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  1. klnell
  2. Disease Specific
  3. October 30, 2019
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I am a T1 Diabetic.  I started following Dr. McDougall's program about 3 years ago.  I've never been to his residential program (although I would like to).

Lately, I've not been as strict with the diet.  I know this will sound very counter-intuitive but, my blood sugars have been so high for such a long time that I kind of gave up when we eat out.  I always cook well at home.  I eat steel-cut oats every morning for breakfast w/berries and an apple.  Before when my blood sugars were elevated I always knew something was wrong physically. With the exception of 2 visits to the doctor this year, I've been told there is nothing wrong.

I finally saw a new endo who seems to be proactive but, she changed my pump settings and then told me to get off my high carb diet.  It kind of threw me into a tailspin and quite frankly I was afraid to eat much of anything.  My sugars still remained somewhat high even after the adjustments.  I noticed that if I stick to eating just fruit in the morning and keeping my starchy carbs and fruit separate it seems to stay in range (except for this morning).  

I'm kind of at my wit's end.  Does anyone know of a Dr in the East or North Dallas area who agrees with a starch-based diet?  @kenscircus, I would love to know how you've managed to manage your blood sugars so masterfully.

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  1. drcarney
  2. 1 month ago
  3. #18
Karen,
Thanks for writing.

It is essential not to eat any foods that contain more than 20% of their calories from fat. Ever.
Because it will take 15 to 30 days to get your levels of blood sugar and insulin back down to ideal.

You need beans or lentils for breakfast and for lunch.

I recommend a food coaching consult by phone, which you may purchase here for customized lifestyle advice, although I am not functioning as a physician in these consults, as I am not writing orders nor prescribing pharmaceuticals.
https://www.veggievore.com/advice/one-hour-custom-coaching-consultation

I recommend my starch smartest program, which is free to you here:
https://www.drcarney.com/starch-smart-system/starch-smartest

I also advise that you read each of the blogs written by Ken Thomas and do exactly as he does: No nuts, seeds, avocado, olives, oils or restaurant foods that you don't know for sure were made without oil.

Thank you for being a member of DrCarney.com,
Dr. Carney
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Karen, 

Thank you for sharing your experience and your question. I am going to send a message to Ken to let him know you asked this question. I also changed @kenthomas to @kenscircus which is his user ID hoping it would work to link to him and notify him. But, it did not work. So, I am asking for help from our software vendor to figure out how to make that work. 

In the meantime I would suggest you read all of Ken's blogs starting from his first work and working your way through them. He has some tremendous insights and I believe you will find answers to your question(s). 

Thank you,  

Sean

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  1. more than a month ago
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Dr. Carney just asked  me to send you this url so that you can start reading Ken's story:

https://www.drcarney.com/blog/condition-related/ken-s-type-1-diabetes-journey

She is busy taking care of patients. :-)

Sean

 

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Thank you both.  I will most likely sign up for the consultation.  And thank you for the info regarding Ken Thomas.  I first read about Ken on Dr. McDougall's site 3 years ago but, didn't know how to contact him.  I actually found your website by doing a search for Ken Thomas.  I've already read two of his blogs. I will follow the rest.  Thanks again.

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  1. more than a month ago
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Karen, We also set up a Support Group for Type 1 Diabetics that is not real busy but Ken does pay attention to what goes on there as well. Lately he is very busy due to family responsibilities so we are not seeing his participation as much as previously. But, I know he will eventually interact with you. Check out the Support Group: 

https://www.drcarney.com/community/groups/type-1-diabetes-support

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Thank you, I really appreciate that.  Also, I haven't had a chance to fully check out the website so, I was wondering if you could direct me to recipes that correspond with the Starch-Smartest choices?

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Thank you, I really appreciate that.  Also, I haven't had a chance to fully check out the website so, I was wondering if you could direct me to recipes that correspond with the Starch-Smartest choices?

