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Low carb but continued high BG (type 1)

Discussion in 'Low-carb Diet Forum' started by JoshPowJenks, May 3, 2021 at 8:57 PM.

  1. JoshPowJenks

    JoshPowJenks · Newbie

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    Hi all - my first post here so please be gentle!

    I've been type 1 for almost 8 years and my control has been pretty poor for a few years now - in fact, it's probably never been good, but I just didn't pay as much attention previously.

    Anyway, I've recently got myself a Libre 2 and, in doing so, noticed how insanely high my spikes were when following the traditional carb-heavy diet. For instance, a breakfast of oats, whey protein and a banana would send me up in the 20s (mmol) and would occasionally drop back to a normal range, but usually stay in the 12-15 range regardless of how much insulin I would take.

    About 2 weeks ago, I started a low carb diet to try and get some control, with a macro ratio of roughly 50-70g carbs/150g protein/150g fat. This has helped somewhat - for example, my Libre 14 day time in target has increased from 48% to 61%, and >13.3 has decreased from 16% to 3% - however, I'm finding myself stuck around the 9-12mmol range constantly.

    I seem to be gradually increasing throughout the day which leads to me injecting more and more Novorapid throughout the day. An occasional pattern seems to be a spike 2 hours after I've eaten, followed by a gradual rise for a few hours later, so I have to take up to three separate injections for a meal, one immediately for any carbs, one 2 hours later, and occasionally an additional a few hours after that (although at that point it's usually time to eat again).

    As an example, today I've only eaten about 40g carbs from blueberries, a glass of milk, some spinach and a few squares of dark chocolate, yet I've had to inject 8.5u Novorapid to cover this (and I'm still around 10mmol on average). As a comparison, when I was on a carb heavy diet, my ratio would usually be 1:10 to 1:15, so it seems as if my insulin resistance has somehow increased which surprises me as I'm in pretty good shape - 5'8, 150lbs, about 15% body fat and lift weights 3x a week.

    I've only recently dropped my basal (Levemir) dosage after a few basal fasting tests indicated my dose was too high, and my current dosage seems to keep me pretty level, albeit too high.

    I know I'm still new to the low carb diet so it could be my body adapting to it, but I'm already a little frustrated as the general consensus seems to suggest BG levels drop more or less straight away, while mine are a still too high.

    Does anybody have any suggestions or insights that could help? I'm in the middle of reading Diabetes Solution but I'm not sure how much of the method I'll be able to put into practice without being on regular insulin.

    Thanks in advance, looking forward to discussing in more detail.
     
  2. EllieM

    EllieM Type 1 · Well-Known Member

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    Probably a complete red herring but
    Any chance you've got an underlying infection? Have you had covid?

    So night and first thing readings are roughly the same?
    What happens if you just up the insulin for the meal? Honestly, I'd be assuming you need more basal from that second paragraph but if your night time levels are steady then I guess you are OK.

    If you go sufficiently low carb and high protein then you may need to inject for protein....
     
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  3. EllieM

    EllieM Type 1 · Well-Known Member

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    Have you had a chance to talk to your team about your levels? They may (or may not) be surprisingly helpful .....
     
  4. JoshPowJenks

    JoshPowJenks · Newbie

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    Thanks for your response @EllieM

    If I do have an underlying infection, it's not something presenting any obvious symptoms. I've not had Covid as far as I'm aware, and I've been vaccinated so I'd be unlikely to have it rough.

    My night and fasting readings are roughly the same at the moment (but can be too high, 10-12mmol roughly), although this does change quite frequently. A few weeks ago I dropped my nighttime Levemir from 6u to 5u which seemed to be right based on my night vs morning readings, but I've had to drop it again to 4u as 5u started dropping me too much again. It's worth noting that I occasionally have unexplained spikes at around 2-3am. Could be dawn phenomenon or even delayed stomach emptying, I'm not sure.

    If I up the bolus for the meal, it'll likely be too much in the short term and I'll go low. I'm usually OK for the first two hours when Novorapid should be peaking, so any more bolus would probably send me low, followed by a 2 hour spike.

    As for my team, they're pretty rubbish in all honesty. I don't have a dedicated team per se - there are various diabetic nurses at the hospital, and if I need to speak to anybody I have to leave a voicemail and it's total pot luck who calls me back, and 9 times of out 10 it's somebody I've never spoken to before and they have no knowledge of my medical history. It's rare I get advice that actually helps, they just seem to give me basic cookie cutter advice that doesn't actually address the problem I'm having at the time. In fact, I'm still waiting for them to call me back after the voicemail I left them last Thursday for something unrelated.
     
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  5. EllieM

    EllieM Type 1 · Well-Known Member

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    I'm sorry your team aren't more helpful. I guess there's no chance they'd put you on a pump then? That could solve the issue of potentially needing more basal in the day time than at night....

    I
     
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  6. JoshPowJenks

    JoshPowJenks · Newbie

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    Well I'm actually in the middle of the remote DAFNE course with the aim of going onto the pump. I asked about this at my last appointment and they were open to it fortunately, but we'll see how that goes after the course has finished I guess.
     
  7. Rianne

    Rianne Type 1 · Well-Known Member

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    I recognise what you experience. A few years ago I tried a keto diet, with a max of carbs between 20 to 50 grams a day. I noticed high spikes about 5 hours after meals and learned that the lower the amount of carbs I take, the more impact the proteins have on my bloodsugar. When proteins do get digested, which takes much longer than carbs, they are being transformed partly in glucose. This gives a rise in bloodglucose. This might be happening with you. Maybe you could search the net or in the keto-groups, for more information on this. When I changed to a more moderate low carb diet I did not have these high spikes late after meals, although I find it still a challenge to prevent them. With help of the FSL since last year and a low carb diet I have now reached a TIR of 85% and a HbA1c of about 38. I wish you good luck in finding a balance that feels good for you!
     
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  8. Goonergal

    Goonergal Type 2 · Moderator
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    Hi @JoshPowJenks

    This is a very long article (a good one), but it includes an explanation of what @Rianne mentions in relation to the insulin/glucagon response to protein, and includes some specific information in relation to type 1 diabetes: http://www.tuitnutrition.com/2017/07/gluconeogenesis.html

    If you want to scroll down, it’s the sub-section called: Managing blood glucose: the insulin and glucagon dance
     
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  9. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    I am trying to do the same thing for the same reasons! I am now on a pump and this has helped me tweak my basal as it is programmed on an hourly rate. I think chasing down highs with novorapid is always gong to leave you behind the curve or over correcting so IMO the basal rate is the way to go bearing in mind you will need more if you're ill, stressed or tired.
    Don't forget that if your body is used to rollercoasters holding steady at 8-12 is a great improvement.
    Your results so far do sound excellent but from your comments you are expecting even better.
    Re dosing at mealtimes are you dosing for protein? I do about half a dose for protein at the time of my meal. If you are eating plenty of fat then this should help prevent any spiking.
    Are you doing weights/interval training to prompt a spike?
    But yes some days it feels like my liver is just pumping out glucose at what seems to be random times! I adopted this way of eating in order to make my life easier because I don't want to count carbs and do want smoother blood sugars. I do feel that it is working but I still have to put the work in to keep on top of it as with all things type 1 diabetic. It s not as though we all get our doses perfect and that's it for life!
    I hope you're enjoying interacting with the Dafne course mates and will get to try your pump soon anyway.
     
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