Conventional food habits vs flexibility on basal-bolus insulin

Hi,
I just visited a diabetologist (not my regular doctor who is in another city) today and my HbA1c stands at 8.3% (which though still far off the ideal < 7%) is a big improvement from my previous level of 9.7%. Probably I could have edged closer to 7% if not for my hospitalization (for diabetic ketoacidosis, which was till now undiagnosed because the doctor who treated me during hospitalization didn't suspect or treat it :(, but the diabetologist immediately made sense when he told about diabetic ketoacidosis).

He was so adamant about me getting to the 7% mark to avoid complications as I am just 23 years old as of now and have a long life ahead to live.

I currently use a flexible food routine with my NovoRapid-Levemir regimen. Whatever I eat, I count the carbs and then take the bolus. I adjust the basal if and whenever needed. By flexible, I don't take sweets, bulbous/root vegetables and other things that any diabetic shouldn't take. But I take other food items that are higher in carbs than the very safe, but I scale my insulin to that level.

But this doctor and dietician advocated a food regimen that involves spreading my eating over 6 times (which imho is a good idea) and restricted the eatable things to include only the fully safe foods in very restricted quantities. (In fact almost all the doctors in India including my regular doctor do the same). This is a new, difficult change for me to try and get used to. I can understand that this will surely help better control, but I fear that I am losing the flexibility that is possible with the basal-bolus regimen.

The doctors approach sounds very orthodox, conventional and inflexible. My heart wants me to make full use of the flexibility without compromising control. But I am scared about the control that I'd actually end up achieving.

What could be the best position to draw the line between the 2 extreme approaches?

Tags: basal-bolus, flexibility, food, habits, orthodox

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I've been prescribed StorVas 20 mg to be taken once a day at night.

That's a statin, not exactly a mild medication. Please let your doctor know right away if you experience muscle pain or weakness. One side effect of statins is muscle wasting.

Aww! :(

The bottom line, Guruprasad, is that you have to eat SOMETHING.

Our calories come from one of three macronutrient sources:

1) Carbohydrates;

2) Protein; or

3) Fats.

So as the saying goes, "Don't let the perfect be the enemy of the good." Keeping your blood-sugar in the normal range is going to be hard enough WITH some fat in your diet. Doing it on a high-carb, low-fat diet is going to be ... really, really hard.

I am taking a dietary supplement capsule Nuala E that contains Vitamins including B12. So I guess I am safe here. :)

Good!

Sorry to be the bearer of bad tidings. Most doctors recommend statins for diabetics. I've refused them for almost 4 years because they're quite risky. My doctor gives me an Rx & I toss it in the trash. Controversial if statins are even effective. They're a huge cash cow for the pharm industry & heavily marketed to doctors.

You're correct about the green veggies, Gerri, but the complicating issue I'm thinking of here is that Guruprasad is a young male in his twenties who appears in his photos to be on the slim side (sorry to talk about you in the third person on your post, G.)

Low-glycemic veggies don't provide many calories per the normal volumes eaten -- for example a gut-stuffing two cups of steamed broccoli is only about 125 calories. I'm concerned that if he tries to subsist on salad, steamed greens and a bit of nut butter that he's going to waste away.

I have a couple of vegan friends on very restricted diets and to me they look like concentration camp victims: hollowed out at the temples, elbows bigger than their upper arms, nobs for knees and no calf muscles. That kind of low-calorie eating is great for someone like me (obese) but my thinnest vegan friend couldn't conceive because she had too-little body fat -- she isn't anorexic, she eats all the time, she and her husband are just eating greens all day and wasting away.

It's all fine and well for Dr. Bernstein -- with the metabolism of a man in his late 70's -- to eat so little, but a strapping young man in his early twenties needs FOOD. If food = carbs in a diabetic vegetarian, and carbs = high glucose = high insulin requirements = greater odds of hypos...then what? I'm truly perplexed.

Protein & fat are calorie dense & why Dr. Bernstein advocates moderate protein/high fat, the mainstay of low carb.

Vegetables don't need to be steamed (ugh), nor should anyone subsist on salads & nut butter. I wasn't suggesting living on greens. For more calories & variety, vegetables can be breaded in nut flours & fried, or sauteed. Veggies can be cooked in cream sauces & with cheese, cooked with spices & coconut milk or yougurt, made into fritters with nut flours. I was vegetarian for 30 years:) Of course, Guruprasad has access to all those beautiful South Indian sauces. All these are higher caloric options that can be made with low carb vegetables.

Hard for vegans to get enough protein & of course they eat no staturated fats. Both account for that unhealthy gaunt appearance. Vegans I know eat a lot of calories from grains & legumes, as did I when vegetarian. I've known chubby vegans. What do your friends eat?

Consistent high BG leads to weight loss. Hard to maintain body weight with persistent spikes.

"Consistent high BG leads to weight loss. Hard to maintain body weight with persistent spikes."

Exactly. And what leads to persistent spikes...???

Carbs and poorly matched insulin dosage. And as you said, I am on the slim side, though by no means like the concentration camp victims that you mentioned :). I was chubby and 60 kg 3 years before Type 1 diabetes happened. Strangely I had a fever at that time and I lost all the chubbiness and my weight remained consistent in the 52-57 range till recently.

Probably starting the basal-bolus regimen and exercising at gym helped me touch 62-63 kg mark before DKA and the recovery brought me down to 59. I admit that I could do with a bit more chubbiness. :)

Hey,

There's lot's of great advice in this thread, but there is not much mention of how valuable a consistent exercise program can be to help control your BGs and maintain body weight.

My body type is very similar to yours and I also eat between 200-300g of carbs daily. Without a consistent exercise program, there is no way I'd be able to maintain either that type if diet or my current body mass. I'm at around 74 kg (180cm), but if I cut back on my gym routine, my carb intake could easily drop well below 200g and my body mass could easily drop under 65kg.

I know your concern about routine is why you posted this thread, but I'd say that having some kind of routine is good to have for your diabetes management. For me, that means a rountine that revolves around a consistent execise program.

Your overall level of activity will most definitely complicate the relationship between carb intake and insulin dosage, but it sounds to me like getting back on a consistent gym routine might be something that helps you achieve your goals.

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