Low Carb for Type 1?

Type 1 & LADA
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Low carb for type 1?
I am type 1, diagnosed in 1945. I knew nothing about an appropriate way of eating. My doctor told me to take my insulin before breakfast and to avoid sugar, but there was no other advice given back then. I could eat anything I wanted, and as much as I wanted, if it did not contain sugar. I lived on a farm, and there was soooo much to eat. I drank milk from our own cows with every meal. We had an orchard with many kinds of fruit, and an acre of garden space. I ate tons of carbs every day, but I did not eat sugar, so my parents thought that was OK.
There was no device for testing my blood sugar until the mid 1980’s. I survived and thrived that way for 50 years until the 1990’s. I started testing my blood sugar with a glucometer, and before the dawn of the 21’st century, I was counting carbs and using a fast acting insulin. I began gaining weight. I had never been overweight until then. I was diagnosed with insulin resistance in 1998. Yes, type 1 diabetics can have insulin resistance. I started taking oral meds for the insulin resistance. With Metformin, eating an average of 130 carbs per day, and getting a lot of exercise, I lost all of the extra weight. My A1c’s were in the high 5’s and everything seemed good, but then I started having diabetes complications. Retinopathy and neuropathy were diagnosed. The roller coaster control, with too many highs and lows gave me a good BG average and A1c, but the complications were there.
I started using a pump in 2007. There were fewer highs and lows. My diabetes management improved so much that the retinopathy disappeared, and the neuropathy was not much of a problem at that time. My A1c’s have remained in the 5.4-6.4 range for about 15 years. I am averaging 150 carbs per day, and I am not overweight. I am obviously not following a low carb diet, but my diabetes management is good. I am using a pump and a CGM, and my complications are under good control. Why should I follow an even lower carb diet? There are many type 1 people following a very low carb diet but I don’t think a low carb is necessary for all diabetics.

What do YOU think?

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Personally (and I have no research to back this up, and only a year of experience as a diabetic), I feel I’m doing fine if my numbers are well managed (not just A1c, but minimal roller coaster ups and downs daily), and right now, I eat ~200g carbs/day and manage fairly well. I am planning to bring that down to the 150ish range, except for occasional carb splurges here and there, but again, that’s just a personal choice, not because I fear complications eating 200 carbs versus 150.

I’m still in awe when I hear your story! Amazing to have had such a full (of yummy food :drooling_face: ) life even with what would now be considered poorly managed diabetes.

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No, it is not necessary for all. There isn’t a single diet that works for everyone. It is important for people to find what works best for them.

I like carbs!

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My sense is that there is a low percent of true Bernstein low carbers, 12-6-12, or below 50.
I decided to reduce carbs and make decisions based on what helped me maintain a balance of lifestyle and BG control that is comfortable for me. I don’t actually even count carbs these days, but probably average 80-100 per day, and considerate it moderate low carb.

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@Richard157 If it ain’t broke, don’t fix it.

This is a very individual thing. I would not recommend the regimen (or lack thereof) that I followed for my first thirty years of diabetes, but after 46+ years of it I’m completely complication free.

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I eat low carb. I don’t count carbs, but no sugar, grains, fruits, or starchy veges. My whole household eat this way, including my daughters. My a1c is 5.1. So it works for me, and no one goes hungry.

IMAG1949
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dinner last night… steamed fish on a bed of spinach and tomato drizzled in olive oil, zucchini spiralised and fried with garlic. my daughters had Greek yogurt with frozen blue berries for dessert.

Dinner tonight is fathead pizza crust, and a salad of fetta, cucumber, lettuce, tomato, capsicum, also with sesame and olive oils.

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I think @eric is right. There’s no right answer. For some people, a high-carb diet best meets their needs, and for other people, a low-carb diet best meets their needs. As long as their diabete is is in good control (both A1c and day-to-day blood sugars), that’s all that matters. A low-carb diet, like an insulin pump or CGM or exercise or inhaled insulin, is just another tool in the toolbox of possible options that we can use to help control our blood sugar. People may choose to use it or not to use it, but it’s no more valid or invalid as any other choice. In the end we’re all aiming for the same goal. Exactly how we get there doesn’t really matter. The beauty of forums like this one is that we can read and find out what works for others and decide if we want to experiment in our own life and evaluate whether it may also work for us.

