Low carb Paleo vs. Low fat whole food plant based diet?

I have been trying to figure out the best way to eat to keep my blood sugar stable. I’m pretty constantly on a roller coaster. I thought that a low carb Paleo diet would be the best way to go but then started reading about a low fat plant based diet that is not low carb. They claim this is the best way to eat for blood sugar. So I am confused about what to do. Does any one have any expirience/success with either one?

I’m not sure if you’ve heard of it but there is a book from a Dr. Bernstein. He discusses low carb eating. It’s very similar to paleo and keto but with a few differences. Anyway, I read the book and have started eating this way. It’s a lot of learning but is paying off tremendously. So far, my A1C has gone from 7.3 to 6.5. It’s still a work in progress for me but I’m getting there. I’ve not heard of the low fat plant based diet so I’m not sure on that one.

hello @valeriemarie,

in my opinion, please beware of “they” when it comes to internet claims regarding the best way to eat or diabetes diets… many of the opinions out there refer to the treatment of type 2, which is much more common, and there can be a lot of general confusion as well.

for me, for the last 35+ years with t1, high carb = high insulin = high potential for mistakes and or roller coaster rides.

low carb = low insulin = comparatively, low potential for mistakes. this is the “law of small numbers” and there isn’t much more to it than that. I do way better with small carb and medium fats, and my blood sugar flat-lines when I eat very low carbs but it can be hard to do.

maybe you do better with high carbs? If you do that’s awesome. you can always try something new and observe what happens. diabetes is a bit of a science experiment anyway. good luck!

Hi @valeriemarie,

My thought about “diet”, even for people with Type One, is to eat what your body NEEDS for an individual’s lifestyle - of course, with diabetes added into the mix balance between foods, activities and insulin must be maintained. As a general rule, keep overall health in mind when choosing foods.

During my 60 years living with T1D, I have been all over the board as far as amounts of insulin needed for my body to stay energized. In recent years as my sensitivity to insulin has become more sensitive, I’ve had increase my carbs [more than 225 grams per day] and decrease my insulin, average almost 21 units per day total; my pump standard pattern calls for 6.25 units per day if I keep the pump working for 24 hours. For about 15 years I kept my HB A1c between 5-9 and 6.1 - now at recommendation of two endocrinologists I try not to let my A1c drop below 6.5.

Bottom line Valerie Marie, choose the foods you enjoy and need to live a healthy and full life and experiment CAREFULLY with the insulin you need - and before and continuously after trying anything discuss plans with and get advice of knowledgeable medical professionals. I retired a half dozen years ago and can spend what ever time I want learning about my diabetes, and I’ve found that I can go without eating for full days, engage in normal activity and let my nine basal rates flow, without correction and my BG, checking every couple of hours, stays between 100 and 140.

Just to add a comment on Dr. Bernstein’s diet . . . I was a patient of his about 8 years ago, shortly after my diagnosis (at age 56). I really liked that he was Type 1 himself and knew firsthand how hard this disease is to manage. I learned a lot from him, and have been following his diet since then. I have lots of energy, much more than I had before I was diabetic and was pretty much living on carbs. And my A1c has never been higher than 5.4. So I’d say give it a try. It’s not always an easy diet to live with, but I find that the more I stick to it, the more stable my blood sugars are.

I was diagnosed type 1 in 1992 and struggled with the roller coaster of trying to eat low fat, like we learned in the 80s. I read Dr. Bernstein’s Diabetes Solution in 1999, and cried as I read through the testimonials: here was the common sense approach that never occurred to me! After all, it was only my carbs that were ‘costing’ me insulin, and I never knew insulin was a fat storing hormone.

I adopted his way of eating and almost instantly the roller coaster was over. My TDD went from 65 units of insulin a day to an average of 28 units. I lost 38 pounds in three and a half months. I felt great, never had food cravings, and figured I’d live that way forever.

But, life got in the way, I got married, started going out more, and believed I could eat ‘everything in moderation.’ So of course, the roller coasters returned, I regained weight, etc.

