Type 1 Diabetes: More Info

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Amy Kubal shot me an interesting link talking about the dramatic increase in type 1 diabetes. It’s both scary and sad. The increase is going to be dramatic, the fix is completely in our control. Avoiding grain and dairy exposure in our kids would virtually eradicate this disease. these bozo’s are hand wringing about a “need for more observation and research” when the mechanism is well understood. Yeesh.

Shifting gears but still on the topic of Type 1 diabetes. You might recall from a previous post on this topic that I cautioned people with Type 1 that high intensity exercise might play havoc with blood glucose levels due to exercise induced hepatic (liver) glucose release. I knew this was facilitated by the release of adrenal hormones such as epinephrine and norepinephrine, but I was unclear about the magnitude of the release, what types of exercise produce the largest release and a few other issues. Well, thanks to one of our clients who is an ex-phys grad student at CSU Chico, Martin Freigard (thanks dude!) I have a pretty solid resource and support for my caution. In the book Exercise Physiology by Brooks, Fahey and Baldwin all aspects of integrated fuel metabolism are considered including hormonal and substrate (in this case fuel) consideration while exercising. Pages 193-194 have the information we need to make some informed decisions about trainign around Type 1 diabetes. Here they are:

1-Untrained individuals see a marked increase in glood glucose levels at both high and low intensity training (as measured against % VO2 max).

2-Trained individuals see little increase in blood glucose in response to training at low-moderate intensities (below 70% VO2 max).

3-Trained individuals see a markedly LARGER increase in blood glucose levels in response to training up to 100% VO2 max, and an even greater response at sprint intensities that are above 100% VO2 max (anaerobic).

So…what does all that mean for the Type 1 diabetic? It explains why we have seen Type 1′s who have a rocky time regulating blood sugar after CrossFit WOD’s. They are ALL anaerobic. The information referenced in the book is from people sitting on a bicycle. The authors make the point that running elicits and even larger blood glucose response because its harder. I suspect a Fran or Helen would be even larger in this regard and this does seem to be what people are seeing.

What to do?

1-For the health and longevity minded Type 1 I’d keep the lions share of your training in the low-moderate intensity range. Lift weights, to CF style met-cons but keep things at about a 60-70% intensity, perhaps far less. Eat a largely ketogenic paleo diet and map your blood sugar response to exercise so you have a solid picture of what exercise doe what. Endeavor to use the absolute bare minimum of insulin by smart diet and training (ie. do stuff that DOES NOT crank you blood sugar through the ceiling).

2-You’re Type 1 and you are going to train CF no matter what. Well, try to keep your carbs as low as you can handle them, and just try to figure out what training does what (mapping again). Understand that what your doctor is ok with, high blood sugars, higher than normal A1c’s and all that are not good for your long term health. It’s your call, be informed, make decisions based on your goals.

Hey Theresa- Here’s your reference.

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  1. Loni
    October 14, 2009 at 3:31 pm

    Robb,

    I am signed up for the nutrition cert December 5th in North Carolina. I see that you now have a east coast team. Does that mean that you won’t be there on the 5th? That would be a bummer.

    • robbwolf
      October 14, 2009 at 9:54 pm

      Loni-
      Nope, N. Carolina will be me. this transcontinental travel is literally killing me however. that’s why we are bringing on Mat and Bobbi. that and they totally kick ass at this stuff, folks are just not as familiar with them as they are with me.

  2. Mark
    October 14, 2009 at 5:12 pm

    We’re getting spoiled with all these posts, thanks Robb!

    Coming back to Sears, I know your thoughts on his view that the ideal protein to carb ratio should be from 0.5 to 1.0 from the Journal video (it’s junk) but do you think there is any relevance when we’re talking about fat loss or performance?
    What led me to think about this is that one of the arguments from other camps (Tom Venuto, Martin Berkhan – great guys by the way) is that of course quality is important but that calorie count matters most and not necessarily macro’s when it comes to fat loss, as long as protein is sufficient. Assuming we’re doing the standard Zone protein allotment, do you see any reason why a balanced/Zone diet would be more efficient at burning fat than a diet like Mat’s if calories (rx’d Zone from CFJ21 for example) and quality (Paleo) is held constant? The view, as I understand it, is that as long as protein needs are met (something you touched on in an earlier post), then carbs and fat is a matter of personal preference as long as quality and calories are maintained. I’m not arguing for a zero fat approach but just trying to understand the balanced opinion. I’m sorry to ask this but it’s something that comes up with people and I don’t want to blindly follow Sears and I know it’s going to be tough to listen to his presentation in Beverly, MA with a skeptical ear. Thanks

    • robbwolf
      October 14, 2009 at 9:52 pm

      Mark-
      it;s a great question. I might expand on this in the first podcast, this is a hot topic. I agree with Martin and Tom about the minimum protein issue, then its largely calories but the macros DO matter based on ones insulin sensitivity. Someone who is not that insulin sensitive (me for example) is hungry as HELL on a base zone (calorie restricted, adequate protein…in theory). If I tweak that Zone however and cut more than half my carbs, add a little fat, I am the same calorie level but a completely different world with regards to insulin. I am not particularly hungry and can lean out STUNNINGLY fast. Smart use of intervals vs steady state cardio efforts etc can really add to this as well.

