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Old 10-29-2009, 01:57 AM   #1
Casey Crooks
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No way around low blood sugar with low carb diet?

For the past two weeks I have been trying to eat as close to paleo as I can.
However, I have type one diabetes. I have severly decreased both my long term once a day insulin (Lantus) and my meal time insulin, Novolog. I cannot seem to avoid low blood sugars without eating some type of carbs that arent paleo. I can eat as much protein and fat and paleo friendly carbs as I can without taking any insulin, and I am still forced to eat and drink various non-paleo carbs to bring my blood sugar back up when it drops low during the night. It has been unavoidable so far. With the amount of physical exertion I am putting my body through daily, it seems that there is no way to be able to keep my blood sugar in a safe range overnight by only eating protein, fat, and paleo friendly carbs. This is beginning to get very frusterating for me.
Can anyone help? Can my body and diabetes just not handle a low carb diet? Will I have to stick with a lower carb diet, not low carb? I am in very good control of my diabetes, which is why I felt it was safe for me to experiment with paleo. But if these are the results I keep getting I cannot continue to eat low carb/not eat processed carbs like bread, pasta, and rice.
I may be switching terms such as paleo/low carb, but give me some leeway with terminology.
Help!
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Old 10-29-2009, 02:45 AM   #2
Moran Bentzur
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Re: No way around low blood sugar with low carb diet?

I'm not a doctor and I know very little about TypeI diabetes, so take everything I say with that in mind.

I would advise you to talk to Robb Wolf. He has experience with TypeI diabetics and Paleo. He might put you in touch with other Paleo diabetics, which can be helpful. Read his posts concering typeI on his blog.
http://www.*************/ (wfs)

My initial guess would be to make the shift to paleo slowly. Even within the grains family you have better/worse choices. avoid Gluten. You can eat rice (preferably brown) instead. Try out starchy tubers like potatos and sweet potatos.
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Old 10-29-2009, 05:03 AM   #3
Nick Wilson
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Re: No way around low blood sugar with low carb diet?

Casey,

Your body can definitely handle the low-carb paleo approach; it just takes time to work out the details, like everything else with diabetes. Don't despair, just take it one step at a time.

First things first, and sorry if this is all stuff you already know. Your lantus is intended to cover your body's insulin requirements without food - so if you ate nothing for a day, your lantus should keep your blood glucose stable. If you're having to eat food to prevent night-time hypos, it strongly implies that you're injecting too much lantus.

One slight complication is that, although lantus is meant to last 24 hours and have a flat delivery, many people find that it doesn't - it can actually act more powerfully in hours 3-6 (or 2-6 or 3-8 or whatever, depending on the person) and can "run out" after 20 hours or so. If you're injecting in the evening, this curved delivery could easily account for your night-time hypos. One strategy to mitigate this is to split your injection in two and inject half in the evening and half in the morning; this has the effect of flattening these curves out. Many people find this helps with things like night-time hypos.

The other alternatives are that you're simply injecting too much lantus, or you're injecting too much Novolog with your last meal (if you inject close to bedtime).

Getting the basal dose right is critical. After that, figuring out how much Novolog you need to cover your food, and how to adjust for exercise, should be a lot easier.

Don't be worried if you need to reduce your insulin quite a bit. Let your control dictate things; if you can eat low-carb paleo and keep good control then you're doing things right, and if that means you hardly need much insulin I'd see that as a massive positive! Generally speaking, if you're struggling with too many hypos it simply means you're injecting more insulin than you need. Rather than eating carbs to raise your blood glucose, look at ways to reduce insulin intake so it doesn't drop too low in the first place.

For what it's worth, when I switched to low-carb paleo I ended up dropping my background dose by about 20% (from 42 units split 21/21 to 34 split 16/18). However, my Novolog requirements dropped from maybe 40-50 units per day to only a handful. Some days, if I eat very few carbs, I inject no Novolog at all.

