Type 1 Diabetes and Low Carb Diet [Archive]

mark-TN

01-31-2008, 07:47 AM

With regards to weight loss, I firmly believe it's the calories that count, not the carbs...

It has been known since the 1950's that the hormone insulin is what counts in regards to weight control.

For a great introduction into this way of thinking I highly recommend listening to this interview from NPR’s Science Friday hosted by Ira Flatow. (http://www.sciencefriday.com/program/archives/200711024)

The guests on this particular show were:

Gary Taubes
Author, "Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control, and Disease" (Knopf, 2007) Contributing Correspondent Science Magazine New York, New York

and

Ronald Krauss
Senior Scientist
Director, Atherosclerosis Research
Children's Hospital Oakland Research Institute
Oakland, California

Very informative to say the least.

Mark

tanyatype1

01-31-2008, 08:58 AM

Mark, I want my carbs AND your A1c! That's not asking too much is it? LOL!

notme

01-31-2008, 09:03 AM

I try to eat lower carb, but it is because I want to take as little insulin as possible. I am one of the weight gainers with more insulin (despite what some people think). So, I try to stay in thirty carb range per meal.

mark-TN

01-31-2008, 09:49 AM

Mark, I want my carbs AND your A1c! That's not asking too much is it? LOL!

:D No not at all, lol!

I try to eat lower carb, but it is because I want to take as little insulin as possible. I am one of the weight gainers with more insulin (despite what some people think). So, I try to stay in thirty carb range per meal.

I eat very low carb for blood sugar control and general health. If I did not have diabetes I would still eat low carb for general health and weight control, just not as low as I do now. It would be more like 30g/meal instead of 30g/day.

Mark

shabbie

01-31-2008, 09:54 AM

i pump, eat 130grams carbs per day which helps me maintain a healthy weight, and my Bg's are pretty stable (now)

i have to restrict the amount of carbs i eat in one sitting to around 30g otherwise i get a huge postmeal spike that comes back down to a normal pre-meal number later, i just prefer not to go all sleepy after every meal ;)

BlueSky

01-31-2008, 11:40 AM

I’m T1 on a VLCD, ~30g CHO per day, since May 2003. ....
Hey Mark,

At that level of carbs (30 grams a day), are you in ketosis most of the time? The reason for my question is that, at about 60 grams of carb a day, I hardly ever test positive for keytones.

TrueWorship

01-31-2008, 11:59 AM

My New Year's resolution was to get better control of my bg. At first I was checking my bg more often and counting my carbs better, and figuring my boluses more correctly. This, of course, meant I was taking more insulin. I wasn't eating any different. I wasn't exercising any differently. I was just taking more insulin. And I gained 5-10 lbs in about 2 weeks. (It's really irritating that I can't get into half of my jeans anymore.) I think it must be the increase in insulin that caused my weight gain. That's why I'm trying to cut back on carbs so that I can cut back on my insulin. I'm also trying to exercise more. But I realize that I can't just cut back on my insulin to lose weight, because it's just gonna cause me more health problems in the long run (and make me feel horrible from high bg).

Jenn

Jan B

01-31-2008, 12:33 PM

I just got a terrible post prandial reading (325) 2 hours after having oatmeal. I was at 78 before and bolused for the carbs.

That would be a reason to go low carb. Maybe I'll start eating spinach salad for breakfast too.

mark-TN

01-31-2008, 12:58 PM

Hey Mark,

At that level of carbs (30 grams a day), are you in ketosis most of the time? The reason for my question is that, at about 60 grams of carb a day, I hardly ever test positive for keytones.

BlueSky-

I have no idea. In July 2003, a couple of months after starting the Bernstein Diet, I was curious to see if I was in ketosis so I went to my local pharmacy for some Ketostix’s. They were sold out. The lady behind the counter told me that they could not keep them on the shelf because of the "darn Adkins Diet craze". Go figure. I tried for a couple of weeks to get some but finally lost interest. I've thought about getting some since but have never remembered to pick some up. I have a hard time believing that I would show even small ketones in my urine as my weight has been stable for a couple years now. I need to pick up a prescription after work, so I’ll pick up a bottle of Ketostix’s and test tonight and do a fasting test in the morning. I’ll let you know.

Mark

BriOnH

01-31-2008, 05:37 PM

I’m T1 on a VLCD, ~30g CHO per day, since May 2003. I’m 6’0”, ~175 lbs. I enjoy very stable blood sugars. Last A1c: 4.4%. I’m on MDI.

Mark

4.4%!!!! That is effin AWESOME. Long time since we have talked Mark. Wow. I would love to just get into the 5's. Do you have many lows?

susique333

01-31-2008, 06:25 PM

I love reading how everyone handles this important issue. Im on Metformin and currently no more than 60 carbs per day (approx 20/20/20) tho I fudge a little. :o

Locutus, I found your comment on how protein effects your BS and Im going to keep an eye on that. I did some reading and found excess protein turns to glucose. :eek:

Shabbie. I so totally agree. Before Low Carb I suffered from food coma so bad I couldnt drive for awhile. How weird is that?? :confused:

mark-TN

02-01-2008, 07:08 AM

…I’ll pick up a bottle of Ketostix’s and test tonight and do a fasting test in the morning. I’ll let you know.BlueSky-

For the first time since starting Bernstein over 4-1/2 years ago I finally tested my urine for ketones. 3 hours after dinner I showed moderate ketones, before bed I showed small ketones and first thing this morning it was back to moderate again. This shouldn’t be a surprise to me since the diet is a ketosis diet (low carb/high fat) but since my weight has been stable I assumed I would just have trace ketones, if any. That’s what I get for assuming. I learned a long time ago that “you need to inspect what you expect”, in other words never assume anything. Showing ketones does not bother me in the least though as ketones with normal blood sugars are harmless and help provide fuel for the brain, nervous system, heart, muscles, etc.

4.4%!!!! That is effin AWESOME. Long time since we have talked Mark. Wow. I would love to just get into the 5's. Do you have many lows?Brian-

Since starting Bernstein in 2003 I have not had a low that I could not treat myself. My target blood sugar is 83mg/dl. 90+% of the time my blood sugar is below 90. I correct any reading below the mid 70’s with the appropriate amount of glucose to bring BG to target. I will correct blood sugars above 100mg/dl with the appropriate amount of insulin to bring to target, but I never correct if I have insulin on board, (I follow Bernstein’s rule of never correcting an elevated blood sugar if it has been less than 5hours since last meal or correction bolus) and this goes a long way in preventing lows. Two or three times in the past couple of years I’ve had a blood sugar reading in the 40’s, but this is rare and it is always due to an error on my part. I have my regimen dialed in and as you know I take it very seriously and at the same time very much enjoy life.