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Hello klnell,

Thank you for asking this great question. Creating a section of Starch-Smartest recipes is something that we really want to get to but have not yet accomplished. We actually use very little in the way of recipes and live Starch-Smartest ourselves. Basically we use our instant pots to always create large batches of beans, grains, root vegetables, etc... and then we add to that salad materials and leafy greens. So, not fancy recipes. We don't have time for them. That said we do create a lot of variety simply by changing the spices we use when we prepare things and changing the type of beans, type of root vegetables, type of grain, etc...
I hope this is helpful.
Also, I have just changed the "Editor" that we are using in our discussion forum to one that is supposed to support the use of the @ symbol in front of a users login to notify them through the social network when they have been mentioned. I am about to mention Ken Thomas here as an experiment by adding kenscircus to see if he gets notified. I will see him later today and hopefully this will work and I will let him know about your other questions.
Sean
PS. I will also test this by creating a link to myself @scarney
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Thank you, Sean! I very much appreciate your support and help.
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We are glad you are here. I did speak with Ken today and he told me that he is working on a reply for you. So, stay tuned. He is very busy but is planning to respond to you here.
Sean
@kenscircus
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Hi Karen and a big welcome to DrCarney.com!

Yes, I was on the McDougall forum a while back, but tapered off due to time constraints. I then found Dr. Carney and moved to DrCarney.com, especially since she became my primary care physician. Also, I do not agree with Dr. McDougall regarding type-1 diabetes management.

As far as a good doctor who agrees with a starch-based diet, I would recommend Dr. Carney. True, she is not local to you, but she is worth the travel. I see it as a value thing. I think one's health is worth the travel. By the way, she does have patients in the Dallas area (and some even farther) that travels to see her.

As far as a good doctor to control you blood-sugar's, I do not believe any doctor can do that regardless of their knowledge or skill, or at least to the level that I believe in. I believe that T1D control is personal - more personal than can be controlled by any doctor's orders. It would be like another person telling you how to walk a tight rope. Regardless how skilled the person, real-time commands just cannot keep you balanced on that rope. Only you can do that.

I call my method the SPP method or Synchronous Push-Pull method. Synchronous means the insulin, food and metabolic system is in sync. Push-Pull means that blood-sugar control is exerted on both ends; Pushed down and Pulled up. Nothing is left to "free-run" or "hope for the best."

The SPP method is a control method that I developed out of fear of diabetic complications (I did and do not want to be diabetic). The method maintains blood-sugar between 70 mg/dl to 100 mg/dl at ALL times. The SPP method is not yet published, but I am currently working on finishing a book - I'm still suffering from time constraints. Once finished, I intend to publish it as a PDF format for free distribution. In the meantime I will try to answer any questions here. The book title is: Synchronous Push-Pull Type-1 Diabetes Control: The Non-Diabetic Diabetic Method.

The primary benefit to a low-fat plant-based high glycemic diet for T1D is the predictable, syncable blood-sugar spikes. The predictability of the spike levels and duration makes it conducive to matching the insulin dose and timing. It also means that a continuous insulin supply is not necessary, thus a pump is not necessary. Instead of pumps and doctor prescribed management, the SPP methods primary control element is a detailed running log of foods, activity, insulin and blood-sugars. The log is a requirement because I can't imagine anyone who could remember all the details over the days and weeks needed for tracking to manage the control. Low-Fat (10% or less calories from fat) is also required because fat increases insulin resistance. Insulin resistance raises the blood-sugar baseline and slides control out of sync.

Here is an excerpt from my book to help give an idea of the method:

The best way to avoid diabetic complications is to not be diabetic. The condition of diabetes is defined as chronic high blood-sugar or hyperglycemia. The purpose of the Synchronous Push-Pull method is to control blood-sugar to non-diabetic normal levels, specifically to maintain blood-sugars between 70 to 100 mg/dl at all times - non-diabetic normal. This level of control makes a Type-1 diabetic a non-diabetic diabetic.