One of the main benefits of eating low-carb is that the reduced insulin makes control easier. If you feel yourself going hypo and you injected 2 units an hour earlier, you can probably get out of the hypo with 10g or so of carbs. If you'd injected 20 units, you'd need a lot more. The hypo would also probably be faster, and the rebound worse. Eating low-carb and therefore injecting less insulin dampens everything down and makes the highs and lows a lot less severe.

On occasions where you do feel that you need to raise your blood a little bit, but you're not actually hypo, try to use paleo foods - so don't go for bread / rice / pasta, use sweet potato or fruit instead. Generally speaking, if you're eating low carb and you get your insulin nailed, you can manage this kind of stuff with very small portions - half an apple is usually enough for me to shift my blood away from an impending hypo, whereas when I used to eat a lot of carbs I might need a sports drink and a few slices of bread. My blood would probably sky-rocket half an hour later, and thus begins the rollercoaster.

Having said that, if you're actually hypo then use whatever you need to treat the hypo - if that means dextrose / sports drinks or whatever, then don't sweat it. Try not to overtreat the hypo though, 10g or so will usually do it.

I'd also advise you not to tie yourself down to someone else's definition of how low-carb you need to go. You might find that you need 50g per day to get your best control, or 30g per day, or 75, or 100... whatever that number is, it's the right one for you. My general advice to type 1's is that reducing carb intake and getting those carbs that you do eat from paleo sources will give you the best control; but everyone just needs to experiment and find their own sweet spot (pun not intended).

Finally, one thing you didn't mention is how long you've been diabetic. If you were recently diagnosed there's a possibility that you're seeing some recovery of pancreatic function (like a honeymoon period) which would obviously contribute to your low bloods. If you are newly diagnosed, I'd urge even more strongly that you go full-on paleo as strictly as possible, as this gives you the best possible chance to preserve what pancreatic function you have left (or even regaining some of the lost function).

Hope that's of some use; do post back with any more specific questions and I'll help if I can.

Cheers,
Nick.

Last edited by Nick Wilson : 10-29-2009 at 05:32 AM. Reason: Fixed a typo and added one point
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Old 10-29-2009, 05:04 AM   #4
Darryl Shaw
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Re: No way around low blood sugar with low carb diet?

First paleo isn't necessarily a low carb diet, it's just a different carb diet. Second, I agree with Moran's suggestion that you eat more starchy roots and tubers but if you're in need of something sweet/sugary to keep your blood sugar stable you could try experimenting with dried fruit like dates or raisins.
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Old 10-29-2009, 06:56 AM   #5
Casey Crooks
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Re: No way around low blood sugar with low carb diet?

Quote:
Originally Posted by Nick Wilson View Post
Casey,

Your body can definitely handle the low-carb paleo approach; it just takes time to work out the details, like everything else with diabetes. Don't despair, just take it one step at a time.

First things first, and sorry if this is all stuff you already know. Your lantus is intended to cover your body's insulin requirements without food - so if you ate nothing for a day, your lantus should keep your blood glucose stable. If you're having to eat food to prevent night-time hypos, it strongly implies that you're injecting too much lantus.

One slight complication is that, although lantus is meant to last 24 hours and have a flat delivery, many people find that it doesn't - it can actually act more powerfully in hours 3-6 (or 2-6 or 3-8 or whatever, depending on the person) and can "run out" after 20 hours or so. If you're injecting in the evening, this curved delivery could easily account for your night-time hypos. One strategy to mitigate this is to split your injection in two and inject half in the evening and half in the morning; this has the effect of flattening these curves out. Many people find this helps with things like night-time hypos.

The other alternatives are that you're simply injecting too much lantus, or you're injecting too much Novolog with your last meal (if you inject close to bedtime).

Getting the basal dose right is critical. After that, figuring out how much Novolog you need to cover your food, and how to adjust for exercise, should be a lot easier.

