars and my low HBA1C, thank you very much!

Keep updating us on how you are getting on!

 

[paul-1976]

Good luck Charles and I think you're doing really well and all the right things to get control of your condition!