For those who've been able to eat low carb for YEARS

Type 1 & LADA
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Hi Eric,

Minimal carbs for “breakfast” (2 coffees, each with heavy cream and about total 6 Splendas. Ground beef with some cheese on top (o carbs). Then, right before the bike ride, 1/2 a banana (12g carbs).

The 8K ride was medium to intense. I was still a little sore from the last ride, as I’m just getting back into biking with the better weather. I do strength training + 20 mins of cardio at the gym 3x per week. Other days I do indoor rock climbing, hiking, mountain biking or kayaking. I rarely do nothing, but if no specific activity, I’ll at least go for a long walk.

Intent: I deal with depression and anxiety, but no longer take meds for either. Keeping busy and exerting myself helps. I also enjoy doing these things, and I would like to lose a bit, strictly for vanity, as I like the way I look at 125lbs, but I don’t need to (I am 5’7” and 135lbs).

I always ride medium to intense. I don’t enjoy slow leisurely rides.

I like to exercise right after work, before dinner on weekdays, and morning/day on weekends.

I was diagnosed 11 years ago and I still haven’t got things figured out. That said, I was diagnosed with depression and anxiety about 6 years in, and everything went to ■■■■ until about 2 years ago when I started taking care of myself again.

I’ve experimented with the exercise mode, but still went low and had to eat glucose and suspend or a long time. With my Omnipod I just suspended totally. On MDI, when things were working, I had it dialed in 1 glucose tab per 20 mins of jogging, but there were a few years I did nothing active or much at all and then I went on the pump and haven’t got back to where I was yet.

Interesting commentary re fats and carbs as fuel for energy. Not totally wrapping my head around it, but not sure I can pull of keto anyways, so the fat as fuel method may not much matter.

To add to last night, I ended up with a really bad low about 2-2.5HRS post ride, and wished I hadn’t bloused the 2 units for the 25 carbs. I ate whatever I could find in my house with carbs and skyrocketed. By morning I was 4.5. I had coffee with heavy cream and gagged down more ground beef for lunch. Then we had a scary situation at work, and ended up in a lockdown which the police just deemed safe to end, and I notice I am 14, which IDK if that was the protein in the beef or the stress response.

During the nights, consistently, my Tandem is suspending entirely at times so I think my basal may be too high.

Thanks for taking the time to respond and help!

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You have no idea what can of help you have opened. I am chuckling to myself a little. @Eric is one of the most helpful loyal friends you can have. If you are open to it you will probably be an Olympic class rider, with perfect blood sugar, when he is done with you. Enjoy the ride!

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Being active is a great way of dealing with it. Let’s help you do it even better.

The information on all of that was just to give a little background on how our body fuels activity. A simpler way of saying it is that our body uses various sources to fuel an activity, and it uses those sources in different proportions depending on how intense the activity is.

Just like how a leisurely walk does not affect your heart rate in the same way as an intense ride, your body is not going to fuel those the same way.

I wanted to emphasize that if you are going low-carb, your body does not have all of the resources it needs for the more intense activity.

That’s really the simplified version of all of that stuff I wrote in my previous post.

When your body goes from rest to activity it needs to quickly mobilize an energy source. The easiest and fastest fuel source it has is the glucose in your blood.

Not counting what you have recently eaten, when your BG is 5.5, you only have about 4 grams of glucose in your blood. That’s almost nothing!

(Imagine starting an 8k ride with only 4 grams of sugar in your pack and nothing more! Not enough, right?!?)

And your body can’t even use all of the glucose in your blood, because then your BG would be zero.

For the non-D, their body releases stored glucose from their liver whenever their BG drops too low.

Your body will use stored glucose from your liver too, but it does not release it as a response to low BG, it will only use it as a response to your muscles needing fuel.

So when you are starting off exercise, the easiest thing for your body is to grab glucose from your blood. That is troubling if you don’t have a supply ready to give it.

Are you with me so far?

Every single pump that has an “exercise mode” that targets a higher BG. I don’t particularly like a pump’s version of exercise mode.

Does a non-D’s body raise their BG before or during exercise? Of course not! And why should you? Instead of trying to target higher BG, instead let’s do it like the non-D’s body would do it.

We will get to that, just wanted to give a little overview first.

You absolutely :arrow_up: should not be doing low carb for that.

You can do some activity on low carb and do it well. You can do occasional activity. You can do low intensity activity. You can walk all day on low carb. You can walk all day every day on low carb. Not a problem.

But not for what you are describing.

You have a certain amount of glucose stored in your body. When you do intense stuff every day, you eventually run that tank down to empty, and that’s when you get into trouble.

Before we get into any suggestions for you, let me stop and see if you have any questions for me first.

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heard_so_much_about

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Yes, I am with you so far.

