Diagnosed as Pre-Diabetic

Nutrition
41

[quote]DoubleDuce wrote:
I’ll go ahead and write this out, though there are more knowledgeable people here. I have read that both fasting glucose and AC1 can be as bad as 60% inaccurate (both for missing and false positives) for insulin resistance or pre-diabetic diagnosis’s (is that a word?). They both are supposedly pretty reliable for finding diabetes, but really suck for borderline people.

That would mean, that you most likely aren’t a full blown diabetic, but if you really want to know if you are getting close you basically have to do the long tolerance test.

Also, there are other things you can look for that may be affected if you are starting to have insulin problems. For example, low HDL and high triglycerides. The other thing I personally would want tested is inflammation markers. Elevated insulin and glucose even in non-diabetics can cause heavy inflammation in arteries and lead to heart attacks and strokes even without heavy plaque build up or blockages in arteries (which don’t actually directly cause heart attacks FTR). If you are insulin resistive, you are at substantially elevated risk for heart attack and stroke so it is much more than just wanting to avoid diabetes. [/quote]

If someone had a 107 and 110 morning fasting AND a 5.8 A1C in my opinion they are insulin resistant without long to go.

If someone had a 101 and was 5.4 they probably are tending toward high fasting blood sugars in the morning from the dawn effect. Even a 107 with a 5.4 might make sense. You can get a 107 with stress or dehydration or dawn cortisol or even caffeine withdrawal if you don’t drink it (or from drinking it in the morning) but a 5.8 means that you probably have been having 101-110s for a while.

If you had a 5.8 but your fasting is 95 that is a little different too.

So 5.8 and 95 is not critical. 5.4 and 101-107 is explainable, but 101-110s AND 5.8 is not. Its basically the very edge of the cliff.

42

[quote]mertdawg wrote:

So 5.8 and 95 is not critical. 5.4 and 101-107 is explainable, but 101-110s AND 5.8 is not. Its basically the very edge of the cliff.
[/quote]

Good point - I’m actually glad I caught this soon enough.

43

[quote]mertdawg wrote:

[quote]DoubleDuce wrote:
I’ll go ahead and write this out, though there are more knowledgeable people here. I have read that both fasting glucose and AC1 can be as bad as 60% inaccurate (both for missing and false positives) for insulin resistance or pre-diabetic diagnosis’s (is that a word?). They both are supposedly pretty reliable for finding diabetes, but really suck for borderline people.

That would mean, that you most likely aren’t a full blown diabetic, but if you really want to know if you are getting close you basically have to do the long tolerance test.

Also, there are other things you can look for that may be affected if you are starting to have insulin problems. For example, low HDL and high triglycerides. The other thing I personally would want tested is inflammation markers. Elevated insulin and glucose even in non-diabetics can cause heavy inflammation in arteries and lead to heart attacks and strokes even without heavy plaque build up or blockages in arteries (which don’t actually directly cause heart attacks FTR). If you are insulin resistive, you are at substantially elevated risk for heart attack and stroke so it is much more than just wanting to avoid diabetes. [/quote]

If someone had a 107 and 110 morning fasting AND a 5.8 A1C in my opinion they are insulin resistant without long to go.

If someone had a 101 and was 5.4 they probably are tending toward high fasting blood sugars in the morning from the dawn effect. Even a 107 with a 5.4 might make sense. You can get a 107 with stress or dehydration or dawn cortisol or even caffeine withdrawal if you don’t drink it (or from drinking it in the morning) but a 5.8 means that you probably have been having 101-110s for a while.

If you had a 5.8 but your fasting is 95 that is a little different too.

So 5.8 and 95 is not critical. 5.4 and 101-107 is explainable, but 101-110s AND 5.8 is not. Its basically the very edge of the cliff.
[/quote]

Any thoughts on pre-diabetes/IR and inflammation. I’ve read that it can cause inflammation, but don’t know the mechanism. Is it the glucose or the insulin or something else?

Also curious if you know at what point you’d start to see beta cells die. Can you see any permanent loss in Pre-diabetes?

44

[quote]DoubleDuce wrote:

[quote]mertdawg wrote:

[quote]DoubleDuce wrote:
I’ll go ahead and write this out, though there are more knowledgeable people here. I have read that both fasting glucose and AC1 can be as bad as 60% inaccurate (both for missing and false positives) for insulin resistance or pre-diabetic diagnosis’s (is that a word?). They both are supposedly pretty reliable for finding diabetes, but really suck for borderline people.

That would mean, that you most likely aren’t a full blown diabetic, but if you really want to know if you are getting close you basically have to do the long tolerance test.

