This section is for everyone.
HOW DO I COVER A STRICT LOW CARB REGIME WITH INSULIN?
Dr Richard Bernstein, Dr Annika Dalquhist’s, and Dr Atkins diet have been described in previous sections. They can all take you to the strict low carbing end of things amounting to about 30-42g a day of carbohydrate.
I have chosen this level of carb for your meals to differentiate a strict low carb diet from a typical low carb diet. All of these diets in this strict range will give you the possibility of entirely normal blood sugars.
Dr Bernstein’s diet is more specific about what sorts of macronutrients you eat and in what amounts. For simplicity of eating and insulin regime combined with effectiveness it is my opinion that this is the “Gold Standard.”
If you are eating faster digesting carbs even within the 12g total carb limit you would need to experiment to see if a single insulin type covers your meals to entirely normal blood sugar standards or not. The levels you may be aiming for have been described previously. If you get what you want this is perfect and if you don’t you may wish to try the specific insulin regime for the typical section which follows.
Dr Bernstein recommends using regular insulin to cover meals. These are of no more than 12g of non starchy vegetables three times a day with 6g allowed for breakfast because of the effect the dawn phenomenon has on insulin resistance at this time of day.
The regular insulin is best injected 45 minutes before eating. Because you are having such small amounts of carb and therefore insulin at each meal you don’t really need a separate insulin for the carb and protein. Just a little more regular such as actrapid to cover your protein. The usual formula for most people is 2 units regular insulin to cover 3oz lean protein or meat the size of a deck of cards.
The protein amount and consistency depends on your goals concerning weight gain or loss. For people with delayed gastric emptying they may be on quite small portions of protein at their evening meal such as 2oz. With guess and test you will quickly learn what works best for you.
Rapid acting insulin analogues are used for correction doses.
HOW DO I COVER A TYPICAL LOW CARB REGIME WITH INSULIN?
I have chosen Dr Jovanovich’s carbohydrate limits as the border between what could still be considered low carb and what is out with that range. Dr Atkins and Drs Allen and Lutz diet’s have been described previously and fall in this range. If you are on another diet such as Protein Power, South Beach or Barry Groves “Eat fat and Stay Slim” diet you are in this range.
Once you get to higher carbohydrate levels of 13-30 g a meal of carb you increasingly need a bit more oomph with your insulin to deal with more rapidly rising blood sugar levels. At the same time protein continues to digest slowly so you need techniques to deal with that.
The most accurate technique that I know of was perfected by Dave (Iceman) from Alaska. Sadly he died of cardiovascular complications of his longstanding diabetes. For all our benefits he passed his method throught the Bernie forum onto Adam (Adam DMer) who graciously passed it onto me. It is a beautifully simple technique that can also be used at lower and higher carb levels than I am describing in this section if desired.
Use rapid acting analogues to cover carb. This can be done according to your individual carb sensitivity for that time of day.
Use regular insulin to cover protein. This is to the tune of 2 units of regular insulin for each portion of lean protein which is a deck of card in size.
Both are optimally injected 15 minutes before eating.
HOW DO I COVER A HIGHER CARB REGIME WITH INSULIN?
The higher carb your meals the harder it is to get perfect or even acceptable blood sugar control. You can usually get an improvement from what you have been getting however,from the techniques I will be describing.
Although I much prefer to eat a typical low carb diet myself I was aware that my son Steven did miss the occasional treat. What was more important was that the meals provided at school emphasised high carb /low fat dishes in keeping with the ubiquitous “healthy eating” guidelines. The odd high sugar due to either of these reasons didn’t bother us at first because it was so infrequent.
For almost 18 months from diagnosis Steven did excellently on a typical low carb diet and twice daily mixtard combinations. Due to his lower carb diet and lengthy honeymoon his hbaic was 4.8.
Then his growth spurt and reduction in endogenous insulin became obvious. We continued mixtard but started on novorapid for lunch coverage in a half unit increment pen.
