Low-Carb Diets and Cycling

[amymisk]

Thanks for all your updates. It sounds like you have put a lot of effort into solving your issues! Way to go, I am sure your body thanks you!

[onimity]

Wow, interesting post; thanks for sharing this.
I've read a bit about type 1.5 and assume that your doctors are testing to confirm that you are indeed producing insulin and that you also have Islet cell antibodies? Are you taking any medication, either insulin or something to help you produce more?

Carbs are important fuel, especially if you are active, but you are right to be keeping your blood sugars down. My sister is type 1 and we ride together so I've seen firsthand the ups and downs of balancing insulin/carbs/exercise; she's learning to do a great job with it. We've both been reading a great book called The Diabetic Athlete by Sheri Colberg that is really wonderful. It covers both type 1 and type 2, but it primarily deals with type 1 with some discussion of how type 2 medications can cause some of the same insulin/carb balancing issues that type 1 athletes have to deal with. It does a great job of explaining nutrition for athletes and how you have to adapt to that with diabetes. You might want to check it out.

Also, there was a great article on type 1 athletes in the NYT yesterday.
I would love to see tt1 in the TdF!

Anne

[poetcomic]

Hi everyone. I'm not so much eating low carbs as I am correctly carb balancing. Well, I'm trying to anyway! Going to the diabetes nutrition classes at the local hospital made a HUGE difference. I learned I had 2 major problems: not eating breakfast and not eating enough. Could've knocked me over with a feather re: not eating enough! (Of the right things, of course.)

I am just planning to get on my bike and know I will need to monitor my BS closely. I've already lowered my HgA1C from 7.4 to 5.8 by adding cinnamon to my diet.

I generally eat 14 carb units per day (1 unit = 15g of carbs). It's spread so that it's 3 units per meal (3x day) and 1-2 units per snack (3x day). I am following the color code system used in the glycemic index diet, which I prefer to look at as the GI eating plan, lol.

[Triskeliongirl]

Yes, blood tests revealed that while I do make insulin, my fasting levels are low, and my response to a high carb meal is both low and slow (I seem to lack a phase I insulin response). My insulin sensitivity is fine. So, while taking insulin or other meds is an option, the disadvantage of taking insulin is that its easy to overshoot and go hypoglycemic which is very dangerous. Hence, I am choosing to control it by diet. Of course a type I must take insulin. I was heavily influenced by what I read in Dr. Bernstein's Diabetes Solution, and recommend it to any diabetics reading this thread (he also recommends this diet for type 1's, which lets them take lower doses of insulin w fewer complications). While carbs *can* be a useful source of energy on the bike, substantial amounts of carbs are not an *essential* fuel. One can cycle on a mix of fat and glucose, and even train to run on a higher ratio of fat to glucose. By eating a diet not only low in carbs, but high in protein, one can convert the excess amino acids to glucose by gluconeogenesis and store them as glycogen, or use them directly as fuel. I never would have believed this could work as well as it does, until I did a hilly metric century on nothing more than turkey sausage for breakfast, hard boiled eggs on the bike, and a grilled chicken salad w iced coffee and cream at the rest stop. And my blood glucose measurements for the day were in the 70-120 range. Eating this way my A1C is 5, my cholesterol is low, in fact my endo said I have a healthier blood chemistry profile than most of his non-diabetic patients. And, I feel great too!!!!!!!!!!!!!!!!!

[Triskeliongirl]

I generally eat 14 carb units per day (1 unit = 15g of carbs). It's spread so that it's 3 units per meal (3x day) and 1-2 units per snack (3x day). I am following the color code system used in the glycemic index diet, which I prefer to look at as the GI eating plan, lol.

WOW that's a LOT of carbs. I eat more like 20-30 g per day (effective after subtracting fiber grams). Are you a type 1, 1.5 or 2? Do you measure your blood sugars frequently? What is your range? Do you take medication? If I ate like you I'd be over 200 A LOT. My goal is to always be in the 70-120 range.