Now, I’m back to what I know works for me and my body. I’m eating foods I like and don’t feel deprived. Whenever I ‘splurge’ and eat off plan, I pay for it, so I’ve come to realize it’s just not worth it for me.

I don’t think all the low carb desserts, bread substitutes, and processed or packaged foods are the best choices, but they make a nice treat now and then.

I have also followed Bernstein’s diet for decades and it works. I have never needed much insulin, and the only time I run into trouble is if I eat an enormously fatty dish at a restaurant or party. My HbA1C’s are between 6.1 and 6.9. I use 24-30 units of insulin per day depending on what I eat. And I have been using that same amount of insulin for as long as I can remember (since 1975 at least).

My son stopped eating meat about three months ago and moved to a primarily plant based diet. Within two weeks his blood sugars stablized almost immediately. His A1C dropped an entire point at his last check. It’s been amazing and completely unanticipated.

The source of carbs for me is primarily non-starch veggies. So depending on how you define “low carb,” eating lots of non-starch veg could be low carb. Bernstein, I believe, say 30 carbs per day max including the non-starch veg. I do not count non-starch veggies, other than Brussels sprouts, which for some reason have an impact on my BG. Otherwise i eat the vegetables without limitation and without carb counting them. All other carbs I do consider. But again, the overwhelming majority of my carbs are the non-starch veg variety.

Which all goes to say, you can combine a low carb, vegetable diet or lifestyle and they can be one and the same. It depends on what works for you and how you define ‘low carb.’ I prefer the term ‘restricted carb’ meaning restriction of certain foods and food groups, as opposed to ‘low.’

2 days, 23 hours ago
Hey i have been diabetic for like 10 years now. recently i am facing postmeal hypo despite having raised BG before meal.reason could be that my bolus is high bt i ate low carb diet to keep my sugar in range bt it leads to hypo. could you please suggest me that how much carbs i should be consuming for each meal or total no. of carbs in a day. How many carbs are covered by one unit of insulin? if it depends on weight i am 41 kg and of 25 years(female) and taking multiple injection and lantus as basal. total dose is 30 units.also i am underweight( horribly thin) could you please suggest me any book or website to gain weight in diabetes.

Hi @Nancie,

I suggest that you try looking at the probable cause of your frequent hypo from another angle. Instead of attempting to make your food and activity balance off the amount of insulin you inject, make adjustments in your meal bolus [take less insulin] insulin to just cover the foods that you actually eat while compensating for activities. Hopefully what I wrote is clear, but message me here if you want to talk this through. For me, and for many other PWD, carbohydrate to insulin rations differ significantly at different times of day; for instance, in the morning I use an 8:1 ratio and at other times a 16:1. The only way to get YOUR proper ratios is to VERY CAREFULLY experiment.

I’m not a medical doctor and I really don’t know anything about you, but 30 units of Lantus appears high to me for your “underweight” 41 kg; and I don’t know your height or body build. Each one of us is different - and some bodies really need more insulin than others. Years ago I would take 80 units of long-lasting background, now my basal daily total is in the single numbers.

HEY Dennis i dont take 30 unit of lantus. 30 units are my total dose i.e bolus plus basal. i take 8 or 9 unit of basal depends on requirement bt yea when i take 10 unit of lantus it leads to hypo in morning. do you have any idea of person aged 25 height 5’3 and weight 41 should consume how much carbs in a day or per every meal. cos i feel too weak all the time. i can consider incresing carb and insulin.

I read Dr Bernstein and found it helpful. I don’t want to go that extreme because I love fruit (he hasn’t eaten fruit since 1970). I decided to go moderate carb instead of low carb. My high carb a1c was 6.2 and my moderate carb is going to be similar based on my bg averages. I am using a lot less insulin for bolus and am now having to reduce the basal Lantus dose as well. I like the moderate carb level I am on.

Nancie, I was underweight too. Lost a lot of weight before diagnosis. I also got acid reflux after diagnosis and would regurgitate or gag if I tried to eat a normal amount of food. My doc prescribed prescription strength Prilosec which stopped the gagging and regurgitation. My CDE suggested snacking on low carb cheese, avocado and nuts to put on weight. It took 6 months but I am now mid range on BMI for my height. Dr Bernstein advises against nuts with his diet because they have carbs. I personally have noticed little or no effect on my blood glucose when eating even a lot of nuts, but you may want to see how they work for you.