      This is all an easy test to run. Roll with a base Zone, see what happens. Roll with the 1/2 carbs increased fat (still base zone calories) and tell me which is easier to DO and which one is better for fat loss. I rarely recommend a Zone approach but if someone REALLY wants to lean out this 1/2 carb Zone is money. Adequate protein, calorie restriction, and some fat to prime the pumps.

  3. Mike Kesthely
    October 14, 2009 at 5:35 pm

    Great stuff, Robb. I think you’ve mentioned BGL chaos & Crossfit WOD while referencing Lowy’s significant other in the past. This puts more pieces into the puzzle and makes more sense. Props to you on doing a shitload of applicable research regarding IDDM and athletes.

    Regarding furthering one’s education: “UPDATE: We are working on an advanced topics educational program for several different educational tiers. Trainers, RD’s all the way to Doctors and pharmacists.” —any update to the “update”? I’m highly interested, but I’d rather stick forks in my eyes than take an R.D. or some other typical nutritionist program.

    The Exercise Physiology text—related, or was the fuel metabolism reference isolated? I have university A&P and a fairly basic understand of nutritional biochem.

    • robbwolf
      October 14, 2009 at 9:45 pm

      Mike-
      The educational programs are some ways off. Can’t even speculate on when. That exercise phys text is spot on for strength coaches. Good shite.

  4. Nick W
    October 14, 2009 at 6:30 pm

    Hey Robb,

    Great stuff as always. Keeping track is the KEY to this; I found that a basic “Starting Strength” workout (say squat, Bench and Power Clean for 3 x 5 with 5+ minutes rest between sets) can spike my blood a LOT (e.g. from 80 to 200+), but it only took 2 sessions to figure how how much insulin I need to cover it and when to inject; I can now keep my blood sugar stable. CF workouts are harder because of their unpredictability of course, but you’re bang on that this is the key to good control.

    I’ve got a question for you following your comment a while ago about T1 endurance athletes (and how they so rarely have good control). What are your thoughts on “cardio” for insulin sensitising purposes? I’m not talking about training for marathons or banging out hours at a time, but rather hitting up some moderate-paced jogging / cycling that lasts half an hour or so. For myself, this kind of intensity and duration doesn’t need any extra carbs to fuel it, and it doesn’t seem to tap out my (limited, since I’m ketogenic) glycogen stores if I do this on consecutive days, but it does mean I can drop my insulin intake a little for the rest of the day. Seems like a win-win situation to me (less insulin, probably leading to more stable BG through the day, no extra carbs needed) and I’ve considered doing this on a daily basis; am I missing anything here?

    As I say I’m not looking at this as a way to improve fitness directly; just as a way of minimising insulin requirements.

    One more thing while I’m on; I’m working under the assumption that as a T1 my goals for long-term health should be a good HbA1C first and foremost, and to achieve this with the lowest amount of insulin I can as a close second. Is this a fair model, or again am I missing something else? Would having a very low intake of insulin interfere with absorption of nutrients in any way? Hypothetical example here, but I know that if I go hiking all day I can get rock-steady BG’s on a very low amount of insulin; if I did this every day for a week (or month, or year) would there be a minimum amount of insulin I’d require before things started going wrong? Not expecting you to know how much that might be, but is it even an issue – or should it just be a case of driving the intake as low as it can go? All this assumes no pancreatic function at all of course.

    Sorry if this is all bollocks, and tell me to bugger off and research it myself if you like, but I’m always interested in your opinion on this stuff; you tend to be on the money every time!

    Thanks,
    Nick.

    • robbwolf
      October 14, 2009 at 9:43 pm

      Nick-
      You are spot on with all of this. Lower level activity establishes a solid base fitness Ie.- insulin sensitivity. And yep, in my mind, keeping those A1c’s as low as possible which the concomitant bare minimum insulin makes you start looking like these folks who live to be 100. But a GOOD 100.