[poetcomic]

WOW that's a LOT of carbs. I eat more like 20-30 g per day (effective after subtracting fiber grams). Are you a type 1, 1.5 or 2? Do you measure your blood sugars frequently? What is your range? Do you take medication? If I ate like you I'd be over 200 A LOT. My goal is to always be in the 70-120 range.

I'm type 2. Yes, I test frequently. I'm generally between 85-120. Before I started the cinnamon I was always in the 140-160 range. I am on 2 oral meds but if things look good on my next visit, I should be able to go off 1 of them and cut back the other. I was able to stop taking BP meds after I lost the first "bunch o' pounds."

BTW, my mother is also diabetic. She sought her doctor's advice about the cinnamon and when the dr said okay, mom went from 4 shots a day, glucophage, and avandia to 2 shots a day and no oral meds. It does not work for everyone from what both mom's doc and mine said.

Your mileage may vary.

[Torrilin]

Weird. Mom's sugar generally behaves best when she stays with low glycemic index foods. I can't really see a chemical reason why cinnamon would have an effect. Plus, is it US cinnamon, or EU cinnamon? They're chemically different (as well as biologically different... bark from two different trees). Is there a specific amount you're supposed to take?

[Dianyla]

I'm baaaack with some updated information. It just gets curiouser and curiouser. I picked up a glucose meter at my local pharmacy and played around with it all weekend. I was all emotionally geared up for a premeditated pancake sinfest on Sunday. It would have been doubly sinful due to the fact that I've been off gluten for the last 6 months and I was really looking forward to an intentional indulgence. All in the name of research, right? Anyway, I got to my favorite cafe and they were out of pancakes! Who runs out of pancakes?!?!??!

Fasting plasma glucose should be below 6.1 mmol/l (110 mg/dl). Fasting levels between 6.1 and 7.0 mmol/l (110 and 126 mg/dl) are borderline ("impaired fasting glycaemia"), and fasting levels repeatedly at or above 7.0 mmol/l (126 mg/dl) are diagnostic of diabetes.

So I didn't yet do the glucose challenge, but I took quite a few blood sugar readings over the course of several days. My glucose level after fasting or sleeping is consistently 130-135 mg/dl. My post-ride "starving shakey shivery feeling like I've bonked" level is around 100-110 mg/dl.

The 2 hour glucose level should be below 7.8 mmol/l (140 mg/dl). Levels between this and 11.1 mmol/l (200 mg/dl) indicate "impaired glucose tolerance." Glucose levels above 11.1 mmol/l (200 mg/dl) at 2 hours confirms a diagnosis of diabetes.

In spite of the high fasting levels, my post-food numbers only climbed as high as 170 mg/dl. Most of these meals had a goodly amount of complex carbs and a small amount of refined sugars, with fat and protein. It took about 3 hours on average for my blood sugar to get back down to it's "normal" premeal value of 130 mg/dl. Sugary snacks (dark chocolate with whole hazelnuts, mmmm) failed to provoke anything higher than 160 mg/dl, though I didn't actually consume pure sugary stuff without fat or protein to balance it out. I'm hoping that the glucose challenge test will be more revealing.

So... verrry interesting. The biggest question in my mind is the 4 mcg of cytomel that I've been on for the last 4 weeks. I have no idea what my glucose levels were like before starting on this medication. I've been reading around and all the information I can find in the drug handout info, etc. is that cytomel can change blood sugar levels in diabetics, so one should monitor very carefully. I couldn't find much information about how exactly it changes levels. Might it raise or lower them, depending on the person and the condition? Could this just be a temporary adjustment effect of the medication?

I guess I'm a little stunned because I've never thought of myself as being at risk for diabetes. However, that Type 1.5 that you mention is very intriguing to me because I am intolerant to gluten and soy, both of which I consumed heavily until the last 6 months. In general I've never experienced the more common symptoms of diabetes, except during a long walking trip I did three years ago. On that trip, I had horrible edema, constantly infecting blisters on my feet, and neuropathy in most of my toes. I figured it was all because of the difficulty of walking 500 miles in 30 days, and just chalked it up to that. Now... I wonder. Plenty of other people who did the same trip had problems with blisters and sore feet, but not to the degree that I did.