Also, there are other things you can look for that may be affected if you are starting to have insulin problems. For example, low HDL and high triglycerides. The other thing I personally would want tested is inflammation markers. Elevated insulin and glucose even in non-diabetics can cause heavy inflammation in arteries and lead to heart attacks and strokes even without heavy plaque build up or blockages in arteries (which don’t actually directly cause heart attacks FTR). If you are insulin resistive, you are at substantially elevated risk for heart attack and stroke so it is much more than just wanting to avoid diabetes. [/quote]

If someone had a 107 and 110 morning fasting AND a 5.8 A1C in my opinion they are insulin resistant without long to go.

If someone had a 101 and was 5.4 they probably are tending toward high fasting blood sugars in the morning from the dawn effect. Even a 107 with a 5.4 might make sense. You can get a 107 with stress or dehydration or dawn cortisol or even caffeine withdrawal if you don’t drink it (or from drinking it in the morning) but a 5.8 means that you probably have been having 101-110s for a while.

If you had a 5.8 but your fasting is 95 that is a little different too.

So 5.8 and 95 is not critical. 5.4 and 101-107 is explainable, but 101-110s AND 5.8 is not. Its basically the very edge of the cliff.
[/quote]

Any thoughts on pre-diabetes/IR and inflammation. I’ve read that it can cause inflammation, but don’t know the mechanism. Is it the glucose or the insulin or something else?

Also curious if you know at what point you’d start to see beta cells die. Can you see any permanent loss in Pre-diabetes?[/quote]

I have considered the possibility that oxidized and glycated VLDL particles, the same ones that cause inflammatory heart disease are in fact the agents that cause beta cell death (as well as dementia and basically a lot of everything else). I am not proposing this, because both type 1 and type 2 diabetes become autoimmune mediated, but what if you just get beta cells damaged from these two agents and they leak contents which instigates an autoimmune response (like what happens after weight training or IF) and then the autoimmune responses become frequent and take long enough to down regulate that they destroy beta cells.

So possibly removing omega 6s would help. Anyway, sugar, and glycated VLDLs and triglycerides are inflammatory. VLDLs ARE used up during periods of immune activity like an infection.

I think that there is evidence that Beta cells are damaged when blood sugar AVERAGES go over about 108 (because there is an increase in CHD and other issues when averages excede that level. It is an A1C of about 5.4). It rises slowly but at 140 or about 6.5 it goes up much faster. There is question as to whether short term blood sugars over 140 cause beta cell death if averages remain normal, but I think that it is a good idea to minimize time over 140, and maintain an average of 90-108 (A1C of 5.0 to 5.4) and also to minimize the generation of oxidized VLDL and also minimize inflammation due to poor gut flora.

Beta cells can proliferate and regenerate as well as return to function. In fact beta cells are known to proliferate when more insulin is needed! This may mean that moderate, not low levels of blood sugar are best, in conjunction with improving insulin sensitivity. The pancrease can be rested, but occasionally challenged by moderate blood sugar level excursions for short periods of time.

45

And for clarity VLDL and triglycerides are also related to unused carbohydrate intake when converted in the liver, correct?

46

[quote]mertdawg wrote:

So possibly removing omega 6s would help. Anyway, sugar, and glycated VLDLs and triglycerides are inflammatory. VLDLs ARE used up during periods of immune activity like an infection.
[/quote]

So what’s your go to diet advice for the average lifter here who needs an optimal carb intake to fuel performance? I know you’ve said you are a lower(ish) carb guy, I think. Do you have preferred ranges of macros? Any foods that you normally avoid at all costs?

47

[quote]DoubleDuce wrote:
And for clarity VLDL and triglycerides are also related to unused carbohydrate intake when converted in the liver, correct?[/quote]

Yes. I am trying to put all of the pieces together anyway, but you are right that triglycerides, LDL and VLDL are largely due to having more than optimal glucose and also fructose intake. I’ll put some more in the next post.

48

So there are basically 6 things that knock out the pancreas.

  1. Overwork. This is complicated because it does NOT seem to kill beta cells as some suggest, it may simply lead to problems #2 and #3
  2. High acute blood sugars, that is to say periods and levels above 180, 160, 140. There appears to be little problem up to 140 in the short term.
  3. Oxidated and glycated lipids. I suspect that this is basically correlated to HbA1C above about 5, fructose intake above about 25 grams a day and spaced out, and PUFA above about 10 grams a day.
  4. Acute autoimmune response. I think that THIS may only lead to other problems, primarily #2. If you can survive the acute autoimmune responses without getting #2 and #3 then you might be able to out-regenerate beta destruction. Keep in mind that for insulin resistance, you will often have #1, and therefore #2 and #3 and the only way to avoid this is to improve insulin sensitivity. If you have idiopathic destruction you need insulin, but if you can survive the periods of #1, #2 and #3 you might survive the acute attack
  5. Chronic autoimmune destruction-this may be more of an end stage, and quite possibly the damage is done by #s2,3 and 4.
  6. UNDERWORK? Again without high blood sugar peaks over 140 and without #2 and #3, and during periods when #4 is not happening, beta cells regenerate, but not by disuse, by USE! Insulin can be stimulated without #s2-3 happening by proteins, fats, ketones.