Mark

susique333

02-01-2008, 07:21 AM

Mark, Ive been a fan of Dr. Bernstein and read his book in one sitting. On the ketones and weight issue, when I did Atkins, i found very often I was spilling moderate ketones daily yet not losing, upon closer inspection I found my calories were high. I too was under the impression that ketosis ment weightloss and didnt take into account my calories.

mark-TN

02-01-2008, 07:56 AM

Susie-

I guess this is a common miss understanding, but now that I think it through it makes perfect sense. The presence of ketones just means that your liver is converting fatty acids to be used as fuel. This naturally happens on a low carb diet. A calorie deficit still must exist to loose weight and I think Bernstein and Eades both agree on this principle. I’ve never read an Adkins book so I do not know Adkins’ stance on this.

Mark

lisa821

02-01-2008, 09:41 AM

This is all so interesting. I'm curious about trying to at least cut back some more on carbs, though I didn't thing I was eating that many to begin with (average 30-40 grams per meal). Maybe that's still too much for me. I also suspect I haven't been eating enough protein, or at least a balance of protein and carbs. Low carb might be tougher for me since I'm vegetarian and I rely on beans and whole grains pretty heavily, but I think there's probably a way to do it without driving myself nuts.

What do low-carbers do about maintaining level blood sugars during and after exercise?

~Lisa

kgm0612

02-01-2008, 10:36 AM

Quote:
Originally Posted by kgm0612
I'm a pumper and follow a low carb diet. I try to stay under 100g a day. My weight has remained the same for the last five years, give or take a pound or two.

15g at breakfast
15-20g at lunch
35-60g at dinner
10g if I have an evening snack.

Karen

WOW - I need to ask - what is it you eat on average?
My meals are 100Carbs a meal + I love me my carbs.
I don't think I could do something like that.

Breakfast could be one of the following: 2 scrambled eggs and one piece of light wheat toast; or 1 pc of light wheat toast and a Dannon Low carb yogurt; or 1/2 cup Special K Protein Plus cereal with 1/2 cup Hoods Calorie Countdown 2% milk. Sometimes I just eat a pear or a small apple.

Lunch: usually a garden salad with or without grilled chicken; or a sandwich consisting of 2 pieces of light wheat bread, lean ham or turkey breast and a slice of cheese; or a small portion of leftovers from the night prior. Lean Cuisine makes several small microwave meals that are 12g or less and they are very good.

Dinner: Chicken, pork, or beef, usually served with green beans; Whole Grain pasta; Grilled cheese sandwich; hot dogs & beans. I try to avoid rice & white potatoes. Obviously, the pasta meal would be the high of 60g for my evening meal.

Karen

REDLAN

02-01-2008, 12:32 PM

The presence of ketones just means that your liver is converting fatty acids to be used as fuel.

the actual cause of ketosis in a very low carb diet, is gluconeogenesis.

synthesising glucose (from protein and glycerol) requires oxaloacetate. Oxaloacetate is a key component in the citric acid cycle.

fatty acids are broken down into acetyl CoA and then oxidised in the citric acid cycle. While guconeogenesis is going on the liver's supply of oxaloacetate drops meaning the liver's capacity to burn fats via acetyl coA drops. the liver's response is to convert the excess acetyl coA into ketone bodies, which then enter the circulation and are taken up and burnt by other cells in the body (particularly heart and brain)

gluconeogenesis causes ketosis - no gluconeogenesis no ketosis.

low carb diets force the body to synthesise the carbs that it needs from protein and glycerol - and whilst your body is doing so the liver's capacity to burn fats drops and it responds by converting fat to ketones.

PS - ketone bodies spontaneously break down into acetone - it is acetone that appears within the urine and is detected by the ketostix. Acetone is also excreted in the breath.

BlueSky

02-01-2008, 06:43 PM

I’m T1 on a VLCD, ~30g CHO per day, since May 2003. I’m 6’0”, ~175 lbs. I enjoy very stable blood sugars. Last A1c: 4.4%. I’m on MDI.

Mark
Mark,

How much insulin do you use to cover the 6, 6 and 12 grams of carb in breakfast, lunch and supper respectively? Have you found that you need to cover protein, and do you need to take the so-called Chinese Restaurant effect into account. The reason for these questions is, I have found that reducing carbohydrate in meals does not appear to cause a proportional reduction in the insulin requirement. While variation in the basal requirement no doubt has something to do with this, I still seem to need a lot more bolus insulin to cover a low carb meal than I would expect.

mark-TN

02-02-2008, 02:39 AM

BlueSky-

I eat 6,12,12; meaning 6g CHO for breakfast and 12g CHO at both lunch and dinner (although you could eat 6,6,12 if you prefer- the 30g is the upper limit he recommends). I take Regular with meals and my current doses are 4.0units, 4.0units, and 3.0units for breakfast, lunch, and dinner respectively. Yes I do observe the Chinese Restaurant Effect. The CRE is caused by Incretin Hormones (Byetta, Symlin and Januvia are drugs that were developed to counter this effect). Bernstein just gave this Incretin Effect a name. Yes protein raises my blood sugar and my meal insulin covers this.

Hope this helps.

Mark

Jan B

02-02-2008, 06:57 AM

I guess I'll read about Bernstein's plan. It sounds backwards and not at all healthy. I tend to go the Dean Ornish way, which is vegetarian, extremely low fat and complex carbs. I have been eating salmon, tuna lately. My doctor challenged me to follow Ornish a couple years ago, since I have a bit of heart disease (Ornish has a heart disease reversal diet). Doc doesn't think 99% of people are able to follow it. I've gone off it for a few months at a time because I get sick of going to a restaurant, seeing all the rubbish they serve, and feeling like a freak!

I've also read all about the Blood Type diet/way of eating, which is very interesting, but it's also blasted by several critics. (I'm type O and should be a meat eater.) However, since I almost eliminated gluten from my diet, swelling in my hands is almost gone. I've also eliminated the naproxen I was taking (substituted Dr. Franks pain & joint spray).

When reading about ketones, it also sounds very dangerous for them to be floating around. I understand what you said Mark, about ketones being ok with good bg numbers.

All I want is to be sure of the healthiest way to go, since I can follow whatever eating plan. Eating is a way to stay alive & hopefully healthy; it's not my entertainment.

I have a very hard time with eating in general and am losing weight because my list of healthy foods keeps shrinking. Most of my diet consists of complex carbs . . . fruits & vegetables, beans, and sometimes fish & eggs on occasion.

I'm so confused! I wish this could all be explained in simple terms. I love reading arguments . . . I just wish I could spot the "truth"!

cheryl

02-02-2008, 07:25 AM

Hey I just want to tell you when I started pumping I got low a lot, so I lowered my carbs tremendously just to see what is my true bolus to insulin ratios, I seemed for a while not going over 30 carbs a meal, So this is an example of what I ate, so it might help you with weight loss...