  5. BJ
    October 14, 2009 at 7:11 pm

    Hey Robb,

    Thanks for posting this, but I had a couple of additional questions. First off, since high-intensity workouts tend to raise anyone’s blood sugar (not just that of diabetics), wouldn’t it be advisable for non-diabetics to avoid crossfit as well, to prevent the additional insulin release? As I understand it, your view is that insulin is the bad guy, and the only real difference is that a diabetic must inject insulin to keep blood-sugar levels from becoming toxic, whereas a non-diabetic’s body produces its own insulin. Either way, more insulin will be present in the system afterward. Is that correct, or do non-diabetics have some other mechanism that lowers the post-workout blood sugar?

    Also, can you elaborate on the low-to-moderate intensity activities you’d recommend? I know you’ve mentioned lifting weights, but since weight-lifting is an anaerobic activity by its nature, I’m just curious what kind of loads/reps you think would be ideal? I notice that my blood sugar seems to spike the most on strength days, but to be fair, these generally include attempts for a 1, 3, or 5-rep max, so they’re a little more intense than standard.

    Finally, is your conclusion that it’d be best for a diabetic to (for lack of a better term) “give up” on being much of an athlete? I just have a hard time seeing how it’s possible to perform at a high level (in just about anything) when your training is made up of giving only 60-70% of your max effort. I imagine this is what you mean when you say it depends on one’s own goals. Still, when you’re a competitive mid-20′s, it’s tough to decide if you’d rather be the best or live the longest.

    Anyway, thanks for all the info you put out there. It’s definitely eye-opening.

    • robbwolf
      October 14, 2009 at 9:40 pm

      BJ-
      The pancreas has both neurological and chemical inputs for responding to blood sugar issues. That means it;s quick and accurate. Insulin boluses are at best a guess. Imagine shooting at a target using a laser scope and an indicator ont eh target that you are “on”. This is your normal pancreas. Now imagine shooting at a target by facing away from the target, with the gun slung over your shoulder…using a mirror to get a bead on the target.

      As to whether one should do CF or not because of the blood sugar increases, obviously a normal functioning pancreas is a VERY different animal from trying to dose insulin or use a pump. That said, this is an argument for smart programming on yet another level. We do not do well digging super deeply in that met-con pathway day in day out.

      Check out Nicks post and my response for some ideas on the intensity piece. It’s all subjective and requires tinkering. And No, I’m not recommending folks do any particular thing other than track what they are doing and understand that there ARE tradeoffs. All of this stuff first came to my attention because Dutch Lowy asked me to help his girlfriend who is type 1 and who experienced horrible blood sugar swings post CF. It;s always been my intent to get the best of both worlds but the reality is there are tradeoffs.

      • Greg white
        September 15, 2012 at 10:01 am

        I know this post is old but as a type1 I find when I do max effort interval sprints (max effort 30 secs, off for 90 secs, x 8) that it lowers my blood glucose post workout and keeps it low throughout the next 24 hours so my experinece is contrary to what is suggested. I’m type 1 for 23 years.

  6. Eric Pelletier
    October 14, 2009 at 9:10 pm

    Robb,
    You Rule! Seriously. I have been Type 1 since I was 28 days old and now I am 22. Yep, born with it, and I can say that I have found no greater solace than in the fact that someone who actually looks fit and healthy (you) can give me advice and that “advice” is amazing. I would like to know if it would be possible to be a guinie pig for research. I have been crossfitting for about 1.5 years with a good degree of success but would like to be apart of trying to help the world know more. It’s a waste for me to be so afflicted and not help people deal with the same thing in there own lives. ANy advice you could give would be amazing and greatly appreciated

    ERic Pelletier from Zion, Il

    • robbwolf
      October 14, 2009 at 9:15 pm

      Eric-
      I’m glad this stuff is helpful!! I think an amazing way you could help would simply be to keep track of your food, training and numbers (blood sugar and A1c’s). Shoot me an update once a month if you want and we can keep track of how things are going and try to improve both performance and lab numbers.

  7. miss spinach
    October 15, 2009 at 12:50 am

    Interesting discussion…as a fairly insulin-sensitive person my experience on base zone with half the carbs/replace carb blocks with fat blocks to replace the deleted carb blocks…. vs. standard base zone is like the difference between high-speed internet and a telegram.

    Robb, to connect this to your discussion of adrenal fatigue (and thanks for the honesty and detail in that post) I think the tweaked zone is helping me address my own adrenal issues which I’ve slipped in and out of over the years. The “extra” fat (I don’t think it really is “extra”) isn’t just protective. I don’t think I’m using it just so that I can run myself into the ground longer before crashing. I feel like I’m recuperating, and I didn’t even realize I felt like crap in recent times. Because I didn’t feel as crappy as I had in the past.

