You can't go LCHF if you're on insulin?

uart · Mar 30, 2015

Let me say right upfront that I don't believe this is true. Yet I've heard several people say it to me, including a diabetic/dietary nurse!

The latest incident was just today when I mentioned to someone about my LCHF diet. She immediately replied that her husband (T2 on 40 units of insulin per day) couldn't possibly do that, "he'd have hypos all the time".

Has the thought never entered these people's minds that you can actually reduce your insulin dosage, and that it's not necessarily undesirable to do so?

Anyway I just had to vent that. It's surprising how pervasive this idea seems to be.

tim2000s · Mar 30, 2015

The difficulty is that many IDDMs are not confident/aware that they can be in control of what they do and don't need to take. It all comes back to carb counting, ostensibly. Those with no experience are likely to be unaware and a little afraid.

LucySW · Mar 30, 2015

This is bonkers isn't it. Why not see high insulin doses as the problem ... Get them down. With LCHF

Dillinger · Mar 30, 2015

You can't go on LCHF if you are on insulin and want to continue having a really hard time managing your blood sugars. If that's not the case then you most certainly can...

phoenix · Mar 30, 2015

It would be more difficult using the mixed insulins prescribed to most T2s.

They are designed to work with consistent meals; ie consistent in both carb content and timing. (that's why they don't always work very well since many people aren't really told how they work and eat very varied meals ) In many cases the majority (70-75%) of the insulin is actually basal because often in T2 a big problem is too much glucagon.

So typically someone may be on twice a day biphasic insulin. The morning injection includes some faster acting insulin that covers breakfast carbs (and dawn phenomenon) and the rest is intermediate insulin which acts in the background to cope with glucose from the liver. As there is no injection at lunch, there is no extra fast insulin to cover lunch but there is a peak from the intermediate acting basal . This could cause a hypo without some carb intake. In the evening the 2nd injection provides more fast insulin to cover dinner carbs ( if the same dose then possibly more carbs than at breakfast because no dawn phenomenon) plus the basal to last through the night.

There is no way that you can adjust the insulin to fit the meal . So changes of any sort need to be done carefully A ketogenic diet would need a change of insulin regime.

.

emm2012 · Mar 30, 2015

Personal perspective from a different angle....I think in reality the pathophysiology of type one is really very different. A type 1 diabetic doesn't produce insulin and has done nothing to cause this and has absolutely no way of preventing the condition.You could argue therefore high insulin doses isn't really the case. They are simply just injecting what any other healthy fit person without diabetes would be producing. In a condition that can be very burdensome and difficult to manage at times, and which is influenced by many things way beyond food you could argue that HCP's are simply giving them the human rights to eat and live as normal a life as possible like anyone else. It's a condition for life and isn't going anywhere in the foreseeable future!! Of course a type one could go on a LCHF diet if they chose, with 'if they chose' being the operative word, but they would also then have to be educated. In reality we are very lucky and have a great NHS service to provide us with the basic education to go about our ADL's. Whilst it would appear LCHF works for weight loss and insulin resistance you have to appreciate that until there are enough long term studies providing long term evidence there is no way the NHS is going to recommend this type of diet. It is very possible for a type 1 to eat carbs at every meal, maintain good control and be fit and healthy. I personally feel routine for a type one is more important and therefore eating the same amount of carbs at each meal whether that be 10 grams or 60 grams is more important in maintaining good control. An active person at these levels is unlikely to suffer insulin resistance or obesity, the problem in this country is the majority of people eat way more then this, and thats a whole nother story!!!

phoenix · Mar 30, 2015

Yes, I too worry about the implicit idea that there is something wrong with dosing the amount of insulin required for a normal healthy diet for your activity level, gender etc.
I also agree that routine and normally eating consistent amounts of carbs is more likely to result in more stable levels. My doctors here in France still stress that to the extent that people are given fixed amounts of carbs to eat for each meal. I normally stick more or less to those amounts but I'm glad that I also know how to be able to miss a meal or eat a larger meal and cope with varied activity levels because consistency isn't always possible
. I know of one lady who sticks to her prescribed amounts faithfully because she's scared of doing otherwise. She eats the right amount,at the right time and does her daily exercise at the same time also. She has a good HbA1c (low 6% last time I spoke to her) and is slim. I would think that she probably has about a 50/70/60, carb prescription
She gets upset because she finds it difficult to adapt at family gatherings and fetes which are so important to French life. (they hate people not eating what is put in front of them) I suspect she would be even more unhappy if advised to eat a LCHF diet .I also suspect that it is just as unlikely here as in the NHS.

