Licking morning/breakfast glucose sensitivity/insulin resistance: this works for us

NPH is just barely okay, but cinnamonā€¦ :laughing:

I just came back, it was a 10 day-trip after all:-) Here is the summary (basically, what the thread above discusses):

  • we changed his diet to from regular breakfasts, to less-carb breakfasts, to very low carb breakfasts. His final breakfast plan is:
  • 1 omlet consisting of:
    . eggbeaters (1.75 servings, i.e. about 83 grams)
    . 1.5 oz celery
    . 0.75 oz bell pepper
    . 1.5 oz mushrooms
    . spices (important)
    . 5 gr grated cheese
  • 2 links of turkey sausage
  • 4 oz of full fat yogurt with 1 bag of splenda and 0.5 oz blueberries

Total calories are about 450, total carbs are about 11-12.

Depending upon where he is when he wakes up, he may need to dose between 0 and 1 unit of insulin. When he injects, he injects right after waking up, then takes a quick shower, then eats, about 15 minutes after injecting. I believe that, in the picture I showed, he had injected 1/2 unit insulin upon wake-up. The picture is fairly representative of what his morning picture now looks like. He feels really full, he loves his breakfast, and we are thrilled with the control.

We were in Louisiana for a food and music trip the past 10 days, and had a good bit of trouble dosing for restaurant meals there. The quantity of unexpected carbs and fat was significant, and we underdosed regularly, despite overdosing over what we were guessing. We were out of control range on average 3-4 hours per day:( Breakfast we did at home though, and it worked well all the way through:-)

Congrats on figuring out how to select a breakfast that satisfies both your son and the blood glucose meter!

Hi Michel,
Itā€™s good to hear that you guys have developed a good breakfast plan that works for you. Itā€™s wonderful to start the day without the struggle of bad BG chasing you throughout the morning!

I know that diet requirements are unique to every individual. But since Kaelan is very involved in sports, keep in mind that different types of sports will make use of the different fuel sources. Fat is the most concentrated source of energy we have (over twice as much potential energy as carbohydrate or protein). It is an almost unlimited source of energy for low aerobic activities. But fat metabolism always requires a small background of carb metabolism.

When he does more anaerobic activities, make sure his diet supplies him with the necessary carbs. Carbs are more efficient than fat because it requires less oxygen. Carbs are vital during high-intensity exercise when the body cannot process enough oxygen to meet its needs.

Just wanted to bring this up, since you mentioned Kaelan is very involved in sports.

Lots of good references for sports nutrition. I liked the first one. The second book, one of the authors is a CDE. But none of these are diabetes specific. For diabetes specific exercise books, many people reference Diabetic Athleteā€™s Handbook, by Sheri Colberg, but I strongly disagree with some of her pre-exercise BG recommendations.

Nancy Clarkā€™s Sports Nutrition Guidebook
by Nancy Clark

The Nutrient Timing for Peak Performance
by Heidi Skolnik & Andrea Chernus

Advanced Sports Nutrition
by Dan Benardot

Oh, and welcome back from vacation!

1 Like

Eric, thanks so much for the message. We are still struggling with sports nutrition for him. He does not have significant sport sessions on mornings, which is why we are OK with low carb breakfasts. All his long practices (particularly fairly grueling 2 hour swimming sessions) are in the late afternoon after school. We try to top him off with carbs 3 hours prior but it is rarely possible during the school week. We also try to start the practices and competitions right around 150 BG, then replenish non-stop (for him, it means about 15 carbs every 20 minutes for intense effort such as non-stop swimming).

I have the Colberg book, but I was a bit disappointed by it: it did not help me as much as I hoped. Iā€™ll buy the other three. I wish there was better info around on diabeticsā€™ sports nutrition! I was inspired and also totally impressed by both your sports regimen and your understanding of your own physiology in how you manage your BGs while running. This is quite amazing to me - and it was to my son, who loved your end-of-marathon picture.

Thanks again for all the advice!

One of the things I have learned which was helpful, is that the sooner you take in carbs after you finish exercise, the quicker it can replenish your muscle glycogen. The longer you wait, the longer it takes for muscle glycogen to be replenished. It can take 24 hours if you do it right away. But if you wait, it can take several days! If he is participating in practice every day, it is helpful that he have that restored quickly.

Post-exercise, athletes take in protein and carbs (the protein is to fuel muscle growth, the carbs are to restore the muscle glycogen). So where I kind of go against the normal diabetic teaching, is that after exercise I immediately take insulin in addition to the carbs and protein. I have to take insulin to make sure all the carbs get pushed through to restore the glycogen.

