Little bit confused..

[Maco]

After seeing numerous posts on low carb I’ve moved over to the dark side, haven’t particularly done it for diabetic benefits as my control when eating carbs was really good.

I started low carb yesterday, 29G of carbs a day. I’m still weighing/counting my carbs precisely & taking the insulin for it even though it’s really minimum. Sometimes less than 1unit which is possible to give because I’m on a pump.

Anyway, my BG is all over the place. Really fighting to keep it under 10, don’t get me wrong it’s not spiking into the 11/12’s but usually I’m 100% in range and since yesterday I’m down to 86% which is weird considering I’ve gone from 200g of carbs to 29G. My pump is giving non stop correction doses because it can sense me wanting to go above 10mmol & when I’ve give my self a corrective dose it doesn’t actually budge my BG at all.

Is this just my body adjusting?

 

[StewM]

Yeah it sounds like your body’s panicked* at the change and is dumping your energy reserves to make up the difference.

*Mildly informed speculation

 

[Maco]

Yeah it sounds like your body’s panicked* at the change and is dumping your energy reserves to make up the difference.

*Mildly informed speculation

This is what I’d though, energy levels are non existent at the minute.

 

[Antje77]

Can it be your basal rate is a bit off?
I assume when you ate plenty of carbs you dosed for the carbs you ate. Sometimes more, sometimes fewer. If some of that dosing went to your basal needs it may be both your basal and your I:C ratios are a bit off. Have you done any basal testing with fasting during different times of the day lately?

It's just speculation on my part, not advice. From experience (usually lowish carb but not as low as 30 grams) I'm pretty sure my bolus takes care of some of my basal needs.

 

[Maco]

Can it be your basal rate is a bit off?
I assume when you ate plenty of carbs you dosed for the carbs you ate. Sometimes more, sometimes fewer. If some of that dosing went to your basal needs it may be both your basal and your I:C ratios are a bit off. Have you done any basal testing with fasting during different times of the day lately?

It's just speculation on my part, not advice. From experience (usually lowish carb but not as low as 30 grams) I'm pretty sure my bolus takes care of some of my basal needs.

I’m on the 780G @Antje77 so the basal is not something I can control, looking at my 7 day history it actually looks like the pump has given me more basal over the last 36hrs than it normally does. An increase from 25% basal to 36% if I’m working it out correctly. As for carb ratios, I’ve tried to over count the carbs to see if that will work but unfortunately it had no effect. For instance my tea was 7g of carbs so I did a bolus for 20G, it seemed pointless taking 0.6units. My BG is risen from 9mmol to 10.2mmol and the pump is now auto correcting again.

I know I’m making a big fuss out of BG readings of 10mmol, but when I’m usually never above 7/8 when eating 200g of carbs and now I’m out of range more than ever eating hardly any carbs at all. I’d usually have a bowl of chocolate coco pops after the gym and a Rice Krispie squares bar before I train, both high in carbs & id never see a spike at all. I’ve swapped these for snacks with around 3G of carbs and seeing raises which is mega annoying

 

[StewM]

This is what I’d though, energy levels are non existent at the minute.

If we’re right, it should take your body a few days to adjust and then you should go back to normal.

 

[Maco]

Upto 12.4mmol from 9 now with 7g of carbs. Very weird

 

[ert]

How much protein are you eating? I follow Dr Bernstein's Diabetes Solution. I'm on a low carbohydrate diet so dose for my protein as well as my 30 grams of carbohydrates a day. 1 oz of protein is covered by 0.5 a unit of fast-acting insulin. I give this as a split dose as protein takes longer to break down than carbohydrates and I'm using Fiasp which is fast.

 

[Maco]

How much protein are you eating? I follow Dr Bernstein's Diabetes Solution. I'm on a low carbohydrate diet so dose for my protein as well as my 30 grams of carbohydrates a day. 1 oz of protein is covered by 0.5 a unit of fast-acting insulin. I give this as a split dose as protein takes longer to break down than carbohydrates and I'm using Fiasp which is fast.

I’m on a LOT of protein but I have been for the last year & the protein amount and protein sources haven’t changed (mince, turkey, chicken + whey shakes). For instance for dinner tonight, 200G of mince which id usually have with 200g of rice. Instead of normal rice I had cauliflower rice & broccoli. I’ve never had any issues with protein and needing to bolus for it & if I’m totally honest if I started to need to bolus for protein I’d just swap back to eating my normal carbs as I couldn’t really be bothered with the faff on of counting it etc

 

[HSSS]

Switching to keto is a huge adjustment for non diabetics and type 2. I’m guessing it is for type 1 too. It turns the body and many of it’s processes upside down if you do it cold turkey. Somewhat scary I should imagine when relying on insulin and watching the changes on a chart. No useful advice at all other than a hope you get through the adjustment without feeling at risk and find a new settled normal the other side. Typeonegrit on Facebook might be useful.

 

[Antje77]

I know I’m making a big fuss out of BG readings of 10mmol

Don't worry about that. Sometimes it's hard to ask questions when you are generally well managed, all to often the answer is "I wish I had your numbers" when you have a genuine question. People who manage to stay below 10 most of the time are allowed to try to improve their diabetes too, no need to be apologetic about it!

it actually looks like the pump has given me more basal over the last 36hrs than it normally does. An increase from 25% basal to 36% if I’m working it out correctly.

I'm not familiar with pumps, so you need to help me out here. Do you mean it gives you more basal in absolute numbers, so insulin units, or do you mean you first had 25% of your daily insulin as basal (and 75% as bolus) and now 36% basal (and 64% as bolus)? What about the total amount of insulin over the day?