FWIW, right now I still feel more on the hypothyroid side of things, being tired, sluggish, needing lots of sleep, low body temp. I don't feel overmedicated to the point of hyperthyroid with racing heart, hot/flushing, etc. In fact, other than being slightly less lethargic, I actually don't feel much different on the cytomel compared to before I started taking it. My next followup with my doctor is next week, I'll be interested to see what he says about this.


ETA: I did calibrate my meter with the provided glucose situation, and all that. I subjected my sweetie to a few random tests and his numbers all looked pretty good. So I think the meter is giving accurate numbers.

[Triskeliongirl]

Dianyla, the measurements you have taken so far are consistent with impaired glucose tolerance. First of all, your fasting numbers really should be under 100. I used to be ~110 but now I am 70-80. The post-prandial numbers you indicate are also too high (although you don't say how long after eating). You didn't mention you are gluten sensitive. You don't have to eat pancakes. The idea is to challenge yourself with ~100g of carbs. Another way is to just eat the equivalent in cycling gels. Feeling like you are bonking at 110 is exactly what happened to me. You are not bonking when your blood sugar is 11o, but you FEEL like you are because your blood sugar got so high during your ride that you felt like you were bonking due to the rapid change in blood sugar as it fell back to normal. Cytomel will not cause this problem. For years I blew off my symptoms as being due to my thyroid, but it was only when my endo asked me to measure my blood sugars that I realized what was going on. There is some connection I think. My body temp goes down when I eat carbs too, which is a thryoid thing. PLEASE BUY YOURSELF A COPY OF DR. BERNSTEINS DIABETES SOLUTION. I thought it wouldn't work for cycling, but I was amazed how much better I could cycle once I got my blood sugars under control.

A blood sugar of 130 is NOT NORMAL. Even though your post-prandial numbers may not be high enough to be classified as a diabetic yet, they are high enough to be classified as having impaired glucose tolerance which is a pre-diabetic state. Getting your insulin levels measured will tell you if you don't make enough insulin like me, or if your cells are not as sensitive to insulin as they should be. Do the test with gels and bring the results to your doctor to speed up your diagnosis and treatment, or bring what you have and ask him to order a glucose tolerance test.

[Dianyla]

OK, I called my mom up today to ask her about diabetes in the family and told her about the numbers I've been getting all weekend. She mentioned that she actually happened to have a nice quality glucose meter (OneTouch Ultra2 from LifeScan) with some nifty bells and whistles and she offered to loan it to me for a while to try out. I picked it up from her tonight on my way home from work and did some side-by-side tests. The cheap-*** meter I got last Friday is would give readings about 30 points higher (in mg/dl) than her meter. Before eating dinner her meter said I was at 95 mg/dl and my meter read 120 mg/dl. Pretty big difference, geez. I'm going to continue to monitor and track using her meter for the next week until I see my doctor to rule this in or out as a possible issue.

Cytomel will not cause this problem. For years I blew off my symptoms as being due to my thyroid, but it was only when my endo asked me to measure my blood sugars that I realized what was going on. There is some connection I think. My body temp goes down when I eat carbs too, which is a thryoid thing. PLEASE BUY YOURSELF A COPY OF DR. BERNSTEINS DIABETES SOLUTION. I thought it wouldn't work for cycling, but I was amazed how much better I could cycle once I got my blood sugars under control.

It is really hard to separate all of these issues. The more I read the more I'm getting confused. One minute it seems that hypothyroidism can cause glucose/insulin problems, the next it seems that diabetes can cause low thyroid function. I think I just sprained my brain. I will definitely check that book out, thanks for the recommendation.

ETA: PS: I know it doesn't have to be pancakes. I was just looking for a legitimate excuse to be naughty.

[Torrilin]

Even a cheap meter should give consistent results with other meters. It's pretty easy to get your meter calibrated incorrectly, so I'd recalibrate *both* meters. If your mom's meter is right, you're still getting spikes. And well, if your meter is right, those are scary spikes. That's part of why most diabetics trust their A1C numbers more than their daily numbers.

