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Type 1: A good HbA1C without hypos?

Discussion in 'Type 1 Diabetes' started by Soplewis12, Jan 8, 2017.

  1. tim2000s

    tim2000s Type 1 · Expert
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    I think the point here is that there isn't just a diet for Type 1. It's a whole lot more factors than that. Logically, it makes sense to reduce carbohydrate in order to reduce the need for insulin and therefore the variance attributable to that, but it's not the only thing that matters.

    I've spent plenty of time eating low carb, and not had any physiological resistance. But at the same time I've also exercised, usually involving a decent amount of resistance training. Much along the lines of what Bernstein recommends, as it happens. Why is this important? We all know that exercise is great at increasing insulin sensitivity as it seems to activate and maintain GLUT4 transporters in an active state. I personally find that, even with pre-bolusing, and we're talking 30-45 mins here, standard carbs will still cause me to go higher than I want to, which is not an issue I see with low carbs. The doses are right, but the way the insulin works just doesn't offset the effects of the food properly.

    I also find that if I need to lose weight, low carb works. Moderate carb just doesn't.

    But then we're all different. A lot of non-forum members have jumped on the low carb approach and had very good results from doing so. Quite a lot of forum members have too. While education can help with getting numbers in line, typically, the DAFNE outcome is measured in reduction in Hba1C, not achieving the recommended level, as even then, very few DAFNE graduates do.

    What's been interesting reading the Libre group on Facebook is the number of people realising that reducing their carb intake makes a big difference to the mountain range that they see on the device. Sure, they also learned about pre-bolusing and basal testing more efficiently, but that's been one of the biggest things to come out of the widespread Libre take up that I've seen.

    But rather than rambling on, I don't think there is a T1 Diet. If you look at any personal training approach to getting body transformation results, they don't simply say one size fits all. Any diet that you decide to use needs to work for you, so for some, 180g of carbs a day might be fine, but for others, it simply doesn't work. My advice would always be to try the various approaches until you find something that works for you. My best variance and Hba1Cs have been achieved using low carb, so that's a diet that works for me.
     
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  2. ironf15t

    ironf15t · Member

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    My Hba1c yesterday was 7.1% and hasnt moved since my last one 6 months ago.

    Doctor said that was fine, and that all the checks were fine too (feet, blood pressure, eyes, kidneys etc).

    I would like it to be better but it seems like there is no concern where its at currently.
     
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  3. zebs

    zebs Type 1 · Active Member

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    I agree. Its hard. So many variables affect my sugar levels, I struggle to keep up with why my sugar is so unpredictable. I notice that my friend who has type 1, similar age, similar time diabetic and about the same daily insulin seems to have a much more linear relationship with carb ratio. When on holiday together she couldn't believe why my sugars didnt behave in a predictable way. And its not through lack of effort, we just have different body make up I suppose
     
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  4. Dillinger

    Dillinger Type 1 · Well-Known Member

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    Well, ok knowledge is the key and I completely agree that the training of diabetics in the management of their condition is appalling. However, knowledge or no, the fact is most Type 1's are not getting in range and the simplest way to address that is look to the carbs. How many carbs and eating to your meter are individual quantities of course and I don't think anyone disputes that but it doesn't do anyone any good to be told to 'eat normally'; just look at the audit results I posted.

    As an aside a non-sequitur is a logic issue where 2 statements are presented as being connected to form an argument when they have no apparent connection such as 'carbohydrates are bad for diabetics' therefore 'Donald Trump is President'. I may have made considered assumptions on who is in the band of diabetics below 48 mmol/ml but that's not a non-sequitur.
     
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  5. azure

    azure Type 1 · Expert

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    I'm glad we agree on the idea of knowledge being key :)

    You responded to my comment about LCHF not being the only way to get good results, by mentioning the poor HbA1C results of many Type 1s and thus implied LCHF was the answer. You didn't provide proof that the poor results were as a result of the failure of those people to follow LCHF, which I felt you were implying - hence my use of 'non sequitur'.

    A non sequitur isn't two unconnected statements, it's a logical fallacy - such as 'Many Type 1s have a poor HbA1C therefore LCHF is good' which is what I felt you were implying.

    That is, the prevalence of poor HbA1C results doesn't prove LCHF is the answer.

    As you say, 'eating normally' is far too vague, and without appropriate training on carbs/insulin adjustment then it would be hard for anyone to gain optimum control.

    So - back to education.
     
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  6. CathP

    CathP Type 1 · Well-Known Member

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    I'm sure education is key. Unfortunately the current diabetic training is 'eat want you want and cover with insulin', which judging by the statistics is setting people up for failure. The average paediatric hba1c is about 8.2% which is shameful. Something has to change.
     
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  7. noblehead

    noblehead Type 1 · Guru
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    It is unacceptable @CathP no one would argue with that.

    Education is the key, but telling people to cut out carbs completely (as Dillinger implied earlier) isn't the solution either, a better approach would be to tell people to reduce the carbohydrate content in their diet to a level where they can maintain good bg levels.

    We only have to look at the successes by Dr David Unwin and the DCUK Low-Carb programme, both approaches are lower carb and don't demonise or exclude carb in their dietary recommendations, when I first joined this forum a popular saying on the forum was ''Eat to Your Meter,'' IMHO that advice was excellent and still relevant today for newbies and old members alike.
     
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  8. Amy993

    Amy993 Type 1 · Well-Known Member

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    I have not long turned 17, and have been diagnosed almost 5 months. I'm in paediatric. I eat the exact same diet as i did before being diagnosed. The only difference now is that i take insulin for it all. When diagnosed, i had a very high HBA1C of about 148. At the start of december, 3 1/2 months after diagnosis, it had gone down to 41.
    I have been managing my levels quite well until the last week, as i have got tonsillitis and my levels are a bit up and down.
     
