why dose diet matter ?

The advice in this thread is, I believe, poor.

Insulin total daily dose is directly linked to hypoglycemia frequency, and inversely linked to life expectancy.

Insulin makes you hungry, thus eat more, thus you will have higher sugars later. People on this site need to read Bernstein's book.

The law of small numbers: small carb intake -> better sugars with less insulin needed -> low insulin TDD -> low hypo risk -> safer -> better life expectancy

A well balanced health diet should be eaten by everyone. This includes reducing processed sugars. A lot of processed foods are high in sugar. Look at the sugar content of stir fry sauce, cereals, pasta sauces etc...

Hoping4Cure said:

The advice in this thread is, I believe, poor.

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I really don't see how telling a newly dx'd T1 that, within reason, they can live a relatively unrestricted life counts as bad advice.

No-one is saying that T1s should go eating a bowl of trifle every day.

I personally have got by quite happily without low carbing, but I'm not going to dis it for people who choose to do it. Likewise, I wouldn"t expect my choices to be dismissed out of hand - a bowl of tortellini is totally manageable.

Type 1s eat a variety of different diets. If there was a magic diet, we'd all be eating it.

None of the people who've lived with Type 1 for 50+ years ate a very low carb diet.

The insulin Type 1s take is only to replace the insulin they can't make. The comments about 'excess insuoin' aren't really relevant. Moreover, many Type 1s following a very low carb diet actually take a fair bit of insulin, having to bolus more for a carb-free meal than many of us would for a moderate carb meal.

One size doesn't fit all.

Hoping4Cure said:

Insulin makes you hungry, thus eat more, thus you will have higher sugars later. People on this site need to read Bernstein's book.

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I just don't agree - whether I eat a stir fry (15g~) requiring a small bolus dose or a full pizza (220g~) needing a large split bolus, just because I've had many times more bolus units for the pizza doesn't make me want to have another shortly after. Provided the ratio is right, the bolus is taken at the correct time(s) does not guarantee that my glucose is going to shoot through the roof either.

It is perfectly OK to eat trifle - or something close. Chose a low carb mixture of frozen fruits and allow them to thaw a little as a sugar free jelly cools, mix the two and allow to set and then pour on real custard, made with cream and eggs, cooled to just slightly warm, and allow to set.
Delicious and low carb too.
There are so many delicious low carb foods I do sometimes wonder if Type 1s are missing out when advised to stick to normal foods and take the sugars, and the insulin. Leek leaf lasagne, fathead pizza, caulirice - all seem better 'than the real thing' rather than a poor substitute.
There is also so much concern about hypos - eating fewer carbs seems to mean lower doses of insulin are required, so a miscalculation - as a percentage of the total, is also reduced in severity, with any luck. So being half a unit wrong when eating 20 gm of carb is perhaps easier to deal with than when eating 100gm. It would certainly make me think on the options.
The diabetes education teams I saw seemed to have the opinion that type 2s got the worse deal, but I rather think that all diabetics could do with more options than the standard advice given.

Type2s need to watch their weight and diet plays a huge part in that. Far more than exercise and metformin.
A type1 has different priorities than type2s weight affecting insulin resistance.
Insulin therapy is a fantastic med for diabetes but like I've said before it's how you use it depends on weight gain.
I'm currently losing weight on basal and bolus insulin.

Resurgam said:

It is perfectly OK to eat trifle - or something close. Chose a low carb mixture of frozen fruits and allow them to thaw a little as a sugar free jelly cools, mix the two and allow to set and then pour on real custard, made with cream and eggs, cooled to just slightly warm, and allow to set.
Delicious and low carb too.
There are so many delicious low carb foods I do sometimes wonder if Type 1s are missing out when advised to stick to normal foods and take the sugars, and the insulin. Leek leaf lasagne, fathead pizza, caulirice - all seem better 'than the real thing' rather than a poor substitute.
There is also so much concern about hypos - eating fewer carbs seems to mean lower doses of insulin are required, so a miscalculation - as a percentage of the total, is also reduced in severity, with any luck. So being half a unit wrong when eating 20 gm of carb is perhaps easier to deal with than when eating 100gm. It would certainly make me think on the options.
The diabetes education teams I saw seemed to have the opinion that type 2s got the worse deal, but I rather think that all diabetics could do with more options than the standard advice given.

