Sean’s Story: Paleo, Type 1 Diabetes & the Endurance Athelete

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Hey guys, Diane from Balanced Bites here! Many of you know me from my blog, around the web on Facebook and Twitter or from my Practical Paleo Seminars that I teach in gyms around the country. Well, what you may not realize is that I also coach clients 1-on-1 in their efforts to create diet and lifestyle plans that are unique to their needs and their own specific health conditions. Check out this story from one of my clients, Sean, who came to me back in August of this year looking for help making a Paleo diet work for his half-Ironman race and to get his health (ahem, blood glucose) to a much better, more stable place thereafter.

“Hoooowdy, and welcome to Paleo Town.”

Perhaps it’s fitting that my story starts in rainy Seattle, where Robb first started to develop his work on evolutionary-based nutrition. I was there last December, visiting my friend Erica on the way to Europe for soe desperately-needed travel and vacation. I had just quit my job in politics after a grueling few years (turns out I lack the necessary proclivity for bloodletting, torture, and self-flagellation that the job requires). Seattle was my first stop to rethink my life and my direction. Then it was off to Amsterdam to, uh, not think about my life and my direction, so to speak.

I’d known Erica since high school–she’s always been slim and athletic, and also happens to be one of the smartest people I know. She had recently started CrossFit and running marathons, both of which intrigued me as “good” paths toward “great” health (I would learn later this was naive, but more on that later). When we got to the discussion of diet, she told me that her diet was entirely grain-free. No bread. No pasta. She lived off the fat of the land, literally, to run marathons. I distinctly remember thinking that my friend of over fifteen years may have developed a severe mental condition. Maybe it was something in Seattle’s water supply. I felt increasingly nervous about her mental state when she told me of her plan next year to hunt and kill a wild pig, store it in an industrial meat locker in her “home office” and then cook the captured beast, hooves and all.

While I considered escape routes out of her apartment, we started talking about how I was going to spend the next year. I brought up a couple bucket list items: to finish a double-century bike ride and maybe run a half-marathon. Both of these are potentially complicated goals for most people, but it was even more so for me, as I’m a type 1 diabetic.

My pancreas suffered an autoimmune attack of some sort when I was twenty, destroying the beta cells that produce insulin (among other hormones) and requiring me to dose insulin with any meal. It was a shock to everyone (and myself) when it happened; I’d always been lean and athletic. Played baseball and basketball as a kid. Having to determine a ratio of insulin-to-carbs–as the process of “eating” is known for many type 1 diabetics–is an difficult undertaking due to needing to assess the carbohydrate count in any piece of food and to account the action time of synthetic insulins–even the fastest-acting insulins on the market are a poor substitute for the real thing, taking thirty minutes before they actually start working.

Still, I’d created a system to manage my diabetes and remain active. And according to endocrinologists and other doctors I’d worked with in the past, I was extremely healthy, even compared to their non-diabetic, “normal patients.” I was in better shape than any friend or family member. So I was pretty sure I knew something about energy, metabolism, food, and exercise. Hearing any talk of a high-protein, high-fat diet made me think of my brother’s attempt at Atkins, which, as far as I could tell, consisted mainly of him eating giant bowls of salad while drinking vodka in his boxers and watching “Cops” on daytime television. It’s safe to say that I didn’t hold this kind of diet in the highest esteem.

“How the hell do you have enough energy to run a marathon by eating meat? And fat?” I asked Erica. “And where do you get the will to live…without bread?”

She told me how your body not only becomes “fat-adapted” once you switch to a high-protein, high-fat diet, but cutting out gluten produces other incredible health benefits as well. I had heard the no-gluten spiel before–I’m from California, where Whole Foods actually has an entire section dedicated to cleanses with lemon juice. With accompanying books. Despite being wary of what she was saying and offering her the recommendation of a great psychiatrist, for some reason her talk of an ancestral-based diet made sense to me. It wasn’t that what she was saying was particularly illogical–it in fact seemed very logical– but it was just such radical departure from nearly everything I knew about food. I guess I was just at the right period of my life to be able to consider it. And then I went to Amsterdam and promptly forgot about all of it. Seriously.

Fast forward to June of next year: I was back home in San Francisco. I had decided to take the entire year off from working and take better control of my health. My goals: 1) lose the “tech belly” that about anyone with a computer in the Bay Area suffers from, and 2) train for a half-Ironman–the bike and half-marathon goal weren’t enough, I decided. I had never done any triathlon before, either). This spawned a number of projects experimenting with diet, exercise, and lifestyle changes that increasingly brought me better health in every measurable metric, in addition to how I felt mentally and emotionally. Six months toward that end, I was ready to go deeper, and try some things that I had thought were previously a little crazy. I thought the answer was some crazy-intensity workout program like CrossFit.

I wrote to Erica:

“Hey there. So I’m interested in pursuing a CrossFit program and/or starting a Paleo diet. I’ve been gluten-free for about a month now (with a few lapses) and regularly doing the gym routine (weights, biking, swimming). Have lost some weight and am stronger. Yay. Now I want to [the following said in a Macho Man Randy Savage voice] “TAKE IT TO THE NEXT LEVEL!” Do you recommend getting into paleo with the workout I currently have for sometime and THEN attempting Crossfit, or just get into Crossfit now and work paleo next, or should I just kill myself?”

She wrote back, presumably after returning from stalking a boar in the forest over the weekend:

Hooowdy, welcome to Paleo town. So I was thinking on this problem, and I suspect that getting started with the diet first makes more sense.”

And so like that, she introduced me to the work of Robb Wolf, Mark Sisson, Kelly Starrett, and huge community of like-minded, smart folks. She also said that seppuku is a perfectly valid option regarding the grain detox. I didn’t end up committing ritual suicide, despite listening to every episode of The Paleo Solution (PRO TIP: Play your podcasts at 2x speed! Slow enough to hear and understand normally, half the total time). I picked up The Paleo Diet for Athletes, The Paleo Solution, and just absorbed information. And I tried to put it all into practice.

So there’s the backstory. Where am I now?

For the past two months, I’ve had near-normal, non-diabetic blood glucose ranges. And I don’t mean in the ADA’s warped sense of what a normal blood glucose is, I’m talking about numbers that I think Robb could appreciate. 

And because talk is cheap and electronic type even cheaper, here are graphs from my continuous glucose monitoring system, a handy little device that provides me with an approximate reading of my blood glucose, 24-hours a day.

Perhaps the main take away from these graphs (also linked below) is that my overall mean blood glucose levels have decreased significantly, as did my average blood glucose for any particular hour of the day. For example, back in May, my mean blood glucose was 115 mg/dL, with my blood glucose likely well above 100 mg/dL at any hour of the day. Today my mean glucose is 80 mg/dL, a 30% decrease. That’s a great improvement just in percentage points alone, but in the past six months as I’ve gobbled up numerous studies, reports, and podcasts, what nearly all of them tell me is–in spite of what the ADA recommends– that a truly normal A1c is between 4.6% and 5.3%. It is a world of difference between waking up with a fasting blood sugar of 105 mg/dL and 70 mg/dL, as I regularly do now. I don’t just mean mentally or emotionally, but I feel better in every perceivable physical sense. And in the long term, keeping my A1c levels under 5.3% is likely going to significantly lower my risk of cardiovascular disease.

Chris Kresser wrote a great article about this a while back:

“A number of studies show that A1c levels below the diabetic range are associated with cardiovascular disease. This study showed that A1c levels lower than 5% had the lowest rates of cardiovascular disease (CVD) and that a 1% increase (to 6%) significantly increased CVD risk. Another study showed an even tighter correlation between A1c and CVD, indicating a linear increase in CVD as A1c rose above 4.6%* – a level that corresponds to a fasting blood glucose of just 86 mg/dL. Finally, this study showed that the risk of heart disease in people without diabetes doubles for every percentage point increase above 4.6%.”

