[rak1978]

I have been trying for quite some time now to gain good control/steady numbers while still eating carbs. It seems unlikely that I'm going to nail down a good I/C ratio despite my best efforts. If I take enough insulin so that I don't spike at the 1 & 2 hour marks, then I'm too low by the 3rd hour. If I lower the dose, so that I don't plummet, then I'm high up in the sky the first couple of hours. Plus, because I'm a mother of three young children, I really can't have a consistent activity level every day. I'm consistently inconsistent!
My doc seems to think that I am VERY unusual in that I can't seem to get my numbers steady even with careful attention and constant modification of pump settings (especially in the morning).
I know that there has been MUCH debate and heated discussions on the forums regarding carbs, and I don't intend to initiate one. I would like to keep an open mind to both sides since everyone's body responds differently. I know people are gladly posting their excellent numbers while low carbing, but I don't see a lot of numbers from people who are not.
I sincerely want to know if any of you are able to achieve good control while still eating carbs? I have been beating my head against a wall trying to make this work.

Thanks for reading.
Rachel

[fgummett]

Probably not what you are asking, but have you read up on Dr Bernstein's Law of Small Numbers? It makes a good deal of sense to me that smaller inputs lead to more predictable outcomes.

[rak1978]

Originally Posted by fgummett

Probably not what you are asking, but have you read up on Dr Bernstein's Law of Small Numbers? It makes a good deal of sense to me that smaller inputs lead to more predictable outcomes.

Yes, it makes really good sense to me also. I was completely on that track until I started coming here and realized that people (type 1's at least) were able to eat moderate, even high amounts of carbs as long as their bolus ratio's and basal settings were correct. Since then, I've been trying to do the same and it's simply not working.
Now I'm just confused and quite honestly despressed!

[fgummett]

I can't provide a link (against policy) but do a search on "Dr Bernstein's Law of Small Numbers" and I was able to read on-line chapter 7 of Bernstein's book. Even if your ultimate aim is to eat higher amounts of carbohydrates, it might make sense to start off by cutting right back... regain good predictable numbers as a baseline and then gradually re-introduce your chosen foods one by one with plenty of testing.

[sarahspins]

I have 3 kids (2, 4, & 8).. I manage to eat carbs without huge spikes "most" of the time... below is a CGM image from last week, where I had a huge breakfast including 2 cups of coffee and then later for lunch I had pop tarts (2 of them!) of all things, and I was rock solid steady... and it wasn't because the CGM wasn't working. (and this may look peaky, but anyone who has work a CGM for any lenght of time can appreciate how over 12 hours, it's really not).



I am active, and our schedule is VERY unpredictable. No two days are the same. The key for me is pre-bolusing (usually 30 minutes unless I am low-ish), dead-on accurate carb counts, and making the BEST use of combo boluses. If I bolus and immediately eat, I'll go high no matter what the food is... without a combo bolus for most things, I'll be fine for the first hour or so, but usually end up on the higher side by 2 or 3 hours. I am rarely low because of meal boluses.. if I go low it's usually because I fail to set a temp basal for increased activity - usually it's when I get caught up in something like housework, and just don't think about it. Thanks to the CGM though, I am catching those faster, rather than not having a clue and testing with say, a 43.

I try to keep my basal profiles dialed in so that I'm taking the LEAST amount of insulin possible.. I don't rely on my basal to cover any snacks or the effects of eating lots of protein. I bolus for just about everything that I eat.

That said, I'm not suggesting this works for EVERYONE. I know it doesn't, and there are days the Dex screen doesn't look so wonderful (such as today, but I seem to be having accuracy issues, not bad #'s exactly.. dex keeps drifting up while my BG is not.). However I personally find it more difficult to manage my D with a low-carb type diet... my #'s become much more erratic and I end up with stubborn persistent highs.

[rak1978]

Originally Posted by sarahspins

I have 3 kids.. I manage to eat carbs without huge spikes "most" of the time... below is a CGM image from last week, where I had a huge breakfast including 2 cups of coffee and then later for lunch I had pop tarts (2 of them!) of all things, and I was rock solid steady... and it wasn't because the CGM wasn't working. (and this may look peaky, but anyone who has work a CGM for any lenght of time can appreciate how over 12 hours, it's really not).



