T Nation

Living and Lifting With Type 1 Diabetes


#1

I created this thread for all of the type 1 diabetics out there who are constantly looking for information about eating, training, supplements, ect. Regardless of your goals, this is a place where we can discuss everything type 1 diabetic related and reach our full potentials with this disease.


#2

I’ll get things started with the topic of fat loss and insulin. How should/can insulin dosages be manipulated and controlled for fat loss?


#3

Hello sir! I will take a stab at this:

First, we have to say of course, that managing this disease and keeping BS in a good range should always be the priority. There are so many factors involved here, so i will go under the assumption that good control and understanding of how insulin works and frequent testing are all a given. If those things are not done, worrying about fat loss should not be the priority.

Now, I will go ahead and say that a food log IMO should be kept by every Type 1 Diabetic for a number of reasons (BS control being the 1st and best reason). As an extension of that, good control also means a regular routine with diet and training. 90+ % of food intake should be planned ahead of time and kept fairly consistent (for fat loss, that number should be as close as possible to 100%). By extension and as a reslult of that, insulin intake will be fairly consistent as well.
Now, once that is done, you know how many calories, protein, fat and carbohydrate is being consumed, as well as how much insulin is being taken daily.
At that point, a plan for fat loss can be implemented with (relative) ease. This is not really different from weight loss when planning a diet for Normos (my name for normal folks whose bodies aren’t trying to murder them by killing their pancreas).

So, with discipline, we have calculated caloric intake, macros are counted, and insulin is tracked.

IMO, without all of that, becoming really lean cannot really be contemplated as a type 1 diabetic. It is possible that a Normo can “wing it” to a degree and still make good progress for the most part, but we have to be a bit more disciplined to keep from dying.

To get back to the actual question, the goal is to lower calories, and insulin needs will be lowered as a result. Instead of saying “how can we manipulate insulin” we should say “how can we manipulate diet and training to require less insulin” and facilitate fat loss.

This thread is a really good idea, BTW. We were discussing T1 over in Mertdawg’s thread, but I felt bad taking it in other directions like this since the purpose of that thread was Mertdawg in dealing with his son’s diagnosis and management. Maybe we can get JonneKytola in here to discuss. If I remember right, he mentioned losing a good bit of weight after. Maybe a few more Type 1’s will come out of the wood works with some questions or insight as well.


#4

Thanks. I may post here though if that’s OK if its relevant. The most unexpected thing that
I found over this past year was that a LOW carb (around 30% of total calories) diet actually made my son resistant to insulin in a unique way. He needed much MORE than typical amounts of insulin to manage carbs because there was so much fat plus protein involved. Eating a low carb diet does NOT make you more insulin sensitive as I had once thought.

But my son is very lean-too lean in fact to use an insulin pump (about 5th percentile BMI). It could be other issues but my point is that he gets a fairly high amount of insulin but doesn’t store his food, carbs or fat as adipose at all. (And he’s not clinically insulin resistant which would mean that he would need at least 1.1 units per day per kilogram of bodyweight, he just requires much more mealtime insulin.

Since he is not storing adipose, the only conclusion is that he is storing dietary fat in and around his muscles in the form of inter and intra muscular fat. This fat can be burned and insulin does not block it getting to muscles like it does when fat is stored in adipose.

He is lean, but he also does not have much muscle on him and so despite great blood sugar control I am considering trying to cut saturated fat (which I have long been a proponent of) because it seems to block the effects on insulin on muscles AT LEAST when one gets below about 30% carbs and their body starts to prefer to store fat rather than glycogen in muscles.

That being said, I think the key to this all (D or Non T1D) is to train your muscles in a way that makes them more insulin sensitive which means 60 seconds hard, short rest periods etc. This is in contrast to what I (non-D) had been doing for the last 12-15 years, low reps with long rest periods. I think now that both are critical. Low rep strength training like CT recommends with high force, AND training a muscle at an output that outruns the rate that glycogen can refuel them.


#5

I am interested in other Type 1’s experience with “bulking”. I had an eye opening experience this last summer and fall.
I had been doing a lot of conditioning work and had been keeping really tight control of my BS, and had let myself shrink down to 180lbs. Carbs were moderate to low at that time (around 150 a day or so on most days and on non training days even below 100 grams), and i was feeling pretty fatigued and burnt out on training. I had lost fullness in the muscles and was just kinda doing lousy.

Now, it just so happens that I train at a gym with a fellow poster on here Bluecollartr8n, so I was discussing this with him and decided to have him look over my diet and tweak it. It must be said that this guy knows his stuff as anyone who knows him or has read his posts can attest to. A very smart guy.