How is the SPP method different from traditional T1D control methods?
* The SPP method is log driven, pattern tracking.
* The SPP controls both rising and falling blood-sugar (Push-Pull) - eliminating concerns about hypoglycemia (low blood-sugar).
* The SPP control is predictive and preemptive instead of corrective (Synchronous with your biology - your life).
* Mealtime insulin dose is set for the absolute blood-sugar peak instead of any predetermined post prandial time. The insulin dose injection timing is aligned to match the insulin action peak with the food blood-sugar peak to cancel out at 85 mg/dl. Yes, this results in a post prandial blood-sugar dip (hypoglycemia), which is preempted by strategic snacks.
* Strategic snack food time and dose is derived from the log to synchronously fill blood-sugar dips.

Yes, the SPP method means you are eating something almost all day, about every 1.5 to 2 hours or more - but, I kinda like that! :D
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  1. more than a month ago
  2. Disease Specific
  3. # 10
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Thank you Ken for such a detailed response,

I would like to recommend that anybody interested in Type 1 Diabetes might also want to join our Type 1 Diabetes Support Group at https://www.drcarney.com/community/groups/type-1-diabetes-support

Our groups are not taking off real fast like I think they should, and wish they would, but they are very convenient because they allow for easy file sharing and the creating of multiple on-topic discussion threads all under one group.

So, please excuse this little ad for our support groups. This is for anybody finding this discussion, however, they get here. :-)

Sean
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Thank you so very much!

I had wondered about the pump. I took a pump vacation for about 3 years and started back up not quite 2 years ago. I have been feeling recently that the pump is actually getting in the way of maintaining my blood sugars appropriately. I also added a Dexcom CGM.

I hope you can forgive me but I have so many questions for you.

Do you use a CGM?
Do you use a pen or just syringe and vial?
Is there a specific log that you would recommend?
I was told to wait 20 minutes before bolusing if my blood sugar was over a certain amount so that the insulin and food peaked at the same time. Is that right? Or, is there a different formula based on the individual and how different foods affect their blood sugars.

Again, thank you so much. I am not much of a mathematical or science whiz so, I definitely need some remediation but, once I get it I'm good to go. I know you're very busy and I totally understand that so I would like to thank you in advance for any of the questions that you could answer for me.
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Hi Karen,

So sorry for the delay. My computer access time has been reduced to a few minutes every few days.

Answers to your questions:
CGM? I just use a cheapie glucometer. Never tried a CGM. It might be good, but I never felt that my cheapie glucometer was inconvenient. Also, I don't like having devices on me. I don't even wear a wristwatch.

Pens? I use syringes and vials. I find keeping things simple and basic gives me the most personal control.

The question about 20 minutes before insulin and different foods are part of the core of the SPP method. Timing is a major part of SPP however, the timing is not a fixed figure. It is derived from the log and varies. It may be 20 minutes, 10 minutes, 5 minutes or even 30 minutes.

The log I started out with was an 8-1/2 X 11-inch spiral bound notebook. The format and content evolved over the years. The important thing to realize is that every individual is different. So much so that there is no one size fit's all. There are so many variables that metabolic balance is different per individual (even identical twins) and everything changes for each individual throughout one's life. There is no standard, at least for control to non-diabetic levels. Changes occur daily, weekly, yearly, etc. To maintain non-diabetic blood sugars, all of the parameters must be tracked continuously. It is never static. The purpose of the log is for pattern tracking which determines the insulin dose and timing, food type, quantity and timing. While it is a detailed control method, you don't have to worry about any math or complicated science. There is no carb or calorie counting or carbs per insulin, etc. It's all about pattern tracking. Although, when I first started, I logged the ounces (weight) of everything for reference. Eventually, I stopped logging the weight once I learned to "eyeball it".

Logging is a matter of recording all the food eaten throughout the day and night along with the time and quantity of each item eaten - even a nibble. Glucometer testing is logged with time. I often double test, 15 - 30 minutes apart to determine if blood-sugar is rising or falling and at what rate. I typically test about 12 times per day. Insulin doses are logged with the insulin type, time and dose units. The point is to track the patterns, learn what affects what, in what way and in what time frame and learn how to make adjustments and fine tune to continuous non-diabetic levels.

