Low low to no carb....lots of lantus low dose novo....please help

Hi Megan,

I think first things first; you need to take bolus for meals irrespective of the carbohydrate consumed; your blood sugars are testament to that. Are you aware that your liver will release glucose into your blood in response to food eaten (the so-called 'Chinese restaurant effect')? That needs to be covered.

Please can you set out your current insulin to carb ratio; i.e. 1 unit short acting : 10 grams of carbohydrate.

Please also set out your correction factor; are you saying that it is 1 unit : 1 mmol/ml?

You also need to chose a target blood glucose number (to correct to). I correct to 5.5 mmol/ml. Please set that out too.

For your breakfast try working on the basis that the eggs and cheese equal 5 grams of carb and take insulin to cover that (plus any correction dose) and see how that works? You may need to increase or decrease that.

Keep in mind that your insulin sensitivity may change throughout the day; I get much more sensitive from morning to night.

I think this can all be sorted out; it's just a question of testing and figuring out what is right for you.

Best

Dillinger

Megan are you now doing small bolus doses, or are you still only correcting after (and cautiously), when you go high?

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megan said:

this is where i got to then this morning i had a blood of 6 for breakfast....2 scrambled eggs with cheese.....midmorning blood 14......12 o'clock bloods were 9 and 1.30 they were 6 and I'm aware they're dropping now.

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Hi Megan,

That's a good start to the day with 6 - but that 14 is odd and then you are getting caught by the long peak of Novorapid it looks like.

Have a look at this chart for peak times for insulin;

http://www.diabetes.org.uk/Documents/Magazines/Insulinwallchart.pdf

I changed from Apidra to Humalog because it has a more gentle peak that works for me in matching a low carb diet.

I would also say that I think Lantus is a funny long acting; I found that it started behaving very strangely with me and was in no way a flat 24 hour insulin.

Currently I split Levemir; so take half a dose in the morning and half in the evening which makes things much easier to control. Perhaps have a think about changing insulin?

I think you should try being a bit less cautious with your corrections and correct to a lower number say 6.0 mmol/ml - subject to hypo sensitivity and the like.

In the above description did you go hypo? You sort of suggest that you think you are at lunch? Because if not then you are on the right track. Possibly the 14 is not just the eggs but dawn phenomenon as well; how long after you got up did you do the blood test where you got the 6?

There's never a dull moment with diabetes eh?

Best

Dillinger

Hi Megan,
Like Dillinger has said, it would be worth looking up the Chinese Restaurant Effect. In summary, when you eat, food will enter your large intestine, which stretches as food enters. This signals to your body to release glucagon, which triggers glucose production in the liver, so that you can immediately benefit from the meal you have just eaten. Ever been really hungry, eaten and satisfied almost immediately after, even though it takes hours to digest food? Well this is why.

This is why you must take fast acting insulin even though you don't consume carbs. The way I estimate my fast acting dose is by looking at the size of my meal. A large low carb meal will stretch my large intestine more than a small one, so I'll need to take more insulin. This is really down to trial and error, but I highly recommend you persist with low carbing, once you figure it out, it makes excellent control easy.

megan said:

then what's the advantage of leaving the carb out? Its a genuine question which is confusing me....if I cant get the insulin quantity down and I can't lose the weight....I cant combat the insulin resistance so my weight stays the same??

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I know others have commented on this too; so it's a good question. The positives are that you are moving from a starch based diet to a protein/fat based one and it will take time for your body to adjust.

The fact that you are having to take insulin at about the same levels is annoying I'm sure, but it sounds like you (like me) have some insulin sensitivity issues and it strikes me that as one comes off a starchy diet your insulin/carb ratios will change; I certainly need to take much more insulin if I were to have a 'normal' carby meal than I used to, but that's ok because I don't want to eat that way.

Hopefully your bloods are improving and as you have said you are less hungry. Both of those will help to improve things further. The bloods though are the key ones; that is the whole point of what we are doing. Low carbing is not a miracle slimming solution; it will help but its only part of the solution. I think exercise is the other key thing.

I think the metformin is a very good idea; I take it too (and by the way I find that in the evening taking it as I go to bed helps with dawn phenomenon) and hopefully you will find that it helps with insulin sensitivity and weight loss (but again it's not a miracle solution) it will just improve the position.

Best

Dillinger

megan said:

Thanks for that. I have recently read up about the chinese restaurant effect. Interesting. Until I started this low carb I was hungry such a lot....im not now....just makes me wonder as im having to take boluses of novorapid for a no carb meal which is actually the amount id be taking if I had the carb in it....then whats the advantage of leaving the carb out? Its a genuine question which is confusing me....if I cant get the insulin quantity down and I cant lose the weight....I cant combat the insulin resistence so my weight stays the same??

