When I was 20 years old, I was diagnosed with type 1 diabetes, which is considered late-onset because T1D is usually diagnosed in kids. Throughout my 20s, I diligently followed the low GI, low fat, moderate-high carb, food pyramid guidelines that I was told to. After nearly a decade of unmanageable levels, I made the transition to low carb and haven’t looked back since.
A bit about what diabetes is
A diagnosis of type 1 diabetes happens when the immune system attacks itself and destroys the beta cells in the pancreas. Beta cells produce insulin which is critical for glucose metabolism. Without insulin our cells cannot get energy from the food we eat, and they essentially starve. Insulin is therefore a requirement to stay alive, so anyone with T1D relies on taking insulin injections (or wearing an insulin pump 24/7) in order to stay alive. Insulin also has other functions, but glucose metabolism is one of them.
Type 1 diabetes is different to type 2 diabetes because with T2D the body can still produce insulin, but it becomes insulin resistant. So the insulin the body does produce has a hard time metabolising the glucose (carbs and sugar) that we eat. Which is why people with T2D are on medications or they might take insulin injections to help the body convert the glucose in the blood. Gestational diabetes happens only in some pregnant women, and they need to test their blood sugar, and may need to take insulin injections and convert to a low carb diet to help manage the resistance, but it usually goes away after giving birth (but not always, as with my type 1 friend Renae whose gestational diabetes turned into type 1). Pre-diabetes is a precursor to T2D where the body becomes insulin resistant, which results in higher levels of blood glucose, but not enough to be considered diabetic yet.
What it takes to manage T1D
I now take several insulin injections each day and use 3 different type of insulins which are slow acting, medium acting and rapid acting to manage my basal and bolus doses. I take usually 6-8 injections a day, but it depends on how many meals I have, the type of foods I am eating, and how many corrections I may need to take. Most people with T1D will take about 4 injections a day, plus any corrections. Basal is background insulin for non-food related function, and bolus is the insulin you take for the food you eat. There is a lot of thinking and calculating involved, and even though I was never good at maths at school, I think I am a master at algebra now! I am constantly calculating how much carbs or protein is in every bit of food I am eating, the ratio of insulin I need and the best timing for the injection (e.g. 30 mins before, 10 mins before, at the meal, after the meal).
Every time I put food in my mouth, I am thinking about what my carb or protein to insulin ratio should be for the food I am eating for this particular day. Whether I have exercised, if I am feeling stressed, if I haven’t slept well, if my hormones are all over the place, whether it’s a hot or cold day, whether I had a drink last night or not, if I’m sick, how much fat/carb/protein is in my meal, etc… all make a significant impact on my insulin doses and timing of the injection. So it is never a simple process of matching carbs to insulin, there are a lot of factors that come into play. (Have a read of DiaTribe’s 42 Factors that affect BG).
I thought I was a pretty “good” diabetic. I diligently followed the low GI, low fat, moderate-high carb, food pyramid guidelines that I was told time and time again that I should follow. I checked my blood sugar regularly. I ate low fat, cut out full cream milk and included plenty of wholegrains such as oats and wholemeal bread as well as low GI fruits and veggies like sweet potato in my diet. I attended carb counting workshops and tried what I felt like was everything to get in control of my diabetes and manage my blood sugar levels.
Unfortunately and despite my best efforts, for a lot of the time my levels were a constant up and down rollercoaster, with hypos and highs through the day and night, at work and at uni, during and after exercise; the highs and lows could happen at any time. I regularly had to wake up through the night to treat a hypo, and there were times where I would wake in such a dizzy, sweaty mess that I was so lucky to have my partner next to me to help feed me sugar in those moments when I could barely function. I would then wake up a few hours later and go to work like everyone else, except I was exhausted and usually suffering from a 3am post-hypo carb-binge high.
The highs made me feel horrible. Nausea was a normality, irritability was common, constantly feeling thirsty was just what I considered normal, and feeling fatigued was just a part of having diabetes and sleepless nights, I thought. This is how I was managing day to day. At times I got really down about my diabetes, and it was difficult to lead a normal life. I often felt tired, sick, irritable, and needing to stop what I was doing to fix a low or high. I was anxious to exercise because of fear of having yet another hypo, and I was injecting such huge quantities of insulin at each meal, not really sure if it was too much or too little.
A turning point was at a friend’s party where I was eating bread and dip and discreetly giving myself insulin injections to cover it, and then plummeting to a low from too much insulin which resulted in tears and having to leave the party from feeling so distressed by it all. I couldn’t just enjoy myself because I was constantly thinking about carb quantities and insulin injections and obsessing about checking my blood sugar levels and then feeling upset if I got it wrong as a result of a high or low.