Don't be worried if you need to reduce your insulin quite a bit. Let your control dictate things; if you can eat low-carb paleo and keep good control then you're doing things right, and if that means you hardly need much insulin I'd see that as a massive positive! Generally speaking, if you're struggling with too many hypos it simply means you're injecting more insulin than you need. Rather than eating carbs to raise your blood glucose, look at ways to reduce insulin intake so it doesn't drop too low in the first place.

For what it's worth, when I switched to low-carb paleo I ended up dropping my background dose by about 20% (from 42 units split 21/21 to 34 split 16/18). However, my Novolog requirements dropped from maybe 40-50 units per day to only a handful. Some days, if I eat very few carbs, I inject no Novolog at all.

One of the main benefits of eating low-carb is that the reduced insulin makes control easier. If you feel yourself going hypo and you injected 2 units an hour earlier, you can probably get out of the hypo with 10g or so of carbs. If you'd injected 20 units, you'd need a lot more. The hypo would also probably be faster, and the rebound worse. Eating low-carb and therefore injecting less insulin dampens everything down and makes the highs and lows a lot less severe.

On occasions where you do feel that you need to raise your blood a little bit, but you're not actually hypo, try to use paleo foods - so don't go for bread / rice / pasta, use sweet potato or fruit instead. Generally speaking, if you're eating low carb and you get your insulin nailed, you can manage this kind of stuff with very small portions - half an apple is usually enough for me to shift my blood away from an impending hypo, whereas when I used to eat a lot of carbs I might need a sports drink and a few slices of bread. My blood would probably sky-rocket half an hour later, and thus begins the rollercoaster.

Having said that, if you're actually hypo then use whatever you need to treat the hypo - if that means dextrose / sports drinks or whatever, then don't sweat it. Try not to overtreat the hypo though, 10g or so will usually do it.

I'd also advise you not to tie yourself down to someone else's definition of how low-carb you need to go. You might find that you need 50g per day to get your best control, or 30g per day, or 75, or 100... whatever that number is, it's the right one for you. My general advice to type 1's is that reducing carb intake and getting those carbs that you do eat from paleo sources will give you the best control; but everyone just needs to experiment and find their own sweet spot (pun not intended).

Finally, one thing you didn't mention is how long you've been diabetic. If you were recently diagnosed there's a possibility that you're seeing some recovery of pancreatic function (like a honeymoon period) which would obviously contribute to your low bloods. If you are newly diagnosed, I'd urge even more strongly that you go full-on paleo as strictly as possible, as this gives you the best possible chance to preserve what pancreatic function you have left (or even regaining some of the lost function).

Hope that's of some use; do post back with any more specific questions and I'll help if I can.

Cheers,
Nick.
Many thanks Nick.
I was diagnosed when I was almost five, and I'm eighteen now. So Im a little passed my honeymoon phase . I have always been in very good control of my diabetes, and because of that my A1c has only been out of the upper sixes once in thirteen years. Im used to having to adjust my insulin (Lantus) in accordance to dietery and exercisey (i know i made it up) requirments as I played high school football and have lived a very active lifestyle. Over the last couple of weeks I have dropped it from 35 units once nightly to 30 units once nightly; tonight im going to drop another unit to 29. This is at a body weight of slightly over 200 pounds. I am interested in trying a split dosage. Its something I had considered, but never had any need for since i was eating heavy carbs. What advice would you give for me to move towards this? Its also tough for me to buy some paleo foods to have on hand as snacks since I am currently a college student and get most of my food from the dining halls. (Its remarkably easy to eat well at our dining halls with some effort.) I really like paleo. I can definatley see and feel some results from it and I really want to continue using it. Im going to be reading both your and Wolffs blog to see what I can get from it, and anything else you can tell me will be greatly appreciated. Many thanks, Casey

Last edited by Casey Crooks : 10-29-2009 at 07:18 AM. Reason: Im dumb
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Old 10-29-2009, 07:05 AM   #6
Nick Wilson
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Re: No way around low blood sugar with low carb diet?

