No Carbs??

[Sparkle]

Has anyone tried cutting carbs out (while on 4 injections a day)? Want to lose a bit of weight and wonder if my sugars really will climb up if I cut out carbs and don't inject maybe with dinner or lunch. I know can't be done all the time....

[Cinnabon]

Kinda risky though but you would have to test a whole lot just to make sure you dont have any hypos. I attempted it a few times, resucing my insuling, but had real bad headaches due to the carbs, had a bit of low BS, and my bosy was feeling real weird. But we are all different, just please be careful.

[DeusXM]

Um....if you reduce your carb intake, your bg level will drop, unless you adjust your insulin.

The best way to lose weight is to reduce your carb and calorie intake AND reduce your insulin intake accordingly. Cutting out carbs completely will simply make you tired and hungry all the time, regardless of bg, and put you in pretty much the same health situation as someone on Atkins.

The best way to lose weight, in fact the ONLY way to lose weight, is to eat less and do more exercise. If you do not burn up more calories a day than you eat, you will not lose weight.

[LauRa Lu]

When I was first diagnosed I was on a high carb diet and started to put on wieght, now im on a very low carb diet... just some at inght to keep me going through bed time. In the day I either eat no carb, very low carb or just not eat at all, and my sugar levels are much better.

try testing with some foods and see what happens, test your bg levels more often to keep an eye on things and you'll soon see what works and what doesn't. When i first ever skipped lunch I was worried i'd go low, but i just didnt take my fast acting shot (novorapid) and i was ok.

Theres no reason why you should eat more carbs than you wnat to, it just takes a while to figure out what works for you.

[Sparkle]

Will be careful etc. Any tips on how to burn calories and not having to have something to eat due to sugar drops would be appreciated! I guess it's a balancing game but finding it a bit hard work at the mo...!

[Cinnabon]

Def. A trial and error situation. Remember, the different types of carbs also go into the body differently and have different effects as well. I'm always
Lo-carb and with me, wheat and muti grain products take much longer to take effect. Same as for veggies (Lo GI)

A snack before you workout will most def prevent the lows.

[sparkle9]

When I exercise after a meal, I reduce my premeal insulin significantly. If I wait until 3-4 hours after eating, I test my bs. If it's normal, I can usually exercise without a problem. These are ways to burn calories without having to eat extra food.

[CarlyesHope]

This may or may not help since we are new at this game, but, Carlye has decided that Lunch will be her big carb meal of the day (since her ratio is 1:20) so at dinner, her goal is no carbs.... and she has done it for a week now, she just has chicken and cheese, or steak and cheese etc. and that way she doesn't have to take any shots either (another big goal of hers) and for the past week, her bedtime (9ish) numbers have been nice, right around 80. I was nervous about this little trend of hers, but so far she is doing okay with it. I don't know if this is healthy or not, but as long as she is eating a good balanced lunch and is getting protein at dinner I think we're okay.

[Amanda_Jo22]

I had an endo who set a goal for me of 20 units of lantus/day (my basal) w/NO bolus at all...a completely carb-free diet (needless to say that was slightly unrealistic and I now have a new endo). If you reduce your carbs, you will reduce the amount of insulin you need. If you want to try this, I would recommend seing a dietitian first (preferably a dietitian who's a cde as well) because they will guide you through the process.

[MarkMunday]

Sparkle,

You can't eliminate carbs entirely from your diet without risking dangerous hypos. The reason for this is that carbs you eat are utilised to top-up glycogen reserves in your liver and muscles. Glycogen can quickly be released into your blood stream as glucose. So it is a readily available source of energy. And your body uses it in emergencies and between meals.

Eliminating carbs from your diet would mean that depleted glycogen reserves would not be restored. So the risk of hypos during exercise and while you are sleeping would increase. Having said that, you only need 30grams of carbohydrate a day to keep your glycogen reserves topped-up.

Many people do well on 30gm of carbs a day. I find that I lack energy and lose weight if I have less than 60-80 gm of carbs a day. But you certainly don't need the 200+ grams a day the ADA and most dieticians suggest is required.

You will probably find that a low carb way of eating will help you lose weight, simply because you don't get so hungry.

Cheers,

Mark

[mark-TN]

You can't eliminate carbs entirely from your diet without risking dangerous hypos. The reason for this is that carbs you eat are utilised to top-up glycogen reserves in your liver and muscles. Glycogen can quickly be released into your blood stream as glucose. So it is a readily available source of energy. And your body uses it in emergencies and between meals.



