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Subby

A simple warning for insulin users

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Subby

This is a basic factoid I have found for myself over the past few weeks. I've been mod carb for some time, years now, but the past few weeks I have been doing below probably 50g carbs most days. I've done this before, but not for quite as long and not while as active as I now am. My control is pretty good for me at the moment, but nothing really special.

 

And I wanted to put in black and white - and simply - that my ability to recover from a hypo naturally, is definitely impaired. I need to force more carbs into me, and I need to be more vigilant to check in 20, 40, 2 hours later.

 

This makes reasonable sense based on the likely phenomenon that I have less glycogen stored and hence less reserved auto hypo fixes. It makes sense, but then again, so do many things that don't turn out to be true. for me, this does.

 

Other than that, and perhaps being a bit more smelly, the lower carb side of life has been nothing but positive this time around.

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foxl

Well, wow. I know you know how to handle insulin, the diet becomes a confounder, though. BE CAREFUL, please! Looks like you will need to cut back your insulin quite a bit ...

 

Also, I would add the 45- 65% of protein g -- glucose made from protein into your factoring for insulin, for one thing, when low-carbing. I am learning that protein is a very important factor, for ME, when low-carbing. I have over time upped my protein intake without really paying attention, and now am thrilled to find what happens, when I cut back.

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Cormac_Doyle

The problem is that if you REALLY low carb, your liver and muscles do not have a store of glycogen to dump if your BG drops low. Obviously, this is helpful if you're trying to eliminate DP ... but if you are on insulin, you need that facility to cope with unexpected lows ...

Remember the lcassic advice - take 10/15g carb if you have dropped low, and test agin in 15 mins?

If you are low carbing, that can be a considerable % of your daily "planned allowance". More importantly, your glycogen stores are probably depleted, so your BG will rise, and but may then start dropping again because the slower energy release doesn't happen.

 

I would still advise carb restriction, but only in conjunction with in-depth regular testing and a reduced insulin dosage also!

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notme

Thanks for the heads up. I think you make a very good point about insulin users. Ultra low carb doesn't work for me. I am active, but not scheduled active. My husband will come home early from work to take a long bike ride. We don't plan it, he just walks in the door. I work in the yards, play disc golf and many other activities. I found when I was trying the very low carb diet, I would drop low very quickly and then have to eat carbs to recover. Generally my ratio would be much higher for recovering and that would destroy my ultra low carb diet. I thought maybe I was doing something wrong. I had a lot more lows when eating less than 50 carbs per day. I try to keep my carb consumption below 90 or so.

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MCS

Not on insulin anymore but other factors to consider as well. If on a LC/HF diet you do have some what depleted glycogen stores. Your body will try to replenish these stores with what food you consume, mostly protein. Anything that you do to compromise your bodies gluconeogenesis, alcohol, drugs, metformin is one, will lower the rate at which your body can manufacture glucose. Anaerobic exercise will also deplete your glycogen stores as well.

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DeusXM
If you are low carbing, that can be a considerable % of your daily "planned allowance".

 

I'd argue that if you have a rigid carb goal for the day, hypo fixes shouldn't count towards that allowance. Low-carbing is, at the heart of it, the art of managing your blood sugars through carb intake, and that works both ways.

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xMenace

I totally agree Subby, but I have about 10% of the hypos I had high-carbing, and they are nowhere near as bad. I do take extra care, though. I always try to "know" my sugars, and it's easier to know with LC.

 

Consider that lowered glycogen output also as a need to reduce basal insulin. I find a week or two of LCing requires a 20% drop in me, and then another 15-20% drop follows some time later if I really stick to very HF. Test¿

 

I'd argue that if you have a rigid carb goal for the day, hypo fixes shouldn't count towards that allowance. Low-carbing is, at the heart of it, the art of managing your blood sugars through carb intake, and that works both ways.

