Low-Carb Diets and Cycling

[Triskeliongirl]

Anne, I have to take exception with a few of your remarks.

1. "Please, ladies, if you are worried about your ability to process glucose have a glucose tolerance test done by a medical professional who has accurate equipment and the expertise to interpret the results. There are so many variables, meter accuracy, digestion, etc. etc. etc. "

No one is asking anyone to do anything without the help of a medical professional. With that being said, many medical professionals, my endocrinologist included, appreciate when patients bring them data that can often be more informative than that provided for a lab. It was my doctor that asked me to do the eat the pancakes glucose tolerance test and email him the results. He said it was very hard to get a lab to follow you beyond 2 hours, and especially beyond 4 hours, and to take accurate time points. He also said he would rather know how a body responds to a real meal, since that is what we are going to eat, vs glucola syrup. Dr. Bernstein also, suggests that one keep detailed records of food intake and post-prandial blood glucose readings that you bring with you to your doctors visits. Of course all these recommendations assumes that one buys an accurate meter, but accurate meetings are out there, and that a person is trained in how to make and record the measurements, but that information is out there too (very detailed in Dr. Bernstein's book). In fact, my doctor tried to order a test to measure my insulin and glucose response to a high carb meal, but my insurance company refused to pay for it. However, they were happy to pay for single glucose, pepC, and insulin measurements. So, he wrote 2 lab slips and had me take them to the lab with instructions to have the first test done (I was still fasting), then to go to a diner and eat 3 pancakes with syrup, and to return to the lab and ask them to process the second set of tests 2 hours after the first bite of food. I then continued to take more frequent glucose measurements over 6 hours, and he put my data together with the lab's glucose, insulin, and pepC results to determine that my body does not make enough insulin. He could also tell from the ratio of insulin to glucose that my problem is not a lack of sensitivity to insulin, but that there is simply not enough insulin to clear the glucose at the correct rate.

So, all I was suggesting was that while Dianyla was waiting for her doc's appt., she take these measurements and bring them to her visit to have a more productive visit. It sounds like that happened since he ordered a diabetic panel that my have been delayed without the information she provided.

2. "I don't know *anyone* that doesn't have a reaction to a lot of refined carbs and it isn't necessarily an indication of a glucose tolerance problem; The sugar crash will happen to most people as we have evolved to eat a wide variety of foods over a very long time and refined sugars are a very recent addition to that mix. I can feel absolutely exhausted after too much refined sugar and have a BG reading of 90 mg/dl... "

We are not talking about 'a reaction'. We are talking about a very specific reaction, blood sugar rising too high and staying there for two long, with clear definitions of what those numbers are. That is why I suggested a specific test that anyone can do with a $17 meter (the one I recommeded in an early post is both inexpesive and rated as being very accurate).

3. "But low-carb diets are not an ideal solution, especially for an active person."

What is the source of this information? I am a very active person and I am thriving on a low carb/ high protein diet. I cycle 100-150 miles per week., and weight train ~1-2 hours per week. I have now ridden as far as 68 miles on this diet and felt great (and I only stopped because my son was tired, I could easily and comfortably have done a full century that day). The human body is amazingly adaptable, and can run on many different fuel types. Dr. Cordain is an eminent exercise physiologist with many peer reviewed papers cited in his paleo diet for athletes book. I would follow that plan if my body were more glucose tolerant. However, I can eat even lower carb than he recommends by carefully targeting protein (amino acids can be slowly converted to glucose by gluconeogenesis, I am a professor biochemistry at a major research university and I know what I am doing makes biochemical sense), and low carb veggies can also slowly generate some glucose without a glucose spike. You can also train your body to run on a higher percentage of fat to carbs, which has amazing benefits for weight loss (I have painlessly lost 23 pounds with this approach).

So, what is an 'ideal solution.' That may be very individual. I am not advocating that everyone do this diet, but for me, I perform better on this diet because my blood sugars are stabilized. Before, even on the bike, I would go through swings of hyperglycemia and hypoglycemia, all the while not being able to access fat stores that was definitely not performance enhancing. That is because when my blood sugar was high, even though I would have insulin turned on, it would be too little to get the glucose into my cells, yet with insulin on glucagon was off and I couldn't get my fat out of storage, so I would be literally starving on the bike, despite having glucose coarsing through my veins and plentiful fat stores. This bugged me for years, because while I understood this, I didn't know what to do about it.