The key for me is pre-bolusing (usually 30 minutes unless I am low-ish), dead-on accurate carb counts, and making the BEST use of combo boluses. If I bolus and immediately eat, I'll go high no matter what the food is... without a combo bolus for most things, I'll be fine for the first hour or so, but usually end up on the higher side by 2 or 3 hours. I am rarely low because of meal boluses.. if I go low it's usually because I fail to set a temp basal for increased activity - usually it's when I get caught up in something like housework, and just don't think about it. Thanks to the CGM though, I am catching those faster, rather than not having a clue and testing with say, a 43.

I try to keep my basal profiles dialed in so that I'm taking the LEAST amount of insulin possible.. I don't rely on my basal to cover any snacks or the effects of eating lots of protein. I bolus for just about everything that I eat.

That said, I'm not suggesting this works for EVERYONE. I know it doesn't, and there are days the Dex screen doesn't look so wonderful (such as today, but I seem to be having accuracy issues, not bad #'s exactly.. dex keeps drifting up while my BG is not.). However I personally find it more difficult to manage my D with a low-carb type diet... my #'s become much more erratic and I end up with stubborn persistent highs.

Interesting! Thanks for sharing. It helps a lot to hear other people's experiences....especially when they're in a similar situation. I don't usually pre-bolus. I tend to bolus while I am eating. I will try this. Thanks.
It's not that I'm trying to get away with eating junk, I just would like to eat moderate/reasonable amounts of healthy carbs and not be on a roller coaster. I am not good with moderation in anything. It's all or nothing for me.
That's interesting that you find it hard to control on a low carb diet. Everybody is so different and obviously, what works for one, may not work for another.

[Gordonm]

I don't low carb by any means. I average about 180 or so most days with some days in the 220 range. I am also on the CGMS and have had days look like the above figures. My activity level can be from driving all day to riding my bike for hours. It is challenging and some days the IC ratio seems out of whack. I just look at the averages and do the best I can from day to day. I do try to limit most meals to 50 carbs or under but on occasion do go over and still get pretty good results. I am on the theory of eating more small meals than 2 or 3 bigger meals.

[sarahspins]

Originally Posted by rak1978

It's not that I'm trying to get away with eating junk, I just would like to eat moderate/reasonable amounts of healthy carbs and not be on a roller coaster.

No worries, I completely understand.. I don't usually eat a ton of junk or processed foods either.. and 72g of carbs for lunch (and all at once!) is definitely pushing it even on a good day, but it was a craving I just *had* to satisfy (you know, chocolate, crunchy, salty.. can you tell I was PMSing? Hence the Chocolate Chip Pop Tarts!) I usually cook from scratch and most meals are heavy on fresh produce.

That's interesting that you find it hard to control on a low carb diet. Everybody is so different and obviously, what works for one, may not work for another.

I don't find it that weird.. the liver can process 60% of the protein you consume in to glucose... whether you low carb or not, this is a process that still goes on. My experience is that the effect is often somewhat unpredictable.. it could be a steady rise, or the liver can suddenly kick out a bunch at once. I don't like the unpredictability - especially since I am one of the few who can match insulin to carbs fairly well. It's easier for *me* to just eat carbs - that isn't the case for everyone. We are all unique. I don't even pretend to think that "my way" can be universally applied to everyone.

Anyways, I like to place myself solidly in the "moderate carb" diet category... I generally do best with about 40-60g carbs for a regular meal.. 10-20g for a most snacks... it's really right in line with the ADA diet as far as carb content, except that I don't intentionally follow the ADA diet at all. I usually average about 160-180g a day, which by many standards here is "high carb" however when I compare what I eat with what my husband and kids eat, it's definitely not Also, when you consider what the boluses are for those, I am not usually taking large amounts of insulin all at once either... and I think that helps in terms of ups and down. Combo bolusing also make a difference... because any lows that are the result of a miscalculation generally happen in sort of slow motion.. I usually have more time to react/treat before it becomes serious (I don't feel lows at all).