 

I don't count tabs in my load, but I now rarely use them. For me, LC does eliminate dips and spikes, but my A1C has barely moved. The quality of the sugar waves change; it's a different style of management. I'd question the primary role of LCing. I tell myself it's for better health: heart, cancer, mental, etc, but I do know smoother waves are important for me.

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Subby

I'm not really finding less hypos, then again I haven't gone from high to low carb quickly or anything like that. In general, my stability is indeed better, and I sure get knocked around less from hypos when they occur than back in the day - what has been comes along with this lately are suspicions/concerns of hypo unawareness. I am going to have to adjust my day to day awareness thinking, I did use to get pretty clear hypo signs in a timely matter I could rely on to at least tap me on the shoulder. Much more subtle now, right down into the low 3s or lower.

 

Yeah, as for the cause of some of the hypos I'm referencing, my basal profile has become/is becoming a new picture, and I have the complicating factor that I can only use NPH due to reactions to other insulins. While the curve and life of NPH was great for my whacky basal profile before, it is now evidently less compatible, especially at night. Well you can only work with what you got, so I just need to keep trying dosage scenarios to avoid the landslides that can occur when you get that wave of basal that's just a bit much. May need to split 4 a day to try and reduce those big peaks while still providing coverage.

 

These are all very relevant issues of course. But not really to the heart of my main message here, which is that any old hypo that comes along that tends to hang on just that bit more tenaciously than before. I'm burning strips until I adjust and work things though a bit more.

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Subby
I'd question the primary role of LCing. I tell myself it's for better health: heart, cancer, mental, etc, but I do know smoother waves are important for me.

 

Whether it's LCing or whatever else does it, I agree that smoother waves are incredibly important at least for some of us (probably all, but maybe more for some than others). Back some years ago when I was on set doses, inadequate basal, high carbs, low education and yo-yoing like a, well a yo-yo, everything suffered, not just feeling physically ill and constantly fatigued and knocked around, but also difficulties just thinking and feeling straight... These days when I have a bad bg day that echoes those days, I get a little taste of the sledgehammer effect fluctuations have on me, and I really do wonder how I got through those years. It was ghastly. It's a big reason I hang out here, hoping to help other people (who may not even realise what is going on) find a way out of, or avoid, that kind of situation.

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ant hill

There's just a simple thing about insulin, Once that you inject, There's no off switch!!! So you must test to see where you are. The fast acting insulins are very reactive!!! For many years I have seen many different insulins and it is no different from the insulins of old except watch the low's. today we have the most valuable tool that makes this disease far much easier to manage and less diet restriction as before it's a strict counting of carbs and those carbs are of a very low GI variety as bread was the easiest to measure. No sugar, No treacle, No chocolate or honey, Basically anything that has sugar in it was on the not allowed list!!! So that was at a time that I remember too well and unfortunately non diabetics also. To day insulins is more powerful and a Basel Bolus regime witch makes diet more of a pleasure once more.

 

today's insulin is better with one caution, Track it with your BG meters!!!

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Subby

Yeah, you are no doubt right that insulin use is in general tricky, and there are lots of dangers to be aware of.

 

What I'm talking about here is a bit of a general difference in the way the body seems to handle recovering from lows when you're on a low carb diet. Something to look out for if you do go to that level at some stage.

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ant hill

OK Subby, You can go low carb BUT with today's insulins are stronger and to do this is the knowledge of carbs and how long it lasts in your body and match it with bolusing it. If you are getting low's then back off the basel. Also the Basel Bolus regime should be 50% of each other to cover your TDD. ;)

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Subby

Peter, as I've said this thread is about any low I've had in the past few weeks. I get lows, and I would hazard that most insulin dependents striving for reasonable control (or at least not just skating high all day) get a few as a matter of course. The issue is how they have tended to run: not that I've been having them. Unless they develop some incredible new technologies, I imagine I'll be having a few lows now and then til the day I die.

 

I have to vehemently disagree with your suggestion to follow the 50/50 rule. I consider it the barest stab in the dark for a high carber, and likely wrong anyway. If I were to follow your advice and currently match one to the other, I'd probably be in hospital within a day or so. At a guess, I'm currently around 80/20. The important thing in my book is to get your basal right and your bolusing right independently, and forget neat and symmetrical ideals if they don't fit.

