My Quest for a Smaller Jean Size and A1C

We began watching our carbs. But I didn't feel safe trying to go completely low-carb.

| Oct 21, 2011

Trying to lose weight as an insulin-injecting person with type 1 diabetes couldn't be more frustrating. It gets on my last nerve that exercise can trigger mind-numbing lows, lows that cause me to inhale a portion of those recently burned calories. That said, I don't skip exercise to avoid lows. I just check my blood sugars more often, use caution with my insulin dosing, and follow the advice of my doctors.

At a doctor appointment a few months ago, I discovered to my horror that I'd gained seven pounds since declaring war on my A1C. Determined to have a lower A1C, I had started a higher insulin-to-carb ratio with help from my diabetes educator. While giving myself tighter control, I also had to eat to treat more lows than usual. Although my A1C did respond positively, some of my meals had high amounts of carbohydrates, so I was taking even more insulin to avoid elevated blood sugar. I started thinking, what if I ate fewer carbs and therefore needed less insulin?

My husband and I decided to begin watching our carb intake. He avoids most carbs, adding a few healthy, high-fiber ones like beans to soups. Since I don't feel safe trying to go completely low carb with insulin-dependent diabetes, and because I honestly can't imagine life without my precious carbs, I spoke with my nutritionist and decided to limit mine to about thirty carbohydrates per meal. In her words, "Any less than thirty carbs, and it's not a meal". I also try to keep snacks at fifteen or less.

Hubby lost forty pounds in a little over two months. I lost ten. You might think I'm disappointed, but really, I'm ecstatic that I didn't gain ten! I've been far less strict, allowing myself small treats here and there. It keeps me motivated a whole lot better than total deprivation.

Losing weight is hard work for everyone. It's even more frustrating with diabetes, however, because when I'm low, I don't give a hoot how many calories are in something--I just want to eat everything. When my brain is starving for glucose, it simply doesn't care that the cupcakes we keep in the house for my son's lunches are not "diet" food. With diabetes, when you need food, you need food. Sometimes you eat when you're not hungry, or even just after you had a meal, if your carbs and insulin doses were miscalculated or your activity levels were elevated.

My father and I had a discussion about eating one evening when he knew I was working on losing weight. Without thinking about my diabetes, he said, "Eating late at night isn't going to help with weight loss," as I munched on a mouthful of granola bar. Sometimes even our loved ones forget that we need to have safe numbers before going to sleep. For me, that means eating a snack at bedtime most nights. Depending on my blood sugar, I cannot skip my snack--the consequences of low blood sugar overnight are too dire.

I explained to my dad that while Oprah might boast about cutting herself off three hours before bedtime, until there's a cure, I will not have that luxury. Sometimes you eat, sip, or suck on various forms of glucose until you feel nauseated, just to stop the shaking and avoid emergency medical attention.

I'm not in my "skinny jeans" just yet, or anywhere near zipping up my old high school prom dress (though the fashion police would likely argue that not fitting into my prom dress from the nineties isn't such a bad thing). I'm sticking with it though, and little by little, through healthy eating and exercise, I'm determined to watch both my weight and my A1C continue to diminish.




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Categories: A1C, Carbohydrates, Diabetes, Diabetes, Food, Insulin, Losing weight, Safe Numbers, Type 1 Diabetes, Type 1 Issues, weight gain, Weight Loss

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Posted by Anonymous on 21 October 2011

I to have been reducing carb intake in an attempt to lower my daily insulin intake and I have also seen weight come off. My question is - Is it normal to see an increase in blood sugar readings within a 1/2 hour after exercising? Can exercise cause the body to release stored glucose when stressed by activity?

Posted by Anonymous on 25 October 2011

Ms. Esler ... if your basal is correct, you don't have to eat a bedtime snack. I use 3 small doses of Levemir 8 hours apart. Since I deep-sixed 2x a day Lantus, snacks and 2 a.m. lows are a thing of the past. It can also be done with an insulin pump.

Doris J. Dickson

Posted by Anonymous on 25 October 2011

I am menopasual and have addisons disease. I try to watch what I eat and I ma exercising everyday for about 35 minutes. i still get highs.