Mark-

I disagree with this statement. About 38% of protein is converted into glucose which can be used to refill glycogen stores, used immediately for fuel, or what is left over is stored as fat. This is the same thing that happens to the carbohydrate we eat. The only difference is that almost 100% of the carbohydrate gets turned into glucose. We can survive without any carbohydrate, but it is necessary to eat some carbohydrate in the form of vegetables just so that we can get essential nutrients that we can not get from protein and fat alone. Non-starching, nutritious vegetables, supply essential vitamins, minerals and phytochemicals, protein foods provide essential amino acids, and fats provide essential fatty acids; and this is all that we need.

Mark

[DeusXM]

The difference is that protein takes a lot, lot longer to be converted into glycogen than carbohydrates.

[Lee73]

Hi Sparkle,

You have already received good advice and I don't have much more to add. I would just reiterate the "be careful" statements and, of course, trial and error will be a big part of figuring out how your body responds to cutting carbs etc.

I just want to add one thing....I admit I am a bit of a curmudgeon when it comes to cutting carbs, because I love them, but also because it just seems very drastic. I work in the culinary/restaurant field and I have seen every diet known to man in practice (don't even ask me how many "sandwiches, without the bread" I have been asked to make). Here's the thing....if it is about weight....carbs don't "make you fat"....regularly consuming more calories than you burn causes weight gain. So right off the bat I would say, cutting carbs and simultaneously increasing exercise sounds a bit risky in terms of hypos and just plain old energy. If you plan on exercising more, carbs are actually an important source of energy. By now it is cliche, but I will say it: moderation is key. Choose your carbs wisely (especially if exercise is involved). If you do decide to cut carbs out completely, do it slowly, gradually reduce your intake of carbs and guage how you feel.

Ok, having said all that....
Good luck!

[Sparkle]

Hmmm...not going to cut out carbs completely. Think I just need to cut back on calories as well. Think I get confused between calorie intake and carbs and how they affect sugar levels. Maybe cutting out the vino would help!! Also, low fat is good etc especially for us.

Thanks for advice - will calorie count a bit more!

[mark-TN]

The difference is that protein takes a lot, lot longer to be converted into glycogen than carbohydrates.

Protein does take longer to get converted into glucose, but what you actually need to restore and or maintain glycogen stores is adequate blood sugar levels. Glycogen stores are not replenished directly from carbohydrate or protein. Carbohydrate and protein must first be converted to glucose by enzymes. This glucose is picked up by the blood stream mostly through the gut. With the help of certain enzymes and peptides a portion of this glucose is stored as glycogen; mostly in the liver and muscles. The liver is the main storage depot of glycogen that is used, through the release of glucagon, to help regulate blood sugar; and it does it very well in a non-diabetic. No matter what you eat or how you get your glucose, after a severe low blood sugar where injected Glucagon was used it will take a full 24 hours of normal or above normal blood sugar levels to replenish glycogen stores that have been drastically depleted from the liver and other storage locations. Also during a low blood sugar the adrenal glands release epinephrine which causes the muscles to release glycogen for there own energy. (FYI: Glycogen released from muscle cells is oxidized only by the muscle cells and is not converted into free glucose, therefore cannot contribute to blood sugar levels. Glycogen can only be converted to free glucose in the liver, kidneys and intestines, but the main store that contributes to blood sugar levels is in the liver because it is by far the largest store of the three. Muscle cells because of shear volume contain the most stores of glycogen in the body, but again these stores cannot be used to raise blood sugar.) Keeping adequate blood sugar levels will ensure that glycogen stores are kept topped off. It is consistent below normal blood sugars and hypoglycemic attacks that will lead to inadequate glycogen storage, and not what is eaten. A low carb diet and well match medication regime will keep blood sugar levels at a normal level and keep glycogen stores full, just like a diet rich in carbohydrates is capable of doing.

Mark

[MarkMunday]

Mark-

I disagree with this statement. About 38% of protein is converted into glucose which can be used to refill glycogen stores, used immediately for fuel, or what is left over is stored as fat. This is the same thing that happens to the carbohydrate we eat. The only difference is that almost 100% of the carbohydrate gets turned into glucose. We can survive without any carbohydrate, but it is necessary to eat some carbohydrate in the form of vegetables just so that we can get essential nutrients that we can not get from protein and fat alone. Non-starching, nutritious vegetables, supply essential vitamins, minerals and phytochemicals, protein foods provide essential amino acids, and fats provide essential fatty acids; and this is all that we need.

Mark

Mark,

You are quite right . I was probably rationalising a flawed perception. I have noticed that, when eating only 30grams of carb a day, I lack energy and and easily go hypo. I had assumed that low levels of glycogen was the problem. But something else is probably going on here.

Your comments raise the question of how much protein is too much? I am getting about 70 grams a day, which is probably more than enough. But I need to eat more of something to maintain my weight. Most sources of fat also contain protein. So how much protein can one have before risking kidney damage?