After 4 months on this we started an intensive insulin regime on levemir and novorapid. By this time he was growing faster than our high fat/mod/protein/ low carb diet could sustain and his bmi was just under 16. This is the bmi of eg Liz Hurley the actress who is indeed slim.
The dietician and diabetologist started threatening me. “Feed your kid a high carb/low fat diet and he will fatten up. Or else.” Presumably child protection procedures.
They did have a point. Indeed I had never seen a skinny diabetic on a high carb/ low fat diet. It did seem to work like magic to fatten people up.
The problem was that Steven was just not hungry. Effectively reducing hunger is a major reason for the success of low carb diets in weight loss . But it is a disadvantage if you are hitting adolescent growth spurts.
I increased the carb in his diet knowing that he needed to have more carb for weight gain but also knowing that this would play havoc with his beautiful blood sugar pattern.
I decided to go for it and fatten him up like a goose destined for pate de fois gras. “Have what you like Steven. We have to learn how to control whatever effect it has on your bloods sugars. You could eat a bit more bread and potatoes than that couldn’t you? Please.”
I started this intensive fattening regime while on holiday abroad when we had almost unrestricted access to foods of all types and while I could monitor his sugars day and night.
To start with it seemed quite fun to Steven. “You mean I can eat a whopper with fries?”
“You certainly can. You must.”
Soon the wildly fluctuating blood sugars and blurred vision got us both down. “Please mum. Can’t I go back to low carbing? ”
“Please, Steven. Just keep going with this a bit longer. I am getting nearer and nearer to perfecting the carb weighting figures.”
We had a three month period of hellish sugars. We did loads of blood sugar measurements including most nights between 2-4 am. I could hardly sleep with anxiety.
This is what your average mother with an average kid with type one diabetes goes through all the time. It was bloody awful. I had no idea how bloody awful till I did it myself.
Fortunately I had some ideas about why Dr Bernstein strongly advised limiting carbs. The reason is to stop any spikes after meals that normal people don’t have.
And why does Dr Jovanovich limit a meal to 30g of carb? The reason I figured out is that linear doses of insulin based on reliable carb insulin sensitivities become increasingly unreliable above this level.
The more carb you eat the higher your blood sugar goes.
The higher your blood sugar goes the more insulin resistant you become.
The more insulin resistant you become the more insulin you need.
There is no longer a linear relationship between carb and insulin dosage after 30g.
There is an exponential curve.
Figuring out the sweep of that curve will vary from person to person.
To do this you MUST do extensive self experimentation.
Your carb counting skills must be well developed.
You must increase your carb counts above 30g in a progressive way.
You must keep meticulous records.
Give yourself a break every so often. It is best only to do these experiments when you have help around and you are able to monitor day and night.
Unless you absolutely have to, you are much, much better off on a typical and preferably strict low carb regime. Low carbing is extremely efficient at curbing your appetite. This is a major benefit for most diabetics but I can see where it can be a problem for skinny toddlers and teenagers. If you need to resume a higher carb diet I hope our experiences and learning of techniques can help you through this process.
I know that for many diabetics the hectic blood sugar patterns that they simply accept as the package deal that comes with diabetes is actually due to the high carb diet.
I found the high carbing process extremely traumatic. Steven was unhappy. I was unhappy. Yet, no matter how much fat I added to his diet I could not fatten him up. He is not as much as a carnivore as me and carb seemed the only answer. The high carb diet has worked and now Steven has a healthy bmi at 18. Teenagers have lower bmis than adults but your dietician won’t know this. They don’t know a lot about a lot of things you no doubt are finding out.
There is no quiz for this section.
Acknowledgements to Dr Bernstein, Dave (Iceman) and Adam (AdamDMer) from the Bernstein Forum and my son Steven.
Where to Next?
Please continue onto the How To: Do Dr. Morrison's Carb Weighting System section.