Posted by Anonymous on 25 October 2011

Ask your Doctor about Victoza. I have been on it for about 6 months and have lost 40 lbs. I am type II and use an insulin pump. It has cut my insulin use in half also.

Posted by Anonymous on 25 October 2011

Wow. This is just want I needed to read. I am on week one of a much lower carb diet after seeing a nutritionist. I was taking 16 units of Lantus now I am taking 8 units daily. My insulin to carb ratio is lower too. I have a lot more lows now. I expect to see a much lower A1C and the number on the scale to go down. I have a weekly appointment so I have accountability.

Posted by Anonymous on 25 October 2011

Yippee - so glad to see an article that addresses the frustration of trying to get healthy through exercise and then having to add calories to deal with lows. I'm sitting here with Coke and M&Ms after lunch cause I played golf, had snacks while walking but since I usually go up if I skip insulin with any meals, did 2 units of Humalog - WRONG.
Also, comment, my doc does not just look at A1c if a lower A1c is due to many, too frequent, lows. She wants me to avoid so many lows.

Thanks again for speaking up.

Posted by Green Lantern on 25 October 2011

"Less than 30 grams of carbs and it's not a meal"?! PLEASE read Dr. Bernstein's Diabetes Solution. You are on the right track--your dietitian is not. Just by virtue of saying "my precious carbs," they play too large of a role in your food life. Dr. Bernstein has diabetes himself, and has reversed complications through a VERY low carb approach.

I am prediabetic and working hard not to get type 2. I aim for 30 grams of carbs PER DAY. I eat 3 meals--no snacks. So, it's certainly possible to eat (and eat well) without needing tons of carbs and tons of insulin to cover the carbs. The message of insulin in the body is "STORE FAT NOW!" This was a feast-or-famine survival mechanism. Today, all we do is feast. It's no wonder so many of us are overweight...

Posted by Anonymous on 25 October 2011

We need more articles out there like this one! Type 1 diabetes and much needed weight loss is hardly talked about but is a BIG problem!

Posted by Catherine Archer on 25 October 2011

Sometimes shooting for a lower A1C is not such a good idea. Take care, and try for 'not too high, not too low.' That works for both your glucose levels and your A1C. (I've had type 1 diabetes for 42 years now).

Posted by kdommer on 25 October 2011

Thank you so much - it was like reading my own life story! I've only had to watch my weight in the last year or so as it started creeping up. I, too, fight the reasoning of having to eat more to get my blood sugar high enough so I can exercise - really, what's the point? It is a delicate balance and requires careful attention to avoid the lows frome exercising. My quest isn't for smaller jeans, it's staying in the ones that have fit for years! :-)

Posted by Anonymous on 25 October 2011

I didn't feel safe trying to go completely low-carb. Your feelings versus the science. Feelings always win.

Posted by cde on 26 October 2011

Ah, yes...the old-fashioned "treating" of hypoglycemia with food (instead of with partial or whole DEX4 glucose tablets). The results are predictably and understandably weight gain (98% of the time accompanied by rebound hyperglycemia).

The glucose exerts a predictable, measurable effect on BG levels; food does not.

1 gram of glucose (each tablet contains 4 grams) raises BG by about 5 mg/dL for an adult (each person is different and must calculate its effect in his or her body and body size, but once calculated, the BG rise per gram remains highly constant). An example: if BG is 50 mg/dL, and the goal BG is 80 mg/dL, 1.5 tablets will do the job effectively, without rebound hyperglycemia (supposing that BG rises about 5 mg/dL for each gram of glucose ingested). Those 6 grams of glucose contain only 24 calories, which do not contribute to easy weight gain...unlike food items, which contain many more calories.

As far as I know, there is no other brand of glucose tablets marketed.

Dr. Stan De Loach
Certified Diabetes Educator
México, Distrito Federal

Posted by Anonymous on 26 October 2011

As an RD, CDE, I can tell you it is very important to limit carbs in either type of DM, but those of you who are type II have to understand your dz is not the same as type I. Carbs make you need more insulin. Insulin helps you store more fat. Lean protein and good fats cause CCK release which helps you feel more full. It's just that simple. the more carbs, the wider swings in glucose.

