Time to reduce my carb intake

[Mattinnes74]

hi guys, i am 42, i developed type 1 diabetes when i was 34 , currently i am injecting 68 units lantus at dinnertime (when i generally wake up ) (i work nights), and novorapid as and when. My HBA1C is currently at 7 i believe, and it has been steady at this for last 3 years. After coming down from around 9 . My doctor and health nurse are pleased with my progress, they have said it would be nice to get it a little lower, which i aim to do. I believe though, that the only reason the hba1c is reasonable is the fact, i test loads, possibly 20 times per day, and am constantly injecting little ammounts to adjust.

I will be very honest here. I dont really watch what i eat, and i know its got to change. Ok, i dont eat cakes and mars bars or drink full sugar coke, but i eat far too much high gi carbs. At the moment, if i can get my BG around 8, i am happy, any lower and its too close to hypo territory.

The problem is, the fact i work night shifts, (generally from 1600 to 0300) mon to thursday. The job varies greatly in physical effort, one day may involve a 2 hour drive with high physical exertion when we arrive on site for 6 hours, the next day may involve a lot of sitting around. And there is no knowing of the ammount of plysical effort that will be on the cards until i get there. So its hard to know what to eat, i dont want to be sat driving for 2 hours with a high BG, but then, if i start work at a relatively good BG, then once i start physical activity my BG is going to get low.

So at work i am constantly testing myself and either injecting or eating a small snack. Its a pain in the a##e !

So, i plan to make a concerted effort to reduce my carb intake, i think lowering my units of lantus will help keep my BG under better control at work, and of course will be much healthier for me.

But i dont really understand how you lead an active lifestyle with a low carb diet. Eg. If i was to wake up with a good BG of 7. Great ! But what if i decided i wanted to take the dog for a good 5 mile walk ? If i just had bacon and eggs for breakfast, i would be hypo ing after half a mile !!!! And needing a choc bar to revive myself !

But i would welcome any advice you guys have.

I have just discovered this wonderful forum and website and i am sure it will be a great help to me.

 

[noblehead]

But i would welcome any advice you guys have.

Hi @Mattinnes74 and welcome to the forum

Certainly a change in diet will help somewhat but you should also ask your diabetes team if using a insulin pump would help manage your diabetes better, having days where your workload/activity varies and injecting above the normal amount (5/6 injections a day) would make you an ideal candidate for pump funding.

If you look at the following from INPUT it lists the NICE criteria for a pump but also lists the ABCD recommendations, if you read the ABCD recommendations it mentions Specific quality of life issues & Excessive number of injections for optimised control which I believe you would meet with your present circumstances:

http://www.inputdiabetes.org.uk/alt-insulin-pumps/is-it-provided-by-the-nhs/

 

[tim2000s]

But what if i decided i wanted to take the dog for a good 5 mile walk ? If i just had bacon and eggs for breakfast, i would be hypo ing after half a mile !!!!

Welcome to the forum @Mattines74 What you've posted above is where it becomes a very interesting equation. As you eat fewer carbs you will use less insulin, so in theory, you won't end up hypo after a bit of exercise. Secondly, if you go very low carb, then your body stops using glucose as an energy source when you are walking and starts to burn lipids instead. Once you are in this state, you are much less likely to go low with aerobic exercise.

I've also tagged @diamondnostril and @robert72 as low carbers.

 

[slip]

As you've alluded to, unknown levels of activity make it hard to manage, the fact you test a lot, and give multiple injects for corrections, a pump could help - have you thought about that? you'd be able to lower your basal rate once you get to the work site and have an idea what work load you'd be doing.

If you're planning to exercise/walk the dog you can reduce your insulin before hand to help avoid a drop later. Unplanned you just need to have some extra carbs at the time - which I'm assuming you're doing.

As for going low(er) carb you still shouldn't drop as you'd be adjusting your insulin to cover the carbs consumed, and if going really low carb you may need to factor in protein and fat into your I:C ratio. Going low carb your body uses the fats for energy instead of carbs so can still be active!

Also have you considered a Abbot Freestyle Libre, may help manage your current situation anyway.

 

[Mattinnes74]

Thanks guys, i didnt realise insulin pumps could even be an option unless paying for the, yourself, which wouldnt be possible for me, reading the costs involved. I will look into this with my gp.

At present, i think it may be sensible to reduce my carbs by changing my main meal choices, using wholegrain rice, and cutting right back on potatoes and bread (i eat a lot ), using bergen bread for a sanwich etc. I have got a lot of reading and homework and adjusting to do, but i am up for it.

What would you say is an average lantus unit injection for my kind of lifestyle ?, ive been awake half an hour and would normally now inject myself with 68 units. Because i am going to start day one of eating less carbs, should i maybe reduce it, to say, 50 ?

 

[Sauron]

Other than the suggestion of a pump I would look at the amount of carbs you eat in a typical week and look at small ways of reducing the amount and see how it effects the weeks average

 

[Mattinnes74]

Hi slip, to be honest, the testing doesnt bother me too much, my gp has acknowledged i need to test more due to my work etc, so i have quite a few on my prescription. So , For fear of reducing the smmount prescribed to me, i think i may leave it as is for the moment.