After easing into it with Tim Ferriss’s “slow carb” diet, and then using The Paleo Diet for Athletes as a guide, I made the real paleo plunge–that is, no grains of any sort–in August.

Ok, actually I was pushed into the paleo vortex by my nutritionist, Diane of Balanced Bites.

After mentioning that I was diabetic, I think I got about six seconds into listing what I ate before Diane cut me off and told me that Grain Land would no longer be an option. Holy cats indeed, man.

I completely eliminated gluten and grains and nearly all dairy, though I continued to eat some cheese and a little grass-fed butter or ghee. Switching to this diet template not only helped achieve normal average blood glucose ranges, but it has wiped out extreme highs (160 mg/dL and up) and curved postprandial blood glucose down to much better levels. Pre-paleo, in addition to generally running high (above 100 mg/dL), I’d often be between 130 mg/dL – 160 mg/dL for hours after meals. Today, this rarely happens because my blood glucose rarely spikes, period.

The full paleo switch came shortly before attempting the Half-Ironman, which I had been training for pretty rigorously. It was surreal (and a bit frightening) to be eating a breakfast of a couple sweet potatoes slothered with almond butter and a 10oz steak before heading out to an intense five hour event–especially when all the conventional wisdom said that I should have been loading up on carbohydrates. Even though I had tested routines numerous times before the big day, to be committing to a diet so utterly opposed to what nearly every athletic, health, and medical expert has preached your entire life messes with you, to say the least. And when you make a mistake in counting carbohydrate or insulin dosage, you could end up in the hospital.

So how’d I do?

I had enough energy to utterly crush the 1.2 mile swim, beating the majority of people in my age group, and was solid throughout the rest of the event energy wise. My blood sugar was perfectly stable through the entire event. Through a combination of paleo-nutrition principles, a lot of training, and religiously following Kelly Starrett’s mobilitywod.com, I did pretty damn good.

This shit works.

Some other observations I’ve had from this year:

  • After my blood sugars had been in good ranges for a month or two, I noticed something else: normal hunger pains. I mean that as an incredibly new and wonderful thing. In the past, when my blood sugar dips low, that’s typically when I start think about eating. If you’ve ever been “hangry” you know what I’m talking about. But now I’m getting hungry at predictable times while at a stable blood sugar, like a non-diabetic. I haven’t experienced this sensation in over ten years, before I was first diagnosed as diabetic. It’s actually a different physical/mental feeling as compared to being compelled to eat due to low BG. That signal to eat–and I think I literally mean hormone signaling–was lost in the noise before, but now is really apparent in the midst of all the lifestyle improvements.
  • I’M USING ONE-THIRD THE AMOUNT OF INSULIN I WAS AT THE BEGINNING OF THE YEAR. I hope that perked your ears, diabetic athlete. And keep in mind that I was a pretty skinny, athletic dude to start off with. At the beginning of the year, I was using about 50 units of insulin a day. Now I’m averaging about 20 units a day. This is also awesome financially, because I’m now able to stockpile insulin–in the past I’d never have more than two vials on hand (insurance wouldn’t pay for more). Now I have six. Suck it, Big Insurance Company!
  • I started getting crazy environmental and seasonal allergies starting around when I was 25. They have almost entirely disappeared. I’ve noticed that I start to get a little congested once my blood sugar hits 100 mg/dL. It gives me a way to intuitively know my blood sugar levels without even testing. Nose snuffed up? It might be a sign I want to test. This has held true throughout the year, in the midst of the worst allergy times, during a year where I’ve been outside more often than any other time in my life due to triathlon training.
  • As I adjusted my diet, and then my sleep, and then reduced my insulin dosage, I discovered I experienced what’s known as “dawn phenomenon”–blood sugar spikes in the morning that happen soon after waking. I’d never had it before, or rather, I’d never thought I did, probably because my circulating insulin levels at any given point were always so high, and from my horrible sleep schedule staying up late, my cortisol production had “flipped” (low in the morning, high in the evening) and thus I never noticed it (and I certainly didn’t have an continuous sensor to help monitor). Now that my sleep schedule is normalized, my cortisol production is happening mostly in the morning as it should, I can now account for it, take a quick bolus when I wake up, and keep blood sugars totally normal throughout the morning. Instead of hating mornings–I always liked to sleep in–I’ve become a morning person. Instead of waking up depleted and becoming more alert throughout the day and night, I have energy from the start and naturally tire at the end of day. It’s almost like I’ve become a human being or something.
  • After completing major endurance events in the past, my insulin sensitivity usually decreased for weeks after. I’d need more insulin at meals and circulating my system. My understanding is that this is largely due to the body repairing cellular damage from the stress of the event. After completing my triathlon, my insulin sensitivity was unchanged for weeks. And in fact, despite doing absolutely no exercise for over a month and very little in general these two months after the triathlon, my insulin sensitivity continues to improve. I attribute this almost completely to diet and sleep. It can be difficult to gauge the effectiveness of whether diet, lifestyle, or exercise, or something else as the biggest causal factor for improvements. I’ve focused on changing one thing at a time at various points this year. I started with hardcore exercise. I thought that’s how you get six-pack abs and the cardio health of a Kenyan. I’ve since learned that’s not how you get healthy. Diet has played the biggest part in my health transformation this year, without a doubt. Surprisingly to me, sleep was the next most important, more so than exercise. I’ve been able to achieve better body composition and good health metrics primarily through diet, sleep, and a low stress lifestyle– more so than through exercise alone. Exercise is certainly important, but doesn’t have as much payoff as the diet/sleep/stress triforce. If you have to start somewhere, fix your diet and your sleep first. Then hit the gym and get strong.

Here’s a description of each of the screenshots:

Glucose Distribution – May: My blood glucose level distribution, by percentage, for the month of May. Important note: I set my low blood glucose threshold at 63mg/dL, but in this format, it considers anything under 70mg/dL as “low.” When I’m eating a solid paleo diet and sleeping well, I typically run between 65-70mg/dL fasting with no problems.

Glucose Distribution – Oct: My blood glucose level distribution, by percentage, for the month of October.

Sean CGMS May-Oct-IMPROVEMENT: Here’s essentially a before and after from May, pre-paleo and MANY health adjustments, etc., compared to the month of October, which is after three months of strict paleo.

Sean CGMS May-Oct-AVG: Same thing, but showing average blood sugar values for each hour of the day.

Sean CGMS Sept-Oct-IMPROVEMENT: Before and after between Sept-October. This is interesting because at the beginning of September, I had just finished the Half-Ironman. For the remainder of September, and almost all of October, I did almost no real physical activity. No gym, no swimming, no biking, no running, etc. I was a sloth. Yet my insulin sensitivity actually improved and my average blood glucose went down. In the past, and in the experience of most diabetic athletes, insulin sensitivity usually decreases after a major sporting event like a triathlon. I attribute this to my diet and getting my sleep schedule in much better control.

Sean CGMS Sept-Oct-AVG: Same thing, but showing average blood sugar values for each hour of the day. – Insulin picture: That’s three months of insulin I now have on hand due to lower insulin usage, as opposed to only having a single month on-hand.

Thanks to Erica, Robb, Diane, and Tim. I truly have a new lease on life–a healthy, long-lived one I predict–thanks to you all.

Thanks to Sean for sharing his story. If you have questions for me, contact me via my website here. If you have questions or comments (or accolades!) for Sean, please post them to the comments below.

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  1. Ann Wendel
    November 18, 2011 at 9:45 am

    We should get Sean and Dave http://bit.ly/uBsctS together in a room and let them geek out for hours over their charts and graphs! A whole book could come out of that!!

