Help for a Type 1 Diabetic + celiac friend

radiii

So I'm a hardcore keto person, I usually either eat 20g carbs or less, or i go off the rails. I don't really have real world experience eating a low but not keto level of carbs.

I've got a close friend who is diabetic AND celiac, so she needs to also remain gluten free. She really wants to avoid ketosis, so we've been chatting about ways to get 100g of carbs in a day while avoiding foods that spike her blood sugar. I'm so used to keto levels I'm just blanking on a lot of things I think. I'm hoping for suggestions for gluten free things?

We've talked about fruits, higher carb nuts (cashews were my first thought, any others?), she says that eating a baked potato spikes her pretty bad, I suggested sweet potatoes.

She's a 3 meals a day type, so we're looking for possible suggestions to spread out 100g carbs over 3 meals, staying gluten free.

I'm hoping that some of the 100g carb folks can help me out with suggestions, i'm embarrassed that i'm just blanking. Celiacs welcome too!

She doesn't weigh much. I'll update with stats or calories when I find out, but I'm estimating something like 5'4" 120 lbs. On the lower end of a healthy BMI range.

Anyway, thanks in advance for any and all food suggestions

canadjineh

I'm gluten free too, she can easily add legumes (Chili with beans, split pea soup with ham, daal with other Indian veggies), sweet potato, brown rice, regular oats (NOT instant or quick cook), cashews and almonds, any veg except corn and carrots, some fruit like apples, peaches, plums, oranges, pears, some dairy (regular milk and plain yogurt). Those are all low glycemic index foods and still fairly healthy. Is she trying to gain or stay at the weight level she is at?

nvmomketo

Dr Bernstein Diabetes Solution may be a good place to start. It is a low carb plan for T1D's or T2D's. It is not a weight loss plan but a level blood glucose plan. It is basically keto but I don't think he ever really says ketosis - he knows ketosis is not a dangerous state for diabetics unless it is ketoacidosis (not taking enough insulin). Bernstein goes at it from a "lower your carb intake which lowers your insulin needs" sort of approach.
http://www.diabetes-book.com/read-online/

Low carb usually has less gluten in it than the average diet. I am a celiac and find meals based upon meat/eggs/ seafood/ full fat dairy and vegetables (usually leafy green) is completely gluten free (GF). A breakfast of bacon and eggs with veggies, lunch of roasted chick on a salad and dinner of a steak with a side of roasted veggies would be well under 100g of carbs but will appear to be carb loaded due to all the veggies... plus most people associate a healthy diet with eating lots of veggies. These meals just don't have the sugar or grain fillers like toast, croutons, a bun, a potato, or rice, which no one really needs anyways. Throw in some fruit and nut snacks and she'll be up to 100g.

radiii

canadjineh wrote: »

Is she trying to gain or stay at the weight level she is at?

Blood sugar control while eating enough carbs to avoid ketosis is the only part of the conversation currently. BMI wise she is slightly underweight but I don't' think its a concern of her or her doctors currently.


I think she's needlessly worried about ketosis, she's afraid of additional stress on her kidneys and my understanding is that truly excessive protein on keto is the only concern there? But, for the moment, that's a non-starter, so this is not "100g or less", its "making sure to get all the way to 100g without spiking the blood sugar"

Thanks

T1DCarnivoreRunner

I'm a type 1 diabetic and I'm confused why she is trying to avoid ketosis.

There is a HUGE and measurable difference between nutritional ketosis and ketoacidosis. Diabetic ketoacidosis (DKA) must be avoided... it kills. Starvation ketosis (still pretty far away from DKA) can be stressful on the body, especially over long periods of time. But why exactly is she concerned with nutritional / dietary ketosis?

Also, I would point out that she is not going to avoid BG spikes on 100g of carbs daily unless she uses very carefully planned insulin quantity and timing. Drugs like Symlin, which reduce food absorption rate, could help and so could pairing carb consumption with fat consumption. In fact, protein can easily cause BG spikes in a type 1 without having to eat any carbs whatsoever... especially if consumed without carbs.

