Low Carb and Insulin Regimen
Since I've been reading so many posts recently related to low-carb and I've put on a few pounds this winter, I thought I'd start my annual experiment with going really low carb. My normal carb intake is around 100-120, but even at that level, I have a lot of roller coaster BG readings.
Starting yesterday, I am eating just vegetables, cheese, meat and a few nuts. Very typically I am struggling in the morning with BG rising up to the high 100's and needing a lot of insulin to come down. Once it gets down late morning, then my BG readings are incredibly level. Overnight, my Dexcom and meter readings were flatlined from 85-95.
Without a breakfast bolus, I know that I will have to increase my morning basals by a huge amount and probably just take a wake-up bolus although I'm not eating carbs. I don't have dawn phenomenon in the traditional sense, but like many Type 1's, my BG starts rising once I get up. Unfortunately it doesn't do it all of the time, just some of the time. When I eat carbs, I eat breakfast soon after I get up and then exercise immediately after breakfast. This usually stops post-breakfast spikes, but does open me up to lows mid-morning.
My question though is: For those of you who low-carb, did you have to re-do your insulin regimen from scratch when you started low-carbing, especially your basals? And how do you cover your meals? Normally I don't bother dosing for protein and fat, although you could argue that some of that is built into my basals and bolus ratios. But obviously I need to do something if I'm not eating many carbs.
Thanks for any advice.
Replies to This Discussion
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Permalink Reply by Laddie on -
I've never had green Tabasco, so might have to give it a try. Yesterday I hard-boiled all the eggs I had left in the house, so will go to the store today to get more. I think I'll definitely try an omelet or just scrambled eggs mixed with spinach and other vegies.
For all of you who use egg beaters instead of eggs, is it for health reasons are just because it's easier and faster?
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Permalink Reply by drmom777 on -
Green Tabasco is a wonderful substance that makes eggs and many other things quite delicious without doing anything bad to them nutritionally. It is not as hot as regular tabasco and has a different flavor. My non-diabetic kids also love it, so it is endlessly running out at our house.
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Permalink Reply by kristy on -
I fully understood dka until I started researching low carb diets which have always dropped my bs and my a1c..I came across a page that told everyone to go out and buy their keton strips and enjoy ketosis!! Obviously as a T1 it freaked me out a little...thanks for clearing that up!
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Permalink Reply by MyBustedPancreas on -
When I started doing low-carb, I found that I had to change a few things:
- I had to increase my overall amount of basal insulin. I think was hovering around 9 units per day on a more typical diet for my basal needs and ended up needing between 10 and 12 units per day on a low-carb diet (albeit one that consists of more protein and fat).
- I had to decrease my bolus amounts. My I:C ratio went from 1:10 to 1:15.
- I had to bolus closer to mealtime (not 15 minutes before, but more like right as I sat down to eat).
I think all these changes were needed because when I low-carb it, I definitely eat way more fats and proteins, which digest more slowly and can cause my BG to go up far longer after eating. That said, my BGs are definitely more stable overall when I can keep the cards down under 100 g/day (and I'm pretty active; on days when I'm less active, I try to stay around 70 grams total).
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Permalink Reply by Laddie on
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I think what you're doing makes sense based on what I'm seeing right now. I'm five days into this still eating super low-carb. I need to start planning how to add back a few carbs while being comfortable that what I'm doing has reasonably adequate nutrition.
I'm going to read Dr. Bernstein again. I haven't read it in years and I know I'll never follow his WOE completely. I'll probably read some old Tu posts to see what others are eating.
Usually when I go really low carb I don't feel great, but actually I've felt really good this week. The flat lines on my Dex are truly awesome. I can join the Flatliners Group now which I could never do honestly when eating 100-150 carbs per day. But I'm waiting to see if my commitment continues. It never has before, but every day is a new day.
I think that you're right that a basal increase probably covers the slower digestion from protein and fat. Right now I'm doing well with my current basals with just an occasional 0.1 or 0.2 correction nudge.
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Permalink Reply by Tabacblond on -
Did anyone else had to increase their basal on low carb? I had 8 -10 units total but now I feel like it is not enough, Tried 12 today.
Can anyone explain why this is happening, physiologically wise I mean :)
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Permalink Reply by Brian (bsc) on -
It is not uncommon to have modest increases of basal on low carb. I think this is for two reasons. First, protein may be digested over many hours and rapid insulin may wear off too quickly and you may depend more on your basal to cover your meals. And second, low carb will increase the production of glucose in your liver and that may require additional basal. Most people find that overall, while there may be some increase in basal, the bolus and total daily dose fall with low carb.
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Permalink Reply by Tabacblond on
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thank you!
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Permalink Reply by Kilij on -
Tabacblond, here's a link to a study on the impact of fat in those with type 1 diabetes. Fat and protein intake naturally increase as one decreases carbohydrate intake.
Dietary Fat Acutely Increases Glucose Concentration and Insulin Req...
They didn't test low carb, but it would make for an interesting study, I think.
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Permalink Reply by Shawnmarie on -
Just skimmed the report - very interesting, but what a bummer that it provides support for the conclusion there's yet another thing to add to the mix when figuring out boluses.
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Permalink Reply by Terry on -
Thanks for posting a link to this current (published April 2013 in Diabetes Care) study. It mentioned that a previous study developed a formula for dosing insulin based not only on using carbohydrates but also including fats and protein. It noted that this formula has not been vetted using a crossover study. It added that the current study "showed no relationship between carbohydrate-to-insulin ratio and the need for more insulin to cover the HF [high fat] meal."
I find it interesting that researchers have noted that simple carbohydrate dosing does not give good consistent postprandial BGs. I'm glad that science is finally catching up with we PWDs have known for a long time.
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