Either a mini bagel....and strawberries..or oatmeal only....

a low carb sandwhich which was 20 carbs total, and free veggies with string cheese

and dinner was meat veggies, and something that added to be 18-25 carbs, half a cup of mashed potato's, or some health french fries, or some sweet potato's something like that or another piece or two of toast, some chips or salsa, something like that I melted 25 pounds in a month and a half fast yes, tired yes, irritable yes...scared yes....When I finally got out of the fear, upped things to 30 minimal a meal, and 37 max....and still lost weight but slowly by this point.....

Now, I eat 40-50 carbs a meal. One 10-25 carb snack at night....I am maintaining between 105-109 pounds I flucutate....and feel very well, my bg's stay pretty stable, I am still very insulin sensitive....and what not. My bp is 100'/60, my cholesterol is LDL 91 and HDL, is 67.....i refuse medication....Kidney function is excellent....My thing I don't eat any hydrogenated or partially hydrogenated oils period, I eat no MSG, I don't touch bleached products, I don't eat red meat or pork.....turkey, chicken(very seldom), or soy.....I don't drink milk I drink a low carb soy, that has the same amount of calcium as milk, hey 5 carbs a cup who would argue....I drink 2 liters of water a day now, and still enjoy a cup of coffee, no ketones in my urine and eat tons of fruits and veggies, Now my calroies seem to be 200 to 300 calories a meal. and my snack is between 40 and 100 calories....I do very well and maintain.....I don't aim for very low bg's I don't like it, I think it is too dangerous for me being so insulin sensitive....my last a1c was in the beginning or end of August, My bg's since that point have been a lot lower, I was struggling with going back to work, but my 6.5 a1c was a very level one, no dramatic swings and that is what I aim for if my body feels like staying in the 140's one day, I don't go nuts....I notice how I feel, if I am giddy and happy, and happy go lucky, I don't mess with it....but I am very cranky when I am in the 80's irritable moody and I have tried to stay that way in the 80's I seem to not be able to maintain that number but I am happy with what I have do right now....I don't see 200's unless I did something wrong or my set is absorbing funny and only have bad post meal spikes if I didn't wait 15 minutes to eat after a bolus

Hope that helps a bit...

Cheryl

soso

02-02-2008, 08:30 AM

Jan,
I did Bernstein for a couple of years and it is not really that hard...provided you like nd can tolerate some higher fat foods.

I never had more than trace ketones whenever I checked. The main problems I had with the diet was my IBS which means I cannot tolerate nuts wheat bran or flax...IMO all mainstays of the diet.
For bf instead of oatmeal, try this... 2 TBS ricotta cheese mixed with a beaten egg, add 2 TBS ground walnuts of Almonds or hazelnuts.. micro for 2 mins, break up with a fork and pour a little whipping cream on top and sweeten with a sf syrup or a little splenda... very like oatmeal only waaaayyy tastier!
Check out the recipes on the Berstein forum.. I still use many of the foods and if ever I hit a rough patch I revert to the good Dr's ways....

Lisa,
as to maintaining bg while exercising, as the plan is to keep normal sugars, I don't believe it would matter what one ate at that time to maintain, providing one is not pushing ones sugars over the optimal range.. I think for that reason the Doc probably recommends glucose tabs.. I think one regular at Dr B's is a big runner and he uses sweet tarts every few mins as he runs and stays in range the whole time without being high when he is done.. Telling that from memory as I haven't read him lately.
I know I used to use chocolate Smarties(English type) which are .8 of a g or carb each... a couple at a time every 10 mins.. then I developed an aversion to the taste of sweeties, which is a problem for me.. it worked well though....

REDLAN

02-02-2008, 08:58 AM

I have found that reducing carbohydrate in meals does not appear to cause a proportional reduction in the insulin requirement.

I think that there are 2 causes as to why this is so...

1) insulin resistance. Eating high fat and low carb increases the body's insulin resistance (at least in normal people without insulin resistance and type 2 diabetes & rats and mice of course). Physiologically it makes sense - essentially glucose becomes a scarce commodity, and insulin resistance (particularly of the muscles) ensures that other organs (i.e brain and I believe kidneys) get priority access. Interestingly what happens with insulin resistance is that the muscle cells switch to burning fats, and also become stuffed with triglycerides - which is exactly the same adaption shown by endurance athletes. (source of Bluesky's assertion that the body becomes fat adapted after being on a high fat for a while perhaps??)

2) gluconeogenesis - in a carb poor diet, the liver is pushed into synthesising glucose from glycerol and protein. Insulin suppresses gluconeogenesis by the liver - hence high rates of insulin are required to properly regulate gluconeogenesis by the liver.

on incretin, I find myself disagreeing with Mark's assertion.

incretin has 3 actions - stimulates insulin production, suppresses glucagon production, and slows gastric emptying. Byetta is in fact an incretin mimic, (but with a much longer half-life), and so doesn't counter the effects of incretin.

wiki links here

Incretin - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Incretin)

Exenatide - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Exenatide)

When reading about ketones, it also sounds very dangerous for them to be floating around. I understand what you said Mark, about ketones being ok with good bg numbers.

I think there is some confusion about ketones and whether they are dangerous or not. The simple answer to this one is that it depends on the concentration of ketones present in your blood.

the confusion I think arises because of DKA. the source of the ketones in a very low carb diet and DKA is exactly the same - fats converted into ketones by the liver because their normal metabolism has been blocked/slowed by gluconeogenesis.

Ketones are acidic - which will lower the pH of the blood. Normally this does not matter because the blood is buffered - the body uses carbonate to maintain the pH within a very tight range (essentially a buffer mops up excess hydrogen ions).

the small amount of ketones released by a low carb diet are buffered by carbonate, and so do not affect the pH of the blood (very much).

In DKA, the liver goes into uncontrolled glucose synthesis overdrive, releasing a flood of ketones. These ketones overwhelm the blood buffering systems, and the blood becomes acidic - the reason this is so dangerous is because proteins only work when they are a particular shape - lowering the pH causes them to become unstable, and once they change shape (usually they clump) they no longer work, and then you have major organ failure, followed by death.

Jan B

02-02-2008, 09:12 AM

I'm so glad you are here REDLAN. I feel fortunate to be one of your "students".

mark-TN

02-03-2008, 02:54 AM

the actual cause of ketosis in a very low carb diet, is gluconeogenesis.

synthesising glucose (from protein and glycerol) requires oxaloacetate. Oxaloacetate is a key component in the citric acid cycle.

fatty acids are broken down into acetyl CoA and then oxidised in the citric acid cycle. While guconeogenesis is going on the liver's supply of oxaloacetate drops meaning the liver's capacity to burn fats via acetyl coA drops. the liver's response is to convert the excess acetyl coA into ketone bodies, which then enter the circulation and are taken up and burnt by other cells in the body (particularly heart and brain)

gluconeogenesis causes ketosis - no gluconeogenesis no ketosis.

low carb diets force the body to synthesise the carbs that it needs from protein and glycerol - and whilst your body is doing so the liver's capacity to burn fats drops and it responds by converting fat to ketones.

