Comment by mono812 | Hacker News Reader

Comment by mono812 | Hacker News Reader

Interesting stuff! I'm a late T1D and there is just so much that subtly influences your blood sugar levels. I adhere to quite a strict diet and adapt my insuline dosage based on not just the carb contents and glycemic load of the meal, but also the starting point / trends I see in my libre readings. If you can predictably consume carbs (and glycemic load) you can also inject early with confidence (or even post-meal if your meal is really 'slow' or your blood sugar level is low). Going for a 20-30 minute walk during a meal spike (mostly after breakfast and lunch) does wonders for me too.

I manage to maintain roughly 99% TIR (4-10mmol/l) on my Libre with this, virtually no hypos and just the occassional bit of hyperglycemia when I just don't want to care. Although obviously this does require you to plan a lot of things in advance and requires effort and all of this is just based off of personal experience and experimentation and does not necessarily translate to anyone else.

I'm still really hoping for a more low-effort solution to T1D treatment (or even a cure), but I'm skeptical that we'll see that anytime soon.

I still haven't found a tactful way to bring this up, but have you considered a low- or zero-carb diet?

As far as I underdstand it, if you don't eat carbohydrates, you don't require insulin to deal with the spikes, and apart from a few grams in the bloodstream, humans require extremely little to no exogenous carbs.

I'd love to hear your thoughts if you've looked into this already.

Imho you can't really do a zero carb diet that's healthy. Keep in mind that even leafy vegetables have a bit of carbs in them. Low carb is possible and does indeed generally keep your blood sugar levels more stable. But even a meal that's mostly low carb vegetables and some meat still requires insulin if your pancreas has stopped working entirely.

I'm obviously a patient and not a doctor, but from what I've read as a Type 1 diabetic with (next to) no insulin production you have a life expectancy in the order of weeks, no matter what your diet is.

I didn't mean 'requires no insulin at all,' I know T1D requires some insulin to regulate blood sugar and to perform other functions in the body.

What I meant was that, for example in the OP article, a 60g bolus of carbs brings blood sugar from the bottom of healthy range all the way to the top of the healthy range in one go.

It just seems like an unnecessarily large and (for most) difficult to control jump in blood sugar. A lower-carb diet, say under 50g total carbs per day, should reduce blood sugar swings and increase their controllability, letting patients be in the healthy range of blood sugar for a higher percentage of the day.

Type 1 diabetic as well here - I do this and I can confirm that I have much better control over my HB1C (average blood sugar reading) since I eat mostly a keto and plant based healthy diet (composed of minimally processed foods). One issue that I have though deals with hypoglycemia (low-blood sugar levels) since type 1 diabetics don't just require immediate insulin after meals - they require long-term acting insulin which works throughout the day. I've had multiple cases where I lost consciousness and woke up either in an ambulance or in a hospital feeling like someone hit me with a truck and having no recollection of how I got there. There is no 'magic' in managing type 1 diabetes unfortunately. The issue with us is that our blood sugar can swing in both directions - with the lower swing possibly resulting in death.

In general yes, but again, unfortunately there are a lot of complicating factors. I can eat meals with 60g carb content and have my blood sugar levels barely move at all and I can also have, for instance, a beer with 15-20g of carbs that causes a 6 to 8 point rise. The trickiest part for me is finding the right balance between not having a massive meal peak, but also having stable levels in between meals. What works best for me personally is eating 'slow' meals i.e. meals that have a low glycemic index. These don't necessarily have to be low on carbs, but should be high in fiber, protein and unsaturated fats, which again is also very personal since each of our guts responds differently resulting in different rates of blood sugar production for different meals.

The problem with just eating low carb meals in my case is generally that it offsets the balance in between meals, i.e. I'll start seeing a consistent rise that might be something like 0.5-1 point per hour which eventually adds up. Of course you could increase your baseline insulin to offset that again, but it requires a lot of experimentation to get that balance right.

I do occasionally switch out my somewhat carb heavy lunch for a lighter low carb meal if I'm really busy and don't have time to go for a walk for instance. Generally that does work just fine to keep the initial rise low, but requires another 2 units of insulin about 2.5 hours after the meal because my blood sugar level keeps rising.

So in short, yes moderating your carb intake and especially ensuring your meals are slow are ways to make managing your blood sugar levels easier, but in my opinion it still requires experimentation to find out what works or does not work for you personally.

> As far as I underdstand it, if you don't eat carbohydrates, you don't require insulin to deal with the spikes, and apart from a few grams in the bloodstream, humans require extremely little to no exogenous carbs.

To put it bluntly: You don’t understand it.

Type 1 is different from Type 2.

A Type 1 person without insulin will die.

> “I will see that in someone with 0 percent insulin production, they’ll begin to fall ill within 12 to 24 hours after their last insulin injection, depending on its duration of effect. Within 24 to 48 hours, they’ll be in DKA. Beyond that, mortal outcomes would likely occur within days to perhaps a week or two. But I could not see someone surviving much longer than that.”

https://www.healthline.com/diabetesmine/ask-dmine-lifespan-s...

99% TIR... that's crazy. Well done. You're an inspiration!

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