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LOW CARB NOT WORKING?

Annb

Expert
Messages
9,199
Location
Western Isles, Scotland
Type of diabetes
Type 2
Treatment type
Insulin
These days I believe I had gestational diabetes, which never went away, over 50 years ago. Despite going to doctors over these years with symptoms I now recognise as being diabetes related, I was usually sent away as being neurotic and wasting doctors' time. Finally, in 2008, took a sample of urine to a locum doctor and asked if I was diabetic. He tested it and said I was. Prescribed Metformin, (2000 mg daily) and eventually put onto insulin (basal and bolus). Fairly standard process, I'd imagine.

I have been trying to improve matters over the last 2 years by low carbing but ended up feeling very ill so have finally, today, decided that the experiment is over. It seems that low carbing is not for overweight, insulin resistant and insulin dependent diabetics, from what I have read. So where do I go from here?

I'm still not eating all that much carbohydrate but am taking high doses of insulin but my Metformin is down to 1000 daily (innards can't take any more than that). It requires no carbohydrate at all to put my BG up more than 2 points even with a large dose of insulin. This morning, I did have a roll with a slice of sausage and a fried egg after a FBG reading of 12.5. 2 hours later BG was 15.5. The 60 units of insulin and 500 mg Metformin had no effect, it seems. Or maybe it would have been worse without the medication.

Has anyone else had this kind of experience? If so, what did you do?
 
It could be the roll that’s to blame as the sausage, depending on meat content, and fried egg should be ok. I’m fairly lucky in that I can keep my hba1c in non diabetic levels with approx 100g carbs a day and a slice of the bread that I usually eat doesn’t normally affect my bs too much however bread rolls will push me higher than I like.
 

It definitely was the roll and I knew it was going to happen. But I decided to go ahead anyway - measured to check the exact effect - because my peculiar stomach really prefers there to be some carb content at least once a day.
 
Annb said:
I was hoping so, but it really doesn't work or suit for me. Then other things I've read indicate that it isn't.
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I think there is a difference between "doesn't work" and "doesn't suit".

If you don't like the food then tell us what you are eating and we can try and make it more palatable.

It definitely does "work" as it has for many of us.

What things have you read that indicate it doesn't work? I'd be interested to read if you have any links?

Thanks
 
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Only my opinion.
Metformin didn't agree with my body, T1 47 yrs now with libre I balance insulin with food (Dafne) if sugars high before meal compensate by adding to injection pre meal etc. Currently 5.8 40mml over 90 days, plenty of exercise is key.
If you over compensate with insulin correct with measured fast carbs and small until your meal carbs cut in.
 
Annb said:
because my peculiar stomach really prefers there to be some carb content at least once a day.
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Am wondering if you should maybe have that carb content at a different time of day? The dawn phenomena means your liver is pumping out sugar then, so it's always going to be the worst time of day as regards needing insulin for your carbs.

How much basal are you on? Does that normally keep you level overnight?

I am a fairly insulin resistant T1 and find that insulin resistance
1) goes down when I do light cardio exercise (eg a walk)
2) goes up if my bg is more than 10ish
3) is definitely worse first thing in the morning - I need bolus insulin even if I have zero carbs for breakfast.

How are you calculating your insulin doses? In theory you should have insulin to carb ratios (which may vary by time of day) and correction ratios (amount of insulin to reduce your bg by 1 mmol/L). (Assuming insulin dependent T2s calculate their doses in the same way as T1s.)

Are your injection sites all OK? Insulin not gone off? There's a check list of things you can go through when you inject insulin and nothing appears to happen but am guessing you are used to large doses if you're injecting 60 units of bolus. But they do makes U300 nd U500 insulin strengths specifically for insulin dependent and resistant T2s.

Lots of virtual hugs. Honestly I find that low carb is the best way for me to keep my insulin needs and my weight down, but everyone is different. I assume you've had stuff like thyroid checked, because that is much more common in diabetics.
 

Hi there. I note that before your meal you were 12.5 and 2 hours later 15.5. Now I know that the 'goal' is to be within 2mmol of where you started out after 2 hours but on a recent (albeit type 1) course, they said that it can take 4/5 hours before your reading comes down to what it was before the meal (notwithstanding the differences in types and things like insulin resistance, etc). They said the 2 hour mark is a useful marker, but to try testing it at 3hrs, 4 hrs, 5 hrs (not all the time obviously but as an experiment).