PS - ketone bodies spontaneously break down into acetone - it is acetone that appears within the urine and is detected by the ketostix. Acetone is also excreted in the breath.
Do you believe that a properly done low-carb diet is lean muscle mass wasting or lean muscle mass conserving? Studies seem to indicate that it is lean muscle mass conserving. Ketosis evolved in a sense to supplement gluconeogenesis. Our successful ancestors needed to conserve muscle mass especially in times of starvation so that when time came to chase down pray it still had the capacity to do so. I’m afraid our species would have been extinct before too long if it had to rely only on glucose and gluconeogenesis for energy. Fortunately we evolved an efficient way to metabolize fat (ketosis) and use its byproduct (ketones) to lower the requirement for glucose by tissues and reduce the need to break down protein (gluconeogenesis). So even during starvation ketosis conserves lean muscle mass. A properly done low-carb diet is not starvation though many confuse it with starvation because the metabolism on a low carb diet in many ways mimics the metabolism seen during times of extended fasting or starvation (ie- state of ketosis and gluconeogensis). However, when on a low-carb diet with adequate protein intake, the metabolism converts the ingested protein into glucose (gluconeogenesis) and conserves or even builds up protein stores (lean muscle mass) and protein stores are conserved even more by the fact that many glucose energy requirements in the body are supplemented with ketones.

PS- Ketones are byproducts of fat metabolism. Acetone is just one type of ketone body and the one that is the least produced during ketosis and the only one that is excreted in the urine and breath. The majority is excreted in the urine, and a very small percentage excreted in the breath. Keto-breath (the result of a relatively high amount of acetone being present in the blood) is associated with very large ketones (ie untreated diabetes or extreme starvation) and is not typically experienced on a low carb diet.

I think that there are 2 causes as to why this is so...

on incretin, I find myself disagreeing with Mark's assertion.

incretin has 3 actions - stimulates insulin production, suppresses glucagon production, and slows gastric emptying. Byetta is in fact an incretin mimic, (but with a much longer half-life), and so doesn't counter the effects of incretin.We are in complete agreement here- I meant to say the CRE is caused by the lack of Inretin Hormones and that the drugs counter the Chinese Resturant Effect not the Incretin Effect. My error.

Mark

REDLAN

02-03-2008, 04:13 AM

Do you believe that a properly done low-carb diet is lean muscle mass wasting or lean muscle mass conserving?

personally I don't believe it is either. Ketosis is simply an adaption to supply the body (mostly brain but also heart and I believe kidneys) with energy during periods where glycogen stores are low - muscles will quite happily metabolise fat.

The notion that ketone synthesis is an essential component of fat metabolism is as I understand it incorrect. ketone synthesis only occurs when the liver is making glucose. At other times there is more than enough capacity within the citric acid cycle to metabolise all the fat needed for energy - I'm not totally sure of the switch for ketone synthesis, but I would assume that very small amounts of ketones are continually produced by the liver.

so on the point that ketones are there to supplement glucose I guess we are agreeing - however I'm not sure that this actually leads to significant conservation of protein (because it isn't needed for glucose generation) - I would suspect that the body (i.e. the liver) has a biologically set point for glycogen storage that it tries to maintain - and whether the energy supplied by ketones whilst it is synthesising glucose is that significant I remain to be convinced (if you have links to some studies that would be cool).

You would need to compare someone on a ketogenic diet with someone who was ingesting sufficient carbs to meet their base glucose/glycogen needs - and although theoretically the carb eater should be better at conserving protein than the ketogenic eater (they don't need to synthesise glucose), I personally doubt that you would find much (if any) difference between the 2 groups.

- just as an aside -

contrary to popular opinion weight loss (from any kind of diet) is due to loss of both fat and muscle. Even exercise does not do very much to conserve muscle - and some types of exercise will actually accelerate the rate at which muscle mass is lost.

mark-TN

02-03-2008, 04:39 AM

…I have found that reducing carbohydrate in meals does not appear to cause a proportional reduction in the insulin requirement. While variation in the basal requirement no doubt has something to do with this, I still seem to need a lot more bolus insulin to cover a low carb meal than I would expect.

You can determine easily enough if eating low carb makes you insulin resistant. One afternoon, well after your last meal or bolus of insulin, do a test to see how much one unit of fast acting insulin will lower your blood sugar. This determines your insulin sensitivity.

You can not test your insulin sensitivity during meals because there are too many variables. The ratio of insulin to carb used when carb-counting is not a determination of your insulin sensitivity. Let me try to explain. If you do some research you will find that when eating a meal the three main hormones the pancreas is signaled to release are insulin, amylin, and glucagon. Insulin and Amylin are released by the beta cells and glucagon is released by the alpha cells. In a diabetic (no matter the Type) beta cell function is diminished to some degree (from partially to completely, depending on the diabetic). However, the alpha cells still work so the release of glucagon is not diminished. A T1 diabetic will receive the full effect of the glucagon as there are no beta cells remaining to release insulin or amylin to counter it. Also, I think most all of us are in agreement that eating protein has an affect on blood sugar albeit a much smaller and slower effect than carbohydrate. When eating a high carb meal most of the influence you see on blood sugar is caused by the carbohydrate in the meal and a correspondingly small percentage is the effect of protein and the release of glucagon. So on a high carb diet, if you count carbs, you determine an insulin to carb ratio. Now on a low carb diet- say a meal consisting of 12g of carbohydrate- the opposite is true; most of the effect you see on blood sugar is from the protein and glucagon and a much smaller percent is from the carbohydrate. If you control blood sugar by counting carbohydrate you ignore the effect of protein and glucagon. On a low carb diet you can not do this. When eating low carb, if you use the same ratio you used while carb counting it will not work because you are not factoring in the relatively large impact that protein and glucagon has upon blood sugar.

Mark

mark-TN

02-03-2008, 06:41 AM

I apologize for the double post.
so on the point that ketones are there to supplement glucose I guess we are agreeing - however I'm not sure that this actually leads to significant conservation of protein (because it isn't needed for glucose generation) - I would suspect that the body (i.e. the liver) has a biologically set point for glycogen storage that it tries to maintain - and whether the energy supplied by ketones whilst it is synthesising glucose is that significant I remain to be convinced (if you have links to some studies that would be cool).

You would need to compare someone on a ketogenic diet with someone who was ingesting sufficient carbs to meet their base glucose/glycogen needs - and although theoretically the carb eater should be better at conserving protein than the ketogenic eater (they don't need to synthesise glucose), I personally doubt that you would find much (if any) difference between the 2 groups.