In some cases large amounts of insulin are needed (sometimes very large amounts) but this is caused by extreme insulin resistance so is a symptom of a wider problem .

Spiker · Mar 30, 2015

@emm2012 I think you make some fair points there. But one thing I would say is that HCPs don't prepare T1s for life on a normal (same as everyone else) level of carbs. If everyone was taught DAFNE or similar, fair enough, especially if they were at least told about low carbing as an option. But actually many if not most T1s are cut loose even without basic education on carb counting, and on mixed (biphasic) insulin that doesn't support carb counting. So no, they are not enabling most of us to live the "normal" life and diet.

Over and above that of course is the question of whether attempting to live the normal carb rich diet is good for the health of T1s. A real choice requires information, and we are not being given that information by the NHS to make a proper choice. The assumption is we want the normal diet, but we are not given the right education even to manage that, much less are we given an informed choice, even less are we supported to carry out all the alternatives. It's one size fits all, and fits badly.

But I agree with you, if they properly supported the options, or even just one option, then it could be described as a matter of personal choice.

CollieBoy · Mar 30, 2015

emm2012 said:
Personal perspective from a different angle....I think in reality the pathophysiology of type one is really very different. A type 1 diabetic doesn't produce insulin and has done nothing to cause this and has absolutely no way of preventing the condition.

@emm2012,
Where in the pathophysiology of types 1 OR 2 is there ANYTHING about doing anything to cause the D!
It is pathophysiology not ignorant typecasting.

emm2012 said:
You could argue therefore high insulin doses isn't really the case. They are simply just injecting what any other healthy fit person without diabetes would be producing. In a condition that can be very burdensome and difficult to manage at times, and which is influenced by many things way beyond food you could argue that HCP's are simply giving them the human rights to eat and live as normal a life as possible like anyone else.

I would argue the opposite, that by blindly adhering to dogma some HCPs deny the D patient the right to consider a LCHF way of eating. Also you mention that the LCHF diet would require education of patiens. It would require also for the education and de-dogmatization of a lot of HCPs

CollieBoy · Mar 30, 2015

phoenix said:
Yes, I too worry about the implicit idea that there is something wrong with dosing the amount of insulin required for a normal healthy diet for your activity level, gender etc.
I also agree that routine and normally eating consistent amounts of carbs is more likely to result in more stable levels. My doctors here in France still stress that to the extent that people are given fixed amounts of carbs to eat for each meal. I normally stick more or less to those amounts but I'm glad that I also know how to be able to miss a meal or eat a larger meal and cope with varied activity levels because consistency isn't always possible
. I know of one lady who sticks to her prescribed amounts faithfully because she's scared of doing otherwise. She eats the right amount,at the right time and does her daily exercise at the same time also. She has a good HbA1c (low 6% last time I spoke to her) and is slim. I would think that she probably has about a 50/70/60, carb prescription
She gets upset because she finds it difficult to adapt at family gatherings and fetes which are so important to French life. (they hate people not eating what is put in front of them) I suspect she would be even more unhappy if advised to eat a LCHF diet .I also suspect that it is just as unlikely here as in the NHS.

In some cases large amounts of insulin are needed (sometimes very large amounts) but this is caused by extreme insulin resistance so is a symptom of a wider problem .

