Not all diabetics who eat low carb are following the same approaches or rules. What’s low carb to you may be high carb to me. That’s why this Low Carb vs High Carb series has been so interesting. It allows us to see what works for others and to gain new perspectives on living with diabetes.
Please share your name, a bit about yourself, your recent A1Cs, and your general approach to a low carb lifestyle.
My name is Holly and I was diagnosed just 2 years ago at 29 years old. Since my diagnosis, my A1Cs have ranged from 4.5 to 5.4. I have a Dexcom – which I believe is the most important key to my success – in addition to still being on injections. I think with injections, you need to think just a tad more more carefully about what you will eat, how you will eat it/correct it, and when you will eat it/correct it. I eat cleanly – organic when possible – no gluten, no processed foods, and I typical eat the same foods over and over again. I also maintain a strict schedule.
(Note: I do hope to have pump in the next year because I feel it’s really important to at least give it a try/know all my options. I’ll be very curious if that will change my mindset on being lower carb or A1C results by being able to just a push a button instead. Stay tuned!)
Have you always eaten low carb? What other perspectives can you share that led you to eat low carb?
I had a working pancreas for 28 years, so no! I was diagnosed gestational diabetic with my first (and so far only) pregnancy at age 28. It was a total shock being a super healthy person to begin with. After meeting with the dietician while pregnant and learning about nutrition, digestion, and gestational diabetes, I decided to keep things very clean and lower carb. (I had been eating Paleo prior to pregnancy for almost 5 years – my husband has serious gluten sensitivity, so I switch to support him. In some ways, it’s wasn’t super hard to make the transition having been Paleo.) I maintained tight control and never needed to take insulin in any form the remainder of the pregnancy. I had a very healthy baby boy and continued to eat lower carb after his birth. Knowing what we know now, I am told my pregnancy sparked the T1D and I was never actually gestational diabetic. They also believe my lower carb diet played a key tole in the reason my honeymoon period lasted so long or why I went undiagnosed for almost 6 months.
I strongly feel that being diagnosed as an adult, it was more of a scared straight program for me. I had this little infant who needed his mama and as many of us feel at diagnosis, I was lost, terrified and feared the worst. I knew I needed to be in the best health possible so I could see my little man grow into a big man. That was HUGE motivation. Knowing that lower carb worked to keep me off insulin while pregnant, I focused my all my research and reading on how that could help manage my new life as a T1D.
On average, how many carbs/grams do you consume per day?
I try to keep it below 60g – no more than 30g for lunch or dinner. Breakfast I eat almost next to no carbs since l tend to run higher in the morning – eggs work great plus maybe a mini protein bar (I like Lara Bars or KIND minis) later in the morning when I need it/if I start to trend downward. I do allow myself cheat days because of parties, traveling, special occasions and hey, LIFE happens. We’re human – even us lower carb people. I’m not perfect by any means! I totally have days where I let things slide a little for the sake of living a little bit or because I’m tired…. T1D is not easy to live with all the time.
What is your approach? Do you eat only certain foods, exercise, etc?
I generally eat the same foods – for meals, snacks, and lows. I cook a lot of Keto recipes. I stick to foods that I know work for me: meat, veggies, eggs, some dairy (mainly just cheese and heavy whipping cream – limited milk), nuts, and just berries for fruit – in small amounts. I enjoy pieces of dark chocolate as a treat if I’m slightly starting to trend downward. If I want to bake, I find recipes with almond flour, eggs, and cream cheese as the main ingredients and use stevia to sweeten. (I actually grew some in my garden this year!) I only drink water, coffee, and red wine. For lows, it’s a half an apple juice box or half a Fair Life Chocolate Milk single serving – sometimes I just take sips and wait until I see my BGs slightly rise. I’m very conscious about how much I eat and when I eat it. I weigh my food when I’m at home, I’m always reading labels, I’m always doing calculations, and I’m always looking at my Dexcom for trends, which I use to tell me when to start eating or making a slight corrections. I’m always eating in moderation – this is really important!
In terms of movement, I’m on my feet all day as a teacher and chasing a toddler the rest of the time. I practice yoga a few times a week when/if I can squeeze it in at home – hoping to join a studio soon. Something important I learned by starting yoga is also mindfulness. I truly think mindfulness helps control stress and worries with T1D, which can also really impact your blood sugars – especially during the extremes. Re-training yourself to think about them differently and NOT panic is important. it took me awhile and my husband has played a large role in helping me do this. It’s also really good to have a support system – mental health is just as important as the physical in this fight.
What kind of after meal blood sugars do you typically see with low carb eating?