    • Sean Knox
      November 18, 2011 at 2:14 pm

      Ha, maybe you’re on to something…Paleo Diet for Diabetic Athletes. We’d sell at least 30 copies! I kid.

      • melissa
        November 19, 2011 at 4:59 am

        actually, i think you should do it sean! i’d appreciate it! type 1.5 here and i am into mma, i haven’t had the luck you have with my numbers. perhaps i should treat myself to a paleo nutritionist to really dial it in. i’d love to be able to to have a day where i don’t exercise and still enjoy good numbers. i’d also like to be able to eat a sweet potato for fuel and not have my numbers shoot to 200 mg/dl.

  2. Kerry
    November 18, 2011 at 9:48 am

    Sean, that’s awesome! Very encouraging. You said:
    > My blood sugar was perfectly stable through the entire event.
    what (if anything) and how much did you eat during the event? And how do you describe your insulin dosing during the event? (Dunno quite how to ask that, not being diabetic myself)?

    • Sean Knox
      November 18, 2011 at 2:12 pm

      Hey Kerry,

      I ate the same way a lot of endurance athletes do: 20-30g of carbs every 30 minutes or so. I used a combination of Gu (it’s liquid form, very quickly absorbed) and bars with some protein in addition to the carbs (Hammer makes some great flavors, all gluten-free, but there’s others).

      I use almost no insulin when I’m doing any moderate to intense activity for more than 45 minutes. In this case, I turn down my basal to almost nothing (0.05u/hour, the lowest my pump will go). I don’t bolus for anything I eat the entire time. It’s syphoned straight to my muscles. That’s some of the magic of GLUT-4 and insulin sensitivity. I’ve even turned off my insulin entirely on longer bike rides (2+ hours) and can still eat 40-60g of carbs an hour without any insulin, but have found that it’s good to have some insulin, even a little, circulating in your system once you stop exercising and the GLUT-4 pathways turn off.

      • Diane
        November 19, 2011 at 9:17 am

        I recommended that Sean still use the sugary supplements as-necessary during the event since we clearly couldn’t have him bonking out. The thing is, this is where the health vs performance stuff comes into play. Clearly we know that dosing a diabetic with sugar and needing to respond with insulin (in a “normal” situation) isn’t ideal for health. In this case, the glucose is being shuttled into the cells without the need for insulin due to the activity (non-insulin mediated glucose transport), so it’s a good method to use for this specific type of activity.

        • Amy Kubal
          November 19, 2011 at 10:44 am

          I’ve had a lot of luck using natural fueling options instead of engineered foods in my athletes. Instead of gus we do a sweet potato, protein powder, coconut milk blend for example, and a little something I like to call “Paleo Powerballs” instead of bars, and shot bloks. It just takes a little bit of tinkering to see what’s going to work for the athlete – it’s fun when you hit on something that works.

          • Sean Knox
            November 19, 2011 at 10:55 am

            Love that. I bet they certainly taste better!

            To be clear, I only used the sugarly supplements as fuel during extended training or for the event itself.

            Meals before and after were real food: sweet potato, meat, veggies, fruit, etc.

          • Amy Kubal
            November 19, 2011 at 11:15 am

            Sean, the homemade gel/gu is like 500 times better than that packaged crap! I’m an endurance athlete too and I swear by it! My fuel belt bottles are always loaded!! And Paleo Powerballs are never in short supply!! :)
            PS – You’re AWESOME! :)

          • Mark
            November 20, 2011 at 5:03 am

            Hey Amy, do you have a recipe for these “Paleo power balls”?

          • Amy Kubal
            November 20, 2011 at 6:58 am

            I do! I’ll include it in an upcoming blog post! It’s a Paleo Dietitian and Endurance Athlete top secret recipe… ;) I’ll share it soon along with some other ‘endurance’ training food options!

  3. Chris Sturdy
    November 18, 2011 at 10:17 am

    Nice work Sean (and Diane, Robb, Mark etc.)!

  4. Crunchy Pickle
    November 18, 2011 at 11:53 am

    Wow! Those health results are even more inspiring than simple weight loss (although I always love a good weight-loss story). Congrats! I am so happy that you are finding a way to thrive despite such a life-altering condition. :)

    • Diane
      November 19, 2011 at 9:15 am

      This is what makes my job so rewarding… when a client listens, does the work and achieves the expected/desired results. I love my job!

  5. Sean Knox
    November 18, 2011 at 2:17 pm

    Thanks, that means a lot. One subtle takeaway is that you can lead a perfectly active life. You can do CrossFit, extreme marathons, be a professional skier, etc., if you are a diabetic. It will be harder, but it is absolutely possible. That said, you sacrifice long-term health when you go pro, diabetic or not. It’s a trade-off every athlete should square up in their head. Both Robb and Mark Sisson have put out a lot of good information on that topic.

  6. Amy Kubal
    November 18, 2011 at 2:52 pm

    Nice work Sean! I know that as a Paleo registered dietitian, my type 1 Ironman athletes run much better on a Paleo protocol. It takes a bit of tinkering – but once it’s all dialed in the highs and lows really level out. And in the experiences of my athletes performance and recovery significantly improved!! Keep up the great work – PALEO POWER!!! ;) http://robbwolf.com/consulting/amy-kubal-consulting/

  7. walt zeankowski
    November 18, 2011 at 3:24 pm

    as a type 1 myself, i have found eating paleo and doing crossfit has have an incredible effect on managing my sugars. i don’t use a pump (maybe this is something i should look into) but i find myself with much better blood sugars after dropping the bread (it’s candy) and exercising like a loon! i try to tell my endocrinologist about this approach and her eyes go cross (i guess she’s trying to imagine selling it to her patients, who are mostly obese).

    • Sean Knox
      November 18, 2011 at 5:38 pm

      Hey Walt,

      That’s awesome to hear. You’re right that most endocrinologists simply do not get it. My endo is quite sharp, and really receptive to the paleo diet actually, but when I showed her a lot of this data, that diet and sleep had such a profound affect on health was hard for her to get.

      It’s going to be hard getting buy in from a doctor who services mostly obese and unhealthy people. They just don’t have a baseline to compare to. My endo is also the doctor of some members of Team Type 1, the pro bike racing team. So we’re on the same page with having goals of a healthy human being, not the goals that the ADA puts out. Yuck.

      Insulin pumps aren’t for everyone, and they’re not perfect. I use an Omnipod wireless pump and found it to be a decent compromise of no tubing plus adjustable basal rates. Kind of a must have in my opinion if you’re into sports too, but I know a number of diabetic athletes that still prefer shots.

      • walt zeankowski
        November 19, 2011 at 6:12 pm

        i hear ya! i guess for a guy who mountain bikes, rock/ice climbs, sea kayaks, etc. i’m worried about ripping that sucker off by accident!

        • Beth
          November 20, 2011 at 9:01 am

          Check out the website bands4life.net – they make arm and thigh bands for Omnipad users – they are terrific for active people!!

          • walt zeankowski
            November 20, 2011 at 4:02 pm

            thanks, Beth!

  8. Jenn Casey
    November 18, 2011 at 3:28 pm

    Sean, your story is fascinating! I sent a link to my husband who is a T1 diabetic.

    He has experimented with low-carb/paleo in the past, but had trouble adjusting his basal rates accurately to account for the changes in his body’s needs. He ended up with a couple of very scary lows (I had to call 911 on him one of those times because he was so out of it). So he’s been nervous about cutting out the carbs significantly.

    Any tips on the transition from a diet that has a significant amount of carbs to a paleo high protein/high fat diet? Did you have any extreme blood sugar readings during the transition? Did you transition quickly or slowly?

    Thanks for sharing your inspiring story!

