I was referring to the good members of this forum who are pro-active in their diabetes management, some low-carb others don't but we are all take our diabetes seriously and hold good bg control.
As for the TDD amongst type 1 here on this forum, I think you find that people like myself who eat carbs in moderation are on similar or less insulin than those who very low-carb (below 50g a day) so going too low-carb doesn't necessarily mean less insulin. If you consider today I've injected 16.5 units of QA insulin for 160g of carbs which works out at around 1 unit for every 10g of carbs, some low-carbers inject similar amounts but only eat 30g of carbs.....therefore that's a insulin ratio of 1 unit to roughly 2g of carbs, so how woiuld you account for that Fatbird.....which is better do you think and do you think I would keep my current insulin ratio were I to eat only 30g of carbs?
Hi Noblehead. I've been a type 1 diabetic for 20 years and moved to a low carb paleo template diet a year and a half ago. You are absolutely spot on about insulin requirements. Initially when I moved over to low carb, my insulin requirements went as low as 15 units tdd from about 45 units on my former diet. However, after a period where my body adjusted to a fatty acid metabolic pathway and the consumption of nutrient rich food, this low total promptly changed and sits at about 30 units daily- 12 units of that is my basal (levemir). Included within this tdd, however, is the need to inject for green tea and coffee as caffeine raises my blood sugar one hour after consuming it. So again, for me, you are spot on with the amount of injections I take - typically around 7 a day on average. I have contemplated giving up caffeine but...nah I've got to have some vices.
Anyway, with respect to my insulin requirements, it took a while to understand why, but, after a lot of reading, the increase in my insulin needs is largely to do with the insulinogenic nature of the foods I now eat and the bodies adaptation to this style of eating. For example, on a low carb diet, there is a high glucagon response from the body whenever I eat a meal that has protein in it. The body requires insulin to allow the amino acids from protein consumed to enter the cells otherwise they can't be used. Part of this process involves pumping out glucagon to prevent the person eating this diet from suffering hypoglycaemia from the insulin response to the amino acids. Of course as a type 1, I don't produce insulin and so need to inject accordingly, otherwise my blood sugars go high because of this glucagon response. This glucagon response does not happen if I were to revert back to eating a high carbohydrate meal (as glucose is consumed with the insulin there is no risk of low blood sugar in a non-diabetic and no need for the body to pump out glucagon). So, bottom line, for me, is that I calculate for 40% of the protein that I eat and bolus accordingly. Interestingly, I don't seem to get that increase in blood sugars from protein consumption, after a couple of hours, that affects other type 1's on a low carb diet, and so don't need to double bolus for it. And I try and inject twenty minutes before eating as the glucagon response happens fairly quickly. This way I prevent my levels from spiking. And if there is a rise in blood sugar, it tends to happen very slowly. Same with lows.
I'm definitely in the camp where, for me, insulin is hugely beneficial (for obvious reasons), and I tend to dismiss a lot of studies because they are observational and do not take into account lifestyle factors, nutrition, stress, and any underlying inflammation within the body, which I believe is the main reason for diabetic complications (type 1 or 2 although the underlying conditions and risk factors are hugely different). Bottom line for me - inflammation, insulin resistance, and high blood sugars together = big, big problems. I'm less convinced that high(ish) blood sugars by themselves, in the absence of inflammation and insulin resistance is as problematic.