A rise of 3mmol does show that the carbs or insulin were tricky but it doesn't seem that far off to me. I think the issue there is why you were up at 12.5 after fasting, that would normally show your basal is off as I'm sure you know after all those years, when were you placed on insulin? What amount of basal are you on?

Incidentally, I was also told that in some circumstances people end up taking too MUCH insulin which then has the opposite effect, ie, the body panics because it senses it's going low rapidly so it throws out yet more glucose (because the liver is still working just fine!!) and up it goes even further.

In relation to the carbs, what would you eat in a typical day? I am a low carber and generally have around 100 carbs a day, this is far less restrictive than keto but again, I know you are type 2 so a 100carbs a day may or may not work dependent on any underlying issues.

I wonder whether your GP would agree to a C Peptide test to try and determine how much (if any) of your own insulin you are producing or has this already been done do you know? x
 
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Thanks to all who have responded to my question. My issues are complicated ones, I appreciate and I am still sure there must be a way through for me. I did have carbs this morning - 2 fried eggs, 2 rashers of streaky bacon and 2 small pancakes (not sweetened). BG currently 20.5. At 4.30 this morning, when I got up, it was 5.0. Clearly, the pancakes, then. Bad idea but I was hungry by 9 am, when I broke my fast. No bread or other carb available, so I just made some pancakes. I didn't bother counting the calories. Trouble is, I'm still feeling hungry despite that and it's only 12.35 now.

This morning's reading of 5.0 was very rare for me, despite taking an overnight dose of Lantus Solostar 64 units every night. Usually it is around the 10 - 14 mark. My diabetes nurse wants me to keep it at that level and would prefer if I don't up the Humilin S any further before meals. Actually, 60 is the most the pen will deliver. She was also very definite about NOT taking a correction dose. I did have a C-peptide test some months ago (when we could still see a doctor, ie before last March). I had to explain to the doctor what it was and why because he knew nothing about it - not that I really understood it. However, he did arrange it and apparently, back then, I was still producing my own insulin and insulin levels were high (injected) but having little effect.

Over the last 2 years I have been measuring carbs and then eventually estimating based on experience and keeping below 20 carbs most days. This has not caused me to lose weight - perhaps because I was not, at the same time, counting the calories in other food. Perhaps, though, simply because I retain too much fluid and I suppose fluid is heavy. (I take medication to try to resolve that - it doesn't work either and my doctors are puzzled. They upped the dose, too far it seemed, and I ended up with my kidneys in trouble.) Neither has it led to a reduction is BG levels.

When I did try, for a few weeks also counting calories, I was not able to keep going physically. I tried using more vegetables (not that they contained many carbs) but my digestive system played up too much and I had to reduce them to a small amount of less irritant ones - cucumber, courgettes, peppers, onion - which I could cope with so was eating mainly unprocessed meat and eggs. I still do have full cream milk and yoghurt but I think the milk is beginning to cause stomach issues now - cheese certainly is.

I take Levothyroxine tablets (75 mcgm daily) to support my thyroid which was damaged when a parathyroid tumour (benign) was removed. It was growing into my thyroid, so that had to be cut away as well. Blood tests seem to indicate that the levels are OK.

I'm in the middle of a whole series of tests to try to figure out just what is wrong with me and everything seems to check out just fine. What they are looking for is a reason why I retain so much fluid and why for many months I have been unable to breathe easily. I think it may be due to the hangover from undiagnosed Covid infection.

Sorry for the long reply. I'm sure I can't be the only one out there with these kind of issues. I am positive that low carbing works very well for many people, but it was (almost literally) killing me and I'm trying to find a way forward.
 
Annb said:
It seems that low carbing is not for overweight, insulin resistant and insulin dependent diabetics, from what I have read.
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Overweight insulin resistant diabetics are exactly who it is for. And those on insulin usually end up on lower or no doses as a result.
Annb said:
It requires no carbohydrate at all to put my BG up
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Do you mean down? Reduced carbs lowers by not raises it.
Annb said:
This morning, I did have a roll with a slice of sausage and a fried egg after a FBG reading of 12.5. 2 hours later BG was 15.5. The 60 units of insulin and 500 mg Metformin had no effect, it seems.
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the roll will be the cause of the rise (maybe the sausage if it had a lot of fillers). The metformin is not designed to work against the food you eat. Rather it reduces background levels of glucose by reducing the glucose dumped into the system but the liver.
Annb said:
However, he did arrange it and apparently, back then, I was still producing my own insulin and insulin levels were high (injected) but having little effect.
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The c peptide shows a substance produced alongside and as a result of insulin production not insulin itself . Was it was these were high or the injected doses you take? So in effect if cpeptide is high it has nothing to do with injected insulin only that you make yourself. It means you are already producing a lot of your own even before you inject. It indicates very high insulin resistance.
Annb said:
think it may be due to the hangover from undiagnosed Covid infection.
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have things been worse since this infection? Many report prolonged higher levels.
Annb said:
Usually it is around the 10 - 14 mark. My diabetes nurse wants me to keep it at that level
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any idea why? It’s quite high

you say you feel ill low carbing? What sort of “ill”?

