Low carb diet and HbA1c

I’m a type 2 so haven’t experienced this but I’ve definitely seen other type 1 on here face similar challenges. Hopefully they’ll be along soon to offer wisdom.

It seems to be based on fear of hypos and an assumption that such an hb1ac must comprise of highs and lows rather than a flatter profile. Also an ignorance of how a well managed low carb diet can really help type 1. Do you fingerprick or libre? The readings from a libre are quite convincing that the profile doesn’t have to have hypos and highs.

I certainly did. I came down from an HbA1c of 9.9% (85 mmol/mol) upon diagnosis to 5.7% (39 mmol/mol) now through carefully watching my metabolism, self-discipline and getting as much info about my condition as I can.

So here I am, finally getting a great result and the doc just nods, slightly concerned.

They really know how to motivate their patients, don't they? Nowadays, it's not about proper treatment anyways, it's all about CYA. All is well as long as they aren't liable. And they'd rather have you go blind or lose a foot because, well, that's just a "normal" thing for diabetics. But if you were to drop into a deep hypo while they're managing your treatment, they're in for a beating.

Heck, I monitor my BG 24/7 with a Libre and hand them the printouts showing just how tiny the standard deviation is. I doubt any of it is really entering their thick skulls.

All I can recommend is that you remember that you're doing this for yourself, so celebrate your efforts.
Whatever you do seems to working just fine, so you must be doing something right.

I keep my carbs to less than 30 g per day, have come off insulin totally but do not tell the clinic as they all talk like this They make rules for the stupidest patients, ignore those who have the education , training and intelligence to take charge of their own destiny and get offended when you do. They noticed I have lost 40 kgs , asked me how I did it, and then the nutritionist was called who gave me the 'NHS guide to food' sort of pamplet, designed for three year olds. OK I let myself go, but I am a research scientist with the ability to go beyond this tripe, but the one size fits all approach adopted serves very few. Having discovered this a long time ago, and how offended they get when they think you are ignoring their 'advice' then I now Just say nothing and let them think what they want. I am afraid that the dieticians and nutritionists you usually see tend to be at the lower end of the spectrum who follow a script. If it works for you , stick to it.

dennisrichards said:

I keep my carbs to less than 30 g per day, have come off insulin totally but do not tell the clinic as they all talk like this They make rules for the stupidest patients, ignore those who have the education , training and intelligence to take charge of their own destiny and get offended when you do. They noticed I have lost 40 kgs , asked me how I did it, and then the nutritionist was called who gave me the 'NHS guide to food' sort of pamplet, designed for three year olds. OK I let myself go, but I am a research scientist with the ability to go beyond this tripe, but the one size fits all approach adopted serves very few. Having discovered this a long time ago, and how offended they get when they think you are ignoring their 'advice' then I now Just say nothing and let them think what they want. I am afraid that the dieticians and nutritionists you usually see tend to be at the lower end of the spectrum who follow a script. If it works for you , stick to it.

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My only issue is if these “experts” don’t see past the status quo and have their fixed opinions challenged how will they ever evolve? They’ll go on thinking “their way” works

I have the same reaction from my GP surgery (every time I have an HbA1c below 50 I get a phone call from the practice nurse to tell me it’s too low and I should reduce my insulin. So basically every time I have one, as it’s been 35-40 for nearly 2 years now, since adopting low carb), yet my hospital team are behind my management methods 100%

Doom said:

Wow that’s fantastic control! Good to know that at least your hospital team is behind you!

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Thank you I do have a lot of tech on my side, tbf. I couldn’t do it on fingerpricks and injections, I don’t think. My hospital team have invited me to go and speak to the department about how my combined low carbing and artificial pancreas system work together so well.

ianf0ster said:

I have 2 points I wish to raise:
1. The OP is a Type 1 on Low Crab - much trickier than for a Type 2. Yet all comments except for @LooperCat appear to be from Type 2s.

2. Since the OP is a Type 1, their Health Care Professionals have a valid concern about Hypos - though in my (self-educated non- T1 opinion) they are taking it too far!

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I absolutely agree with you. I am the same as the poster, most recent result was 38. I have had all of the 'you must be having lows' comments. Now I am on a libre and they were right! It shows lows during the middle of the night (not enough to wake me and I do have hypo awareness) but still, I have corroborated the lows with various other checks btw. . Now though I can manage those lows much better and can take active action in order to prevent them. That's where I disagree with the professionals, if they are concerned about type 1s possibly having hypos, give them the equipment to help prevent it instead of telling them to run higher than an individual would like just because of budgets.

Doom said:

There are valid concerns about hypos but if one is on a libre or continuous glucose monitoring (CGM) then low carb without hypos is imminently doable and in fact should be embraced because of the control that is possible with the obvious positive health benefits!

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I just wave the Dexcom chart for that HbA1c period at them...