As a buffer, I tend to take a few extra units of insulin beyond what should perfectly cancel a rise to 85 mg/dl. With that, I know that I will be going low. Double testing lets me know the downward rate (units per time) so I can estimate when I will cross the 70 mg/dl line and preempt it with a fruit snack pulling back up to 85 mg/dl (before actually reaching 70 mg/dl). The fruit snack is chosen by its rise rate and duration, which is derived from the log. It is the strategic snacks that are used for fine tuning. The fruit or any foods response characteristics in one's system changes with all of life's variables, so log tracking is necessary to make accurate in-the-moment predictions. I also keep a snack bag of medjool dates in my pocket at all times, in case I get distracted and miss a scheduled snack.

Fruits are the typical choice for adjustment snacks because their blood-sugar effect has a fast ramp rate with a short effect duration. This combination reduces the hazard of overcompensating. It is indeed possible to overcompensate with fruit, but the consequence is short lived.

Starting out may be quite shaky and make you think it is all going crazy, but as you start learning the patterns of the foods, activities and insulins it will all start to sync up. One thing to keep in mind is that it is very hard, if not impossible to synchronize your system if insulin resistant. As mentioned earlier, insulin resistance is increased with any fat intake that is 10% (or greater) of total calories. For me, and it appears typical of others, a greater than 10% intake in one meal will increase blood-sugar baseline about 48 hours later. Prior to that is appears benign. After that the effect lasts about 30 days - and it is additive. That is why it is generally not noticed. The greatest detriment is that it slows insulin action and lengthens blood-sugar spike durations of foods that should be short. A killer of keeping everything in sync. What this means is that if you have been on a low-carb diet with any food greater than 10% calories from fat, it will take quite a while before you can get things in sync. It took me almost a year.

In closing, I would like to point out that in the past, I have not been successful in portraying the SPP concept to a fully functional degree to anyone via Q&A on any forum. I believe this is due to it being so different from conventional methods that everyone is used to and tries to add the SPP method to what they are already used to. While it has been helpful to many, none have understood the concept sufficient to achieve continuous non-diabetic levels. That is why I decided to put it all in a book. Although I don't feel the SPP concept is complicated, it just takes more than Q&A to fully communicate the concept. As stated earlier, I don't mind Q&A and I hope it will be helpful, I just hope the book will actually help its readers become non-diabetic diabetics.

Also, if you want faster help, you could get coaching from Cyrus and Robby at: http://www.masteringdiabetes.org. They do not use the SPP method, but they can certainly help. I don't think it is free, but it is probably worth the cost.
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Thank you, as always, Ken for the time you put into this response. And we appreciate seeing a shout-out to Cyrus and Robby at: http://www.masteringdiabetes.org :-)
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I understand delays I have them for different reasons.

I do very much appreciate your responses whenever they come.

My first endocrinologist was a researcher and the only reason he took me on as a patient is because my son was a prior patient. That doctor now works for Novo Nordisk. he was excellent at what he did and I did do some very detailed logs for him at the very beginning prior to going on the pump. He was quite passionate about his work. All my other endocrinologist since then have paled in comparison.

I think my learning style is what hampers me with posting. I really thrive on examples and hand detailed explanations. Therefore, I can understand how Q and A’s in da forum setting could be a problem.
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Yes, the issue with trying to convey the SPP control method in Q & A is that Q & A is information in snippets of information, which is never enough to fully convey the concept. For example, I don't think a Q & A session would work very well for someone learning how to skillfully pilot a commercial airline. I don't mean the SPP method is as complicated as flying a commercial airline, but it is different enough from traditional T1D control methods that the traditional method mindset clouds understanding the SPP concept. Everyone is so use to the conventional method that they try to relate the SPP to conventional thus skewing the concept off course.

I don't really think your learning style is an issue with this. Everyone before you has the same difficulty. I also learn by physical example, experience and only in logical forms. I have an almost impossibly difficult time learning anything in abstract form. I am just hoping the book will be successful in getting around the conventional T1D method pre-conditioning. The SPP control method is pattern tracking, which is physical experience driven.
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