[Editor’s note: This article was originally published in 2017.]
I was diagnosed with type 1 diabetes about ten years ago, as a college student. During my hospital stay, I learned about the day-to-day management of diabetes, including regular blood glucose checks, insulin administration, as well as diet.
A nutritionist advised that I should consume 210 grams of carbohydrates daily, including three meals of 60 g and a bedtime snack of 30 g. I followed the advice diligently and logged my blood glucose four to six times a day for my doctor to review.
After the first few weeks, my A1C was well on its way down, but I was still logging many results in the 150-350 mg/dL range. My doctor explained how to experiment with making insulin adjustments based on my pre-meal result, as well as how to gradually titer insulin doses in response to blood glucose trends. Making my own adjustments based on my observations became my biggest tool in managing diabetes.
After gaining almost forty pounds in the span of just a few months, I thought that perhaps the nutritionist’s carb consumption recommendations were too high for me. I stopped trying to consume 60 g of carbs with every meal and added flexibility to my diet, sometimes consuming 60 g a meal, but many times consuming 30 g or 40 g and adjusting insulin accordingly. I was happy to lose twenty pounds and to be at my optimal weight.
For many years, I ate this way — consuming anywhere from 100 to 200 g of carbohydrates a day. I would simply calculate the carbohydrates in what I was eating and take insulin for it. My A1Cs vacillated from the low 6 percent range to the high 7 percent range for most of this time.
My doctors always said that I was doing well. I still had many highs and lows, but I was assured that this was normal for a diabetic. However, the stress of worrying about my blood glucose dropping during exercise or when I was teaching was taking its toll. It felt easier to run higher to avoid going low.
A few years ago, my A1C came back at an all-time high since diagnosis. At the time, I had started a new job after completing graduate school, had a stressful commute, and had little time to focus on diabetes. However, knowing that I wanted to start a family soon prompted me to seek a more effective and consistent way of achieving better blood glucose control.
I started to wear my Dexcom continuous glucose monitor (CGM) more frequently to try to understand where I was going wrong. Seemingly, no matter how much effort I was putting in, I was still experiencing frequent blood glucose spikes above 200 mg/dL. This was frustrating because I was very diligent in my carbohydrate counting, insulin timing, making frequent adjustments, and trying to keep a consistent exercise routine.
I read many books about diabetes management to try to gain tighter control. I joined many diabetes forums and read the blogs of seasoned diabetics to gather as many strategies as possible. One day, I came across a website that contained free chapters from the book “Diabetes Solution” by Dr. Richard Bernstein.
As a scientist, one idea that I read about particularly struck a chord with me: “the law of small numbers.” Essentially, by minimizing carbohydrate consumption and insulin use, any errors in carbohydrate counting or insulin dosing can be greatly minimized.
Many variables can affect insulin absorption and its activity profile: the time of day, the site of injection, the integrity of the insulin, and insulin sensitivity at the given moment, just to name a few. In addition, it is difficult to pinpoint the exact number of carbohydrates in fruit, and the allowable error on nutrition labels and blood glucose meter accuracy can be up to 20 percent.
Altogether, these variables can make it incredibly difficult to perfect insulin dosing for meals that are high in carbohydrates. Injecting a larger amount of insulin to cover a larger amount of carbohydrates is more likely to result in suboptimal insulin dosing, and thus more variance in blood glucose. In contrast, small amounts of carbohydrates and the corresponding doses of insulin yield smaller, more manageable errors.
At first, I wondered if the diet proposed by Dr. Bernstein would be too restrictive for me. After all, eliminating all grains and sugar seemed like a very big jump from the “typical” American diet. However, after seeing so many success stories online, I decided to try it for myself.
After just a week of eating this way, my blood glucose average dropped by about 60 mg/dL. During this time, I also learned that I needed to learn to calculate insulin doses to cover protein intake, because while protein digestion always results in a rise in blood glucose, the rate of this process is higher when one consumes fewer carbohydrates.
Amazingly, I did not feel deprived. I learned that although I was no longer eating sugar and grains, I could eat everything else. I also learned that there is a low-carb alternative for literally everything.
What was even more amazing was the difference in the way I felt. I had more energy. Seeing my efforts reflect so quickly and dramatically on my blood glucose average and stability was something I was incredibly proud of.
In addition, I now felt hopeful that a more “normal” life was possible with diabetes. I never had giant amounts of insulin on board anymore. As a result, whatever lows I had were mild and easy to treat precisely. I was also able to achieve more predictable blood glucose with less effort during exercise.
Perhaps what made me the happiest, since switching to a low-carbohydrate lifestyle, was having an easy and healthy full-term pregnancy. Throughout, I maintained normal A1C levels (between 5 – 5.7 percent), and according to my Dexcom report, was able to maintain normal blood glucose (60 – 120 mg/dL) about 90 percent of the time, something I never thought I would be able to achieve.
My advice to anyone looking to make improvements in blood glucose management is to try new things before making any assumptions about whether or not they will work. I was skeptical that this way of eating would not work for me for one reason or another. However, it turned out to be incredibly positive and truly life-changing in helping me to optimize my diabetes management.