I, personally, choose to follow a very low carb way of eating (below 40 grams of carbs a day) a vast majority of the time. I used to be one of those people who said I would never follow a low-carb diet. It was crazy, too restrictive, too dangerous, too much work. Then I read half a dozen books on low-carb eating and found that none of those misconceptions were true. Yes, I read Bernstein, but I also read many others. I dabbled in it at first, trying 100 grams a day and 70 grams a day, periodically going back to a high-carb diet for a few weeks to see what worked best for me. I used what I learned to form my own opinion about whether I wanted to try this way of eating long-term, and eventually decided that I did–at least for the foreseeable future. Will I always stick to this way of eating? Who knows. Ten years ago I thought I’d never try it. Who knows what will happen in another ten years?

I will say that eating this way has given me a sense of control over my diabetes for perhaps the first time in my life. It allows me to move through the day without having to think constantly of blood sugar and insulin on board, which is a huge relief. I love the food, and it’s led to me discovering that baking is a hobby I love. It’s helped me feel better and have more energy than I’ve had in years. It’s helped me eat better, because I don’t eat processed foods. It’s helped with insulin resistance and weight loss. It’s made some things, like travel, harder because of the interplay of my food allergies into eating. But overall, just like the insulin pump and CGM, I would never go back even if there are brief moments when I want to throw in the towel.

I try not to push this way of eating on others. It took me years of inquiry and self-reflection, and a lot of reading on forums like this one, before I came to where I am now. I think others have to go through a similar process regardless of the methods they ultimately settle on. There are people who do want to shout about this diet from the rooftops because their life has been changed by it and because they want to counter the myriad of myths and misconceptions that pervade society. Though I’m not one of them, I can understand it. Eating a high-carb diet is the conventional recommendation. If you eat a high-carb diet your doctor approves, your CDE approves, your dietitian approves, other people with diabetes approve, the rest of society approves. You do not have to answer to anyone or prove anything. If you eat a low-carb diet, you’re going against conventional wisdom and everyone, from your doctor to your CDE to your dietitian to others with diabetes to your friends and family will question you. So I can understand those who want to shout to the world that this way of eating is okay, that it’s a viable option, that it’s not dangerous, and that it has real benefits.

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Thanks @Jen, I really like your reply. I’m pleased to hear of your success with low carb.

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That fish looks so delicious! :fork_and_knife:

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I think the main advantage to the low carb diet, if you can stick to it, is it makes managing diabetes much easier because there is a lot less margin for error.

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If your control is good and your complications are negligible or improving, I don’t see why you should change a pattern you’re happy with. To me, 150 g of carbs a day seems totally fine and sustainable.

Our son doesn’t follow a low-carb diet either, we feel he needs the carbs to grow.

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Richard,
I agree with the everyone else - all my research in the last few months (before that I was terrible and didn’t care) - indicates that at the better end of diabetic control which everyone on this site is- there’s still a lot of uncertainty about what is the best route and how to achieve it - so i think everyone needs to pick their goals and then work the diet to achieve them.
For me personally, I am currently trying to keep my A1C below 5.5 (the pre-diabetic threshold) and also keep my excursions below 140 as I’ve read about the evidence that going above this a lot is problematic. I’ve gone low carb 0,13,13 a day to start, but I am currently at 60g and I found 3 things drove me here
1 - it removed all hunger and appetite - so I have lost 30lb since June and i plan to keep this up until I get to a normal BMI which is another 15lb . Since your not overweight and can obviously manage your diet and hunger craving then this isn’t a problem for you
2 -below 40g it created more problems for dosing protein over 5 hrs (when I’m above 50g this doesn’t happen) - so I have raised it back to stop this happening.
3- the irregularity that many complain of and which I suffered as gone away - not sure why but maybe a LC diet calms the liver down - my DP has gone away, and unusual highs in the day that are so resistant to insulin have also disappeared.
Separate to diabetic control, i also believe that starch and sugar are bad for the diet and these foods cause lots of other issues with our bodies, that are slowly being unearthed by science and shouldn’t be eaten anyway - so when you take these out of the diet which I have done, its really hard to eat more than 100g as you find yourself munching vegetables all day !!
There is a ton of evidence that says vegetables are good for the heart and cholesterol as well as blood pressure and given I have goals there as well (below 120/80, below 45 LDL and above 65 HDL) - having these make up the majority of my 50g a day also works for me.
.

