Carb question

[Claremc71]

Hi I'm new to the forum I am type 1 diagnosed 4 years ago and am a bit confused about carbs. I have been on dafne and was led to believe you can eat anything as long as you adjust insulin to match. I have never been told by any doctor or nurse to follow low carb diet just came across it on here?! Is this something new or have I missed something completely

 

[Charles Robin]

Low carbing is a great way of managing diabetes, but not everyone agrees. There are a huge number of reasons for this. If you want a detailed and in depth answer to your question, get hold of Dr Bernstein's complete diabetes solution. If at this point you are more curious than desperate to try it, this video can help explain a lot about low carbing.

 

[Charles Robin]

I should also point out that's Dr Richard Bernstein. There's a Dr Stanley Bernstein that has nothing to do with diabetes.

 

[noblehead]

Low carb diets have been around for decades, the Atkins diet was doing the rounds in the 70's & 80's.

Low carb diets are manly followed by those with type 2 diabetes although there are a few type 1's who do follow a LC diet, if your struggling with your diabetes control then it might be worth trying, if not then there's no reason for doing so, however you might find that eating carbs in moderation (say 150g a day) might work just as well.

 

[CarbsRok]

Hi I'm new to the forum I am type 1 diagnosed 4 years ago and am a bit confused about carbs. I have been on dafne and was led to believe you can eat anything as long as you adjust insulin to match. I have never been told by any doctor or nurse to follow low carb diet just came across it on here?! Is this something new or have I missed something completely

Many people seem to misunderstand the idea of DAFNE.
DAFNE is meant to enable people to follow any type of diet they so wish as the course teaches them the basic values of carb counting and insulin adjustment.
So yes in theory you can eat anything you like, you just have to remember the words moderation and common sense

 

[SamJB]

Unfortunately, carb counting doesn't work for everyone. In fact, it doesn't work for most people. Only 7% of type 1s achieve the HbA1c target of 6.5%. If can do that with carb counting, and have a low hypo frequency, then carry on. If, however, you don't, but want to get to 6.5% easily and reduce your hypo frequency, then give it a go. It's a piece if cake (excuse the terrible pun).

You basically swap carbs for veg, seeds, nuts and protein.

 

[Daibell]

I carb count and have very good overall control; last HBa1C was 6.3%. The advantage of low-carbing is that it avoids unwanted weight gain and results in reduced insulin and hence reduced blood sugar swings. This reduces the risk of hypos; I've not had one in 15 months since starting insulin although I've come close a few times. Sadly DAFNE appears to totally ignore the implications of excess carbs on weight gain and sugar swings.

 

[phoenix]

You can dose adjust to match diets with all sorts of amounts of carbohydrates.
I believe that a healthy diet doesn't include large amounts of junk food but here are lots of foods containing carbohydrates that form part of a healthy diet. Fruit, vegetables of all types, legumes and whole grains, all contain carbohydrates and all also contain lots of vitamins, minerals and fibre, dairy also contains carbs.
As for the quantity you eat, it depends totally on how much you need for your lifestyle and I think that applies to all foods
. When I was doing a lot of long distance running, I ate more calories, and that included more carbohydrates; conversely I had very low insulin needs. I didn't put on weight
More recently, I have not been quite as active, so I require fewer calories and that includes fewer carbohydrates. I actually need somewhat more insulin because my basal requirements are higher.

Edit:
It's off topic but relates to what Sam said.
there is some evidence that carb counting courses alone don't reduce HbA1c by huge amounts. There may be many reasons for this as suggested in this article.http://www.endocrineweb.com/profess...ing-may-not-deliver-vast-glycemic-improvement
I do think that most of us that have very good HbA1cs,tend to try to adapt our doses to the circumstances and previous experience. This is a very proactive and isn't just following a set of carb counting/dose adjustment guidelines
The published study is in the Lancet behind a pay wall but I found it here :http://www.researchgate.net/publica...iabetes_a_systematic_review_and_meta-analysis

 

[Daibell]

You can dose adjust to match diets with all sorts of amounts of carbohydrates.
I believe that a healthy diet doesn't include large amounts of junk food but here are lots of foods containing carbohydrates that form part of a healthy diet. Fruit, vegetables of all types, legumes and whole grains, all contain carbohydrates and all also contain lots of vitamins, minerals and fibre, dairy also contains carbs.
As for the quantity you eat, it depends totally on how much you need for your lifestyle and I think that applies to all foods
. When I was doing a lot of long distance running, I ate more calories, and that included more carbohydrates; conversely I had very low insulin needs. I didn't put on weight
More recently, I have not been quite as active, so I require fewer calories and that includes fewer carbohydrates. I actually need somewhat more insulin because my basal requirements are higher.