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Lower carb foods aren't forbidden. I sometimes eat something like salmon fillet and salad when I go out, but the point is that that makes control no easier. It's just substitutes one problem for another - that is, bolusing for the delayed rise from protein.

I don't understand the point you're making about being half a unit out. Getting any bolus wrong can cause issues, but being half a unit out when eating 100g carbs would probably cause less issues than when eating 20g carbs.

Type 1s aren't given 'standard advice'. Most learn the amount of carbs that suits them.

Type 1 is a very different condition from Type 2.

For me I believe the body needs insulin just like any other hormone.
Only too much insulin is believed to lead to insulin resistance. I'm not sure. I think more to it than that. Always have.

azure said:

None of the people who've lived with Type 1 for 50+ years ate a very low carb diet

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My understanding was that Bernstein had done exactly that? Or have I misunderstood somewhere.. ?

bulkbiker said:

My understanding was that Bernstein had done exactly that? Or have I misunderstood somewhere.. ?

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I think he's just under 50 years on his extremely LC diet - I've got the book but can't find his bio.

I was more thinking of that man reported on recently here - the one who'd lived with Type 1 for 80 years - and the many other UK Type 1s of 50+ years who moderated their carbs certainly, but didn't eat minimal levels of carbs

Things might be different, of course, for diet-only Type 2s.

I believe I've had type2 diabetes 40+yrs but only just started reducing my carbs for lower bgs.
In fact I reduced protein and fat in those yrs but never carbs.
I too was told porriage, weetabix, wholemeal bread and brown rice or wholemeal pasta was best.
I lived off jacket potato and baked beans pre diagnosis years.
I avoided eggs due to scaremongering cholesterol attachment.
I live off those now instead of potato.

I've been at my healthiest on appetite suppressants obviously due to my severe insulin resistance and leptin resistance.
I don't believe many type1s get those much.

azure said:

I think he's just under 50 years on his extremely LC diet - I've got the book but can't find his bio.

I was more thinking of that man reported on recently here - the one who'd lived with Type 1 for 80 years - and the many other UK Type 1s of 50+ years who moderated their carbs certainly, but didn't eat minimal levels of carbs

Things might be different, of course, for diet-only Type 2s.

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So far as I was aware before insulin therapy became prevalent an ultra low carb diet was the only treatment for Type 1?
And even then I guess rarely successful.
Checked on Wikipedia Bernstein has been at it for 44 years.

Yes, they used to get Type 1s to drink cooking oil or put them on starvation diets like black coffee and whisky. Type 1 was always fatal though.

Fortunately, we have insulin now So no need for starvation diets - which I'm very glad about!

azure said:

Type 1 was always fatal though.

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Much like life...

bulkbiker said:

Much like life...

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I don't imagine that was much consolation to the parents of children with Type 1 who died painful deaths before insulin. Nor indeed to adults diagnosed with what was then a terminal illness.

Insulin was a miraculous discovery - as discussed in a recent thread here - and every Type 1 posting here wouldnt have survived without it.

I discovered the same as someone else mentioned. I have had a few carb free meals and straight away I still needed insulin to cover the protein.

You can still eat a similar % of carbs as you did before as long as your bolus insulin covers it by the next meal time. What I now pay attention to is the GLYCEMIC INDEX of various carbs. The lower the better. For instance strawberries (in fact most berries) will spike my blood sure very little whereas pineapple can spike it way more. Quinoa much less than white pasta. White potatoes are killer, sweet potatoes much less. I really love french fries but they'll rocket my BS way up there.

Scott-C said:

I really don't see how telling a newly dx'd T1 that, within reason, they can live a relatively unrestricted life counts as bad advice.