Doom said:

I had my annual type 1 check up today and my HbA1c was <42 I.e in the normal range. Instead of celebrating the normalisation of my blood glucose they focussed on my tight control and the risk of hypos! Furthermore the dietician commented that they wouldn’t recommend a carb diet less than 130 g per day (despite seeing the benefits I have reaped) but when I asked her why she wasn’t able to give me an answer. I wonder when a low carb diet will enter the mainstream and recognised as a reliable way to control blood glucose! Has anyone else had the same experience?

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Despite my HbA1c falling by over 14mmol/l to a value of 40, whilst following a low Carbohydrate / keto diet, the nutritionist at our practice is still following the advice of the NHS, trying to get me to base my meals on starchy foods. In addition my BP readings are now well down.
They are unable to change their thought patterns or seem to update their lecture notes, to take into account recent evidence. Their low fat diets are all based on the findings of one man - Axel Keys, who's disregard and manipulation of data, in 'my opinion' is responsible for both the obesity and Type 2 diabetic disasters of modern life.
In addition my GP has taken me off metformin, as she congratulated me on going into remission, yet still advising me to change my diet ????

Doom said:

. ... the dietician commented that they wouldn’t recommend a carb diet less than 130 g per day (despite seeing the benefits I have reaped) but when I asked her why she wasn’t able to give me an answer.

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There's a mistaken belief that our brains need 130g carbs to be able to function, but this is actually 130g glucose, which is supplied by our liver, generated from fats, or if necessary, protein. And our brains actually function better on the ketones produced when we eat low carb. (See Google - e.g.
The Carbohydrate Brain Fuel Myth - not actually my original information source though)

Ketogenic/low carb diets were recorded as treatment of T2 in the late 1790s, and in the early 1900s were used for treatment of T1 prior to the advent of insulin - so it's beyond belief that we now have the situation were we appear to have returned to the dark ages regarding diabetes and carbs!

I've been lucky enough to have a supportive GP, and recently a low carb diet is now an option suggested to all diabetics in our practice. My DN when first seeing my results told me: "Just keep on dong whatever you're doing"! Which would also be my advice to you...

ETA Dr Bernstein re science of small numbers for T1s...

Robbity said:

There's a mistaken belief that our brains need 130g carbs to be able to function, but this is actually 130g glucose, which is supplied by our liver, generated from fats, or if necessary, protein. And our brains actually function better on the ketones produced when we eat low carb. (See Google - e.g.
The Carbohydrate Brain Fuel Myth - not actually my original information source though)

Ketogenic/low carb diets were recorded as treatment of T2 in the late 1790s, and in the early 1900s were used for treatment of T1 prior to the advent of insulin - so it's beyond belief that we now have the situation were we appear to have returned to the dark ages regarding diabetes and carbs!

I've been lucky enough to have a supportive GP, and recently a low carb diet is now an option suggested to all diabetics in our practice. My DN when first seeing my results told me: "Just keep on dong whatever you're doing"! Which would also be my advice to you...

ETA Dr Bernstein re science of small numbers for T1s...

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Robbity, I do agree but in the 1900s there was no 'treatment' for type 1s, it just prolonged life for a few weeks if that. There is no doubt though that they do need to update the advice around carbs and glucose levels.

I just want to say that I share the same feeling with you. I’ve faced some very negative comments from HCPs on wanting to follow low carb diet.

I switched to low carb diet when diagnosed almost 4 years ago and I maintain normal range hba1c since. I mean how can they possibly not support us a way to maintain a good bs control knowing what is at stake and what is like to have T1

Having seen how manic HCPs got when I was eating low carb foods (with no restriction) during pregnancy, threats, insults - spitting and snarling - telling me I would have a low birthweight baby (actually 9lb 1.5oz) diabetics must be who they practice on......

Doom said:

Great to see all these replies and positive outcomes! I luckily have CGM so monitor my BM continuously meaning that I have very few spikes and lows! All these positive stories need to be amalgamated into a qualitative study so that we can start changing practice, which will be too the benefit of all diabetics!

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I'd like to see this happen too, because achieving a good HbA1c when dosing for normal eating must be difficult. There's a study of the typeonegrit community who have an average HbA1c of 5.7% (39 mmol/l) compared to the average 8.2% (66 mmol/mol) for T1's which speaks for itself.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034614/
It's a tricky issue to solve as you have so many health care professionals recommending us to just eat the carbs and dose for them. To change guidelines these people would have to come out and say they were wrong, which is unlikely. Another problem is time. Many of my friends are doctors and they have patient quotas to meet. When you get 15 minutes with a patient every three months it's difficult to educate him on low carb eating. It's easier with type 2, but when you bring insulin into the picture it becomes a whole different ball game as dosing for protein is not as straightforward as carbs.

Saying this, how we treat diabetes is still pretty chocking to me. I've been diabetic for a year and just like you I've been nagged about my low HbA1c. Not once has any of the doctors I've seen mentioned complications that may arise from high blood sugar. I'm doing a kidney test for my next appointment, and when I asked what for the reply was "Oh, don't worry about it, there shouldn't be any problems...yet". Thank god for the internet.