So maybe insulin should be the FIRST step, to help avoid low blood sugars and get A1C under control and reduce damage.

Anyway, I would recommend mixed meals containing about 50% saturated and monounsaturated animal and plant fat like butterfat, some beef (low omega 6) and some of the good vegetable fats if you want. Keep in mind that butterfat is 1/4 monounsaturated, mostly oleic just like what is in olive oil with only about 3% linoleic. Then no more than 30% carbs, about 2/3 starch and 2/3 sugar. (Starch alone can yield basically a bomb of glucose all at once, while 1/3 sugar to 2/3 starch will lower the peaks of either one by itself. Then 20-30% protein.

Also add in things that reduce GI like whole milk, or vinegar, or citrus, or pectin, and cellulose. Equal size meals. And maybe walk for 10 minutes after or before a meal. I mean that is what I would do. You can have small carb-only portions but I think the key is to not have blood sugar go much over 140 after any meal, and keep average blood sugar at a level that gives a 5.0-5.4 HbA1C.

49

I’ve often wondered if slow carbs are really “better” for you because it seems like moderately elevated blood sugar and insulin for a longer period of time might be just as bad as spiking both for shorter periods. But you seem to be indicating that at least really high spikes might be worse? Or would they only be able to get that high once there is a problem, in which case moderate elevations for long periods might still be as bad for initially causing the problem?

50

[quote]DoubleDuce wrote:
I’ve often wondered if slow carbs are really “better” for you because it seems like moderately elevated blood sugar and insulin for a longer period of time might be just as bad as spiking both for shorter periods. But you seem to be indicating that at least really high spikes might be worse? Or would they only be able to get that high once there is a problem, in which case moderate elevations for long periods might still be as bad for initially causing the problem?[/quote]

I believe that it is very similar to oxidative free radical issues. The body can manage a certain amount in a certain time and above that level free radicals can’t be matched by antioxidants. See this: Glucose Toxicity in Beta-Cells

But if you have a lot of oxidized and glycated VLDL particles from chronically high blood sugar, that will contribute to the acute stress of a high blood sugar, so if your A1C is 5.0 and your dietary PUFAs are low, you might be able to handle a short period of a 165 blood sugar without going beyond your antioxidant ability. If your A1C is 5.8 and you eat 30 grams of PUFAs a day then being over 130 might start to destroy beta cells. Keeping PUFAs low, and A1C low then might give you a higher cutoff before you do any net damage. So it is important to keep your peaks under 140 for example, but also to keep your average blood sugar under about 110 to reduce glycated lipids that would compound the problem of a high blood sugar.

Long acting carbs like say rice may produce a greater period x peak above threshold because they turn 100% into glucose, while sugar turns half into fructose. That is why I think that there is SOME value in fructose/sugar combined with starch.

Keep in mind that glycolysis itself can stimulate Beta cell proliferation, so I do not believe that a 120 blood sugar for 2-3 hours is bad if your daily average is good. Having some carbs (100-150 grams) may produces lower peaks than someone on a low carb (30 gram) diet because it increases sensitivity and stimulates beta cell proliferation.

51

So just a guess here, but glycolytic exercise like 10 rep sets, or basically the things that promote the buildup of glycogen stores over time (10-60 seconds of continuous work) may increase signals and markers of glycolysis that regenerate beta cells. Less than 10 seconds may only use up ATP and CP which can then be restored by fatty acid oxidation.

So 20-40 second sled pushes and hard sets with weights might be one mechanism. Short term hypoxia after a set is a good sign of high glycolysis I think.

52

So as a Type 1 Diabetic I have some observations and awareness that may or may not be relevant. First of all, as mertdawg was saying, how you exercise has a huge impact on insulin sensitivity. Fully body exercises, compound movements done in the 8 - 12 rep range with multiple sets will do a ridiculously amazing job of increasing your insulin sensitivity. This is something I am very aware of due to the nature of my illness. This is one of those situations where you trains specifically for your health rather than for whatever else you want to do. If you want to bodybuild, great, this is more or less on track. But if you want to be a powerlifter, you might want to put things on hold until you get your health back. High reps, high intensity, lots of sets. Fully body.