@phoenix,
I agree to a large part of what you say, that there is nothing wrong with dosing the amount of insulin required for a normal healthy diet for your activity level, gender etc.and agree that the lady should not be advised to eat LCHF, rather all diabetics should be advised of the options of Ways of Eating so that they can make their own choice.

emm2012 · Mar 30, 2015

Spiker said:
@emm2012 I think you make some fair points there. But one thing I would say is that HCPs don't prepare T1s for life on a normal (same as everyone else) level of carbs. If everyone was taught DAFNE or similar, fair enough, especially if they were at least told about low carbing as an option. But actually many if not most T1s are cut loose even without basic education on carb counting, and on mixed (biphasic) insulin that doesn't support carb counting. So no, they are not enabling most of us to live the "normal" life and diet.

Over and above that of course is the question of whether attempting to live the normal carb rich diet is good for the health of T1s. A real choice requires information, and we are not being given that information by the NHS to make a proper choice. The assumption is we want the normal diet, but we are not given the right education even to manage that, much less are we given an informed choice, even less are we supported to carry out all the alternatives. It's one size fits all, and fits badly.

But I agree with you, if they properly supported the options, or even just one option, then it could be described as a matter of personal choice.

As I said there would be very few people in this country on the recommended amount of carbs, so therefore I guess I am not recommending 'the same as everyone else' as a healthy diet....60 grams per meal however can not be described as a carb rich diet and is very little for a person who participates in a lot of sport or works in a manual job. I personally do 100 lengths in the pool every lunch time and work in a physical job. A low carb diet did not work for me I spent every spare minute having to sleep.....in terms of education then yes it appears to be a bit of a post code lottery I have been fairly lucky but equally have taken responsibility for my own health and finding out what works for me, at the end of the day that is what matters.......I really don't want to get in to a what's right or wrong, no two people are ever going to be the same and should not be made to feel bad for eating carbs and equally for not, that is personal choice, and that is the most important thing for any one with a chronic condition

emm2012 · Mar 30, 2015

CollieBoy said:
@emm2012,
Where in the pathophysiology of types 1 OR 2 is there ANYTHING about doing anything to cause the D!
It is pathophysiology not ignorant typecasting.

I would argue the opposite, that by blindly adhering to dogma some HCPs deny the D patient the right to consider a LCHF way of eating. Also you mention that the LCHF diet would require education of patiens. It would require also for the education and de-dogmatization of a lot of HCPs

I guess then I have been lucky with the hcp's I have met who have always supported what ever I want. They can only recommend on evidence based practice and as I said in the original post until the long term trials are available, which I am sure they will they can only recommend as they do.....

emm2012 · Mar 30, 2015

CollieBoy said:
@emm2012,
Where in the pathophysiology of types 1 OR 2 is there ANYTHING about doing anything to cause the D!
It is pathophysiology not ignorant typecasting.

I would argue the opposite, that by blindly adhering to dogma some HCPs deny the D patient the right to consider a LCHF way of eating. Also you mention that the LCHF diet would require education of patiens. It would require also for the education and de-dogmatization of a lot of HCPs

Obesity is one major cause of insulin resistance....and a type one could become insulin resistant the same as anyone else.....loosing weight could reverse this resistance, a type 1 however would still have to inject insulin.......??????

gemma6549 · Mar 30, 2015

emm2012 said:
As I said there would be very few people in this country on the recommended amount of carbs, so therefore I guess I am not recommending 'the same as everyone else' as a healthy diet....60 grams per meal however can not be described as a carb rich diet and is very little for a person who participates in a lot of sport or works in a manual job. I personally do 100 lengths in the pool every lunch time and work in a physical job. A low carb diet did not work for me I spent every spare minute having to sleep.....in terms of education then yes it appears to be a bit of a post code lottery I have been fairly lucky but equally have taken responsibility for my own health and finding out what works for me, at the end of the day that is what matters.......I really don't want to get in to a what's right or wrong, no two people are ever going to be the same and should not be made to feel bad for eating carbs and equally for not, that is personal choice, and that is the most important thing for any one with a chronic condition

I have to agree with you, it's all about what works for you.

I try my best to avoid carbs but I think a lot of that is because of this idea that society has latched on to that "carbs are bad"

Carbs require more insulin and personally I have become to see insulin as the enemy and that it all equates to weight gain (this in part contributed to an eating disorder for 6 years)

Suddenly having insulin on the outside and giving yourself doses gives everything a number that before I became type 1 didn't exist.

