Benefits of a T1 needing less insulin

[ButtterflyLady]

One of the T1s in my life eats a lot of carbs. I have read that for a T1, reducing their carbs is a good idea because it means they will need less insulin. I'm curious to know what this means in terms of benefits for them? If I can get my head around it, I might be able to have a conversation with him and we can end up enjoying healthier low carb food together

 

[Indy51]

IMO, it's well worth pointing a Type 1 in the direction of Dr Bernstein.

I just checked out his Youtube channel because I thought there was one that explained his "law of small numbers", but ran across this one instead about how low carb helpls control hypoglyclemia.

The laws of small numbers from the Diabetes Solution website:

http://www.diabetes-book.com/laws-small-numbers/

Warning: some people find the old guy's presentations skills not the best, but I find him kind of charming

 

[ButtterflyLady]

Thanks @Indy51 . So, if a T1 eats normal/high carb, they will need more insulin, and their BG will have higher highs and lower lows, and more frequent swings?

It's going to be hard for me to have this conversation with my friend, because I really hesitate to discuss it with him, because I don't want to appear to overstep the mark. I want to be able to get the info across as quickly and simply as possible. I strongly believe we should let people do what they want with their own health, but it's hard when you care about someone who is in their 20s, has T1, eats a high carb diet and is getting overweight. I worry about him getting complications in the future - and he has a long future with T1 ahead of him. But I don't want to alienate him and be "that person", know what I mean?

 

[Indy51]

I hear you - I'm very hesitant to discuss health issues with anyone - it's such a personal topic. I also don't know any Type 1's personally and couldn't begin to imagine what it is like for them. I think I'll leave the psychological side of how to approach someone to people with more experience of living with the condition.

I've been in a similar position with a Type 2, but there's only so much you can say without appearing to be interfering

 

[Squire Fulwood]

I am a T2 (disclaimer) but I have two comments. I read a letter from a woman with a T1 son. He had experimented with low carb and she said he now needed much less insulin and he made many fewer mistakes. This may of value to a T1.

The other comment is to draw your attention to a warning on the Diet Doctor web site on this topic.

Note for diabetics

• 
  Avoiding the carbohydrates that raise your blood sugar decreases your need for medication to lower it. Taking the same dose of insulin as you did prior to adopting a low-carb diet might result in hypoglycemia (low blood sugar). You need to test your blood sugar frequently when starting this diet and adapt (lower) your medication. This should ideally be done with the assistance of a knowledgeable physician. If you’re healthy or a diabetic treated either by diet alone or just with Metformin there is no risk of hypoglycemia.

http://www.dietdoctor.com/lchf

 

[Mrs Vimes]

Big, big , massive benefits. Tighter control, lower "highs". I stress about being in the 8s and 9s now not 17 after miscalculating for pasta. Higher "lows" in the 3s so much safer to deal with. Gets you off the blood sugar roller coaster.
Things I miss? Ben and Jerrys any type of ice cream.
Peace of mind absolutely priceless though. I do now have to bolus for protein but the spikes are much lower. Chicken seems to be fastest to hit the bloods and more fattier meats slower.
I eat tons of veg, olive oil, BUTTER!!, nuts. My new emotional eating is now nuts. I could eat them for Britain so have to be careful as too many end up on my belly and I have to bolus for the protein. Used to be Ben and Jerrys or basically anything carby.
As a type 1 I love this way of eating because of the lack of drama! Small numbers = small mistakes. Also a considerable drop in insulin.
Morning all!

 

[hels]

For me it's simple - less margin for error. And if I do occasionally want something with carbs I can still bolus for it, but TBH that is rare. I actually consider carbs the boring, filler part of a meal that I have an excuse to skip.

 

[ButtterflyLady]

Helpful responses, thanks everyone. I had a chance to learn more about my friend's approach to his T1 and I don't think I'm going to have much luck encouraging him to reduce his carbs. He is not worried about complications because he believes that by the time he's in his 40s, there will be new treatments that mitigate them. I didn't respond to that. I think he's unwise but, he's young, and often you can't tell people what they don't want to hear. I'm terrified of complications and doing everything I can to keep my BGs under control. Others are not that worried I guess.

I did encourage him to ask his doctor about changing his insulin regime next time he sees her because he said he had better control when on a twice daily basal compared to now that he is on a once daily. I am going to focus on baby steps, one at a time.

Thanks for the responses, everyone. I will keep the info in my back pocket for a "teachable moment" further down the line.

 

[hels]

In your 20s being in your 40 seems so distant - I'm in my 40s and it seems like yesterday I was still in my 20s!

Back on topic - rather than focusing on the benefits eons into the future how can low carbing improve his quality of life now? For me I feel much better when my control is good which I can achieve so much easier through low carbing. If I'm on a high-to-low roller coaster I feel tired and grumpy. With good control I feel I can lead a more normal life and feel like less of a freak!