 

[Maco]

Don't worry about that. Sometimes it's hard to ask questions when you are generally well managed, all to often the answer is "I wish I had your numbers" when you have a genuine question. People who manage to stay below 10 most of the time are allowed to try to improve their diabetes too, no need to be apologetic about it!

I'm not familiar with pumps, so you need to help me out here. Do you mean it gives you more basal in absolute numbers, so insulin units, or do you mean you first had 25% of your daily insulin as basal (and 75% as bolus) and now 36% basal (and 64% as bolus)? What about the total amount of insulin over the day?

sorry about the confusion, so at first 25% of my daily total was basal & now it’s 36% with 64% bolus. Today’s insulin rates are 12.625units of basal & 23.150 units of bolus which includes correction doses. Going through my pump history, last wednesday I ate 193g of carbs. 11.325units was basal & 24.6units bolus. Not much difference in insulin amounts at all actually considering I ate 160grams more of carbs. Just shows how much my pump is needing to work to keep me in range

 

[StewM]

I’m on a LOT of protein but I have been for the last year & the protein amount and protein sources haven’t changed (mince, turkey, chicken + whey shakes). For instance for dinner tonight, 200G of mince which id usually have with 200g of rice. Instead of normal rice I had cauliflower rice & broccoli. I’ve never had any issues with protein and needing to bolus for it & if I’m totally honest if I started to need to bolus for protein I’d just swap back to eating my normal carbs as I couldn’t really be bothered with the faff on of counting it etc

As far as I’m aware protein effects Blood Sugars way more when you’re on Low Carb than “normal Carb” and you will need to dose for it. Can’t remember the precise theory behind it off the top of my head.

 

[Antje77]

Not much difference in insulin amounts at all actually considering I ate 160grams more of carbs.

Now that is interesting (from a curiosity point of view, I imagine from your side it's mainly annoying!). For most of us the amount of bolus (and therefore total insulin) we use is highly dependent on the amount of carbs we eat (duh), so ending up with the same amount of insulin on less carbs is kinda strange. What is that insulin used for, leaving aside the difference between basal and bolus for now?
I can only speak from experience, so here are some thoughts that may or may not be relevant.
- I vary my carb intake, some meals or days are much higher than others. The amount of insulin (bolus, as I'm on a more or less fixed amount of basal) I take changes in a predictable way: more carbs = more insulin. Follows the book. However, I've never made a drastic change to my diet like you just did. Is it possible to have some stress reaction from your body to the sudden change, driving your numbers up?
- Many people have reported higher numbers need more insulin to decrease by the same amount as lower numbers; insulin resistance seems to increase with higher numbers. I have found this effect with numbers as low as 8, which is on the high side for me. Bolusing for food at 8 needs more insulin to keep a straight line than bolusing at 5. It may be something like that is in play?
- Can it be coincidence? Something brewing to give you higher numbers? Bad night of sleep? Or is your diabetes very much influenced by stress? Nerves for this experiment?

Like I said, I have no answers but I'm curious as to what is going on, so please keep us updated

 

[hyponilla]

You need to dose insulin for protein on a low carb diet. Like ert I also follow the Bernstein solution and I inject 1u to 15g of protein sometimes up to an hour after eating. In the absence of carbs in the diet the body turns to gluconeogenesis and synthesize glucose from the back bone of the protein you eat. If you were having lots of protein before but also the carbs you got all the glucose from carbs.

 

[KK123]

I agree with hyponilla above. My team told me that generally, when the body is getting its energy from the carbs, and the carbs are turning to glucose, we inject for them thus it does not need to bother turning any additional protein to glucose (albeit some do need to inject for protein as well) because it has enough. In the absence of carbs it turns to getting its glucose from elsewhere (protein) and turns that into glucose instead. If you are not injecting for that protein up stays your glucose levels.

 

[Maco]

You need to dose insulin for protein on a low carb diet. Like ert I also follow the Bernstein solution and I inject 1u to 15g of protein sometimes up to an hour after eating. In the absence of carbs in the diet the body turns to gluconeogenesis and synthesize glucose from the back bone of the protein you eat. If you were having lots of protein before but also the carbs you got all the glucose from carbs.

Okay so now I’m confused, I’ve had 25units of bolus insulin today. 3.5units of that has been for the carbs I’ve actually eaten. That’s means between me giving correction bolus & my pumps automatic correction system I’ve had 22.5units of corrective insulin. I’ve eat 220g of protein today, so going off your 1u to 15g of protein I’ve had enough insulin today to cover protein and stop the spikes?

Another though, my pump gives me auto corrective bolus when I go above 10, it’s being giving me these all day which should correct the highs from protein I didn’t calculate. But for some reason no amount of correction insulin is bringing my BG down.

 

[Brunneria]

Protein also digests more slowly than carbs (and fats slow digestion further), so timing the insulin differently may make a huge difference.

 

[Antje77]

so going off your 1u to 15g of protein I’ve had enough insulin today to cover protein and stop the spikes?

Just like with carbs, our ratio's vary vastly. From what I've heard from other low carbing T1's, a ratio of half the insulin you'd take for carbs is often used.

 

[Maco]

Just like with carbs, our ratio's vary vastly. From what I've heard from other low carbing T1's, a ratio of half the insulin you'd take for carbs is often used.

Mmm, so that’s strange again as that would only be 11u of bolus to cover the protein on my ratios but I’ve had 22.5units of corrective.