This is a great (interesting) question from Kirez who is dealing with Type 1 diabetes by using a paleo diet and hard training. Here is the original question/statement:
I’d like to talk again regarding insulin-dependent diabetes sometime. I’m noticing some surprising, unanticipated effects with strict paleo diet and heavy training — after initial decreases, my insulin requirements have gone UP. ?!?! I seem to be in caloric deficit (for 2-3 months now), maintaining weight but not increasing, high performance levels, ramped up metabolism — and requiring more insulin. It defies credulity. Higher metabolic rate, only protein & fat —-> increased gluconeogenesis???? I’m baffled, but monitoring everything rigorously and can’t explain it. My wife’s an endocrinologist, she’s with me on all this. (Neither of us is especially well educated regarding nutritional biochemistry, however.) From my experience, I’m seeing caloric deficit and simultaneously maintaining body weight and don’t know how this is possible. The only credible thought is that I can’t count very well.
By my way of thinking, minimizing insulin requirements is an objective measure of a diet’s quality and effectiveness.
I’m not expecting you to know all the answers, but this is on my mind and I wanted to share it with you.
cheers,
Kirez
Kirez-
The type 1 Diabetes really complicates things due to a lack of precise insulin management. From what you are saying however you have been in caloric deficit for some time, have seen a performance slump and escalating need for insulin. I’d wager you have some elevated cortisol and what amounts to a chronic stressor. I’d try a little more post WO carbs and possibly raise your total caloric content. Ideally we should see an up-tick in your performance and following on that an improvement in your insulin regulation. If you want to shoot me a detailed food log we can get a bit more detailed.
Robb
Could the higher insulin requirement be a result of lean muscle/tissue growth (achieving body recomposition)? Are you on an insulin pump (I have a CDE but don’t work with pumps)?
Some type 1 diabetics still produce a small amount of insulin thus reducing the ration of injected insulin to carb consumption. Over time their natural insulin production will drop off even more changing that ratio to favor more insulin per carb.
On another note, I just found your blog a few weeks back and I must say it is one of the most informative out there. Thanks for sharing.
Eric G
Thanks for the info and the kind words Eric!
Robb
Robb, first an apology — I meant to follow-up with more specific info. There’s a huge item I failed to mention, which was that for 5 months (until 2 weeks ago) I was on a horrendous sleep cycle: I slept from ~4-6 a.m., worked about 8 hours, then slept another 2.5-3.5 hours, then worked — breaking for a workout at 24:00 — for another 8+ hours. I was totaling 4-5 hours sleep/day.
I’ve been a type 1 diabetic for 14 years (no honeymoon effect relevance). There are significant stressors, and you nailed it with the cortisol. The combination of sleep deficit + 2 periods of falling asleep today meant I fell asleep hard and fast, hit REM sleep, then awoke (by alarm) prematurely, followed by dawn phenomenon — the cortisol spike. Elevated insulin needs at this time especially, but insulin demand seemed to be elevated across the board.
Perhaps cortisol is also relevant because of chronic sleep dep? (I haven’t read the beloved “Lights Out!” book…)
The sleep cycle was causing problems, and affecting my time management. Finally I was desperte enough to pay the price: give up a few days of productivity, in order to reset my sleep cycle. It was hell, but I seem to have succeeded. A few *really* unpleasant and less productive days, but the last 13-14 days I’ve been sleeping 23:00-05:20, and doing my crossfit workouts from 05:30-06:30.
My performance has continued in a slump, however; I’m hoping we’ll see this turn around as I get better acclimated to the schedule. Not sure.
My insulin levels are still elevated abnormally, and — anyone following this should be told you cannot possibly speak to this without knowing specifics of my diet and insulin regimen, and potential other factors such as the sleep cycle which I failed to tell you about.
I’m not on a pump anymore due to lack of insurance; I’ve been on injections almost a year now. It sucks but I do pretty well. I’ve never had an HbA1c above 6.0 (!).
