Friday, January 27, 2012

Carb Limits

Since being exposed to so many other Diabetics via the #DOC, I've been surprised by how carb-limited many people are.

To begin with, I'm slim and slightly underweight. Could stand to gain 10 or 15 pounds. Gaining 5 takes constant work and the first time I waver it melts away. So I don't need to limit for weight reasons.

I have a self-imposed per-meal limit of 70g of carbs. I'm pretty good at sticking to it. Sometimes I misestimate. Sometimes I intentionally blow past it. But generally, 70 is my limit and 50-60g is common. That makes my per-day carb limit about 210g. In reality, I come in closer to 170g. So that's just north of half the FDA guidelines.

The only reason for that self-imposed limit is how much harder it becomes to manage blood sugar on larger meals. 70 is hard. 90 is... harder.

But when talk turns to food, I notice people limiting themselves to 70g... a day. Less than half of my common day and fully a third of my upper limit. Some people eat 20-30 a meal. And I ask, how? I can eat a huge steak dinner, but without a couple servings with bread, I'm simply not full.

From my understanding, there isn't a maximum safe dose of insulin. So given controlled numbers, there's no downside to taking the insulin to cover the carbs. And if I need that many carbs to satisfy hunger, then I may as well dose for them.

Largely, then, I wonder two and a half things:

  1. Is my understanding about insulin wrong? Do I need to use less? Presently I use about 45U on a good day, up to mid-50s when battling highs.
  2. How do you stay satisfied with so few carbs? Do you adapt? Did you never want them?
  3. And last, how do you deal with lows, especially when so carb-limited? If it takes 20g to produce a rebound, and you only get 30g for a meal, then you're looking at salad. Right?

Generally what I'm doing is working. But seeing so many people, with so similar a regiment, that is so different than mine, leads to second-guessing my plan.


  1. i don't intentionally limit carbs either. for me, focusing on eating healthy is more important than the total number of carbs per day. i love fresh fruit, which adds the carbs up really quickly.

    i'm thrilled that some people have such success on a low carb plan. but it's not for me.

  2. 1. The amount of insulin YOU need is very dependent on YOUR body. Things like muscle to fat percentage, general metabolism, and other confounding factors in addition to how much (and what) you are eating determines your daily insulin usage.

    2. When I (super-briefly) did the low carb thing, there were lots and lots of veggies and water involved. Some low-carb substitutes like spaghetti squash are very, very filling. Plus tons of fish. Which when you're eating that much protein or "free" vegetables at once, you still require a fair amount of insulin (negligible carbs add up).

    3. I still drank juice or chomped on glucose tabs. There's no way around it. Other than to adjust your insulin so that you don't have lows. Which is still super impossible for me regardless of my diet...

  3. This is a bit late, but I just found your blog.
    I do a low carb way of eating. I follow Dr. Bernstein's (Book: Diabetes Solution)recommendations. At the beginning I felt the need to create low-carb versions of carby foods to feel like I was eating normally. Lately, I have found myself well adapted to feeling satisfied by protein and fat along with veggies (I'm eating a Primal/Paleo way). My insulin requirements have changed, but not as much as you would think. I used to take an average of 5 units for a meal and these days its more like 2-3 depending on how large the meal is. My control now is much better because I don't really have much in the way of post-meal spikes. I can usually keep it close to 100 mg/dl unless a meal is overly filling, in which case I get a glucagon release and everything gets out of sync.
    1. You seem to be fairly insulin sensitive, based on your total daily dose and your carb intake. That's good. I'm 150 lbs. and I take 25-30 units a day. 18-22 is basal. The ratio isn't the expected because I'm eating differently.
    There are some indicators that insulin isn't a great thing to use more of, and insulin resistance is not good for us. It looks like you are not using a lot, and if you are struggling to put weight on, then it's being put to good use, and not causing excess fat storage.
    2. I no longer need fast-acting carbs to feel satisfied. I've been eating lowish carb for several years and I've found that once you go for about 5-7 days without fast-acting carbs you lose the cravings for them. Consuming healthy fats helps with satiety. I eat avocados often.
    3. When your carb numbers go down, so do your insulin doses. With lower insulin doses you are less likely to overshoot or undershoot your target. I don't have lows very often, and they aren't fast dropping. Lately my basal rates have been changing and I might dip into the 60s, but they aren't moving fast. I'll have a single glucose tab to bring it up. I don't really care too much about how much correction carbs I need to keep myself in range. Ironically, I feel like I'm kind of less sensitive to insulin, and more sensitive to carbs with the way my body runs on low-carb.
    Honestly, it's taken me years to get to the optimum place with this thing. I had some good results, and then had a few steps back. Getting an insulin pump was good, and then a CGMS was even better. But, until I used them all together to the best possible synergy it was always just "okay" results. Now, I feel like I'm really getting somewhere.
    Great questions! I'll be reading your blog.