Why not?

Why can’t I, with type 1 eat strictly high protein meats without constant shots, maybe raise lantus and exercise some and only take a shot if my sugar is above 150? Any ideas?

Unfortunately insulin is not just needed at mealtimes. A non-diabetic pancreas infuses insulin into the system in tiny doses throughout the day to metabolize sugar that builds up in the blood from stress, metabolic functions, and hormonal activity. So even if you were to eat zero carbs during the day or not eat at all, you still need a little trickle of insulin 24/7, and a pretty good trickle if you are under stress. Exercise can reduce the need for insulin, but you would need to do extreme exercise constantly to avoid some insulin supplementation. If you are taking shots, this trickle is simulated by injecting a long-acting (time release) insulin like Lantus/Toujeo, etc. For pumpers, the pump delivers a little drop of fast-acting insulin every few minutes throughout the day and night.

A healthy blood glucose range is 70-100 fasting, 100-130 post-meal. Blood sugar readings for extended periods above those levels will gradually harm the capillaries in your body, which in turn impact your circulatory system, nervous system, eyes, and major organs. So keeping our BG in a normal range as possible as often as possible reduces/delays that damage, and in turn the complications that can arise from that damage. Are you needle-phobic? I always was, and having a pump helped me with that. If you are super athletic and struggle with BG stability, you may want to read “The Diabetic Athlete’s Handbook” which is full of good information.

I think that’s a very good question. There is a strong insulin independent pathway that is unregulated by exercise. Angivan is right though, you will eventually die without insulin (all type 1s died before insulin discovery, exercise and zero carb or starvation diets delayed but didn’t eliminate the mortality). Some people who are very active and low carbs get along with just basal insulin pump or injection and don’t require meal bonuses unless they have a meal with unusually high carb or if they have an infection, illness or other stress.

A low carb diet (such as Adkins or Keto where you primarily eat protein and fats) with diabetes is very tricky. When you are breaking down fats, one by-product is ketones. This process will happen even in a high protein diet since protein is not a fuel source for the brain (carbs are, followed by fats). In healthy people, they have adequate insulin to prevent the overproduction of ketones that lead to DKA. However, with taking Lantus alone (even with exercise) you are walking a fine line of maintaining a healthy BG and taking enough insulin to suppress the ketone production.

If you are extremely careful, it is possible to reduce your carb consumption and in turn take less insulin. However, it does put you at a high risk for DKA so you will want to talk to your endo about how to do so safely. Also, a lot of people feel very sluggish and mildly depressed when in nutritional ketosis of a low carb diet, so if you have ever struggled with depression you will want to keep that in mind.