Optimizing Diet and Exercise as Tools for Managing T1D: Thoughts from an Entrepreneurial Certified Diabetes Educator

Colette finished her Master’s degree in Clinical Nutrition to become a Registered Dietician and a Certified Diabetes Educator. She is also a board-certified Sports Dietician, inspired by her former career in professional bodybuilding.

I have been living with Type 1 diabetes since 1984, signifying 35 years with the disease. I have watched some of my dreams come true including the Dexcom G6, a better basal insulin (Tresiba) and a noninvasive way to take insulin, Afrezza.  I understand the physiologic benefit to being on an insulin pump, especially those that DIY close loop their pumps and have basal modulation to help keep blood sugars in range, even if you don’t quite get the carb counting correct.

My issue with wearing all these devices comes with being a professional athlete.  Although I don’t compete anymore, I still try to live my life around a bodybuilding lifestyle, which means going to the gym five to six times per week.  I never liked being attached to a pump and having to find that perfect spot to put your infusion site.  I wear a weight belt when I train, which rules out my entire midsection, leaving only my right and left glute and outer thighs.  That didn’t work too well for me and I developed severe lipohypertrophy. Now, Afrezza and Tresiba offer me more freedom with much less worry around low blood sugar due to its fast in / fast out absorption.

While waiting for advances in T1D management, I have found that the best advice is to minimize the amount of insulin you need to inject before each meal and maximize your insulin sensitivity so that you don’t require that much basal insulin.  It is also crucial to keep in mind that the more carbs you eat, the more basal insulin you will need.  Insulin is NOT predictable, especially the injected, rapid-acting insulins.  In order to perfectly time them, you really need to inject 20-30 minutes before you eat in order to match up the peak of the food with the peak of the insulin.  To manage this difficulty more effectively, try to have your blood sugar < 100 mg/dl before eating.  That way, you have less insulin resistance.  It is also important to differentiate between the two sources of glucose when a person with diabetes eats – liver glucose and food glucose.  The best approach is NOT a keto diet because it is too difficult to sustain long term and, quite frankly, who wants to eat all that fat!  A true keto diet is comprised of 70% fat. We need more antioxidants and micronutrients than what can fit in the remaining 30%.  My T1D management diet philosophy includes high protein, moderate healthy fats and high fiber carbs such as legumes, vegetables, bean pastas, low carb wraps, spaghetti squash/acorn squash/butternut squash, and artichokes. Keeping the fiber high offsets how quickly carbohydrates turn to sugar, thereby giving insulin time to work and suppress the liver from producing glucose. It also allows for more variety in one’s diet and the one thing that the ketogenic diet lacks: fiber.  I have been following this diet throughout my competition years and continue to do so now.  This is not a fad diet, but instead a way of life and approaching food choices.  Understanding the unpredictability of insulin, we can infer that the more we need to take it, the more unpredictable it becomes. Optimizing diet as a tool is simple: eat the foods that require less insulin to ensure greater predictability and better blood sugar control.

Exercise is also another key component to my success. Similar to making dietary changes, this also was not without struggle.  Given that I love to weight train, high volume, high intensity weight training sessions involving my legs and back would often raise my blood sugar > 100 mg/dl.  I would have to take insulin on an empty stomach before my workout in order to keep in normal range. Interestingly, it is typically the stroll in the park when your blood sugar drops because it is non-stressful and does not promote the secretion of adrenaline and cortisol.  Don’t be surprised if you need insulin to workout, as it was common practice for myself for quite some time.

My last suggestion is to not be afraid of the lows.  My patients would rather be low than high. Although all too often our doctors want us to stay high where there are less short-term consequences, I stand by this statement. If you are wearing a CGM and more aware of your trends and predictability, incidences doctors worry about like insulin shock and passing out should not be happening.  If you ate something and think you might have taken too much insulin, be prepared with 1-2 glucose tabs.  You often don’t need that much when taking smaller amounts of insulin at each meal, especially if also following a low carb lifestyle. Even if you took one extra unit, we aren’t talking about a severe low.  It is also always important to choose a straight glucose source rather than food. If you take a glucose tab, it won’t cause that same reaction as food, resulting in more predictable rebound sugar and less weight gain.

The reality is we can’t just stop taking our insulin, but we can help it work better and be more user-friendly. Minimalizing the amount of insulin you take is one step towards better management.

To summarize, Type 1 diabetes is an autoimmune disorder, meaning there is no cure at this point in time. However, through efficient application of dietary practices and the implementation of a fitness routine, you can create a maintainable lifestyle that will ultimately make your diabetes more manageable.