I like the idea of not making myself higher just to do an activity. Eagerly awaiting this advice…

What about no breakfast, low carb lunch and carbs after exercise, at a (late) dinner time? I think that could work lifestyle wise for me, but IDK how activity fits in here…

I like opening cans of worms :nerd_face:

~ J

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Ripped out the 3rd site THIS WEEK. Very frustrated. How the heck do people keep these things on??!! Defeated, I finally accepted that I have to wear a Spi belt or similar. Then today, I did a fresh site change, and just somehow caught my thumb around the tubing. I swear the tugging on the tubing from my thumb was not even that intense and the site just ripped off almost like it wasn’t stuck on at all (it was). I have wasted SO MUCH insulin and supplies this week. I feel badly about that.

EDIT: OOPS I posted this in the wrong convo…oh well. I’ve been seeking so much help getting this Tandem up and running, can’t even remember my own convo threads…

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I think I missed something. How was the insulin wasted? Not from ripping out a site, right? If you rip out a site, just disconnect it from the tube, insert a new site (throw away its tube), and reconnect to the new site. No insulin waste there except for the tiny “fill cannula” amount.

If you continue to have trouble ripping sites out, one trick is to make a loop in the tubing near the site, and tape it down well with a good tape like hypafix. Then a sharp pull on the tube will be caught by the tape rather than by the infusion set. A minor disadvantage of this trick is that you have to remove the tape whenever you need to disconnect the pump from the infusion set.

I keep my t:slim in a medtronic holster that fits their old MM723 pump. The holster has a good clip that can hang on to any kind of belt or hemmed seam. The pump is just a friction fit into the holster, but even a good tug on the tube won’t pull the pump out of the holster. I haven’t tried it on a trampoline, but normal active motion doesn’t give me trouble. A Spibelt is clearly safer, but there may be less extreme options that are better than the original t:slim holder.

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I didn’t know I could do that, but I can totally see the logic!!! I don’t know whether I feel better or worse now (not serious, I feel better, as I’ll now never waste again).

Thanks for the looping of the tube/taping suggestion–I’ll give that a go. I see a lot of images on Instagram of people who have what looks like a 2nd site, but the tube just threads through it or something? I imagine it’s for a similar tactic.

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The right-angle infusion sets with steel needles (instead of plastic cannulas) tend to have a second adhesive patch. If I remember, the tube disconnects at that second spot, maybe because you probably (ouch ouch) don’t want to be pressing on the steel needle.

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This could work as long as you have it in mind that the time your body really needs the glucose is during activity. So if you don’t eat a meal before the activity, you need to at least be prepared to feed the activity somewhat.

Feeding during bike riding or running is easy. I think you can also feed the activity for almost anything else too. Like if you are rock-climbing, you just need to get to a spot where you can take a break and open up a gel pack or some carb source and eat it.

I think the only exception is swimming. Feeding while swimming is a challenge.

  • Do you have a water bottle attached to your bike?

  • How are you checking your BG during exercise? Do you test it with a meter, or use a CGM?

  • When you do your strength training and cardio on the same days, which do you do first?

I gotta add the units I am familiar with so I can translate it in my mind…

Going off your post above, you started around 7.5 (135 in my units :grinning:), ate 12g and after 4k (2.5 miles :grinning:) you had dropped to 5.4 (97).

That is not horrible at all. But then you spiked up to 10.2 (183), without any decrease in basal.

What happened there is that your body had an initial drop because you were transitioning from rest to activity, so it immediately pulled the glucose from your blood. (As I described earlier).

But then as you continued at a moderate to intense level, your body released glucose from your liver to fuel the activity.

What your liver released combined with the power bar you ate caused you to go to 10.2 (183).

Can you try a repeat of that activity and intensity?

Do almost the same thing all around, except for 2 differences…

If your BG is in that same range, take in about 15 grams about 10-15 minutes before you start. But…

  1. Turn your basal off completely right before you start
  2. Don’t take that power bar mid-ride

Let’s see if you level out if you keep the same intensity level.

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I love swimming, but it was a challenge even with the pod. I’ll still do it, but probably not weekly.

  • Yes, I usually have water on my bike, and a juice in my backpack.
  • I wear an Apple iWatch which shows my Dexcom data.
  • Gym routine: 5 mins cardio, stretch/foam roll, strength training (45-1HR), 20 mins cardio, stretch/foam roll.

I AM LOOKING FORWARD TO THE EXPERIMENT! I will have to do this next week for similar results, so I’ll aim for Monday evening (it’s rainy tonight, and the wknd’s are totally different than the week days).

Thank you!!!

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Not to do with the above experiment, but today as another example, I woke up at 4.9, had a coffee, did some chores before work. Decided to do my gym routine at home (not my usual routine), as I am working from home today, and decided to just get’r done. I was 7.8 when I started (I usually see my sugars lower than I like when I wake, then creep up after I get out of bed, but not enough to correct). WORKOUT: 5 mins elliptical, foam roll/stretch, strength train 45 mins, 20 mins elliptical, stretch/foam roll. I had lunch at 130pm (didn’t count it, but it was about 2 cups lettuce with ceaser dressing, cheese and cheese croutons (ie croutons made of cheese). I knew it would be max 5g carbs so I didn’t bolus. I think my sugars were around the 5 or 6 range. Now it’s 253pm and I’m low! 3.9 so not too low, but still weird. Control IQ is working, I can see that.

