Delaying the Progression of Type 1 Diabetes

SamJB said:

Great conclusion to our little conversation; you scorn away, whilst those who low carb are rewarded by the benefits of “low dose, low error”!

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This surely assumes all the errors work against you? Some will, some won't; with enough degrees of freedom (and I'm sure high, medium and low carbers will at least agree there are many variables!), the probability is that the sum of the errors will be considerably smaller than the worst case scenario...

Shiba.

Shiba Park said:

This surely assumes all the errors work against you? Some will, some won't; with enough degrees of freedom (and I'm sure high, medium and low carbers will at least agree there are many variables!), the probability is that the sum of the errors will be considerably smaller than the worst case scenario...

Shiba.

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Reducing your exposure to dosing errors will only ever work in your favour.

SamJB said:

Reducing your exposure to dosing errors will only ever work in your favour.

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That's not necessarily true; it depends on the magnitude and likely effect of the remaining errors and what you're trying to achieve. But mathematically and empirically, reducing the number of sources of error can actually increase the variability - it depends how dominant the variable you're controlling is.

Getting way off topic with this now! I agree it works for some people, unfortunately not for all...

Shiba.

Shiba Park said:

That's not necessarily true; it depends on the magnitude and likely effect of the remaining errors and what you're trying to achieve. But mathematically and empirically, reducing the number of sources of error can actually increase the variability - it depends how dominant the variable you're controlling is.

Getting way off topic with this now! I agree it works for some people, unfortunately not for all...

Shiba.

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Getting your dose correct won't work in your favour? How?

Sure, if you've got 100 stochastic error sources and get rid of two of them, the variability could improve due to chance (just as much as it might not), but that's not what we're talking about - it's not about accounting for noise. Low carbing is about reducing the two most dominant sources of dose errors - nutritional labeling and the quantity of injected insulin becoming active.

SamJB said:

Low carbing is about reducing the two most dominant sources of dose errors - nutritional labeling and the quantity of injected insulin becoming active.

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Any thoughts on how cgm changes the picture?

Sure, I know not everyone has it but it's only a matter of time until it's as commonplace as meters.

That point aside, for those of us who do, it's an accepted part of ideas like Sugar Surfing that there are unpredictable variables but just by being able to see how a trace is playing out after a meal, we can make small adjustments to sort any initial dosing errors long before we're out of range. It reduces risk massively.

Sure, it might mean I have to spend a bit more time glancing at my watch and maybe a few more injections, but that's a trade I'm willing to make to be able to have a bit of cheesecake every now and then.

Scott-C said:

That point aside, for those of us who do, it's an accepted part of ideas like Sugar Surfing that there are unpredictable variables but just by being able to see how a trace is playing out after a meal, we can make small adjustments to sort any initial dosing errors long before we're out of range. It reduces risk massively.

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This is what I'm thinking too. It's making our injections work more like a pancreas - a closed loop control system, not open-loop planning only.

SamJB said:

Getting your dose correct won't work in your favour? How?

Sure, if you've got 100 stochastic error sources and get rid of two of them, the variability could improve due to chance (just as much as it might not), but that's not what we're talking about - it's not about accounting for noise. Low carbing is about reducing the two most dominant sources of dose errors - nutritional labeling and the quantity of injected insulin becoming active.

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I'm certainly not saying getting your dose right won't work in your favour!

But the two most dominant sources of error have been addressed since Bernstein developed his philosophy; we don't use Dulux colour charts to measure (guess!) our glucose levels and insulin is much more flat for basal and rapid for bolus.

But what is 'right'? For me, right is primarily being where I expect to be once the carbs and insulin have both run their course. Secondary (but still important) to that is what was the journey during that period.

Don't get me wrong, I'm not being negative about low carb, but for a sample size of 1 (me) it's more challenging than eating a moderate amount of carbs. I'm just putting forward the idea that it's not the panacea for all.

For example, I'm very insulin sensitive; using even a half unit pen gives me a dosing granularity of about 15g carbs or 3mmol/L. When eating small amounts of carbs it's very difficult to end up where I want to be, and there's frequently a race condition between the insulin and the carbs as the insulin kicks in very quickly...

I'm not pretending I'm typical, but equally I'm not that rare either.

