I have always enjoyed your commentaries and experiments and I have to say I completely concur, as a type 1. Am lower carb than you as my stomach doesn’t tolerate a lot of the foods you eat but I have to restrict protein to about 45 g per day. I don’t tolerate much at bf. Mostly just fat like avocado. As the day goes on I can ramp up a bit. The fattier the meat / Fish, the more insulin I need so I stick to leaner. I fill my 20carbs per day and 45 G protein with fat to satisfy. Mostly comes from an avocado a day divided into each meal, mayo, olive oil and a few nuts scattered through the day JUST until satisfied. I take low doses of insulin so if I eat more than two ounces of protein at one meal I need to split my bolus. Proving protein raises me and I become insulin resistant. However I am vlc so I gluconeogenisis like a rock star. I think I eat balanced but a higher percentage of fat. Plant fats are much kinder to me than animal fat
This is what works for ME. We are all different.
Hello my beautiful Kristin,
I, always, get so happy when I read a comment from you; I hope that you are very well.
I, honestly, believe that for a Type 2/LADA, you are handling your nutrition very accurately. Please let me explain why…
When I was firstly diagnosed with Type 1, I went through a prolonged honeymoon period (which, now, seeing it in retrospect, is very similar – in its handling- to Type 2/LADA diabetes). I was, initially, prescribed metformin pills (which I was taking for 2 years). As my diabetes was getting worse, we added a background insulin (Tresiba), then Tresiba and metformin, finally, as my diabetes progressed, Tresiba and Novorapid (and now Levemir and Novorapid). So, it is almost as if I have been through the whole process from Type 2/LADA to Type 1 and I have tried most remedy combinations.
Similarly, I have also experimented with any type of diet you can imagine. Through my experience, here is what I came up with:
1. Most people believe that our food turns into sugar once it reaches our stomach. This is incorrect. Digestion starts in our mouth and ends in the intestine, which means that food has to travel all the way to the intestine and this is where it gets absorbed and becomes sugar. (This is the reason why, when we want to treat a hypoglycaemia, even quick acting liquids like Lucozade, need some 20 minutes and sometimes even more to start working).
So, food turns into sugar in the intestine, not in the stomach.
2. We know from bibliography that simple carbohydrates need anywhere from 30 minutes – 2 hours to turn into sugar. Protein like fish and poultry need around 2-3 hours. Beef around 4-5 hours and types of meat like lamb can take anywhere between 6-8 hours.
Keeping this in mind:
The pancreas of a Type 2/ LADA still produces some insulin (the problem is insulin resistance and its absorption). So, when a Type 2 who doesn’t use insulin, eats a bacon and eggs omelette, because of the protein content and the fat in it, the omelette breaks down into sugar very slowly… it may take 4 or 5 hours, maybe more (after all, this is why it is so filling). The innate insulin production of a Type 2, can catch up with this slow bg rise…
I think, this is the reason why, most Type 2s/LADAs find the Ketogenic diets useful to them. Their own insulin production can handle the sugar content of a low carbs diet and, if they add a little bit of background insulin or a unit of quick acting to cover the carbs intake then it’s all good for them.
During my honeymoon period, I used to swear by Paleo diets. If anyone told me to eat, even, an apple I would think they don’t know what they are saying and they don’t understand diabetes. This is the reason why, I understand all these people who support Ketogenic diets, I have been in this place myself, I have done it too.
I am a Type 1. My pancreas doesn’t produce any insulin and, if it does, it is very little. In order for me to eat, I need Novorapid, which lasts about 4 hours (5 to some people but, lets take 4 hours as an average). As a Type 1, I have this 4 hours window that Novorapid gives me therefore, I need to find foods that my body can digest and turn into sugar within these 4 hours. So, in my case, if I eat, say, lamb, my insulin will cover the carbs with my meal within this 4 hour window but, from then onwards lamb will start turning into sugar and I won’t have any insulin onboard to cover this…
So, if I have this lunch at 13:00, my Novorapid ends around 16:00 and lamb starts to turn into sugar between 17:00-20:00. I end up with high blood sugar for dinner, and I cannot calculate my dinner Novorapid correctly as I cannot calculate how much I need for the lamb that I had for lunch earlier that day.
Unless I have a pump to make hourly adjustments (and I don’t) there is no other way to control it than either injecting 2-3 times until dinner (and I can’t do this… for me, 5 injections are already too many every day, I think) or I can exercise better control regarding my food choices. This is what I decided to do.
So I sat down together with the glycemic load list and figured out what I can eat that will act well for me within the 4 hours Novorapid window. This is fresh fruits and salads, some types of legumes, wholemeal pasta, wholemeal bread (tortillas etc but not rye bread or pumpernickel bread, they act way to slow) and healthy plant fat like avocado (which is also good for us as it protects against breast cancer), olives and some olive oil (although I try to avoid processed foods of high calorific content) and dairy alternatives.
I think this is the reason why you may hear many Type1s complaining about their elevated blood sugars well after the Novorapid 4 hour window and they keep wondering if their basal insulin isn’t well balanced. I do believe, in most cases, it’s not an insulin dosage problem. It’s the type of foods they choose.
3. According to nutritionists, our body needs 0.8 – 1.0 gram of protein (meat/pountry/fish etc) per day (not per meal…per day… it made such an impression on me when I heard this… I was amazed by the fact that we generally tend to eat much more than the amount of food we need…) to repair damaged tissue so for a person who weights 70 kilos, they will need 70 grams of protein per day. That’s it. Everything additional (like these delicious 8 oz steaks that some have for lunch) becomes sugar.
So, as a Type 1, I have found my solution in big bowls of fresh salads, fruits, wholemeal pasta, nice recipes with turkey, bacon, spinach and kale / ratatouille (which is very traditional for us coming from the French side of Switzerland) and so many other delicious dishes… from fresh salads with pomengranate to heary breakfasts with coconut yogurt, some fruit and honey and a small butter croissant, Greek Kakavia (fish soup)… lentil tabbouleh, roast aubergines with mince, lentils and coconut yogurt… Honestly, I could write a cook book, the list of delicious foods is endless… and they all work well and within the 4 hours provided by my Novorapid. And all not exceeding 30 grams of carbs (when in the right quantities).
And if I crave a handful of hazelnuts (or two), I go for a jog or yoga after 4 hours and I don’t need to worry about a hypoglycaemia. So, it all works well (like a Swiss clock
).
The reason why I believe you have figured it our correctly is because you balance your protein and fat content. Most Type2s/LADAs eat incredibly large amounts of protein and fat, which will give them a good result when it comes to their blood sugar levels but, what they don’t understand is that, in a few years they will be challenged with clotted arteries, heart conditions, elevated triglycerids and high cholesterol so, their doctors will ask from them to turn to a more plant based diet. Eventually, they will be forced to it in order to save their heart. Additionally, all this protein and fat will make them more insulin resistant and, chances are, they will end up in a basal/bolus scheme eventhough they aren't Type1s.
Keto diets (without a correct balance or fat and other nutrients) are nutritional micro-options (they serve a purpose for now) but, not marco-options.
And before the hordes of Keto-diet supporters start coming at me (because I can already sense the reaction coming
) by saying that there is no study verifying that animal protein is responsible for heart conditions etc, I have to admit that, indeed, animal protein is not connected to any heart conditions… but, I don’t know of anyone who opens a can of tuna in water and eats it with a glass of water… the problem with animal protein is that no one eats only protein and, when protein gets into a mix of fat and even the lowest amount of carbohydrates, then complications start.
Thank you for your patience.
Love & hugs and wishes for a beautiful weekend ahead!
Josephine.