On really good days, I can keep it around 130/140 mg/dL. On off days, I can keep myself around/below 170mg/dL and return to the 100mg/dLs 2 hours later. Just like any other T1D, when I’m sick, menstruating, off schedule, trying a new food, or somewhere I have to guess what is in the food/limited options, this all goes out the window. Those rougher days, I’ll spike easily into the mid-200s – even if I have almost no carbs. (To be really honest, haven’t seen anything in the 300s since diagnosis with choosing the lower carb life.) When these more extreme spikes happen and I’m not sick, I’ll try to drink more water before I correct. I have also been known to start doing some yoga after a meal if the setting allows. Hydration and movement can really help bring the numbers down quicker before adding more insulin to the equation sometimes.
Do you need to bolus for protein or fat? If yes, how do you do it?
I never bolus for protein, but sometimes for fat. Usually only the fat in dairy. I’m still not very good at predicting this one and still figuring it out. (I’m still very much a Padawan learner amongst the Jedi Low Carb masters!) For example, if I eat cheese by itself, I hardly need any insulin. BUT if I eat it with other food/in a meal, I’ll take an extra unit or two about an hour after eating knowing that cheese fat will spike me later. It’s all about knowing your digestion, your body, and your needs.
How often do you have low blood sugars? Is this something you worry about with a low carb lifestyle?
I would say I have a really bad low (which for me, it’s between 55mg/dL- 60mg/dL – seldom any lower than that) about three times a month. It’s almost always because I tried a new food, I’m off schedule, I’m sick, I’m menstruating, or slept through an alarm. I think being diagnosed as an adult, I don’t fear lows they way many others others do I’ve met in my journey. I fear highs more than I fear lows. Mainly because I can correct a low faster than a high.
If drop into the 70s for awhile, I’ll let myself hang out there for extended periods time if I’m stable. No reason to worry/treat until it dips below that or the arrow is pointed in a downward direction. Because I always work with small numbers/small amounts of insulin, I’m very on top of how much I’ll need to correct or anticipate to correct – which took about a year to understand with lots of observations and notes. I usually do just half a juice box for these corrections so I don’t over correct and only taking the other half of the juice box if I don’t rise after 15 minutes. It’s a lot of patience and discipline – especially to power through any horrible panic feelings of eat the whole fridge when super low. Mindset is important and focusing on not overeating during lows helps keep me in better control for sure.
If you use a CGM, what is your blood sugar standard deviation? This is interesting to see the overall control of blood glucose values.
I’m not actually sure – I don’t hook up my Dexcom to my computer at all. And I honestly? I have no interest in knowing. What’s most important to me is more how I feel (physically and mentally) each and everyday. I take one day at a time – literally. My focus is more on if I’m able to keep to my goal of staying between the lines each day/maintaining that semi-normal range. If it’s an off day, I focus on what I can learn from it and move on.
What do you think is the biggest key to eating low carb and maintaining an A1C less than 6%?
Listen to your body and work to understand how it processes the food YOU eat. It’s not a matter of just reading labels, counting carbs, exercising like crazy, reading books, or reading this interview how I do it – there’s so much more to it. It’s a lot of work, maintaining routines, and self control. Everyone is different, everyday is different, and every meal/situation is different. You need to be true to yourself and your own goals!!
Anything else you’d like to add:
With barely 2 years into diagnosis, I didn’t realize how sensitive people can be about their A1C. Particularly how you are judged on it or what you do or do not eat. I’m still very new to T1D etiquette and it’s not like someone sat me down after diagnosis and was like “Hey, these are things you might want to stay away from talking about if you happen to fall in these categories….” I just see it as information. What you do with that is up to you. I learned really fast you can be judged for having a super low A1C just as much as people with a high one. About a year into diagnosis, I stopped sharing my A1C when it started to dip into the high 4’s because people seem to feel I either 1.) I have poor control/multiple episodes of hypoglycemia/not care about being low, 2.) think I’m some sort of freak of nature/still honeymooning/eat lettuce and celery all day long/run marathons/never spike at all, or 3.) I’m a liar about it all.
We all have our own demons we are facing in this battle. I never judge anyone on theirs and provide support to all. I feel an A1C is like swimming or running – everyone has their own personal best (and worst!) and their own accomplishments/goals depending on those circumstances. We need to focus on supporting the individual – not the number.
Thank you, Holly!
The fact of having a super low (but NORMAL) A1C is sometimes just as criticized as a high A1C. But when you know YOU are in control, don’t let the hatters hate! It’s important to learn what works for you and what you can learn from others; perspective is everything.
Post your questions here so that Holly can see and answer them! If you’re wondering about something, more than likely someone else is too.
P.S. Holly is not a medical professional, neither am I. This is her personal experience and is not meant to be taken as medical advice.