Good stuff Casey; keeping good control over the long term is vital as you obviously know. Who knows, the move to low-carb paleo might help you improve your A1C's even further; I know mine dropped like a stone once I committed to it, and went from low-7's to 6.2 in about 9 weeks of low-carb paleo, and into the mid-5's after a further 6 weeks.

Good luck with it, and let us know how you get on!

Cheers,
Nick.
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Old 10-29-2009, 07:32 AM   #7
Casey Crooks
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Re: No way around low blood sugar with low carb diet?

How did you make the switch from once daily lantus injections to twice daily? Just do it? It seems theres gonna be a slight high in between. Probably nothing to worry about, but if you have any experiences to share they wont fall on deaf ears!
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Old 10-29-2009, 07:37 AM   #8
Casey Crooks
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Re: No way around low blood sugar with low carb diet?

Also after some of the reading I have done, I am wondering if I may still have some insulin production capacity left. I was diagnosed with a blood sugar that was only in the 400mg/dl range, so I never really lost control even from the beginning. This could explain how I get low post meal even without taking any novolog.... Just a thought.
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Old 10-29-2009, 08:12 AM   #9
Nick Wilson
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Re: No way around low blood sugar with low carb diet?

Hi Casey,

I actaully don't use lantus, I use Insulatard which is a shorter-acting long-acting insulin (if you see what I mean) - it only lasts 14-16 hours. So I've always had to take 2 doses per day, never had to switch from one to two.

To be honest I'm not sure of the best way to make the transition; you might be able to find some info on some diabetic forums. If I were doing it myself, I might be tempted to take my normal dose one night; take about 1/4 of that amount the following morning; test very regularly that day and take in extra carbs as needed to prevent hypos; then take half the dose that night; and half the dose the next morning; then continue with the half-doses every morning and night. That way you avoid the highs and shouldn't have major problems with hypos during the transition day. But that's just what I'd do given my own comfort levels; the way you suggest (just take a half-dose one night then half the next morning) would probably also work, maybe with some extra exercise or small extra doses of Novolog during the day to keep the blood from rising too high. I really don't know, that way may actually be better. Like you say, it's a one-off thing so whatever you decide to do should be fine, as long as you test regularly that day.

One thing I neglected to mention is that some people also find they run best with slightly different splits (e.g. they don't take 50% in the morning and 50% in the evening, they go 45/55 or 40/60 in one direction or the other). This comes down to what works best for you, it just depends on whether you find you go high/low at certain times. Trial and error showed me that I need 16 units in the morning and 18 in the evening for example. I'd say start at 50/50 and monitor from there.

The only way to tell if you've got any pancreatic function left is to get a c-peptide test; I don't know if that's something your doctor can order up for you? I have to say it's unlikely since you've been diabetic for 13 years; it could just be that variation in your diet and exercise is what's doing it. Once you get into the swing of low-carbing and paleo it tends to even things out and make things a lot more predictable, in my experience at least.

Definitely go over Robb's blog and read up everything you see there (including the comments), it's a gold mine! I've only just started my own blog so there's not much on there at the moment, but I'll be posting regularly from now so hopefully you might find it useful going forwards.

Cheers,
Nick.
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Old 10-29-2009, 09:49 AM   #10
Casey Crooks
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Re: No way around low blood sugar with low carb diet?

I think im going to make the transition this weekend. Not sure how Im going to go about it yet, but ill figure it out.
The only other thing i was thinking about is this-
lantus last about 24 hours. so splitting a dosage wont make it last 12 hours and 12 hours. the first small dose will still last 24 hours, it will just be a smaller dose for 24 hours. then ill be throwing in another half dose (or quarter or whatnot) on top of a dose thats already going. i could forsee this making my BS drop a bit.
OTOH, since i am going to be taking a smaller evening dose, my blood sugar may run high(er) so that the second morning dose wont push me down.
idk. when i do this, ill try to document my BS for 12 hours before, during the transition, and 24 hours after the transition.
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