Something had to change because it wasn’t a sustainable way to live anymore, so I took it upon myself to read everything I could and connect with other type 1s who were managing their diabetes successfully.
Transitioning to low carb
I feel so thankful to have a group of type 1 friends who I met through networking and support groups who are strict low carbers and have given me the support and advice I’ve needed to transition to low carb and stick to it. There are lots of online communities on Facebook too, and you can also find networking groups on Meetup or through Diabetes Australia. I strongly encourage you to reach out to other people going through the same thing, especially if they have found success with their diabetes management. Everyone is different, and all my type 1 friends have a slightly different management style, but it is important to have people around you who can provide little tips and moments of support.
In addition, I searched until I found a dietitian and diabetes educator who would support my transition to low carb and she helped me massively. She helped me learn about counting proteins, about how much fat should be in my diet now that fats were going to be my main source of energy instead of carbs, and how I should adjust my insulin accordingly. You can find a good low carb dietitian (preferably one who is a also a credentialed diabetes educator too) if you ask around or search for it. Also, having a good endocrinologist and GP who gets it will also really help. I didn’t always have this, and it actually took me a while to find health professionals who supported my way of managing diabetes, but it is now a lot more common to be low carb so it is easier to find professional medical support.
I read a lot – articles, books and studies – and the more I read the more I am convinced that low carb is the answer to diabetes management (both type 1 and type 2). It became so clear to me that if I don’t produce the hormone that converts glucose to energy, and if there are other energy pathways through protein and fats, then why am I feeding my body with so much glucose in the form of carbs and trying to cover it with massive doses of synthetic insulin?? It just didn’t make any sense to me.
I started playing around with low carb meals. I ate eggs for breakfast or lunch (scrambled eggs, omelettes and frittatas), started eating avocados, cooked up bacon and got my hands on some low carb bread. I ate salads for lunch, adding in tuna or chicken or eggs, and switched my pasta and rice meals to simple meat and veg. I got cooking courgetti, cauliflower mash and cauli-rice, and I realised I wasn’t missing out at all. I was eating delicious steamed fish at Thai restaurants instead of noodles, I was having the steak and salad at the pub and grilled fish from the fish and chip shop, and I was enjoying it so much more than what I was eating before! Plus, massive bonus when I saw my levels drop to a normal range and hypos reduced significantly too because my insulin doses were now so much lower.
As I started reducing my carbs, I started thinking clearer. I wasn’t foggy headed anymore, I could concentrate and I wasn’t constantly thinking about where my blood sugar was at, I didn’t need to drink a litre of water every hour, and I was sleeping through the night! I could exercise without going low after, plus I could exercise without being tired or have a high blood sugar to start with so I could run for longer and faster. Things were looking really good, and I started to feel so much better. I was getting comments on how I had lost weight (which wasn’t even in intention) and I was looking better and healthier. I must have looked pretty sullen before without even realising it, but as I look back on photos I can see I looked bloated, grey-faced and tired.
Maintaining low carb
I can honestly say that I don’t miss bread, pasta, rice, potatoes, cakes and sugary treats and I don’t crave them anymore like I used to. I will occasionally have a bite of my friend’s pasta or a sip of someone’s milkshake out of curiosity more than anything, but it’s not something that I feel like I am missing out on. I find sweets way too sweet now, and pasta and rice just bland. I don’t feel the need to binge eat carbs, so there’s no way I would be craving a plate of pasta or a bowl of noodles anymore. I always want to base my meals around lot of veg now, so even if there was a plate of pasta there, I would only want a small quarter of a plate of pasta with a lot of veg and protein. My meals are mostly veg and protein, with some healthy fats, which I find really satisfying and tasty, and much healthier overall.
It’s amazing how the body adjusts. After a couple of weeks, the cravings for carbs start to dissipate. Any headaches you might experience from the change in blood sugar levels and the reliance on glucose only lasts a couple of weeks. After a month or two, you start to feel really good; lighter, happier, less moody, and it’s easier to jump out of bed and get on with the day.
My advice to stick to low carb…
- Do a haul of the food in the house. Give away the potatoes or chips or bread or biscuits you have lurking around.
- Find the foods you do love. I have stacked up on peanut butter, low carb bread, low carb pancakes, nuts of all types, cheese, olives, cold meats, low carb veggies (I can’t get enough eggplant, zucchini, capsicum, cauliflower and broccoli!) and frozen berries.
- Find good substitutes for the carb foods you love. E.g. zucchini noodles for pasta, cauliflower rice for rice, cheesy cauliflower bake for mac and cheese, low carb bread for sandwiches, toast and toasties, sugar free maple syrup and low carb pancakes, that sort of thing.
