Adults Living with Type 2

[arabella1212]

I've been diabetic for a while, but only compliant for approx 2 months.  I've been reading these forums and am trying to soak up all this valuable information....especially about low carb eating.

I'm reading the John Walsh book "Using Insulin" and his aprroach and examples don't seem very low carb at all.  As I said I'm not finished with the book yet, but I'm almost getting from this books that you can eat whatever you want as long as you bolus for it".  That the exact opposite of what I read on these forums.

I am learning slowly but surely about carb counting and carb to insulin ratios.  I've been trying to keep my carbs to no more than 50 a day.  Am I being  to strict with the carbs?  Can I eat more carbs and "just bolus for them".  I must admit, limiting my carbs has certainly taken all the fun and enthusiasm out of eating and I'm feeling pretty sad about the way I'm eating?

I'm on 30 Lantus at night and Novolog on a sliding scale at meals.  My FBG #s are usually in the 70s and 80s...never over 100.  Lately my 2 hour PP is hardly ever over 150..,...usually closer to 130/140.  Before compliance, I lived in the 200 and 300w.

Any feedback would be greatly appreciated.

[__bsc_]

You are right, Walsh is not low carb.  In fact, his principles are based on an assumption of 45-65% of calories from carbs.  What I have found is that you can adapt his principles to low carb by changing his formulas a bit.  I currently use a basal/bolus ratio of about 75/25, far different than his 50/50 and it works quite well.  The difference is low carb.  Doing proper basal testing and then carb counting and bolusing before meals using a proper insulin to carb ratio can make a dramatic difference in your control.

And make no mistake, if you strive for tight blood sugar control, lowering your carbs can have a significant role in helping you improve your control.   Bernstein in his book "Diabetes Solution" discusses this "Law of Small Numbers."   Don't believe for a minute that you can just eat anything you want and just bolus for it.  I consider that a "lie."  That being said, you will need to find your own "sweet spot."   You may well be able to increase you carbs and attain satisfactory control.  Your meter will tell you the truth.  But you may also find that over time, you learn to eat low carb and enjoy it.  Friends actually come to my house just to eat the low carb dinners I cook.  Yes, they are that good.

[jpg391]

Does John Walsh say in his book if he is a type 1? If he is a type 1, he does not have to watch the carb intake as much as us type 2s do.

[Caloh]

Hi Arabella.  I've been using insulin for 3 years now.  I am not an extreme low-carber.  I average 235 grams of carbs per day, which provides me a well-balanced diet and matches my exercise level. I am averaging 27 total units of insulin per day.  There are meals when I take no insulin and other meals when I take what is for me a fair bit of insulin.  I love the freedom and flexibility that rapid insulin gives me.  My CDE recommended that I work out my ratios.  In the beginning of my insulin use,  by carefully writing down what I ate per meal and what I dosed and consequent post-prandial readings, I calculated my insulin-to-carb ratios.  My ratios will not be yours.  I need more insulin-to-carb for breakfast, a different ratio for lunch, and yet again a different ratio for dinner.

What is important is that you eat nutritious meals.  Yes, you can take bolus for junk food, but why would you want to eat that?  A very occasional treat - well yes.  But a daily or even weekly diet - no.  My CDE says that if your are on target 80% of the time, you won't have complications from diabetes.  This allows for 73 days per year off target.  I personally average about 1 day per month, but some months maybe 4 days.   Her first words to my insulin start class were  "Welcome to the world of real chocolate.  No more awful no-sugar candies for you".  It is wise to plan for treats so that you don't feel deprived and just give up.

Have you reached your goal weight?  Remember, being overweight also puts you at risk for various cancers.  We need to eat healthy to be healthy.

Btw, I do have tight control.  And, John Walsh has type 1.

[mollythed Respected Contributor]

When you read "Using Insulin, it pays to keep in mind that the audience for the bood is NOT primarily people with type 2 diabetes.  For people with type 1 or 1.5, the whole idea of using insulin is not to minimize carbs, but to eat a fairly normal diet and then balance the insulin with the the diet.  A teen-age boy with type 1 will likely eat a tremendous amount of carbs, pretty much like any other teen-age boy.  A 75-year-old might eat more like person with type 2.