Before I got type 1 I ate a "normal" balanced diet which included carbs without a second thought.

Now I find myself on some sort of permanent diet, trying to avoid every other kind of food because it's "bad for you"

Yes I lose weight when I cut carbs but I also lose energy, enthusiasm and my mood is effected.

It's all too much of a numbers game in my opinion!

emm2012 · Mar 30, 2015

gemma6549 said:
I have to agree with you, it's all about what works for you.

I try my best to avoid carbs but I think a lot of that is because of this idea that society has latched on to that "carbs are bad"

Carbs require more insulin and personally I have become to see insulin as the enemy and that it all equates to weight gain (this in part contributed to an eating disorder for 6 years)

Suddenly having insulin on the outside and giving yourself doses gives everything a number that before I became type 1 didn't exist.

Before I got type 1 I ate a "normal" balanced diet which included carbs without a second thought.

Now I find myself on some sort of permanent diet, trying to avoid every other kind of food because it's "bad for you"

Yes I lose weight when I cut carbs but I also lose energy, enthusiasm and my mood is effected.

It's all too much of a numbers game in my opinion!

Lovely post and a very similar story to me all this what's right what's wrong can end up taking over your life and driving you mad. My mood, enthusiasm and energy were also severely effected. At the end of the day we all have to just try and do our best, there is no right or wrong but what works for you, your life and happiness

jack412 · Mar 30, 2015

emm2012 said:
As I said there would be very few people in this country on the recommended amount of carbs, so therefore I guess I am not recommending 'the same as everyone else' as a healthy diet....60 grams per meal however can not be described as a carb rich diet and is very little for a person who participates in a lot of sport or works in a manual job. I personally do 100 lengths in the pool every lunch time and work in a physical job. A low carb diet did not work for me I spent every spare minute having to sleep.....in terms of education then yes it appears to be a bit of a post code lottery I have been fairly lucky but equally have taken responsibility for my own health and finding out what works for me, at the end of the day that is what matters.......I really don't want to get in to a what's right or wrong, no two people are ever going to be the same and should not be made to feel bad for eating carbs and equally for not, that is personal choice, and that is the most important thing for any one with a chronic condition

where most go wrong with a low carb diet is they don't have enough fats. endurance athletes are breaking records

http://www.examiner.com/article/end...ewer-carbs-than-thought-says-sports-scientist

but if your BG and weight is stable, why would you want to change from the carbs you are having now?

gemma6549 · Mar 30, 2015

emm2012 said:
Lovely post and a very similar story to me all this what's right what's wrong can end up taking over your life and driving you mad. My mood, enthusiasm and energy were also severely effected. At the end of the day we all have to just try and do our best, there is no right or wrong but what works for you, your life and happiness

Definitely, because at the end of the day anything above 0 is going to be wrong!

Insulin numbers, carb numbers, body measurements, weight, what the scales say, BMI, hba1c, blood pressure

Whilst some of those numbers have importance a lot are given more importance than they deserve and I was guilty of that for a long time.

As long as my sugars are what they should be and I'm as healthy as I can be I'm sticking with that.

I don't have any scales anymore or know what my weight is and will allow myself food and treats sometimes.

The problem isn't the types of good we eat is the amount we eat. Moderation is the key.

Dillinger · Mar 30, 2015

emm2012 said:
A type 1 diabetic doesn't produce insulin and has done nothing to cause this and has absolutely no way of preventing the condition

you could argue that HCP's are simply giving them the human rights to eat and live as normal a life as possible like anyone else.

you have to appreciate that until there are enough long term studies providing long term evidence there is no way the NHS is going to recommend this type of diet.

I've got to disagree with these 3 points from your post.

