Keto diet

[Agnes14]

Hi!
I'm new to posting here, been type 1 on insulin for over 20 years. I'm looking for advice.
I started following a low carb diet about 1 month ago which is fantastic during the day - very few hypos. However despite repeatedly reducing my dose of background insulin and now taking NO lantus at all (my usual background insulin) and not taking ANY insulin after 7pm I spend most of the night with my blood sugar under 3! The constant repeated hypos are exhausting me- I'm having 3 a night!

I don't understand why this is happening as I'm thinking there should be no active insulin during night? (the amounts of fast acting I do take for meals during the day are fairly small ie 4 units for dinner at 5.30pm...)
Do any other type 1s have similar issues with low carb?

 

[Daibell]

Hi. How were you diagnosed originally as T1?

 

[Agnes14]

I developed diabetes as a teenager over 22 years ago, I was given tablets to see if they helped but then needed to start insulin as the tablets didn't work very well. So think it s just assumed I was type 1? Think they were sulphonylurea tablets that I was taking (but it was a long time ago !)
My insulin dosage has always been on the lowish side--12 units of basal and approx 14 fast acting on normal diet.

I have no idea why I keep having these prolonged night time hypos- do you have these problems also?

 

[Cobia]

Hi my levimir went up with the lchf diet....

Only thing i can think of is go back to your GP for some tests... somethings not right.

 

[endocrinegremlin]

If you are type one, it doesn't matter what your diet is, you will need some sort of background insulin. It sounds like your body is reacting horrendously to your change in diet and you should constant the hospital asap. If you don't want to consume carbs they can help you with that but no type one can rely on no insulin at all.

 

[Tophat1900]

I developed diabetes as a teenager over 22 years ago, I was given tablets to see if they helped but then needed to start insulin as the tablets didn't work very well. So think it s just assumed I was type 1? Think they were sulphonylurea tablets that I was taking (but it was a long time ago !)
My insulin dosage has always been on the lowish side--12 units of basal and approx 14 fast acting on normal diet.

I have no idea why I keep having these prolonged night time hypos- do you have these problems also?

If your type was made by just an assumption, then I'd suggest you get tested to confirm which type you are.

 

[Agnes14]

Thank you for your replies.
I do like the low carb diet as it means not having hypos during the day, but having been on insulin for so long it makes me VERY uncomfortable not having my background lantus. As soon as I wake up in the morning I go from 5 to 12 in an hour so I know I do need insulin.
I would like to speak to the diabetic team but as I dread their reaction-- my night time readings (I have Freestyle libre) over the last month are really horrific...

 

[bulkbiker]

Thank you for your replies.
I do like the low carb diet as it means not having hypos during the day, but having been on insulin for so long it makes me VERY uncomfortable not having my background lantus. As soon as I wake up in the morning I go from 5 to 12 in an hour so I know I do need insulin.
I would like to speak to the diabetic team but as I dread their reaction-- my night time readings (I have Freestyle libre) over the last month are really horrific...

Do you sleep on the side with the sensor? I know that some members have reported they get hypo readings when wearing the Libre due to the pressure on the sensor making it read low? I think it may have been @Brunneria who noticed/reported this?

 

[Daibell]

I developed diabetes as a teenager over 22 years ago, I was given tablets to see if they helped but then needed to start insulin as the tablets didn't work very well. So think it s just assumed I was type 1? Think they were sulphonylurea tablets that I was taking (but it was a long time ago !)
My insulin dosage has always been on the lowish side--12 units of basal and approx 14 fast acting on normal diet.

I have no idea why I keep having these prolonged night time hypos- do you have these problems also?

Hi. It sounds like you may fit into the LADA category which is T1 but may have a long honeymoon period (mine has lasted 10 years or more and continues). Yours appears to be different in that your pancreas might be recovering which is quite unusual whereas mine continues to degrade. Don't worry about needing to reduce your insulin as you just need to match it to your needs and perhaps your Basal is still too high resulting in hypos. Your GP can do two tests (there may be others). GAD tests for antibodies but isn't that reliable when it gives a negative result and as NICE says it often gives a negative as time goes on after diagnosis. The c-peptide test could be useful as it measures whether your insulin production is high or low and that might guide you into where you are on the diabetes spectrum? Obviously your GP may be able to find out more about your specific condition.

 

[DCUKMod]

@Agnes14 - Whilst I am not T1, I have used several Libr sensors. Without exception the Libre night time traces prove evey day I am a walking miracle, in that I either live at 2.2, or quite simply Lo, according to the Libre traces.

Have you ever tried testing during the night, if you wake, or conversely waking yourself at 2 or 3am and doing a finger prick test?