Only thing I can think is that when I ripped my site out earlier, I also did a dexcom change, so for that 2HR warm up I wasn’t getting Control IQ. Maybe I was dropping from the exercise and but as it was still giving me full basal I’m getting the low now?? IDK…

Anyhow, just documenting the experience, as it may be helpful. This would be similar to a weekend day, as I’m often getting the exercise outta the way earlier or doing something outdoors earlier like a hike.

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Regarding my earlier statements, I didn’t realize you were that active.
I wouldn’t eat low carb with your routine!
I know on weekends that I will be active, I eat more, and either don’t bolus, or give a very small one. I often find myself trying to remember to EAT during the day to keep my BG up where it needs to be.

Btw, I think you might need to rethink your basals. Spend some time getting them more fine tuned.
As for the eating/active lifestyle, I will leave that to Eric!
My only comment, if you are planning on fats for your glucose energy, remember you have to eat these well in advance. 2 hours for me does it. They last longer than carbs, but are harder to compensate for if that is the bulk of how you are getting your glucose. This advice is for a low carb diet though. I think you should follow Eric’s advice though. He will get your ready for a triathlon if you want!

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I don’t really think my routine is uber-active. Like 1-1.5 HRS of activity time on gym days, and on days of kayaking/rock-climbing/bike days it’s like 1.5-2HRS activity time. Hiking days is a lot more, like 3HRS+, but keep in mind I have a desk job so I think it is more balanced than it sounds.

I think you’re right about basal rate. I have one across the board, at 1 unit per hour. The trainer plans to switch that up, but that’s what I’m starting with. BUT, it shows on the reports as like 16 of basal and the rest bolus or something, even though what we put in the settings is 1 unit per hour. If that makes sense.

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The basal setting is just a baseline. If you use T:Connect app on phone, you can see the adjusted rate set by CIQ.
The web T:Connect will show trends and rates. Do you use that, or has your doctor reviewed them with you for patterns/adjustments??

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Exercise nutrition advice request: (haven’t competed internationally but have been beaten by some of the top athletes occasionally)

Theoretically, if one was racing 55 minute races over the course of a weekend with 20 minute breaks in between…4 on Saturday and 3 on Sunday…what type of carb loading would an expert recommend.
Upwind, like 2:30 to 4:15…the goal is to flatten the boat by hanging over the side as much as possible (a lot of lactic acid like riding a bike uphill) and use the body to get it through the waves as well as possible, whereas downwind (4:15 to 7:00) it’s necessary to stand up and move around to get it to surf.

In general I make sure to bring plenty of carbs and protein out there and have found Perfect or Cliff Bars helpful…alongside an endless supply of short-term carbs just in case.

Is breakfast carb-loading good? Pre-race carb loading?

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Eating only a reasonable amount of carbs for breakfast would be best. There is a limit to how many carbs you can store. The “tank” only holds a certain amount.

The big meal should be 2 nights before the race. If your glycogen stores are completely topped off the days before the race, the pre-race breakfast can be smallish, like 50 grams of complex carbs.

Since you have breaks, that’s a good time to do BG checks and take in carbs and hydration. If you have the ability to bolus a little before your race is over (not sure if that is possible with the conditions), that would also be helpful, since your breaks are kinda short.

The main thing is to take in complex carbs so they stay with you a little bit longer. As you said, having some quick carbs just in case, but mostly taking in the slower carbs will sustain you longer.

And since the races are about 1 hour, that gives you a time-frame to shoot for. You don’t need to target having perfect BG for longer than that, just try to get through the 55 minutes and then fix your BG for the next race.

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Thanks a whole ton…Will give this a go

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I know Dr Bernstein is a bad word here. (I still eat peanuts and drink beer so I’m not 100%.) Learning his low carb method changed my life and halved my insulin, eliminated spikes, and almost all hypos. If I do have a hypo it requires maybe a half glucose tab. You cut all that stuff out and eventually don’t crave it anymore. It took me about 3 months to full transition. If I am craving Doritoes - I get a bag of spicy pork rinds. I rarely touch pizza but if I do - I skip the crust or find a cauliflower crust and indulge a bit. You find occasional substitutions. You look at food and eating as something you have to do rather than a form of entertainment. I also make a large hotdish on the stove with protein, veggies, spices and container them for the fridge to live off for a couple days. I’ve been very low carb since my dx in 2018. I haven’t touched a slice of bread, rice, or beyond a spoonful of chili beans for a treat. MDI with NPH and R insulins. Dexcom G6.

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Wow that’s amazing you were able to fully embrace Dr. Bernstein’s methods of eating. I am familiar with his book, I’ve read it a couple times. I’ve tried the method several times, but I always cave and then binge on carbs. I am really hoping I can stick to this for a bit, by allowing carbs at dinner and a keto lunch, but IDK if I’m one of those people who can eat carbs in moderation. I like the idea of not craving carbs, which I suspect I may only ever achieve by going full keto.

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