Is low(er) carb always necessary?

Something I’ve been curious about, looking towards the end of my honeymoon period and trying to think of ways to balance my various health issues (one of which I was originally told required 70% of my daily intake to come from carbs :grimacing: ) - Is good control impossible with a high carb diet? Already I’m struggling with breakfast (sometimes going high no matter what I bolus or eat, unless I use Afrezza). What have been your experiences?

@Pianoplayer7008 I’ve found that if I eat high carb my insulin requirements increase exponentially. I was doing a TDD of about 200 units :scream: eating around 150-200g carbs/day. At my current ~75-80g carbs I have much better control with a TDD of about 75 units.

I didn’t make any drastic changes. Just swapped sandwiches for salads, and stopped eating high carb when low carb alternatives are available.

I will start by saying that we are lower carb (around 100g a day), but we know plenty of diabetics who are not and who have good control.

Through diabetes and testing you will learn what works for you. We have members that eat high carb and do fine, (my guess) is the largest group restricts carbs to the 60-120 g per day range. I am not aware, but we must also have some that eat keto.

Why we started: Eating lower carbs makes the dosages smaller and therefore a carb counting mistake leads to smaller issues.

Why we stay: my son is very carb sensitive. If we are low at 50 and eat 15g of carbs without giving insulin he will spike to over 300 very quickly. This is unusual in our experience, his diabetic friends can do the same thing and will go from 50 - 130 and flatten out. Consequently, we often treat lows with 5g of carbs.

So, in summary, I would say give low carb a try and see how it works for you, but don’t feel like low carb is the only way.


It is not impossible. I eat a lot of carbs.

@britt_j and I had humorous PM conversations about our diets and would laugh at each other’s dinner because we are at opposite sides of the spectrum.

(It was always Carb-Monkey :cake::monkey::fries::monkey: :pizza::monkey::icecream::monkey::hamburger:
versus Bernstein-Nutter :herb::seedling::leaves::peanuts::broccoli:)

The point being, despite the huge difference in our carb intake we both have good control. You can do it anyway you want.

Exercise helps with the carbs, if that is something that you can do.

High carb is not impossible. Maybe a bit more challenging to manage, but certainly doable. I do it almost everyday.


I don’t think it’s impossible, no. There isn’t anything “off limits” per say. You have to do a lot of testing and dialing in to find the right mix of basal/bolus, but it is possible to manage successfully. Many people, like our son Liam, have their biggest BG issues (the biggest spikes) in the morning. So we sometimes give less carb foods in the morning to take that into account. Liam usually eats 15 - 30g carbs in the mornings whereas the other two meals he may eat 20 - 50g meals (big ranges, but this really just depends on the meal we happen to be eating.) Liam eats what we eat…we don’t like for him to feel like he’s somehow “different” (other than the non-stop shots). We sometimes have to limit and supplement with other foods, but we never deprive him of what his brothers are eating.

Good luck!


I do not think low-carb is necessary for good control; my theory is that you simply have to use different management strategies for low- versus high-carb meals.
For instance, our son pretty much ALWAYS goes over 300 if he eats just scrambled eggs (0 carbs) and doesn’t get a bolus for it. The issue is that we have no strategy for bolusing for fat and protein in the absence of carbs.
Meanwhile, with all the birthday parties we go to, bolusing for cake seems like a… piece of cake.
So I think it’s really about learning different strategies, experimenting and testing to figure out how to bolus for a given food.


Why we stay: my son is very carb sensitive. If we are low at 50 and eat 15g of carbs without giving insulin he will spike to over 300 very quickly. This is unusual in our experience, his diabetic friends can do the same thing and will go from 50 - 130 and flatten out. Consequently, we often treat lows with 5g of carbs.

I’m curious @Chris, whether this is always the case or whether this level of carb sensitivity might dissipate if he was eating a higher-carb diet? I remember my husband spoke with a girl who was on an intense keto diet and she ate one-half a glucose tab to raise her BG 40 points!! This was not the case when she ate a normal number of carbs.

And it does seem to be well-documented that, at least at the ketogenic scale, people become much more sensitive to carbs and will spike higher from lower carb dosages.