Type 2 diabetics have not 'brought this on themselves'. To suggest that they have is pretty offensive to our many Type 2 brothers and sisters. Type 2 diabetes is fundamentally a metabolic disorder that results in reduced insulin sensitivity and associated weight gain. If this were not the case you would not have any slim Type 2 diabetics. The people with the lowest body fat in the world are those suffering from the very rare 'Beradinelli-Siep generalised lipodystrophy' all of whom have no body fat at all and are all Type 2 diabetics whilst at the other end of the spectrum is the engineered obesity of sumo wrestlers who have virtually no diabetes whilst in training. In any event even if you are correct (which I don't accepts) so what? Are you suggesting that we treat people for illness in differing ways dependent upon their complicity in that disease? Should we just leave car crash victims beside the road if they didn't put their seat belts on? It's their own fault after all.

Where is this 'human right' to normal eating set out? That's nonsense. Also, diabetics are not 'normal people' we are diabetics.

The long term study point is a false one; how does one do a double blind study for low-carb/high fat? It would be incredibly obvious from what you are eating which diet you were on, also there is no pharmaceutical impetus to spend all that money (and you'd need a huge amount) as you can't monetise not eating a certain type of food. The flip side of that is that is that at least 3 meta studies of dietary observational studies (including a gold standard Cochrane review) have shown that there is no suggestion of a relationship between dietary fat and heart disease (the presumed worry with eating LCHF) and as you know carbohydrate is and of itself not an essential nutrient so why would one wait for studies that are not going to be done in order to follow that diet when there is no suggestion that it is associated with any sort of ill-health?

Best

Dillinger

gemma6549 · Mar 30, 2015

Type 2 diabetics have not 'brought this on themselves'. To suggest that they have is pretty offensive to our many Type 2 brothers and sisters.

@emm2012 did not actually say this.

I think she was referring to the fact that type 1 is caused by the fact that the pancreas just stops working and nothing else. I wouldn't take a comment about a type 1 and misconstrue it into something to offend a type 2

emm2012 · Mar 30, 2015

Dillinger said:
I've got to disagree with these 3 points from your post.

Type 2 diabetics have not 'brought this on themselves'. To suggest that they have is pretty offensive to our many Type 2 brothers and sisters. Type 2 diabetes is fundamentally a metabolic disorder that results in reduced insulin sensitivity and associated weight gain. If this were not the case you would not have any slim Type 2 diabetics. The people with the lowest body fat in the world are those suffering from the very rare 'Beradinelli-Siep generalised lipodystrophy' all of whom have no body fat at all and are all Type 2 diabetics whilst at the other end of the spectrum is the engineered obesity of sumo wrestlers who have virtually no diabetes whilst in training. In any event even if you are correct (which I don't accepts) so what? Are you suggesting that we treat people for illness in differing ways dependent upon their complicity in that disease? Should we just leave car crash victims beside the road if they didn't put their seat belts on? It's their own fault after all.

Where is this 'human right' to normal eating set out? That's nonsense. Also, diabetics are not 'normal people' we are diabetics.

The long term study point is a false one; how does one do a double blind study for low-carb/high fat? It would be incredibly obvious from what you are eating which diet you were on, also there is no pharmaceutical impetus to spend all that money (and you'd need a huge amount) as you can't monetise not eating a certain type of food. The flip side of that is that is that at least 3 meta studies of dietary observational studies (including a gold standard Cochrane review) have shown that there is no suggestion of a relationship between dietary fat and heart disease (the presumed worry with eating LCHF) and as you know carbohydrate is and of itself not an essential nutrient so why would one wait for studies that are not going to be done in order to follow that diet when there is no suggestion that it is associated with any sort of ill-health?

Best

Dillinger

Wrong wrong wrong and not what I am saying at all. Sorry if I have offended you but I didn't say type twos had done anything to bring about their condition. In fact I haven't mentioned type twos at all. I said that type ones had done nothing to cause their condition and therefore have the right to manage it how they choose. I have absolutely no interest in comparing type one and type two at the end of the day they are different conditions with the same symptoms. My point is that every single person should be able to manage their condition how THEY choose and by a method that works for them. There is no right nor wrong we can only suggest what works for us. A variation of this might work for some one else and that's great

You can't go LCHF if you're on insulin?

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