    • Amy Kubal
      November 18, 2011 at 4:21 pm

      Jenn,
      In my experience with type 1 clients I have had the best luck with transition – adjust insulin dosing according to carb intake and switch carbs from the traditional Bread, pasta, etc. to yams, sweet potatoes, winter squash, etc. Take it one day and one meal at a time – eventually your husband will find the ‘sweet spot’ and get everything dialed in! Let me know if you’d like to talk or have any questions! And know that it is possible to do this!! :)
      http://robbwolf.com/consulting/amy-kubal-consulting/

    • Sean Knox
      November 18, 2011 at 5:32 pm

      Yeah, Amy is spot-on. Your husband doesn’t have to give up carbs, but figure out the right amount for him based on his activity level (that’s true of everyone actually, diabetic or not). For your carb sources, stick to sweet potatoes/yams/squash.

      Your husband should try doing a work out without eating sometime. This was totally counter-intuitive to me the first time Diane suggested it. For my triathlon training, I had been waking up at 6am, eating 20-30g carb worth, with bananas or other fruit, then I’d go swim for an hour. I was convinced that I wouldn’t have the energy otherwise. Diane suggested I try a workout fasted and see how I felt. Turns out I was fine in that case–cortisol levels up are in the morning, so my blood glucose hangs steady despite the intense workout. Found that 60 minutes was about max I could go without eating though, so for anything longer, you’ll want to eat before or during at some point.

      Like Amy says, make smaller changes at first. Try a fasted workout in the morning or the evening, and see how your husband responds. Depending on when he ate, his blood glucose when he starts, and the activity, he might want to lower his basal significantly. Once you clear the mental roadblock of “needing” carbs before most workouts, it makes it much easier to truly eat what you need and use carbs as recovery fuel.

      A great book I’d recommend picking up is The Diabetic Athlete by Sheri Colberg. Good fundamentals and case studies with bolus/basal/eating strategies. The food suggestions aren’t very good, but most everything else is solid.

      • melissa
        November 19, 2011 at 5:04 am

        sean, couldn’t you just replace her recommendations with paleo substitutes though? thanks!

        • Diane
          November 19, 2011 at 9:13 am

          You could definitely do this, but generally speaking, most docs still recommend WAY higher carb intake than is necessary for managing T1 or T2 diabetes. Getting the person to become more fat-adapted and rely a bit less on the sugar/insulin game is extremely helpful in managing their health.

        • Sean Knox
          November 19, 2011 at 9:37 am

          That’s exactly what I did–replaced the exact foods with things that fit a paleo template. Personally, it wasn’t too horrible for me when I gave up grains and moved to fat. Didn’t have a lot of the withdrawal symptoms. Everyone’s different, depending on body type and activity level, though.

      • Mark
        November 20, 2011 at 5:09 am

        Sean I can vouch for this too. I’ve been playing squash for a number of years now always eating crazy amounts of carbs to “fuel” my exercise. I’ve only recently started on Paleo, and needed to get over that menal block too. I did – and my energy, performance and control was better than ever before! I was seriously impressed, but now just make sure to tap up after the game with some dried fruit to restore glycogen levels – your thoughts on this?

        • Amy Kubal
          November 20, 2011 at 7:03 am

          Mark,
          Dried fruit isn’t going to be your best option post training/game. This is where the sweet potatoes, yams, etc. and in some cases white rice and corn tortillas or a recovery shake (I’ve concocted one that works VERY well!!!) are important to refill glycogen stores. These ‘starchy’ carb sources will do you more favors in terms of restocking glycogen, recovery and next session performance!!

          • Mark
            November 20, 2011 at 8:07 am

            Noted, thanks Amy. What size sweet potato do you recommend post workout, 100g (15-18g carbs)? Or more?

          • Amy Kubal
            November 20, 2011 at 8:35 am

            I would have to know what you are currently doing pre-, during and post workout, the length/intensity of the workout, current recovery stats, and what your blood sugar levels are… I usually go higher than that for male “hard chargers” – somewhere in the 8-10 ounce range, and couple that with some high quality animal sourced protein. Shoot for a 4:1 or 5:1 ratio of carbs:protein in the post workout period – see how your blood sugars respond and tweak from there. Unfortunately there is no perfect answer that works for everyone! I wish it were that easy!!! :)

  9. steph
    November 18, 2011 at 3:36 pm

    Awesome job Sean :-)
    Ive reccently just found out i am diabetic. Ive been following a strick paleo diet, wow i feel so diffrent, in a good way! Very inspiring story, thanks for sharing.

    • Amy Kubal
      November 18, 2011 at 4:16 pm

      That’s AWESOME Step!!! Keep up the Paleo lifestyle and you will be SO much healthier!! If you ever have any questions please let me know!! I would be happy to help you!!

  10. Daniel F.
    November 18, 2011 at 8:53 pm

    This was an excellent blog post. Thanks for sharing!

  11. DonDraper
    November 19, 2011 at 2:18 am

    Thanks so much for sharing. So much good info for any paleo nerd!

  12. melissa
    November 19, 2011 at 5:08 am

    sean, one last question. did you cut out all of the “autoimmune foods”? (nuts, eggs, dairy, nightshades.)

    • Diane
      November 19, 2011 at 9:12 am

      @Melissa- I didn’t recommend that Sean cut out nuts, eggs, dairy or nightshades strictly at all since his issues were extremely focused around blood sugar regulation and his triathlon activities. He wasn’t experiencing any other systemic issues and, for my money, focusing on eliminating grains and getting sleep dialed in are FAR more important in impacting blood glucose than any other possible irritants – again, in Sean’s case. If he came to me with a condition more susceptible to joint pain or other inflammatory responses besides altered glucose readings, I’d possibly have recommended that as well. It’s important, in practice, to help a client to move boulders before moving pebbles. In this case, cutting the grains, lowering carbs somewhat and getting Sean to sleep better were the boulders, so to speak.

      • Sean Knox
        November 19, 2011 at 9:41 am

        ^^^ Everything she said.

        Now that triathlon season is over, it is A LOT easier to pick up signs of food irritation. I tend to get a little congested when I eat dairy, but it depends on the amount, and isn’t usually a deterrent from enjoying some parmesan on a stew.

        • melissa
          November 19, 2011 at 5:25 pm

          ok, i will just have to treat myself to a nutrition consult asap then. i feel like i am still trying to balance out things with too much exercise and still not making any gains per se! thanks guys!!

  13. Chantel
    November 19, 2011 at 2:42 pm

    Awesome story Sean! I am also a type 1 diabetic who went from 70+ units of insulin daily down to 25-30. My A1C used to be in the high 9s (makes me cringe now to say that!) and at last test was down to 6.3. So while I am still a work in progress, I feel a bajillion times better. My body is very sensitive to carbs (my ratio is 6 to 1) so i don’t ever eat sweet potatoes and it’s a rare day when I eat fruit. Also, exercise was causing my blood sugar to spike 100-150 points. But after getting some advice from Jason Seib, I now strictly do weight-training which doesn’t cause those pesky spikes.
    I don’t know how many of us paleo Type 1 diabetics are out there, but I can’t ever seem to find enough info. I think we need some sort of online support group/forum. Or does anyone know if one exists already?
    And it’s sad but true that endocrinologists seem to think that diabetics should be eating 35-40 carbs per meal and that an A1C less than 7 is good. I just tell them that I’m “eating healthy and exercising” and they don’t bug me because they see that I’ve lost weight and lowered my A1C. But maybe when i get down to a 4.6, I’ll share my “secret” with them. ;)
    Keep up the good work and if anyone knows of any good resources out there for us paleo T1 folks—please do share!

    • melissa
      November 19, 2011 at 5:21 pm

      +1 on that one sister!