One of the big things Bluecollar does is increase portions as a means to add/decrease calories. Food choices and such were pretty spot on already, so it was a matter of adding a bit of carbohydrate and fat (much more than I normally would eat) and protein here and there. the difference was almost immediate in general well being feeling. This is all stuff I knew really, but as is said, he who coaches himself has a fool for a client. Left to my own devices without outside input at all, I had drifted away from some of the more common sense stuff I knew. As I discussed my diet with him, as is often the case when trying to explain oneself, I answered/solved many issues I was having on my own. Bluecollar has that effect on people.

I normally train for no more than an hour, 4 times a week (sometimes just 3). I have a wife and kids and work, so I try to be very economical with my time. Get in, hit it hard, and get out. Now, these 4 hours include cardio time, so volume for weights is naturally limited by time. I can lift, then hit cardio or whatever and I really need to get out and home to the family. If traffic coming home from work is bad, well, the workout suffers, not the home time. 6:30 and I leave the gym, even if I had not finished what I had planned on doing. At that time, I was doing a lot more conditioning like I said (preparing for an event called the Death Palace my friends and I came up with and Bluecollar referees), and the metabolism was blowing and going. In the summer with the kids not in school, I also took advantage of a later bed time and decided to go to the gym more often and longer. This allowed me to hit it 5-6 days a week for an hour and 15 or so. Along with the increase in calories and volume (I switched to a bodypart split for training), before school started in late August, I was up to 190, feeling good and hitting numbers in the gym I hadn’t hit in a long time.
When I stalled gaining weight for a few weeks, each time Bluecollar slightly increased the calories and all seemed to be going well.
As for blood sugar, at first it was awesome. The increase in volume just made it all better. No doubt I had been in a deficit with insufficient carb and fat intake for a while.
This was going very well until school started again. I was forced to cut back on days and time. Volume went down and I put cardio on the back burner to try to make more time for weights.
At this time, my weight had stalled at about 190 and blood sugars started running high in the morning and insulin/carb ratio was getting worse. Where I could count on 1:10, at that time, particularly in the AM, I was looking at 1:7 or worse. Sensitivity was suffering. Looking back, it was no doubt a combination of many things. Less cardio, less volume with the weights. Weights were getting heavier and required more rest to complete a set, which in turn took more time, which in turn meant less volume and so on. My personal preference for training is along the lines of shorter rest periods and antagonist sets, which add to the metabolic fire, but I was not doing that at all at that time. Also, fat intake was going up pretty good. While this was the most logical thing to add, and really the only place it made sense to add calories at the time, this had much more of an impact on sensitivity than I had at that time anticipated. As we discussed before, BS went up as a result of the extra fat. So even more insulin was needed.
So, sensitivity was going down. Insulin was going up. I would say I was beginning to get a bit “soft”. I was feeling sluggish and out of shape.
It could be said this is the price to pay for gaining the strength and muscle. The cost of specialization maybe. Either way, through the holidays, as time became more precious and training naturally took a back seat I decided to reduce calories a bit and alter training.
Now, taking the valuable lessons from Bluecollrtr8n, I have come out the other end a better and smarter lifter, and have kept my weight at 188-190 and BS sensitivity has returned.
It seemed there was a sweet spot with macro/calorie intake for the volume/time I am able to expend. No doubt if I had more time to train, it would be higher, or if less time it would be lower. As of now, I am holding my weight and working on getting stronger and improving my conditioning a bit.

I would like to hear of anyone else’s stories about bulking or cutting and how it has affect insulin intake or BS.


#6

The only thing that comes to mind is that Tim Belknap was a T1D bodybuilder and I remember reading about how he used intermuscular rather than subcutaneous injections so that the muscles absorbed the carbs but the fat was not affected. I don’t know if it is safe. I don’t know if it is healthy/


#7

I have actually had a bit of experience with intramuscular injections. My first run in was when I had my wife give me a pre meal bolus in my arm. It hurt more than normal, and at the time did not realize it, but she had stuck it too deep and into the tricep instead of the fat. My BS tanked really quickly and I had a pretty bad low. This go me thinking and doing a bit of research, I came across an article about intramuscular injection as a tool by Gary Scheiner (the guy who wrote “Think Like a Pancreas” which is the book that I originally read to educate myself on managing insulin). I wound up emailing him on the subject and his response was (copied and pasted):

“In addition to testing IM (intramuscular) injections myself and having several of
my patients try it out, I’ve asked many prominent diabetologists and none have
reported any bad experiences with IM injections. Perhaps it is not widely used
because of the discomfort and potential for hypoglycemia if not done
"intelligently”.