As to the concern for kidney stress due to excess protein... That is something that happens in people who have existing kidney deficiencies. Those of us with normally functioning and healthy kidneys don't have the same concerns with excess protein consumption. However, osmotic diuresis has been shown to occur when blood glucose is >225 mg/dl... and this is stressful on kidneys. The best thing she can do for kidneys is to have tight control over BG and avoid those especially excessive highs.

I believe the concern about nutritional ketosis is unfounded and she may be confusing ketosis with DKA.

nvmomketo

Her thinking on carbs and DKA and kidney issues is fairly uneducated for someone who is managing a complex disease. I think she needs to do some reading. Or maybe start her on videos if health books are not her thing.

https://www.youtube.com/watch?v=9VaNJO7KMgg

Sunny_Bunny_

I wonder if she’s underweight from low bodyfat or low muscle or maybe even both?
I’m asking because my own daughter who’s T1D became very underweight, dropped to about 90-95 pounds at 5’6” and so much of it was muscle loss.
Being in ketosis could help to prevent any further risk to muscle loss since it mimicks fasting in that way.
Anyway, there’s really no reason necessarily for her to either seek ketosis or avoid it. 100g carbs will definitely be helpful overall but Dr Bernstein recommends a carb total of 6g/12g/12g for each of the 3 meals for best blood sugar control and to minimize insulin need.
With 3 meals trying to be around 100g she’s basically going to aim for about 33g per meal which is 3 times the amount Dr Bernstein suggests and the people at TypeOneGrit are eating to achieve non diabetic blood sugars.

radiii

regarding the ketoacidosis stuff, its definitely not that:

Every time i have kidney tests it shows I'm on the edge of having something wrong. Like it always looks like i have a minor kidney infection, but they've never done excessive testing because i rarely have any symptoms

Thanks, I'm sharing all of this stuff. I agree with all of you on all of this, and I've been taking openings when possible to gently nudge in this direction for awhile now. My current idea is to see if I can help get her carbs consistently down and seeing where the blood sugar ends up. But maybe some of the stuff you guys are saying, especially as type 1's or parents of type 1's yourself will land

MurpleCat

Insert the usual caveats that each person's diabetes is different (i.e., what can spike one person is a non-issue for someone else, and vice versa).

I'm T1D, aim for 30-45g carb/meal. Not gluten free but I naturally gravitate towards potatoes or corn over pasta & bread anyway. Legumes (beans, peas, lentils). Greek yogurt. Ricotta cheese. Peanut butter. Regular cheetos (but not the low-fat-- there's some gluten in them. Go figure). White rice spikes me, brown rice not so much.

She may have to watch/count onions & carrots. Some of my T1D friends have issues with one or the other; I do not.

I find caffeine helpful for preventing spikes; another friend gets spiked by it.

The biggest anti-spike, though, is exercise. If I play a 2-hour tennis match, I have about 48 hours where I can do no wrong and my numbers are rock steady.

If she's T1D, its likely her insurance will cover a CGM & insulin pump. It helps to have lots of data when trying to figure out how specific foods affect your BG.

Feel free to message me (or have your friend message me) if you want more details.

MurpleCat

It may also help to know that spikes are going to happen for T1D, even for the most vigilant. You all know the difficulties of counting carbs accurately. For T1D there’s also variability in the timing of the insulin from the injection/ infusion site — it’s not going straight to the blood stream, and since you are injecting different sites each time (to prevent scarring), sometimes you’ll be nearer a capillary or a nerve or catch a bit of denser fat or whatever. So to prevent a spike you have to time the insulin injection perfectly with food absorption, neither of which is a precisely known value.

The spike will happen if the food gets absorbed faster than the insulin distributes. That’s better than the alternative though— if the insulin won the race your BG would dive — which is much more immediately dangerous than a temporary spike. High numbers are bad in the long term but a hypo can kill you now, before you ever get to those long term consequences.

It can be hard to let go of that fear of spikes — believe me, a DKA is no fun. But it’s not possible to avoid them entirely.