4. Anne, I just clicked on your homepage and saw you have first hand experience riding with a type I diabetic. Please get her to read Dr. Bernstein's book. This diet is also advocated for type I diabetics, because by eating lower carb, they won't need as much insulin, and won't experience the kinds of blood sugar fluctuations you described your friend going through, which is better for their long term health. The idea is with small inputs there are small changes. If a diabetic eats a high carb meal and their blood sugar skyrockets, they have to get the insulin dosage just right, or it will first go to high, and can then shoot too low. But, by eating lower carb, the blood sugar won't go up as high, so less insulin will be needed to bring it down, and there is less chance of overeating. On this diet I can keep my blood sugars in the 70-120 (OK sometimes it goes up to 130 on the bike........) most of the time. I also ride with a type I diabetic who had to have a pancreas and two liver transplants. My dad was a type I diabetic who died in his 50s. I don't want to end up like them, which is why I follow the diet I do. PLease have Sarah (and her doctor) consider the advice in this book.

[Triskeliongirl]

Anne, I never replied to this message, as I was waiting for my antibody test reults, but here goes:

1. "Triskeliongirl, that's great that you are able to control your diabetes so well with diet. Type 1.5 as I've seen it defined (though of course I've seen multiple definitions ) is more or less late and slow onset type 1, where you produce islet antibodies."

You are correct that usually both type I and type 1.5 diabetes are autoimmune in origen, that is not always the case and the antigens are not always found. We are using the definitions that type Is make very little to no insulin, type 1.5s make some but not enough insulin, while type 2s make plenty of insulin by lack insulin responsiveness. So yes, with or without autoantibodies, type 1.5 is more similar to type I than type 2, hence the 1.5 designation

With that being said, my doctor did order a diabetic antibody panel, and while I have pateinetly waited more than 3 weeks for the results, they just came back only to learn the nurse filled out the order wrong and I was tested for anti-gliadin and not anti-gada (grr, she ordered the celiac panel instead of diabetic panel...........) so I still don't know. However, regardless of these results, my doctor classified me as type 1.5 since while I still produce some insulin, its way below what it should be. Its too high to be type I, but I am not type II since type IIs usually make too much insulin, but lack insulin sensitivity (and my sensitivity is good based on my post-prandial ratio of insulin to glucose at 2 hours).


2. "Also, there are a number of studies that suggest that medications including insulin therapy may delay/decrease beta cell destruction but as you know this is territory that is just becoming understood, but if that interests you it might be something to look at. "

What I have read, is that what prevents disease progression is achieving good blood sugar control. While medication is one way to do that, diet is another. While my doc also pushed pharmacological intervention early on, as long as I can keep my blood sugars in the 70-130 range as I am doing, he is quite happy to let me control it by diet. I think this is a better approach for the reasons explained in my previous post, and why I think your sister should consider this.

3. "My sister just got a continuous glucose monitor and it is a little off from her plasma glucose (it measures glucose in the interstitial fluid) but it really helps her see when her glucose is trending down and she can set it to alert her when she gets too low/high. Lots of new options if you end up having to take insulin in the future."

Can you tell me more about this. We discussed this, but the units my doc found info. on said they don't work while exercising (i.e. sweat can interfere). Does her unit give direct measurements. My doc had one that I could borrow, but the data needs to be downloaded later which really doesn't help you much on the bike.

4. "You are right too that endurance exercise is well-fueled by a relatively low ratio of carbs but a higher ratio of carbs is necessary for other types of activities, i.e, high-intensity aerobic exercise relies almost entirely on carbohydrates to fuel it. "

Please define high-intensity aerobic exercise. I can push myself pretty hard on the bike and am fine on my low carb diet, but I am careful to refill glycogen stores slowly by eating not only low carb but high protein, and sometimes on a ride I'll need to eat a single dried fig every 20-30 miles if my glucose gets too low.

[onimity]

Hi Triskieliongirl,

A few responses...

"No one is asking anyone to do anything without the help of a medical professional. With that being said, many medical professionals, my endocrinologist included, appreciate when patients bring them data that can often be more informative than that provided for a lab."

It looked a heck of a lot to me that when Dianyla recommended this to sundial:

"You might want to try your own oral glucose tolerance test that TriskelionGirl told me about a few posts back, and measure your response."

I agree that it can be very useful to test and measure your response to different types of food, especially the sorts you are actually likely to eat, for your own use or your doctor's use. But to do that you need to know how to use a meter properly, how to interpret the results and what sort of tests give you meaningful feedback. You *know* that you have glucose tolerance issues, it is WONDERFUL that you are active and on top of your health, my sister does those sorts of tests/experiments all the time, and they help a lot, but I don't think it is appropriate to recommend homegrown GTTs to someone that doesn't have a known issue/isn't working with an endo. Yes, Dianyla is working with an endo, but is sundial? Self-diagnosis of any condition can be dangerous and misleading IMO. It isn't my intention to be critical of anyone, I realize that we are all here to discuss issues and help one another. I just disagree with the advice I quoted.

