So I don't read Slowtwitch as much as I used to. Okay, I used to read it a lot when I had free time between experiments in my previous lab job. These days I rarely read it, and if so it's for the articles and no longer the forum. But today I stumbled across a thread titled, The Official Diabetic Triathlete Thread. Talk about great timing! I was looking for info on IMAZ water temps - but instead being able to communicate with a bunch of other diabetic triathletes, including another diabetic coach who authored this article on a low carbs strategy for IM. Talk about a gold mine. I ended up posting my 'intro' which turned into a manifesto, which I figured I may as well share as a blog post. So here it is:
I'm 34. Was diagnosed almost exactly a year ago, type I - LADA. I've raced 3 IM in the past, more HIM than I can count, tons of endurance cycling etc. I'm racing my first diabetic IM next week in AZ and planning to use it as a learning experience.
I think it's great that resources such as this thread allow us all to find another and discuss these topics. It really is amazing the progress. I'm am incredible grateful for those who have tested the boundaries and been brave enough to achieve the success that they have had. Every diabetic is different, physically and mentally. Hell, I'm different depending on the day - but that said I'm also going to vouch for Vinnie and the benefits of being low carb and ketogenic adapted.
I have also been pursuing this strategy, admitted I'm new to the scene so I know my place. However, how I choose to care for myself is my decision. I'm not here to pressure anyone else to do things my way, but it works for me. My goal is to try to preserve my beta cells - hell I'll openly admit that I'd love to reverse this thing. Even if that's an unrealistic or unobtainable goal it still leaves me with my health.
I'm not saying it's unhealthy to treat your diabetes in the traditional manner, but for me I want to pay due respects to the 80 year old future me. I don't want to (in my opinion) risk my long-term healthy by exercising with BG's in the 140's. I am able to train in the 80-100 range very well. I do not experience any rapid hypos, and if I do ever go low I can just stop or slow down and my body will auto-correct. Vinnie's comments about the law of small numbers is only part of the benefit. The real benefit in my view is that being adapted to burning ketones as a primary fuel source means that my body can handle them and actually use them.
There is more to it than just 'low carb'. I've trained by body to burn fat (in the form beta-hydroxybutyrate). So not only do I not get high BGs from food, although high intensity intervals do cause a bump, I'm protected from lows. I guess I can't prove this, but I am putting my life on the line that I am more protected from lows. I haven't ever been low to a point where I haven't been able to think clearly and care for myself (again, this is year 1 so knock on wood) It's not a hypo unawareness issue, it's that my brain and body aren't choked off from their only fuel source. There was an interesting study I read about in "Good Calories, Bad Calories" where they took patients who they ketoadapted through starvation for a couple weeks and then administered enough insulin to take their BG's below 20, and they apparently suffered no neurological deficit - I think this was in the 1930's since you can't fund that study these days! Not that it's my goal to ever go that low, but if I do I'd rather not go into a coma.
My blood ketones are consistently in the 0.5-2.5mM range, no where near the 15mM DKA risk category. I feel better and perform better at 80 than over 140. I get stronger as a workout duration increases - I feel like a big diesel engine. Admittedly I'm probably a small portion of my anaerobic metabolism, but I've also upregulated my aerobic (just through diet!). I should do a VO2 max test and measure my respiratory quotient - been waiting on that since the first year of diagnosis is $$$. But I can tell I'm more aerobic while swimming and require less air, etc.
A note about CGM's. I use a dexcom G4, but it doesn't seem to tell me much. My theory is that this could be unique to the whole ketoadapted thing. It's great when sedentary, but once I'm 40 minutes into cycling workout the CGM shows that I've dropped below 50 while blood values show me still in the 100's. This could be related to my ketoadaptation, either way it doesn't tell me what I need to know for it to be a reliable tool during exercise. Maybe my interstitial glucose values really are 40's, but I was knocking out killer hill repeats feeling very strong the last time that occurred.
Other benefits beyond and up-regulated aerobic capacity is that I'm noticeably less inflamed now. No more allergies - I can breath though both nostrils at the same time! My flexibility increased which I thought was crazy (I got better at yoga while not actually practicing?! ), my energy is very steady - I can miss a meal and not be hungry and have stable BG values, I could fast for a day and train just fine.
Now again, I'm not forgetting that I'm still new at this. I was likely honeymooning a bit, and hopefully I still am and will continue to for the rest of my life. Right now I'm using an OmniPod (no tubes!) and run a 0.4U/hr basal. I set a temp basal of 0.15u/hr for aerobic efforts. I turn that temp basal on 30-45 minutes pre-workout before swim and bike, but time it at the start for runs. I experience similar BG effect that I quoted from Vinnie above. For high intensity workouts or short runs I don't reduce a temp basal.
With my first diabetic ironman next week I did 4400 swim yesterday. By swimming a comfortable easy pace my BG dropped from 90 to 70 and my splits where nice and consistent. Normally I'd do that distance in about 65 minutes - but yesterday's pace time was 75 minutes. Then for shits and giggles I did a hard anaerobict 200yd effort to finish my workout. By the time I was dressed I was back up to 90 from the intensity. That's pretty cool in my mind. (using my own glucagon rather than injecting).
As for losing 10 minutes in my swim - I don't care. I'll be stopping to test on the bike. I'll be happy with a 6hr+ split (where as I know I could probably ride sub 5:15, at least I could pre-diagnosis). And I'll just be happy to finish the run.
Its funny how I feel a little pressure to prove that this strategy works by actually going all out, but it's not worth the risk to me. I have a much longer term vision. Maybe I'll go harder in IMWI'15. There is hopefully going to be a big group participating.
Oh, and more details. My A1C after my first year is down to 5.6%. I eat mostly fat. Typical meals: Breakfast is either bacon and eggs with kale in coconut oil or lard. Lunch (if I need it) is a salad with olive oil and vinegar dressing perhaps with avocado and sardines on top. Dinner is usually a home-made soup from bone broth with non starchy veggies, maybe 6-8oz of pork, fish, or steak (sometime liver). Snacks are almonds, macademia nuts, or a spoonful of coconut oil with nutbutter and/or chia. Dessert is coconut milk chia seed pudding with cinnamon and cocoa powder mixed in. And I admit to putting kerry gold butter in my coffee if I'm in a hurry.
Sorry for the length of my post. Again, I think it's amazing that we can all share this info. I'm so happy to read what Vinnie has posted because it reflects what I too have learned and experienced. We all have a choice in how we care for ourselves. And even if you choose the HCLF strategy, your better off than someone who chooses no strategy and doesn't exercise. We are all doing the best we can. I'm just glad to have the choice. It was hard for me to find info on choosing this method so hopefully my words (and Vinnie's) will help explain this option to anyone else that might be interested.
If you sadistically want to read more about me I do write a blog at koryseder.blogspot.com. I think I'm just going to post this as a blog as well - wholly manifesto!
I'm not on ST much anymore, just happened to check in for info on AZ (water temps, etc), but I'll follow this thread - good timing I guess! And from my blog address I'm easy to find on FB. Good luck everyone! I know how afraid I was a year ago - and it's due to the work of all of you that I have the confidence to continue on in the sport that I love, hopefully for a long time to come.
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