Insulin Pumps & Low Carbohydrate Diets
High carbohydrate diet? Low carbohydrate or no carbohydrate diet? Low Fat diet?
Mediterranean diet? South Beach diet? There are so many choices and different ways to manage food. What is the fuss about carbohydrates? What role do carbs play in the body?
In the presence of insulin, carbohydrates are funneled through a complex metabolic pathway called glycolysis, which ultimately provides energy for your body. Think of insulin as one of the keys that helps to unlock carbohydrate breakdown and provide energy for daily activities. Carbohydrates are necessary for survival. Without carbohydrates in our diet, other sources of energy such as fat and protein are broken down, but these provide less energy to your body overall. If your body only uses fats for energy or insulin isn't around to help with carbohydrate breakdown, you could possibly develop byproducts of fat metabolism or ketones. These chemicals can build up in your bloodstream and lead to the possibility of high acid levels, which can cause vomiting, fluid loss, decreased energy, and in the worst case, diabetic ketoacidosis resulting in hospital admission.
Insulin pumps are meant to function like your body would, but you must tell it how to work. When you eat foods with carbohydrates, your pump delivers a pulse or "bolus" of insulin that enables the carbs to flow through that metabolic pathway I talked about earlier. It doesn't matter how many carbs you eat because the pump delivers the necessary insulin to cover them based on the information programmed in the pump (insulin/carbohydrate ratio).
What happens when you don't eat carbs or have an extremely limited amount? You still need energy for your daily activities like school or sports. Instead of breaking down carbs derived from food, your liver first breaks down glycogen (a limited amount of stored glucose) for energy, which requires insulin to "grease" the pathway. Therefore, the pump provides "basal" insulin to cover the blood glucose when you are not eating. Most teens have several or more basal rates to deliver this background insulin.
Of course, many other factors come into play such as exercise, stress, and hormones that affect how much or little insulin is necessary. After repeated experience, most kids learn how to manage their insulin needs. Sometimes, we stop the pump for a limited time or use a temporary basal rate when we are concerned about the possibility of going "low." Typically, this may happen after exercise or illness when you have a decreased appetite. In addition, sometimes, a low carbohydrate diet is recommended if one wishes to lose a bit of weight (just like people without diabetes). The most important thing to remember is that insulin is necessary whether we eat or not. We need to be able to tell the pump to give more or less insulin based on individual circumstances. Carbs are not the enemy; but rather the fuel that enables our body to function optimally!
I appreciate hearing your comments, questions, or thoughts.