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  9. Amy993

    Amy993 Type 1 · Well-Known Member

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    Please see my comment just above, as it is the complete opposite of what you have said.
     
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  10. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Guru

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    @noblehead a large number of low carbers on this forum eat to their meter, which is why they are low carb, because their meters tell them what they can eat and in what portions. I'm one of them. I know I can eat a couple of small potatoes and a few chips without issue, but one slice of bread sends me sky high so I can't eat it if I want to keep my levels acceptable. So even low carbers such as myself (30g) don't entirely exclude starchy carbs. I use the phrase "eat to your meter" daily on this forum, probably more than once. It was eating to my meter that got me down as low as 30g after starting much higher (120g) and gradually having to reduce.
     
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  11. noblehead

    noblehead Type 1 · Guru
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    Absolutely and yours is a good approach @Bluetit1802 , but I'm sure the same can be said for the members who don't go very low-carb and eat carbs in moderation, after all we are all guided by our bg meter results.
     
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  12. CathP

    CathP Type 1 · Well-Known Member

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    Yes, it's eating to the metre that brought us to 30g carb approx daily too.
     
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  13. CathP

    CathP Type 1 · Well-Known Member

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    That's fantastic it's working for you Amy. But I think statistics show that the current approach is failing about 80% of patients.
     
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  14. azure

    azure Type 1 · Expert

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    Again - and at the risk of sounding like a broken record - education would help.

    If I could, I would be able to show you two graphs of mine - one with the dreaded peaks and troughs after meals, one without.

    So what diet change did I make to achieve the vastly improved graph?

    Answer: None. I learnt how to use my bolus insulin more tactically.

    Out of interest, I've never been told to eat whatever I want and as much as I want. Is that something that's said to paediatric patients in a misguided attempt to 'soften the blow' of a Type 1 diagnosis?
     
  15. ann34+

    ann34+ Type 1 · Well-Known Member

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    i agree with your posts - i too am very insulin sensitive and use varying insulin amounts, and, especially when i was younger even more so, ( doctors explained that there was no way to plan for how unpredictable monthly hormonal changes, stress, illness, etc would alter insulin sensitivity). Everyone's diabetes is different - recently diagnosed people may still be producing insulin, women under 55 may have more difficulties, insulin sensitive people may find it is very easy to slip into hypo levels (i do), and other illnesses and long term conditions may significantly alter ease of control, i do not think that a particular diet suits everyone. For instance, higher fat diets irritate my digestion, and some people have kidney problems, which may or may not be related to diabetes - and need low protein diets.
     
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  16. ann34+

    ann34+ Type 1 · Well-Known Member

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    Hi, Dillinger, i am interested that you list metformin as one of the drugs you are prescribed.....i am puzzled..... When i have asked doctors about metformin, i have been told that it is only prescribed to type ones when they are insulin insensitive, and that they are also often heavier people, and that someone like myself - lighter and insulin sensitive - would not be able to use it. Could it be that we are all so different and one diet would not fit all?
     
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  17. Soplewis12

    Soplewis12 Type 1 · Well-Known Member

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    I know! I'm not too bad but have been told that I'm sensitive to insulin, I use a paediatric pen with 0.5 measures. I was also told in the past that they think I was still producing insulin myself, I have nothing to back this up & as it was a number of years ago but am quite curious about this now......
     
  18. Dillinger

    Dillinger Type 1 · Well-Known Member

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    I'm puzzled too! If you want to reduce the amount of insulin you are using you could take metformin to do that, there are some good studies relating to using metformin as an adjunct to insulin therapy for Type 1's. Speak to a doctor who knows about diabetes.

    I'm also a bit puzzled by your 'heavier people/lighter people' point; being what exactly? Bit of an assumption you are making there isn't it?

    Lastly, I'm puzzled as to what it means when you say that we are all 'different'. It's a strange thing to say something so blindingly obvious as if it were words of wisdom. What are you actually trying to say? Is it that you think that moderating carbohydrate is not the way to go? We are not so different though on this forum; the evident similarity between us is that we all have diabetes, we therefore all suffer from a dysfunction in glucose metabolism, and the key way to address that is to reduce the amount of carbohydrates we eat to a point where our blood sugars do not spike, don't you think?
     
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  19. ann34+

    ann34+ Type 1 · Well-Known Member

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    Hi, Dillinger,
    i have spoken to diabetes consultants! Several times! And my GP, who specialises in diabetes! and i have read the recent studies!
    But all doctors say no to metformin for me, i am just too insulin sensitive already, they say. And they also made the other points re maybe for larger/heavier people, but not for me - i am just repeating what i have been told, very recently. Over the years i have been fortunate to see many consultants, and all have stressed the complexities regarding how injected or infused insulin reacts with numerous hormones in the body at any one time - some making the insulin even more potent, others having the opposite effect. I have understood that if one is naturally very insulin sensitive then all these factors make things even more difficult.
    And this is all before one adds in the effect of other chronic conditions. Things have been a bit better for me in the years on the pump - but most type ones in the uk are not using one, and the OP has for the moment decided against it.
    Re carbs, best wishes with low carbs. and for all who want/ can manage this, no problems. I myself do not feel at all well on low carbs, though i do keep carbs lower than i used to.
     
    #59 ann34+, Jan 17, 2017 at 4:16 PM
    Last edited: Jan 17, 2017
  20. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Guru

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    I have been told that Metformin reduces insulin resistance, suppresses appetite (so aids weight loss in heavier people) and helps reduce the glucose produced by the liver, but all to a limited extent. So unless you are heavy and need to eat less, are insulin resistant, or suffer too much by way of liver dumps, I can't see it being of much use to either T1s or T2s.
     
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