"We are not talking about 'a reaction'"

sundial was, it seemed to me. She stated that she is sensitive to refined carbs and that is what I was responding to...

"what is the source of this information...The human body is amazingly adaptable, and can run on many different fuel types."

There are countless studies that recommend rough macronutrient guidelines for people in general, for athletes, and for diabetics. Very few recommend that the majority of calories consumed be from protein and fat. Some do, of course. A lot of type 1.5s seem to have good luck with the Bernstein diet but the 'paleo' diet isn't necessarily good advice for someone that 1) wonders if she's taking in enough carbs 2) has no known BG issues and 3) has said that she tried a low-carb diet for weight loss without much success.

IMO a variety of foods (and I mean real foods here, not different brands of processed/fast foods) is good in that it gives you a variety of nutrients. I assume that you are being very careful about getting your daily requirements but low carb diets can have a detrimental effect on your health if you aren't getting your basic nutritional requirements. You have chosen a specific diet for a specific reason, it works for you and I don't argue with that. However, I would encourage people reading this thread that DO NOT have glucose tolerance issues to investigate other alternatives.

It is true that human body is remarkably adaptable, but that doesn't mean that all means of fueling the body are ideal. Protein does not provide a readily-accessible form of energy like carbohydrates do and that is important to realize if you are exercising regularly.

"Before, even on the bike, I would go through swings of hyperglycemia and hypoglycemia, all the while not being able to access fat stores that was definitely not performance enhancing. That is because when my blood sugar was high, even though I would have insulin turned on, it would be too little to get the glucose into my cells, yet with insulin on glucagon was off and I couldn't get my fat out of storage, so I would be literally starving on the bike, despite having glucose coarsing through my veins and plentiful fat stores. This bugged me for years, because while I understood this, I didn't know what to do about it."

It is kind of hard to tell from the description, but it sounds a lot to me like you are using the insulin that you do produce to maintain your needs apart from food, and compensating for your lack of ability to produce adequate insulin in response to food intake by avoiding carbohydrates. It makes logical sense that this would result in lower BG readings, assuming you still produce adequate insulin to meet your daily needs and that you are taking in enough sources of energy to maintain your needs. Before my sister was diagnosed she lost a ton of weight and we were very worried. Now she thinks that she had issues with her BG in the year leading up to her diagnosis from the feelings she has come to recognize as high blood sugars, ketones, etc. But it was literally as you describe, that she was starving in spite of the food she took in and the fat she'd had previously. Her body just couldn't use it without insulin. If you can get your necessary nutrients, maintain your activity and glycemic control by diet alone, more power to you.

"Anne, I just clicked on your homepage and saw you have first hand experience riding with a type I diabetic. Please get her to read Dr. Bernstein's book. This diet is also advocated for type I diabetics, because by eating lower carb, they won't need as much insulin, and won't experience the kinds of blood sugar fluctuations you described your friend going through, which is better for their long term health."

Sara's my sister (& roommate) & we've both read a lot of Dr. Bernstein's articles but the logic, while it makes some sense, doesn't really work for her. My sister keeps in very good control (her top priority) but doesn't want her life to be dictated by the disease; keeping a well-balanced diet is critical to that. By the same token, neither of us eat a lot of refined anything with the exception of fast-acting carbs for exercise. Our meals tend to have a good balance of protein, fat and complex carbs, she tends to be very good at calculating her boluses and monitoring her BG to determine if she needs to correct in either direction before it becomes a problem. We've both been placed on low-carb diets by well-meaning doctors (I had some episodes of hypoglycemia during a mid-college growth spurt) and the result for both of us was that we were extremely tired, gained weight (in spite of reduced calories), and couldn't maintain our active lifestyles. It didn't work for us, but everyone is different.

Sara always needs some insulin on board or her blood sugars will rise, regardless of whether or not she is eating anything, and this is what has happened in the high blood sugar episodes I wrote about on my blog. She's had a couple of tough episodes lately, all because she was got no insulin overnight. She uses an insulin pump and since she has been cycling a lot has lost most of the body fat on her abdomen and legs and has been having problems with the cannula on her infusion sets getting mangled (she's getting a new type of them though!) Without her basal insulin being delivered (even without eating anything) she can wake up in the 400s. Even a carb-free diet, or total food abstinence won't keep her BG from going sky-high if she doesn't have insulin.

She has virtually no problems in glycemic control related to food intake; her sugars are remarkably stable regardless of what she eats as long as she doses her insulin correctly. Basically, she will take a bolus for whatever she eats, and choose the type of bolus (immediate, or delivered in 30 min increments over a range of time, or a combination of the two).