- just as an aside -

contrary to popular opinion weight loss (from any kind of diet) is due to loss of both fat and muscle. Even exercise does not do very much to conserve muscle - and some types of exercise will actually accelerate the rate at which muscle mass is lost.

This paper from Journal of the International Society of Sports Nutrition (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2129158) sites some studies on this subject. Here is a copy and paste from the paper:

The Composition of Weight Loss
Although the greater weight loss has obvious significance, an equally important question is related to the composition of weight loss. In 1965, Benoit et al. published the first systematic study of the effect of a very-low-carbohydrate (ketogenic) diet on composition of weight loss [21]. They observed that when a 1,000-kcal ketogenic diet (10 g of carbohydrates/day) was fed for 10 days, their seven male subjects lost an average of 600 g/day, of which 97% was fat. Young et al. compared 3 isoenergetic (1,800 kcal/day) and isoprotein (115 g/day) diets differing in carbohydrate content (30, 60, and 104 g/day) [22]. After 9 weeks on the 30-g, 60-g, and 104-g carbohydrate diets, weight loss was 16.2, 12.8, and 11.9 kilograms and fat accounted for 95%, 84%, and 75% of the weight loss, respectively. More recently, Volek et al. examined the effects of 6-week very-low-carbohydrate diet on total and regional body composition [23]. Interestingly, their results indicated that fat mass was significantly decreased (-3.4 kg) and lean body mass significantly increased (+1.1 kg) at week 6. As expected, a very-low-carbohydrate diet led to significant decrease in serum insulin concentrations and there was a significant correlation between the decrease in insulin and the decrease in body fat, indicating that adipose tissue mobilization was up-regulated, which was also supported by the elevated beta-hydroxybutyrate concentrations. Finally, Willy et al. examined the efficacy and metabolic impact of a ketogenic diet in the treatment of morbidly obese adolescents [24]. The authors concluded that ketogenic diet is "a safe and effective weight loss regimen... The weight loss with this approach is rapid, consistent, and almost exclusively from body fat stores." It is frequently claimed that additional weight loss with low-carbohydrate diets is entirely explained by dehydration. However, the classic study by Rabast et al. demonstrated that alterations in the water and electrolyte balance observed during the low-carbohydrate diets are reversible phenomena and should thus not be regarded as causal agents of the different weight reduction [25]. Also, the modern studies that measured body composition by dual-energy X-ray absorptiometry did not find any indication of excessive reduction in lean body mass [26,27]. Thus, the greater weight loss is attributable to fat loss.

Mark

cheryl

02-03-2008, 06:45 AM

Those posts above sound like me, and really for me is too much work. LOL............I like my moderate carbs which help attack the protien as long as it's not over 30 grams in one sitting....I feel more free......maybe one day when I don't have to worry about 4-7 kids and work and all that, but thinking about carbs and protien constantly was driving me up the wall....

Cheryl

REDLAN

02-03-2008, 08:02 AM

Young et al. compared 3 isoenergetic (1,800 kcal/day) and isoprotein (115 g/day) diets differing in carbohydrate content (30, 60, and 104 g/day) [22]. After 9 weeks on the 30-g, 60-g, and 104-g carbohydrate diets, weight loss was 16.2, 12.8, and 11.9 kilograms and fat accounted for 95%, 84%, and 75% of the weight loss, respectively.

what's nice about this study is the dose dependency young et al have demonstrated. The lower the percentage of carbs in the diet, not only gives greater weight loss, but also fat mass comprises a greater percentage of that weightloss.

the explanation that it is down regulation of insulin that drives the fat mobilisation would seem to make the most sense.

Jan B

02-03-2008, 08:10 AM

Mark or anyone,

I apologize if you have already answered this -- do you believe a high fat & protein diet is as healthy for the heart as a low-fat diet?

REDLAN

02-03-2008, 09:22 AM

do you believe a high fat & protein diet is as healthy for the heart as a low-fat diet?

this is about as controversial as it gets...

opinion time - what I am about to voice is my own personal opinion. It is not a diet recommendation, or in fact any other kind of recommendation of any sort.

It does not really matter, the exact proportion of what you eat as long as you are receiving sufficient calories, and you have met your vitamin and mineral needs - if you have covered these then you are probably OK.

things that are actually bad for your heart...

restricting your calories most definitely is. Calorie restricted diets are not particularly good for your long term health (I don't just mean super models)

stress - rarely talked about, but a biggie this one.

being underweight (not so obvious, but true none the less)

being poor

being a man

being old

(the last three are somewhat difficult to do something about)

there is some limited evidence which suggest that high fat diets in certain individuals and populations rather than being harmful is actually protective - in other words...

doesn't really have any effect.

lisa821

02-03-2008, 09:28 AM

Currently I'm reading "The Insulin Resistance Diet", written by an M.D. and a dietician. The book is targeted mostly toward overweight people who have a hard time losing weight and Type 2 diabetics--not really for an insulin pumping Type 1 like myself. However, I've been wondering if I haven't been eating an adequate amount of protein in the 5 years since I've been vegetarian because I've gained at least 25 pounds in those 5 years, despite not eating more and exercising consistently. I also get very insulin resistant in the week before my period begins.

What I've learned so far is to try to eat more of a balance of carbs to proteins. The book recommends a ratio of 15 grams carb to 7 grams of protein, and not to eat more than 30 grams of carb at each meal. However, you can increase the amount of protein you eat, as well as eat as many veggies as you want. So Cheryl, since you've been eating roughly 30 grams of carb per meal, it sounds right up your alley!

I'll be interested to see how this works for me. It looks like I'll need to bolus a little extra for the protein, even though I'm pretty much sticking to the ratio of 30 g ch:14 g protein per meal. There are some things in the book that would not work for Type 1s, like counting milk as a complete protein and drinking as much of it as you want (oh, really? Not in my case...) but it does have some pretty common sense advice.

Anybody else familiar with this book?
~Lisa

mark-TN

02-05-2008, 06:07 AM

Mark or anyone,

I apologize if you have already answered this -- do you believe a high fat & protein diet is as healthy for the heart as a low-fat diet?

I can't answer that question. Now, if you asked what do I believe is healthier: a low carb/high fat diet, or a low fat/high carb diet, I would definitely say imo the former (low carb/high fat diet) is the healthier choice.

I think the way we choose to eat and the way we choose to treat are diabetes is very personal and everyone must make their own decisions on the matter.