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ant hill

OK Subby, I am sorry to bend your thread. :(

I have been known to have lows and not notice them or I would be not at all shocked to find 3/54 but with some concern and nibble on some carbs otherwise no panic. Any lower and I can go in a dazed mode and snoose. I can remember the days of shake and worry and sweats as that many years ago, Not today. :confused:

 

Why the difference???

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PinkRose

Subby, perhaps I've missed something in this thread but if I was to go on a very low carb diet, the expectation would be to lower the TDD of insulin accordingly. Otherwise you'd risk more hypos. That's the theory anyhow ... Have you adjusted your insulin dosages to accurately match your current low carb diet?

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Sandra94103
Yeah, you are no doubt right that insulin use is in general tricky, and there are lots of dangers to be aware of.

 

What I'm talking about here is a bit of a general difference in the way the body seems to handle recovering from lows when you're on a low carb diet. Something to look out for if you do go to that level at some stage.

 

Thanks for the advice Subby. Didn't think about having lower glycogen stores on a low carb diet. Fortunately, not my problem, since I seem to compensate by eating too much protein for added stores. Argh... not that I want to overeat protein.

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Subby
Subby, perhaps I've missed something in this thread but if I was to go on a very low carb diet, the expectation would be to lower the TDD of insulin accordingly. Otherwise you'd risk more hypos. That's the theory anyhow ... Have you adjusted your insulin dosages to accurately match your current low carb diet?

 

I can guarantee I wouldn't be in a position to post anything if I wasn't adjusting my doses. ;) Basal is probably at about 80% what it was a few months ago, based purely on basal testing/ongoing adjustment, and I bolus according to carb counting (and a reduced rate for some proteins and fats).

 

The reduced insulin doses have been a boon for me especially as side effects I get from insulin are of course lessened with small doses. I've been like Nancy in the past, finding various problems with low carbing. The biggest one I used to find was an insatiable hunger for meat and greasy foods, the idea of self-limiting on fats did not happen for me and it was very unpleasant. This time around, probably with the addition of really significant most-day exercise as the difference, it's working very well for me.

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Subby
Thanks for the advice Subby. Didn't think about having lower glycogen stores on a low carb diet. Fortunately, not my problem, since I seem to compensate by eating too much protein for added stores. Argh... not that I want to overeat protein.

 

Someone mentioned that earlier, and it's what I'm going to concentrate on to see if I can rectify the problem. Although I always have a whack of protein in the morning, I tend to have very light lunches and dinners, and I'm going to see if adding more protein later in the day might help have just a little more emergency juice in store.

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MCS
Someone mentioned that earlier, and it's what I'm going to concentrate on to see if I can rectify the problem. Although I always have a whack of protein in the morning, I tend to have very light lunches and dinners, and I'm going to see if adding more protein later in the day might help have just a little more emergency juice in store.

 

I found that protein in the evening seems to replenish glycogen stores more so than in the morning. This is observational, I will gain weight if I increase protein in the evening. D-Ribose will inhance your bodies ability to create and store glycogen but may introduce some instability. It will reduce the glucose in your blood stream in response to trying to make glycogen. My result was a noticeable decline in BG level, then slow rise over a 3 hour period. It was most effective if I took it while exercising.

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Richard157

I am seeing more and more T1's using a LC diet, and eating less than 100 carbs per day. I needed to lose weight in the very early part of this century and gradually lowered my carb intake from the high 100s to 100 per day. I did not have the energy to do my exercises and home repairs. Taking a one hour walk was a chore. I raised my carb intake to 130 per day and rested while exercising. I adjusted well and lost weight too. I think some of us will have more difficulty with a LC diet. I do eat some protein and fat, but not very large amounts.