I think IM injections are a good tool for bringing very high BGs down quickly,
treating ketosis, and offsetting anticipated sudden BG rises that might occur
during competitive sports and acutely stressful situations."

Now, I had spoken to my Endo at the time and my PCP, both of which were very much against the idea of IM injections. the only reasoning they had was that it was potentially dangerous and had not been studied.

As a rule, I do not do IM injections normally, only sometimes to quickly treat a high (like if I am really hungry and my BS is high already I will sometimes IM inject to bring it down faster and take regular subcutaneous injection for the meal). My personal rule is never to IM inject enough to kill me and I pretty much cap it at 2 units.

It would scare me to do it post workout when sensitivity is so high though. Regular injections work fast enough at that time IMO and I would be afraid I wouldn’t digest fast enough to offset the drop.

I am sure it varies, but IM injections seem to work 2x faster than subcutaneous for lowering BS. More so if the muscle is being used I would think (i.e.: injecting into quad and going for a run or something). A very dangerous thing I to play around with.

On that point, I would agree that we do not in fact know how safe or healthy it is and it should, at most, be used very sparingly if at all, and again only while closely monitoring BS levels and by someone who genuinely understands insulin and how it works and their bodies very well. It can definitely kill you.


#8

The thing is that IM injections might not block fat burning, while still being anabolic or anticatabolic to the muscle


#9

I have played around with IM injections. To be honest, I think my major issue is monitoring how much insulin I take in daily and blood sugar readings. I’ve researched IM injections specifically concerning peri workout nutrition. I’ve also brought this topic up in another post and it caused a shitstorm. So that is my next question. If body composition is the main concern here, is having high insulin levels while training GOOD or BAD for FAT LOSS. Currently I ingest whey about 15 min before training, 60 g carbs with bcaas and finish with whey. I’m more interested in how insulin works when it comes to training.


#10

It’s great that this subject is being discussed here!

As Greenchikin mentioned, I did lose a good amount of weight after the diagnosis (whoa, it’s now been a year and 4 days, maybe I should’ve celebrated, haha).
I’ll attach a magnificently crafted progress pic to give an idea

So, my pancreas started working pretty well after the initial diagnosis up to the point that I didn’t need Lantus at all for coniderable periods of time. The greatest change that I made was that I figured out how to eat. Before it was just “enough protein” and usually eating a lot of home made food in the evenings; no portion control etc.

I was anal about my eating for something like 6 months, now I have a good eye for portion sizes, so I don’t count that much anymore. I eat similar meals 9/10 times, so it’s easy to figure out. I didn’t reall have to manipulate insulin “for fatloss”, I just tightened up the diet. But as you can see, I was quite nasty looking when starting the diet so they were some easy “novice gains” in that regard.

Right now I’m having a deload week after 6 weeks of doing “base level” 5/3/1: lot’s of bodyweight stuff and getting to the habit of doing conditioning after every session (3x/week). Deload weeks suck, 'cause they make my sensitivity low, sugars high etc. I’ve needed to start Lantus on non-training day evenings and currently am battling highs from meals that have not previously caused problems. Either it’s the deload week or maybe the honey moon period is starting to fade out, who knows.

I am currenty thinking I’ll start adding in more calories, since I’ve spun my training wheels for quite some time though. I figured that I’ve now been maintaining my weight for around 4 months, and maybe it’s time to give some eating for size and strength a shot now. Though now that I’ve noticed I need a bit more insulin recently, it makes me hesitant… Which takes me to couple of different quoestions:

How do you people deal with the mental side? Sometimes I just look at the fucking pen thinking “this is liquid death”, and is a scary thought. I just read about a study linking insulin to decreased longevity, which makes total sense to me, but at the same time it really makes you question this stuff in a totally different way. Being healthy and eating without a care was something I can’t even anymore remember well, even though it’s just over a year. Thinking that “hey, this fluid sucks all the stuff you shove into your mouth into your body” makes me think about the possible consequences of wanting to get stronger and bigger. Ehh, I’ll hold this topic for now, and wait to see if it sparks conversation.

For Greenchikin and why not others too: could you elaborate on your experiences regarding conditioning/cardio? I’ve persnolly done just intervals for the past months (20 s on/40 s off x10 on the bike) and recently bought a jump rope (mainly for warm ups and active recovery). I believe the intervals help in the same way as shortrest/high volume training in regards to helping with I-sensitivity. I haven’t done structured steady state in a long time, so can’t comment on that.


#11

First, great progress! You have a great physique!!