Secondly, another great thing is complexes and conditioning. For just 15 minutes a day, you can crush insulin resistance in your body… Sorry, just saw and ad on TV and was inspired. But seriously, conditioning on your non-training days will help keep you insulin sensitivy.

Thirdly, diet. This may be heresy, but I’m speaking for health purposes here, not for ideal weight training purposes. I would recommend a mostly ketogenic diet with twice a week carb loading, and even then limit the carbs to 100 or 150 grams each time. The periodic carb loads will keep your insulin sensitivity from going bad and also help with leptin sensitivity. Keto may not be great long term, but for a few months, even half a year, it may do wonders for your pre-diabetes. Ketogenic diets have been shown to have positive short term benefits to certain health issues, and the carbs twice a week will help offset the insulin sensitivity issues your body throws out there for purely ketogenic diets.

Fourth, IFing. I would strongly recommend that you try fasting for one day a week. I mean, for the whole day. This shouldn’t be enough to significantly affect your ability to gain strength and muscle (unless you are an elite athlete, in which case it may very well fuck up your performance. But whatever). But IFing does seem promising with certain studies done (I need to find them) in treating T2 Diabetes.

My thoughts. good luck!

–Me

53

Kravi, my 9 year old son was recently diagnosed with type 1. In less than 3 months he is down from an 8.7 A1C to a 5.9. I am curious about parts of your post.

He is taking just 1 Lantus at night and 1 unit of fast acting insulin for each meal. of about 40 grams of carbs, but he has regained (temporarily) 80-90% of pancreatic function. So I wanted to have him optimally insulin sensitive so his own insulin could do the job of self regulation as much as possible. He now is doing even better averaging PEAKS of 115 after meals, and averaging 95 at meals.

Are you worried about going low carb and having a low blood sugar at night? I have checked him and he is usually about 110 at night until 2 am, and then slowly slides down to 90 and will stay above 70 even if he eats late.

Also is there worry that on a very low carb diet you will get ketoacidosis? How good are your blood sugar controlled? He doesn’t even hit 120 after meals, and sometimes will have a weird thing where he comes up to around 140-150 at bed, 4 hours after dinner even though he was 90-110 for 3 hours after dinner, but that’s when he gets his lantus, so he really maybe scratches 140 for an hour each day.

I decided to use mixed meals to prevent spikes, so he gets about 40 grams of carbs, about 24 starch and 16 sugar (so he doesn’t go low in the first hour) and about 15 grams of protein and then 50-60% of his calories from full fat dairy (half and half) butter and beef and some chicken. So his breakdown is about 55% fat, 20% starch carbs, 10% sugar carbs and 15% protein and it just seems to give him one long 4 hour run without any real peaks. He will just move up and down between 95 and 115 after breakfast, lunch and dinner until the last hour before bed when he comes up to the 130s.

Are you afraid to go to sleep with a blood sugar under 130? Or without a snack? He always eats dinner 3-4 hours before bed so I don’t expect that he will still be dropping from his dinner insulin at night.

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Lots of questions. The first thing I’d like to recommend is that you read the latest version of Dr. Bernstein’s Diabetes Solution. The doc is a diabetic, and changed how I thought about diabetes and dealing with it. That book got me from an 8.something HbA1C down to a 5.1. I could even go lower, but it isn’t worth it. :slight_smile:

First of all, your son is lucky in that is he likely still on his honeymoon period. So his pancreas, for a while, at least, is still making “some” insulin, which means he needs much less supplemental (injected) insulin than he will need later when his eyelet cells finish biting the big one. This obviously makes it easier to treat diabetes at first because you have more of a safety cushion.

Now as for getting sugar low at night, I am not worried at all. While low carb diets have their disadvantages, they also have serious benefits to diabetics. Diabetics (easier than writing Type 1 Diabetics, but this is who I’m referring to) do not need to inject a lot of insulin if they are eating low carb. Less sugar == less insulin. 3 units of novolog (or humalog) can only have a small effect on your blood sugars. If you are taking 20 units of novolog after eating pasta, for example, it is a huge amount. Should the carb source run out while the insulin is still active, you will get very sugar low, and if not treated, nasty complications if not death.

So low carb is safer. I eat carbs at lunch if I am weight training that day. Otherwise I eat very low carb. This means that I need usually ~4 units of novolog before dinner. At bed time, my blood sugars are around 95 - 105 usually, so I don’t need any more, just the lantis that I split into two injections a day. Because no carbs to raise my blood sugars, I don’t need much insulin to lower them (just the basal which counteracts the gluconeogenesis), and I wake up between 85 and 120 depending on a wide variety of factors. But again, the swing isn’t bad because small amounts of insulin (and carbs) mean small changes to blood sugar.