 

I started taking Metformin early last year, for my insulin resistance. Now I weigh 17 pounds less than before starting Met. I was not trying to lose weight, so it must be the Met that caused it. My weight is now only 6 pounds above my ideal weight. Thay is great, but i was losing 1-2 pounds per week for awhile. I thought I might eventually drop below my ideal weight. So I raised my carb intake to 150-160 per day. My weight stabilized, and I am no longer losing weight. I'm not gaining either. Very little fluctuation. That many carbs would have caused a lot of weight gain before Met. My IR and the Met seems to be a very important factor in the mix.

 

Now I can take long walks, climb ladders and paint my house, and work out at the gym without any problem. My stamina has greatly increased. The gym workouts and higher carb intake seem to be responsible for that. LC dieting does not work for me at this stage of my life. We are all different!

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jojeti
I'd argue that if you have a rigid carb goal for the day, hypo fixes shouldn't count towards that allowance. Low-carbing is, at the heart of it, the art of managing your blood sugars through carb intake, and that works both ways.

 

Thats how I look at it also. I am on Lantus and ultra low carb, occassionally I slip into the 50's and usually eat some Dove dark chocolate (one or 2 pieces and that seems to bring it up adequately) but I don't count it into the day...just look at it as one of those things, or medicine in a sense. To me low carbing is a lifestyle and occassionally life doesn't go as planned so you take care of the bump and move on...not another thought about it.

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jojeti
I am seeing more and more T1's using a LC diet, and eating less than 100 carbs per day. I needed to lose weight in the very early part of this century and gradually lowered my carb intake from the high 100s to 100 per day. I did not have the energy to do my exercises and home repairs. Taking a one hour walk was a chore. I raised my carb intake to 130 per day and rested while exercising. I adjusted well and lost weight too. I think some of us will have more difficulty with a LC diet. I do eat some protein and fat, but not very large amounts.

 

I started taking Metformin early last year, for my insulin resistance. Now I weigh 17 pounds less than before starting Met. I was not trying to lose weight, so it must be the Met that caused it. My weight is now only 6 pounds above my ideal weight. Thay is great, but i was losing 1-2 pounds per week for awhile. I thought I might eventually drop below my ideal weight. So I raised my carb intake to 150-160 per day. My weight stabilized, and I am no longer losing weight. I'm not gaining either. Very little fluctuation. That many carbs would have caused a lot of weight gain before Met. My IR and the Met seems to be a very important factor in the mix.

 

Now I can take long walks, climb ladders and paint my house, and work out at the gym without any problem. My stamina has greatly increased. The gym workouts and higher carb intake seem to be responsible for that. LC dieting does not work for me at this stage of my life. We are all different!

 

I think you make a good point. LC is not the answer for everyone. For myself it is, I actually get more energy. The amount of carbs you eat would put me on the couch taking a long nap or if at work, I would fall asleep at my computer. Just goes to show how we are alll different and one way is not better than another but just different to meet the different needs of us as individuals.

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ant hill
A little more emergency juice in store.

Isn't that the case for all T1 and 1.5's Subby?? Anyway, Can you train yourself to go low carb as you adjust insulin to carb intake. I'm sure you can as if you concentrate on it. :confused:

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Subby
Isn't that the case for all T1 and 1.5's Subby??

 

Um... yep? Not sure what you mean.

 

Anyway, Can you train yourself to go low carb as you adjust insulin to carb intake. I'm sure you can as if you concentrate on it. :confused:

 

I'd consider training myself to match my diet and insulin as well as possible, to be one of my main tasks of living healthily since becoming a diabetic. It only really became a more fruitful task though, when I realised that fixed dosing is a joke, about 5 years ago.

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ant hill
Um... yep? Not sure what you mean.

Well it has been the practice of all diabetics especialy T1's

 

 

 

I'd consider training myself to match my diet, to be one of my main tasks of living healthily since becoming a diabetic.

Would you expect to be a finer carb counter to insulin Sub?? I have a lot of fun if I were to low carb with my savage I:C ratio. LOLOL Or again reavailueate the I:C ratio?? :confused:;)

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