Not many endos or diabetes educators will advise a diabetic to take insulin immediately after a long period of exercise! But the point I want to emphasize is that post-exercise, if he has high BG, any carbs he takes in will not be restoring him as effectively for the next day as it otherwise would.

Thatā€™s a tough thing to balance. You want to be careful, but you also want to make sure the carbs can do their job soon after he finishes his exercise. It just means a lot of testing, and watching for double arrows on the Dexcom!

1 Like

This is really interesting to me. So far, he typically ends up his practices fairly low, and right afterwards he takes full fat milk to bring himself up (since full fat milk appears to be the best way to restore after exercise per available research). Because he typically goes lower after exercise, I have not considered using insulin. Weā€™ll try increasing his milk and adding insulin, and see how it goes. Iā€™ll let you know!

If heā€™s low, than you donā€™t need too much (or any) insulin. The low will take care of the carbs for you! I take insulin because I consume a big amount of very simple sugars immediately. I donā€™t take in complex carbs post-workout because I want them very quickly. So I consume quick carbs, like chocolate milk!

I know milk is a great drink for after workouts, because it has essential amino acids, and good forms of protein, such as casein. But I am surprised about the high fat, since that would seem to slow the rapid carb absorption that you would want.

What is the reason youā€™ve heard about for the full fat? Is that specifically for diabetics to prevent a rapid BG high?

Yes, this is specifically for diabetics. There was a specific study done about the best way to replenish after exercise (maybe more than one study, really - I just read about that one) for diabetics. They tested different food combinations and found that the cleanest way, with the least risk to go either high or low, was whole milk. So we piggybacked on the findings. I am not quite sure where I read about it, but it may have been in the Colberg book. If you want the source, let me know: I will try to find out where I read about it.

We have not done a huge amount of experimenting ourselves on post-exercise food. First we tried straight carbs: raisins, dried pineapple and dried mango, because of the different glycemic index between them. There was no difference at all for us. Then we tried the whole milk as per the study. It worked as well, to our eyes. So we have been sticking to the whole milk, since my son also needs to get plenty of calcium (he is growing like crazy, about 7" in a year) and we felt the backing of the study was a good thing.

In retrospect, of course, trying straight carb without protein for a post-exercise snack was not well thought out:-)

What I do with the whole milk is that I fill a thermos before taking him to practice, and leave it in the car during practice. When he is done, on the way home he tests, then drinks the milk right away.

Ok, I understand why they are recommending the high fat milk. They donā€™t want the BG spike, and the fat helps slow down the carb absorption.

But my thinking has been that I didnā€™t want slow carbs, I want fast carbs so I can more efficiently restore muscle glycogen.

I mix milk, whey protein, and chocolate milk powder mix (like Ovaltine or Nesquik, which is basically just pure sugar!). Something like that would usually spike me very high, so I counter that with a fairly big dose of insulin. The larger-than-needed insulin dose prevents the spike, but I also have to keep a close eye on it, and then take in more simple carbs an hour later.

So there is a bit of a risk in the trade-off. I donā€™t mind the risk of a low BG later on, because itā€™s just an opportunity to eat or drink more! But of course, with a child you want to be more careful.

What I am doing is possibly not ideal for your situation. I have been trying to follow non-diabetic recommendations, because I didnā€™t want the diabetic ā€œsafetyā€ advice to get in the way of the ā€œperformanceā€ advice.

Since you are kind of just starting out, go slow and careful. Make small adjustments over time. A good healthy meal a few hours after practice will also replenish the glycogen, it will just take a bit longer.

EDIT:
A lot of the stuff we are talking about here, including the high fat milk after workouts that you referenced, is in the Colberg book. I just found it in chapter 4. In that chapter, she also references the optimal time to restore muscle glycogen is immediately after a workout, and the 24-48 hour time it takes to restore. Thatā€™s a good chapter to review.

Restore BG or muscle glycogen? Bodybuilders tend to rely on milk post-lifting for protein and carbs, but not sure how that works for Type 1. Iā€™ve just started a lifting routine myself, so want to make sure I know what the research says! What I can say is this, so far:

Lifting as a newly diabetic and suddenly-old guy is a lot harder than I remember it being from my 20s.

The study was discussing how to replenish glycogen for diabetics after exercise with the least effect on BG:-) It is quoted in the Colberg book.

Mazel Tov! Please post what you find out. I am sure that lifitng will have different requriements and results. My son is too young to lift yet, so we have no experience at all.