 

[teacher123]

A few weeks ago I was on 8-10 units of fast-acting insulin for meals and 8 units of long-acting insulin. Experienced hypos because of being very sporty and misjudging the carbohydrate content or absorption of pasta for example.

I decided to give low carbohydrate a go. Wow, what a change. I've had two hypos in 12 days (both because of meals out and had no choice), I don't need any insulin for meals during the day because still in honeymoon period and my long-acting is only 6 units. I know the honeymoon won't last forever but my confidence has risen dramatically, I feel full every meal and sport levels are less up and down.

Thank you to this forum for making me aware of this diet and Dr Bernstein's book has enlightened my understanding further

 

[ButtterflyLady]

In your 20s being in your 40 seems so distant - I'm in my 40s and it seems like yesterday I was still in my 20s!

Back on topic - rather than focusing on the benefits eons into the future how can low carbing improve his quality of life now? For me I feel much better when my control is good which I can achieve so much easier through low carbing. If I'm on a high-to-low roller coaster I feel tired and grumpy. With good control I feel I can lead a more normal life and feel like less of a freak!

That's an excellent point, I will use that

 

[noblehead]

@CatLadyNZ, the benefits of needing less insulin is being able to predict how the insulin will be absorbed, higher doses of insulin are less predictable and can often lead to postprandial high's and low's which makes diabetes harder to control.

Some of the factors which can determine how much insulin one uses is diet (as discussed above) activity level, weight, insulin resistance, if the person is newly diagnosed and still in their Honeymoon Period plus other medical conditions and medication to name a few.

If your friend is eating a very high carb diet then its likely he will be using higher insulin doses than someone who low-carbs or eats carbs in moderation, but the amount of insulin type 1's use does vary from person-to-person and from previous discussions on the forum it's quite surprising how much insulin people use (total daily dose) compared to the carbs they eat in their diet.

For example someone who eats 30g a day may be on the same TDD as someone who eats 150g a day and that person may be on similar amounts to someone who eats say 230g a day, nothing is straight forward and I know if I eat a very low-carb meal I can use a similar amount of insulin to a meal that contains 50g of carbs which can be quite frustrating, but that is type 1 diabetes and nothing is ever straight forward.

Keep persevering with your friend and if you can get him to reduce his carb intake by a third or half then that should help matters somewhat, there's no need to go as low as Bernstein unless you really have to, but from my own experience a basal/bolus insulin regime is better than a twice daily fixed doses as you can adjust the carbs in your diet and there's no need to snack, but if your friend is more suited to twice daily injections and has better control on this regime then that is the one to go for.

 

[ButtterflyLady]

Thanks @noblehead that's useful info.

He is on a basal/bolus regime and has 32 units of lantus at night and around 10-14 units of novorapid with meals. I mentioned that I had heard lantus might not last a full 24 hours and some people split the dose, but he didn't seem to take that idea on board. *shrug*

He's had T1 for 6 years. His fasting BGs are usually between 10 and 18 and average around 14 (!)

In the last two weeks he has had a before-dinner 26 (!) and a before-lunch 3.7.

He can be moody and is often fatigued, but doesn't complain about that. He doesn't seem to care about it. Assuming he will continue eating high carb, if he was to adjust his ratios, or something, would that reduce his BGs?

Hard to watch someone ruining their health

 

[tim2000s]

@CatLadyNZ Your friends fatigue and mood are likely to be a direct consequence of massive fluctuations in bg levels and some of those very high levels. He is also at quite high rising retinopathy with those kind of swings.

It's very possible to eat high carb rather than average carb, but it requires careful management, a lot of observation and exquisite timing skills to manage the spikes.

With his average at 14 and norms between 10 and 18 he is very much running in an at risk zone and is already doing significant damage. That's the equivalent of an Hba1C of 91, so you don't need to hear anymore. All you can do is your best to encourage him.

 

[ButtterflyLady]

@CatLadyNZ Your friends fatigue and mood are likely to be a direct consequence of massive fluctuations in bg levels and some of those very high levels. He is also at quite high rising retinopathy with those kind of swings.

It's very possible to eat high carb rather than average carb, but it requires careful management, a lot of observation and exquisite timing skills to manage the spikes.

With his average at 14 and norms between 10 and 18 he is very much running in an at risk zone and is already doing significant damage. That's the equivalent of an Hba1C of 91, so you don't need to hear anymore. All you can do is your best to encourage him.

Thanks Tim. I might ask him when he last had an eye test. Maybe getting a bad result and a little chat from the optometrist might get through to him.