- Don’t get down on yourself if you have the occasional potato off someone else’s plate or a sip of an iced coffee. We only live once and going low carb isn’t about deprivation at all. I let myself have a little bite of something every now and then, as it reminds me that these foods should only be treats and not everyday foods!
- Remind yourself why you’re doing it. If I’m having a weak moment, I remind myself how good my levels are now and how great I am feeling and I would never want to go back to what it was like before.
- Pack low carb snacks with you when you’re going on a day trip, getting on the train, going on a plane, or going to work. Having a bag of nuts or something I can munch on when I’m out always saves me. Low carb snacks are popping up now at supermarkets and convenience stores too, but you still need to search for them next to the chocolate bars.
- Find your crew. Network with other people who can support you along the way.
- If someone is not helping you – anyone, whether it is a friend, family member or health professional – don’t take on their advice. Only take on the advice that is having a positive impact on you. Someone might have the best intention with their advice, but if it doesn’t serve you, listen politely, but don’t take it on board. I learnt this the hard way, because I kept listening to the advice that simply wasn’t working for me. Everyone will have their opinions. I have had lots of conversations with dietitians and other health professionals, other people with diabetes, and friends and family, and not everyone will agree with my approach. But I do what works for me and I won’t let anyone change that because it is my life in the end.
- If you slip up, don’t be hard on yourself. I am known to have the occasional avocado on toast or an apple, but I don’t do it all the time and I know the consequences I have to deal with. I might need more insulin, I might have a hypo after if I have had too much insulin, and I might have a high following the meal. I know if I have something low carb instead, I will be able to manage my levels much better, though. I am realistic with my expectations on myself.
What I eat and drink:
- Plenty of low carb veggies (green veg such as spinach, zucchini, kale, Chinese greens, lettuces, leek/onions, asparagus, Brussel sprouts, cauliflower, capsicum, eggplant, broccoli, cucumber, tomato)
- Plenty of avocados and other fats including olive oil, macadamia oil, butter, coconut oil, nuts and seeds
- Herbs and spices on all my foods including salt, pepper, chilli, fresh herbs, as well as cinnamon or vanilla on sweeter foods
- Lots of eggs. I make omelettes or frittatas for lunch or dinner regularly. Baked eggs with leftover mince and roasted capsicum/eggplant is also a fave.
- Almond milk, full fat dairy including cheese and Greek yoghurt
- Courgetti and cauli-rice or cauliflower mash with almost anything
- Low Carb Pancakes with Queen sugar free maple syrup, Greek yoghurt and warmed berries or butter or Nativa and lemon
- Low Carb Bread for toast, sandwiches, toasties, foccacia and low carb pizza made with ALCK Bread Mix
- Steak/chicken/fish with salad or veggies
- Curries and casseroles with lots of veg and a side of cauli-rice or mash
- Soups made with low carb veg
- Salads with lots of protein and good fats
- Berry smoothies, low carb granola/porridge or Greek yoghurt with berries and nuts
- Cheese, low carb crackers, veggie sticks, cold meats and low carb dip such as basil pesto, baba ganoush or tzatziki
- I drink black coffee, tea, herbal tea, water, almond milk, red wine or spirits with soda water
- ALCK cakes, muffins, cookies and slices for something sweet or a quick and easy breakfast, treat or snack on-the-go
- A couple of squares of dark chocolate with a tea at the end of the day if I feel like something sweet
- Peanut butter, tahini, other nut or seed butters (which is delicious with a square of melted dark chocolate)
- The occasional higher carb fruit, veg or bean/legume, such as carrot, pumpkin, small amount of beans or lentils say in a soup, the occasional low carb banana bread or banana smoothie, or apple/pear/kiwi fruit if I really feel like it (but I will have this only occasionally and only in small quantities)
I avoid bread (except for low carb bread!), chips, corn chips, veggie chips, pasta, burgers (unless without the bun!), sugar (including honey, agave or maple syrup), high sugar fruits (such as pineapple), sweet cocktails (including espresso martinis!), low fat yoghurt (as it’s high in sugar), rice, sushi, cakes, biscuits, pastries.
I will have had diabetes for 12 years soon, and I can say that the last 2 years has been by far the easiest, since transitioning to low carb, and probably the most delicious.
Another article you can read about low carb for type 1 diabetes from DiaTribe: The Best and Worst Diabetes Food Advice I’ve Seen.
Before low carb
(I only have a few snapshots of my highs. After getting the Libre I realised just how bad my levels had been and tried the transition to low carb not long after. In general, I was high in the high teens almost every day, and sometimes up to the 20s, and usually had a hypo frequently due to over-correction.)
After low carb
(Beautiful flat lines at all times of the day and night………this is pretty much what my levels look like at least 80% of the time, and now a high for me is around 9 or 10, not 19 or 20, and I don’t get a spike after meals)