When Sara is exercising she needs roughly 40g of carbohydrates per hour at a minimum. She doesn't take any extra insulin for these carbs as she would if sitting on the couch, she takes only her basal rates while exercising. Some athletes suspend their pumps while exercising and still consume about the same number of carbs, but that really depends on the person, insulin, and the duration/type of exercise. If she didn't consume those carbs, though, she'd have a serious hypoglycemic episode. Because she is fit, healthy and active she really needs to take very little insulin and has very good carb-insulin ratios. (I should mention too that we're riding ~150 miles a week, a lot of it uphill. We eat a *lot* of food in general.)

"If a diabetic eats a high carb meal and their blood sugar skyrockets, they have to get the insulin dosage just right, or it will first go to high, and can then shoot too low. But, by eating lower carb, the blood sugar won't go up as high, so less insulin will be needed to bring it down, and there is less chance of overeating."

Yes, this is a common problem, but with experience, accurate dosing and devices like an insulin pump (which allows precise dosing of short-acting insulin) it doesn't have to be. It's hard *not* to over-correct for a stubborn high or low, and you are right that it can cause harm but that's one of the realities of taking insulin and something people need to learn to avoid. Sara has actually worked out with the various glucose tabs, gels, honey, bars, etc. that we have for exercise what will hit her when and how hard and depending on her BG and rate of drop will choose the appropriate solution. She tests a lot on the bike and keeps her BG amazingly steady. She usually ends up using glucose tabs to correct a low (because they hit her most quickly and allow for more precision than, say, a Gu) and other foods with slower-acting carbs to maintain her BG through the ride.

"what prevents disease progression is achieving good blood sugar control"

clearly we don't know what prevents the progression of autoimmune diabetes, how that may or may not differ in the various forms it takes, or we'd be able to prevent it. The problem is that we don't know, but there is a lot of interesting research going on in the field at this time. I just brought that study up because there is a lot of interesting stuff going on and I wanted to be sure that you were aware of it, not because I think that it constitutes good advice. I am not an expert, by any means.

As far as type 1/1.5/2/3 I have heard 1.5 sometimes described as the so-called 'type 3,' basically type 1 + type 2. Others say there are only type 1 and type 2 (completely distinct diseases really, with a common symptom) and that type 1.5 is late-onset and generally slow-progressing, though there seems to be a lot of variation. A lot of people also use the terms LADA and MODY... I've read a number of articles/studies and the like because it is a concern for me too as clearly there is a major genetic component which is present in my family. From what I've read there are multiple significant antibodies, especially GAD65, that may or may not be present; the antibodies present can (possibly) indicate the speed at which islet cells are destroyed. But the most common outcome for type 1.5 patients is insulin-dependence, about 80% (of known) cases within 6 years is a stat I've seen frequently but I take that with a huge grain of salt because there are probably many undiagnosed people not figured in, then there are so many mis-diagnoses and people that are diagnosed as adult type 1s because they present full-blown symptoms by the time they seek medical help.

My sister often visits tudiabetes.com, a networking site for people with diabetes & others impacted by the disease. She has learned a lot there and really enjoys being able to bounce ideas off of others that are in the same boat.

The continuous glucose monitoring device is really cool, as long as you have your expectations set accordingly... My sis just tried the Dexcom 7 for several weeks (newly approved by the FDA) and had mixed feelings about it. But yes, you can use it during exercise and while the readings are approximate (it measures glucose in the interstitial fluid rather than in the blood, and as you know even BG readings from the arm and the fingertip can vary significantly) so the Dexcom was sometimes dead on (generally when she was in range) and sometimes 20 points below her BG, sometimes not reporting at all, but it was very good at showing trends. She noticed in particular that the Dexcom was great at predicting lows. You definitely need to use it in conjunction with a BG meter for accuracy/calibration, but it is very useful for watching overnight trends, workday trends, exercise trends, etc., since you can't exactly test 500 times a day. When she went back for her follow-up appointment they looked at all of the results with her over two weeks and it really helped Sara to adjust her overnight basal rates since she was able to see that her glucose readings vary very little but are too high (she worries a lot about hypoglycemia overnight). She had some problems with the transmitter, and the device not receiving data from it so it was kind of hit or miss but very, very useful all in all. She was able to borrow the unit through the Barbara Davis Center for Childhood Diabetes (she's a patient there) and she only had to pay for sensors ($35 each, lasting 7-9 days). She will be getting the sensors that work with her MiniMed/Medtronic pump and those are supposed to be better. Insurance companies are starting to cover these devices, my sister's just got approved. I don't know if you have a major diabetes center near you or not but if so they might be a good place to go to find out about any similar programs. If that doesn't work feel free to PM me and I can see if my sis can find out anything about classes in your area from the Dexcom guy. I've read about the CGMS devices like your endo has too. Of course they don't have the added benefit of showing you (more or less) what is happening as it happens but I've heard they can help a lot in determining the same sorts of patterns that the Dexcom helped Sara with. As long as you kept good track of when you were exercising, etc. that might be a good thing to investigate.