The biggest problem with conventional treatment of diabetics is that the treatments are left over from the old days. In the old days they figured that a drastic sugar low would kill you, being sugar high would not, thus diabetics should all eat carbs to avoid sugar lows, who cars if they get gangrene and erectile dysfunction form perpetually high blood sugar levels? At least they would survive the next 20 years despite it.

Now, because everyone can test their blood sugars regularly, that approach should be thrown away. But the medical profession evolves slowly. I think I explained the rational above.

So no, I don’t snack in the evening. And I have a very low carb dinner. This means I don’t have to worry about getting sugar low at night. At the same time, I can eat meat and potatoes for lunch, take more insulin, and have the carbs I need to train in the afternoon. I’m awake, so I can check my blood sugars and add sugar/insulin to keep me level, and by the time I’m in bed I have no residual carbs messing me up.

Let me know if you have any more questions! But seriously, read Dr. Berstein’s book. It is fantastic and a lot more coherent than I am. He’s a Type 1 and really gets it. :slight_smile:

–Me

55

[quote]kravi wrote:
So no, I don’t snack in the evening. And I have a very low carb dinner. This means I don’t have to worry about getting sugar low at night. At the same time, I can eat meat and potatoes for lunch, take more insulin, and have the carbs I need to train in the afternoon. I’m awake, so I can check my blood sugars and add sugar/insulin to keep me level, and by the time I’m in bed I have no residual carbs messing me up.

Let me know if you have any more questions! But seriously, read Dr. Berstein’s book. It is fantastic and a lot more coherent than I am. He’s a Type 1 and really gets it. :slight_smile:

–Me[/quote]

I’m awful about night snacking, or at least I have been in the past. I don’t eat a ton of archetypal junk (e.g., candy, processed baked goods, sugary drinks, etc.), but if I have carb cravings I can sit down and eat a cup of Greek yogurt and 4-6 servings of oatmeal or grits with protein powder which, while not terrible, is still a big carb load a few hours before bed. Thus, I’ve had the propensity to overeat on complex carbs later in the evening, which might have exacerbated my problems in the past, and on some of those days I certainly did exceed a normal 200g/day carb intake on training days (normal is 100g or so on off days).

56

I have read some point, counterpoints with Bernstein. Again, my son is on “low” but not extremely low carbs. He gets just under 30% so the other foods help to make the digestion very slow. I have read a lot of research that insulin sensitivity is highest when the brain glucose needs (about 100 grams glucose) per day are met by diet. This is still VERY low by what my son’s doctor wants, basically 65% carbs, but yea my thinking was that lows come from dosage errors or inaccuracy, but also people with more than about 30% carbs gradually become more and more insulin resistant over time and have to increase their doses.

I mean, he gets 1 unit of humalog and 42-44 grams of carbs at 4:30 pm basically every night, so I don’t think that if he is 105 at bed time 4 hours later, 1 unit of lantus is going to make him go low. He wakes up between 74-95 on 1 unit of lantus every day.

I am also limiting his omega-6 intake which is something that Bernstein doesn’t know about, or at least didn’t care about when he was working on his own nutrition. Omega-6s oxidize and are the primary causes of heart disease, and also tissue damage, so I am thinking that by keeping his blood sugar between 70-120, even during peaks, and keeping his omega-6s low, he can maintain beta cells for a while, although one year is considered “long” I almost think that the doctors WANT to knock out the pancreas so that you are dependent on insulin, or at least in their minds, you have to face the inevitable reality sooner.

Another issue with Bernstein is that I’ve seen strong evidence that TOTAL mortality by ALL causes goes up when HbA1C goes under 5.0. 5.0-5.4 produces the greatest (basically normal) lifespan. Going below 5.0 may reduce heart disease a little (down to 4.6) but it raises stroke risk even more. Also there is evidence that Beta cells continue to grow in small pockets and that they are stimulated (not killed) by blood sugars in the 110-130 range, so again trying to stay super low may not be best. Some people have pockets of Beta Cells after 15 years. Bernstein claims that his HbA1C is 4.2 which is below optimal for overall lifespan, and would be in-line with an average blood sugar of 70. Also I have read that type 1s without beta cells can go into ketoacidosis even with low blood sugar if they get liver glycogen depleted and don’t have enough insulin to shut down gulcagon. So I am a little worried that super low carbs won’t provide enough insulin to prevent ketoacidosis under stress.

