Part 3  

Obeying the Laws of Small Numbers 

In the Part 1 and 2 we explained the importance of small numbers and how to begin to achieve predictability by using the Law of Carbohydrate Estimation, The Law of Insulin Dose Absorption and the Law of Insulin Timing.  Today we will discuss the How To, in obeying the laws of small numbers. 

Obeying the Laws of Small Numbers 

Essential to "obeying" the laws of small numbers is to eat only small amounts of slow-acting carbohydrate when you eat carbohydrate, and no fast-acting carbohydrate. Even the slowest-acting carbohydrate can outpace injected or phase II insulin if consumed in greater amounts than recommended. 

 If you eat a small amount of slow-acting carbohydrate, you might get by with a very small postprandial blood sugar increase. If you double the amount of slow-acting carbohydrate, you'll double the potential increase in blood sugar (and remember that high blood sugar leads to even higher blood sugar). If you fill up on slow-acting carbohydrate, it will work as fast as a lesser amount of fast-acting carbohydrate, and if you feel stuffed, you'll compound it with the Chinese Restaurant Effect. 

All of this not only points toward eating less carbohydrate, it also implies eating smaller meals 4 or 5 times a day rather than three large meals. If you're a Type II diabetic and require no medication, eating like this may work well for you.  One difficulty with this sort of plan is its inconvenience, but some people don't mind and actually prefer to eat this way. I have one patient, a Type I diabetic who still makes some insulin. She eats a couple of bites of protein every 15 minutes and takes long-acting insulin. In a 16-hour day, that adds up to a lot of meals and a lot of clock-watching. This routine would drive a lot of people nuts, but it works for her. As long as she keeps up with her frequent little meals and covers the insulin, she's fine. If she misses a few "meals," there could be trouble. 

The major problem with multiple small meals for Type 1 diabetics lies in the importance of correcting high or low blood sugars with insulin or glucose respectively, throughout the day.  Since pre-meal regular or lispro insulins, even in small doses, continue to affect blood sugar for at least 5 hours, it is potentially dangerous to correct an elevated blood sugar with “fast acting” insulin before the prior dose has finished working.  Thus meals should be spaced at least 5 hours apart if such corrections are to be made without risk.  Such timing is impossible with multiple small meals. 

For the Type II diabetic who doesn't need insulin injections, smaller meals throughout the day can be a very effective way of maintaining a constant level of blood sugar. Since this kind of diet would be tailored to work with a phase II insulin response, blood sugars should never go too high. It would, however, involve a certain amount of daily preparation and routinization that could be thrown off by changes in schedule—illness, travel, houseguests, and so forth. (People with gastroparesis, or delayed stomach-emptying, may have to eat this way. We will discuss this phenomenon in a future article.