At the onset of this screwed up sleep cycle, and during huge stress period, I also experienced outrageous carb cravings; but I persevered and the carb cravings passed, and as I said before my diet is solid, if severely limited.
I eat
-meat: chicken, turkey, beef, ground beef, eggs, tuna (2-3/week), fish dinner 2/month
-dairy: milk 1L/day, kefir .8L/day, cheese often
-vegs:cucumber & bell pepper & carrots (daily) peas, green beans 2-3 times/week
-fruit: occasional apples
-misc: 30-35 oz coffee/day; almonds, cashews; a lot of peanut butter (~5-7 tbsps daily); occasional tomatoes (bothering me recently), mayonnaise, diet coke; oatmeal (2/week)
Cheats: pizza, 2/month; juice to treat hypo
No supplements.
I think you’re also right about carbs post-WO, as I’m often concerned how to prevent hypo crashes when glycogen stores are depleted; my wife is advising the same.
Kirez-
I’d wager your WHOLE insulin resistance situation is a lack of sleep. It takes only a day or 2 of suboptimal sleep, to say nothing of the tough schedule you have had to reduce someone to the level of a type 2 diabetic. Now we have a situation of something like a type 3 diabetic (except this is a label now for Alzheimer’s) in which we have an insulin dependant, insulin resistant individual! The most telling fix for this is return to a normal schedule with accompanying return of normal insulin sensitivity. Take care of yourself Amigo…this is nothing to dismiss lightly.
Robb!!
I’ve been waiting for yout to touch the Diabetes issue. Meggie has been doing well on the carb restricted diet recommended by Dr. Bernstein. Recently her levels have been high but stress has also been high at work. Dr B claims there is no link between stress and blood sugar. What do you think? You mentioned somethign about cortisol levels which relate to stress.
Meggie has noticed elevated blood sugars post crossfit style workouts which we have atributed to the adrenaline produced with such high intensity work. Does this sound right? I would love to hear your thoughts and anything else you have to say about type I diabetes. I have become very interested over the past months for some weird reason… 😉
See ya soon!!
-Dutch-
Dutch-
Hey Brother! I think the stress/elevated blood glucose is a pretty sure thing. Cortisol or adrenaline (odr both) could certainly do it and other folks have reported the same thing. There is a weird interplay of increased/increased insulin sensitivity and blood glucose post WO. We can see decreased blood glucose levels due to an attempt to replenish glycogen, however if glucose goes too low we may see insulin resistance (at the muscular level) to spare glucose for the brain. This can happen even in ketosis. It is anything but straight forward or linear. I think for the Type 1 diabetic we really just want to keep insulin usage to a minimum as well as swings in blood sugar. We can track that by the Hb1AC. We want that to be LOW.
Robb
Does anybody know how long Art De vany’s website will be down for???
Thanks
Not a clue Steven!
Robb
I seem to remember reading somewhere that there was a link between overtraining (aka under recovery) and insulin resistance increasing. If insulin resistance is going up, you would need more insulin right?
-jj
Absolutely and that is likely a result of increasing cortisol levels.
Robb
Robb,
After hearing your lecture I was inspired, thought id give your 16 block diet a shot.
http://themariozone.blogspot.com/
Mario!!
Looks like a good start! Keep me posted on how thing progress!
Sometimes the simple approach can determine the source of problems.
A significant history is petinent to determining what could be your causing your problems.
Were you diagnosed with type 1 as a child are a young adult?
How long have you been living with type 1 diabetes?
What was your activity regimen like before you initiated Cross Fit work outs and changing your diet?
The majority of people think modern medicine is mostly crap, but those of us who try to be very progressive use several key rules in integrating or initiating a new approach.
Before any changes, make sure you have adequate sleep!!
You need to determine your baseline as to how you feel, your insulin levels, and normal activity levels, on a consistant basis before a new program is begun.
For those of you experiencing a diagnosis or injury that you have been experiencing for longer than 3 months, please heed the following words.
Start with changing one thing at at a time.
