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Type 1 and low carb suppers

Juicyj

Juicyj

Expert
Retired Moderator
Messages
9,269
Location
Worcestershire
Type of diabetes
Type 1
Treatment type
Pump
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Hypos, rude people, ignorance and grey days.
Hi all,

I need some help please.

I am low carbing so avoiding potatoes, pasta, rice, sugar, fruit. I have around 50-60g per day.

Each evening I eat low carb so either just the bolognaise sauce, omelette with ham/courgette that type of thing. If I eat a protein heavy supper I always take 2-3 mmol of short acting insulin and try to eat around 7.30 so I can test before bed at 10pm to see that i'm ok through the night, some evenings it's a little bit later.

Each morning I wake up at around 10-12, which leads me to 2 conclusions, either i've not taken enough SA insulin or i've had a hypo in my sleep.

I can't figure out what it is but it leaves me frustrated as getting my nightime levels spot on is really important - this has been going on around a month now.

Can anyone recommend what I can do please ? So either suggestions for what to eat in the evening or what could be going wrong ?

Thanks Jus ;)
 
My suggestion would be to test yourself a few times during the night for a couple of nights to get an idea of which way your levels are going, before deciding on what to do insulin/diet wise.
 
I would go along with what Hooked has said and do some testing in the early hours, however a 'protein heavy supper' takes time to digest and protein (in the absence of carbs) converts to glucose by around 50-60% so this could be the cause of your morning highs.

The only way of knowing if it's your basal insulin is at fault is to have a normal carby supper (not high in fat or protein) then tests during the night.
 
Hi Hooked - thanks for the response, I really wish I was able to do this but to be honest as soon as I go to sleep I don't wake till morning, only my daughter has the ability to wake me up, I have asked my DSN for a CGM but they are not prepared to loan me on as have limited supplies of them.

I know if I could wake at 1pm this is the lowest BG i'll get during sleep, but not sure if the protein is taking a long time to turn to glucose hence the high reading in the morning if you catch my drift.

I never used to have this issue, just in the past couple of months and my DSN is on long term sick due to having too many patients to care for, so just trying to see the best way round this.

I am tempted to try a low protein supper and see what the AM reading comes to - generally before sleep I am around 8 so this for me is ok.
 
I find that if I eat a lot of protein I wake up high, or if a lot of fat. I look at how much protein I'm eating, divide by three then bolus for that many carbs. Some people divide by four. Sometimes it works well.
A lot of fat can actually cause the liver to produce more glucose so even though you are low carb you could actually be taking as much qa insulin as if you were eating carbs. Got this from "Think like a pancreas" Gary Schreiner ?

It's a fine balancing act. Good luck!


Sent from the Diabetes Forum App
 
Juicyj said:
Hi Hooked - thanks for the response, I really wish I was able to do this but to be honest as soon as I go to sleep I don't wake till morning, only my daughter has the ability to wake me up, I have asked my DSN for a CGM but they are not prepared to loan me on as have limited supplies of them.

I know if I could wake at 1pm this is the lowest BG i'll get during sleep, but not sure if the protein is taking a long time to turn to glucose hence the high reading in the morning if you catch my drift.

I never used to have this issue, just in the past couple of months and my DSN is on long term sick due to having too many patients to care for, so just trying to see the best way round this.

I am tempted to try a low protein supper and see what the AM reading comes to - generally before sleep I am around 8 so this for me is ok.
Click to expand...
How can you know that your blood sugars are at their lowest at 1am if you haven't tested through the night?

Set yourself a loud alarm and make the effort to do those tests in order to help yourself. What if it was hypos you were suffering through the night and some night your liver didn't kick in? For the sake of a couple of interrupted nights sleep, it's worth making the conscious effort to wake and do those tests.
 
Hi Hooked - my partner also sleeps in the same bed so I think if I set an alarm to go off loudly at 1am he wouldn't be very pleased as he's up at 5am !!!

I appreciate what you're saying and yes doing this would certainly clear any doubt - I really wanted to get more advice on this first and see if there's anything I could think about before doing a night test.

Grateful for your input.
 
Mrs Vimes said:
I find that if I eat a lot of protein I wake up high, or if a lot of fat. I look at how much protein I'm eating, divide by three then bolus for that many carbs. Some people divide by four. Sometimes it works well.
A lot of fat can actually cause the liver to produce more glucose so even though you are low carb you could actually be taking as much qa insulin as if you were eating carbs. Got this from "Think like a pancreas" Gary Schreiner ?

It's a fine balancing act. Good luck!


Sent from the Diabetes Forum App
Click to expand...

Thanks Mrs Vimes - this is really useful information - I was more concerned that the amount of protein was causing something to go adrift with my BG, i'm not so concerned having a night time hypo as I do wake up normally, but it's the level i'm at in the morning that's causing me concern as I like to try and get my 8 hours sleep within a nice tight parameter of around 6-8, taking QA insulin is very much hit and miss so this gives me an idea of what to take, either that or try and eat more low carb veges perhaps ?
 
Hya juicyj,

You cannot assume that your blood sugars are at their lowest at a certain hour when you are asleep.