Posted by Anonymous on 26 October 2011

It's so nice to see an article like this on type 1. I totally agree with the not caring how many calories ate in something when you're shaking even though you regret it later.

Posted by goozer on 26 October 2011

Great article. I have had type 1 for 63 years and a pump for the last 7. I understand your frustration over exercise & lows & carbs. We hike on mountain trails & I have lots of Dex 4, my glucometer & glucagon with me. I check about every 30 min. And I too want to get into a smaller sized jeans. When you & others say low carb are you talking about starches, bread, cereal etc only or are you including fruits & veggies too? It is pretty hard to be low carb or very low carb & get the recommended 7 or so servings a day.

Posted by Anonymous on 26 October 2011

After talking to my diabetes educator, I felt I needed more information. I felt that the diet was too high in carbs 40-60 per meal and I read Dr. Bernstein's book. He is the reason I lost all my weight within 6-8 months, 35 pounds, with a low-carb diet. Now, I don't do as low carb as Dr. B but I have found what works for me. I try to stay at under 60-70 carbs per day, including snacks. I was amazed at the weight loss. I am a MODY and not insulin dependent but I use metformin and glimperide (low dose). Since my weight loss in 2008 I have maintained a steady weight that agrees with me. Do I miss carbs, sometimes but I know the consequences so I choose to eat low-carb. Dreamfields Pasta which is a low-carb pasta is very good. I make low-carb treats with stevia and try not to be tempted. Its hard. Halloween is one of my favorite holidays. Guess I will need to make some extra low-carb no sugar treats... Good Luck. Listen to your body, experiment with foods and find what works for you!

Posted by Anonymous on 26 October 2011

Being a type 1 for 48 years, I am always interested in others' stories. When telling a story, primarily to diabetics or people who are working with diabetics, it always is more relatable if numbers are used such as weights and A1Cs. Thanks for your story. Weightloss is difficult for us!

Posted by Anonymous on 27 October 2011

Read Dr. Bernstein! I second that comment!

Posted by Anonymous on 27 October 2011

Nice article. I am also interested in an article focused on blood sugars *increased* by exercise. About half the time I work out my blood sugar goes UP dramatically (I am assuming from a liver dump), but half the time blood sugar stays consistent or drops. There doesn't seem to be a good way to predict what will happen. More information on this would be great!

Posted by Anonymous on 27 October 2011

It's so nice to see an article like this. There so many little tweaks we as type 1's have to deal with when trying to loose weight. It's true that people mean well but they don't really understand the struggle issues.
I sooo can relate to the exercise/low/ shovel food in my face etc. etc..

Posted by Anonymous on 27 October 2011

Thank you for the article and all your comments. Its helpful to know that I am not alone. I have been counting carbs, eating more than usual to keep away from lows(usually 60-84). Once I hit below 90, I drop fast. I had one last week (34), very scary. The key is to maintain your own balance (of course, its hard to find it at first). Thank you again.

Posted by Anonymous on 15 November 2011

Thank you for your article. I am a Type 1 who struggles with obesity-obesity which did not occur until after diagnosis. I have begun to exercise and done the things needed to control my diet only to see my A1c drop but my weight go up. There is nothing much more discouraging than to get in a great round of exercise only to go low later and eat more than what you worked off. As to others comments which suggest treating lows is a simple matter of 15, wait 15 minutes, eat another 15 is still low, has never had the "pleasure" of passing out from a low blood after already downing 30 grams of carb (juice) plus additional candy or the "pleasure" of waking up convulsing and asking you husband to get you something now, anything. The panic and fear lingers with you for many, many years after just one bad episode. We are not a pancreas and cannot perfectly manage blood sugars-we do our best, but we can never mimic that function perfectly. Weight loss and being insulin dependent are difficult but I am determined to keep at it myself. I would love to hear from any Type 1 diabetics who were able to lose 50 or more pounds with diet and exercise-I am just not sure there are many of those stories out there.

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