For Kirez, Diabetes Type 1 is a serious diagnosis, that can result in long term side-effects. If you want to change it, plan to change it over time. Your body does not produce insulin!
You have increased your bodies need for energy, and desire to store energy to prepare for the next workout.
If you were not active before, or even if you were moderately active, starting Cross Fit should have a biochemical effect.
If you started doing Cross Fit, and changed your eating habits, all at once, you have tested your body very severely.
Adding sleep deprevation, your outcomes could have been worse.
From what I have already said, you can see that it would be very hard to determine what could be causing any type of problem.
Your body desires to adapt, but when it suffers from something like Type 1 diabetes, asking it to ramp up improving performance with Cross Fit, changed ratio of nutrients, and having limited sleep, well. Step back.
Re-evaluate.
You must get your sleep, work or no work. Your commitment must be to your body if this is the path you are taking.
2. Are you overtrained? Cut it back a little, add some more nutrients, and relaxation.
3. Let your body get conditioned to the performance you want before you fine tune or calorie restrict.
Remember: Your body doesn’t produce Insulin. It seem logical to me, that if prior to Cross Fit you weren’t doing intense performance training, then to begin activating all your muscle fibers, your normal need for insulin should go up. Add the stress from no recovery time, and you need a lot more insulin.
At the same time Kirez, I want to say that I admire you greatly. Taking an active approach with Type 1, is the sure way to have an active and full life.
Just respect it for what it is.
Thanks for listening.
Robb,
This doesn’t really fit under this topic but I thought I would ask for your advice. I have been on the Zone Diet and Crossfit for about a year and have had fantastic results. I converted my wife to both about 3 months ago. She started the program at 5’6″ and 144lbs and she is currently 148lbs. She is eating 11 blocks a day and Crossfit 4x/week. She is getting discouraged. Do you have any thoughts/advice?
Thanks
Al
Al-
What is her body composition? You might bump her to 10 blocks but is the body comp improving or are you guys overly concerned with a scale shift that might be a gain of lean mass?
Robb
Robb, the article I’m linking to below provides a more authoritative and practically sound guide to managing type 1 diabetes than many, perhaps most, type 1 diabetics get within their first few years of living with type 1 diabetes (and I’ve met many type 1 diabetics, and practicing endocrinologists, who haven’t gotten this much after 10+ years). This covers much of what an endocrinologist or diabetic education program should cover for a new diabetic.
There may be valuable insights in here for anyone concerned with insulin and diabetes.
There’s HTML markup in this blurb that may not work in your comments, but I expect it will.
— Kirez
I’m going to open the hood on basic diabetes management so you can see the nuts and bolts of how a type 1 diabetic uses blood glucose measurement and insulin injections to manage their blood sugar.
This explanation of diabetes and insulin therapy covers the basics of a Diabetic’s How To:
Establishing a basal rate of insulinEstablishing a ratio of insulin-to-carbohydrateLearning to judge carbohydrate content of food and the effect of what you eat on your blood sugarLearning to correct high blood sugar with a bolus of insulin
Valhalla CrossFit: Diabetes 101
The above page is a long article (3,000 words, about 5 pages). It includes brief explanations of:
blood sugar and insulin
the two types of insulin, long- and fast-acting
how a diabetic establishes a basal rate of long-acting insulin
how a diabetic decides how much insulin to take for food: the official, theoretical model, and the actual practice of experienced diabetics
how corrective boluses work
insulin injections versus the insulin pump
hyperglycemia and hypoglycemia
fitness and nutrition for the diabetic
For the non-diabetic, this article is a sound, informative explanation of how a diabetic must survive, cope with his disease and manage his insulin. The more informative ‘under the hood’, nuts-and-bolts view is extremely helpful for type 1 diabetics’ loved ones, coaches or trainers, significant others, or just well-informed and caring friends.
can we minimize insulin dependence by doing exercise such as jogging and swimming?
Yoan-
Yes, exercise is essential for maintaining insulin sensitivity. Lower intensity activity might be a good choice for folks like Type 1 diabetics, at least part of the time.