I am following a low carb diet and have a CGM. I have discovered that sometimes after a small evening meal at 19:00 consisting of protein with salad type stuff I manage to record a nice steady line by 23:30. But, the CGM records a slow rise around 02:00am up to 10mmol then gradually falls back down in hills and troughs to around 5mmol at 07:00.

Edit: Typo
 
Last edited by a moderator:
Ambersilva said:
Hya juicyj,

You cannot assume that your blood sugars are at their lowest at a certain hour when you are asleep.

I am following a low carb diet and have a CGM. I have discovered that sometimes after a small evening meal at 19:00 consisting of protein with salad type stuff I manage to record a nice steady line by 23:30. But, the CGM records a slow rise around 02:00am up to 10mmol then gradually falls back down in hills and troughs to around 5mmol at 07:00.

Edit: Typo
Click to expand...

Hi Amber - thanks for your response.

I have been told by both DAFNE and from reading Dr Bernsteins book about this being the lowest point - so it's not an assumption.

With the greatest respect if I had access to a CGM I would be able to understand more about what my patterns are during the night - so you are very fortunate to have this.
 
Juicyj,

Thanks for your response.

Before watching my blood sugar trends on the CGM I had no idea what was happening to my blood sugar at night. I thought that if I went to bed with a reading of 7 mmols and woke at 5 mmols that the only change had been gradually downwards. I have yet to discover what is causing the rise while I am sleeping because it doesn't happen every night. I also see a small drop in blood sugar when I eat and a rise of about 3mmols when I drink a black coffee!!!.

I self fund the CGM and am currently on day 62 with the current sensor. But I do have to keep applying glue to keep the adhesive dressing secure..
 
Juicyj said:
Hi Amber - thanks for your response.

I have been told by both DAFNE and from reading Dr Bernsteins book about this being the lowest point - so it's not an assumption.

With the greatest respect if I had access to a CGM I would be able to understand more about what my patterns are during the night - so you are very fortunate to have this.
Click to expand...

Hi, I've just got back from an appointment with my consultant where we discussed CGM's and she said whist I would have to self fund, if I contact the companies and say I am considering buying their product they will loan you one for a trial period - perhaps give that a go? Good luck x


Sent from the Diabetes Forum App
 
Juicyj said:
Hi Hooked - my partner also sleeps in the same bed so I think if I set an alarm to go off loudly at 1am he wouldn't be very pleased as he's up at 5am !!!

I appreciate what you're saying and yes doing this would certainly clear any doubt - I really wanted to get more advice on this first and see if there's anything I could think about before doing a night test.

Grateful for your input.
Click to expand...

My partner does shift work too - but I know that he would accept a couple of disturbed nights in the interests of my health. Does your partner work 365 days a year? If not, time your tests for one of his days off.

Alternatively, one of you could sleep on the sofa for a night or two.

Your health should be a priority, and the risk of night time hypos should be taken seriously.
 
Brunneria said:
My partner does shift work too - but I know that he would accept a couple of disturbed nights in the interests of my health. Does your partner work 365 days a year? If not, time your tests for one of his days off.

Alternatively, one of you could sleep on the sofa for a night or two.

Your health should be a priority, and the risk of night time hypos should be taken seriously.
Click to expand...

The first night with the CGM we didn't get much sleep! All the alerts were set (there are several) and were triggered every few minutes at full volume. I had not realised that you have to acknowledge the alert so that it does not keep alerting you to the same event. Hubby made no comments. The next day I asked him if he had heard the alerts despite the receiver being under my pillow. Yes, he had heard the alerts but he is happy that I now have something that will wake me if my blood sugars are dropping too low.
 
Juicyj, could it be 'dawn phenomenum' where the liver releases some glucose in the early hours to give the body a boost to wake up? My basal rate increases between 5am and 7am to account for this.Try googling 'Rocky Morning Highs?: Diabetes Forecast Magazine' for more info about possible causes for morning highs.
Ambersilva, did I read that correctly? Day 62 of your sensor? That is amazing, what cgm system are you using? I am considering signing up for medtronic cgm and they say each sensor lasts just 6 days at a cost of approx £50 so it will be very expensive to self fund.
 
JuicyJ, if you can't wake up in the night try staying up later or eating supper earlier, or both. As noblehead and others mentioned, testing after 2.5 hours is not enough time to check the progress of a protein meal. In fact it's not enough time to check the progress of a carb meal, let alone a protein meal. The most likely causes are the protein meal continuing to climb through the early hours, or the dawn phenomenon, or a mix of both. Since it's new you have to look at what has changed. It's not always the case that anything has changed, but if anything has changed, you need to look at that first. Are these high protein meals relatively new? Then most likely it's the high protein meals.

Now, deep breath... nobody, not Dr Bernstein, not DAFNE, can tell you that your peak BG is at 1am. Absolutely, totally, completely no way. If they can say that, they are saying that about every single diabetic in the world, and that's a total impossibility. The only thing that can tell you when your peak or trough BG is during the night, is measuring it. This means waking up or begging / borrowing / stealing a CGM. You can get a fairly good idea by doing things like getting up very early one day and staying up very late the next. Not perfect as the dawn phenomenon is linked to your own body rhythms, but it's a start. But please put aside this idea that a DAFNE course or a book can tell you when your blood sugars are at their highest or lowest. It is, honestly, complete nonsense.

Stick with it, we are here to help!
 
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