Type 1 Diabetes and CrossFit

Robb,

Thanks so much for the article. The trainers at my affiliate turned me onto the article (thanks Harry and Ben) and it is eye-opening.

I became a type I diabetic at 29 and am 45 now. I started Crossfit about 3 years ago. My diet is mostly eggs, fish and vegetables, and I eat very little in the way of grains (except when I eat out, maybe once a week), and no milk. My cheats are a few bites of chocolate during the day, crackers with cheese (I eat too much of this), and a bit of agave nectar. My kids laugh at me because of the monotony of my diet (“Dad’s eating salmon and broccolli for dinner, what a surprise!”). Breakfast is the same every morning – three eggs, one Morningstar farms sausage pattie (I know, not a great choice) and a cup of coffee with 1 tsp Agave nectar.

When I started crossfit, I’d have these terrible hypoglycemic episodes. These went away and my blood sugar leveled off. Within the last year, though, my blood sugar started to slowly rise during my workouts. I wear a Continuos Glucose Monitoring System, and I can actually watch a linear rise as I go through the workout. I’d go to the workout with normal blood sugars many days (say 110 – 140) and I’d walk out with 200 – 300. I haven’t tracked this carefully, but I suspect this does not happen during rest days.

Interestingly, my strength has gone way up during the time I’ve done Crossfit, but my metcon performance has moved very slowly. When I started, I could not do almost any of the workouts as rx’d. Now I can, but my times still suck. I’ve been busting my butt and couldn’t figure out why my improvement is so slow. Not only that, but I felt really lousy for hours after metcon workouts. I was also puzzled by the rise in my blood sugars.

I guess I can stop banging my head on the wall. You’ve provided me with a likely answer. I’m going to try lightening up on the metcon and tightening up on the Paleo.

Cash, are you familiar with what Dr. Denise Faustman is doing at Mass General? The solution to Type I may not be stem cells, but a generic, commonly available vaccine called BCG. She’s used it to reverse Type I in mice and then permanently cure them. Her work was published in Science (http://www.faustmanlab.org/docs/academic/Science_2007.pdf)and has been duplicated by several other labs. BCG suppresses the t-cells that attack the Eyelets of Langehorns. She has shown that they will grow back once the t-cells are suppressed. She’s just finishing up Phase I clinical trials on humans. I live in Boston and am going to try to participate in the Phase II trial. Check her out here: http://www.faustmanlab.org/

Thanks Robb,

What’s really interesting is that Dr. Faustmann thinks the treatment might work for other autoimmune diseases besides diabetes, e.g. crohns, MS, rheumatoid arthritis, etc.

Sadly, she is having trouble getting her research funded. Phase I got a big boost from Lee Iacocca’s foundation, but the major charitable organizations like the ADA and JDRF are stonewalling her. She is strapped to fund Phase II.

Robb,

Thank you for all of the work that you put into your blog. I usually read a weeks worth at a time, and I have learned a lot.

I am a Type 1 diabetic, diagnosed at age 11 and am now 28, and a regular crossfitter for the past 20 months. I struggled with hypoglycemia throughout highschool and college. At its worst I was being brought back to conciousness by the EMS at least once per month (always while sleeping). Turns out that the carb-loving doctors kept telling me to increase my Lantus (one of two insulins I take, this one works in the background for 24 hours) when my A1c would come back a little elevated (never over 7.4). I obeyed until one day I realized that I was feeding my insulin, literally like 10 Chips Ahoy cookies before bed so that I wouldn’t have a hypoglycemic seizure. Once I started thinking for myself, I cut my Lantus dose in half and made sure that my morning BS was within 10 mg/dL of what it was at bedtime.

I started CrossFit in January 08, and I have routinely gone to the 6 a.m. class. I would typically go to the gym fasted unless my BS was low, and then I would have an apple or Zone Perfect bar. Like Kevin, I was surprised to see some of my post WOD blood sugar levels at 250-300, and I noticed that I crapped out faster than my friends. I was able to connect the logical dots that my body was producing glucose in an attempt to provide fuel to my muscles, but without insulin, that fuel was unusable. As an illustration of the jump, one morning I had a routine 3-month check up with my endocrinologist where I was to give a fasted blood sample. I woke up at 5 and my BS was 47 mg/dL. I didn’t want to break my fast, so I went to CF and did a WOD. After, it was 150, and by the time I reached the doctor it was 127.