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WOW! That is a very successful program you have described. Not many T1D’s would even begin to take all those step. I congratulate you on a super diabetes management routine!

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Thanks - I’ve got 35 yrs of awful behavior to make up for. First big test is this week - I’m off to Baja Mexico for a week - will see how it goes surrounded by rice / beans and fish tacos - trying to convince my endo today to give me a sample of affreza in addition to the apidra he is putting me on !!

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We are moderate carb but switch to low carb for sick days.

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I like carbs, and get reasonable results with 150 to 200 g carb (anywhere from 100 to 250, really) by using the CGM to correct early and often (“sugar surfing”). I don’t have the results of @Robellengold, but am satisfied with an A1C of 5.8, 70% of my time between 80 and 130, and standard deviation 30. I do believe the assertions that low carb makes it significantly easier to avoid spikes, but I think you can have good health and eat tasty clean-burning carbs too. Maybe reach for the oatmeal rather than the frosted flakes, though…

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K[quote=“bkh, post:16, topic:2421”]
I do believe the assertions that low carb makes it significantly easier to avoid spikes, but I think you can have good health and eat tasty clean-burning carbs to
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This varies, like everything else. It may be true for some people, but not others. I use sugar surfing techniques, too, many times throughout the day, but even using sugar surfing in conjunction with eating low carb, I haven’t yet hit control as tight as you (after 26 years, so it’s not lack of effort or experience). Eating a high carb diet, I can’t even get within the same ballpark. There are many on this site who have similar control to you while eating carbs, but there really are (a significant number of) people out there who simply cannot achieve that type of control while eating a high carb diet.

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I readily accept that assertion. First, not everyone has a good CGM. Second, not everyone has the kind of personality or circumstances that can enable them to check the CGM frequently after eating. And then to respond well to subtle changes in the CGM graph is not a natural ability, it is an esoteric learned skill. I gather that Ponder’s book gives many examples to teach the skill, but this is not something that is routinely taught to us by our medical caregivers. I can see the attraction of low-carb eating, which largely avoids the whole problem of managing BG spikes.

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I think I am one of these people - I took a walloping dose of 12 apidra waited 45 minutes until my bg was 65 before I ate a small fish taco here in Mexico and it wasn’t enough to stop the spike for the taco going up to 200 in 30 minutes before dropping down again - at least I don’t have gut absorption issues I guess but I just can’t fit sugar or starch into my diet I think now going forward

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So this says that for your body, the digestion of the taco is “too fast” for the activity rate of your insulin, even though you are using a drastic pre-bolus.

One way I deal with this is the “split-carbs” technique. It’s kind of the opposite of the “split bolus” technique that MDI folks use to slow down their insulin. For split carbs, you would pre-bolus as you did, but only eat part of the taco at first. Enough to prevent a crash, but not enough to cause the huge spike. Wait a while (until the smaller spike has turned back down?), then finish the taco to use up the remaining insulin that is just now becoming active. I’m not saying it’s easy, but I do believe it can be made to work. You won’t get a flatline, but you can get a smaller spike.

You can slow the absorption of carbs by eating them over an extended period of time rather than all at once. That reduces the spike.

Another alternative is to accept a brief spike to 200 that quickly resolves. I wouldn’t want that for every meal every day, but I don’t think it significantly hurts my health to have occasional brief spikes.

Or you can just avoid troublesome carbs. That’s a valid approach too.

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