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Tia, I would absolutely agree with you if we were eating ketogenic, i.e. using the protein pathway for the majority of the bodies carb production.

For us, it is totally different. At diagnosis, we tried to keep him eating the same way he had been pre-diagnosis. We did this based on the education we were given, as well as the feeling that now that things had changed, if we took away carbs it would be adding a second loss to his life and we had no interest in that.

During this time, (pre-Dexcom) we got pretty good at controlling things, his first A1c post-diagnosis was in the 8’s, but even during this time we noticed that the recommended 15g low treatment was way way too many carbs. Of course when we got the Dexcom we were able to confirm our pre-CGM hunch that he was much more carb sensitive than the average bear.

Because of this, I asked him one week to consider lowering his carbs to 100g and see what happens. It was like magic, once we dropped below this threshold. His control immediately improved. We saw many less highs and lows.

So, in summary, I don’t think that increasing his carbs to 150-200 a day would reduce his sensitivity, although I am hopeful for him that as he grows this will become less prevalent.


I eat many fewer carbs than I was recommended to do at DX (135-180!!!) and this has helped reduce spikes. I now eat from 70-100, more if needed for activities or on “treat days” or vacations. I feel much better and also can manage the exceptions better now that I am on a pump.


@Chris, interesting. My son usually takes a 4g correction and that is usually enough to mop up about 0.1 to 0.2 units of excess insulin and he will typically rise from that by about 30 to 50 points. He only spikes high with that amount if he has negative IOB – i.e. we took away some of his basal. That usually happens at night if he’s been zero temped for hours but still drifts low.

And we’ve found that for him, carb sensitivity definitely shoots up if he eats too few carbs in one meal. So if he eats a breakfast with less than, say, 10 g carbs, he will require the same amount of insulin as if we’d just fed him an English muffin. And his TDD does not go down with fewer carbs…somehow we just wind up making up the difference in correction boluses or more high temp basals. He becomes very insulin resistant with a high-fat diet.

There does also seem to be an upper threshold though – like he would basically never eat more than 60 g of carbs in a sitting, and the rare times he does we are dealing with the aftermath for many hours. My guess, though, is that 60 g represents a total caloric overload for him; he’s pretty small and I doubt he eats more than 1,200 calories a day. And it’s always, always worse if we combine high-fat and high-carb.

My guess is that some of the same physiological processes are at play in most people but that the thresholds and parameters vary for each of us, which is why for some people low-carb seems to result in better control while others do just as well or better with lots of carbs.

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I think that individual physiology plays heavily into whether someone finds a low-carb or higher-carb diet easier. I have lowered carbs gradually and find a low-carb approach much easier to handle than high carbs. But this has also changed over time for me. Two years ago I was able to eat 30-40 grams of carbs per meal and maintain an A1c of around 6.0%. Then I got Graves’ disease, and since then I just can’t eat carbs without spiking. I can’t explain it, but it’s like something in my body changed. So these days I usually stick to 15 grams or less per meal/snack, and I have better control than I’ve ever had before with less effort. The few times in the past few months that I’ve eaten carbs I’ve always ended up battling highs and lows over the next few hours. I just find the low-carb way of eating minimizes those battles. In fact, part of the reason I’ve gone so low-carb is that I’m starting a practicum (and then career) where I’ll be teaching people in potentially dangerous conditions, so I need to be focused on my student(s) and aware of the environment at all times, and was worried that having to spend time managing my diabetes while teaching would distract me (or, worse, going low while trying to keep a student safe). I still use dynamic management techniques: micro-boluses and eating a glucose tablet here and there and using temporary basal rates, but these take a secondary role, and I find that I’m not having to pay meticulous attention to timing, watching my CGM, or tracking BG and IOB. So, I think it just depends on what works best for your physiology and also how you prefer to manage your diabetes.


interesting, because this is exactly the opposite of our experience. He can eat eggs and a slice of toast (20g breakfast) and will only require a minimal amount of insulin (2 units; 1:10 ratio for breakfast), but when he eats a high carb meal (big hamburger and fries) of 70g he will require 1.5 to 2x the expected insulin to stay in range. When we go over 60g of carbs at a meal, we start adding insulin because he gets more resistant.

I agree with this statement. His best diabetic friend has completely different responses whenever we eat dinner with them.