"Please define high-intensity aerobic exercise."

Sorry, I mis-typed there. I meant to say high-intensity exercise, roughly 80% of your max heart rate or greater.

"and sometimes on a ride I'll need to eat a single dried fig every 20-30 miles if my glucose gets too low."

Out of curiosity, have you done experiments with your glucose tolerance while exercising & immediately after? i.e., can you consume more carbs without a BG spike when you are actively exercising? And do you notice a difference based on how complex the carb is and whether you mix it with protein/fat? I would be curious to know as this is definitely what Sara experiences (granted there are huge differences in your situations) but I wonder since people without diabetes also have lower circulating levels of insulin during exercise and active muscles are able to take up glucose from the bloodstream without the involvement of insulin. Without sufficient supplemental carbs you will, at some point, deplete your available glucose and bonk (like anyone) but I wonder if you might extend your endurance/improve your recovery for long rides (if you even need to) by supplementing with carbs during exercise, assuming you don't have BG issues...

I hope you didn't read my posts as critical, I am really impressed by the active role you are taking with your health and the way that you manage it and work with your doctor; that is the way to prevent long-term complications. Living/riding with my sister is very interesting and inspiring to me because there really are so many variables to take into consideration and so many unexpected turns but it is fortunately increasingly more manageable.

Anne

[Dianyla]

I've had two different kinds of experiences going to doctors. The first kind is where I do not do my own research and experimentation, but rely entirely on the medical professional to lead the troubleshooting. The second approach is where I become as informed as I can and partner closely with my personal physician to work on these problems.

The more educated and motivated I am as a patient, the more progress I make towards solving my own personal health puzzle. Most physicians spend the bulk of their time attending patients who are markedly unhealthy with very obvious health problems. When an apparently healthy looking person walks into their office and says they are not feeling optimally healthy and vibrant, they will most likely run a set of generic tests (which may show nothing at all) and find nothing seriously wrong. There's a big grey area between being completely healthy and completely ill. Now I am choosing to be a lot more proactive in managing wellness, rather than just continuing the current course until I develop a serious enough problem that is easily diagnosed. But, that is the approach I am choosing to do for myself

Some DIY health experiments are risky and even downright dangerous. Eating a high glycemic index breakfast and measuring your blood sugar a half-dozen times afterwards is not one of them. If you check my posting history you'll see that every time I have suggested that someone investigate iron supplementation I also urge them to see their doctor and get their ferritin tested, since taking oral iron willy-nilly can be quite dangerous for some people. I do not care for the implication that I am endangering the health of other members here simply by sharing information and advice.

Advice is just that - advice. You can take it or leave it. You're free to disagree with whatever you like.

[Triskeliongirl]

I think what Omnity is getting at, is that impaired glucose tolerance is not likely to explain why most obese people strugle with their weight, or why most people experience reactive hypoglycemia following a sugary treat. But, I bet it explains why 10% of them do. When I first realized that I had impaired glucose tolerance, I assumed it was why many people I knew couldn't lose weight, but many of them did check their blood sugars, and find out their response was fine. But one friend checked, and found out it wasn't, and took his results to his doctor for follow up, and indeed he also has impaired glucose tolerance. So, I still think its fine for folks to self monitor, but of course the intention is to share the results with their doctor. My friend said his doc had missed this, since his fasting glucose levels were fine, but his response to carbs wasn't. I am like that too, my fasting levels are either fine or only slightly elevated, its what happens when I eat carbs thats off. But, often this can be missed in routine screening. What made him check was when I started talking about falling asleep after eating a high carb meal. If reading this thread makes a light bulb go off in someones's head, then I think that is great. But indeed, impaired glucose tolerance is only going to apply to a small sub set of people.

I think its great that Sara has achieved such a good level of control. I am curious, how tight is her control? The reason I ask is that I have seen first hand what even apparently well controlled diabetes can do to someone. My dad died of type I diabetes in his 50s (or rather the complications) even though he took his insulin and monitored his sugar and ketones (urine tests in those days, more crude I know) and did everything he was supposed to. A good riding bud of mine did the same, and is now on his second kidney transplant, first pancreas transplant. He also didn't believe I could bike without eating more carbs, and accompanied me on the metric century I did on protein and veggies, as he was so worried I'd end up bonked out in a ditch somewhere. Now, he is getting his brother with type I to read Dr. Bernstein's book. This is why I am resistant to taking insulin, at least for now. Of course, if it progresses and I can't do it with diet alone I will have no choice, but I feel really good about what I am doing.

