To preface, probably the first unexpected thing that I found over the last year was that my son required the same total daily dose of insulin if he ate 30% carbs or if he ate 60% carbs as long as his total calories stayed the same! The reason: he became less sensitive to meal time insulin when it was combined with fat and protein almost exactly to match the decrease in carb intake for the day. (Now he DID have incredibly better blood sugar readings with the lower carb diet, but it did NOT decrease his insulin requirements, it just lowered his peak blood sugar after meals, so if someone is insulin resistant or type II diabetic, reducing your carb intake and replacing it with fat or protein may not decrease the amount of insulin your pancreas has to put out at all! because the increased fat makes you more resistant to your own insulin to match for the decrease in carbs. You WILL however get lower peak blood sugar levels, lower average blood sugars, lower A1Cs, and lower blood sugar means less damage to the beta cells of the pancreas, but it doesn’t mean less demand on the pancreas.
My son was diagnosed with type 1 diabetes just over a year ago. Prior to that time, I had personally favored a high fat, but not super low carb diet, about 100 grams of carbs or 20%-30% base plus some additional carbs post intense workout. I never pushed that on my kids or wife, but my oldest daughter and my wife and I all eat basically a fat based diet with 30% carbs.
Since my son’s diagnosis I have spent most of my time thinking about how to manage his diabetes and insulin. He fortunately went into virtual remission at about 3 months where he could actually get back to fasting blood sugar numbers within about 3 hours after a meal without insulin. His case was unusual because I could give him insulin and his own pancreas would just dial it back to match for the meal.
At about 6 months in, his mealtime needs started to rise. At that time we got a continuous glucose monitor. Also he had developed an aversion to large amounts of carbs because they had made him feel bad for quite a while leading up to diagnosis. As a result he was only getting about 1100 calories a day and I started adding fat to his meals, but still keeping 30-40 grams of carbs in each meal. I used a combination of beef, dairy fat, and olive oil with occasional seeds and limited high linoleic oils and canola. This let me get him about 1600 cals a day which is recommended for him: he is small, closing in on 10 years old and 55 pounds, but very lean.
Anyway, he remained very stable in a “honeymoon” where his pancreas helped out especially at night for another 6 months, but in the last 4-5 weeks he has lost about 90% of that help and is almost completely covered by injected insulin. We are right on the edge. In the last 6 months we have been able to have what is considered to be supra-tight control with average blood sugar weekly averages of 110-115, only a few days with averages over 130, and only occasional peaks over 180. This is extremely rare even with a diabetes honeymoon. We have also avoided all but 3-4 short periods of hypoglycemia.
Anyway, I am starting this thread for 3 main reasons. 1) I think it will be therapeutic. I am pretty burned out by the last year. I stopped working out and tried to get back, but haven’t stuck with it. I can’t write too much science on the “parents of type 1 diabetes kids” website because there are a lot of very defensive people who are understandably more concerned with how to manage their kids day to day life and give them as much normalcy as possible. 2) I have experienced and researched the effects of diet on blood sugar in particular for hours a day for the last year. I have made discoveries that I never would have imagined. Pages worth. I will start with one: when my son transitioned from a carb based diet to a 30% carb diet with higher fat content, he needed TWICE as much insulin to cover the same amount of carbohydrates as he needed when he was eating about 60% carbs! That’s right. He is not insulin resistant. A unit of insulin will lower his blood sugar by a normal amount for a kid his size (about 80-100 points) but he needs a unit of insulin to cover just about 10-12 grams of carbs while kids on high carb diets only need about 1 unit per 20-25 grams of carbs! So in other words, his insulin needs are basically the same over the course of the day eating 30% carbs as eating 60% carbs given the same amount of total calories-in a later post I will discuss some of the research I have read about why a high fat diet causes muscles to actually become insulin resistant…3) my third reason is that I hope that there are smart people who can help me reflect on this last year in light of their knowledge of nutrition to help me manage my son as he loses the last 5% or so of his help from his pancreas.
Some teasers in case anyone would like to open a conversation along any of these lines:
People who eat 30% carbs or less will often fail a glucose tolerance test because of physiological insulin resistance, but the effect goes away within about 3 days of eating higher carbs.