I DO think that developing mild ketones is good because it trains the liver to produce ketones with blood sugars in the 60s and 50s to support the brain. Under ketogenic conditions it appears that the brain can do fine with a 60 blood sugar that would cause a lot of stress without ketone. I personally prefer to have him IF not for a day, but by eating dinner early, around 4:30, with breakfast at 7:30, meaning that all of his food intake is in about a 9 hour window. This gets him small ketones in the morning WITH blood sugar in the 70s occasionally.

By the way, he loves the way he eats. He is not hungry. He really feels good. His carbs are basically cut in half from before his diagnosis and his fat intake is doubled. I had to look at a meal plan that worked for him psychologically first, and fortunately he has really good results so far. The plan is that as he grows, I will not increase his carbs from the approximately 125 grams a day that he has now, but I will simply ADD more quality fats to each meal.

57

[quote]mertdawg wrote:
I have read some point, counterpoints with Bernstein. Again, my son is on “low” but not extremely low carbs. He gets just under 30% so the other foods help to make the digestion very slow. I have read a lot of research that insulin sensitivity is highest when the brain glucose needs (about 100 grams glucose) per day are met by diet. This is still VERY low by what my son’s doctor wants, basically 65% carbs, but yea my thinking was that lows come from dosage errors or inaccuracy, but also people with more than about 30% carbs gradually become more and more insulin resistant over time and have to increase their doses.

I mean, he gets 1 unit of humalog and 42-44 grams of carbs at 4:30 pm basically every night, so I don’t think that if he is 105 at bed time 4 hours later, 1 unit of lantus is going to make him go low. He wakes up between 74-95 on 1 unit of lantus every day. [/quote]

Remember, while your son is still in the honeymoon period, his diet will be a lot more forgiving. I’m not saying that ketosis is necessary, just that low carbs mean less insulin which means less significant swings of blood sugar. When the honeymoon period ends, it gets more difficult.

I don’t disagree with you at all, and neither does Dr. Bernstein. I’m not 100% on him, it is more the general approach that I agree with. I wouldn’t worry so much about low omega-6s and more about enough omega-3s. The concept of a 1:1 or 1:2 ratio of omega3s to omega6s has been fairly thoroughly debunked. It is more an issue of avoiding the bad omega6s and making sure you receive enough omega3s :slight_smile:

Remember that these studies are mostly crap. Most of the people with a HbA1C below 5.5 have low blood sugars because they are swaying between 220 and 45 during the day. If you have blood sugars that don’t drop below 80 more than once a week or two, you are not going to have the accumulated damage that consistent low blood sugars cause. IE the studies on people who have low HbA1Cs don’t allow for the fact that many people with lower numbers have frequent sugar lows. That is bad. The fact that Dr. Bernstein is like 500 years old (I exagerate) and is in great health at least indicates that by avoiding both sugar lows and sugar highs you can avoid alot of side effects. If the only way to get below 5 is to have lots of sugar lows which then “balance” out the total numbers, you might have problems.

Again, I wouldn’t stress ketosis (very different from ketoacidosis). Avoiding the sugar lows is key, and to do that you need to avoid larger amounts of insulin. There is a good facebook group for Paleo Diabetics with a lot of interesting information on it. PM me if you care to join. Carbs aren’t evil, it is just that carbs require more insulin, insulin can cause fluctuations, thus minimize insulin. Being in ketosis arguably increases insulin resistance because your brain needs a minimal amount of glucose, so it wants to make sure that the limited amounts you get (in ketosis) go to the brain, hence insulin resistance. But also don’t forget that gluconeogenesis can produce most, if not all, of the glucose your brain needs.

I don’t think 125 is a bad number. I keep myself between 75 and 100, and make sure almost all of them are at lunch. It is more an issue of timing. If I take my carbs at lunch time, I don’t need much insulin in the evenings or at night, thus keeping my blood sugars nice and level. At the same time, because of the bolus of carbs during the day, I can train while still checking and adjusting my insulin levels.

My two cents.

–Me

58

[quote]mertdawg wrote:
I have read some point, counterpoints with Bernstein. Again, my son is on “low” but not extremely low carbs. He gets just under 30% so the other foods help to make the digestion very slow. I have read a lot of research that insulin sensitivity is highest when the brain glucose needs (about 100 grams glucose) per day are met by diet. This is still VERY low by what my son’s doctor wants, basically 65% carbs, but yea my thinking was that lows come from dosage errors or inaccuracy, but also people with more than about 30% carbs gradually become more and more insulin resistant over time and have to increase their doses.

I mean, he gets 1 unit of humalog and 42-44 grams of carbs at 4:30 pm basically every night, so I don’t think that if he is 105 at bed time 4 hours later, 1 unit of lantus is going to make him go low. He wakes up between 74-95 on 1 unit of lantus every day.