You know the old saying: if it ain’t broke don’t fix it. Well it goes the other way too: if what you are doing is not working than why continue to beat your head against the wall? Here are a couple of articles to mull over:

From dLife, by Richard Feinman:
What if Saturated Fat is Not the Problem? A professor of biochemistry provides perspective. (http://www.dlife.com/dLife/do/ShowContent/food_and_nutrition/what_if_saturated_fat_not_problem.html)

From msnbc, by Nina Teicholz:
What if bad fat isn’t so bad? No one's ever proved that saturated fat clogs arteries, causes heart disease (http://www.msnbc.msn.com/id/22116724/)

Mark

gettingby

02-05-2008, 06:18 PM

Ok, thanks to some replies from BlueSky, I've decided to try low carbing but do it on a meal to meal basis. If I start with breakfast, what are some things I can eat? Just so you know, I don't eat eggs. Haven't since my papaw died in '75. Mom thinks it's a psychological thing but I WON'T touch em. :)

Dan Gato

02-09-2008, 09:31 AM

Mark, I want my carbs AND your A1c! That's not asking too much is it? LOL!

I want Mark's A1C !!! :)
But I'm not on insulin, yet.

Mark, your A1C is so perfect.

David_S

02-18-2008, 07:59 PM

We do eat lower carb. My wife eats the same as I do... about 30 a meal. The diet recommended by the ADA was almost double.. and trouble. We figured out our 30 a meal plus I eat snacks.. low carb ones.. but snacks throughout the day as I walk 4-5 hours a day and it drops me too. ( mailman here)
The good news is my wife lost 75 pounds since I was diagnosed! The bad news is.. I still have diabetes ! Oh well.. can't win them all.

Metermaid

02-19-2008, 11:09 AM

Wow, that is a great weight...what do you use for your MDI?
And how much insulin? I eat the same amt of carbs, but I am 5'2" and 138#!! My goal is your weight! Do you exercise a lot?

Mich

02-19-2008, 02:23 PM

My personal experience only here:

In 1972 I read the first Dr Atkins book. I decided to try the diet but was nervous about the ketosis getting out of hand. But the diet made sense to me because I remembered losing weight under the influence of ketosis before my diagnosis as T1 12 years earlier.

Long story short...I lost weight, my A1c began to run in the neighborhood of 6 or less and I lived all of the time with mild ketosis. (I always keep Ketostix around as a diabetic.) When I reached my desired weight, I added a few more carbs to a point of balance between diet, exercise and insulin. I was full, ate enough "good things" that I never felt deprived and endured everyone laughing at my eating habits because I felt great. I had learned by that time to take regular insulin for my meals, in addition to my NPH (the doctor insisted but I didn't like the 8 hour "bump.") Little did I know I was doing MDI, I just did what felt correct and worked for me.

Later, Dr Peter Forsham, who was also a diabetic switched me to Lente Insulin, then Humalog. He got me my first blood sugar meter (Lifescan) and swapped stories on what worked for both of us. He approved of my way of eating and did a modified version of it himself. He was my hero. (By the way, he injected through his clothing too :) )

I've been eating like this since. My ketones run "trace" at all times. That would be thirty-six years. I never stop researching and keeping up on the latest diabetes treatment. My cholesterol is just now edging up (familial trait) but my HDL runs very high.

Diabetics living low carb? Read Dr Bernstein.

Dr Bernstein seemed a bit extreme with the 30 grams a day rule, but it actually works pretty well for me too, unless I meet up with a taste of cherry pie. Any time I need to lose weight I revert to 30 grams or less, all of my carbs coming from low-glycemic veggies. Since I do not eat the same or exercise the same each day, I tend to yo-yo a bit in my weight--especially seasonally.

Bernestein's ALA suggestion is very helpful for my neuropathy.

My aim, like Nancy's is to take as little insulin as I can, especially when losing weight. I take about 30 units total a day--less when dieting or very active. I am 5'8" tall and have weighed 160 for the last 36 years. Well...except for right after the holidays :T

I'm a believer.

Mich

kstreeter513

02-19-2008, 05:28 PM

Holy cow!!! How do some of you low carbers survive??:D

WOW - I need to ask - what is it you eat on average?
My meals are 100Carbs a meal + I love me my carbs.
I don't think I could do something like that.

I guess you and I are the odd balls here. I enjoy running, and as a result, I frequently eat 400 CHO/day (I'm not over weight either, maybe from the jogging?). I don't think I could enjoy life without my pasta!!!

Do any of you following a low carb diet do any endurance sports? How does your diet work for you as a result?

BlueSky

02-19-2008, 05:58 PM

Do any of you following a low carb diet do any endurance sports? How does your diet work for you as a result?

You need to provide as much glucose as is required during exercise. But usually there is only a big need during the first 20 minutes or so. The body then switches to fat burning mode. And low-carbers rely more heavily on fat for energy than carb-loaders. As you become fat-adapted, the body becomes more efficient at burning dietary and stored fat. So there is no lack of energy. And "hitting the wall" is not the problem it often is for carb-loaders.

I do a lot of hiking. The night before, I reduce the Lantus by three units. Before a 20km hike, I would eat a high-fat breakfast (eggs, cheese, sausages & mushrooms) and I eat enough carb to get my BG to about 180. After 30 minutes, I stop and test. If neccessary I will have a bit more carb (10-20grams). And I am normally fine for the rest of the day. I eat normally and cover any carb with insulin.

Eddy

02-19-2008, 06:16 PM

My meals are 100Carbs a meal + I love me my carbs.
I don't think I could do something like that.

I hear ya. I usually have 75-90 g/meal. A big lunch might be 180 g. When I'm feeling gluttonous? I've done lunches in the neighborhood of 240 g. (These are by no means my normal lunches.)

Today so far: ~7 U worth of pancakes for brunch, 5 U (nailed it!) worth of pita wraps for early dinner, and 2 U worth of Mojo bar and Fritos to cover Lantus stacking. I'm feeling full, so that'll probably do it for today, unless I pull a late night and get hungry.

Ironically, the bigger meals don't give the huge spikes. I used to tend toward hypo; I've since realized that 10+ U meals usually require replacing 2-3 U of regular with like amount of NPH. With enough food ingested, digestion slows down and levels out... one is still going 4-5 hours after eating. (Hence the NPH!)

5'11", 175 lb.

Eddy

02-19-2008, 06:30 PM

Maybe I'll start eating spinach salad for breakfast too.

I've found that spinach seems to help stabilize my BG. ("Seems" = "could be placebo although I don't think so")

ENoebel

02-28-2008, 07:37 PM

My nine year old daughter was just diagnosed type 1 with an A1c of 10. We are starting out on 15:1 ratio for Novolog and 15units of Lantus at bed. Her sugars are not totally stable yet, but I noticed last night (and I"m a former Atkins dieter who couldn't quite make it permanent) that when I gave her a very low carb meal for which I did not have to bolus, her sugars were predictable and steady throughout the night (we are still monitoring BG at 2am) and excellent in morning.

