Insulin to carbs or carbs to insulin

The advice I was given when diagnosed with type 1 is that it should not stop me doing (and eating) what I want.
I have followed that advice ever since and maintained good results.
I sometimes get my carb calculation wrong and need to correct and can understand if you eat less carbs, your insulin calculations are likely to be more accurate.
However, I believe in balance and for me, that includes a balance of diabetes control and living the life I want.
I may be lucky because I enjoy exercise and the only weight problem I have is making sure I eat enough to maintain my weight.

I was told NO potato, sugar and related (honey, glucose etc), little bread (multigrain) and the list goes on. I was told fresh fruit is ok, even though some fruits are higher in sugars. There are a few Keto fan boys here. Humans are omnivores. We need minerals and vitamins from a range of foods. Being diabetic does not reduce the need for vitamins and minerals. My carb to insulin is quite high. When I’m able to do a lot of exercise I halve my ratio of insulin to carbs. Occasionally I do misbehave and have potato’s, rice etc, but I really have to up the insulin.

Insulin is a nasty drug (hormone to be exact) and it’s accused of a number of issues, however for a diabetic the side effects pale into insignicagance, so the less you consume the better off you will be, but remember if you need x units take x units of insulin

I match insulin to what I want to eat for meals, but also use food to correct if necessary.

I was diagnosed just after they'd given up doing carbohydrate restriction as normal, and a bit before DAFNE was a thing. I was encouraged to eat normally, and not to worry about rice, pasta, etc. I mostly worked out dosage tweaking for myself.

High carb suits me - I burn it off doing things in hills, also I just like it. The Libre is helping with managing it better.

(caveat - I'm not a natural binger, moderation seems to suit me. That makes life easier too.)

Hi, @JAT1 , as you say, you're still new to this and still finding your way.

I've been doing T1 for a long time, about 30 yrs.

I'd encourage you to have a close look at who is posting and what their background is - are they T1 or T2?

T1 and T2 have fundamentally different biology. If you get a T2 saying you should never eat that, that might be good advice for a T2, but it means diddly-squot for T1s.

There is no reason at all why T1s shouldn't eat fruit. T2s talk about fructose, but that is of no relevance at all to T1s, because the biology is different.

Provided you get your pre-bolus timing and absorption clues figured out, there is absolutely no problems at all for a T1 with a few figs, greengages, plums, peaches, melon etc after a meal.

They contain lots of nutrients, which are good for our health, and the pleasure of eating them is good for our psychological welfare too..

This site can be useful at times, but just be aware that the main contributors are T2. As I've said, T1 is a fundamentally different condition.

It is a serious mistake to take T2 advice and apply it to T1. We have considerably more latitude with carbs. You shouldn't allow yourself to be terrified of either carbs or insulin by people who are playing a completely different metabolic game.

Edited by moderator to remove rude comments about others.

Hi @JAT1, Are you diagnosed as T1 or T2 or another category?
If T1, what insulin are you prescribed and what doses do you take.?
Do you use a correction factor for high BSLs ato calculate correction doses of insulin and an insulin to carbs ratio also?

Less carbs means less insulin, means less chance of things going wrong, so experiment for yourself and find what works for you.
Personally I have been low carb for the last year or so. Aiming for <50g carb per day. I do a physical job but can"t always predict how much exercise will be involved, and I don't get many breaks. The low carb really helps.
I use a libre with a smartwatch to help towards tighter control.
Humalog & Levemir.

I'm T1 and eat about 200g of carb per day, which is not so far off the recommended amount (at least 260g according to the NHS). The most significant way I notice this restriction is to limit any one meal to a max 50-60g of carbs, with the very occasional exception. That can be frustrating but I just find these amounts far easier to manage.

I like to exercise and be active so feel i'd struggle on v low carbs (though I know is possible).

For me, I would find it impossible to eat anything I want and get a sub 42 HbA1c.

My last HbA1c was 34 and i've been in the higher 30s for the last 3 years or so (since using Libre and now Dexcom).

For me nothing is off the menu and will adjust my insulin depending on what I eat.

I will do low carb but only because it looks more tasty that something that is high carb for example.

Its all a game, and a little bit of an experimentation to find out what works for you.

Even after 50+ years I am still experimenting.

Whichever path you choose, it’s critically important that if you’re experimenting with lower carbohydrate eating, then you need to monitor your blood glucose concentration with extreme caution. This is true for all insulin dependent diabetics, whether type 1 or type 2. The risks of hypoglycaemia if incorrectly dosing your insulin are very real and very dangerous. I’m sure you already know this but it’s worth bringing attention to it for the benefit of those reading who may not.