 

[noblehead]

I will look into this with my gp.

You would need to discuss the pump with your hospital diabetes team (or get referred to them if not under their care) as it needs approval from a consultant.

At present, i think it may be sensible to reduce my carbs by changing my main meal choices, using wholegrain rice, and cutting right back on potatoes and bread (i eat a lot ), using bergen bread for a sanwich etc. I have got a lot of reading and homework and adjusting to do, but i am up for it.

I eat all those but keep the carbs in moderation, on average my carb intake is 180g a day, with careful monitoring and adjustments you should be able to mange a lower carb diet without too much trouble, if you go too low with the carbs then you will have to factor in protein and fat in your bolus calculation.

I'd definitely look into the possibility of a pump

 

[slip]

Hi @Mattinnes74 I didn't mention the libre to ease your fingers (although it will help) - just that it provides so much more info than static finger prick blood tests (however many you do!), it's the difference to watching a blockbuster on a 14" black and white CRT TV (with an indoor aerial!) against a HD 50" LED TV + Blu-ray, an eye opener.

But as others have said you're prime candidate for a pump!

 

[Mattinnes74]

Hi @Mattinnes74 I didn't mention the libre to ease your fingers (although it will help) - just that it provides so much more info than static finger prick blood tests (however many you do!), it's the difference to watching a blockbuster on a 14" black and white CRT TV (with an indoor aerial!) against a HD 50" LED TV + Blu-ray, an eye opener.

But as others have said you're prime candidate for a pump!

ah right, will definately have a look into this as well then, thanks. i think i need to arrange an appointment with my diabetes care team up at the hospital. havent seen them in 5 years. i only see the nurse at the health centre every 6 months for diabetes checkup. there is no annual review with the specialist team at hospital any more

 

[slip]

ah right, will definately have a look into this as well then, thanks. i think i need to arrange an appointment with my diabetes care team up at the hospital.

The libre unfortunately isn't on prescription so it will be an extra cost to you but you don't need to use it all the time, and you never know your clinic might have a trial on for it or have some to give out FOC (from Abbot as a loss leader).

Think your in for a nice long chat at your clinic!

 

[robert72]

Hi @Mattinnes74

I have been on a very low carb, ketogenic diet for around 3 years now and find that I can do moderate exercise without hypos because I am burning fat for fuel. As an example, I did a 10 mile walk a few weeks ago - I had no carbs prior to the walk and kept a very level BG throughout. It only went pear-shaped when I got the the pub at the end and had chips Here is my CGM trace for that day. The walk was from 11:00 to 16:00

 

[Snapsy]

I have been on a very low fat, ketogenic diet for around 3 years now and find that I can so moderate exercise without hypos because I am burning fat for fuel.

@robert72 could you just clarify - do you mean very low carb? Am I missing something here?

 

[robert72]

@robert72 could you just clarify - do you mean very low carb? Am I missing something here?

Oops sorry... low CARB.

Thanks @Snapsy

 

[Snapsy]

Phew - I thought I was doing it all wrong! Thanks for the clarification, @robert72 !

 

[Mattinnes74]

does it vary as to how people tolerate low sugar levels? Anything under 5 and i feel the very first signs of a hypo. i have tested myself in the middle of woken up full blown hypo and its been around 3.5. i see that robert was around 4 for a lot of the day. i would be in a constant state of hypoglaecemia . unless my tester is not accurate enough ?????

you say it went pear shape at 8.8, around 7/8 is my target,! especially when working. any less and i'm in possible hypo territory!

 

[robert72]

I think over time I have got used to being in that range. I still have hypo symptoms below 4, but they seem more pronounced if I still have bolus on board, which would mean I was dropping, rather than coasting level on basal only and burning fat for fuel.

 

[slip]

TBH I'm concerned that you say your ha1bc is 7 but you 'hypo' at 5, normally (and I know we're all not normal!) having hypo symptoms at a higher then expected level (a false hypo) normally means your body is use to BG levels running higher generally - 2 reasons that may be causing this is 1) you blood meter is inaccurate and your ha1bc is correct or 2) you have funny blood! there's a possibility your red blood cell life span is not 'normal' and affects the result meaning it could in fact be higher.

You can get control solution for your blood meter from the manufacturer. I believe a fructose(?) blood test gets around this sort of blood 'disorder' but is not widely used/available.

Then again I might just be jumping the gun

 

[Mattinnes74]

to be honest, at 5, i would be ok, anything under 4 and i would be having a hypo. its just that if i aimed for a BG of 5, i wouldn't be very far off the onset of a hypo, especially working, and i would be constantly eating small snacks or dextrose tabs to raise it. At the moment, if i aim for 8, this allows me to work for say, a couple hours, then have a planned snack break etc.

 

[Mattinnes74]

If i can lower my daily bolus (lantus) injection, by lowering my carb intake. would this reduce the number of hypos or 'almost hypos' i might have during my evenings work? i understand this is going to take a bit of trial and adjustments.