My father and I are arguing about Bernstein's diet. He believes the diabetes educators who tell us 60 percent carbs and mashed potatoes and sugary stuff okay (just compensate). I, on the other hand, have a strong gut feeling that low carb will help Katie tremendously. Plus, even I wouldn't eat that amount of potatoes and sugary stuff. It just HAS to result in rapid spike and decline (and it does appear that way with her BG) I don't want to fight with dad (her other primary caretaker) on this. If you want to write me and let me know your experience with this, I'm all ears. I'm still in shock, and eager to read and know as much as possible. He feels I'm thinking wrong, like an Atkins dieter or type 2 diabetic. I told him I am suspicious of the ADA guidelines, as I am of the USDA food pyramid. Every other country I've lived in, where diabetes is much more rare, folks eat more veggies, meats and fruits and far less carbs. Go figure. I've also read Neanderthin, Protein Power, Life Without Bread, and all the Atkins books. Also: Breaking the Vicious Cycle. I have had some success in the management of my Crohn's Disease by reducing carbs.

Please advise. Kind regards and thanks for sharing.

E. Noebel
Arizona

Real4

02-28-2008, 08:20 PM

Please advise. Kind regards and thanks for sharing.
E. Noebel Arizona

Kept reading, thinking and trying. That's the best advice I can give. (I do think you're on the right track [ADA is a dirty word in some circles].)

BlueSky

02-28-2008, 08:47 PM

.... It just HAS to result in rapid spike and decline (and it does appear that way with her BG) ....
That just about says it all. The more carb she eats, the more insulin has to be injected to cover it. And the more likely a mismatch between the two becomes, causing blood sugar to shoot up and and come crashing down. Managing the condition with children is more difficult, and you will probably have to compromise. One way to handle it is to let let her eat lots of carbo during the day, but to limit it for supper and breakfast. Doing this helps ensure that the blood sugar is stable over night and the day gets off to a good start.

Welcome to the forums nd good luck ;) .

HelenM

02-29-2008, 03:45 AM

I eat a diet of about 50% carbohydrates and sometimes more. I am fit and active. My HBA1c has been stable at 5% for 3 years. As with any type 1 I try to match my insulin to carb intake. As with anyone if I eat too much (too many calories) compared with my activity levels then I put on weight. I also find my insulin sensitivity decreases. If this happens I exercise a bit more and cut back the total calories. I cannot see any benefit in a low percentage carb diet.

My father and I are arguing about Bernstein's diet. He believes the diabetes educators who tell us 60 percent carbs and mashed potatoes and sugary stuff

I am very scared of the idea of introducing a low carb diet to a young child. Their energy demands are much higher than those of adults. Your doctor is not just following ADA guidelines but those adopted worldwide. According to most authorities a 7-10 year old girl with normal activity levels should indeed be eating a diet of about 60% carbs (about 260gm). I believe strongly that those carbs should mostly come from high quality foods, wholegrains, fruits and vegetables. and few from highly refined, higly processed foods and almost none from totally empty (nutritionally) products such as sweetened fizzy drinks. (6 cans a day would provide almost all the carb requirements and nothing else). If you google children diabetes carbohydrates you will come up with lots of information which perhaps might help in your discussions.

Every other country I've lived in, where diabetes is much more rare, folks eat more veggies, meats and fruits and far less carbs.
Type 1 diabetes is much more common in people descended from Northern Europe. Incidence is particulary high in Scandinavia. It is not caused by the diet. Type 2 is more prevalent in certain Western societies and has associations with diet. I live in an area of SW France with the highest life expectancy in the country,(84.5). The incidence of type 2 diabetes and of heart disease is low. The traditional diet contains lots of fruit, veg, it is relatively high in fat (but mostly derived from duck and olive oil), every meal is acompanied with large quantities of bread ( sourdough risenmade with unbleached white and rye flour.) They also drink red wine. The only thing that the diet is low in is processed food. Most people including the elderly are physically active. Sadly the diet amongst the young is changing .

Having a child diagnosed with diabetes at nine must be very difficult and although there are lots of people on here with good intentions (myself included) most are not the parents of diabetic children. I think that it might be a good idea to also ask your question on a specific forum such as 'children with diabetes'. But don't leave us as there are some parents here and lots of people who have experienced diabetes as a child so can give a different point of view.

Eddy

02-29-2008, 09:12 AM

My father and I are arguing about Bernstein's diet. He believes the diabetes educators who tell us 60 percent carbs and mashed potatoes and sugary stuff okay (just compensate).

It often is possible to bolus for carbohydrates, although the timing can be "interesting".

When I eat pineapple, I wait as long as possible (usually 20-30 minutes) after injecting Humalog; otherwise, I'll spike.

When I eat whole-grain rice spaghetti, I use 20% Humalog, 20% human, and 60% NPH. The spaghetti digests slowly enough that modern insulin analogs drop me far too quickly.

It just HAS to result in rapid spike and decline (and it does appear that way with her BG) I don't want to fight with dad (her other primary caretaker) on this.

"It depends." The rapid spikes happen when the glucose release wins the race against the insulin [analog] kicking in. Conversely, one can observe a rapid drop if the insulin acts faster.

Before I added regular and NPH to my regimen, I was frequently getting my rearend kicked by Humalog; sub-40 mg/dL drops were a daily affair. Two such hypos per day was fairly common. I could correct... but then I'd go higher when the food digested. Two shots per meal? No, I think I'll use the much-less-expensive "horse and buggy" insulin instead. :)

Larger, higher-carbohydrate meals mean more opportunity for error. However...

I've had some of my smoothest postprandial numbers with huge (between 180g and 225g CHO) meals. Any increases happen around the 4h postprandial mark, and I can feel them happening; I don't know that I've gone above 180 mg/dL (not the greatest, but not "through the roof") from one of my "monster meals" -- where I understand the food.

Things like allergic reactions, excess caffeine, and unfamiliar foods have sent me past the 200 mg/dL mark with much smaller quantities.

Bottom line: There's no substitute for "getting a feel" for diabetes. It involves science, art, and forensics; I semi-jokingly tell people that, were I 20 years younger, I could be my own science fair project.

If you want to write me and let me know your experience with this, I'm all ears. I'm still in shock, and eager to read and know as much as possible. He feels I'm thinking wrong, like an Atkins dieter or type 2 diabetic.

I agree that you're thinking along Atkins or type 2 lines. However, by no means do I discount your concerns.

I told him I am suspicious of the ADA guidelines, as I am of the USDA food pyramid.

Good call. :)

And you'll encounter situations where observations contradict printed "facts". I say you're doing the right thing by researching as much as possible, attempting to make informed decisions, and then acting.

REDLAN

02-29-2008, 09:29 AM

low carb diets - do they work? well obviously some people report great success with low carb diets. However I have to echo Helen's caution about low-carbing - bernstein/atkins style with a young child.

If you don't know what you are doing, a low carb diet and type 1 can be a dangerous mix.