For me, the Libre has been useful in identifying trends, but less useful in identifying absolute numbers. I am very slight, with very lean arms, and I have asked Abbott is this impacts on the Libre performance. It allegedly doesn't, and I guess bearing in mind it is authorised for your children with even less arm fat than I, due to their size, if nothing else, I suppose I can buy that.

I think I simply lie on the sensor and the lows are either compression lows, caused by the pressure on the sensor, or it gets very hot, and that impacts things.

Of course, my reaction, aside from a little disappointment has virtually no implications, but for a T1 a true low obviously has far greater implications.

Would this be an opportunity to do some basal testing, along with some finger rprick testing through the night? It could be quite enlightening.

I'll not comment further, as I'm sure some T1 Libre users will have much more useful suggestions, in terms of yourr medication and next steps.

It is very annoying though!

 

[Brunneria]

Thank you for your replies.
I do like the low carb diet as it means not having hypos during the day, but having been on insulin for so long it makes me VERY uncomfortable not having my background lantus. As soon as I wake up in the morning I go from 5 to 12 in an hour so I know I do need insulin.
I would like to speak to the diabetic team but as I dread their reaction-- my night time readings (I have Freestyle libre) over the last month are really horrific...

Hi Agnes
Please do not dread discussing this with your diabetic team.
You should contact them immediately to get their input.

Your night time very low readings could be several things, from compression lows, as @bulkbiker suggests, genuine lows, or maybe the sensor(s) reading low. All my recent sensors have read consistently at least 1mmol/l lower than my prick tests do. No idea why, and I REALLY wouldn’t like to use the Libre to assess hypos or insulin! Nor would I be trusting it to verify I was safe to drive.

Whatever your D team say, I would urge you to double check those night time readings. Repeatedly. Set an alarm and do a prick test. Different nights. Different times during the night. Knowledge is power.

Hope that helps!

 

[KK123]

Hi. It sounds like you may fit into the LADA category which is T1 but may have a long honeymoon period (mine has lasted 10 years or more and continues). Yours appears to be different in that your pancreas might be recovering which is quite unusual whereas mine continues to degrade. Don't worry about needing to reduce your insulin as you just need to match it to your needs and perhaps your Basal is still too high resulting in hypos. Your GP can do two tests (there may be others). GAD tests for antibodies but isn't that reliable when it gives a negative result and as NICE says it often gives a negative as time goes on after diagnosis. The c-peptide test could be useful as it measures whether your insulin production is high or low and that might guide you into where you are on the diabetes spectrum? Obviously your GP may be able to find out more about your specific condition.

But the poster has stopped the basal?, and their levels are going up to 12 in the mornings.

 

[LittleGreyCat]

But the poster has stopped the basal?, and their levels are going up to 12 in the mornings.

Perhaps it should be noted that T2s can see similar (or worse) readings especially after a liver dump.

The OP seems to be seeing results which could be in line with a low level of Insulin production coupled with Insulin Resistance.

Time to check for the pancreas still being at least partially functional.
There has been interesting recent research on beta cell regeneration in T1s.

 

[Agnes14]

Thank you all for taking the time to read and reply
Yes I regularly do finger prick blood glucose also, (I have to set alarms to try and catch them before they go too low) and have noticed that the libre usually does exaggerates the lows, I never realised that was compression on my arm during the night, that's very helpful to know. It's a really useful tool to have-- and I absolutely LOVE the libre , not 100%accurate but great for picking up trends and seeing when your heading low/high.

Thank you Diabell - asking for a C peptide test sounds very helpful, think it does seem like maybe there's still a bit of insulin there - but it seems very erratic and unreliable. It would be good to know if my body was still producing some insulin after all this time! Can I ask what are your approx insulin requirements as LADA? Are your basal and fast acting dosage still quite low? My requirements have always been really erratic!!

 

[Agnes14]

Sorry just seeing the last replies since I posted - it would be great if there was still insulin being produced!
Yes think my liver seems to 'dump' glucose, the minute I wake up it starts to go high I need to take 2 or 3 units just to get it back down. Then my levels are fine after this during the day, with small amounts for meals as they are all no/low carb. Then when I even start to get tired at night my BG falls like a rock, always need to take fast acting carbs before I go to bed, and still end up hypo! (and no basal at all, it's so frustrating! )
Thank you all for helping me to understand what's going on, as I've been getting so confused. It's so good to be able to speak about problems like this with people who live with diabetes! Diabetes is such hard work.

 

[MayAnderson]

I like the keto diet to taste. But my body strongly protests against the removal of carbs completely. I try to stick to just a moderate diet (without fast carbs), as long as my health allows it.