Edit:
It's off topic but relates to what Sam said.
there is some evidence that carb counting courses alone don't reduce HbA1c by huge amounts. There may be many reasons for this as suggested in this article.http://www.endocrineweb.com/profess...ing-may-not-deliver-vast-glycemic-improvement
I do think that most of us that have very good HbA1cs,tend to try to adapt our doses to the circumstances and previous experience. This is a very proactive and isn't just following a set of carb counting/dose adjustment guidelines
The published study is in the Lancet behind a pay wall but I found it here :http://www.researchgate.net/publica...iabetes_a_systematic_review_and_meta-analysis

Interesting articles. I think many of us who carb count can see that it is an imperfect science. I tend to add a bit more insulin if I'm having fats and protein with the meal and may delay the injection if I can see that the fat in a mixed meal or complex carbs might slow absorption. Both articles talk about alternate methods besides carb-counting but don't say what these are apart from the obvious fixed meal approach which is not a life-style I would like to follow. So, imperfect though it is, I think for many of us it remains the best approach overall.

 

[Spiker]

Unfortunately, carb counting doesn't work for everyone. In fact, it doesn't work for most people. Only 7% of type 1s achieve the HbA1c target of 6.5%. If can do that with carb counting, and have a low hypo frequency, then carry on. If, however, you don't, but want to get to 6.5% easily and reduce your hypo frequency, then give it a go. It's a piece if cake (excuse the terrible pun).

You basically swap carbs for veg, seeds, nuts and protein.

Sam I think that implies that it's either carb counting or low carb. There are also all the T1 diabetics T1 who are just on fixed per meal bolus doses, or those on mixes but who weren't advised to carb count. The old school (fixed quantity) carb counters (diagnosed pre 1980s? ) are now an endangered species, and the practice has died out from hospitals. I actually learned (variable quantity) carb counting (and dose adjustment) from Dr Bernstein as a key part of his low carb approach, so for me they are the same thing, not different things, and not the only ways of managing T1.

But it's mainly just terminology I suppose.

Miraculously sent via Diabetes Forum App. Probably on the 4th or 5th try :-/

 

[phoenix]

The old school (fixed quantity) carb counters (diagnosed pre 1980s? ) are now an endangered species, and the practice has died out from hospitals

It hasn't here. I was put onto a fixed dose with a counted but fixed amount of carbs for each meal in 2005. (adjusted up or down based on the previous three days results). The carb content was about 180g total.(including, veg, fruit, dairy as well as starches which all have a fixed place in the meal pattern) There is no doubt in my mind this can work as long as you live a 'regular' lifestyle. Insulin is adjusted but according to a sliding scale
I occasionally meet a couple of the people from that initial course and they continue to follow their regimen . They are doing well as far as HbA1cs go (both in the low 6s) .
.

 

[iHs]

There's no need for anyone to feel that good control involves getting an Hba1c of 6.5% or less.
Good control can be achieved with an a1c between 6.7 and 7.2%. There are loads of type 1 diabetics who have an a1c within that range and like me, have diabetes for about 40+ years, with very little going wrong. Tighter control means eating far less carb or injecting more insulin but whatever, hypos are usually a frequent problem resulting in changes to awareness even when eating more protein and fat. That's why I keep my target bg levels ranging from 6mmol before eating, then allow bg to rise up to 8-9mmol 3hrs later. If I used the target of 5mmol rising to 7-8mmol, then hypos a plenty and mild loss of awareness and constant feeling of walking on a tightrope, frightened to fall off.

Sent from the Diabetes Forum App

 

[phoenix]

Edited to add: I tend to agree with you, I think that we are all very different and there are certainly many people who cannot safely aim for very low levels. I myself would never want to try to get back down to the low 5s again. I'm much happier being able to feel hypos at around 4mmol/l because there is a far bigger safety net.


The targets in the NICE pathway for Type 1 are not indeed not as low as stated earlier in the thread
Targets for clinical monitoring
HbA1c < 7.5 %
If increased arterial risk: HbA1c = 6.5 %.
http://pathways.nice.org.uk/pathways/diabetes#path=view:/pathways/diabetes/managing-type-1-diabetes-in-adults.xml&content=view-node:nodes-monitoring-blood-glucose
(and the Joslin medalists have average HbA1cs in the low 7%s )

 

[Spiker]

It hasn't here. I was put onto a fixed dose with a counted but fixed amount of carbs for each meal in 2005. (adjusted up or down based on the previous three days results). The carb content was about 180g total.(including, veg, fruit, dairy as well as starches which all have a fixed place in the meal pattern) There is no doubt in my mind this can work as long as you live a 'regular' lifestyle. Insulin is adjusted but according to a sliding scale
I occasionally meet a couple of the people from that initial course and they continue to follow their regimen . They are doing well as far as HbA1cs go (both in the low 6s) .
.