    So, a lot of the questions that come up tend to involve amounts of carbs. I have a question regarding amounts of fat vs. amounts of protein. The generally-paleo adherent Nora Gedgaudas advocates what amounts to like 6 blocks of protein per day. I don’t know if she recommends more for athletes because I haven’t read her book. That said, here’s her blog post which is kind of interesting. http://www.primalbody-primalmind.com/blog/?p=295
    What she says about fats in general rings true, however, and it is interesting that her focus is mental health (probably not athletic performance).

    So, I gave this a try yesterday to see what it would do. I certainly wasn’t hungry on 6 blocks of protein, 4 blocks of carbs, and what came to 44 blocks of fat. (Normal would be more like 10/5/25.) My performance on the WOD was actually pretty damn good, but on a regular basis an athlete probably needs all 10 blocks of her protein.

    • robbwolf
      October 15, 2009 at 1:43 am

      Sarah-
      Yea, keep in mind the 10 blocks is only ~75-80g of protein. I think going lower for periods of time is just fine, as is higher, but I;d think the 6 block level would be REALLY low for most folks. Nicki eats that much in a sitting most meals!

      the main point is one needs to keep protein below 30% of cals to prevent any nitrogen disposal issues. That’s pretty easy to do by simply adding a bit of olive oil to a meal.

  8. miss spinach
    October 15, 2009 at 3:37 am

    Thanks Robb!

    I’ll have to read up more on nitrogen disposal. I think I’m getting plenty of fat to avoid such a problem from all the fish oil I’m taking on top of whatever fat I use for cooking or dressing.

    I’m taking 30 of those Costco fish oil caplets per day, divided into 3 doses. When I started out taking the fish oil again after several months off of it, I just went straight to the high dose. I wanted to see if it would make a difference, physically and mentally, and yes, it has. Removing grains was not nearly as scary as I had feared and helped considerably too. I don’t know why it took me so long to take these steps. It is like night and day, honest to goodness!

    Well that has little to do with the subject of the post so I’ll wrap up my comments with…

    THANK YOU!!!

    I

  9. Matt
    October 15, 2009 at 8:04 am

    “The increase is going to be dramatic, the fix is completely in our control. Avoiding grain and dairy exposure in our kids would virtually eradicate this disease.”

    You didn’t get that from the article, but seem to link it together. Or are you just stating that? Avoiding grain and dairy will help prevent Type 2 Diabetes, but how will it affect Type 1? Is there a ‘fix’ for type 1 at all? I feel like I missed something….

    • robbwolf
      October 15, 2009 at 3:09 pm

      Matt-
      That is my opinion based on the understanding that Type 1 is an autoimmune disease and autoimmunity stems from a cascade starting with gut irritation.

  10. Michelle
    October 15, 2009 at 2:29 pm

    Hey Robb, I love when you talk about type 1 diabetes! I agree with your exercise advice for those with type 1 diabetes, like myself. I have found that low to moderate exercise is what is best for my bloodsugar and the instense workouts would usually exacerabte my bloodsugar. So far I’ve been paleo for 9 months and off insulin injections for 3.5 months.

    • robbwolf
      October 15, 2009 at 3:05 pm

      Michelle!!
      That is AWESOME!! Would you mind writing that all up so I can make a post out of your experience?

  11. Deanne
    October 20, 2009 at 6:33 pm

    Just found this. Can someone PLEASE explain EXACTLY what a paleo diet CONSISTS of ? Is there a LIST of food somewhere ? I’m hopping around on this site, and can’t find out what you’re supposed to eat !

  12. Esther
    August 30, 2013 at 10:32 am

    Hey Robb,

    I’m a t1 Diabetic for 8 years now. I’m 38, a CrossFitter and mountaineer. I was a dancer as well and teach yoga and Pilates. You’re post has been very valuable to me. I’ve noticed that my sugar swings up dramatically after some crossfit workouts and drops during hikes, yoga ect… I’ve been Paleo/Primal even before I knew what that was, but have struggled to lose 10/15 lbs since going on Insulin. My A1c is just under 7 so it’s not too bad.

    I would love to read how Michelle managed to go completely off Insulin. Despite my very active lifestyle and eating paleo/Primal for about 95% of my diet I haven’t experienced her success. Would love any advice. CF has been essential in helping me train for mountain expeditions. Should I find an alternative approach?…

    Thank you,

    Esther

    • Robb Wolf
      September 2, 2013 at 7:55 pm

      Esther-

      I believe she still had pancreatic function, stopped the inflammation and manages to find a workable carb tolerance…there is just a ton of variability to this. Mapping the training and trying to match carbs/insulin/training is the best advice I can give you.

      Keep me posted.

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