This low carb stuff . . . I don't get it

[Alasdair]

I read people writing about how they maybe only have 20g carbs a day etc. and it completely bamboozles/scares me(that I might be doing something wrong). I see so much of it on here yet I'm a T1 taking in easily 200g carbs today.

I get that insulin will narrow my blood vessels and that high carbs means more insulin but am I really doing something wrong? doc never advised me otherwise.

Or is it more just for T2?

 

[CambridgeLass]

No no, insulin doesn't narrow blood vessels, uncontrolled blood glucose levels does this. I get that it's confusing as you read posts from those with T2 who are low carbing to keep their BG levels low, they're not on insulin. As a T1 you need to take insulin. You are fine to eat carbs as long as you balance this with your insulin dose. Saying that, it's not as simple as this, the type of carb, the amount if exercise, stress levels etc can all affect your levels. Have you been on a carb counting course? I would ask to go on one if not. Hope you are able to access support.


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[Alasdair]

Have been on a waiting list for 3 years now!!! When I chased it up at the hospital last week they said 'oh we're sorry, it looks as though we just assumed you'd already been referred to it, we'll definitely get you on DAFNE as soon as we can . . . . . by the way all the courses in 2013 are full but we'll definitely have you a place in 2014' :crazy: :yawn:

 

[mrman]

Also a type one and I aim to have 300 carbs a day just to maintain my weight as I'm a slim 6 ft 3 guy. Its a personal choice though. If a type one needs to loose weight obviously reduce carbs but also reduce insulin and up excercise. Personally I could not low carb but others do and see great results type 1 and 2 alike.

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[librarising]

Then you could do no better than to read

Dr Bernstein's Diabetes Solution: A Complete Guide To Achieving Normal Blood Sugars

Written by a diabetic, this will clear up your confusion.

Read what Amazon readers have to say :

http://www.amazon.co.uk/Dr-Bernsteins-D ... 920&sr=1-1

Geoff

 

[CambridgeLass]

Oh no, that's no good at least get on a waiting list for any cancellations. Apart from DAFNE, do they not do any others? You know there is the online course too meanwhile, haven't done it myself to recommend, but see that some other members have - google BDEC.


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[Alasdair]

Oh no, that's no good at least get on a waiting list for any cancellations. Apart from DAFNE, do they not do any others? You know there is the online course too meanwhile, haven't done it myself to recommend, but see that some other members have - google BDEC.


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I'll check it out CambridgeLass and see what it's like. Nothing else on offer at the hospital I'm afraid, it's a pretty poor show here but then I've been lazy in pushing them so . . . .

I'll check that book aswell Geoff, thanks

 

[Daibell]

HI. Yes, it does depend a bit on which type you are. Type 2s may have to control carbs if they want to avoid meds or the meds aren't working (like me). Type 1 can change insulin dose to match carbs, but the higher the carbs the more likely there will be weight gain and also bigger blood sugar swings, so even T1s need to be sensible with carb intake. Yes, some keep carbs below 50gm/day, others like me go for less than 150gm/day. The important thing is to keep within the good BMI range to avoid insulin resistance and to measure your blood sugar to keep it within NICE guidelines. I would suggest you are probably doing nothing wrong, but I would tend to not go above 200gm on average assuming you have a good BMI at present.

 

[Alasdair]

Bmi is 20-)

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[phoenix]

If you have a normal weight and good glucose control then you aren't doing anything wrong.
If your weight is lower because you are running high glucose levels then perhaps you need to look at how you are using the insulin.

The amount you eat and the amount of carbs you eat/need depends on how much fuel your body needs. There are people who need huge amounts . Someone like Kris Freeman the T1 Olympic cross country skier will use many times more carbs in an hour than is advocated by some people on low carb diets, no doubt he is fit and healthy.