Of course, that's no license to eat all the carbs you can and cover them with insulin, and as Brian pointed out, sticking to a more moderate amount of carbs will minimize the chances for missteps for all people using insulin. 

I wouldn't consider it a failing of the book in any way.  It's just that the focus of the book is on finding the right dose, not the right diet.

[arabella1212]

Thanks all for your answers. 

Caloh, I am not at my ideal weight.  I needed to drop about 60 lbs and have already dropped 8.  I'm not really looking to bolus for cake, cookies, and junk food.  What I really miss  are fruits, especially bananas.  So this morning I decided to indulge myself and eat a banana.  Before the banana I was at 81.  One hour later I was at 146 (without bolus).........that's a big jump.  My normal breakfast has no carbs (eggs/turkey sausage) so I don't have to take any insulin.  What I learned is that in order to eat a banana, I would definitely need to bolus (not even sure how much insulin).  

I also have a secondary issue of Obsessive Compulsive Disorder (OCD).  Right now this OCD is kicking my butt.  I have a very black/white, right/wrong look at diabetes.....thank God the rest of my life runs pretty smoothly :-).  I'm really struggling to find my middle ground with food.  Somehow, I've got it in my head that having to take a fast acting insulin before meals means I'm a FAILURE AT DIABETES CONTROL.

[Caloh]

Arabella, the fact that you are working on control means you are a success. Imho, being a little OCD may be a good thing in that you are more likely to record your bg readings along with your carb counts for your meals.  I am not trying to make fun of your situation.  But good control does require a lot of record keeping, especially when you are trying to learn how to use insulin.  I actually asked my doctor to put me on insulin because I was needing more and more oral meds to stay in control.  I don't think of insulin as a sign of failure but as a sign of need.  I was never ashamed to wear eyeglasses and I am not ashamed of using insulin.  My mindset is that I will use whatever means necessary to stay in control.

Ask your doctor for a referral to a CDE who is trained in teaching insulin use.  My doctor refused to write the prescription for insulin until I went to the insulin start classes given by a team of well trained CDEs.   Not everyone here goes to them, but I think they were a tremendous help and my doctor was right.  I learned how to calculate how much insulin I needed by carefully recording what I ate and what I dosed for each meal.  Practice makes perfect.  At first I was put on a very low dose of insulin plus oral meds.  I eventually asked for just insulin and stopped the oral meds.  It took me 2-3  months to get it right.

We eat out alot and I have favorite dishes at various restaurants.  I now know how much to dose if I go to an Indian restaurant, or a Chinese buffet or whatever.  I check my log before I go, and then dose accordingly when I get to the restaurant.  I do travel with a little book of carb info.

Re that banana:  did you weigh it?  The usual portion is half a small banana.  Check your books or on-line to figure out the number of carbs for the weight of your banana (or whatever it is you are eating).  When you know your insulin-to-carb ratio, you can take the correct dose before eating.  When one is overweight, it may take a bit longer for the rapid insulin to take effect, so dose about 10-15 minutes before eating.  I also enjoy fruit, but I make sure that I have it with a meal that includes protein and some fat, so the fruit will not spike me.  Most of us have more trouble with carbs in the morning than at any other time, so bananas might be best as a treat for lunch or dinner.

Most people on insulin are not low-carbers.  Low carbing is necessary if you don't want to use meds, or to use only minimum meds.  I rather eat a varied and healthy diet, plus have a few treat days here and there.  I've had diabetes for 20 years and so far no complications since diagnosis.

Good luck in your endeavors.  I think you are on the right track.

[deafmack]

John Walsh's book has nothing to do with diet. It is about appropriatle dosing insulin and is more geared to those with type 1. I think you if you are looking at it as a book to promote low carb diets that isnot its purpose.