sorry for so many questions but like you I am very confused.
 

Thanks so much for your interest.

Do you mean down? Reduced carbs lowers by not raises it.
I expressed myself wrongly. What I meant was that, even with no obvious carbs my BG rises, despite taking insulin.

The metformin is not designed to work against the food you eat. Rather it reduces background levels of glucose by reducing the glucose dumped into the system but the liver.
I have been told that, but however the Metformin works, I still end up with too much glucose in my system.

The c peptide shows a substance produced alongside and as a result of insulin production not insulin itself . Was it was these were high or the injected doses you take?
Apparently, the c-peptide test indicated that I am producing insulin. However, at the same time I was taking a lot of insulin and the GP said that I still had plenty in my blood to reduce BG levels, but it wasn't happening. I often feel very stupid when doctors blind me with information I can't grasp or remember (brain doesn't function as well as it used to either). He did say that I clearly have very high insulin resistance and he spoke of "metabolic disorder" but I still don't understand what that is.

have things been worse since this infection? Many report prolonged higher levels.
any idea why? It’s quite high
Levels were already high before the infection but have been more consistently higher over these last months.

you say you feel ill low carbing? What sort of “ill”?
Dehydrated, despite drinking lots and fluid retention. Very and weak fatigued. Nauseous. Constipation. Occasional collapse, but so far, no harm done. I usually manage to fall against a wall, or into a chair. I don't sleep very well but that is due to worsening arthritis - not sure if that is another effect or if it was going to happen anyway. Also have to get up for the toilet at least twice a night - that's the diabetes, not the low carbs, I think. But I then tend to spend much of the day asleep in 2 - 3 hour spells.

When I think about it, I am a mess but I do think there must be an answer somewhere. Whether at 75 I have time left to work it out, I'm not sure. By the way, nothing further to eat so far today and BG has dropped to 16.5.
 

to be clear this isn’t medical advice, just experience and reading widely and being on here a whole lot.

insulin resistance/metabolic disease is linked to each other. Fundamentally insulin resistance means that you have plenty of (too much) insulin. The problem isn’t that you need more. It is that you don’t respond well to it. Adding more and more insulin tries to do the job by brute force. Eg if you hit the nail with the hammer and it doesn’t go in - hit it harder. This sort of works in the short term reducing blood sugars but long term actually makes you more insulin resistant making the background problem worse not better. You have to hit ever harder and harder. actually need to do is (err the analogy is falling apart a bit here) ...make the nail more slippery and easier to move. (Sorry best I can do) . Metabolic syndrome is this along with associated conditions such as excess weigh around the organs, high blood pressure, high cholesterol etc.

feeling ill.
Are there other conditions/medications that could be causing these symptoms? The drinking, nausea and constipation could be related to electrolytes ie sodium, magnesium and potassium. Carbs hold water. Water holds electrolytes. Take away the carbs and the processed foods and you can easily lack both and both can make you feel terrible. Is it really a lot you drink or just what feels a lot?

Have you replaced the ditched carbs with extra protein and fat or are you restricting these too (calorie counting)? If so, no wonder you don’t have any energy you have no fuel.

Did you say how low carb you go? How sure there isn’t food or drink that’s sabotaging you that you haven’t realised is high carb? Eg orange juice or banana etc.

Arthritis, or more the pain from its inflammation, is often helped by low carb as it results in less inflammation.

Lack of energy, peeing at night, feeling sleepy are all symptoms of high blood sugar, and at your levels more likely than the low carb.
 

Once again - many thanks for your interest and advice. The carb level I was aiming at was about 20 g daily. Sometimes I didn't manage it and slipped over to about 30 g, but mostly I kept it down to between 15 and 20. I stopped eating fruit, except the occasional binge on about 1/4 of a punnet of strawberries (around 50 g weight). I don't think I had much of a rise from them but haven't had any for a while. I did have one banana about 3 weeks ago, but that was an aberration.