Even if you turn out not to have diabetes, the book Triskeliongirl is suggesting is good. Our endocrine systems are complicated, and a tiny change in the function of one part can have very large effects. So yes, if your thyroid doesn't work right, it can affect your pancreas, and your ovaries, and your pituitary gland... Thankfully most of us are old enough that the pituitary gland is off .

Note: Even with the meter error, you may *still* be looking at impaired blood sugar regulation. The high spikes you're getting are a lot higher than the high spikes my sister, dad, brother and I would get when we acted as Mom's normal guinea pigs while she was learning to use her meter. A "spike" on us would be around 110 (even for sugary stuff), and most random tests would have us in the 90-110 range. Mom uses any handy normal person as a quick way to check meter calibration after all that testing.

[Triskeliongirl]

Hi Dianyla, obvioulsy you need a reliable meter. The meter I recommended, while cheap to mail order, costs a lot in the store and is rated as very reliable (my doc gave me mine, same model). Technique is important too, be sure you wash your hands first so no food residues contaminate the results. Its harder on the bike, try to wipe the sweat off your finger or it can dilute the blood.

I also suggest that you arrive at you doctors appt. fasted and ask to have your fasting glucose measured in a lab, since a lab test will be most reliable. A real glucose tolerance test may also be indicated because of the problem described losing weight when you eat carbs. Again, a lab test removes the meter error. Knowledge is power.

I think you are getting confused because you are trying to put disease labels on things. That is why I am careful to use the word impaired glucose tolerance vs diabetes. Diabetes in fact is not a single disease. Type 1, 1.5 and 2 all have very different causes, although the end result in all 3 is impaired glucose tolerance. While of course thyroid disease is separate, sometimes the symptoms can overlap. For example, in the past when I complained about being tired all the time, falling asleep after lunch, etc., and my TSH was high I was given synthroid, or my dosage was raised. BUT, when these symptoms reappeared and my TSH was low, these symptoms were intially ignored (anti-depresssants were even suggested which I refused because I knew I wasn't depressed). It was only when I complained a year later that these symptoms continued, and I was gaining weight despite extreme diet and exercise that my internist referred me to an endo. He picked up right away on my only slightly elevated fasting glucose measurements. BUT, I was also put on a combo of T3/T4 (cytomel/synthroid) to be sure my thyroid was being treated optimally, and asked to start measuring my blood glucose response to food, which for me was much more problematic than my fasting levels. My new thyroid meds I know are helping, because my body temp is now higher (used to always be 96s-97s, now its 97s-98s), but even on the new thryoid meds, I still have impaired glucose tolerance, but I can control it by my diet, and keep my blood sugars always in the 70-120 range (even after a meal) by being careful what I eat. You may also want to start tracking your body temp. as a separate indicator of how well your thyroid meds are working.

You mentioned taking cytomel, but do you also take synthroid? If so, what are your dosages? What is your TSH now that you are on thyroid meds? If this is all too personal send a PM. Whether you do or don't have impaired glucose tolerance, you need to get your thyroid meds optimized.

[Triskeliongirl]

Another thought Dianyla. I know right now probably fear is the biggest emotion going through your body. However, I think you need to turn this around, and think KNOWLEDGE IS POWER. Yes, there were times I was scared to realize I am a diabetic, but that is because that fear conjured up images of the sad outcomes of UNCONTROLLED diabetics. For me, now knowing what has been wrong with me all of these years, has brought more joy and relief. As long as I eat correctly for MY METABOLISM, the weight falls off like it should. I have more energy. I FEEL 20 years younger. I LOOK 20 years younger. I agree with torrillin, even with meter error, the post-prandial numbers you are reporting in the first test are simply too high. This is good news, not bad news, becasue if you have a way to quantify what is wrong, you have a way to change it. I feel lucky that I have a disease that can be controlled so easily by diet. In fact, even with the type 1.5 label, I don't think of it as a disease. I think of it that humans have a range of metabolisms, and my engine runs best on protein and fat. If I feed my engine what it can metabolize, then I am healthier than most non-diabetics. My resting heart rate, cholesterol, etc. are all low. Even my blood sugars are low the way I eat (A1C was 5.0 at last measurement). SO I AM HEALTHY. You can be too, you just need to figure out what foods your body can and can't handle.