Now a few thoughts:

This is something that weighs on me as well. If we are talking about “diabetic burnout”, this seems to come in waves to me and was much worse in the beginning after dx. Particularly after periods of really tight control. Nowadays it hardly comes up as the habits have become so engrained. I know exactly what you mean though when you say you can’t remeber what it was like before! I used to frequent the pizza buffet before dx, but now I won’t even touch a slice! The lack of freedom brings me down a bit. It could be ironically argued (and rightly so) that I am much healthier now than before I had diabetes. Nowadays I do not even crave pizza, but it would be nice if the option was even on the table without the consequences!

If we talk about the idea of more insulin = decreased longevity, I have run across this idea before as well. What helps me is to remember a few things. For one, and this sucks, but we have a serious disease and have to supplement with insulin to live, so not having it means a much more immediate death. Thoughts on longevity take a back seat to that. This idea really bugs the crap out of me as I take a great deal of pride (before dx and even more so now) in being healthier and performing better than your average human. Being held back, at no fault of my own, does not sit well with me. Hence the drive to push in the gym and in the kitchen. Having said that, I would bet that study was done on type 2 diabetics who use an HUGE amount of insulin in comparison to us. As Bluecollartr8n once said to me when discussing the subject, he thinks the idea would be to use as much insulin as is necessary to get the job done and no more. I would tend to agree.

In my run in with post dx “bulking” I have come out on the other end thinking leanness and insulin sensitivity are much more important to me than shear size. The nature of what we do almost mandates that we seek size and strength (in addition to other physical qualities), and I will continue to have those things on my radar. I just have to prioritize them differently. When sensitivity started tanking so bad, it scared me TBH.

Also, I think it important to remember when talking about insulin and it’s dangers, that even Normos need it to live and there has been nothing, as far as I know, saying that the artificial stuff we use is dangerous in and of itself. I would wager as trained individuals who eat well that we have to take less than most Normos make for themselves, and if not, certainly it is about the same amount.

I watch The Walking Dead and have always been a zombie fanatic of sorts, so after dx, I got curious as to how long I could live if the shit hit the fan and society fell apart and I ran out of insulin. My old endo didn’t have a clue, but let me borrow a book that detailed the creation of insulin by Banting way back in the 20’s (surprising fact: after I read it and tried to discuss it with her, I find out that she had not, in fact, ever read the thing…). In the early chapters of the book it went in to how diabetes was treated before insulin was created, and the only thing they had that seemed to work at all was a starvation diet. They would test the patient for sugar in their urine and basically reduce calories until the body stopped excreting it. Sometimes it got as low as 4-500 calories a day. This of course was really just prolonging the inevitable and they all died in the end, but some managed to live a surprisingly long time. Maybe because they still made a bit of insulin themselves. Either way, the point is (other than in a zombie apocalypse hoard insulin and find a way to refrigerate it) that we need it to live regardless if taking it will kill us earlier than Normos. I know that that is not a lesson that you need at all, it just always helps me to point it out to myself when feeling burned out. It could always be worse…

This is a good topic for discussion and I wish I had more to say, but I would just echo what you have said. Intervals are my cardio of choice and in my experience also intervals are similar to weights in that they increase IS. SS cardio, while I tend to loathe it is sometimes a necessary evil though. the difficulty I have with it is that it lowers BS, so finding a way to do it to actually burn fat is difficult. I mean, if you hop on the treadmill (or go for a walk) for 20-30 minutes or whatever, you are going to have to take some glucose or something when you start to drop. Adding calories seems counterproductive when trying to burn calories! A possible solution would be to use it post meal ans give less insulin before the meal. There are extra carbs/calories in the system and by being physical, you enhance the ability of the insulin you do have to do it’s job. The net result is less overall insulin is used and there is no need to ingest more glucose when going low during cardio . For example, let’s say you normally take 5 units and 50g of carbs at dinner and go sit on the couch. All is good in a few hours. Now, let’s say you take only 3 units (or even 2) and go for a walk or something. The extra carbs you ate will still be taken care of by the insulin because you are being active and you won’t have to worry about going high. you would have eaten the calories anyway, but didn’t have to add more just for cardio. I hope that makes sense… Another way may be to weight train with less insulin in the system as it can tend to raise BS, and do cardio afterwards to lower it. Less overall insulin is used for this as well and no extra cals neded. This of course requires more time in the gym. You would have to train in a way to raise the BS (more intensity and such), and have the time to do enough cardio to lower it.

IMO intervals are the way to go most of the time. SS cardio has it’s place though and should still be done to some extent. I have found that my BS doesn’t really begin to drop until around 15-20 minutes in, so used as a warmup/cool down or something has little effect. Faster, higher density weight training and supersets are always a good thing too.

