If someone is a brand new diabetic, everything is different for a little bit, but the idea that I would consult with my endo for insulin changes period is completely laughable. He and I talk about general trends when we meet, and even if he is like, I wonder if your basal needs to go up a bit, he’ll suggest a range and leave it to me to implement, unless I ask for more guidance. That said, he knows I’ve had this disease for the better part of 3 decades and know the ins and outs of living with my diabetes infinitely better than he ever will. I’m sure he has some patients who are not very aware of their own care that he would be more hands-on with. And if someone has very minimal or simple insulin needs, and does not do much in the way of regular glucose monitoring (like some T2s on just 1-2 injections of a long acting), then it may make much more sense for an endo to consult on changes, since they are probably relatively infrequent.
That said, some internet places have strict rules beyond suggesting ask your doctor about X (for whatever condition it’s about) out of fear of litigation if it goes badly, even if realistically, people make treatment decisions on their own all the time.
John, our pediatric endo has put my son through 6 classes as he has progressed from a 12 year old to a 16 year old. These classes are designed to educate and make the patient aware of how to manage their diabetes and insulin during all activities and conditions, i.e. sick day, exercise, normal day, etc etc. Unfortunately, the adult endos don’t seem to offer the same level of support, which is where online forums help tremendously. The really criminal education gap in my mind is young adults who are diagnosed with T1 but not given the education opportunity. Really a shame.
It is more than a shame. This missing education is in all reality stealing someones life they could live. This is why healthcare and business models do not mix.
And to internet forums having strict rules. Sure, everyone fears litigation. But if a forum that calls themselves “Keto for diabetics” promotes low-carb nutrition but suggests that their diabetic members, including those on insulin regiment, follow this diet without the ability to freely change the dosage of their regiment, they are playing with the lives of their forum members. That suggestion to place this warning somewhere after hearing replies from several members that they would not know how to change their insulin dosage was enough to get me kicked. That is keto-fanatic and fanatics are the biggest enemy to education. And it opens them up even more to litigation and lawsuits if anything happens to one of their forum-members.
That said, I just hope that everyone is about as fanatic as I am about their children as I am about my daughter and does everything in their power to educate them especially as a parent of a T-1.
I think many of us, myself included, may be qualified as a fanatic, or worse. But essentially that is exactly why we started this forum.
Before finding forums, I relied on books like Using Insulin and Think Like A Pancreas as much better education than endo team. And more recently Sugar Surfing and articles from Integrated Diabetes website.
Have not discussed diet or meal choices with any medical team since 1980s session on using Exchanges, and then carb counting in conjunction with pump training.
For me, bottom line is choose variety of healthy foods, and eat to your meter (dexcom).
Good books, but sad that the books are better than the endo team.
Interesting subject. I was a low carb sceptic for some time, although I thought I knew a lot about it, but it was more the traditional physiological and medical views, which is not necessarily the same as the research / evidence base. However, for quite a few years some of my MD colleagues (the kind of brilliant polymaths who see patients, research and fit in additional PhDs) have been very much in the LCHF camp. I don’t know why I avoided the larger body of research for so long, but after a lot of reading, I’m firmly a LCHF advocate from a health perspective and there is a huge amount of information out there about this very topic that also addresses the old myths like we need to ingest carbohydrate for our brain. I do not however think there is one diet for everyone, or that everyone needs to go low carb, but it’s certainly an area we should all at least read about.
I’m currently on 20 - 60g of carbs per day and have been for several months? It’s been an interesting learning experience and certainly not straightforward, lots of trial and error and I now also realise how important the adaptation period is, both from a metabolic and physiological perspective and from a mental / decision making perspective. My watershed moment came a few weeks ago when I did a hard three and a half hour mountain bike ride; half of it at high intensity and the rest at the high end of moderate. No carbs before, no carbs during and no carbs after but with better performance on hill sections than I have managed over the last 15 years (I’m 46 now). In the past, before, during and after this ride I would have taken in 200g+ of carbs and I would have struggled that night with lows and would have been fatigued the next day. Instead, I had no lows and felt fresh enough the next day to do another two hour ride (at a more sensible moderate intensity). The recovery post exercise initially surprised me, although it makes sense in context of the research that shows how quickly fat adapted athletes replenish muscle glycogen. Overall for me, it’s quite wonderful and liberating how I now don’t need to think much about exercise or activity levels. My BG can be 5.2 mmol and I know I can go out for a few hours on the mountain bike, run, hike or whatever, and the only thing that will happen is my BG may go up by 1 mmol. As a side effect, the symptoms of my inflammatory bowel disease have largely abated and a lot of the intermittent tiredness I’ve had over the last few years has now gone.
I’m under no illusion about this being for everyone and I realise that people are different, but for me I am quite enjoying LCHF, low steady BGs and all the other benefits I’m getting. I do intend to write a bit more about my thoughts and experiences on LCHF, but I would like to do that when I’ve spent a lot more time on it so I can give the full warts and all account; who knows where I will be in 12 months and there will definitely be warts!
As an aside, my wife is a card carrying foodie (she did her chef qualifications as part of her original degree, works in food development and as such was initially very anti LCHF), but since we’ve started eating like this, I don’t think we’ve ever enjoyed our food more. Hey ho, let’s see where it goes…
That’s because alcohols are poisons. We produce ethanol internally and to make it worse it occurs regularly in ripe fruit for example; in things that have been part of the human diet way before the hunter gather meme, indeed before humans emerged as a distinct species, maybe even before we eukaryotes.