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Excellent question.

I have never quite understood what Dr Bernstein is on about with his Chinese Restaurant effect, and I am not sure I believe in it. Maybe it affects some people but not others.

Here it is from the horse's mouth (apologies Dr B!) - scroll down to Chinese Restaurant Effect.

http://www.diabetes-book.com/cms/ar.../2922-richard-k-bernstein-md-face-facn-fccws-

I am not seeing anything there that says you would have to take the same amount of insulin as if the meal were all carbs, just that you can't take zero insulin. So you do get an improvement from low carbing, your carb metabolisation is reduced, just not completely eliminated, due to this Effect? It looks like he is saying it's only significant if you eat a large volume of no-carb food at one sitting, and also there is a delayed reaction.

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Megan, I also do a bit of low carbing but do use small amount of bolus to handle protein in meat, fish, eggs and othrr stuff. I followed anothrr membrrs tip on bolus for protein which was add up the protein content, then divide it by 4 and whatevrr that amounts to, thats the csrb bolus. For me, dividing by 3 was bettrr than 4 but I got not too bad results. Nowadays, I tend to acd a tiny bit of carb to a meal and just bolus for the carb and that works ok as well

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iHs said:

Megan, I also do a bit of low carbing but do use small amount of bolus to handle protein in meat, fish, eggs and othrr stuff. I followed anothrr membrrs tip on bolus for protein which was add up the protein content, then divide it by 4 and whatevrr that amounts to, thats the csrb bolus. For me, dividing by 3 was bettrr than 4 but I got not too bad results. Nowadays, I tend to acd a tiny bit of carb to a meal and just bolus for the carb and that works ok as well

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Dividing protein by 3 works well for me too (only when low carbing). So 24g of protein I would treat like 8g of carb.

I think once you have bolused for the protein, any residual Chinese Restaurant Effect will be pretty negligible.

megan said:

Thanks for that. I have recently read up about the chinese restaurant effect. Interesting. Until I started this low carb I was hungry such a lot....im not now....just makes me wonder as im having to take boluses of novorapid for a no carb meal which is actually the amount id be taking if I had the carb in it....then whats the advantage of leaving the carb out? Its a genuine question which is confusing me....if I cant get the insulin quantity down and I cant lose the weight....I cant combat the insulin resistence so my weight stays the same??

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You may find once you begin to lose eight your insulin requirements will decrease even when you are low-carbing.

The question you ask is a good one and the main reason why I don't follow a Bernstein style diet, there's no such thing as a free lunch when it comes to type 1 diabetes and if you eliminate carbs you have to increase your protein and fat intake, protein in the absence of carbs converts to glucose by around 50-60% and a high-fat diet can cause insulin resistance, that is why many who do follow a very low-carb diet can be on similar insulin doses to those who eat carbs in moderation.

I know if I eat a low-carb breakfast of say eggs & bacon I would still need 4 units of insulin split into two doses to cover the meal, as where if I eat my normal breakfast of porridge (45g of carbs) I just need a 1 unit more and don't need to split dose, I'm sure there's a point (but can't say where as we are all different) that when you reduce your carbs too far the benefit of low insulin doses is somewhat lost.

Good points by Noblehead there. I just want to clarify the 60% conversion of protein to carbs is a maximum value not a typical value. Unless you are starving, a good chunk of dietary protein will be used for structural repair even when low carbing, so a typical conversion value would be in the range of 25% - 33% carbs from the protein you ingest . It actually will vary depending on the absolute amount of protein you eat, your body mass, exercise, other factors. It is harder to estimate than carb counting. One reason why low carb high fat (LCHF) is easier for diabetics than low carb high protein (eg Atkins).

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megan said:

this morn my blood was 11...so I took the bull by the horns. ...took 2 to correct and 2 for my eggs......this time before I ate...before I ate I also took the creon and omeprazole antacid...then ate then took my metformin...within 20 mins I was 2.7! So was this taking insulin first? In which case I might be able to lower it in future. ...or would metformin react that fast?... ive never known my insulin to react that fast! !! How do I know what did it...its now 1 1/2 hours on amd my blood is 11 but I am literally humming and shaky still...feel dreadful and a stinking headache

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So sorry you had a hypo. :-(

In this situation I would ask myself

- was the 11 mmol/L high reading contaminated?
- was 2u too much for just eggs (it would be for me)?
- is my correction ratio changing (needing less)?

I agree 20 min is very fast for that drop, so I would suspect that the high test was contaminated.

My calorie split for LCHF is currently 5% Carbs, 20% Protein, 75% Fat. Have you tried using myfitnesspal to keep track of your dietary intake?