On the positive side, his mother has had a look at his record book and told him she wants to see an improvement, so he may well listen to her. He continues to talk excitedly about the possible artificial pancreas system that is being developed, but doesn't seem to connect with the fact that he is risking complications in the here and now. I haven't said this to him but my impression is that the first people to be offered that treatment will not be people with uncontrolled BG levels. Doctors will expect to see some commitment from prospective patients first.

 

[dancer]

If he's worried about putting on weight, you could suggest cutting down on carbs (and hence insulin). This would help him lose weight and, you never know, maybe he'd get better control.

 

[tim2000s]

I think the other aspect of this topic is the Hyperinsulinemia discussion (a la Fung and the fat emperor). Whilst a T1 by definition has Hyperinsulinemia due to the mechanism of insulin delivery, the degree to which it is in place may affect cardio-vascular health. In non-Ds, low levels of insulin correlate with better CV fitness. In the extreme world of the T1, higher levels of insulin may cause more rapid CV health issues such as quicker onset of Atherosclerosis, etc.

The various pieces of research available are rather variable as to whether increasing the insulin dose increases the already higher risk of CVD in T1s. There is research taken from reviewing medical records in the UK that links exogenous insulin in T2s to an increase in multiple death causing conditions, CVD, strokers and cancers being just some of them. I am unable to find the study, but there are multiple articles about it:
http://medicalxpress.com/news/2014-12-insulin-dosage-diabetes-linked-death.html
http://www.cardiff.ac.uk/news/view/77780-study-probes-insulin-effect

Quotes from those who ran it include:

"When compared to patients who received doses of less than 0.5 units [per kg of body weight], our findings indicate that patients receiving doses of between 1 to 1.5 units and more than 1.5 units were associated with a much greater death rate over time," says Principal Investigator, Professor Craig Currie, from Cardiff University School of Medicine.

"An estimated 15% of patients taking a dose of between 1 and 1.5 units had a 40% increased risk of death compared with the under-0.5 unit group, and the 5% of patients receiving more than 1.5 units had a 75% increased risk of death when compared with the same group."

 

[ButtterflyLady]

Another ray of hope is that he intends to increase his exercise and lose weight in a few months time when his living/work circumstances will change. I'm confident he will actually do this. He had to start taking an antidepressant last year and he believes it contributed to weight gain and I agree with that.

I recently read about antidepressant-induced weight gain and realised that may have been what set things in motion many years ago for me to develop T2. If I had things over again I would still take the meds, because I needed them. But it's such a shame that people need these meds sometimes, and that they can cause weight gain in some people. I really hope one day that better drugs are developed.

 

[noblehead]

Thanks @noblehead that's useful info.

He is on a basal/bolus regime and has 32 units of lantus at night and around 10-14 units of novorapid with meals. I mentioned that I had heard lantus might not last a full 24 hours and some people split the dose, but he didn't seem to take that idea on board. *shrug*

He's had T1 for 6 years. His fasting BGs are usually between 10 and 18 and average around 14 (!)

In the last two weeks he has had a before-dinner 26 (!) and a before-lunch 3.7.

He can be moody and is often fatigued, but doesn't complain about that. He doesn't seem to care about it. Assuming he will continue eating high carb, if he was to adjust his ratios, or something, would that reduce his BGs?

Hard to watch someone ruining their health

Hi @CatLadyNZ,

The first rule for anyone on a basal/bolus insulin regime is to get the basal dose right, if you don't get that right then everything else fails and you just end up chasing your tail all the time.

Gary Scheiner ( The author of the book Think Like a Pancreas) gives a good explanation on what role basal insulin plays and why it is important to get the dose right, if possible give your friend a link to it or print the article off, he should also consider buying the book as it offers up some great advice on controlling type 1 diabetes:

http://integrateddiabetes.com/basal-testing/

Hopefully when he gets the basics right and starts seeing improvements in his bg levels he can then look at his diet and overall health, do try and get him to join the forum at some point as there's some very knowledgeable type 1's on here who will help him on his journey.

 

[ButtterflyLady]

Hi @CatLadyNZ,

The first rule for anyone on a basal/bolus insulin regime is to get the basal dose right, if you don't get that right then everything else fails and you just end up chasing your tail all the time.

Gary Scheiner ( The author of the book Think Like a Pancreas) gives a good explanation on what role basal insulin plays and why it is important to get the dose right, if possible give your friend a link to it or print the article off, he should also consider buying the book as it offers up some great advice on controlling type 1 diabetes:

http://integrateddiabetes.com/basal-testing/

Hopefully when he gets the basics right and starts seeing improvements in his bg levels he can then look at his diet and overall health, do try and get him to join the forum at some point as there's some very knowledgeable type 1's on here who will help him on his journey.

Thanks for that info. Yes I would love it if he would join the forum.