Insulin Sensitivity on a Low Carb Diet

[Deekin]

Hello,

I'm a Type 1 diabetic and I decided to go low carb a week and a half ago. I eat about 30g of carbs a day.The first week was really good, with my blood glucose levels staying between 4 and 6 mmo/l. However, last weekend, my insulin resistance shot up and I've had trouble keeping my blood sugars stable. Has anyone else had any experience with this?

Thanks.

 

[noblehead]

I'll 'bump' this thread up for you Deekin as we do have type 1 low-carbers (30g and below) who have experienced similar.

 

[alaska]

Hi Deekin

I would be a little surprised if insulin resistance had developed after only 1 and a half weeks.

What I think is more likely is this:
If you've significantly reduced your carbohydrate intake, your body will probably now be using protein to raise your blood glucose levels so you can expect to see your insulin ratios changing -meaning you need to inject more insulin you would expect (following normal carbohydrate counting rules)

If I decide to have a steak and a virtually carb free salad (say spinach leaves), I find I still need to inject some rapid acting insulin to account for the protein in the steak.

Even if I have just cheese, I find that a single unit of insulin is needed. So my guess is that your body isn't becoming insulin resistant but likely to be adjusting to coping with less carbohydrate by utilising protein and/or fat to raise glucose levels.

Ed

[Interestingly, on a visit to Poland I noticed that the packets of milk warned/reminded people with diabetes that protein and fat also need to be taken into account for people with diabetes. It's worth noting that countries on the continent tend to have less reliance on carbohydrate so this may explain the greater need to point this out to consumers there. On trip to Germany and Poland I frequently notice that meals are served with salads much larger than the chips/potatoes portion, a relatively rare occurrence when eating out in the UK.]

 

[insanity]

Hi Deekin

I would be a little surprised if insulin resistance had developed after only 1 and a half weeks.

What I think is more likely is this:
If you've significantly reduced your carbohydrate intake, your body will probably now be using protein to raise your blood glucose levels so you can expect to see your insulin ratios changing -meaning you need to inject more insulin you would expect (following normal carbohydrate counting rules)

If I decide to have a steak and a virtually carb free salad (say spinach leaves), I find I still need to inject some rapid acting insulin to account for the protein in the steak.

Even if I have just cheese, I find that a single unit of insulin is needed. So my guess is that your body isn't becoming insulin resistant but likely to be adjusting to coping with less carbohydrate by utilising protein and/or fat to raise glucose levels.

Ed

[Interestingly, on a visit to Poland I noticed that the packets of milk warned/reminded people with diabetes that protein and fat also need to be taken into account for people with diabetes. It's worth noting that countries on the continent tend to have less reliance on carbohydrate so this may explain the greater need to point this out to consumers there. On trip to Germany and Poland I frequently notice that meals are served with salads much larger than the chips/potatoes portion, a relatively rare occurrence when eating out in the UK.]

Really interesting read, I'm wondering if that's what's happening to me at the moment. Everything has been great for weeks with my sugars (resting not including exercise) but in the last few days my normal routine / bolus's seems to be pushing my sugars up abit. Would make sense if the body then starts taking it's carbs from elsewhere

 

[alaska]

I missed out an important fact that is how the body responds to different meals in terms of insulin and glucagon release.

Consumption of carbohydrates triggers release of insulin from beta cells. Alpha cells become inhibited and cease to secrete glucagon.

A protein-rich meal leads to release of both insulin and glucagon. The very moderate rise in insulin associated with the protein meal stimulates uptake of the sugar formed in the liver by muscle and fat tissue.

More about this here
http://www.medbio.info/horn/time 3-4/homeostasis_2.htm

This perhaps offers a better explanation of why blood glucose levels can rise quickly after protein based meals.

Noting that those of us with type 1 diabetes won't be producing our own insulin but I would imagine the glucagon will react in a similar way as in these graphs to the different meals.