I can generally stay between 70 and 120, although I do go up to 130 during exercise. Yes, my glucose tolerance is better with exercise. When I was doing pre-exercise carbo loading, I had the best luck eating a sweet potato together with some protein and fat (say a chicken breast or turkey sausage). If I didn't exercise, my post-prandial blood sugar might go up to 180 and stay high for 4 hours. But, if I hopped on my bike for 30 minutes I could get it down very quickly. But, that proved inconsistent. Sometimes, if I would eat a pre-ride sweet potato as part of my breakfast, it would lead to my blood sugar going too high (say 180), and then crashing too fast making me sympomatically hypolycemic even at normal values (say 110). My doctor thinks this was from my blood sugar falling at too fast a rate, which is why we decided to use the protein gluconeogenesis and veggie route to fuel my exercise. I feel best on the bike in the 100-130 range. Anything higher and I get nautious, sleepy, etc. And if it gets too high and then falls too quickly, I get confused to a point where it can be dangerous. I do ride in the 70-80% max HR range this way, but it has taken time to both learn how to do it and train my body. And its not consistent, so I always have to carry figs and eat one if I get that I am out of ATP in my muscles feeling (I know cuz my pace suddenly slows and I just can't turn the pedals over anymore). I will add that I am not a 'competitive' athlete. I can keep up with a group, but I am not racing. But, I can move at a decent clip, and have great endurance.

Diabetes is not a single disease, it is a collection of diseases, in the sense that there can be multiple reasons why someone ends up even just a type I diabetic. Yes, in most cases it is autoimmune, but different antigens can be attacked, or there can be other reasons that cells are lost, or in some cases there can be a problem with the insulin secretion and synthesis machinery that are not due to cell loss. I think the type I and type 2 designation make sense, but not in the old juvenile vs adult onset terminology, but because type I is a disease characterized by hypoinsulinemia while type 2 is characterized by hyperinsulinemia. In that regard, type 1.5 or whatever you want to call what I have is more similar to type I than type 2.

FYI, I may have said this, but I do have confirmed thyroid peroxidase antibodies. Still waiting to get re-tested for the diabetes antigens.

To answer your question further on the glycemic index of foods, I have to say its not consistent. The foods I am least sensitive to are sweet potatoes and canteloupe, eaten together with protein, BUT I am very sensitive to strawberries with are also low on the glycemic scale. BUT, I am always less sensitive if I follow it with exercise. In fact, that is what keeped me from being diagnosed. I'd have a slightly high fasting glucose measurement. they'd want to repeat it, and I'd ride my bike to the appointment, bringing down my blood sugar levels. What I have read is that exercise increases the number of glucose transporters on the cell membrane, so more glucose goes in for a given amount of insulin. SO, even with a low insulin levels, with exercise I can clear a light glucose load. But the inconsistency of it all is why I just gave up on eating these foods and went with the Bernstein diet (although I do eat tomtoes and carrots, I base my food choices on what they do to my blood sugar vs blanket recommendations).

[Triskeliongirl]

Anne, one more thing, I apologize if the tone of my posts have been defensive. I just get really tired of folks that criticize what I am doing when it is so clear to me that what I have figured out about my body is huge. I too never would have believed I could cycle at the level I am on this diet (read this thread from the beginning and you'll follow my experiences in real time). I was also aggresive with you, becauase I want others to benefit from this knowledge, and I was concerned about Sarah, but I understand that every body is different. I really mean that. I think that is one of the problems with nutrition recommendations and obesity now. There are people that can really handle carbs and thrive on them and others that don't. I can't assume everyone is like me. And, I am sure that since you think Sarah is doing so well, you also get defensive if I suggest that she try something different. If her blood sugar control is really good, then obviously what she is doing works for her, just as what I am doing works for me. To me, that is what is key for anyone with diabetes/impaired glucose tolerance, regardless of the etiology, maintaining good blood sugar control, which I operationally define as 70-130 (I am usually closer to 80-120, just sometimes on the bike when glycogen stores are very full it goes up to 130, and sometimes it will drop to 70 if many hours have gone by since a meal). I also read an article that trained endurance cyclists perform best with blood sugars around 110-120 on the bike, which while they need to eat to carbs on the bike to ahieve, I seem able to achieve without eating carbs on the bike.

