Type 1 and low carb -how low do you go?

Hi @alaska, I'm currently on Very Low carb at about 25-30g per day. This primarily isn't to do with Diabetes, but in order to reduce body fat. I'm currently in a state of light Ketosis (around 1mmol/l blood Ketones) and I'll be keeping it up for a while while I bring my body fat levels down.

It does mean that i have some magnificently flat lines, but on about 180g of carbs a day, I still managed an Hba1C of 5.9%.

I tend to call myself moderate carb around 150g a day. My blood Sugers do not spike like they used to, l think this is due to the amount of protein and fat I put into my diet. My blood Sugers do increase but they increase a lot slower than when I was on high carbs and my blood suger control was not that tight . My blood Sugers tend to be below 9mmol a hour after a meal. Hba1c 63 or 7.9 I am currently working on getting this a lot lower. I call it work in progress.

I have to keep protein low or I will spike. I also need to add some fat to all meals to not spike. On the other hand too much fat will keep me higher longer. Delicate balance. I need to keep carbs very low as well. I could always eat more and split my bolus but that's too much hassle for me. I'm maintaining a good weight and good control so I'm not messing with the system.

I am however having a recent upward trend and insulin isn't carrying me the way it used to so I'm going to need to up my dose. I'm thinking it's the weather as we have just gotten quite warm and humid.

My experience is as follows:

1. When eating VLC (<30g carbs per day) protein has a noticeable effect, and that starts to be noticed within an hour of consumption, even with high fat content. It lasts for around 3-5 hours. I identified this with the Libre. On MDI my strategy was a bolus on eating and then a further bolus two hours in. I bolused as though I was eating half the weight of carbs on the first and approximately half to two thirds of this on the second. On the pump, I use a multi/dual-wave bolus with the same upfront bolus and then the remainder over the next two hours.
2. When not eating LC (100g+ per day) fat and protein have a kind of accelerant effect on carbs, in my experience. Highish protein combined with carbs and fat can really push glucose levels up quickly, which was unexpected, and then keep them there. Fried bread with Sausage and Egg is a classic example of this. Even though the carb plus protein amounts equate to what should work, I need twice as much insulin to stop it going up massively and then staying there, just in the pre-meal bolus. I also need add ons (either additional bolus or use of dual wave) to ensure late effects don't come into play. This is very much the Pizza effect, and is seen with Pizza, Fish and Chips, etc. Many of us have already established that multiple boluses are needed to handle this type of food.
3. I can't say that I really get an effect from the Fats. I know that we're told that this should be 6-8 hours, and in most cases I've eaten again by that time, but if I look at overnight levels, I should in theory see a raise, which isn't there, so either I've got my basal rate set such that it accounts for this, or my fat conversion level isn't that high. If you consider that fat conversion is considered to be about 10% of fat intake in a meal, this makes sense on what I'm eating. As you only need 167g of fat to account for 60% of your daily calorific intake, it makes sense that I'd see little effect of fat on blood glucose, as, effectively I'd only be getting 16.7g of carbs from that across the entire day (although I know that isn't the physiological mechanism explanation).

There's an interesting recent paper here discussing how high fat, high carb meals can be addressed, and of course, there's also the Polish method for working with a pump, that @ewelina is far more of an expert on than me.

I low carb'd for the last ~7 weeks less than 30 g per day for the sole purpose of reducing body weight. As a result my running performance has improved significantly and I'm a bit quicker on the bike.

I went back to a higher carb diet recently including cakes ,chocolate bars the works. Previously I strictly low carb'd for 3 years but found out by accident I can tolerate more carbs in the evening.

Surprisingly I don't see much difference in my HBA1C results between low and higher carb. The last one was 4.7 (during low carbing) and prior to that 4.9 (higher carb intake).

alaska said:

That's great Wurst. Were you diagnosed as type 1 as an adult? Was the diagnosis recent or have you had it for years and years?

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Yep as an adult , @ 39 and only had it for 4 years, although no longer in my honeymoon period.

alaska said:

Do you use a CGM or Libre, Wurst?

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No, don't have a CGM or pump, only my trusted one touch verio meter(s) and am on MDI's.

alaska said:

Same as I was until recently. MDI and monitoring with Verio

I'm trying to understand how you get an HbA1c under 5%.

On the one hand, you do a lot of exercise which will soak up any high sugar like a helpful sponge.

On the other hand, you may be consistently going hypo through the night and not be aware of it.

Since getting a Libre, I've found out that I'm going hypo through the night more often than I'd given credit for.

I currently wonder just how serious elongated mild hypos really are as, after all, extended periods of nocturnal hypoglycemia appears to be relatively normal in people without diabetes -see graph below
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769652/figure/fig2/

Graph comes from this study

Continuous Glucose Profiles in Healthy Subjects under Everyday Life Conditions and after Different Meals

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A very interesting graph, however If I hypo during the night I wake up as I'm a very light sleeper. Also I can't get to sleep if my BS is too low and have excellent hypo awareness.