As someone said earlier the DAFNE course or the BDEC online course have helped lots of people learn to adjust their insulin.

http://www.bdec-e-learning.com/
Think Like a Pancreas recently updated is also a very useful book http://www.amazon.co.uk/Think-Like-Panc ... 0738215147

As to evidence about long term diet and T1there isn't much but the available evidence points to better HbA1cs in those T1s whose diets is higher in carbohydrate and fibre and lower in saturated fats

The long term DCCT ( there are limitations to the evidence ) found that

Among intensively treated patients with type 1 diabetes, diets higher in fat and saturated fat and lower in carbohydrate are associated with worse glycemic control, independent of exercise and BMI.

http://ajcn.nutrition.org/content/89/2/518.full

similarly higher fat diets (and smoking) were associated with greater progression of retinopathy. HIgher fibre/carb/protein were inversely correlated (ie associated with slower progression.) As was calories , this was indirect, those who ate higher carbs/protein tended to eat fewer calories: See table 6.
http://www.medscape.com/viewarticle/496168

 

[CambridgeLass]

Phoenix, you're a star. Such a wealth of info with all the refs and links! You should have a web page


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[Robinredbreast]

Phoenix, you're a star. Such a wealth of info with all the refs and links! You should have a web page


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:thumbup: agree with you there CambridgeLass RRB

 

[sue cope]

Many Type 2 Diabetics are on Insulin - I am on around 200 units (2 kinds) a day (the amount varies according to the carbs I eat) and I eat lots of carbs...because I like them.....and that's partly why I am on high Insulin dosage, but I haven't been told that this is a problem.

 

[xMenace]

As to evidence about long term diet and T1there isn't much but the available evidence points to better HbA1cs in those T1s whose diets is higher in carbohydrate and fibre and lower in saturated fats

The long term DCCT ( there are limitations to the evidence ) found that

Among intensively treated patients with type 1 diabetes, diets higher in fat and saturated fat and lower in carbohydrate are associated with worse glycemic control, independent of exercise and BMI.

http://ajcn.nutrition.org/content/89/2/518.full

similarly higher fat diets (and smoking) were associated with greater progression of retinopathy. HIgher fibre/carb/protein were inversely correlated (ie associated with slower progression.) As was calories , this was indirect, those who ate higher carbs/protein tended to eat fewer calories: See table 6.
http://www.medscape.com/viewarticle/496168

I don't disagree with these findings, but I still maintain that LCHF is much healthier.

It is more difficult for type 1's for a few reasons
- carbohydrate behaviour is farily well known. Most of us know our carb ratios and can easily treat a new food. How many know the total available glucose (TAG) in a hamburger or a cup of cream? I don't, and I've been doing this awhile. If I've lost you already, 58% of protein and 10% of fats are supposed to convert to carbs via gluconeogenesis and from the glycerides in fat.
- many protein products aren't labled, again, how much protein in that steak? Guidelines suck.
- how fast does your protein convert to glucose? Longer than carbs. How long does it sustain?
- how does food quantity affect your BGs? With LCHF my plate sizes can get big. It's often very difficult to estimate the glucagon dump I'll get from simply shoving something into my gut.
- I often skip meaks -- it's called fasting, something I can easily do on LCHF. But the following meal can be h e double hockey sticks due to built up glucagon stores. I can count on a 2x bolus 90% of the time, but if it doesn't raise like I expect ... here we go, Roller coaster time.

My own A1C has risen, but my weight is down and my energy and health are up.

 

[JontyW]

Have been on a waiting list for 3 years now!!! When I chased it up at the hospital last week they said 'oh we're sorry, it looks as though we just assumed you'd already been referred to it, we'll definitely get you on DAFNE as soon as we can . . . . . by the way all the courses in 2013 are full but we'll definitely have you a place in 2014' :crazy: :yawn:

Hi Alistair,

While you wait for a DAFNE course to be available, this document from Diabetes UK "An introduction to carbohydrate counting and insulin dose adjustment" (https://shop.diabetes.org.uk/usr/downlo ... educed.pdf) explains all you really need to know about carb counting and insulin adjustment. I don't know what insulin regime you are on but you really need to be on a basal/bolus regime using slow acting Lantus or Levemir, plus fast acting Humalog, Novorapid or Apidra to match the carbs in each meal.

I've been a T1 for 43 years and only in the last 6 months, since finding this excellent website, did I learn about accurate carb counting, insulin-carb ratios and how to get even better control than I had managed previously using common sense, experience and guesswork. In my experience I found that reading this ebook really explained it well, and my understanding is that the content is what is taught on a DAFNE course. So you really need to get going on learning all these new techniques to achieve good control and avoid the long term complications.

