Is a Low Carb Diet Sustainable to Manage Type 1 Diabetes

[xjessica.rose]

Your high basal could be due to physiological insulin resistance. Read my post just above. LCHF doesn't suit every Type 1 (or every person). Aim for a level of carbs that suits you and keeps your blood sugar in range. Think Like A Pancreas is an excellent book to get to grips with Type 1

Thanks for your advice! I will have a go at giving that a read Tbh, I am trying to ditch the carbs in the effort to keep weight gain to a minimum so don't really want to add anymore than the 40g I already have from veges...

 

[CathP]

I think it's just as likely the process of protein being converted to glucose as your liver creating problems. You really do need to bolus for protein when low carb. And too much fat creates insulin resistance in my experience, moderate fat is the way to go. Best wishes.

 

[Brunneria]

Thanks for those links @azure ,

Interestingly they are probably the same links I would have come up with to explain what physiological insulin resistance is, and how normal and non-'shocking' it is.

Plus, it is probably worth noting that your two first links emphasise that they are discussing long term ketogenic diets. These are typically under 50 g carbs a day. So if we take 'low carbing' as anything under 130g carbs a day, there is a huge amount of leeway between 'going low carb' and 'going keto'. Plenty of scope there to avoid a bit of extra insulin resistance - if it is viewed as a problem.

My own experience is that I can 'break out' of physiological insulin resistance with just a few days of around 60g carb a day (coming out of ketosis), or a few long brisk dog walks, since the exercise also lowers insulin resistance. I love being able to fine tune things like this, at will. Although, from choice, i prefer being in ketosis and experiencing physiological insulin resistance, because of the comfortable buffer it gives me against hypos.

The link on the 'pizza effect' is also interesting, because, of course, pizza is a high carb food. So the blood glucose hiking after eating pizza is late because of the fat and protein, but it wouldn't happen without the high carbs in the meal. Beyond that, of course, I can't comment because I don't use insulin.

 

[azure]

@Brunneria I think the difference is you have your own insulin production. As I mentioned above, I believe the affect of physiological insulin resistance is different in Type 1s because we, by definition, lack insulin. Also, of course that then affects any recovery of sensitivity for Type 1s, and also can greatly affect insulin requirements.

I appreciate you're a diet treated Type 2 so probably not familiar with the use of insulin, particularly in Type 1s, but such an IR can mess up ratios and insulin doses greatly. As a related aside, it's also generally easier to bolus for meals that contain a moderate level of carbs as you don't have to bolus for the protein unless you're having a large amount.

As Cath P says above, controlling fat can help, but then, of course, you have to eat extra protein to maintain weight and that adds to the bolus calculation work. It's no simple answer.

LCHF is no magic bullet unfortunately - not as far as Type 1 is concerned.

A note about my use of the word 'shocking'. I don't mean that I'm shocked my body would do that, but I do mean I'm shocked at the effect physiological IR has on insulin requirements, and I'm always shocked when I read about Type 1s of a similar build to myself who are using far greater amounts of insulin than I am even though they're eating a fraction of the carbs.

So yes, it's normal and not pathological, but it is still something I would hate - because of the effect on insulin dosage and general Type 1 management.

 

[robert72]

Hi @xjessica.rose

Have you done any basal testing? You won't be able to work out your bolus requirements until your background insulin is level.

https://mysugr.com/basal-rate-testing/

 

[xjessica.rose]

Hi @xjessica.rose

Have you done any basal testing? You won't be able to work out your bolus requirements until your background insulin is level.

https://mysugr.com/basal-rate-testing/

I haven't tested in as much detail as the link goes into. I've gone from Levemir 8/8u to begin with to 17/17u now and my Dafne guides have said not to add anymore basal.. Think because they assume my liver will just counteract it?

I'm fairly new to all the liver/sensitivity/resistance stuff so just going on what I have been told during Dafne!

 

[robert72]

I haven't tested in as much detail as the link goes into. I've gone from Levemir 8/8u to begin with to 17/17u now and my Dafne guides have said not to add anymore basal.. Think because they assume my liver will just counteract it?

I'm fairly new to all the liver/sensitivity/resistance stuff so just going on what I have been told during Dafne!

Ah, OK - don't do anything you're not comfortable with.

 

[Brunneria]

@Brunneria I think the difference is you have your own insulin production. As I mentioned above, I believe the affect of physiological insulin resistance is different in Type 1s because we, by definition, lack insulin. Also, of course that then affects any recovery of sensitivity for Type 1s, and also can greatly affect insulin requirements.