The issue particularly surrounds exercise - especially strenuous exercise. After a bout of strenuous exercise it is possible to virtually deplete the muscle's store of glycogen. (cyclists call it bonking, runners call it hitting the wall). The muscle cells adapt to their low energy state by becoming very sensitive to insulin - this effect can last up to 2-3 days. The muscles in effect act like a glucose sponge, sucking glucose out of the blood stream. The ultimate source of this extra glucose is the liver. Unless steps are taken to ensure that the liver's glycogen is replenished, then the muscles' demands for glucose can deplete the glycogen store in the liver.

for anyone not on insulin this doesn't matter one iota - you will just feel a bit tired. For someone on insulin the consequences can be extremely serious.

Normally if you go low during the night, what happens is that after a while the liver kicks in and starts releasing it's supply of glycogen - it's not uncommon for night time lows to produce rebound highs by the time you wake up.

however if after strenous exercise you go low (and there is a greater risk due to your now highly insulin sensitive muscles), and you have failed to replenish your liver's glycogen store, then the liver can not protect you from the low. Your muscles will eventually drop your BG down to dangerous levels, and then hold it there. Brain damage and death can result if it goes on too long.There have been fatalities where people with type 1 have got exercise and glycogen replenishment wrong.

For anyone on insulin, you must ensure that after strenuous exercise that you replenish your liver's glycogen supplies - you could argue that the gluconeogenesis caused by a very low carb diet is sufficient to do the trick. Personally I would rather rely on scoffing a goodly dose of pasta/bread/potatoes, and know for sure that if I need it, my liver will definitely protect me if I go low in the night.

BlueSky

03-01-2008, 10:18 PM

.... For someone on insulin the consequences can be extremely serious. .... if after strenous exercise you go low (and there is a greater risk due to your now highly insulin sensitive muscles), and you have failed to replenish your liver's glycogen store, then the liver can not protect you from the low. Your muscles will eventually drop your BG down to dangerous levels, and then hold it there. Brain damage and death can result if it goes on too long.There have been fatalities where people with type 1 have got exercise and glycogen replenishment wrong. ....
I think that arguement is specious, to say te least. It sounds plausible, but it doesn't explain reality. Sudden blood glucose drops may be aggravated by increased insulin sensitivity. But they are actually caused by injecting too much insulin. So if, as a T1 low-carber, you inject very little insulin, this is not a problem. Because insulin use is so much lower than it would be on a high-carb way of eating, blood gluscose doesn't drop suddenly. Low-carb eating protects against the very phenomenon you are warning against.

The risk of liver glycogen depletion is overstated. Muscle glycogen depletion can occur, especially during anaerobic exercise. All that happens is that the muscles become fatigued, performance deteriorates and suitable amounts of carb have to be consumed. While I have had hypos after exercise, they are never severe. I am always able to deal with them without assistance. I seems to me that, while muscle glycogen perhaps is depleted during exercise, liver glycogen stores remain pretty much intact. They are kept topped up and continue to be available for supporting falling blood glucose. This would explain why low-carbers typically have fewer problems with hypos.

Having said that, muscle glycogen depletion doen't seem to be as much of a problem as it was back in the high-carbing days either. I can't remember the last time I "hit the wall". I have a far more consistent energy levels, presumably because fat has become the main source of calories.

For me, low-carb eating has reduced the frequencey and severity of hypos, both during and after exercise. Warnings against combining low-carbing with exercise are, IMO, unecessarily alarmist and very speculative. People who actually try it typically find that it works really well. Children do just as well on a high fat diet. The difficulty, of course, is compliance. Children love the sweet stuff! ;)

REDLAN

03-02-2008, 04:24 AM

I think that argument is specious, to say the least.

never the less glycogen depletion of the liver can and does happen to people, and if you have type 1 it can be very serious, and there have been fatalities.

I personally know of one person to whom this actually happened. She was doing a low-carb diet (to lose weight), and exercised heavily. During the night she went low, and didn't wake up. Fortunately for her, her husband was woken up by her going low. He phoned the ambulance when he couldn't wake her. They came and gave her not one but 2 shots of glucagon - neither of which worked (it doesn't take a genius to figure out why not). They had to rush her into ITU and fix her up with a glucose drip.

There's a big difference to old hands like yourself Blue Sky who have been low-carbing for a long time, and are well used to the effects of exercise on your body, and someone starting to experiment with low-carbing. They need to know that there is a risk with strenuous exercise, and how to ensure that they are safe during the night. This is especially so if they live alone and there is no one to check they are OK.

This is no different to advising people that there is a hypo risk during the night with alcohol.

BlueSky

03-02-2008, 01:36 PM

... I personally know of one person to whom this actually happened. She was doing a low-carb diet (to lose weight), and exercised heavily. During the night she went low, and didn't wake up. Fortunately for her, her husband was woken up by her going low. He phoned the ambulance when he couldn't wake her. They came and gave her not one but 2 shots of glucagon - neither of which worked (it doesn't take a genius to figure out why not). They had to rush her into ITU and fix her up with a glucose drip. .....
I don't doubt that this unfortunate event actually happened. And it certainly sounds like there was inadequate glycogen at the time. But I am questioning whether eating low carb should be blamed for this, and whether this is normal or typical for people who restrict carbohydrate. The next part of the question is, would the experience have been any different if she had been eating high-carb? I suspect the answer to this question is "no" too.

I don't think it is typical for low-carb eating to cause glycogen depletion, simply because I would have noticed the effect. I don't run out of energy when exercising. And I don't need to carbo-load to restore glycogen reserves after exercise either. Most importantly, since eating low-carb I have never had a severe hypo, in spite of exercise which is often intense. My glycogen reserves stay topped up, and I don't have to do anything to make this happen. Gluconeogenesis is presumably responsible for this.

Switching from high-carb eating to low-carb eating really hasn't made a difference. So I am suggesting that perhaps your friend's hypo experience had nothing to do with the way she had been eating.

finelysculpted

03-07-2008, 01:32 PM

are any of you bodybuilders? i'm dieting for a show right now, and i'm trying to limit carbs more and more each day til i can eventually get it down to under 20g. but on a typical day i'll eat over 300g of protein. (fat varies, depending on a lot of things)

i don't use the pump. i've tried it, but it didn't work well for me. my low body fat made it incredibly difficult to keep in. and my white blood cells constantly attacked the injection site and clogged up the little pin. needless to say, my bg was never as bad as it was for those 2 months.

in any event, i use humalog and humulin. which is amazing for gaining muscle (just ask if you want tips on that) but it's terrible for stripping off most body fat.

can anyone suggest how to mix the humulin and humalog to find a good balance for very little carbs? if i get too low, and need to eat an apple or something, that throws the whole low carb part off and ruins the effect i'm looking for.

any advice would be GREATLY appreciated. thanks.