I am also limiting his omega-6 intake which is something that Bernstein doesn’t know about, or at least didn’t care about when he was working on his own nutrition. Omega-6s oxidize and are the primary causes of heart disease, and also tissue damage, so I am thinking that by keeping his blood sugar between 70-120, even during peaks, and keeping his omega-6s low, he can maintain beta cells for a while, although one year is considered “long” I almost think that the doctors WANT to knock out the pancreas so that you are dependent on insulin, or at least in their minds, you have to face the inevitable reality sooner.

Another issue with Bernstein is that I’ve seen strong evidence that TOTAL mortality by ALL causes goes up when HbA1C goes under 5.0. 5.0-5.4 produces the greatest (basically normal) lifespan. Going below 5.0 may reduce heart disease a little (down to 4.6) but it raises stroke risk even more. Also there is evidence that Beta cells continue to grow in small pockets and that they are stimulated (not killed) by blood sugars in the 110-130 range, so again trying to stay super low may not be best. Some people have pockets of Beta Cells after 15 years. Bernstein claims that his HbA1C is 4.2 which is below optimal for overall lifespan, and would be in-line with an average blood sugar of 70. Also I have read that type 1s without beta cells can go into ketoacidosis even with low blood sugar if they get liver glycogen depleted and don’t have enough insulin to shut down gulcagon. So I am a little worried that super low carbs won’t provide enough insulin to prevent ketoacidosis under stress.

I DO think that developing mild ketones is good because it trains the liver to produce ketones with blood sugars in the 60s and 50s to support the brain. Under ketogenic conditions it appears that the brain can do fine with a 60 blood sugar that would cause a lot of stress without ketone. I personally prefer to have him IF not for a day, but by eating dinner early, around 4:30, with breakfast at 7:30, meaning that all of his food intake is in about a 9 hour window. This gets him small ketones in the morning WITH blood sugar in the 70s occasionally.

By the way, he loves the way he eats. He is not hungry. He really feels good. His carbs are basically cut in half from before his diagnosis and his fat intake is doubled. I had to look at a meal plan that worked for him psychologically first, and fortunately he has really good results so far. The plan is that as he grows, I will not increase his carbs from the approximately 125 grams a day that he has now, but I will simply ADD more quality fats to each meal. [/quote]

I’ve kinda asked this before.

About super low carb and insulin sensitivity:
Why do you need insulin sensitivity in very low carb diets? In that case, blood sugar should be moderate and stable and insulin low. If your body isn’t processing carbs, why does specifically insulin sensitivity of tissue matter if neither insulin nor blood sugar are elevated? ESPECIALLY if eating carbs in that state increases sensitivity. Because that would mean that in the times that sensitivity would matter (if you start eating more carbs) your sensitivity would increase.

It may make you bad at processing carbohydrates but you aren’t eating carbs. And even if you do then eat carbs, you’ll get good at using them. Maybe I’m missing something.

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[quote]DoubleDuce wrote:

[quote]mertdawg wrote:
I have read some point, counterpoints with Bernstein. Again, my son is on “low” but not extremely low carbs. He gets just under 30% so the other foods help to make the digestion very slow. I have read a lot of research that insulin sensitivity is highest when the brain glucose needs (about 100 grams glucose) per day are met by diet. This is still VERY low by what my son’s doctor wants, basically 65% carbs, but yea my thinking was that lows come from dosage errors or inaccuracy, but also people with more than about 30% carbs gradually become more and more insulin resistant over time and have to increase their doses.

I mean, he gets 1 unit of humalog and 42-44 grams of carbs at 4:30 pm basically every night, so I don’t think that if he is 105 at bed time 4 hours later, 1 unit of lantus is going to make him go low. He wakes up between 74-95 on 1 unit of lantus every day.

I am also limiting his omega-6 intake which is something that Bernstein doesn’t know about, or at least didn’t care about when he was working on his own nutrition. Omega-6s oxidize and are the primary causes of heart disease, and also tissue damage, so I am thinking that by keeping his blood sugar between 70-120, even during peaks, and keeping his omega-6s low, he can maintain beta cells for a while, although one year is considered “long” I almost think that the doctors WANT to knock out the pancreas so that you are dependent on insulin, or at least in their minds, you have to face the inevitable reality sooner.