    • Mark
      November 20, 2011 at 5:14 am

      + 1 too! I recently started on Paleo and couldn’t find enough info, so I started a blog to try provide some info.at this stage I’ve just been keeping a logbook, ideally though I’d like to add more “constructive” info around adopting the Paleo lifestyle and what are the real considerations for managing your bgs. My name should link to the site, otherwise it’s at http://www.paleobetic.com. We need a community for sure! With these awesome results I’ve been achieving so far, it’s inevitable a wave of Paeo type 1 are coming, provided of course, these people are really interested in their health, and not seeing spit as another silly “diet”.

      • Chantel
        November 20, 2011 at 2:42 pm

        Paleobetic! I love it! From now on, I’ll be referring to myself as such! ok. i’m gonna look into to setting something up for all of us paleobetics so we can share advice, questions, resources, etc.

        • Amy Kubal
          November 20, 2011 at 3:06 pm

          Chantel,
          The group sounds awesome! Let me know if you need any help setting it up – we can announce it on the blog and I would love to have a support resource to send my clients too! Shoot me an email at amyk.rd@gmail.com You are AWESOME!! :)

          • melissa
            November 23, 2011 at 2:31 pm

            chantal,

            yes! please set up the group! that’d be great!

      • Sean Knox
        November 20, 2011 at 8:19 pm

        Love this man! Paleobetic is an awesome term.

      • alix
        November 21, 2011 at 9:44 am

        thanks mark for this site. i will enjoy reading it and passing it on to my son, who i wrote about previously.

        our biggest issue is the afternoon when he is continuously hungry, 16 and going through puberty, he will often eat more than once and the insulin cannot keep up with the foods and his numbers stay high for hours….
        he does try to eat one big snack but it idoes not work… any suggestion on how to handle this?

        • Sean Knox
          November 23, 2011 at 3:06 pm

          Thinking back to how much I ate as a teenager, this can be a tough one. Perhaps the closest I’ve been able to re-experience that was training for the triathlon. I was hungry ALL the time and I constantly ate.

          Focus on meals with higher protein and fat–good quality, beef, chicken, and fish–and veggies. Protein and fat causes a longer sense of satiety, both because it takes longer to digest and because blood sugar isn’t rising and falling rapidly as it does with a carbohydrate meal. Robb talks about this in his book and on numerous podcast episodes.

          Work with a doctor to determine a good baseline insulin-to-carb ratio, and do some testing and experimenting to figure out how it changes throughout the day. I’m much more insulin resistent in the morning compared to the afternoon, and by evening I’m using significantly less insulin. Once you have a good sense of the ratio, you can time eating and insulin better. Remember that protein is converted into carbs in the body, so you’ll need insulin for that too. Ask your doctor what this should be (I’ve seen several ways to determine it. I’m currently using the formula [ Total Protein ] / 4 = net carbs).

          A continuous glucose monitoring system can be a helpful tool in helping figure out your baseline and blood sugar stability throughout the day. Definitely not a perfect system but if you have insurance that will cover it, it might be worth considering.

          And I can’t say it enough: there’s nothing inherently bad about carbohydrates, but you need to figure out how a) how you react to them (insulin-to-carb ratio) and b) how much you actually need. I’d guess an active 16 year old might need more than a 35 year office worker. I’ve found it helpful to eat low or zero carb for a week or so, see how I feel, and then titrate up until I’m at the right balance of energy, mental acuity, and stability.

          • alix
            November 23, 2011 at 7:14 pm

            thanks for your response sean. we do eat a higher protein and fat diet with lots of veggies. his carbs are less than 1/3 of what kids his age eat. we have worked with our dr. and the diabetic clinic but they are so insistent on tyler eating a ton of crap so he meets the 200-400 carbs a day and we were battling every time. i am a nutritionist and they felt i was depriving him, they had no respect for my knowledge or degrees since my philosophy goes against the grain.. no pun intended :) we do work with the dr. every 3 months in fine tuning the pump along with weekly downloads and tweaks. tyler seems to be more insulin resistant early in the morning.
            we are gfree and if he has treats they are coconut or almond flours baked goods with a small amount of sweetener. i guess snack have been the most difficult, the filler food until dinner.

            our insurance will not cover the cgm which is a bummer.. it can be such a good tool.

            again sean, thanks so much for your support. any snack ideas?????

          • Sean Knox
            November 24, 2011 at 12:20 pm

            I’m certainly not a nutritionist (Diane and Amy are), but if it were me, I’d try eating bigger meals with lots of protein and fat. Make sure to drink a lot of water. I drink a couple liters even on inactive days. If you have to snack, quality beef jerky might be a good option (Paleo Brands sells some). Some nuts might be ok, but watch out for carbs and calories since a handful can pack a surprising amount.

            In my experience if I’m eating large enough meals I don’t really need to snack, YMMV.

    • Sean Knox
      November 20, 2011 at 8:17 pm

      That is a HUGE improvement! Your mitochondria are seriously doing some happy dances.

      I’ve found Robb and the paleo community in general to be the best advocate for a diabetic, as well as a source of information. Endocrinologists and most doctors still believe things that athletes disproved many years ago.

      Keep it up! You’re done the hardest part. Just keep experimenting.

  14. alix
    November 19, 2011 at 4:15 pm

    I am enjoying this type 1 dialogue. My son (now 16) was dx 2 years ago. We got the third degree every time we went to the endo’s over my sons diet ( paleo-primal, WAP blend). His Dr. finally does not say anything about his diet. The D clinic is another thing. Every time we have gone, the nurses and dietitians tell me that I am not giving my son his childhood and not feeding him the right foods. They are upset because he takes half the amount of insulin of other boys his age, he is GF and his carbs are less than half. They feel I should be filling him with pizza, cookies and fast foods all other kids enjoy. They suggest somewhere between 250-400 carbs a day. I have 2 degrees in nutrition and have been studying the subject for 30 years, yet they feel I know nothing. I asked them why my son should have so many carbs when he has a disease that cannot process the carbs.. all they said was, that is what insulin is for.
    Thank you Sean for sharing your story and all the wonderful comments from the readers. I have passed this and the other recent type 1 article to my son for him to read. I look forward to more inspiring articles and comments.
    Like Chantel, if anyone knows of other T1 info, groups etc. it would be great if you could share.

  15. Johnny B. Truant
    November 20, 2011 at 6:53 am

    This is fascinating. I’ve been type 1 for 22 years, have had no complications whatsoever, usually run BGs between 80-120, and just completed several big endurance events (that story is in part here: http://johnnybtruant.com/edgework/ ) … BUT have had a hell of a time dialing in my nutrition when training.

    I’m pretty strict about paleo/primal, but I’ve had to adjust it a lot (mostly ala The Paleo Diet for Athletes) around endurance activity. But I still can’t quite get it totally right.

    For one, my understanding was that in nondiabetics, basal insulin never really goes below 50% of normal when exercising, so I try not to set mine much lower (though I’ve gone as low as 25%). My doctor also said that if you turn insulin too low or off, you can’t provide enough insulin to your working cells and can end up going into DKA.

    I’ve also been stumped by how you access your glycogen stores optimally. Every performance site on the web talks about the 2k of calories we have stored in our muscles and liver, but one thing insulin does is to prevent gluconeogenesis to access it. So insulin has to stay low to get at it, but then if it goes too low and I exercise around or above my anerobic threshold and I get a sugar spike accordingly, I’d need the insulin to deal with it and shuttle it to my muscles. So that’s been hard to figure.

    And to top it off, I’ve found that I can’t subsist only on gels and liquids and strict fast-carb sources in general. At the end of my longer events (marathon and half ironman), I was totally crippled NOT by lack of energy or tiredness, but by nausea… and after doing some reading, I see that this is really common in endurance athletes, and that the solution is often to experiment with “real food” sources. (I’ve had some success in training with tortillas filled with hummus. I know that violates the no-grains rule, but I prefer it to hobbling along feeling like I’m going to barf.)