I do, then, have the symptoms of metabolic disorder - high blood pressure (controlled with medication), cholesterol controlled by Simvastatin, and I am carrying far too much weight. Recent blood tests - once I had got over the too high doses of Furosemide prescribed by the GP - indicated that my electrolytes were OK. The excess weight doesn't do any favours for my arthritis, I know. That is another issue I've been working at over the years despite the hospital dietician saying that, once on insulin, weight loss was impossible. In fact, during the time I have been trying to eat few carbs, my weight has increased and so has my arthritis. I should exercise more but can only walk (with a stick) about 30 feet and at that, not very quickly. I do seated exercises and I do hobble around the house as much as possible, but cannot expend much energy doing that. (It's hobble a few yards and then flop, breathless, and in serious pain, into a chair.)

I sound as though I'm feeling sorry for myself - I'm not. I didn't insist on attention when I could have (softee) and I did make a decision to ignore my health while I nursed my late husband during his final years. Silly me. But I would probably do the same again. What I am doing is trying to find out, from people who know, if there is anything I can do to cope with where I am now.
 
Your age shouldn’t mean you put up with health issues that are manageable that you dont need to. Nor is it wrong or feeling sorry for yourself to be trying to address those issues. We have to look after ourselves and even if you did feel a bit sorry for yourself why not? It’s no fun feeling unwell or in pain and we’d feel sorry for others in the same situation. We’re all only human. I can certainly empathise with your confusion as keto should indeed have improved things not made them worse. Though it is hard when there are other conditions and medications confounding the picture.

Statins increase bgl in many people. Do you really need/want them? There’s a lot of evidence they are not the magic wand many say they are in terms of health benefits to individuals especially older females. And a lot to question if the relationship between cholesterol and cardiovascular disease is what’s been believed. A search of other posts in here can give you lots on that issue.

thyroids are a tricky issue (only have half a one myself). And the levels deemed acceptable by many gp’s are in fact still not good for many people needing to be at the other end of the “normal” range to feel well. (Same goes for almost all tests with a relatively wide range). Something to consider as to why things are acting oddly and weight is increasing.

I hope someone can help, I’m stumped for now. Sorry.
 

Thanks for your advice. Take care in these difficult times.
 
In case it is of help to anyone else. Today is the first day of my changed regime so I took no basal dose last night but left it until 6 am today. FBG, oddly, was only 7.0. BG rose to 9.2 before breakfast at 9.30 am. Then I took my 60 units of Humilin S and had some meusli. That put my BG up to 11.2. Not too bad really. I had an early lunch - 12.50 - 60 units Humilin S and a bacon toastie. BG is currently 5.0! Now that shouldn't have happened. I guess the basal dose is kicking in - after 61/2 hours.

Not sure this will work out but it is hopeful. If anyone else is having the same trouble as me - it is worth trying to inject insulin at a different time, or even a different position. Or even seeing if a changed insulin prescription might help.
 
Have you given up low carbing or did you not realise museli and bread would cause a spike in most type 2?
 
HSSS said:
Have you given up low carbing or did you not realise museli and bread would cause a spike in most type 2?
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I dd realise that both oats and bread would cause a spike. I had reached the stage of giving up the low carbing because it just wasn't working - my BG was almost as high with lots of insulin and almost no carbs as with carbs, and the deep reduction I was making in carbs left my stomach feeling very bad for a long time. I've been trying to keep my carbs below 20 g daily for about 2 years to no avail. So, just the day before I talked to my DIL I had decided to give up and to have the same carbs as other folk. When I spoke to DIL I decided to try just changing the timing of my basal dose. I kept to the carbs I had decided to eat today (hence meusli and bread). Even so, something has kept my BG low(ish). For me, anything under 13 is very good. I was expecting the meusli to give me a spike of 4 or more, but it was only 2. The bread actually didn't cause a spike.

This evening I had a frittata with just parmesan cheese in it. So no notable carbs at all. So I cut my insulin dose. I don't want it to drop too low going into the night.

If this continues, I might just go back to reduced carbs, although I doubt if I'll go back to less than 20 g - possibly try to keep around 50 g for the sake of my stomach.
 
Many people have quoted 50 gm of carbs as a good level - I was eating exactly that amount and getting Hba1c of 42 - I decided to go lower, and now eat no more than 40 gm per day, and still have a Hba1c of 42.
 
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