Definitely try pre-bolusing earlier... since you wear a CGM I'm sure you have some idea of how long it takes insulin to really "kick in" - don't be afraid of it. Even if you just start with 15 minutes, that will likely help with your post-meal spikes. As you get more comfortable with it, and can reassure yourself that you won't forget to eat, you can add more time. My general routine for breakfast and lunch is that I bolus, prepare food for the kids, get them all set up and assist them if needed, then sit down to eat as they're finishing... the timing usually works really well. For dinner, unless it's something that will take a while to cook (like anything that has to be baked), I usually bolus when I start cooking.

[SueM]

Originally Posted by rak1978

I have been trying for quite some time now to gain good control/steady numbers while still eating carbs. It seems unlikely that I'm going to nail down a good I/C ratio despite my best efforts. If I take enough insulin so that I don't spike at the 1 & 2 hour marks, then I'm too low by the 3rd hour. If I lower the dose, so that I don't plummet, then I'm high up in the sky the first couple of hours. Plus, because I'm a mother of three young children, I really can't have a consistent activity level every day. I'm consistently inconsistent!
My doc seems to think that I am VERY unusual in that I can't seem to get my numbers steady even with careful attention and constant modification of pump settings (especially in the morning).
I know that there has been MUCH debate and heated discussions on the forums regarding carbs, and I don't intend to initiate one. I would like to keep an open mind to both sides since everyone's body responds differently. I know people are gladly posting their excellent numbers while low carbing, but I don't see a lot of numbers from people who are not.
I sincerely want to know if any of you are able to achieve good control while still eating carbs? I have been beating my head against a wall trying to make this work.

Thanks for reading.
Rachel

Hi Rachel,
It may sound daft but go back to basics.
IE have a set amount of carbs per meal each day. This way you can work out your upper limit of what works for you.
I find that as long as I do not go over 70 carbs/meal I am fine.
So no matter what is on offer that's my top wack. I normally average about 50 carbs/meal now and find I have very good control from this.
Also have a good look at the type of carbs you are eating.
Glycemic index is a very good starting point.
Are you using your pump to it's full advantage? IE using the different types of bolus's depending on what is being eaten.

Best wishes
Sue

[Subby]

Rachel, I think what we need to do is appreciate that there is a wide range of how T1s manage their condition, in terms of ease of bolusing and what carbs or types of carbs they can get away with.

Read some of the answers to this current thread. Type 1's: How Much Do You Allow Your Diabetes To Control What You Eat?

My mouth hangs open at the idea of getting A1cs in the low 5s with just getting rid of the most obvious offenders - but there you go, it appears to be the experience for some people. I suspect it's a lot of T1s who find that.

Then, there are people like you and me. I just don't know if it's classic insulin resistance, or any of a number of things that effectively make insulin slow and unweildy and carbs work fast, but for me that is certainly the case and I have to modify diet heavily and walk on a knife edge to get mid 6s A1cs, and still some pretty regular spiking. For me a lot of it is also basal related, in that whatever I eat I will often fly off at certain times of the day. THankfully metformin is helping somewhat with that.

I think it's a case we need to recognise these differences between people. It is not that the T1s who can bolus and cover carbs quite easily and well are "wrong", it is not that people who find carbs problematic have "got it wrong". We've just got different physical outcomes to food and insulin therapy.

I find much more than 150g of carefully selected carbs and I am fighting highs a lot of the day (the option being to take so much to cover problem carbs it WILL catch up with me in a few hours, as you find. No reasonable middle ground). So all I can suggest is we who do have difficulty (and know it's from limitations of insulin/carb speed, not just from inexperience etc) need to accept it, and employ more the T2 mantra and modify diet according to meter (bearing in mind we can also modify dose too if we think it's worthwhile).

I'd suggest metformin - it's helped me, but I know you are on it, and we both know it just tends to "cap" highs (a great service, though). I think until there are very different ways of administering insulin, you and I just need to be very careful with carbs, and just avoid ones that are spiking problems, and shrug wryly at those who can seem to get away with eating a lot more. The prebolusing mentioned above - it could be a huge benefit for making progress here. I usually aim for 20 min. Without that my spikes would be easily 2x as bad across the board.