Ed

 

[noblehead]

Really interesting read, I'm wondering if that's what's happening to me at the moment. Everything has been great for weeks with my sugars (resting not including exercise) but in the last few days my normal routine / bolus's seems to be pushing my sugars up abit. Would make sense if the body then starts taking it's carbs from elsewhere

I believe in the absence of carbs protein converts to glucose by around 60%. I know if I were to have a breakfast of eggs & bacon I need around 4 units of QA insulin to cover the meal, my usual breakfast of porridge with blueberries, seeds and yogurt (40g of carbs) only needs an additional 1 unit of QA.

 

[insanity]

Really interesting read, I'm wondering if that's what's happening to me at the moment. Everything has been great for weeks with my sugars (resting not including exercise) but in the last few days my normal routine / bolus's seems to be pushing my sugars up abit. Would make sense if the body then starts taking it's carbs from elsewhere

I believe in the absence of carbs protein converts to glucose by around 60%. I know if I were to have a breakfast of eggs & bacon I need around 4 units of QA insulin to cover the meal, my usual breakfast of porridge with blueberries, seeds and yogurt (40g of carbs) only needs an additional 1 unit of QA.

I tried it last night with my chicken stir fry (no carbs) and I gave myself 1.5 units of insulin and it worked! I even managed to do my exercise class without a hypo for the first time in days! The body is very strange!

 

[alaska]

Great to hear it insanity. It's a pleasant relief when a source of confusion suddenly becomes more clear.

Ed

 

[SamJB]

Fascinating stuff Ed. I'm a T1 and have recently converted to low carbing. When I was eating carbs I was on 1 unit per 7g. Now I'm taking 3u no matter what I have for breakfast lunch or dinner. Must be my liver pumping out the same amount of glucogen, presumably the exact amount of energy that it requires.

Really, really interesting.

 

[smidge]

Wow Ed! Thanks for those graphs and explanation. The high protein graph bears out exactly what I see - BGs rising at the 3 - 4 hour mark after a low-carb high protein meal e.g. Steak and salad or omelette. I take about 50g carb a day, but I have to bolus for protein. Bacon and eggs is 1.5 units for example. I know Bernstein talks about 36 percent of protein converting to glucose and he gives a formula for how much to bolus for protein, but the 3 - 4 hour post meal rise was really confusing me and I think you've just explained it. That gives me a lot to think about.

Smidge

 

[phoenix]

I'd agree that a meal containing a lot of protein and few carbs causes me a rise in glucose levels. Personally, I find I need similar amounts of insulin for a non carb English breakfast as my more normal porridge and berries.

Noting that those of us with type 1 diabetes won't be producing our own insulin but I would imagine the glucagon will react in a similar way as in these graphs to the different meals

I'm not sure, I think it's a YMMV
The glucagon counter regulatory system is thought to be abnormal in all types of D. We produce more than we should one writer says ' a relative basal hyperglucagonemia' (lovely word), yet after a while we also have an impaired glucagon response to hypoglycemia.
Some suggest that there is damage to the alpha cells or perhaps there is a defect in the signalling system. Obviously without a natural release of insulin we have lost one side of the insulin/glucagon see saw .
Not going to give references but just google glucagon response T1 diabetes or glucagon levels T1 There are lots of papers but most of the ones that really go into it are very technical.
How normal our response is may perhaps depend on how long we have had D and how much insulin function is still there (they seem to think that at least 2/3 of T1s retain a little for decades)

 

[borofergie]

I'd agree that a meal containing a lot of protein and few carbs causes me a rise in glucose levels. Personally, I find I need similar amounts of insulin for a non carb English breakfast as my more normal porridge and berries.

Phoenix, what do you think about this:
http://www.ketotic.org/2012/08/if-you-e ... -turn.html
which suggests that the research shows that excess protein does not get turned to glucose.

I must admit, it doesn't tie up with my own observations, which clearly show that excess protein depresses ketone production. This could be down to the insulin response for protein, but if I'm not producing ketones or excess glucose, how am I fuelling my brain?