Incidentally, my kidney function and lipid profile have never been better. And I want to keep it that way.

Cheers,

Mark

[mark-TN]

Mark,
You are quite right . I was probably rationalising a flawed perception. I have noticed that, when eating only 30grams of carb a day, I lack energy and and easily go hypo. I had assumed that low levels of glycogen was the problem. But something else is probably going on here.

Your comments raise the question of how much protein is too much? I am getting about 70 grams a day, which is probably more than enough. But I need to eat more of something to maintain my weight. Most sources of fat also contain protein. So how much protein can one have before risking kidney damage?

Incidentally, my kidney function and lipid profile have never been better. And I want to keep it that way.
Mark

Mark-

I can understand how going low a lot can be a detriment to staying on the 30g per day plan. When you were going low easily was it shortly after a meal, or was it at another time? If it was shortly after a meal it may be the insulin that you are using at meal time. Have you thought about trying Regular insulin instead of using the Actrapid insulin (I assume this is similar to Lispo). Regular will more closely match a low carb meal.

Most long standing diabetics will have a slower digestion of food than a non-diabetic person. Any damage to the Vagus nerve can cause any number of problems ranging from mild to very severe. Damage to this nerve can cause problems with enzyme release, muscle action in the stomach, opening and closing of the pyloric valve, and action of the intestines to name a few. Years of even just slightly elevated blood sugars will eventually cause delayed digestion. Of coarse the severity of any type of delayed digestion can have a very wide range. You may not have any physical symptoms, but usually it is very obvious when you look at blood sugar patterns. (ie, if you tend to go low 1-2 hours after a meal and rise at unpredictable times many hours after a meal, or if you go to bed a least 5 hours after your last meal with a normal or even below normal blood sugar and wake up with a much higher sugar, (this will happen when digestion occurs during the night instead of within the first 5 hours after a meal as would happen with normal digestion). The very rapid acting insulins (Lispo or Aspart) can cause problems even if digestion is just mildly delayed. The action curve of Regular matches a low carb meal much better as it does not have a high peak; rather it has a much slower start of action leading to a sustained hill over about a 5 hour time period from time of injection. With normal digestion Regular insulin requires that you wait 40-45 minutes before eating. Any disruption in normal digestion may require eating sooner after an injection (say anywhere from 0-35 minutes from time of injection) so that the digestion more closely matches the action and timing of the insulin. With severe cases of gastroparisis injection may need to be delayed until after eating. It all depends on blood sugar patterns and may vary depending on the time of day. People tend to have faster digestion in the morning and by dinner digestion can slow a good bit even in a non-diabetic. I have slight irregular digestion from years of diabetes that is slowly improving the longer I keep blood sugars in a normal range. I make dinner my smallest meal as I have found that my digestion slows dramatically in the evening. I use regular as my meal bolus insulin. For breakfast I wait 45 minutes after injection before eating, at lunch I wait 35 minutes, and at Dinner I wait 20-30 minutes. This works pretty good for me. I find that easier to digest food are much more predictable in the time they take to digest. I eat a lot of soft vegetables, such as avocado, squash, zucchini, or mashed pumpkin especially at Dinner. For protein at Dinner I eat ground meat, sardines, cheese, or eggs and I limit it to just 2.5 oz. Also I wait at least 5 hours before going to bed and I try to be active in the evening instead of sitting around being idle. This aides in getting my stomach moving and helps to motivate the pyloric valve to open up and empty my stomach. I also found that an enzyme called Betaine HCI (available at health food stores) helps to break down the food I eat and greatly helps in the predictability of digestion.

It is my belief that the major cause of kidney damage from diabetes is the result of high blood sugars. High blood sugars damage the filters in the kidneys. The passing of protein in the urine is a sign of this damage. It is not caused by eating protein. Protein can further damage what has already been done by high blood sugars in the advanced stages of the disease, but if blood sugars can be kept normal of near normal the damage will not occur in the first place. As a matter of fact getting blood sugars in line and keeping them there will reverse damage that has been done by high blood sugars. The minimal amount of protein that you need to avoid protein malnutrition is 1g per kg of body weight. The minimal amount for me is about 71g per day. To maintain my weight with my activity level I have found that I need to consume about 87g of protein per day or about 14.5oz of protein foods. I have been doing this for over 2 years and my kidney function and tests are better than ever also. Another way to protect your kidneys is to only drink fluids when you are thirsty and/or at meal times. The American Kidney Association recently changed their stance on fluid intake to the above. They have come to realize that excess fluids will over work the kidneys, and that is the last thing we need as diabetics. With out of control blood sugars it is almost impossible to limit fluid intake. With normal or near normal blood sugars your kidneys will not be constantly ridding the body of excess glucose and inevitably fluids and it is very easy to limit excess intake of fluids.

