Low Carb?

Butterflywasted

My Dr office wants me to eat more carbs. 45 for breakfast, 45 for lunch and 45 to 60 for dinner... and skip carb snacks... I really feel it is waayyy to many carbs to eat in a day. But... there are days when I do eat that many and more (usually sweet tooth binges or office party temptations). Anyhow, normally I just can't stick to this carb Rx but I don't want to tell them cause I want to do what they want me to... I just also don't want to... thoughts? Also... according to this logger I am getting good carbs, but they don't count a lot of carbs as carbs... they want that number to only include carbs u bolus from (not green veggies, peanutbutter, etc)

T1DCarnivoreRunner

I'm going to ask if you are seeing an endocrinologist or a GP. This sounds like the type of thing a GP (read: poorly educated on diabetes) would suggest. I wonder if they explained why they want you to increase net carb intake.

I ate carbs for years as a type 1, and I still occasionally do. However, since changing to low carb with a fair amount of consistency over the past few months (except for that occasional weekend or vacation), I've found my BG's much easier to manage. I've been losing weight much more quickly, and have had fewer lows even. Unfortunately, I've also become more carb sensitive... so only a few grams of carbs sends my BG high.

Anyway, I totally support low carb eating because I've personally found a lot of success. An endocrinologist should understand the differences between carb spikes vs. protein and fat contribution to BG. I can understand a GP following the old-fashioned diet plan that figures carbs are the highest priority macro, and that is just because they don't have much expertise in any single area of medicine... a jack of all trades, master of none.

okulyd

I would agree with everything Midwestern said. Also I would tell you to do what you think works best for you. I think its hard for any dr. because every patient is different. I find it easiest if I eat a consistent amount of carbs each time I eat. That way basal calculations and fluctuations are the same. I also try to keep it low. 30 carbs per meal or less. Which is just under 100g per day. Most would call that moderate carb. There is also an insulin absorption factor which follows the logic that it takes a certain amount of time to break down carbs so the more you eat the longer it will take before they are used by the body. Thus blood sugar will remain higher longer while the carbs are being digested. For example if you digest 4 carbs every 15 minutes then it would take 7.5 hours to utilize 120g carbs. To cover you'd have to figure out how long your insulin works and possibly split the dose to not go low when your insulin peaks. That's overly complicated for me. If I eat small amounts then I bolus small and use them up quickly. If your doctor doesn't know this I would think about finding another doctor who better understands diabetes and nutrition.

Butterflywasted

I see an endocrinologist and I'm on a pump. My pump says insulin stays active for 4 hours if that matters. I eat around 70 to 140 carbs a day according to this app (it counts non bolus-able carbs). Occasionally I will carb load but that is not the norm, usually just a special event at home or work...

Here is an example of a meal: I would like to eat PBJ with sugar free jelly and natural pb on whole wheat and 2-3 cups green veggies. Technically this is 27 carbs to bolus for.... they want the bolus carbs to be at least 45... so they want me to eat something else.

Or tonight our family had whole wheat spghetti so it was easy to eat over the 60 carb dinnertime max they gave me...

Overall, I'm not doing what I was clearly told to do. I have an appointment soon and I don't want to be "non-compliant". I know when they see my pump download it won't be what I was told to do. To avoid this confrontation, I have faked a few extra carbs on lower carb days... and hope for forgiveness on higher carb days... but I hate that I have to do that... it seems secretive and I don't know why being so robotic on every meal being an exact number (on a pump no less) matters?

okulyd

Just be honest with your endo. They can't help you if you aren't honest. If they tell you, you aren't compliance then explain to them why. If they refuse to listen find someone else but usually they listen if you have a good reason for doing what you do. My endo makes suggestions and I tell her if I plan to follow or not. Nothing is ever forced on me. I bolus for exactly the carbs I eat. I don't eat more just to hit a set number. I eat as many carbs as I want and bolus for the amount that I eat. Works better that way otherwise you'll go low or be way high and meals aren't enjoyable if you are eating extra that you don't want.