[rak1978]

Thanks everyone for the advice. I was talking with my husband about this last night, how I feel like I'm beating my head against a wall over and over. He said respectfully that was the definition of insanity...doing the same thing over and over and expecting a different result.
I have said before that I really struggle with consistency and moderation. It's not in my blood. I am an all or nothing in short spurts kind of person. So, obviously, this makes good control very challenging for me.
Subby, I do see that there is a wide range of how type 1's manage their condition. I am still trying to see where I fit in on the spectrum of carb intake. It's really intriguing to me to see the wide range. I guess I don't want to accept that I would have to eat close to zero carbs even with an insulin pump when others have no problem. So, I keep trying....over and over to eat carbs, and am constantly changing pump settings to try to accommodate, and I am never steady. And, yes, I am going insane.
Hopefully I will get a handle on this soon and figure out what works for my body and STICK WITH IT.
I'm so glad to hear that the metformin is working well for you. That's great news.
It helps me a lot too. My doctor recently prescribed symlin to try in the morning to see if I can get some better results, but I'm having trouble getting it due to insurance.

Sarah, no judgement here on the pop tarts! They sound yummy. You have to satisfy both body and soul!

Frank & Sue,
Thanks for the advice! I do need to go back to basics. Start from scratch! Looks like I have some work to do.


I'm going to try the pre-bolusing today as well as sticking to lower glycemic carbs, a little at a time.
Thanks everyone for putting up with this dramatic post once again! I know that I just need to execute on what I know to do and stay focused. I get real distracted with what works for other people and try to make it work for myself.

Rachel

[dbaratta]

Originally Posted by rak1978

I know that there has been MUCH debate and heated discussions on the forums regarding carbs, and I don't intend to initiate one. I would like to keep an open mind to both sides since everyone's body responds differently. I know people are gladly posting their excellent numbers while low carbing, but I don't see a lot of numbers from people who are not.


Thanks for reading.
Rachel

Key Differences Between Paleolithic and Modern Diets - What Cavemen Ate

[rak1978]

I should've just said this instead of all of the lengthy monologues...

I'm trying to figure out if I just have yet to figure out the correct I:C ratio, or if I truly just can't have carbs and need to call it quits.

[sarahspins]

Originally Posted by rak1978

I'm trying to figure out if I just have yet to figure out the correct I:C ratio, or if I truly just can't have carbs and need to call it quits.

What are your #'s like at 2 hours or 3 hours after eating? That really seems to spell it out the "correct" more than your max spike does.. managing the spikes becomes more about managing the timing.

[lark 27]

Great thread to read and see the divergent experiences many are having. I'm still wrestling myself with balancing what my goals are for carbs, nutritional intake overall, and acceptable BG control. I've definitely found that I had much more difficulty maintaining euglycemic levels in the morning if I have much carbs--quick spikes and hard to bring down. So for breakfast I either go with eggs or more occassionally (somewhat of a treat) plain yogurt with frozen blueberries (yummy and a serving size for me comes in at 15-20 carbs).

thankfully I have better success with having carbs (trying to stick with good GI carbs and still not too many) for lunch and supper. Normally 30-50 per meal seems to work. Once I start going above 50, I'm more prone to having some spikes and then overreacting from the spikes leading to a hypo later.

i'd suspect I could do better still with less carbs for lunch and dinner, but mentally, I'm fine with going low carb in the morning, but I haven't come to that point for all meals. And from experimenting I don't see a significant improvement.

One thing that I'm going to add to my goals for better D management is to try to stick with low carb lunch and dinner if I know I"m going to be active at all following the meal because if I have a bigger bolus on board and then go for a walk with the family or to the pool or something, I am just set up for hypos. Sunday was my wife's birthday so I made her a brunch and had swedish pancakes for a total of 75 carbs. We then went for a walk following and although I'd tried to reduce my bolus somewhat, I still ended up consuming an additional 90 carbs to correct lows/borderline readings over the next 2 hours! That was simply unacceptable.

I guess for me, the law of small numbers makes a lot of sense, but what is sustainable and acceptable for me currently is the law of small numbers for breakfast and the law of medium numbers for the rest of the day and watching for other key times where I need to revert back to law of small numbers.