Another issue with Bernstein is that I’ve seen strong evidence that TOTAL mortality by ALL causes goes up when HbA1C goes under 5.0. 5.0-5.4 produces the greatest (basically normal) lifespan. Going below 5.0 may reduce heart disease a little (down to 4.6) but it raises stroke risk even more. Also there is evidence that Beta cells continue to grow in small pockets and that they are stimulated (not killed) by blood sugars in the 110-130 range, so again trying to stay super low may not be best. Some people have pockets of Beta Cells after 15 years. Bernstein claims that his HbA1C is 4.2 which is below optimal for overall lifespan, and would be in-line with an average blood sugar of 70. Also I have read that type 1s without beta cells can go into ketoacidosis even with low blood sugar if they get liver glycogen depleted and don’t have enough insulin to shut down gulcagon. So I am a little worried that super low carbs won’t provide enough insulin to prevent ketoacidosis under stress.

I DO think that developing mild ketones is good because it trains the liver to produce ketones with blood sugars in the 60s and 50s to support the brain. Under ketogenic conditions it appears that the brain can do fine with a 60 blood sugar that would cause a lot of stress without ketone. I personally prefer to have him IF not for a day, but by eating dinner early, around 4:30, with breakfast at 7:30, meaning that all of his food intake is in about a 9 hour window. This gets him small ketones in the morning WITH blood sugar in the 70s occasionally.

By the way, he loves the way he eats. He is not hungry. He really feels good. His carbs are basically cut in half from before his diagnosis and his fat intake is doubled. I had to look at a meal plan that worked for him psychologically first, and fortunately he has really good results so far. The plan is that as he grows, I will not increase his carbs from the approximately 125 grams a day that he has now, but I will simply ADD more quality fats to each meal. [/quote]

I’ve kinda asked this before.

About super low carb and insulin sensitivity:
Why do you need insulin sensitivity in very low carb diets? In that case, blood sugar should be moderate and stable and insulin low. If your body isn’t processing carbs, why does specifically insulin sensitivity of tissue matter if neither insulin nor blood sugar are elevated? ESPECIALLY if eating carbs in that state increases sensitivity. Because that would mean that in the times that sensitivity would matter (if you start eating more carbs) your sensitivity would increase.

It may make you bad at processing carbohydrates but you aren’t eating carbs. And even if you do then eat carbs, you’ll get good at using them. Maybe I’m missing something.[/quote]

There are four main issues with VERY low carb diets.

  1. suboptimal protective mucose in the lining of intestines and airways. We have mucose for a reason, to keep out allergens and pathogens, and it seems to be optimal at a little over 100 grams.

  2. Decreased leptin sensitivity and levels lower metabolism. Metabolism drops on very low carb diets.

  3. Thyroid deficiency, particularly T3 I believe which causes many to have very high LDL levels.

  4. Physiological insulin resistance. The problem here is not that you will get high blood sugars, like periods over 140, but that fasting blood sugar tends to creep up when carbs are held under 100 grams a day. So you will get fasting blood sugars between maybe 95-105 even over time rather than 74-94 if you take in about 100 grams a day. Now a doctor may interpret the fasting blood sugar as borderline adipose insulin resistance which it is not, so its not a precursor to diabetes, but it may increase glycation of LDL particles a little, and glycated and oxidized LDL particles are the basic diet related causes of cell damage, heart disease, cancer etc.

I have no problem with very low carbs with regard to insulin resistance that would go away in short order upon eating carbs (a couple of days), so I personally stay a little over 100 most of the time for the other reasons: LDL, Metabolic rate, mucosal barrier not being degraded.

My son’s case is different, in his case I do care about insulin sensitivity because he still has significant, but limited insulin production. Given that, being the most insulin sensitive allows his own remaining insulin to control his blood sugar after meals the best because a little bit goes a long way, and the pancreas responds instantly to blood sugar levels. This is combined with one other factor. Beta cells do regenerate at least if there are some left, and people with type 1 diabetes have been found to have beta cell pockets after 50 years. Glycolysis and mild blood sugar rises (between 100-140) actually stimulate the beta cells to regenerate and function. We know that the brain will use just about 100 grams of glucose a day if it is available, but will use ketones if it is not. I want to get that 100 grams of glucose used in glycolysis because it stimulates the synthesis of glycolytic enzymes and glycolytic enzymes signal beta cells to proliferate.

One final factor is that my son has always been near the bottom of the growth chart, 10th percentile in height and 5th for weight. If he were overweight i might consider trying to get him to eat very low carbs, but I think that some carbs and insulin are needed to grow. Kids burn a LOT more calories pound for pound than adults. Estimates are that he is burning about 30 calories per pound of bodyweight.

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How low are we talking for these cases of significantly elevated blood sugar? Like full keto less than 30 grams of total carbs low? Because I personally have never gone THAT low. My incidental carbs from nuts, cheese, veggies, est. are higher than that. I still eat foods that do have carbs, but am generally probably around 50 grams a day (maybe a little less without counting fiber which I get a lot of), but that is still a big difference from there to 100 where you?d really be eating some carb based foods.