Last week I had an appointment with a new nutritionist. I had met with a nutritionist for the first time in December, a month and a half after my diagnosis of type 2 diabetes, but my company switched health insurance providers this year so that meant transferring to a new clinic and getting a new diabetes care team.
We discussed my diet to see things we could do to help me out with a few issues. First were my hypoglycemic lows. I had been on the low side whenever I tested and had a few extremely low blood sugars that were concerning. Second on the list was the issue of being underweight. I have been wanting to put some pounds back on as I have been very underweight for quite some time and haven’t been able to put a single pound back on. In addition to both of these things, I was feeling extremely low in energy, even going for a brisk 20 minute walk seemed like an enormous task that left me feeling very fatigued. The bottom line from my appointment with my nutritionist was that my carbohydrate intake is way too low for me (my previous nutritionist had this concern as well). I need to incorporate more carbs into my diet to have more energy and be able to gain some weight (weight gain is extremely difficult to accomplish on a low carb diet).
My nutritionist said that a diet too low in carbohydrate is probably detrimental for me given that I’m so thin. When eating a diet low in carbs, the body goes into ketosis, where it switches over to burning fat rather than glucose for energy. When we eat meals, the body burns the carbs, then starts burning the proteins and fats, when it runs out it starts burning body fat, and eventually when there’s little to no body fat left, it starts burning muscle. Given that my diet is low in carbohydrate, and I have little to no body fat on me at this point, once my body is done processing the tiny bits of carb I was eating and the protein I eat, it has no body fat to burn so then it starts burning muscle. That’s the last thing I need! I want to build more muscle, not lose what I have left! She gave me a few suggestions to try incorporating more carbs into my diet to get out of ketosis mode while maintaining blood glucose levels in a good range. She said I need to eat 80 grams of carbs minimum a day to get out of ketosis so my body starts using glucose rather than fat as it’s preferred fuel source (that will allow me to put some body fat back on). While I’m starting out with the goal of 80 grams of carbs per day right now, eventually we will want to push the carb totals up some more as women need around 45-60 g of carbohydrate per meal just to maintain weight (LOL, it’s going to take me a looong time to get there!). She said my numbers will obviously go up for a bit as my body needs to get used to processing carbs again. However, as I start to put more weight back on and start getting more muscle back from strength training, my tolerance will hopefully improve.
To get all my carbs in for the day and not destroy my blood glucose readings, she suggested doing small meals of no less than 15g of carbs per meal and eating a well balanced meal with a decent amount of protein. Protein helps prevent both spiking and crashing very low afterwards. It helps keep glucose levels nice and stable as once the body is done processing the carbs from the meal, it starts processing the protein and fats, which will take a bit longer to process. If you eat a meal that is carbs only and little to no protein, you’re going to go up extremely high and then once your body is done processing the carbs it will crash down hard and fast because you have no protein and fats to process. This explains why I always crashed down super fast whenever I tried to correct for hypoglycemia, I would eat pure carbs, spike, and then I would crash down fast and be low again within a couple of hours. For hypoglycemia, she suggested I eat fast acting carbs to get back up, check 20 minute afterwards, and if I’m in range to eat some protein to stabilize my blood sugars so I don’t come crashing down fast again and end up with the the blood glucose roller coaster. I haven’t had any lows since I started balancing my carb and protein intake, but I know this tip will be extremely useful for when I have lows, so I don’t come crashing down so quickly and feel terrible.
In addition, we also discussed my daily caloric needs. She said someone my height and weight needs to aim for around 2,000 calories a day to start putting some weight back on. Now, that’s a lot of calories! After using my fitness pal to see how many calories I was eating in a day, I realized I was getting nowhere near enough to even maintain my weight (plus I was exercising on top of it). It’s no wonder I lost a bit more weight and have been feeling very low in energy. She also suggested I incorporate small bits of fruit and more nuts and seeds into my diet to get all the nutrients I need as from my food log she could see that I probably wasn’t getting all the nutrients I needed. Finally, she also suggested making sure my blood glucose was over 100mg/dL before exercising. Otherwise, I could drop too low, which could further stress out my body.
Since my meeting with the nutritionist last week, I have been making a serious effort to get more calories in. My blood glucose readings have definitely gone up a bit, but it’s a sacrifice I’m willing to make to feel better and get back to a healthy weight range. It was nice to meet with someone that had good knowledge about ketogenic diets and could give me helpful info for my atypical situation. It also sounded like maybe she had diabetes herself (I think she is probably a type 1), given how she spoke about hypoglycemia and what works to help keep blood glucose levels in check when eating carbs. So far, I think I have been doing ok. Yes, I have had some wonky numbers given that I have been testing a lot to see what works and what doesn’t. Figuring out snacks has been the most difficult for me. For snack time she suggested plain greek yogurt (which has a lot of protein) and some fruit, cheese and crackers, or apples with peanut butter. It’s crucial to get the ratio of protein to carb right to avoid spiking and that’s what I’m still trying to figure out. Yogurt with 5g of carb in fruit and some almonds works for me while cheese and blue diamond flax seed crackers unfortunately did not work for me. I think I would need like half a brick of cheese to be able to eat crackers without spiking, which would then make it an unhealthy snack (I was 203 an hour and a half later, which is way too high). Half an apple with peanut butter is ok, but I still end up a bit too high for my liking. I think it will take me a while to figure out what works, but I feel like I’m making good progress already. I’ve also been feeling a lot better now that my blood glucose readings aren’t on the lower side. I hope to have this all sorted out in the next couple of weeks. I meet with her again in two more weeks to see how it’s been going and discuss any additions or further changes we should make to my diet. Will post an update in a couple of weeks!