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Here's just one research link posted on this very site supporting the assertion that low carbing reduces hypos (which can be deadly, as we all know, not to mention extremely awful things to endure unnecessarily):

http://www.diabetes.co.uk/news/2017...-more-stable-blood-sugar-levels-96690294.html

"The low-carb diet resulted in reduced time with both high and low blood glucose levels and more time within the normal range, compared to the high-carb diet.

The fact that participants on low-carb spent less time with low blood sugar levels indicates that it is a safer way of eating, limiting the incidence of hypoglycemic events. "

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The idea that one can just "take the right amount of insulin to match any amount of carbs" assumes:

-that the person knows exactly the number of carbs and fiber and sugar in every single ingredient of every meal they eat (false),

-the exact additional effect of fats and proteins on their sugars (false)

-the insulin-to-carb ratio is a known, fixed value, i.e. constant throughout the day (false, it can vary significantly, especially during exercise, each unit of insulin can become 6X more effective during exercise. meaning if you took the non-exercise amount of total insulin for a large, carb-heavy meal and then exercise you are going to crash),

-that insulin can act fast enough to guarantee no excursions even in the best circumstances (this is known as the Phase I response) (false)

-insulin then disappears from the blood stream once it's no longer needed to cover that meal. (false)

-that people don't OD on insulin to make it work faster when they have super high sugars after meals due to aforementioned "go ahead and eat all the pasta and bread and rice that you want" advice (false). This is known as "rage bolusing"

-that a "good" HbA1C value constitutes "good control". (false) No, control is when one has achieved a low blood sugar variance, not mean. Wild swings due to ingesting large amounts of carbs and appropriate insulin inevitably result in larger variance, thus poorer control. It's basic math. Like, grade-school level math. If you want a low average, in the presence of high variance, you are going to have a lot of dangerous lows to average out those highs. There is no way around this, unless one rewrote the laws of algebra.

TheBigNewt said:

You can still eat a similar % of carbs as you did before as long as your bolus insulin covers it by the next meal time. What I now pay attention to is the GLYCEMIC INDEX of various carbs. The lower the better. For instance strawberries (in fact most berries) will spike my blood sure very little whereas pineapple can spike it way more. Quinoa much less than white pasta. White potatoes are killer, sweet potatoes much less. I really love french fries but they'll rocket my BS way up there.

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Eating a lot of carbs then taking a lot of insulin to cover it is like putting your foot on the gas and the breaks at the same time and trying to steer your car safely. No, it's dangerous and reckless. I followed this advice for years until reading Dr Bernstein's book and learning about the law of small numbers. It's obvious that many type 1s on this site haven't read it and I encourage you to do so. Immediately.

This is not even new stuff, that data has been around for decades. I almost cannot believe my eyes coming to a diabetes forum and reading people say that insulin TDD (total daily dose) doesn't matter. It does.

It can cause obesity and insulin resistance even in type 1s, and even add type 2 diabetes on top of type 1. Is this really the advice that people should be giving here to new type 1s? Just take more insulin and carry on as before? Really?

This exact advice has caused me to nearly die several times.

Until I wisened up and started to see carbs for what they are: NO different than sugar.

Q) Would you tell a diabetic they can eat as much cake or candy bars as they wanted?

Considering that a piece of cake or a candy bar is virtually no different from a metabolic perspective than a potato or a plate of spaghetti. They all spike your sugars and require you to take more insulin, which is like starting a fire and then saying, no problem, I can just put it out with this fire extinguisher as if nothing happened.

Increased insulin injections exacerbates the destructive cycle of insulin resistance and weight gain, which affects type 1s as well. On top of hypos, higher variance, excursions. Many type 1s end up with some kind of insulin resistance, typically as they get older. This is a natural consequence of not only insulin overdose, but appropriate insulin doses as well. Covering excess carbs that the body doesn't need to live will result in the exact same thing as it does for type 2 diabetes: obesity and IR, complications, etc.