Sorry, I didn't mean to suggest there was anything wrong with fixed carb regimes, just that they had become a "lost art" within the NHS. Personally I believe the fixed carb regime was much more effective than the very wooly version of basal bolus - minus carb counting - that I was taught in the 90s. The DSNs were breathless with excitement about this new flexible regime they were offering newly diagnosed patients. But actually it was really ineffective, almost meaningless guidance.

Miraculously sent via Diabetes Forum App. Probably on the 4th or 5th try :-/

 

[iHs]

Probably tighter control without the risk of losing some degree of hypo awareness could be achieved with a very fast onset bolus but one with a very short action to it. These insulins are long overdue. Biodel should have succeeded with Viaject but failed and now its all eyes on Afreeza from Mannkind which has an extremely fast onset and was featured in the trials for the artificial pancreas with good results. Not sure if diabetics will like using the Dreamboat inhaler but 'the proof will be in the pudding'. I could imagine Degludec or another basal being used but it looks promising

Sent from the Diabetes Forum App

 

[Geordie lass]

I have been a T1 diabetic for 10 years now and in the early days I was never educated on carb counting or insulin dose adjustment! It has only been in the last 4 years that I really carb counted and adjusted my insulin doses. My consultant wouldn't even put me on a pump back then as I didn't check my BS levels often and didn't carb count! Now, I use My Fitness Pal app to help with my carb counting and I use this every day. My daily carb intake is currently around 50g. This has improved my BS levels as well as cutting down on the number of hypos I have. I never did the DAFNE course but I have been living in Australia for the last two years and did a similar course called SMART1E. I found this very useful, especially now using a pump.

 

[SamJB]

Regarding HbA1c targets, it all comes down to personal risk. The big DCCT trial that the 6.5% is based on shows that at that HbA1c the risk of complications for a diabetic population is near unity with the non-diabetic population. The 7.5% target is larger that 6.5% because of the assumed risk of hypos that an HbA1c < 6.5% carries. This assumed risk of hypos is based on a non-low-carb diet. One of the great things about a low carb diet is that hypo frequency and severity are reduced.

And with personal risk, when my HbA1c was in the 7s I had retinopathy, but when it dropped to the low-6s, it disappeared. So my complication risk seems to match that of the DCCT study. Others, of course, may be more tolerant of elevated blood glucose levels, and may not get complications with an HbA1c in the 7s.

So, I think an HbA1c near 6.5% (give or take) is optimal for me and should be a national efficacy target.

 

[noblehead]

I think it's fair to say we should all have our own individual targets and try to stick with them, personally I never wanted an Hba1c in the 4's or 5's but appreciate that some people do, 6 - 7 % is a good range IMHO but obviously there are circumstances where people need to aim higher.

 

[Spiker]

@SamJB that's a really good point. The hba1c targets are set based on the point where increasing risks are believed to offset decreasing benefits. But the risks are primarily from hypos. So it makes sense to aim for a lower target, if you can be sure of not increasing hypos. And the hypo data is from a non low carbing population.

 

[Flowerpot]

I have evolved to eating about 70-80g of carbohydrate per day in an attempt to gain better control. I didn't make a sudden decision to cut back, more of a gradual change. When faced with serious complications of sight loss, kidney disease and no hypo awareness plus advice from the clinic to get my HbA1c down towards 6.5 it seemed like my choices were limited.

The only safe way I have found to get my HbA1c to 6.6% is by reducing carbs and consequently reducing my insulin requirements. I'm in the tricky position of having no hypo awareness where you would aim for a slightly higher HbA1c but having complications where I need as good an HbA1c as possible. Getting to an HbA1c in the mid 6's although it has been quite a challenge is where I need to be for my future well being.

My diabetes tightrope has become narrower and narrower to balance on with less wiggle room. A lower carb diet has seemed to help me balance a lot better whilst thankfully avoiding too many hypos. My choice to reduce my carbohydrate intake and insulin needs was met with raised eyebrows at my clinic although they were pleased with the resultant reduction in HbA1c