Pump to injections / Keto diet & CrossFit

Type 1 and LADA
#1

Hi all,

This is my first post on tudiabetes!

I wanted to get some feedback on a few different topics, hence my 'jam packed' subject heading LOL.

Alright, so I have been using an insulin pump up until about 1 month ago. I was on the pump for 18 months and had great control with my diabetes. Latest HBA1C was 6.5. I decided to stop using the pump for a couple of reasons - I was sick of wearing it all the time and having to think about what clothes I could buy that would accompany my pump AND I recently started trialling a high fat, high protein & low carb diet, so essentially ketogenic and was only blousing 1 or 2 times a day with the pump. I also train very hard, do lots of weight lifting and high intensity training (CrossFit).

Since transitioning back to the injections (Lantus and Novorapid), I have thoroughly enjoyed not wearing my pump and feel like a whole new person. However, I am finding it hard to get my basal levels spot on. And I find that if I am not following the ketogenic diet strictly, and decide to cheat a little of have something naughty, then it stuffs all my levels up for the rest of the day.

Wonder if anyone else has had this problem? Has anyone out there experimented with a keto diet? Has anyone transitioned off of the pump?

Hope to hear from someone soon :)

Thanks for caring,

Krystie

#2

I haven't done a specific keto diet but just watch my macronutrient levels, maybe 120G of carbs or so/ day and aiming for a 50 pro/ 30 carb/ 20 fat split as that seems to make it easy to drop some pounds while feeling strong. I just finished a round of P90X3 and am back to running now. Unfortunately for your question, I have a pump and CGM and like using them both a lot. When I do longer distance running, 14+ miles, etc. I like to have a big meal 2 days before, then clean things out the day before. I've only done Levemir for about 3 days and that was after a long run (it rained, trashing Medtronic pump...) so I just took the next couple of days off.

What might work to cover paleo deviance (not that there' anything "wrong" with it but, if you are paleo and go "off paleo", we have to call it something? I like deviance better than cheating. If you have diabetes, you have to be devious...), would be to adjust your carb ratio down a whiff for a carbier and/ or more processed diet. This would put more insulin to match up with the food but for the timeframe involved, rather than more basal which would mess you up for a longer period of time, at least that was my experience when I used to do that stuff with NPH all the time. With a pump, I will boost my basal to 200% while eating the garbage and leave it up there until I hit the "crossover point" (cf. Robert J. McNamara...) and the BG starts going down. A lot of times, this seems to help head off the low but I sometimes then will kill the basal down below 100%, 50%, 33% some situational adjustment on the back end to make the landing smoother. I am not sure that you can plan that enough to do with Lantus as the extra basal would be around longer and there's no way to back off for a landing.

I eat pretty cleanly but will end up hitting some garbage every once in a while. My daughter likes going to the dinner movie theater, where you have to buy something. The last time I went, I figured "well, a shrimp cocktail has some fat but is pretty clean..." to which the waitress replied "We don't have that any more..." so I spur of the momented a fish and chips and it was so freaking salty I about croaked!!

Great profile pic, BTW!! I love PWD throwing metal around!!

#3

Thanks for the reply and info into your training, it's great to hear about what others do to manage! You have a pump and a CGM - woah I don't even want to imagine how much that costs!!!!! haha

#4

Yup, they don't grow on trees. I'm perhaps not a normal example since I went from R/NPH to pumping Novolog in 2008 but it was like night and day. It made things fall into place for me very quickly. I skipped one day of Tae Kwon Do to make sure it was running smoothly and went to class and the instructor said "wow, you look better..." because my BG was just smooth, I wasn't having snacks to get my BG up or any of that stuff.

We are doing ok $$$wise, quite a bit better now than 2008, but I would sacrifice if I needed to because I think that being able to run my BG flat occasionally always inspires me to work for that, instead of the upsy-downsies stemming from what doctors generally recommend.

It is also extremely helpful to have a "gas pedal" to turn it up and down during events. The line on my page, which I'll toss out here for conversational purposes is from the 2012 Chicago Marathon. I had a spike, which the CGM caught, I probably double checked with a meter at some point too, maybe not, I have notes in the "diabetics who run marathons" group, but the little black hashes at the bottom are the correction boluses that I nudged it back into shape so I could get back on track with fueling for the race by mile 17 or so. It was an adventure but I had a an enjoyable experience!!


#5

That hasn't been my experience. I took *a lot* of shots, nudging it here and there, to stay on top of my BG then. In fact, I noticed immediately with the pump that I had more free time because I wasn't doing as much to control my BG, I was able to sit back and enjoy other activities more because I *didn't* have to wonder what my BG was and be fixing it all the time. I have had very good experiences with it. My A1C was 5.8 for a couple of years of straight pumping but has been in the low 5s since I got a CGM in 2010, 5.1 most recently. Without really low carbing, I eat around 120/ day these days.

#6

I've had T1 for 39 years; I've never pumped or used a CGM. I've never tried anything as organized as CrossFit, but I know CrossFit uses erg pieces, and I have a concept2 that I row 5K on three times a week to stay fit (I rowed crew in college). I put in a concerted effort several years ago to improve my control and have kept my A1c in the low 6's for the last few years; my most recent A1c was 5.8 and I hope to keep it there or improve on it.

My advice with tuning basal injections is:

1. Try two shots a day of basal (Lantus) if you aren't already. I found Lantus didn't last a full 24 hours for me (it was more like 20 hours).

2. Consider trying Levemir instead of Lantus; although I used Lantus for many years, I believe Levemir is more predictable. It doesn't last nearly as long as Lantus (a T1 could never use only one injection a day of Levemir), but I don't see the swings in basal that I used to think I saw with Lantus.

3. Try different timing for the two daily shots. I used to take Lantus 12 hours apart; I found it works much better when I take Levemir when I wake up (around 8am) and my other shot at 10pm (I set my cell phone alarm to ring every night). If I don't take the second shot later at night (or if I oversleep by a few hours) I usually see my BG start to rise in the morning.

4. Also consider different amounts in your two daily basal injections. I've found equal shots works for me, but I've experimented with unequal shots and wouldn't hesitate to do it if I found it worked better.

I don't follow anything like a keto diet; I think fruits and vegetables and whole grains taste good and are good for me so I eat them all every day.

#7

I have thought about trying the 2 Basal shots but was not certina how far apart I should take it from when I take my humalog. Parden the ignorance I am quite new at this diabetes thing.

#8

You're a new LADA, so I would recommend you check with your doctor. As a very recent onset probably using little insulin, your doctor may have some reason to suggest one basal injection a day at least to start with.

That said, the typical approach for splitting basal is to start with two injections a day about 12 hours apart, where each injection is half the amount currently being taken as one injection. Timing is typically when you wake up in the morning, and 12 hours later (or closer to bedtime if you find your BG rising overnight shortly before waking). Timing of bolus shots doesn't impact when basal shots are taken (and don't mix them in the same syringe!). And as noted above, it is possible to tune the basal injection timing and relative amounts to make it work better for you.