I appreciate you're a diet treated Type 2 so probably not familiar with the use of insulin, particularly in Type 1s, but such an IR can mess up ratios and insulin doses greatly. As a related aside, it's also generally easier to bolus for meals that contain a moderate level of carbs as you don't have to bolus for the protein unless you're having a large amount.

As Cath P says above, controlling fat can help, but then, of course, you have to eat extra protein to maintain weight and that adds to the bolus calculation work. It's no simple answer.

LCHF is no magic bullet unfortunately - not as far as Type 1 is concerned.

A note about my use of the word 'shocking'. I don't mean that I'm shocked my body would do that, but I do mean I'm shocked at the effect physiological IR has on insulin requirements, and I'm always shocked when I read about Type 1s of a similar build to myself who are using far greater amounts of insulin than I am even though they're eating a fraction of the carbs.

So yes, it's normal and not pathological, but it is still something I would hate - because of the effect on insulin dosage and general Type 1 management.

But again, azure, I repeat, there is no need to develop physiological insulin resistance on a low carb diet. Carb intake is a choice, and low carb, with or without added fat, is adjustable. It is also quickly and easily reduced (if it occurs), by further dietary adjustments.

I find it very reassuring that so many T1s are now doing low carb, and posting on this forum, about how well it works for them.

 

[CathP]

I haven't tested in as much detail as the link goes into. I've gone from Levemir 8/8u to begin with to 17/17u now and my Dafne guides have said not to add anymore basal.. Think because they assume my liver will just counteract it?

I'm fairly new to all the liver/sensitivity/resistance stuff so just going on what I have been told during Dafne!

Possibly though the large amount of basal you're taking is because you're not bolusing the protein in your food? If you were covering your food correctly you wouldn't need so much basal?

 

[Kristin251]

I've just completed the week long DAFNE course and have been on the LCHF for a fair few months (40g of carbs a day roughly all from veg/salad). Even having 0 carb meals and using bolus doses to correct I haven't managed to get my levels under control during this week of the course. All the nurses and docs believe that my liver is overcompensating and kicking out excess glucose because there are no 'readily avaliable carbs' meaning my levels are staying high no matter what. I'm reluctant to add carbs like they suggest so I am waiting to hear what the consultant suggests in a week or so!

Have you read the Bernstein solution? He talks about blousing for half your protein and that ratio works perfect for me. To add, I do have to bolus for vegetables, even salad greens. Broccoli and green beans even more.
I also need to moderate the amount of protein I eat at one time and anything over 2-3 oz I have to split my bolus. 1/2 at the beginning and half an hour later. Excess protein can turn into bs albeit mufch slower than carbs. It takes longer to digest so if we eat large amounts we are most likely missing the peak as it is coming in hence the split bolus. Blousing for protein tends to be needed more when low carbing. Many of us keep out protein levels to just enough for maintenance and repair and no more. The basic formula is .8g protein for 1
kg LEAN ( what you would weight without body fat)
For instance I weigh 122 pounds which is 55 kg. If I use 100 pounds (45kg) I should be eating 36 g pure protein. An average ounce of protein is 7 grams. So I should eat about 5 oz protein. I kind of thought protein was a free food until I read the Rosedale diet and he explained how protein converts to glucose and advises no more than 15-21g per meal and 4 hours between protein. This was key to get bs control.
I have thrived being in ketosis for over 25 years eating 20g carbs or less a day. There is no requirement for carbs to live but there is for fat and protein. If you want to eat carbs then eat them and adjust your insulin accordingly. If you don't want to eat them then adjust your insulin accordingly. I prefer small low carb meals accompanied by smaller doses of insulin but we are all different. I also prefer very tight control with very little fluctuations and cannot do that eating carbs. Even if I could my stomach doesn't like it haha.