This is my first venture into lifting since getting diagnosed. Iā€™ve been a competitive athlete (or at least amateur competitor :slight_smile: ) most of my life, but I havenā€™t lifted since starting Grad School six years ago. Iā€™ve been doing gymnastics-based routines (rings, bodyweight exercises, planks/Yoga, etc.) since May of this year. And although Iā€™ve made quite a bit of progress (gotten nice and flexible again, gotten stronger), Iā€™ve decided itā€™s time to try to add some muscle mass before Iā€™m too old to do it anymore! So itā€™s back to the gymā€¦

Anyhow, Iā€™m entirely out of my element now, and it turns out diabetes and a couple of injuries have made me weak in a serious way. Iā€™m roughly half as strong as I was ten years ago, but at the same weight and body fat %. So while I havenā€™t lost muscle mass, Iā€™ve certainly lost strengthā€¦ Anyways, Iā€™ll give the milk a shot, although Iā€™m worried (of course) about the sugars.

My son keeps on going lower post exercise. This may or may not happen to you. But we dose for the milk (or partially dose) when we feel his post-exercise low wonā€™t do the job. Itā€™s the rare day when we donā€™t have to dose some, typically if he ended up running a bit low at the very end of practice.

FYI, @Eric2 uses skim milk or other carbs, see above in thread - for aerobic that is, same as us.

Once you have set up a regimen, weā€™d love to read about it!

I do tend to go low post-exercise, although Iā€™ll start keeping closer track of how low exactly.

Iā€™ll keep you updated! Kind of excited on the new routine :slight_smile:

I always try to carb up immediately after workouts, because the time to efficiently replace muscle glycogen is right after a workout, rather than waiting for hours. Since I am taking in carbs, I also take insulin.

But it depends on what type of exercise you are doing, and if you are type 1 or type 2. For David49, since he is doing strength work, I am not sure what the formula is. I am pretty sure protein is standard post-workout for any exercise, but I donā€™t know if weight lifters hit carbs the way I do.

I think post-workout is more challenging if you donā€™t have access to insulin, and have to worry about the carbs, or post-workout BG spikes. That seems tough!

Well, I have a pattern that is only slightly different from doing endurance training (which I also do a lot of and have figured out the BG management issues). In the sense that I go low post-workout. The difference between strength and endurance for me is a matter of pattern and timing: I go high from strength training initially, and then drop into a persistent low afterwards (probably due to glycogen depletion); in endurance I drop hard after 40-45 minutes and have to eat a ton of carbs to reach and maintain a level BG, but this only lasts for the duration of exercise and then about an hour afterwards.

The kind of strength training I do is efficient at glycogen depletion second only to sprinting, rowing, and competitive short distance swimming. Deadlifts, barbell squats, pull ups, press, bench press, power clean, etc. A basic power lifting kind of workout, which is extraordinarily efficient at draining glycogen reserves from muscles. So, Iā€™m going to have to spend some time figuring out how much carb intake I can have in order to replenish that muscle glycogen without spiking (since I donā€™t take insulin). Yesterday I had about 18g sugars (from whole milk and pecans) an hour after working out and plenty of fat and protein. My BG actually dropped about 30 mg/dL over the next two hours, so I suspect that means I can take in more carbs immediately post workout.

Itā€™ll be an interesting experiment :slight_smile: I figured out over the summer that 32g of dextrose/starch (Clif gels) at 0:45 and 1:45 into an intense cycling session was perfect for maintaining a steady BG. Iā€™ll slowly ramp up my post-lifting carb intake and see what my pancreas and muscles can handle between the two of them! This kind of thing appeals to my scientific side. My wife will get super-annoyed at me creating more spreadsheets to track calories in, macros, exercises completed, time ofā€¦

2 Likes

While I would never wish diabetes on anyone, it seems well-suited to the engineering-technical mindset. I do feel badly for those with diabetes who struggle with numeracy.

4 Likes

I agree, @Terry4, but then again people like the father on the podcast Ardenā€™s Day seem to have great success without calculating much of anything; so I feel confident that there are ways for people with all ranges of abilities to find a regime that works pretty well for them.

Like good jazz musicians, I think you have to know all the rules (ratios, insulin sensitivity factors) before you can break them and improvise with diabetes. Scott Benner of Ardenā€™s Day is a good example. Heā€™s been closely treating his daughterā€™s diabetes for many years and Iā€™m sure he learned about all the rules before he decided to add his layer of art to his technical understanding. Scott Bennner is a pro treating his daughterā€™s diabetes. And like most pros, they can make the difficult look easy.

This also forms the foundation of Stephen Ponderā€™s Sugar Surfing. I really think that with insulin dosing, you need to know all the rules before you can artfully break them.

1 Like