    One last question: Sean, if you’re adjusting to sugars around 65-70, do you worry about the accuracy of your CGMS leading to lows — especially lows you don’t feel via hypoglycemia unawareness? I find that my sensor is ballpark accurate, but isn’t the kind of accuracy I’d trust my life to without regular meter testing. And I find that the more time I spend at lower BG’s, the less I feel them. I worry that I’d slowly drop to 40 and not feel it… especially overnight. I’m totally paranoid about lows overnight.

    Thanks for sharing this story! I haven’t found anything on the combo of paleo, type-1 diabetes, and endurance activity until now, and I’ve really been looking.

    • Sean Knox
      November 20, 2011 at 9:01 pm

      Johnny, small world––I discovered your site the other day when I was referred to your edgework post. Really good post and really digging your other writing.

      “My understanding was that in nondiabetics, basal insulin never really goes below 50% of normal when exercising, so I try not to set mine much lower (though I’ve gone as low as 25%). My doctor also said that if you turn insulin too low or off, you can’t provide enough insulin to your working cells and can end up going into DKA.”

      Would love to get verification about the basal insulin levels in non-diabetics. Maybe Robb, Amy, Diane, or someone else knows more. I’ve also received the same warning about entering DKA from doctors when turning down basal, but in my experience at least, it’s that they worry that my blood glucose would rise and reach high enough levels to cause DKA. In reading about many other diabetic endurance athletes, almost all drastically reduce or turn off their basal while competing/training. But from the doctor’s prospective, hearing your diabetic patient tell you that they plan on turn off their basal might sound crazy when you have unhealthy patients as your baseline. So, I take with a grain of salt on this one. That said, you run the risk of a rapidly rising BG upon completing an endurance event if you don’t have sufficient insulin circulating in your system. The world is going to be a whole new place once there are truly fast-acting insulins that begin working in five minutes or less and are out of your system in less than an hour.

      “I’ve also been stumped by how you access your glycogen stores optimally. Every performance site on the web talks about the 2k of calories we have stored in our muscles and liver, but one thing insulin does is to prevent gluconeogenesis to access it. So insulin has to stay low to get at it, but then if it goes too low and I exercise around or above my anerobic threshold and I get a sugar spike accordingly, I’d need the insulin to deal with it and shuttle it to my muscles. So that’s been hard to figure.”

      I don’t know the answer to this either. As I’m not an expert or a pro, my only measure of whether I’m utilizing my glycogen stores effectively (read: not optimally. Different) is simply whether I bonk out on a ride or in the event. You bonk when your muscles run out of glycogen. So if I’m able to perform at 80%/90%/etc. intensity and finish my event, then my insulin/eating/exertion tactics worked. That said, change the time length–say another hour–and it may become clear that my strategy fails at that point and needs adjustment. So I guess my answer is if you’re not bonking out, then it’s working. And you have to be religious about replenishing your glycogen stores after exercise. Both in good foods (sweet potatoes, yams, rice) and making sure you feed immediately in that post-workout GLUT4-active window––or so says most of the performance sites I’ve read. And of course you have to factor in timing your insulin dose correctly so that it takes effect at the right time after your meal. That’s hard.

      “And to top it off, I’ve found that I can’t subsist only on gels and liquids and strict fast-carb sources in general. At the end of my longer events (marathon and half ironman), I was totally crippled NOT by lack of energy or tiredness, but by nausea… and after doing some reading, I see that this is really common in endurance athletes, and that the solution is often to experiment with “real food” sources. (I’ve had some success in training with tortillas filled with hummus. I know that violates the no-grains rule, but I prefer it to hobbling along feeling like I’m going to barf.)”

      Yep, nausea is common. Make sure you’re eating AND drinking throughout the entire event. A lot of people forget to drink water like a fiend. On the bike I ensure every 5-10 minutes I’m taking a sip. I also make sure I’m drinking electrolytes. I typically use Nuun or this great product called Drip Drop (Drip Drop has some carbs, I think 10g per half-liter serving.).

      I know guys who eat all sorts of crazy stuff during that would make me yack. Tortillas, cheesesteaks, pita bread, etc. Experiment with what you can tolerate during exercise––for me, Gu gels have been fine for quick fixes as have various bars with a good carb/protein ratio. I just went with the first things that worked and gave me an excuse to pick up more and flirt with the cute girls at the sporting goods shop. Amy’s “paleo power ball” things sound like a great alternative.

      “One last question: Sean, if you’re adjusting to sugars around 65-70, do you worry about the accuracy of your CGMS leading to lows — especially lows you don’t feel via hypoglycemia unawareness?”

      This is a great question. Accuracy is definitely a concern. In fact, I’m currently in an ongoing debate with DexCom about it (thankfully with the support of my endocrinologist). The main issues I’ve experienced are a) erroneous BG spikes and declines and b) ongoing erroneous lows. Sometimes the CGMS will report an insane, sudden spike in BG. Had one this week that said I had suddenly risen to 240 mg/dL, yet when I confirmed with my meter, I was actually at about 80 mg/dL. Also had the inverse with erroneous lows.

      The more troubling/annoying issue is that CGMS, or mine at least, has problems reporting reliably at values under 85 mg/dL. DexCom claims accuracy up to “plus or minus 20%” which means if it says 80 mg/dL, you could be as low as 64 mg/dL (mild hypoglycemia) or as high as 96 mg/dL. At higher numbers this is less of an issue: as to whether I’m 150 mg/dL or 180 mg/dL is kind of irrelevant because both are really high levels of glucose. Once you get into the smaller ranges, those minute differences matter. 100 to 105, no real functional difference. 65 or 70 mg/dL however might mean the difference between hypoglycemia or being stable. What I’m realizing is that these devices have less practical use for people with healthy A1C.

      Sadly there’s no good way technologically around this until the devices themselves are more accurate. Despite using an CGMS, I test my blood between 10-20 times a day. Oh, and don’t forget that the meters themselves have an error threshold of around 10% I think. So even your meter can be off, and it’s sometimes worth testing a few times in a row to determine a mean value. It’s unfortunate that the tools diabetic use to determine health metrics are still so shoddy.

      As for the data I provided with this story, I consider this as “soft data” and more illustrative of trends. My blood glucose meter is a better example of “hard data” as the readings it takes are much more accurate, though it too has problems with accuracy at times, especially at lower ranges (as does the CGMS). That said, I believe I have enough data to account for the outliers, and my blood glucose meter data correlates the CGMS data. Of course this is not a proper scientific study, but ongoing observations I’ve done my best to track.

      • Johnny B. Truant
        November 21, 2011 at 10:44 am

        Hey Sean, thanks for the detailed reply!

        It’d be cool to hear a biochemistry answer to the basal thing, yeah… I’ve turned basal off completely before, but only for an hour at a time, and typically only after starting to go low because I got too much via an earlier bolus/basal. My understanding is that DKA happens when cells begin to starve. Since insulin is required to allow glucose into cells, your body will compensate for the cells not getting sugars by dumping more into the bloodstream, which is why blood sugars skyrocket. But maybe I’m missing part of the picture. I heard you can get a lot more out of the same amount of insulin, but that you still needed SOME.

        As to the glycogen question, it’d also be interesting to hear the biochemistry. I think you could avoid bonking if you could keep enough in the bloodstream via eating, with the balance of your energy coming from fat. So I’m not sure if that’s a foolproof way to know that you’re tapping your stores, but again I’m just guessing!

        I did try an LSD run at well below my anaerobic threshold this weekend using some of what I learned here from you and some of what I’ve read on Matt Frazier’s NoMeatAthlete.com site – including stuff from Stu Mittleman. I snacked on solid foods (with carbs, with grains, but also with fat and protein) slowly and it seemed to work really well. I’ll keep tweaking.

