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Achieving a 6.0% A1c by Eating 40 Grams of Carbs Per Meal – Diabetes Daily

My 6-Month Experiment

“6.0”. I didn’t think I heard him correctly. I asked my endocrinologist to repeat himself. “I said 6.0%. You’re A1c was 6.0%.” My mouth gaped in astonishment. Practically non-diabetic. The lowest A1c I have ever had in my 10+ years of type 1 diabetes.

How Did I Do It?

Over the past ten years since my diagnosis with type 1 diabetes, I would consider myself a “good diabetic”. That means multiple fingersticks a day, remembering to bolus at mealtimes, and an overall idea of what kinds of foods were entering my body. My A1c hovered between 6.8-7.4% — which my doctors thought was just fine. I had a strong desire to lower my A1c, but nothing in the past seemed to significantly work.

About a year ago, I began medical school and became inspired to take better control of my diabetes. I began doing a lot of reading on the subject and started to toy with the idea of lowering my carb intake. There have not been many (if any) conclusive studies on the effects of low-carb diets in type 1 diabetics, yet I had a hunch that something like that could be my long-desired solution. I decided to perform a six-month-long clinical trial testing the effects of a low-carb diet on a particular type 1 diabetic — me.

The Rules

I recognized that diabetes is a lifelong condition and that any new diet I would undertake would have to be sustainable over a long period of time. Many popular diets only allow minuscule portions of daily carbs, and I knew that would not be maintainable long term. I didn’t want my diet to be unbearable and rebound. I, therefore, decided at the start that my diet was not to lose weight, and was not to start eating healthier. I allowed myself to eat cookies, cake, etc. (although I did naturally end up eating more vegetables in order to stick to the rules of the diet).

The diet consists of just one golden rule, plus 2 common sense rules.

The Golden Rule:

  • Maximum 40g of carbs at one sitting (eating to treat/prevent a low doesn’t count)

The Common Sense Rules:

  • Don’t eat any foods that make my blood sugar go wonky (some examples for me are pizza, bagels, and deep-fried foods)
  • Always try to bolus at least 15 minutes before eating

As part of The Golden Rule, each “sitting” is separated into three-hour chunks. For example, let’s say I eat lunch one day consisting of a hamburger (meat is zero carbs, the bun is 25g) and an apple (15g). Two hours later, I find myself hungry. What are my snack options at this point? Well, since I already reached my 40g maximum and it is within three hours of my meal, I must wait one more hour (i.e., three hours from my lunch), at which point the clock resets. I can then eat a snack up to 40g. However, let’s assume my lunch consists of just a tuna sandwich (2 slices of bread=30g). Two hours later, I find myself hungry. What are my options at this point? I can eat up to 10g of carbs because my lunch was 10g shy of the 40g limit.

I also toyed with the idea of imposing a daily maximum on carb intake, but I later nixed it. As mentioned, I wanted this diet to be highly sustainable long term, and I felt that a daily carb maximum might impede that goal. Also, diabetes diets that impose daily carb maximums are somewhat controversial in the medical field. Some medical professionals believe that such diets could even be harmful to people with diabetes, and I wanted to stay clear of that controversy.

Why Did I Think It Might Work?

Most people who start low-carb diets are trying to lose weight. Although I did lose a few pounds since I started this diet, this was not at all my intention in this endeavor (although truthfully, it was nice to finally fit into my wedding suit again). The reason I began doing this is twofold:

Reason #1: The Post Prandial Spike

Following a meal, there is inevitably a spike in blood glucose. The size of the spike is proportionate to many things (the types of carbs eaten, the timing of insulin injection, etc.). However, my personal experience has shown that for me, the spike is most directly related to the number of carbs I eat. Therefore, fewer carbs = smaller spike. (Similarly, giving at least 3 hours between meals allows time for the spike to come down).

Reason #2: The Guessing Hypothesis

Guess how much a single banana would cost you at your local grocery store. Go ahead, guess a price. You may have guessed 15 cents. 25 cents? 50 cents? One dollar? $1.50? The actual price is about a quarter. You may have guessed a quarter (you may have even bought a banana before and this, therefore, was not a guess). Or you may have been off by a bit. You may have even been off by a lot. However, most likely your guess was not off by more than a dollar. Now guess the price of 500-seat Boeing 747. Go ahead, think of a number. A quick Google search priced it at $357 Million. Was your guess off by a couple million? The point here is clear: when dealing with larger values, our estimates tend to have larger ranges of error. By keeping the carbs low, we are giving ourselves a better chance of correctly estimating our carb intake.

Conclusions

My main goal was to achieve better control of my blood sugar and somewhat lower my A1c. Yet, since the start of my diet, I’ve reaped numerous benefits and gained far more than I could have expected. My A1c has dropped a full percent, a stark reduction to a degree I had not anticipated. My day-to-day blood sugar has become much more predictable, and those horrible whacky-blood-sugar days that all people with diabetes experience have become much less common. Additionally, my average daily insulin usage dropped from 50.2U a day to 40.8U – almost a 20% decrease! As a nice fringe benefit, I lost a few pounds and really feel better overall.

One thing that people often ask is if my lower A1c came at the expense of more frequent hypoglycemic episodes. When I started this diet, I did indeed see a slight increase in hypos along with my tighter glucose control (however, I cannot quantify this with an exact number because I don’t have records of my hypo occurrences prior to starting this diet). Once I began noticing that my lows were becoming more frequent, I made a conscious effort to keep an eye on my CGM (Continuous Glucose Monitor) and be more aggressive in preventing them. Following that adjustment, I believe I have been having just as few hypos as I did before I started this diet.

I want to point out that my 40g maximum per meal is a completely arbitrary amount. It’s an amount that is feasible for me and is also fewer carbs than I was normally eating per meal. If you are reading this and thinking that you could never manage on such a meal plan, I would suggest coming up with your own maximum-carb-per-meal formula and giving it a try. Every person with diabetes is different, and this plan may not be the solution for everyone looking to gain better control of their blood sugar. However, this diet has had huge advantages for me, and I believe that there are aspects of it from which every diabetic can gain.

This article is not intended to be a substitute for professional medical advice. Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding your health or a medical condition.



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