I have enjoyed discussing this stuff as there are few I have been able to talk about it with. I hope I do not come across as a Know-it-all though, as there are a great many things I am still figuring out too!


#12

This is a good question as it is something I had to figure out or myself and there is not much info on that I could ever find. When I was first dx, I trained in the AM fasted with no insulin or carbs in my system at all. At that time, I was scared to train with insulin on board as the only thing I ever read was that exercise lowered BS and especially if insulin was in your system. So I went in fasted so keep from dropping dead and experiment. BS went up to 250 or more from the weights alone. So I was like WTF?!? The doc I was seeing at the time had no idea what was going on with that. As I did more research, I finally came across the idea that cortisol was raised during weight training and that it sometimes could raise BS a bit. Well, it seemed a little more than just a bit to me! I assume it was how intensely I trained. When I finally got the nerve to experiment with insulin preworkout, that issue cleared up pretty quickly. No more weight training induced highs. The lesson at the time was insulin was needed in the system. Of course, I ate carbohydrate as well and have never weight trained with insulin and no carbs as I can’t see any good coming from that!

When I switched to evening training, I kept the same regimen and had no problems. However, I have trained a few times with NO preworkout insulin or carbs as an experiment and saw no noticeable rise in BS. Maybe it is because cortisol is lower in the evening. Maybe it is because I was not in a truly fasted state, having had lunch about 4 hours earlier. Maybe I did a session that was not as intense and was more high rep low weight. Maybe a combination of all of those or something else. Either way I almost always train with carbs and insulin in my system. How much of each varies though.

Having blabbed enough about my own experience, I would say that insulin and carbs are good during a weight training session with the intent of keeping performance up and preventing highs, but you must be aware that you are not going to be burning fat at that time anyway. It all depends on the kind of training we are talking about though. If we are talking about a muscle/strength building session, it would work one way. If we are talking a full body circuit session, it would work another. It would depend on your personal level of fitness, strength, bodyfat and so on. I think the overall diet is a much more important factor for fat loss. Calories and macros should be tracked, at the very lest in the beginning to figure out where to start. Keeping carbs lower throughout most of the day and putting them in around the workout is a solid idea.

Might I ask what your stats are to give an idea of where you are coming from?
I would probably swing one way if you are relatively lean already, but weak, and another if you are strong but obese and a multitude of different variations in between.


#13

I’m 5 foot 9 at 200 lbs. I have a belly but I am pretry built. I’ve had diabetes for 15 years. Most of my insulin injections/infusion sets were in my stomach. I’ve been doing mostly I’M injections around my workouts for a few months now. Could my eating be better? Yes. Has all that insulin injections to the stomach a reason? I don’t know. I try to stay away from injecting the stomach region and stick to injecting everywhere else. If pictures would help I can post some. I feel fat but at the same time am not obese and wouldn’t claim myself to be weak. I workout 5 to 6 days a week. Heavy volume high intensity and vise versa. I feel like I’m stuck and just not sure what to change. On a side note I feel no form of over training what so ever


#14

Have you tried tracking your food intake? They have lots of apps that help with it FWIW. In all cases where progress stalls and fat loss is the priority, nothing whatsoever can be done without altering diet. It’s an old saying, but you can not out train a bad diet. No matter how often/heavy/hard/smart anyone trains, without diet alterations, fat loss will not happen past a certain point. IMO training is only relevant to body composition as it tells your body what to do with the food you eat. You eat a slight excess of calories and train for hypertrophy, and you gain muscle. You eat an excess of calories and sit on the couch, you gain fat. You eat a slight deficit and give the body a reason to keep muscle, you burn fat. You eat a slight deficit and go sleep on the couch, your body would prefer to eat up the energy costly muscle. It is an over simplification of course, but is basically how it works. The point being that overall food intake is much more important for fat loss than an other single factor, including training. What is eaten around training is completely irrelevant if burgers and fries and pizza are are dietary staples.

I would be more than happy to offer my input in this area, if you are interested. Could you post what you would normally eat? Eating times, food, etc.
What was your last A1c? How often do you test?
How much insulin do you take normally in a day? Basal? Bolus at meals (insulin:carb ratio?
Can you post your current training? What are a few of your current money lifts?

This sums up the entirety of the dilemma. Eating will have to be better for any favorable change.

As a smart fella once told me, or I read somewhere, it is only when you know where you are that you can figure out how to get to where you are going.


#15

That will have to be my main 2 goals then. Tracking insulin intake and food intake.


#16

I look forward to hearing about your progress!