On a low carb diet increasing fat intake will not cause you to gain weight. On a high carb diet ingested fat will not be metabolized and it will get stored causing weight gain. This has to do with an enzyme called insulin sensitive lipase. Insulin sensitive lipase is responsible for metabolizing ingested fat. It is called insulin sensitive lipase because this enzyme is turned off by high levels of insulin. The large amounts of insulin required on a high carbohydrate diet will keep this enzyme turned off, which means that the fat you digest will get stored. On a low carbohydrate diet which requires much less insulin this enzyme will remain active and the fat you eat will get metabolized and used for energy or passed harmlessly through the bowels and it will not get stored. This has been show in many studies.

So if you want to maintain your weight it is better to increase your protein consumption which will require a little bit more insulin and make it easier to control blood sugar levels. Increasing carbohydrate consumption requires more insulin which makes blood sugar control that much harder. If what you are doing works for you than you should keep doing the same that you are doing, but I wanted to explain what has worked for me just so you have another alternative if you feel it is necessary.

Mark

[Sparkle]

I thought protein didn't need insulin? Thought it was when you had carbs you take insulin???

I was under the impression that if you don't eat carbs with a meal you prob don't need a fast acting injection? Also, slow release carbs stop you being hungry and eating more after a meal. Stops your bg shooting up (as with white bread) and then dipping.

I thought eating low gi carbs/food allowed you to take a little less insulin and be able to exercise without having a hypo later.

Oh I'm confused!

[mark-TN]

Sparkle-

Believe it or not, eating rocks will raise your blood sugar if you eat enough of them. I'm not kidding! When you eat any food, as it passes through the stomach and into the gut, the gut distends. When the gut distends it sends a signal to the brain, which sends a signal to the liver to release glucagon. Why does it do that? It is all part of how the body attemps to keep blood sugar at a normal level. When the gut distends the signal goes out to the brain to release hormones to cause the release of glucagon from the liver, because it is anticipating a large bolus of insulin from the pancreas. Insulin is a very strong hormone. Glucagon is a weak hormone that the body can store a lot of. This weak hormone causes the release of glycogen stores to release glucose into the system to fine tune the action of insulin. Another hormone, also produced by beta cells, is amylin. Amilyn is an even weaker hormone than glucagon and its job is to fine tune what glucagon does. The two hormones that help lower blood sugar and counteract glucose and glucagon, insulin and amylin, are not produced in a T1 because they are made by beta cells and we have lost our beta cells. Glucagon is produced by the alpha cells which we still have plenty of. So the only hormone we can produce is the hormone which has the sole responsibility of raising blood sugar. So if we eat and not take a bolus, even if it is just a large enough handful of rocks to distend the gut, our blood sugar will go up from the action of glucagon which our bodies will have nothing to produce to counteract. What will make it go even higher is if the glucagon release is high enough to lower base levels of injected basal insulin the brain will be told to have the liver release even more glucagon, as glucagon is released whenever the body senses low levels of insulin, because low levels of insulin in a non-diabetic is a signal of low blood sugar. Of course in a diabetic the sugar may be 400 and it will still release glucagon if low levels of insulin are detected. Talk about confusing!!!

As far as protein goes about 1/3 (or about 2g per 1oz of an animal protein food) of the amino acids from protein will get turned into glucose by the process of gluconeogenesis: See my post (#13) toward the bottom of this page: http://www.diabetesforums.com/showthread.php?t=5276.

Mark

[MarkMunday]

Mark,

Thanks for that comprehensive explanation. You ghave obviously been doing your homework! I suspect that there could be some gastroparesis here. The endo doesn't think so. But he hasn't tested for it. And gastroparesis would at least partially explain the symptoms I have been having.

A combination of factors are most likely causing the anomalies I have observed. And there may be more to it. But, in any case, it became clear to me some time ago that relying on a single shot of Novorapid at mealtimes wasn't working well enopugh anymore.

Actrapid is, in fact Regular insulin. I switched to it for the longer action profile. But I found that, while Aspart was too fast, Regular was just too slow. So I now mix the two before meals, usually 60:40 (Aspart:Regular). But it depends on what I am goint to be eating.

So, I am now using four different insulins (Glargine, NPH, Regular and Aspart)! But I am getting much better results. And I am enjoying the increased flexibility it provides.

Cheers,

Mark

[sparkle9]

Mark-Tn and Mark Munday,

You guys are so knowledgeable about diabetes, especially with regard to insulin and diet. I have learned so much from both of you. Along with everyone else here, I'm always trying to improve my control. I had been planning to ask my dr. several questions during my next visit, but I've already found the answers on this thread.

Still learning after 35 years!

Thanks,
Sparkle9