Jonty

 

[candiloo]

Actually, I am on insulin and I count my carbs - I count them so that I have the correct amount of insulin for what I am eating, which means if I want to treat myself I don't get a high level of blood glucose and I can make sure I don't get nasty side effects. Also, keeping carbs down means you can keep weight down. If you are lucky enough not to be overweight, you don't need to worry about this bit, but carbohydrates are energy, they make fat if they are not used, so if you stuff cakes and that before bed and don't do an hour on the exercise bike (trust me, I know this!!) you will put weight on and your blood sugar will go up. The calculation depends on how much slow acting you take and it is very easy to do once you know your specific calculation and you can accurately dose your insulin. I am not type 1 or 2 as I had acute pancreatitis and lost part of my pancreas.

 

[JontyW]

Actually, I am on insulin and I count my carbs - I count them so that I have the correct amount of insulin for what I am eating, which means if I want to treat myself I don't get a high level of blood glucose and I can make sure I don't get nasty side effects. Also, keeping carbs down means you can keep weight down. If you are lucky enough not to be overweight, you don't need to worry about this bit, but carbohydrates are energy, they make fat if they are not used, so if you stuff cakes and that before bed and don't do an hour on the exercise bike (trust me, I know this!!) you will put weight on and your blood sugar will go up. The calculation depends on how much slow acting you take and it is very easy to do once you know your specific calculation and you can accurately dose your insulin. I am not type 1 or 2 as I had acute pancreatitis and lost part of my pancreas.

Hi candiloo,

You make it sound as if you know exactly what you are doing regarding carb counting and insulin dose adjustments .... but .... your HbA1c reading in your Profile says 84 which is about 10%. That is not good control and will lead you to have complications unless you get it down to < 7.5% (58). So do you 1) accurately measure the carbs 2) know the insulin-carb ratio for each main meal, and 3) record all the data so you can see what needs changing to get good BG control? Something here is not being done correctly which results in the HbA1c being so high.

How long have you been on insulin and what have your previous HbA1c readings been during that period?

Jonty

 

[Faith*]

Alasdair:
I've struggled to fully understand the low carbing rules/diets myself until recently.
As others have mentioned a lot of Type 2's follow this diet but for Type 1's it can get a little confusing.

With everything I've learned from the low carb diets I've come up with my own plan which is, as lower a carb diet as I can manage being a Type 1, but not so little as to not be able to function as I'm a runner and need long acting carbs in me most of the time.
Perhaps we should see it as an advantageous diet in that we can get some brilliant benefits to low carb but have a slight indulgenge should the occasion present itself

 

[hanadr]

Get hold of a copy of Dr. Bernstein's Diabetes Solution. It will explain everything.
Low carbing is a choice many of us have made to reduce or eliminate our need for medication. It's not a choice to make just because you see someone else doing it. You need to research the science behind it. It's not a matter of right or wrong, but of informed choices.
It applies to T1s as well as T2s. Bernstein himself now in his 70s and still practising medicine is a T1 from about age 12.
I'm a genetic T2 married to a T1. I got him to come with me on Low carb [I've done it for years!!] and he's reduced his insulin needs by half, eliminated hypos and lost some weight. In addition we think his healing processes have improved and his kidney failure is stable
Hana

 

[alaska]

I've been on a relatively low carb diet for the last 4 years. I tend to have anywhere between 50 and 100g of carbs each day.

I found that going on to a low carb diet helped by giving me confidence I'd been lacking since my honetymoon phase had worn off at some point in my teens. It helped to reduce the big swings in highs and lows I had been getting.

My first HbA1c after starting the low carb diet was about 7.5% -having previously been around 9%. Following that, my HbA1c gradually came down further by building on what I'd learned and making tweaks where necessary. My HbA1c is now at around the 5.5% mark.

I get figures in the 8s and 9s in parts of the day but look to correct these with insulin where appropriate. I test about 6-7 times a day. Ensuring my levels are good over night is one of my main aims because it accounts for 1/3 of the day.

I was always on the border of being underweight. Since going on the low carb diet my weight dropped a little bit but has stayed stable for a long time.

The main reason for going low carb was that I'd been struggling with my control and the low carb diet was helpful at least for me.

Ed