The last HbA1C was achieved with only 3-4 hypo's and loads of exercise. I cycle to work daily ~ 30 km's, strenuously row 4 times a week and run twice per week.

I aim to keep my BS between 4.4 mmol and 5.5 mmol at all times. A 4.7 % HbA1C is roughly equivalent to an average of 4.9 mmol, so almost dead center of target range.

tim2000s said:

My experience is as follows:

1. When eating VLC (<30g carbs per day) protein has a noticeable effect, and that starts to be noticed within an hour of consumption, even with high fat content. It lasts for around 3-5 hours. I identified this with the Libre. On MDI my strategy was a bolus on eating and then a further bolus two hours in. I bolused as though I was eating half the weight of carbs on the first and approximately half to two thirds of this on the second. On the pump, I use a multi/dual-wave bolus with the same upfront bolus and then the remainder over the next two hours.
2. When not eating LC (100g+ per day) fat and protein have a kind of accelerant effect on carbs, in my experience. Highish protein combined with carbs and fat can really push glucose levels up quickly, which was unexpected, and then keep them there. Fried bread with Sausage and Egg is a classic example of this. Even though the carb plus protein amounts equate to what should work, I need twice as much insulin to stop it going up massively and then staying there, just in the pre-meal bolus. I also need add ons (either additional bolus or use of dual wave) to ensure late effects don't come into play. This is very much the Pizza effect, and is seen with Pizza, Fish and Chips, etc. Many of us have already established that multiple boluses are needed to handle this type of food.
3. I can't say that I really get an effect from the Fats. I know that we're told that this should be 6-8 hours, and in most cases I've eaten again by that time, but if I look at overnight levels, I should in theory see a raise, which isn't there, so either I've got my basal rate set such that it accounts for this, or my fat conversion level isn't that high. If you consider that fat conversion is considered to be about 10% of fat intake in a meal, this makes sense on what I'm eating. As you only need 167g of fat to account for 60% of your daily calorific intake, it makes sense that I'd see little effect of fat on blood glucose, as, effectively I'd only be getting 16.7g of carbs from that across the entire day (although I know that isn't the physiological mechanism explanation).

There's an interesting recent paper here discussing how high fat, high carb meals can be addressed, and of course, there's also the Polish method for working with a pump, that @ewelina is far more of an expert on than me.

Click to expand...

I find the same thing which is the biggest reason I eat low carb ( the other is I don't digest them or large meals well) when I first started insulin and was only eating 20 c per meal I would hypo, then hyper and stay high. If I eat a lot ( well for me) of protein regardless of fat content I stay high and it's harder to get it down. Fat has very little effect on my bs. It is said it slows protein and carbs but the only fat I actually have found to do that is avocado. Oils, butter etc have no effect so I'm assuming it's all the fiber along with the fat. I need to keep protein on the low end or I would need to double bolus and I'm not interested in that on a daily basis. Nuts between meals don't raise me but they do stop me from coming back down.
Avocado has become my super food because it slows everything as well as keeps the rise lower. I do find it strange with protein that if I go up I stay up. At least avocado lessens the rise by a lot and allows me to come back down, all very slowly. I definitely have to watch my protein. It's the only food I still weigh but it works because I cook in bulk and freeze in my portions so all I do is defrost. I have many options of precooked food every day. All my raw veggies ar else chopped so all I do assemble what I'm in the mood for. Makes like much simpler and takes the stress of diabetes off my plate.

Wurst said:

A very interesting graph, however If I hypo during the night I wake up as I'm a very light sleeper. Also I can't get to sleep if my BS is too low and have excellent hypo awareness.

The last HbA1C was achieved with only 3-4 hypo's and loads of exercise. I cycle to work daily ~ 30 km's, strenuously row 4 times a week and run twice per week.

I aim to keep my BS between 4.4 mmol and 5.5 mmol at all times. A 4.7 % HbA1C is roughly equivalent to an average of 4.9 mmol, so almost dead center of target range.

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Do you have to bolus for exercise?

Kristin251 said:

Do you have to bolus for exercise?

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Yes, only in the mornings for cycling and running, otherwise DP kicks in and seems to be worse with moderate to strenuous exercise.

alaska said:

Shows the power of regular exercise. That's great to hear Wurst.

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Everyone should do it I dread the day I get an injury that prevents me from exercising for a prolonged period. I will lose all control then.

Wurst said:

Yes, only in the mornings for cycling and running, otherwise DP kicks in and seems to be worse with moderate to strenuous exercise.

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How to do you know how much to bolus and then don't you go low later?
Morning is always worst for me