As a type 2, I have no opinion on the discussion as a whole.

In addition to understanding what type of diabetes the respondents have, perhaps it would also be useful to understand when they were diagnosed as the advice has changed over the years as more and more is discovered about diabetes.
For example, the basal-bolus insulin regime taken by many people with type 1 was introduced less than 20 years ago. This regime, allows you to dose insulin according to what is eaten.
Some people are still on two fixed doses of insulin which limits what they can eat.
Some people have transitioned from one to the other but still has a mindset of fixed doses.

From a general perspective in reviewing t1 comments over time, the majority of t1's here match the insulin to carbs eaten, so many eat their preferred food types and take x insulin to cover it. I personally learned early on that maintaining good control meant watching the amount of carbs I eat, I was diagnosed 6 years ago and struggled with balancing my control, so would swing from 3mmol/l up to 18 daily, mentally this was draining, so i've tightened my control, carb count carefully, pre bolus by up to 20 mins and apply corrections whenever I need to. I know that many cope happily eating x carbs per day and maintain excellent control, and on that basis it is very much a personal thing, so it's good to know how others do it but their way may not necessarily the best method for you.

I am interested to ask how you have arrived at your current way of doing things ?

I do both (T1, diagnosed a bit over 2 years ago, basal/bolus regime on injections). I found bolusing for sweet stuff like cake and fruits difficult, so I usually just take a couple of bites and leave the rest to my friends or my guinea-pigs.
For me, eating a high carb meal like Chinese take-away or spaghetti means I spend the next 5 or 6 hours watching my bg like a hawk to correct with either insulin or some extra carbs. I'm usually too lazy for that so I don't use pasta, rice, potatoes or bread in my meals very often. For stuff I like a lot, like Chinese take-away, fresh bread or beer I sometimes feel it's worth it the extra work . Same goes for eating at friends places, restaurants and things like Christmas, although I tend to choose less carby options like a cheese platter over a sweet dessert.

As a TID, not as professional advice or opinion:
Bluntly put, it is horses for courses. We will have individual responses to food which influence what we eat either as T1s or T2s.
And yes, if you have a metabolism which tends to burn through food rather than store it, and have the capacity, endurance and level of activity and the means (added insulin) to tolerate a high carb diet then that will suit you ....until it doesn't so much.
Why?
What happens if you are unfortunate to be laid up with an injury or illness or cannot maintain a certain activity level?
Yep, your insulin sensitivity drops and the type of carbs you liked so much or the quantities you eat, now put BSLs up too much. Or in trying to keep up the active days you eat , have even more insulin and then you realise that you are gaining weight. Down goes the insulin sensitivity etc.
Yes, your metabolic type in this supposed temporarily infirm state may allow you more food than some diabetic, T1, in the similar situation who has a slower metabolism (or who has an undiagnosed under-active thyroid for example).
High carb might be perfectly OK for your metabolism type but saying that all T1s can eat what they like and just adjust insulin is simplistic. Life is more complicated than that. And naturally you are talking about now and the years before, not about in 20 years time. Some of the T1s you are posting to are that 20 years etc older, their metabolism, activity level etc will have altered somewhat. They cannot get away with as much carb and size of meal, or not without gaining too much weight and its attendant problems.. And I am writing about my experience from ages 13 to 65.
And saying that, as an example "I can eat anything I want" like a badge of defiance over this condition is all very well but not actually helpful to those who find as T1s they cannot do that.
So other diets may suit some T1s better whether young or older , low carb high fat amongst them and that causes some restrictions but as those that thrive on such diets report, hunger is not the problem as it was on higher carb diets, hypos are less common or severe.
And have those putting in unit after unit of insulin, as I have done in the long past, thought about what happens at higher levels of insulin in their blood.?
Yes you say the metabolism of T2s is different but it may be worth sparing a thought about at what level of insulin do troubles associated with hyperinsulinaemia start? I profess I do not have a clue, the levels may not be comparable with T2s but perhaps someone knows.
The work of Feinman, Berstein and others that T2s in particular need to regulate their carb intake is so obvious it was almost a certainty that someone would oppose it - like previously the ADA, still some dietitians and, lest we forget, the food industry.
But the obvious also applies to some degree to all diabetics. Yes, T1s have fruit but a plateful of dates or figs?. They know when too much is too much and have to run it off. Is that smart?
And the saving grace for TIs is that they either have learnt to manage their diets and insulin adjustments very well, bit still have lots of hypos, good on them if they can and life is enjoyable, or they rely on CGM to keep them out of trouble, and if that works that is a vast improvement on yesteryear. But it will also tell them when they overdo it with food moreso than before CGM.
Are T1s on higher carb diets and CGM eating anything and everything or does CGM give them pause?
What much is it regulating carbs and dosing accordingly? How much is playing sliding carb scale, dosing up and correction doses later chasing after the bsl s or running it off or treating the impressive hypo?.

kitedoc said:

What happens if you are unfortunate to be laid up with an injury or illness or cannot maintain a certain activity level?