[onimity]

Some DIY health experiments are risky and even downright dangerous. Eating a high glycemic index breakfast and measuring your blood sugar a half-dozen times afterwards is not one of them. If you check my posting history you'll see that every time I have suggested that someone investigate iron supplementation I also urge them to see their doctor and get their ferritin tested, since taking oral iron willy-nilly can be quite dangerous for some people. I do not care for the implication that I am endangering the health of other members here simply by sharing information and advice.

Hi Dianyla,

I respect that you are trying to help people with your advice but this is just patently false. While severe reactions during GTTs are rare, they can and do happen. First, you recommended a glucose tolerance test; that is NOT the same thing as a high glycemic-index breakfast followed by testing. Since you've talked about trying the test with glucose in this thread I don't think it's hard to be confused about your actual recommendation. I think that Triskeliongirl's original post recommended something quite different -- testing response to a reasonable meal -- which may give you some insight into how you respond to real foods but it is quite different since you have to digest and metabolize the food.

You were looking for hyperglycemia, but another possible outcome is hypoglycemia, which can vary from asymptomatic to deadly. And while the latter is very unlikely, it is quite possible to have a severe reaction. Some people produce too much insulin especially in response to a large quantity of simple sugars and can see a huge drop in their blood sugar after an initial climb. Risk of a hypoglycemic reaction can also be increased by numerous common medications, alcohol consumption (which you may still be metabolizing from the previous night), exercise within 24 hours prior, the carbohydrates you were consuming in the days prior to the test, etc. etc. etc. There is a reason your Dr. doesn't just send you home with glucose and a meter to do these tests.

Beyond the test itself, I think the biggest danger is self-testing/diagnosis without involvement of a medical Dr.; I've seen a lot of people harm themselves by doing this sort of experiment and either 1) determining that they don't have a problem when they do or 2) deciding that they understand and can control a problem they 'detect' without seeing the big picture.

My two cents.

Anne

[onimity]

I think that you are right that there are a lot of people out there with undiagnosed diabetes and misdignosed diabetes and that the best possible outcome of this thread is that people may be able to recognize symptoms of a problem which will cause them to investigate further. Specifically that adult-onset diabetes is not necessarily type 2, which a lot of people (including Drs) assume.

"So, I still think its fine for folks to self monitor, but of course the intention is to share the results with their doctor."

I agree, 100%.

Sara's A1Cs have consistently been in the 6% range since she was diagnosed (minus that test at diagnosis) she's been in the low 7s a few times, but that's rare for her. Now that she has been able to tighten her nighttime basal rates and increase her # of BG readings with the CGMS I expect that she will be in the 5% range on her next visit. She has also never had a severe hypoglycemic reaction or been hospitalized. She sees her endo every three months and goes through the full gamut of tests for general health and complications; after 14 years she has no evidence of complications whatsoever and her doctors estimate that she has a less than 5% chance of developing complications in her lifetime if she continues her current level of control.

Your diagnosis must be particularly terrifying to you because of your Dad and I can't imagine what that must feel like for you; all I can say is that things have changed *so much* even since Sara was diagnosed; the insulins that are available are so much better/more predicatble, insulin pumps are a huge help, and the means of testing and ensuring good control are light years from where they were even 10 or 20 years ago.

I got a kick out of your story of riding your bike in to have your glucose tested.

And no, I don't think your tone was (overly) defensive; and I truly didn't/don't mean to come off as telling you what to do. This has been a really interesting thread and I think that by sharing what we all know, we've probably all learned something. You and I both have a lot of personal history from this disease; you react with the knowledge of what diabetes did to your father and how your body is reacting to its circumstances. To me, your diet/response looked a lot like Sara's instinctual reaction in the year leading up to her diagnosis: avoiding sugars/carbs because she felt bad when she ate them, losing weight, etc. So I think it's natural to compare concerns and experience and I hope that I haven't offended you with all of my questions/comments.

Please keep us updated on your antibody tests and progress. I hope that you continue to do well and feel good.

A few random links that you might find interesting:

http://www.insulinfactor.com/graphic..._exercisel.pdf
http://tudiabetes.com/forum (<- there is a forum specific to type 1.5 and an interesting low-carb v. insulin discussion there as well)

Anne

[Dianyla]

Well, I got my hbA1C results back today - 5.4%. So I think I'm in the clear for now, thankfully. I am, however, going to continue with the paleo style diet (modified for athletes) since I have been feeling better and seeing better fasting values. When I'm going paleo, my morning glucose is ~85 as opposed to the 95-105 that I had been seeing.