T1DCarnivoreRunner

I agree... be honest, but also ask questions. Ask for an explanation of not just what they want you to do, but why. Don't just understand 45g of carbs, but get a clear understanding of what exactly they expect that to accomplish.

Butterflywasted

Okay. It's a few weeks off. I'll let you guys know.

tycoon460

Yeah I agree. Talk to your Endo and be honest. I've found even the nurses at the endo give me contradicting advice at times.

My Endo was telling me the exact opposite. I would normally eat 60g morning, 100-120g lunch, and 60g evening. I would also have snack of 20g each during the day between meals. Then I would put in a good 60 minute sweat dripping workout 6-7 times a week while rotating muscle groups. I was still dropping weight each week and showing moderate-large ketones at times even though my BG was under control. They told me to go back to no more than 50g each meal. I had to drastically reduce workouts just due to energy dropping, now I've spiked in weight from ankle injury and trying to get back into working out again with reduced carb intake and it sucks to say the least.

Best of luck.

2hobbit1

Would ask do you use CGM so you can show your endo the difference in degree of control between low carb and the carb levels that are being pushed?
Will say that for me going low carb has made my ability to stay between 70 - 120 before and after meals possible. I'm no longer chasing highs or lows as the norm. Am able to get 90% in range with only 1% low. Am also no longer eating to inulin but am covering what I choose to eat.

And if endo will not support your low carb efforts with good control and minimal lows then is time for a new endo!!!

My doc knows I'm just in for scripts and we chat about how I get my numbers and what new things have I found to help me get there. There are good ones out there and will know that your D is your D and is not one size fits all.

kjayma1

Have you guys read "The Diabetes Solution" by Dr. Richard Bernstein? It was a revelation.

The dude is a Type 1 Diabetic like us, in his 80s, and still practicing medicine last time I checked!

His advice is radically different than what you will hear from most MDs and even endocrinologists. His key message is stick to a super low carb diet and your margin of error (leading to hypoglycemia or hyperglycemia) goes way down. If you're eating fewer carbohydrates, its way harder to screw up your bolus. He also says, contrary to the majority of his colleagues, that we should shoot for a normal person's blood sugar range. Boom.

Anyhow, I've been on a reduced carb diet for a long time. After I read his book last winter, I tried to switch to an ultra low carb diet.

He recommends no more than 12g per meal. I'm not quite there, but I'm averaging around 70g/day.

My A1c dropped from 7.3 to between 6.0 and 6.3 in my last 3 quarterly checkups. That's the lowest it's been since I was diagnosed more than 20 years ago.

Yet my Endo at the Joslin Clinic in Boston argues with me regularly about what I'm doing - not so much about my carbohydrate intake, although she asks me to raise it a bit, but about my goals. She disagrees with me about how narrowly I set the ranges on my insulin pump/cgms. The concept of trying to achieve a normal person's b.g. range is anathema.

I keep hearing "the data doesn't show this, the data doesn't show that". Yet my blood sugars are more even, and I experience lower highs and fewer episodes of Hypoglycemia. It's working!

The hardest thing to manage is the variability in my insulin sensitivity due to exercise (I do Crossfit 4 times/week). Eating out is also trickier - like midwesterner85, I have become more carb sensitive. However, I had the same challenges before I made the switch, if to a lesser degree.

Butterflywasted, I would strongly encourage you to check out this book.

MelissaSheklian

My endo has made similar recommendations about daily carbs (she literally read it off a nutrition pamphlet). I've experimented with various levels of carb intake and found that my control is much better when I eat lower carb (usually around 40-100 grams total per day depending on activity). Do what works for you.

MelissaSheklian

Haha this is a super old thread, I'm talking to myself

T1DCarnivoreRunner

@MelissaSheklian It's ok. Many of us with diabetes find that lower or low or zero carb works best for us, and it can be helpful to see what others experience.

ETA because I realized this is in the type 1 group.