As people keep saying on this forum, we're all different. Your favoured philosophy doesn't work for all, but just because someone isn't for it doesn't mean their against it...

And while it IS important for people know about Bernstein's principles, it's equally important to know about the other approaches people take.

Vive la difference!

Shiba.

kev-w said:

Yes my ratio would change with more carbs or a higher carb meal, a 90g carb meal (l;ike on my pics but with a little less rice) has a sweet spot of 5u, to up to 120g would want 7 or 7.5u which isn't a proportionate rise and would more likely than not require a correction later on where the 'lower' carb one wouldn't, but over time the sweet spot meal is causing a little weight loss so I upped carbs and insulin for a couple of weeks to put the weight back on, changed insulin time, a couple of days drifting high and its gone again

If I wasn't as active I'd not be able to tolerate the complex carbs I eat in the quantities I eat them in for sure, and I don't drink alcohol, eat cake, crisps, pies, pastries or anything that remotely looks like being made with simple sugars.

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This is interesting!
I think I notice that my ratio changes as my blood sugar goes higher, i.e. if I'm in the 4-7 range I can 'cover' my meal with a normal dose, but if I am high, say 7-8 when I start eating, and eat the same meal (or as same as it can be ..) I often (not necessarily always) need to correct extra 2-3 hours after the meal since my bolus (for high) plus my meal bolus was to small. I think this is due to the fact that I'm higher, I think Bernstein talks about this in his book but I can't remember.
kev-w do you think that this might be the reason, i.e. the more carbs you eat the higher your spike gets therefore you need a higher ratio of insulin to carbs?

Scott-C said:

Any thoughts on how cgm changes the picture?

Sure, I know not everyone has it but it's only a matter of time until it's as commonplace as meters.

That point aside, for those of us who do, it's an accepted part of ideas like Sugar Surfing that there are unpredictable variables but just by being able to see how a trace is playing out after a meal, we can make small adjustments to sort any initial dosing errors long before we're out of range. It reduces risk massively.

Sure, it might mean I have to spend a bit more time glancing at my watch and maybe a few more injections, but that's a trade I'm willing to make to be able to have a bit of cheesecake every now and then.

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I don't really have or have ever had a CGM, but I do have a libre with the MiaoMiao and xDrip+. So maybe we can call that a CGM?
I dropped my HbA1c from about 8, to 5.5 to 5.8 by going low carb. Getting the Libre+MiaoMiao+xDrip+ instead of going low carb for sure would have dropped my HbA1c, but down to below 6, I dont think so.

I have use the libre without MiaoMiao for I think a year, and it has really helped me a lot, but funnily my HbA1c have not gone down, I think this is because of 2 things:
1) my values was already so good that I used the extra data I got to get better life quality instead of chasing better values.
2) The libre for me was showing consistently low values of about 1 mmol/l, I have been afraid to go lower than 4 my whole life, so I just did not dare to go below libre 4, so I basically tried to achieve 4-6 by libre, which was 5-7 by finger prick.

Now I have had the MiaoMiao for 3+ week, my libre average blood sugar is down by 0.5 or more. My blood sugar curve is much flatter, since xDrip+ can give me alarm in the office when I'm working and I can take sugar to level out and at night.

So a CGM should be able to help everyone achieve better blood sugar if you can afford one get one, but I think low carb/low dose is more effective, but better anyone out of two than nothing!

Stefans said:

This is interesting!
I think I notice that my ratio changes as my blood sugar goes higher, i.e. if I'm in the 4-7 range I can 'cover' my meal with a normal dose, but if I am high, say 7-8 when I start eating, and eat the same meal (or as same as it can be ..) I often (not necessarily always) need to correct extra 2-3 hours after the meal since my bolus (for high) plus my meal bolus was to small. I think this is due to the fact that I'm higher, I think Bernstein talks about this in his book but I can't remember.
kev-w do you think that this might be the reason, i.e. the more carbs you eat the higher your spike gets therefore you need a higher ratio of insulin to carbs?

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I don't reckon much to Bernstein tbh, but no, carbs up so more insulin, what I see is a reasonably simple 100g carb meal I can inject 6-7u for working out ok but a 120g carb meal needing a correction dose as an extra 2u pre bolus hypos or mild hypos me.