I’ve touched on the topic of Type 1 diabetes before Here and Here. For those unfamiliar with Type 1 diabetes, it is an autoimmune disease in which the beta cells of the pancreases are damaged or destroyed and the individual looses the ability to produce insulin. Without exogenous (outside) insulin (or very smart nutrition and exercise) the Type 1 diabetic will die. As it is the Type 1 has a hell of a time managing blood sugar levels. There is simply no replacement for the immediate feedback mechanisms which govern normal pancreatic function. This is true not only with regards to monitoring blood glucose highs and lows from food, but also from odd inputs such as exercise and stress.
My Liver! My Liver!
The liver does much more than detox frat-boy livers after a night on the town in Chico, it is also a repository of energy, both in the form of fat and glucose stored as glycogen. Under normal circumstances we have an interplay of the food we eat toping off liver and muscle glycogen stores to be used either immediately or down the road a few hours or even days later. Interestingly, even if we eat a 0% carb diet we still end up with liver and muscle glycogen stores getting filled via a process called gluconeogenesis. In this situation we turn protein into glucose and this is one of the reasons there are no “essential carbohydrates” despite what the vegetardians will have you think. So, what does all this have to do with the Type 1 diabetic and CrossFit? Well, many people have noticed a dramatic improvement in blood glucose levels with a LOW CARB paleo diet. Dr. Bernstein has a great book that is right in line with this concept. A low carb diet pushes the body to use fat as a primary fuel source and this diminishes the need for more glucose to run many of the daily functions of the body.
Think about it this way: if glucose were like electricity and fat was like natural gas we could run our house of one, the other or a mixture of both. Common nutritional wisdom posits that we need to run exclusively off carbohydrate for our preferred fuel. The problem with that is people eat too many carbs, get insulin resistant and have a whole slew of health problems. Several of the Chico State Nutrition professors are remarkably overweight and are die-hard (die-soon?) proponents of the high carb, low fat catastrophe. Anyway, in this example we can shift the body from one primary fuel source (Glucose) to another (fat). Fat is better. Period. Many people have detailed improved blood sugar control until they do what seems to be a good idea: They exercise intensely. You see, high intensity exercise RELEASES GLUCOSE FROM THE LIVER. A lot of it. Folks roll into the gym with normal low blood sugar, hit a WOD and WHAM! Blood glucose levels in the 200-300 levels. Way too high. Then they dose with an insulin bolus to bring things down, create a transient condition of insulin resistance…and have problems bringing things back to normal for several hours.
The solution? REALLY keep an eye on volume and intensity. You may be better served by mild to low intensity activities. Power Lifting, due to the low volume might be a good option. Walking with a vest is a good activity that taxes one pretty well but might be better than standard high intensity training. The type 1 diabetic needs to “map” what volumes and intensities produce what blood sugar responses. Sleep deprivation will worsen this effect. Stress, same deal. If I were Type 1 diabetic I’d:
1-Eat a ketogenic diet. Use the Zone calculator to find your block numbers, then use 42 ways to skin the Zone to bring your carbs to below 50g/day for men, 30g for most women. Adjust fat upwards appropriately for calorie maintenance and when you need to up calories overall for maintenance. I’d add the additional caveat to make this a gluten/dairy free paleo diet. We have seen instance of people REVERSING Type 1 diabetes with a paleo diet because they put their autoimmunity in remission.
2-SLEEP. Screw up your sleep and you are killing your insulin sensitivity. This goes for everyone but especially for the Type 1 diabetic who will battle to keep blood sugar levels normal/low.
3-Chill out. Stress messes with insulin sensitivity AND it releases sugar from the liver. Don’t do it.
4-Ttrain Smart. I mentioned some examples above. Lift heavy, then sit on your ass. Repeat. Intensity (in the puke on your shoes sense) is what drives hepatic glucose release. Take a walk for some “cardio”. Be content with being able to lift a house and have 5% bodyfat, but a shitty Fran time.
5-Train Dumb, but map it. Most of you are CrossFiters and thus, will ignore the most important part of this (number 4) because you will DIE if you do not see God during a WOD. Fine, I’m not going to argue with you on the topic, it’s your life, but at least use your head. Start the intensity low (this may mean stepping back a little…you can do it) and maping your blood glucose response after various WOD’s. How much does Fran elevate your numbers? Helen? Filthy Fifty? You need to build an inventory of what WOD’s do what to you. Then…hope for the best, because every time you do a WOD like this things are different. And you may have a dramatically different response than you might have guessed…hence, recommendation number 4.
I’m not here to preach or prostylitize. I’m not a doctor so you need to use your own good judgment on this. I know someone will have an inspiring story of a Type 1 diabetic who competes in Iron Man triathlon and does great! Well…I guarantee their hb1ac (how high the blood sugar is over time) SUCKS. They are aging far too fast, and that is their decision. The problem is people do not know there are options and this is all I’m trying to do: Provide some information so people can make an informed decision about what they are doing and what the relative cost/benefit looks like.