        Interesting to hear you’re having the same CGMS accuracy issues… I just keep tweaking with my meter when running, but there have been times on my bike when the meter is hard to use (I’d have to stop and get off) and it’s led me astray… I’ll keep eating/drinking Gatorade to raise a supposedly low BG and then find later that it was through the roof! Very frustrating.

        Thanks again for your response!

  16. Lyne
    November 20, 2011 at 2:14 pm

    Hi Sean (and to all type 1 diabetics like me):)

    I’ve been on the Paleo diet for the past 3-4 months. My blood sugar has been stabilizing and dropping too, though not completely because of gastroparesis and other long-term effects of my diabetes (I’ve had it for 40 years). With the paleo diet, I went from taking around +/-18 units of Lantus at night & 5-12 units of Humalog (ultra-rapid) at meal times to taking +/-14 units of Lantus & 1-3 units of Humalog. This is already an astounding improvement. Isn’t it great to run without being in hypoglycemia!! :)

    Even better, I’ve started taking magnesium chloride only for the past week and a half. For the past 2 days, I’ve taken 10 units of Lantus and woke up in hypoglycemia. I took no insulin for breakfast, took 1 unit for lunch and 1 unit for supper yesterday. Today, I didn’t take any insulin after breakfast (this is a miracle!!!), I took 1 unit after lunch and I went into hypoglycemia believe it or not. It seems that magnesium and insulin do a magnificent job together and need each other very much ;) This is all explained on the links given. I can’t keep this for myself. Good luck to you and to anyone who will have the chance to discover the information I’m sharing. Peace, love and health to the diabetics! :) Men, it can get so hard for some of us! xo

    • Sean Knox
      November 20, 2011 at 9:10 pm

      Congrats! You’re making huge strides. Keep experimenting and if you’re not sure, under-dose and then titrate boluses up in the future. I know it’s frustrating to respond to highs, especially when it can take hours to know whether your adjustment helped or not. But start small and keep dialing it in.

      Some things that may help you:
      – Protein and fat digest much more slowly than carbs. Using a pump makes it MUCH easier to time an extended bolus to account for this.
      – The amount of insulin you use and have circulating through your system determines how fast it acts (insulin action). In my personal experience boluses of 1.5U and up of Novolog/Humalog start working within 30 minutes or so, peak sooner, and are out of my system sooner. Smaller boluses are slower to act, take longer to peak, and are working for longer.

      You absolutely need to work with a doctor to help you figure out all these values, and periodically re-evaluate your insulin-to-carb ratio. As time goes on you’ll likely need less insulin.

      Keep up the good fight!

  17. Anthony Brea
    December 1, 2011 at 10:38 am

    Gluten can cause auto-immune activation and contribute to the production of pancreatic (diabetes) and thyroid antibodies. Avoidance of gluten is followed by a normalization or disappearance of these antibodies.

  18. Brad Hansen
    January 5, 2012 at 10:03 am

    Hats off to SEAN. My son, Brooken, was recently diagnosed with Type 1 diabetes. He is 8. This has been a major adjustment for our family. If at all possible we would like to meat SEAN, and possibly learn more about his diet, exercise plan, and fitness.

    Thank you so much for posting such a positive, inspirational article. Go Sean.

  19. Sarah Jane
    January 12, 2012 at 12:30 pm

    THIS IS SO AMAZING. I found this article because I, too am a type 1 diabetic and was searching for a diet that helps regulate my blood sugar. I was diagnosed about two years ago. Being 21 and very active, this came as a shock to everyone. I quickly took care over everything and managed to pull my A1c from 14 to 5.4! After a few months passed, I became a little lazy. I was still exercising as usual but I wasn’t watching my diet as closely. Then I traveled to Italy and it was over. The wine and the pasta (something I usually NEVER eat) made me feel awful. My A1c only went up .2 points, but I didn’t like that it was rising at all. So I started research on the Paleo diet and found this! You are truly an inspiration. I have been following this diet for about a month now and I feel the best I have ever felt!! Also, I have always been a runner, but didn’t push myself to compete. This year I am training for my first 5k and experimenting with barefoot running! I’m obsessed!!

    Anyway, I got a little off topic, but I really have to tell you that I admire you. I have never met or come in contact with another person who was diagnosed with type 1 diabetes in their 20s. I knew they existed, but I never chatted. Every other diabetic I meet (both type 1 and 2, but not many) do not take care of themselves or do not understand why I’m not on the pump. Thank you for showing me that we can still live and accomplish whatever we want, just with a few adjustments.

  20. Jason
    January 16, 2012 at 1:55 pm

    Sean, I’ve been type-1 for 30+ years, I pump insulin, and I’m gluten free (Celiac). Very interested in your paleo success and especially your incredible graphs and data. That’s exactly where I want to be but have been frustrated by the typical high glycemic GF diet. I agree I should just start the diet first, intense exercise later.

    A few hopefully quick questions:
    What’s your advice on starting the diet as a t1 GF
    What is your go-to book for paleo and diabetes
    Do you do ANY dairy at all, ever?
    Coffee?
    What’s your ideal sleep schedule (tipping point)
    What kind of glucose do you take for lows?
    What are typical expectations for energy changes when a type1 moves from a healthy but carb filled diet to a paleo diet?

    THANKS!!

  21. Jared
    January 19, 2012 at 10:37 am

    I have been on the Paleo diet since Saturday. I feel pretty good and have already lost weight. I was at 215 lbs. and want to get to 200 lbs. I have noticed that my feet and hands have been cold. I am not sure if this is from the diet. Also my gf is worried about Ketones. I have been going to the bathroom a lot but I thought that was because I have been drinking much more water. Did anyone have any issues with ketones on the paleo diet? I know they want you to go into ketosis and burn fat for energy, but and I potentially putting myself in a dangerous situation?

    Jared

    Crossfitter, tennis player, type 1 for the last 17 years since I was 11.

  22. Laura
    January 19, 2012 at 9:29 pm

    Hi Sean,
    I am thoroughly impressed by your story. I’ve had type 1 for 20 years (since age 5). I am also gluten and dairy free, due to celiac and allergies. I am wondering how you manage to stave off the liver reaction to having lower amounts of carbs. I could literally just eat veggies as my carb except its always a guessing game about how much insulin I need to cover for my liver releasing glucose due to the low carb. I sometimes lie to my pump and say I’m eating 40 carbs just so that I can eat two scrambled eggs without spiking high. Any suggestions?

  23. DonM
    March 31, 2012 at 8:29 am

    Hi Sean,

    I am a 50 year old T1 athlete who has run 5 half marathons and training for a full (we have a group of T1 athletes here in Dallas… our FB page is at http://www.facebook.com/#!/groups/22048039998/). I run about a 10 minute pace at all distances. Your observations are dead on… I have found that getting rid of most carbs from my regular diet and reserving them for races helps immensely. I would add a couple of things: personally, I’ve found that my body “sucks up” carbs for 16-24 hours after a race, probably because it’s replacing glycogen. I have found that when I push my envelope, my cytokines are up (I can tell because of not only the slightly elevated BG’s but because of fever like symptoms that go away after a long nap). Interestingly, though, halves no longer push my envelope, so I don’t get the cytokine experience unless I’m doing, for instance, a 20-mile training run. So these days, mostly it’s increased insulin sensitivity after a half. I use honey stingers about every 3 miles or 30 minutes, starting 30 minutes before a run and stopping 30 minutes before I finish. My BG’s run about 100 throughout and after, with no spikes.

    I’m not quite where you are, but getting there. Good luck with your half ironmans. I’m working cycling into the mix this year, hope to do some duathlons this summer and maybe a standard (Olympic distance) tri next year.

    Peace

    Don

  24. Excellent Health Analytic Professional
    April 2, 2012 at 11:32 pm

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  25. Yvette Nash
    April 3, 2012 at 1:50 pm

    There seems to be some missing comments. I’m returning to see if there were an responses and it appears that about 8 or 9 posts are missing from the tail end here :( Hazards of the new site I guess.