[Triskeliongirl]

Hi Dianyla- I was wondering about you. Glad you got a good report from your doc. I was very impressed reading the paleo diet for athletes, and think that it is a good choice for you given everything you have told us. I wish I could follow it, its just still a little to carb rich for my body to tolerate, but as I said before, I am really impressed with the qualifications of both co-authors. -eileen

[dinabean]

I know this thread is three years old, but someone directed me to it when I asked a question recently about fueling long rides while on a low glycemic diet. I've been fascinated by everything I've read here -- I was recently diagnosed with Hashimotos Hypothyroidism, my fasting sugars were regularly around 110 and my doctor recommended a gluten-free, low glycemic diet for me, which I have been following for about three months now. I bought a blood sugar monitor (the one from Target, it's house brand, is cheap and the test strips are cheap!) and the food seems to be helping, as my fasting sugar is now more around 90-ish most days.

In any event, are the OPs still around? If so, how are you doing with your diet and exercise? Curious for an update if you're still around.

[Triskeliongirl]

I noticed this thread pop up again. I am doing really well thanks. At this point I have been diagnosed as a mild type I diabetic. Mild because while most type I diabetics make virtually no insulin, I make just enough to maintain glucose homeostatsis without a carb challenge (but still much less than I should, especially when challenged with carbs). Part of why I can maintain glucose homeostasis without much insulin is that tests by a colleague in a research lab revealed that I also have unusually good insulin sensitivity (this is the OPPOSITE of a type II who makes a lot of insulin but doesn't respond well to it). But I am really rather unusual, which is why they don't know how to classify me (and why they call me a mild type I for lack of a better descriptor, since it communicates best that what I have is an insulin defeciency rather than a problem with insulin sensistivity, even though I can manage it without taking insulin).

I still manage it with a low carb/high protein diet and exercise (and lots of glucose monitoring). On the bike, I drink muscle milk lite in my bottles, plus almonds as needed if its a longer or more intense ride. On very long rides (like metric centuries and longer) I've used pretzels.

Recently I started to have problems with the Dawn phenomena, that is slightly higher than normal fasting blood sugars (~110). This correlated with a change from bike commuting (where I was riding 2X a day, am and pm) to morning gym workouts. I found by doing evening (a few hours after dinner) spinervals/trainer workouts instead of a morning gym workout, I am back to low normal blood sugars (~85) in both the post workout evening hours and morning hours. I also noticed that whenever my blood sugars are off even a little my weight also goes up a little (in part because I get hungrier and eat more), but now that I switched my exercise from morning to evening my weight came back down (normalized I call it, that is how I describe how I feel when my hunger/satiety cues are in sync with what my body needs to maintain a healthy body weight).

I also feel best with reduced meal frequency (and find its a painless way to control calories when I need to lose weight), so I use a regimine called intermittent fasting (leangains.com) where I eat a big dinner, but then don't eat anything again until lunch the next day. Basically 2 good meals a day (lunch are leftovers from dinner). The only exception is if I am biking in the morning, then I'll have a high protein pre-ride meal (like 2 chicken sausages), and then my protein shakes and almonds on the bike. I'll also relax it a bit on the weekends, especially with things like alcohol and Lindt 85% dark chocolate (something that's been termed 'flexible dieting').

I also found out recently that I had a vit D defeciency, so now I take a supplemental multi-vitamin, calcium, and vitD every evening with dinner. In the am, I still take my synthroid/cytomel combo for my hypothyroidism (Hashimotos) (150ug synthroid, 5 ug cytomel) and my thyroid numbers look great and I have good energy.

[limewave]

So interesting to read about what works for other people. I have tried many different combination of meals/snack times. I've found that I do best when I eat a large breakfast. I love breakfast. Dinner, meh. I kind of do the opposite of what you do: Big breakfast, Big lunch and then my dinners are more like a snack.

[dinabean]

Thanks for the updates, ladies. Interesting re skipping breakfast -- I find myself much more even since i started eating breakfast regularly. But I am so glad you have found a system that keeps you controlled. My boss is diabetic and he's out of control and scaring the heck out of me (as in, sugars in the 400-500 range lately). I am very worried for him.

[lisathew8lifter]

thank you for the info on this, girls. i have copied parts of this and am brining it with me again next week when i do the glucose tolerance test. my thyroid is being managed and i'm almost hyper (counts are free t4+ .80, TSH .16, Free T3, .83 but i can't lose weight, in fact i'm gaining it. i have been dropping all grains and have found that i have a reaction to them and while eating sugar. i fall asleep like someone turned out the lights! i mentioned this to my endo, and the fact that while my thyroid is low, obviously my metabolism isn't working. i mentioned glucose intolerance, or insulin resistance due to what i was reading in this thread...my doc is out so i have no idea what the test results were but i know AS a result of the TESTS she ordered the glucose test.
anyhow, i'm rambling, but i want to thank you all for contributing to this thread since i has helped me immensely!