Hi Nancie, since you mentioned being at 41 kg (90lbs) of body weight, it sounds like you are taking a lot of bolus vs. basal insulin for your weight. You said you’re taking a 2/3 (66%) split of bolus to basal (i.e., 20 units bolus, 10 units basal, 30 total). That’s a strong tilt toward bolus insulin, and it sounds like you’re covering a lot of carbohydrates per day as well.

Gary Sheiner, CDE, from “Think Like a Pancreas” suggests in his book that a good ratio of bolus to basal should be about 50% bolus and 50% basal as a starting point, and that your total daily insulin needs should be .5 unit to 1 unit per KG of body weight, if you are moderately active, and a bit more if you are not. So that would mean a total daily dose of 20 units to 40 units for 40 KG body weight, with half of those units going to basal and half to bolus on average.

If most of the 20 units of bolus you are taking is to cover carbs you’re eating…and you take 1 unit to 15 grams of carbs…that would translate to eating about 300 grams of carbs per day. That’s a lot of carbs! While that may be a standard diet for most people, it’s also very hard to control your blood sugars on 300 grams of carbs, or even 250 grams for that matter. Dr. Bernstein would recommend a much lower amount of carbs, balanced with more protein, vegetables and healthy fat. I find that 30-50 carb grams a day give me much lower and smoother blood sugars. Others may do well with 100 grams a day, if they have less insulin resistance. But 200 to 300grams of carb is pretty rough on your system and makes blood sugars hard to manage.

You didn’t mention your A1C or average blood sugars, but if you’re running high blood sugars a lot of the time, that may be one reason you’re not gaining any weight. But there could also be other issues, like hyperthyroidism (too much thyroid hormone) or something else. So it’s critical for you to see a doctor who can help you figure this out.

Also, I would highly recommend reading “Think like a Pancreas” from Gary Sheiner, to get tips on insulin and carbs, as well as Dr. Bernstein’s “Diabetes Solution”.

Good luck and Best wishes!

hey @sandra I am hardly having 150gm of carbohydrate in a day. but if i take less bolus then i suffer from hyper. i am soon moving to canada for my higher studies. right now iam in india. i am thinking of getting pump there. but since i have never used it, i dont know about its price over there. could you pls tell me about it like price of pump,price of infusion sets and other costs which add up to it. apart from intial price could you also tell me about its monthly price for insulin and infusion sets or other things which adds up to look afer.i want to make my budget before moving thr. i know price varies from pump to pump bt you can tell me roughly. so i get an rough idea of my budget. and yea if you could also tell me the price of dexcom G5 and its sensors. how frequently sensors need to change?. thanks

I am approaching my 9 year anniversary of my Type 1 diagnosis, and I have been on a super-low-carb diet most of that time, as a result of seeing Dr. Bernstein when I was newly diagnosed. My A1c has hovered in the high 4’s/low 5’s that whole time, but cholesterol has been a bit elevated, maybe because of all the cheese I was eating! For various reasons, I’ve wanted to go vegan/plant based, but thought I couldn’t do it without drastically upping my insulin doses. After watching a few plant-based documentaries, I googled “type 1 vegan diet” and was surprised to see that many people are able to eat this way and still maintain stable blood sugars.

So 2 months ago I made the switch. I’m eating things I haven’t eaten in almost a decade! Beans! Sweet potatoes! Fruit! And to my astonishment I’m using about 25% less insulin on a daily basis than when I was eating low-carb. Who knows why, because my carbs have definitely increased. And I don’t have the post-meal spikes I had expected - BG is about as stable as it was on the Bernstein diet. I’m seeing my endo next month, and am looking forward to seeing what effect, if any, this has had on my A1c. And I’m going to ask her to check my cholesterol as well!

What we choose to eat is very personal, but if you’ve thought about going plant-based, I’d say give it a try!