I am a fairly newly diagnosed late onset Type 1 Diabetic. I am currently trying to learn all there is to basal-bolus, counting carbs, low carb eating, preserving beta cells and so forth.
What I dont understand: I was told in a course for newly diagnosed at my hospital that I do not have to count the carbs in most vegetables, either because they are too low in carbs or their GI is so low. Since I am on a low carb diet, I obviously eat a lOT of veggies ;)
But I dont know how to count for them. If I have a salad with lots of tomatoes, red capsicum, pickles for example (not that that is a particularly yummy combination, just for the sake of argument) My BG definately rises afterwards, maybe by around 30-40 mg/dl.
I dont inject for it though, because my insulin requirements are still very low.. But I WANT to inject a little insulin if I can, just to get used to it and the possible benefits regarding preservation of beta cells.
So are the carbs in veggies to be counted or not? And how do I know how much is in those veggies, if my books tell me that there arent any carbs to be counted in them??? I would appreciate any advice..! Thank you.
If I posted this in the wrong category, I do apologise. I wasnt sure, but i thought since I m a LADA with remaining beta cell function it might be good to ask other LADAs about this?
Also apologize for my english, if there are lots of mistakes!
I think this is an example of the practical side of adding carbs to every meal. The veggies will be converted slowly to glucose. By adding carbs you can inject for the carbs and to some degree for the vegies too. In some cases even the tail of the insulin is enough to cover the carbs from the vegies. For many diabetics insulins like NovoRapid/Log have a tail. This means there is little but noiceable insulin activity at the 3 to 4 hour mark - despite of the fact that this insulin is an analog insulin.
I count veggies. It's very handy to have a food scale to weigh them to get the count very precise, particularly if you are eating a lot of them. a cup of something like broccoli is sort of hard to measure unless you chop it up!
This is a great question. Often, when you are taught carb counting with an ADA style meal plan, you are told to eat 45-60 grams of carbs with each meal. And to simplify the process, you are told that you can consider a broad range of green and leafy veggies to be "free." And relative to a meal with a big ole serving of "healthy" rice, they are free.
But in truth, they aren't. And with a low carb diet, those smaller amounts add up and in fact may end up dominating your carb intake. And to properly adjust your mealtime insulin, you need to count them. So if you have a cup of cooked broccoli, you need to count that as about 12 g carbs, 6 g fiber. And a cup of cherry tomatoes is 6 g carbs, 2g fiber. And things get more complicated, if you eat lots of protein, as much as half the protein can convert to blood sugar over 3-5 hours. But for now, it is ok to just take small steps. A reasonable simple rule is that most non-starchy veggies are somewhere around 5 g carbs/cup. And then over time, you can learn which veggies have more or less carbs/fiber and make refinements.
ps. NutritionData is a good source of carb and fiber content.
pps. I think this question is of interest to everyone, and I'd encourage moving it to either the food or general areas. You can do this by selecting option and editing the original post, all comments will stay.
ppps. And only count the carbs that "matter." Counting all the fractions won't make a difference, only those things that clearly affect your dose calculation.
But to inject for just the vegies will reveal a problem I think. Todays analog insulins are faster than the conversion of vegies to glucose. With the good old Acctrapid the chances are much higher to find the right timing.
I bolus for vegetables as described above, and it has never given me a problem. For me, Apidra matches up well if taken immediately before eating them. Eating anything will cause the liver to dump glucose. There is no free food. You should be fine, as long as you don't over - bolus.
Also, someone should mention that some vegetable will make your BG rise only slightly, while others, like carrots, will make it go up a ton.
To my knowledge the liver will not change its release rate if there is insulin in the blood stream. This is why diabetics on insulin can not counter-regulate lows. The release can only happen if the insulin level is sinking below a certain threshold. It has to do with the orchestration of the digestion and the signaling role of the insulin. A rise in the insulin level is the signal that carbs and fat are being digested. Thus the liver does not have to release glucose and the fatty cells are starting to cumulate fat from the blood stream. Very helpful for healthy people but problematic for us because it impairs our ability to cope with lows.
The fructose of the vegies is digested slower than simpler carbs. This might be an individual factor but for me this means that I have to inject later. Otherwise the NovoRapid would easily overtake the digestion of the vegies.
This is very interesting. I often eat lettuce, only with olive oil and a small amount of lemon juice or ceasar dressing. I need to bolus double my normal carb ratio. It covers nicely, and still adds up to 1u at most. Probably not enough to prevent the liver from releasing glucose. If I eat vegetables as part of a meal, they do not raise my bg as much.
I would be very curious to know the insulin threshold at which the liver stops glycogenolysis, and to what extent?
This "threshold idea" comes originally from the discussion about the "somogyi effect". This is a supposed counter-reaction to lows at night that is leading to a high in the morning. Researchers ruled the possibility of a counter-regulation out for insulin dependend diabetics. I think they argued that you must be very short of basal insulin to get near the threshold of the liver. To argue the other way around insulin dependend diabetics always have too much insulin in their system. This is because the insulin release in healthy people happens continuously in very tiny micro releases. This excess of insulin is also responsible for a shortness in potassium we are all at risk of. I wrote about that here.
Thanks for the potassium info. I should probably get it checked out. I am fairly certain that I have never experienced the Somogyi effect, but many others here seem sure that they have. I am inclined to believe this would explain the relative rarity of extreme hypoglycemia. Not to mention the continuous release of glucose, despite the insulin we are taking to cover it.
What is an extreme hypo anyway? Seizure? Need for external help? Have you seen the campaign run by the JDRF that claims that 1 in 20 T1 diabetics will die from low blood sugar? Not that I am convinced about this figure but the term "relative rarity" is not appropriate in my opinion.
1 in 20 T1 diabetics will die from low blood sugar?? Can that be right? This number seems excessive- and scares me a little..!