I decided to try to mimic what a normal body does during a WOD, so if I saw that it was intense I would take a bolus of 3-5 units of Humalog 15 to 30 minutes before the WOD. This actually works really well for me, though it is a delicate balance because I absolutely don’t want to take too much. I am happy if my BS is sub 170 after a WOD.

Insulin sensitivity is nuts with CF. I have found that after 1 intense WOD, my sensitivity remains high for up to 30 hours (assuming I sit on my ass at work and sleep all of that time). I take about 1/2 the amout of bolus insulin when I have been on a regular CF schedule than when I am on “vacation”. I have labwork done every 3 months, and for the past 5 years I haven’t had an A1c above 6.6, and 6.4 is my average (Doc says I wouldn’t see any real benefit going lower that would be worth risking low BS).

Kevin, Robb, and anyone who reads this, please help support Dr. Faustmann and the search for a cure in general. I have taken over 24,000 shots in the past 17 years and pricked my fingers over 50,000 times, and I will do anything to prevent my kids (and yours) from experiencing the same.

Stats
Worst shape: 23 y.o./ 200#/15% BF/ A1c 7.4
Best shape: now 28y.o./180#/8% BF/ A1c 6.4

It would seem I’m the minority here, but I find several flaws in this article and your subsequent responses to some of the comments. For one thing, there is absolutely no reason a Type 1 Diabetic can’t run Iron Mans and have an EXCELLENT A1C. Don’t put a guarantee behind your own opinion which has no basis in fact. As a Type 1 diabetic myself, I know it doesn’t have to limit the type of workouts we’re able to do and still have a good A1C…it’s called learning to control your diabetes, not letting it control you. And your comment that Type 2 Diabetes is simply too many carbs? There are many Type 2 diabetics whose pancreases are unable to properly dispense insulin, or whose bodies are unable to utilize the insulin as needed no matter what type of diet they follow. Despite what people often think, Type 2 is not just due to excessive carbs or being overweight, and while it can often be controlled through proper eating and exercise, limiting carbs is not a cure-all.

As for some of the comments from people saying their endocrinologists promoted high-carb diets… I recommend a new doctor. I’ve had diabetes since I was 4 (I’m now 25) and not one of the many endocrinologists I’ve had was a proponent of using MORE insulin unless absolutely necessary. Even in cases where my basal rate needed to increase, the goal was always to achieve better responsiveness to insulin and bring my blood sugars back to a more even keel.

It seems irresponsible to offer a specific daily carb amount for a Type 1 diabetic to maintain when you have limited knowledge of diabetes and no actual background on the subject. A paleo diet may very well be a great option for a diabetic, but I would hope that anyone reading this article does their research before altering their lifestyle based solely on your unsubstantiated opinions.

Additionally, it’s proselytize, not “prostylitize.”

Robb –

Thanks so much for the blog. My daugher (6) was diagnosed Sept 10. My husband and I are crossfitters (now), but have been into various types of excercise for years (weight training, powerlifting, etc.). About a week after our daughters diagnosis, we realized too that we were feeding her injections and it seemed like we should clean up her diet and then see where we were at.

We (all 3 of us) went Paleo. And the next thing will amaze you, but her blood sugar readings began to drop like a stone, and we began to reduce her insulin injections in order to avoid so many lows. The poor kid was spending more time in the nurses station eating food to bring her blood sugar up than she was in class. Eventually, we had to stop giving insulin completely, as even 1 unit of Levemir would cause her to have lows all day long.

She has been off of insulin for a couple of weeks and we continue to test her blood every 2 or 3 hours. We have located a new Endo who we hope is open to working with us on her diet (previous guy actually said – “feed her whatever she wants and give her insulin accordingly”).

Perhaps this is the infamous ‘honeymoon’ phase, or she was misdiagnosed (the previous endo did not do c-peptide or antibody test – only looked at her and said “shes 6 years old and thin, she must be a type 1″) but I will tell you that her improvements began the very DAY we started the Paleo diet.

Thank you for making me feel like I am not alone!!!

A Cross Fit Mom.

Robb – sounds great, I will keep you posted on her progress. She is doing just great! Today her blood sugars were probably better than mine. She ranged between 62 (lowest reading of the day) and 127 (one hour after meal).

We see the new Endo on Oct 16th.