While the disposal mechanism (catabolism) of ethanol is pretty simple the poisonous effect messes up rather a lot of human metabolism. One relevant effect is that ethanol has a time-of-action defined only by the relative amount; from that wikipedia page, “At even low physiological concentrations, ethanol completely saturates alcohol dehydrogenase.” See the Metabolism section. This means that the alcohol takes over one pathway and keeps it occupied until all the ethanol has been destroyed.
However those pages don’t talk about the effect on carbohydrate metabolism. The most relevant points in the abstract at the end of that link seem to be (using the numbers from the abstract):
- Ethanol inhibits glycolysis in liver and brain. Or, “your liver stops using glucose.”
Consequence: your blood sugar goes up, this causes the beta cells to generate insulin (unless you are a diabetic) but this does nothing; insulin only enables the passage of glucose into the (liver) cells where glycolysis should occur, but ethanol stops the glycolysis so no amount of insulin will reverse the above effect (though it might encourage glycolysis elsewhere.)
Now this is a bit tricky. You have high blood sugar and it isn’t, initially, going down. Oops; the beta cells don’t stop producing insulin and, as a side effect, your alpha cells stop producing glucagon (unless you are a diabetic; in diabetics alpha cell production of glucagon is continuous because the primary regulatory mechanism from the beta cells is missing. Notice how they are all thin; they’re cheating.)
Of course the abstract observes there are other things going on, such as the inhibition of one source of glucose from gluconeogenesis [4: A degree in Biochemistry might help at this point]. This just makes the situation worse. The abstract observes:
- Ethanol causes an initial hyperglycaemia, a later hypoglycaemia and various effects on glucose utilization.
Seriously, I wouldn’t recommend anyone reading this to drink alcohol, well, unless you are a Type 1 Diabetic in which case the above arguments don’t apply.
So far as @John’s observation is concerned, however, I see the same thing; my glucose processing gets shut down for however long it takes my body to eliminate the alcohol. Bolusing insulin doesn’t really help, though of course I never bolus as much as a functioning beta cell would in the circumstances. An insulin bolus can only lower the blood sugar by finding some cells that need energy and aren’t currently attempting to bale ethanol at the maximum rate. As the abstract I was quoting implies, too little is understood about the interactions of ethanol with a non-diabetic for any scientist to worry about T1Ds.
John Bowler
No.
The only thing insulin does is to allow glucose to pass over the cell wall into the cell, for further use or not.
If you are doing full keto (zero carb intake - like, no coffee man) you are using a process to convert protein and, possibly, fat to glucose. That glucose still has to get into your cells - the protein starts outside, the conversion happens (it is said) primarily in the liver, the glucose has to get out of the liver cells into wherever it is needed.
Everyone out there and certainly anyone with a degree in biochem correct me if I am wrong, seriously.
John Bowler
@SteA thanks for your reply. I’ve been following this thread, and look forward to reading more about your LCHF experiences. While I know there are folks here who’ve had success with a HC diet for exercise, my partner has struggled with that. Good luck and enjoy your tasty food! 
I just read your post - do you eat a quarter cup? wow! My husband thought that I was odd adding 1 T of flax seed to my plain yogurt.
I eat a quarter cup of all seeds in total, not of each seed! Then add a quarter cup fruit, and a quarter cup Greek yoghurt. It’s delicious! 
I have been trying to get a better handle on beans in general. Previous to using insulin (…long time ago…), I liked beans BECAUSE, they most likely didn’t cause my BG to increase rapidly like white rice, or white potato did. I did not have that BG crash feeling from fast sugar, such as cakes, cookies…etc. Since I’ve been using insulin, it’s been tricky to quantify the carb content accurately, and bolus for beans. Beans have so much carbs. If I’m off slightly, the carbs could be off by alot. Therefore, I have mostly avoided beans. I tried them recently and I wasn’t feeling well (may or may not be related) so I took a pause. BTW I don’t have a CGM. Have you experimented with beans? I would love to hear about your thoughts and experience.
Not having the CGM really makes the learning much harder to do. Is there any way you could afford a Libre for 1-2 months. Your learning would be amazingly accelerated.
I have been on keto/ low carb for 3 years. Sometimes I am really strict and count accurately and keep it at 20 g a day, others I stop actually counting and it may be 30 - probably no higher than that. My levels have never been better with less of the peaks and troughs. I used to have so many hypo’s, not severe but still low, sometimes three or four a week, sometimes could be 3 times in a day. I am quite insulin sensitive which is surprising as I am a few kilos overweight and quite sedentary. I only require about 20 units a day, so need to be very finely tuned. Since being on the low carb I have a hypo maybe once every couple of months. I noticed a huge improvement in my general well-being after a day of low carb eating. Initially my lipids were abnormal, but now absolutely fine.
Luckily my diabetes specialist is of the opinion that keto is “ the only way to go” for type one.
My favourite resource is “Diet doctor” you can become a member, but can get most of the info free of charge, no advertising, and loads of food plans and ideas, and expert medical reviews and articles.
I am not on facebook but there is a group on there called Type one Grit, all about keto.
Glad the low carb diet is working for you. I do feel sorry for your diabetes specialist, because while low carb is an option, it isn’t the only one out there. Any practitioner with one approach isn’t doing their patients a favor.
Yes of course you are right! Poor wording on my part.
Not a problem. My poor wording often catches up to me. My mind thinks faster than my fingers can type.