People who eat <30% carbs will store more intramuscular fat, more fatty acids IN their muscle cells, and will increase fat burning enzymes in their muscle cells AT THE EXPENSE of storing less glycogen and less glycolytic enzymes. Their body will however use more fat at different workloads as someone who eats high carbs, and they will tend to store less fat as adipose and have lower basal insulin needs and also have better blood lipid profiles.
Protein does yield glucose. The amount depends on whether the protein is consumed with few carbs or with high carbs. Protein consumed by itself largely turns into glucose, but that is not necessarily anything against higher protein levels for athletes. I used to hold that protein above about 150 grams a day was a waste because it did not increase protein synthesis, but now it looks like bulk protein serves largely as a slow source of glucose that prevents the body from tearing down muscle 4-6 hours after a meal to turn into glucose via gluconeogenesis.
Tight control for a type I diabetic is considered to be an average blood sugar under 155, most peaks under 180 (for adults) and fewer than 2 treated instances of hypoglycemia a week (or less than 10% of pre-meal blood sugars being in the hypoglycemic range) and 50-70% of the time coming to a meal with a blood sugar between 70-130. For a kid my son’s age, the standard is even higher, about a 170 average (which very few achieve) and a 70-180 blood sugar at meal time at least half the time, with most peaks being under 225, and fewer than 2 weekly treated instances of hypoglycemia.
The average type 1 diabetic has an average post meal peak blood sugar of 247, and has a peak of over 300 at almost half of their meals. Less than 1/3 of teenagers maintain an average under 170 (A1C under 7.5).
Type 1 diabetics don’t just lose insulin, they also lose a hormone called amylin that is produced by beta cells. This hormone helps delay the entry of glucose into the blood from the gut, and also tells the liver to not spit out large amounts of glucose after a meal (or sometimes for no reason at all). Type 1 diabetics ALSO typically get dysfunction in their alpha cells causing too much glucagon release (blood sugar raising) when it is not wanted, like from a mere stretch reflex. One experiment showed a man;s blood sugar went up about 100 point to around 200 after eating a head of lettuce (repeated with different types of lettuce) simply from a reflex in the intestines that makes the pancreas release glucagon. In most people the glucagon is matched by insulin. A type 1 diabetic can literally raise their blood sugar by eating cardboard. Also problematic is that after about 5 years most type 1 diabetics will not release glucagon properly when their blood sugar is low anymore so they lose the ability to hormonally fix low blood sugar.
There is a profound difference between moderate, low and very low carbs on the way the body functions. 30% carbs, <20% carbs, and ketongenic diets (less than maybe 10% and also limited protein) are really very different in terms of whether the body is using fat, burning muscle protein for fuel or using ketones for energy.
As insulin levels drop in non-diabetic individuals, this is a signal that blood sugar is low and other sources of energy are needed. (In type 1 diabetics usually happens when blood sugar is HIGH because they didn’t inject enough insulin which creates a crazy problem that blood sugar, gluconeogenesis, lypolysis and ketosis all happen at the same damn time!) Anyway as non-Ds insulin drops, it first signals glycogenolysis, where the liver will spit out glucose from glycogen. As insulin goes lower, the next two things that happen are 1) The body releases cortisol and the liver startes breaking down protein (ie muscle) to turn into glucose AND OR the body starts to activate lypolysis to take fat out of adipose cells and mobilize it for use as energy. Now this is interesting because some people may start breaking down muscle with low insulin levels (low carb diets) while others may turn up fat burning first. When insulin is injected or raised, it can suppress protein catabolism OR fat mobilization and burning! So what determines if your body is going to break down muscle or burn fat when energy needs rise? This really is THE mystery of lean muscle building. ANYONE?
That’s it for now. This is a break for me because I need to get out all of this stuff that I have run across over the last year, hoping to release some stress and maybe help me work through my son’s final stages to full-on type 1 diabetes. I am tired of the parents of kids with diabetes site for now. My wife is a cardiologist, but she needs us to be as normal as possible when she is home and not “talk-D” but since nutrition and human performance have been a big part of my life prior to my son’s dx, I think it will help me. I also need people to help get me back to workout out again-man that has got me depressed.