help/advice re low carb debate

[chocoholicnomore]

Hi

I really need help and advice re the low carb debate.

Can a T2 diabetic who is fully dependant on insulin go low carb or does it not help them in any way?

My dad strictly follows NHS guidelines and has carbs with every meal. He insists he needs them because he is on insulin. However, even though he is very strict with himself his BG control is erratic. He has nothing to eat between breakfast and lunch and sometimes hypos just before lunch. I suggested a low carb snack mid morning but his answer is he needs carbs to prevent going hypo. When I suggested going low carb he said that even if he didn't eat anything at all then his BG level would still increase. He also has hypo 4 hrs after main evening meal which usually includes potatoes. He has reduced his insulin and is taking less than he used to. If he doesn't hypo than he goes to the opposite extreme with readings over 10.

My problem is I am fairly new to this and am controlling BG by diet and metformin. I don't have the knowledge and experience to help him. After reading everything on here I don't think dietician or any NHS advice would help him in any way.
He is so strict with himself and records absolutely everything and doesn't eat between meals but what he is doing doesn't seem to be working.

I so much want to help him to achieve better control but he is adamant that he is doing everything he possibly can. I have my doubts though as he has always followed NHS advice. His last hba1c was 8.something.

Any help/answers/advice/opinions/experience would be greatly appreciated.

Thanks

 

[phoenix]

Ask your Dad what insulin he uses. Any answer is dependent upon the type of insulin regime used by your Dad. Many T2s are on what are called mixed or biphasic insulin where the long term and short term are premixed. This is a much less flexible regime than most of the T1s on this forum use .......Basically with this regime (mixed insulin), if you reduce the insulin you not only reduce the insulin to cover the carbs at the meal but you necessarily also reduce the insulin that deals with the background glucose released by the liver. A fairly rigid type of diet with a fixed amount of carbs at regular times can work well with this type of regime.

edited for clarity

 

[xyzzy]

As Phoenix says an insulin user calculates an amount to inject based on how many carbs they eat. Theoretically they can eat anything so long as they cover it with enough insulin. In practice insulin has a tendency to make people gain weight which means their insulin resistance rises which means more insulin. So the long term dangers for an insulin user are an increased risk of heart attacks and strokes IF they do not control their weight. One of the reasons an insulin user may chose to low carb is to reduce the amount of insulin they need to inject. In reality if your Dad is not putting on weight and is relatively fit he should try as Phoenix says to stabilise his BG's by adjusting his daily regime which is different than lowering his carbs, he may need to eat more!

 

[hanadr]

If you use insulin, you pretty much need carbs to "Feed" the insulin to prevent hypos. It's medication that causes hypo, not Diabetes usually.
Thus anyone using insulin will have to reduce it in line with their carbs. that isn't necessarily easy to do.
How the insulin doses are reduced does depend on what the insulin regime is. Some T2s use only a single dose of a long acting insulin and that would involve, reducing the dose and the carbs and measuring several times a day to see that bg levels didn't go too far off target, in either direction. The pre mixes are more difficult to work out.
Nevertheless testing a number of times per day will be what it takes.
what your dd has found is that the Conventional advice to diabetics just doesn't work. If you tell the healthcare team that, they will usually tell you you are not following the advice correcttly, even if you know you are!!
Diabetics tend not to get support in reducing medication from their healthcare teams. there are a few shining lights around, but they are rare. If your Dad is one of those people ,like my Mum, who believe the doctors know best :lol: , then it will be difficult to find a way round the problem. My Mum has had to lose the sight of an eye, before she'd believe me.she doesn't use insulin, so she has been able to cut down on carbs.
It's worth a try. Even if it proves to be difficult
It's worth looking in Bernstein's book to find guidance on how someone using insulin can reduce the carbs.
Lowercarbs ~ less insulin ~ less vvariation in bg.
Hana

 

[chocoholicnomore]

Thanks for your replies.

It all sounds a bit double dutch to me but I will show it to my dad and, hopefully, he will understand it.

Will probably come back with more questions :?

 

[Anonymous]

I'm type 2 on both basal and bolus insulin. I've found since being on insulin I've had a lot more hypos. I definitely need carbs with every meal. I have also found that I have to be careful what carbs I have. Beginning of last year I was put on a very restrictive diet to test for food intolerance... it limited my carb options. I had so many hypos during that time that my medical team had to take me off the diet... and that's after my dietitian tried to figure it out for me too before concluding that I wasn't able to do it she kept saying "it's not good for you".

 

[Pneu]

chocoholicnomore...

To try and simplify things!

Blood Glucose are increased primarily in two ways

1) Your Liver throughout the day releases stored glucose.
2) Carbohydrate (and Protein in some circumstances) is converted to glucose.

If you are insulin controlled (i.e. you produce none or a limited amount of your own insulin... all type I's and some type II's) then each unit of insulin you inject will allow the body to convert a certain amount of glucose.

There are two main insulin treatment regime's.

1) A 'mixtard' regime... Typically a person injects twice per day.. the injection contains a long acting insulin and a rapid acting insulin.. the long acting insulin deals with the glucose released by the liver and the rapid acting insulin is used to cover glucose from food... these regime's tend to be quite restrictive because the person must eat enough carbohydrates to ensure the rapid insulin doesn't make them hypo...

2) A Basal / Bolus regime... This is the typical regime for Type I's also known as MDI.. here the person injects one insulin for dealing with the liver and a separate insulin for dealing with the food. Because the insulins are separate you can change the balance between the two..

Being able to change the balance is important because it means that you can still inject the amount you need to keep your fasting levels stable but you can inject less if you want to eat more or less carbohydrate than usual... In a mixtard regime you have to eat a set amount of carbohydrate as defined by the amount of inject... so in a mixtard regime if you need a lot of insulin to control your liver then you are going to need to eat a lot of carbohydrate to counteract the rapid insulin you are also injecting.. in a MDI regime you could simply inject less rapid insulin and therefore it is much easier to deal with varying levels of carbohydrate.

 

[Pneu]

I'm type 2 on both basal and bolus insulin. I've found since being on insulin I've had a lot more hypos. I definitely need carbs with every meal. I have also found that I have to be careful what carbs I have. Beginning of last year I was put on a very restrictive diet to test for food intolerance... it limited my carb options. I had so many hypos during that time that my medical team had to take me off the diet... and that's after my dietitian tried to figure it out for me too before concluding that I wasn't able to do it she kept saying "it's not good for you".

Mep... simple answer is if you are hypo'ing then generally you are injecting the wrong amount of insulin.. How did they determine your insulin requirement? have you done any fasting tests to ensure the basal is accurate... this is normally the biggest cause of problems on MDI..

 

[Anonymous]

Mep... simple answer is if you are hypo'ing then generally you are injecting the wrong amount of insulin.. How did they determine your insulin requirement? have you done any fasting tests to ensure the basal is accurate... this is normally the biggest cause of problems on MDI..

Yes that's right... as mentioned my medical team worked with me. It didn't matter how many units I was injecting, I still had at least one hypo every day on that diet. My diabetes management hasn't been that easy due to digestive problems still not fixed... I've just been told I've a hiatal hernia.