  26. victoria
    April 20, 2012 at 12:01 pm

    Oh, I have so many questions, but I’ll keep this post to just one. I’m type 1, have been for 18 years, also a pumper and CGMer. I’m a cyclist, and I drop significantly and do so fast during rides. I’m about to start a variation of the paleo diet, eventually focusing on mainly gluten-free. I am at a loss about what to do for lows. Paleo is no bread or sugar. Honey isn’t feasible and fruit doesn’t work fast enough for me. What should I look at eating or keeping in my jersey for rides? This is my biggest question beginning this diet change.

    • Sean Knox
      April 26, 2012 at 6:17 pm

      Victoria– there are LOTS of non-gluten options these days. Swing by any decent bike shop or sports store in your city and take a look. Hammer makes some decent stuff. Lots of non-processed options too (e.g. you can skip using Gu if you want, which is nice because it’s gross).

      Sugar isn’t prohibited when on a paleo diet. Just figure out the right about of carbs/sugar to match your exercise level.

  27. Anne Marie
    December 31, 2012 at 10:43 am

    Hello!

    I am a T1D and a pumper. I am looking into starting the new year on the paleo diet. Right now I drink Shakeology to start my day. I am nervous about starting this diet due to low BG. I’d like to lower my BG spikes which go as high as 200+ and I want to stop that. My current A1C is 7.0 the lowest in 2 years! I want to keep bringing the numbers down.

    I have already printed the shopping list for the Paleo on a budget.

    My next Endo appt is in February.

    I joined DeafPaleo on FB and many of my friends have already started the diet : )

    Anne Marie

  28. Aaron Maschmeyer
    February 8, 2013 at 4:11 pm

    2/8/2013. My wife Elaine and I love the Paleo diet, my best time period without insulin has now topped out at 285 days! I am a type 2 diabetic, who was insulin dependent for five years.
    I have lost 43 pounds, and am amazed at how much more even tempered I have become without the grains and the “rocket fuel” carb foods. My key thinking is to eat foods that give me the slow burn, without the spikes.
    I went to my doctor this week with a A1C test of 6.8, (the same as it used to be with insulin), and my cholesterol had gone from 174 to 124 even with a high protein and fat diet.
    Insulin is a wonderful thing when you need it, but this new eating lifestyle has empowered me to live a better life without insulin, even my doctor had to give me a smile, and her approval. I just think about what I might have found to eat 10,000 years ago and eat that. I think a lot about the concept of “genetic memory” which to me is an assessment of the foods I eat that are familiar to my history on this planet with my ancestors. If I could not pass it to a relative across the campfire to share the meal (any time date) it must be a processed food and not good for me.
    I love to fast for 3-5 days at a time, knowing that emptying my “suitcase” is what any normal person would have done from time to time when food supplies were not a reliable as they are today. I know that when I take a vacation from food, my body can repair itself, and when I re-approach food, I can do it with more mindfulness about portions and quality. It seems to me we are designed to go through periods of no food, and I have proven this to be true for me. Sometimes, we make so many wrong choices about food, one answer is to take time off and make “no choice” and approach food again with more awareness. Food has always been there, waiting for me when I get back from my “vacation”.

  29. Dru
    July 24, 2013 at 4:03 pm

    Thanks for the great read, Sean and Diane!

    My 11 yr old son is in the process of being diagnosed t1d – we caught it early and he’s been under Dr.’s care for nearly a year. The SAD diet sends his numbers over 300, but we pulled his a1c down to 5.5 after just six weeks on the Paleo Diet. He’s still a little carb heavy, around 50 – 70 a day, but we’re figuring it all out. No insulin or meds at this point.

    Question about carbs and exercise. How do you figure out how many carbs to eat before a long workout? With your cgm, do you see spikes where your numbers go high before you can get the carbs burned off?

    Son has signed up for a bicycling program this summer that culminates in a sprint triathlon and later a 50-mile bike. He’s biking three times a week right now, 1 – 2 hour work outs. We’ve been allowing special breakfasts before the workout and originally thought his numbers looked good. 89 start / 71 finish two hours later. But last week he threw in some extra tests that revealed there’s more to the story:

    7:36am waking – 108. Ate 2 slices French toast and whipped cream (about 30 carbs).
    8:00 started ride.
    9:08 – finished ride – 181, rested for 5 mins
    9:14 – 164, rode for 15 more mins, trying to get numbers down
    9:29 – 125
    10:08 – 86

    In other words, do you somehow ‘match’ your carb intake with your burn rate to keep your numbers flat, or do you see these spikes too? Any recommendations?

    Thanks so much for sharing your inspirational story. It’s means a lot to a young boy to know that others do this and he can too.

    • Robb Wolf
      July 24, 2013 at 4:31 pm

      Dru- use the search feature and look for typ1D…I have several articles.

      It takes a lot of experimentation. Keep in mind, blood sugar elevates in response to stress Regardless of dietary carb intake. Cortisol pings liver, liver releases glucose, non functioning pancreas does not respond…problems.

      I rec lifting weights and walking for t1D. Not very exciting but easy and productive to manage.

  30. Ant Lockyer
    August 5, 2013 at 12:33 pm

    Thanks for the article. 2nd attempt at a paleo diet and the first one since being diagnosed T1D. Just started re-introducing long distance cycling to my life and working on the fuelling. 2nd ride in tells me a banana will not fuel an hour’s ride.

  31. Janean
    October 1, 2013 at 6:46 pm

    @Sean- thank you for an inspiring post! I found it by accident, but have had many frustrating experiences with managing Bgs while trying to adjust or exercise. I’ve researched in the past about paleo eating, but I’m still reserved due to the amount of meals we share with others. We have wonderful whole foods in our home, preserved and frozen, but I need to learn meal-planning again. Weight has always been a struggle and my a1c has been creepin for a couple of years. I’ve decided I need to “reset” myself and haven’t been sure where to start. Your posting, and the string of comments has given me direction. Thank you all!

  32. Willy
    February 16, 2014 at 1:17 pm

    Great article. Thanks.

    I’m interested in finding out what Sean ate “during” the event that was Paleo friendly. As a former Ironman-distance athlete who just got diagnosed with diabetes and put on insulin, I’m trying to figure out my race day eating menu, to maintain not only the calories needed during the event, but also “quick-release” options in case I hit a serious low, in the middle of nowhere while on the bike or run. Can’t put a steak and sweet potatoes in my bike jersey…

    Thanks.

  33. Tonja
    May 29, 2014 at 8:41 am

    Wow Sean, excellent! I know this was posted a few years ago, but it was the first thing that came up when I searched for Type 1 Paleo Triathletes. I have been a Type 1 diabetic since age 8 and made a slow transition to Paleo a few years back after getting frustrated chasing carbs with insulin and exercise. I haven’t looked back since the transition! Paleo has been the best thing I have ever done for my diabetes.

    I am training for my first Tri and am at a complete loss as to how to fuel for race day. My bgs are spiking when I train since I am pushing myself to my limits. I’ve had to increase my basal to 150% during training and the hour after. Yesterday, I did a easy/moderate run/swim to see what would happen, and my bgs dropped from 94 pre-workout to 70 post-workout. While that’s better than my bgs spiking, I hope to be able to go all out on race day instead of taking it easy to keep the bgs better. With race day hormones flying, I assume my bgs will spike, so not sure what to eat pre race…Do I need to eat carbs and bolus, or just eat protein and adjust basal? How do Paleo Diabetics fuel for endurance sports, especially when a banana might send me through the roof pre race with the added adrenalin! Any advice would be much appreciated, I’m at a loss!

    Sean, hope all is still going well!

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