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This is what I did, too. I just made low-carb bread, found low-carb alternatives to pasta (spaghetti squash or zucchini noodles) and rice (riced cauliflower), and picked the lower-carb (dairy-free) yogurt and chocolate and whatnot. I also make cookies, ice cream, or whatever else I might feel like eating. My biggest challenge with eating this way is travel (especially because I also have severe food allergies), but I’m slowly figuring that one out, too.

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On a fun carb note. My son has been working hard to learn how to deal with a piece of Costco pizza. He did manage to come up with a strategy. He doses 100% for the carbs 30 minutes before eating, then doses 60% of the total for 2 hours. He never went over 130.

Note: if you haven’t been to Costco the slice is huge (70g of carbs); but very very consistent in the carbs because it is machine made so it makes a good test.


Hi @Pianoplayer7008. I have been diagnosed for about 1.5 years and I am out of honeymoon.

I don’t eat low-carb. But I eat low carb some meals: at breakfast I am very insulin insensitive, so I normally eat a really good breakfast that I like a lot (omelet with mushrooms, celery, some meat and 2 chicken sausages, plus some full fat yogurt) but only 12 carbs.

The other meals I eat regular meals for us – but that is a little lower carb than most people because we don’t eat very many carbs, maybe 50 carbs per meal average. Some meals (for instance at school) i can eat a lot more carbs, particularly at lunch.

After sports I always high a high carb meal. Also, I often run low at night after sports, so I will need to eat more carbs late at night (12pm-1am). That is on top of my regular carbs.

Also I normally have dinner earlier so that I don’t have IOB for too long after I go to bed (otherwise I have to stay up a long time if I go low or high). My DIA is 5.5 hours, so that’s how long I can go low after I inject for dinner.

So, I think that it is fine to eat lots of carbs, but just not for every meal, at least for me.


I used to eat a lot of carbs with reasonable control and then in my early 30s started to get insulin resistant (like an I:C ratio of 1:3) and my control became very difficult.

I cut back carbs to about 50-60 carbs per day and I have good control and the control comes much easier.

Now if I get really active, I will easily eat 200 carbs in a day and have no problems with blood sugar control. Really active means like a couple of hours a day of hard physical exercise in a day. (like biking at high speed for a couple of hours.) And if I don’t eat the carbs during the day, I find I will be up all night eating glucose tablets even with a -50% basal rate.


@Jen, do you have a good low-carb bread recipe?

@Chris, every few months we redo our Costco pizza strategy :slight_smile: It is the apex of control for us…


Perhaps because we are not truly low-carb at any time, but we’ve just never found the low-carb recipes that can replace the high-carb alternatives in terms of satisfaction.

For things like dessert or pasta, which are very carb-heavy, we typically just serve what I would consider smaller, more reasonable portions. So we’ll serve more veggies and only a single portion of pasta, or thin-sliced bread and a 1/16th serving of pie rather than 1/8th. I do reduce the sugar in my recipes by about 25-50% but that’s because I think most desserts are way too sweet anyways.

I guess if Samson ever did have an absolute carb limit, like less than 70 or 80 g of carbs a day, we may have to look at swapping out foods altogether. But for now I feel like just eating reasonable portions is easier.


Maybe taste buds change over time, but I actually prefer most low-carb dishes to carb-heavy ones. I love cauliflower rice and find it more tasty than actual rice, and find the same is true of most other things. I’ve found online that there are low-carb versions of literally anything you can imagine. So I still eat pancakes, sandwiches, cookies, chocolate desserts, and so on, but they’re just low-carb versions. The one food I haven’t been able to replicate is cereal, but there are low-carb cereals, I just can’t eat any of them because they all have milk protein in them.

I actually ate some popcorn the other day and was surprised at how it didn’t taste that great anymore. It was so bulky yet unfilling. That’s what I seem to find with a lot of carb-heavy foods when I do eat them (as well as my blood sugar going on a rollercoaster). I eat carbs maybe once a month for a day, go on the rollercoaster for 24 hours, and then decide I want off.

The only food I really, really miss and would eat in an instant if I could is cheese (no other dairy, just cheese), and that’s not even a low-carb thing, just an allergy thing.