[Dianyla]

I also suggest that you arrive at you doctors appt. fasted and ask to have your fasting glucose measured in a lab, since a lab test will be most reliable. A real glucose tolerance test may also be indicated because of the problem described losing weight when you eat carbs. Again, a lab test removes the meter error. Knowledge is power.

I do plan to show up fasted (thank goodness it's an 8am appt) and ready to be tested. In addition to regular glucose I'm also going to request the A1C test to see the longterm trend as opposed to "what's going on right now".

I think you are getting confused because you are trying to put disease labels on things.

Um, guilty as charged. Additionally, I always want to dig down until I find the root cause that is the source of all badness. And yet I know it just doesn't work that way - all of these things are more of an interconnected circular web rather than a tidy linear cause/effect structure.

You mentioned taking cytomel, but do you also take synthroid? If so, what are your dosages? What is your TSH now that you are on thyroid meds? If this is all too personal send a PM. Whether you do or don't have impaired glucose tolerance, you need to get your thyroid meds optimized.

I'm taking cytomel only right now, at a low dosage of 4 mcg (compounded). My last TSH was 2.59, getting up there. My Free T4 was .9 which my doc felt was fine, but Free T3 was 3.1, which he felt was somewhat low. Based on this his current theory is that I have enough T4 but I'm not converting T4 -> T3 adequately. This is why he did not prescribe me any Synthroid for now, what's the point in just throwing more T4 at my body that won't get converted to T3? No antibodies suggesting Hashimoto's or Graves' were found.

I've only been on the cytomel for the last 4 weeks, next week is the first followup appointment with lab retesting to see how my body is responding to this first dose. My initial feeling is that it's helping, but I think I may need a higher dose. As for body temp I don't chart all month long, I just usually grab a handful of basal body temp readings on the days between menses and ovulation to avoid hormonal fluctuations.

I know right now probably fear is the biggest emotion going through your body. However, I think you need to turn this around, and think KNOWLEDGE IS POWER. Yes, there were times I was scared to realize I am a diabetic, but that is because that fear conjured up images of the sad outcomes of UNCONTROLLED diabetics. For me, now knowing what has been wrong with me all of these years, has brought more joy and relief.

Yeah, there's definitely a little fear in there. There's a lot of surprise, too, since diabetes has simply never been on my list of things I worry about. Things like cancer scare the crap out of me, and I just never even focused on diabetes as something I'd be at risk for. I think the biggest emotion I'm feeling is incredible frustration. I want to know the answers NOW *stamps feet* so that I can be focusing my energy in the right direction, instead of trying one thing after another with only marginal improvements. I'm tired of feeling crappy and being lame and fat and slow. But, I also know I'm on the path and that I have to walk down it to get to those answers eventually. Patience, grasshoppa.

[Torrilin]

Uncontrolled diabetes is scary. My grandmother died of lung cancer and uncontrolled diabetes. Controlled diabetes is about as exciting as watching paint dry (same as any other chronic disease). Mom's diabetes is controlled, and the biggest excitement involved is planning meals so she and dad each get the kind of food they need.

Just like with most chronic diseases, being calm and relaxed helps. Worry and stress reduce your body's ability to cope. In a diabetic, their blood sugar numbers go up. An asthmatic gets more prone to attacks. Someone with allergies will trigger off less of an allergen. When you're calm and relaxed, minor stuff doesn't cause as much trouble. You *will* get to the bottom of what's wrong with you, and you'll learn about it so it's not a strange and scary dragon .

The way our bodies work is pretty interesting stuff. It is fascinating to see that I really don't process food the way mom does, and that we can measure it. So get more tests, get lots of hugs, and keep eating right. Don't panic