Low carb and type 1

I work on the basis that protein converts to carb at about 50%. I normally inject just after eating. I've only been doing this a month and still experimenting a bit, but I'm not going above 7-8 very often. Mostly in the 5-6 area

Hope you get it figured out soon.

Not too long or I will forget

Also I seem to need 3 units of bolus when I wake up or my BG goes up. Better than dawn phenomenon I suppose.

I thought you were a full-on low carber Ewelina, what with your blog and posts on the LC forum?! Had me fooled!

Regarding dosing, have a Google for "The Chinese Restaurant Effect". The long and short of it is this...when you eat, food enters your large intestine, this stretches it and the large intestine cells produce glucagon so that you can immediately benefit from the food you have eaten. Ever been really hungry, eaten and felt ok within a few minutes despite food taking hours to digest? We'll, this is down to the Chinese Restaurant Effect.

The key to dosing for LC meals is to judge the portion size, so that you can judge how much glucagon is going to be released. This is just down to trial and error, but your doses will be low, so if you make a mistake you won't end up through the roof, or on the floor. In time, you can look at the size of a meal and get your dose spot on.

Regarding protein, for me, a chicken breast will get converted into glucose 2-3 hours after eating it and will cause a rise of 2mmol/l, which is what 1 unit of Novorapid will bring my levels down by. So for protein, I inject 2 hours after eating. The key to protein is to have it in moderation as I don't want to be pumping myself full of insulin to cover protein as the whole reason why LCing works is because if the smaller insulin doses.

Hope that helps, sorry for the essay!!

I eat approximately the same amount of protein that I ate before. I don't mind you asking about my insulin at all! My Lantus ranges between 6 u and 22 u depending on how much exercise I've done recently. My Novorapid is fairly constant with respect to exercise. One of the mistakes that a lot of people on insulin make when they transition to LC is to not bolus for the meal, or to carb count and give themselves a low dose, both of which usually result in high BGs.

The key for me is to match the portion size to insulin, not count the carbs and protein and bolus for that. I don't know what my insulin:carb/protein ratio is, I just follow the Chinese Restaurant Effect method and bolus for portion size. It's working well for me so far, apart from an 11 I had last week after a drunken decision to eat some cake(!), I've not been in double figures for a month now.

To give you an idea of what I eat, here's what I ate yesterday (a typical day) and my insulin doses:

• 
  Breakfast: 50g LC porridge - 20g Linwoods Milled Flaxseed Cocoa & Berries (from Holland & Barrett), 15g ground almonds, 15g wheat bran, almond mil instead of cow milk. Around 5g carbs, 4 units Novorapid (2u for the dawn phenomenon, 2u for the food).

• Mid-morning snack: 50g mix of pumpkin and sunflower seeds, around 4g. No insulin.

• Lunch: mixed leaf salad, with half a chicken breast, cheese, celery, grated carrot and radishes. Around 15g carbs, 5 units Novorapid.

• Dinner: meatballs in a home-made ragu sauce. Around 15g carbs, 6 units Novorapid.

It is surprising yes, as I never knew before LCing that protein could affect BGs. As mentioned, I'm not particularly sensitive to protein, so long as I have a sensible portion of it, it won't affect my levels too much. As mentioned, I just bolus on portion size and judgement based on previous experience.

Since I've been LCing, I've noticed a huge improvement in BG swings and hypos. It really does work very well! I get very anxious about hypos and I'm glad to say that since LCing, I've gone from 2 or 3 per week to 2 or 3 per month and I've not been below 3 mmol/l since I started. As I've said on a lot of posts, one of the main reasons why LCing is so successful is because you give yourself small doses of insulin, which means that any mistakes you make will be small too.

SamJB said:

It is surprising yes, as I never knew before LCing that protein could affect BGs.

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Agreed it is surprising Sam as most HCP would tell you to ignore protein in a bolus calculation. Unlike type 2's (who still have some pancreatic function) we still have to inject unfortunately

Hmm, quite an interesting post. I've been a type 1 for 27 years and after years of roller coaster blood glucose levels , have recently discovered the LCHF way of eating. My insulin requirements have dropped from roughly 45-55 units a day to 19-23 units a day, which i'm very pleased with but i'm still getting unexplained highs throughout the day.

I've always matched my carb to quick acting insulin at a ratio of 1:1 but now i'm not eating the high amount of carbs, the effects of gluconeogenesis are more apparent. I need to learn the effects of different foods on my levels but Sam, I wouldn't feel comfortable taking the amounts of insulin you take, with so little carb intake. I'd be in full blown hypo! But it obviously works for you. It's all trial and error and i'll just have to keep on juggling with it and hope it eventually comes good. (Julie)

A great thread. On the low carb highway I'm still averaging about 90 -110 g carbs per day. I want to reduce this over time.
Sam, I hope you don't mind me asking about low carb porridge. I tend to eat flax seed, a small spoonful of muesli, cottage cheese, low fat yoghurt and a satsuma for breakfast. I probably shouldn't be eating muesli and satsuma. For low carb porridge, would you cook the wheat bran and seeds in the almond milk?
Thanks for advice!

lizdeluz said:

A great thread. On the low carb highway I'm still averaging about 90 -110 g carbs per day. I want to reduce this over time.
Sam, I hope you don't mind me asking about low carb porridge. I tend to eat flax seed, a small spoonful of muesli, cottage cheese, low fat yoghurt and a satsuma for breakfast. I probably shouldn't be eating muesli and satsuma. For low carb porridge, would you cook the wheat bran and seeds in the almond milk?
Thanks for advice!

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Hi Liz, I just bung it in a bowl and microwave! Linwoods do a flaxseed and goji berry mix which is nice in the porridge too.

Thanks Sam, I'll try that. Haven't got a microwave, but saucepan no doubt ok!

Wow, this thread is really helpful! Many thanks to all of you for these insights. LCHF seems much more suitable for me. I do sometimes get the dawn phenomenon and I do have to use a higher ratio Novorapid to carbs in the morning. I wasn't even aware of the protein effect! I eat small amounts of fish or meat, because I never want to eat large amounts - I'm more of a closet veggie. My current diet is getting lower in carbs - 50 g yesterday - but it's still high in fats - cheese, nuts, cream, yoghurt, Greek yoghurt as per the LCHF. So, if fat is a big contributor to portion size, should that affect insulin dosage as much as protein?

lizdeluz said:

...So, if fat is a big contributor to portion size, should that affect insulin dosage as much as protein?

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I don't find that I need to bolus for fat, although I think I read somewhere that we might need to bolus 10% for fat. I can't remember where I saw that. but if it explains any mysteries then it's worth knowing I suppose.

Bear in mind that fat slows down the digestion of food so you might need to take that into account too.

I'm on week five on the lchf diet. To begin with my insulin requirements reduced as per expectation. However at the beginning of week four my blood sugars began to spike to 10mmol about four hours after I'd eaten. This was regardless of how little carbs I was eating.
I'm still struggling with this aspect but after chatting with my DSN she explained that I do need to bolus for protein and like someone else mentioned on here I've started with 1 unit of insulin as per my DSN's advice. This, she explained, is because the body does convert protein to glucose. Luckily I'm on a pump so I simply set this to be delivered an hour after I've eaten. My insulin requirements have now grown slightly.

Just another small observation, when I walk my dog at lunchtime my bs is 6.5 mmol but after exercising this rises to 10mmol. The DSN explained that we need insulin to exercise and that this is normally covered by the carbs we eat (taking larger units of short acting insulin at meals leaves insulin in the system). I'm still getting the hang of it. Let me know how you get on


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