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When I had 3 months enforced inactivity due to a broken hip, I ate less. Simple as that.

I eat what I want and inject to cover carbs. But we are all different and what 1 person finds works will be a disaster for the next. 48 years and still learning new things every day Good luck in whatever you decide to do

kitedoc said:

What happens if you are unfortunate to be laid up with an injury or illness or cannot maintain a certain activity level?

Click to expand...

Nothing - I had surgery 18 months ago and was advised not to exercise for 2 month.
Whilst I only maintained the sedentary lifestyle for a month, I believe my increased insulin resistance was due to the surgery as it was only for the first 10 days.
I would also add that I am not 20 years old. However, being more than twice that, I have not experienced a change in my metabolic rate.
Whilst I eat "what I want", that does not mean I stuff myself with high carb meals all the time. I believe I enjoy a "balanced diet" - some days are higher carbs, some days are lower carbs, some days I may only eat 3 or 4 of my "5 a day" fruit and vegetables, some days I eat more than 10.
When people of the forum mention the amount of insulin they take a day, I am certainly on the lower side. So, in 15 years with the condition, I am not worried about putting in unit after unit of insulin.
I keep a watching eye on my BG levels (not always through the Libre), I exercise (but not to lower my BG or my insulin requirements) and will adjust my insulin dose, lifestyle, diet if or when I see I need adjustments.

Perhaps I am unusual in my experience.
But the same can be said about all of us and I would hate to jump to conclusions based on a sample of one (me).

Hi @JAT1
Lots of answers above. I think that the answer lies with the old “eat to your meter” and you say lots of hypos with lower carb.
So, are you happy eating lower carb? In which case lower insulin if that option is available to you - if not speak to your team.
Or are you miserable without fruit/bread/potato/insert carby foodstuff here? In which case a little more balance of carb/insulin might be good.
We are all different and need to find our own way. I don’t often eat fruit, but take fresh bread away from me and I get angry.

I do low carb but probably not Keto. I'm adult onset type 1 and using insulin only for about 3 years. So I'm very new
I normally eat no starchy carbs but nowadays I'm a little more flexible than right after diagnosis. I can eat small portion of potato mash or bread if eating out and it happened to be on my plate. Low carb suites me well but also it's good to be flexible too. As others say it's a balancing thing and finding what you feel most comfortable.

The reason for doing low carb is it is for me the easiest way to handle the condition (stable bs, no correction) and it's allowing me to live almost hypo free (almost because miscalculation still happens..)

helensaramay said:

In addition to understanding what type of diabetes the respondents have, perhaps it would also be useful to understand when they were diagnosed as the advice has changed over the years as more and more is discovered about diabetes.
For example, the basal-bolus insulin regime taken by many people with type 1 was introduced less than 20 years ago. This regime, allows you to dose insulin according to what is eaten.
Some people are still on two fixed doses of insulin which limits what they can eat.
Some people have transitioned from one to the other but still has a mindset of fixed doses.

Click to expand...

Hi @helensaramay ,

I was diagnosed in 1976 & was doing MDI in 1988. An insulatard & "Actrapid," back then..
It was sold to me as "more flexible" for the lifestyle I was leading at the time when the consultant balked at my R&R exploits.
My first pens were about 10mms longer than they are now, flat on two opposing sides (so the didn't toll I suppose?) & were a plastic commodor 64 in in hue... Happy days.

@JAT1 in answer to your question. I bolus for what I eat. For me though. Not all carbs are equal. I don't eat cake.
I'm a little bit like @Benny G regarding mixing my diabetes & work. But my carb intake isn't quite as low..

Without waffling on too long. A personal basal dosage is what it is... Test what works first as the foundation. Then, whatever diatary choice you chose to bolus for? Will make it easier.

From memory, diabetes is still early days for you. Follow your HCP's advice & get a handle on what you're doing first.
Then as you notice any "snags." Work it from there..

Best wishes.