I had a small hypo for no known reason one day and got just lettuce and Caesar dressingwith no carbs and within two hours popped up 50 points. We all need to test test test. For me, I obviously need to bolus for lettuce. Keep in mind if you are low carb you will most likely be more sensitive to them. Just keep testing

 

[therower]

As a T1 of 25yrs + I've dealt with it in many different ways, diet, exercise regime's, insulin types, guess work, exact carb counting, totally focused 24/7 and take it has it comes.
As the thread relates to LCHF I feel that input is valuable to fellow T1's.
LCHF obviously works for those who it works for.
Personally I think LCHF suits T2 diabetes more than T1.
The term LCHF is extremely misleading especially to newly diagnosed diabetics, 20/50/80/100 grams. Opinions seem to vary.
We are all different , if we were not this forum wouldn't exist.
The fact that a Doctor presents a case for LCHF will always outweigh what i believe.
I've gone down the LCHF route twice , 1st time not totally educated 2nd time with as much information I could obtain from the people here.
LCHF is in my opinion and my experience not the way to manage diabetes. Mentally, physically and emotionally it just doesn't give me the results.
Sorry if this seems negative but to any other diabetics out there who feel a bit left out of the great LCHF way of doing it don't despair you're not alone.
LCHF is a way worth considering, but there are other ways.

 

[Kristin251]

Additionally, I need to add a certain amount of fat at each meal or the carbs and protein will spike me much faster and higher. My go to best bs food is avocado. 1/3 with each meal helps keep things low and slow. Love my avocado!!! Olive oil and other fats don't seem to do the same thing so I'm sure it's the fiber as well.

 

[azure]

But again, azure, I repeat, there is no need to develop physiological insulin resistance on a low carb diet. Carb intake is a choice, and low carb, with or without added fat, is adjustable. It is also quickly and easily reduced (if it occurs), by further dietary adjustments.

I find it very reassuring that so many T1s are now doing low carb, and posting on this forum, about how well it works for them.

Yes - the higher range of LC is definitely a better option to avoid physiological insulin resistance

Most Type 1s eat a moderate amount of carbs and that appears to work well

 

[Kristin251]

I have no signs of physiological insulin resistant. I am very insulin sensative but that could just be me ....or you.

 

[CathP]

Most Type 1s eat a moderate amount of carbs and that appears to work well

Most type 1s fall short of hba1c targets, so they're not doing so well really...isn't around 8% the average hba1c? Not blaming the moderate carbs, just saying most aren't doing so well.

 

[azure]

Most type 1s fall short of hba1c targets, so they're not doing so well really...isn't around 8% the average hba1c? Not blaming the moderate carbs, just saying most aren't doing so well.

Yes, that's very true - and very sad. It would be fair to say that the members here are probably more involved in their diabetes, so don't necessarily reflect the national picture.

What the reasons for the higher HbA1C are, I don't know, but I do think education and support could be improved. I was lucky enough to get a short but exceptionally thorough explanation of carb counting when I was diagnosed, and I find it upsetting to read posts from Type 1s who haven't had that personal input.

 

[Nidge247]

I've been lchf for the last 18 months; 16 of those have been insulin-free (bar the occasional higher carb meal-out/take-away).

My usual meals are double-portion protein with lots of above-ground veg. This keeps my BG's in the 4-5-6 range. No more raging hypers or hypos, and very easy to keep just above 5 for driving.

So far, it's worked very well for me, and I'm so pleased to 'have my life back'. I was so ill in Nov 2014 at diagnosis; it was doubted I'd make Christmas (hba1c of 101). However, here we are - and partly attributed to you fine folks on this forum, with your wealth of advice to share .

I can easily adjust my weight with protein intake, and am happy with my current size. It's all just been a balancing act; a daily intake of 40-60g carbs works great for me. - and far more easily attainable than I thought possible. I recently calculated what I used to eat daily; around 1700g carbs which I thought was healthy as it was all whole grain stuff - my poor pancreas!

Drinking plenty of water also helps. Yes, more frequent loo trips, but it keeps everything flushed through and helps avoid glucose building up in your urine. It also helps with keeping you feeling fuller longer! If you've got the fat content of your diet right, then you shouldn't feel hungry between meals anyway.

 

[Brunneria]

Most type 1s fall short of hba1c targets, so they're not doing so well really...isn't around 8% the average hba1c? Not blaming the moderate carbs, just saying most aren't doing so well.

I recently visited this webpage, and found the graphs there very illuminating.
http://typeonegrit.blogspot.co.uk/

 

[CathP]

I recently visited this webpage, and found the graphs there very illuminating.
http://typeonegrit.blogspot.co.uk/

Yep the statistics speak for themselves. We follow TYPEONEGRIT and LC, and my 5 year old has an hba1c of 5.7%.

 

[azure]

Yep the statistics speak for themselves. We follow TYPEONEGRIT and LC, and my 5 year old has an hba1c of 5.7%.

We're all different I follow moderate carbs and my last three HbA1Cs were 4.6, 4.7 and 5.1