Type 1, Carnivore & Exercise

I’m a reasonably fresh T1D LADA diagnosis, but have been carnivore (not always strictly but largely strict) for the last 4 years. I wasn’t strict when I was diagnosed and I managed to squeeze a week’s accommodation out of the ICU with my DKA when I was diagnosed. So, I’ve been slowly moving back to pretty strict carnivore since it seems like the most logical thing to me and happy with it so far, except for exercising, because I’m not entirely sure what I should be expecting.

I like to hit my treadmill and walk on the highest incline and zone out with YouTube for an hour or so at a time (high-max heart rate), or lift heavy weights, the treadmill is winning for convenience lately, but my BGL skydives after about 20-30mins and if I don’t slow down to add more carbs or stop I’ll hypo out and the I have to stop. What’s the best strategy for handling this? I think treating with sugar isn’t ideal considering I’m trying to encourage ketones, but that’s all I can think of doing. I do experience a pretty decent BGL rise from the dawn phenomenon, I’m slowly moving to higher fat rather than higher protein to reduce additional gluconeogenesis.

Do I need to adjust my diet differently? Should I be working at a lower heart rate to run off ketones? Should I be looking at different exercise?

I’ve been reading Dr Bernstein’s Diabetes Solution and I’m not entirely sure what the best strategy is.

Looking forward to your sage advice, carnivore frens… TIA

I’m type 2 on a pump. I cannot do aerobic/cardio workouts without some carbs. My thing is road bicycling. My suggestion to you is Sheri Colberg’s Athletes Guide to Diabete.

I had similar issues with the 20 minutes BG drop. My solution probably won’t work for you. When I first went on MDI I split Lantus into 3rds. This worked well. I am on a Tandem with C-IQ and can ride for 3 hours in normal mode OK.

Good luck

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Thanks @Luis3, I’ll check her out, appreciate the recommendation.

Welcome to TuD, @Samantha8! I’ve been T1D much longer than you but our way of eating seems similar. While not strictly carnivore, I lean toward that and eat very few carbs. The carbs I do eat have a low glycemic index. I credit it with the more normal blood sugar metabolism that I enjoy. My average BG is < 100 but the most significant metric to me is the low volatility as measured by standard deviation at < 20 mg/dL.

Do you wear a CGM? I can’t help you with current exercise advice but I know from past experience that sustained cardio periods require planning and insulin basal rate reductions and/or timely food interventions. I see the CGM and good consistent observation are the best tools that will enable a successful routine, cardio or otherwise.

I admire your food choices that you’ve made so early in your diabetic life. Your attention to both good nutrition (the way that humans have eaten successfully for millions of years) combined with regular exercise bodes well for your overall health. Good luck to you!

PS - You may be interested in the work of Stephen Phinney and Jeff Volek as they have examined the low carb effects in the extreme athlete context. They don’t cover the diabetic metabolism but you can learn a lot from their research.

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Samantha8, a big welcome to you. I was on the Bernstein diet for 11 yrs and ended up very ill. This way of eating works very well for some while it can be disastrous for others. Watch your lipids. It raised my LDL too much and the fat clogged my arteries causing me to have to get heart stents. For the past 6 yrs, a plant based low fat diet has been removing the plaque and making me feel much better. The two young type 1 diabetics who started Masteringdiabetes.com are extremely intelligent and very fit. Heavy exercise is something that they both love. Their way of eating is close to what the world’s longest living people eat and it works great for diabetics.

It is just another option for type 1’s and 2’s that is becoming quite popular.

Marilyn type 1 dx 1959
Alc 4.7
SD 20

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The type of calorie - carbohydrate or fat - that is primarily being used for fuel is largely based off the intensity of the activity.

For lower intensity exercise, carbs/glycogen/glucose is not used as the primary fuel source. It is secondary. Your body can use mostly fat as a fuel. (Only a small background amount of glucose metabolism is needed to provide oxaloacetate, which is necessary for fat metabolism.)

But when the exercise intensity increases, your body relies more on the carbs/glycogen/glucose source of fuel.

It can even be known where the crossover point is for when carbs become the primary fuel source. It is when the Respiratory Exchange Ratio (RER) gets above 0.85.

It’s easy to understand it in terms of when you start working harder and you become just a little out of breath. And if you work even harder, you become even more out of breath. That’s a simple way of understanding your RER getting higher and higher as you work harder and harder.

If you want to efficiently be able to work at higher intensity, your body needs carbs/glucose. Your BG drop is simply your body pulling the glucose out of your blood to fuel your muscles.

When your BG is in normal range, your blood only has about 4 grams of glucose in it That’s practically nothing.

You need carbs to work at higher intensity.

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Are you on a pump or MDI? I am MDI and have your issue if I do more than mild exercise within 4 hours of taking fast acting insulin. 2 hours after taking insulin, I can walk at a consistent leisurely pace but any more than that, my BG tanks. On the weekends I exercise in the morning before lunch and during the week, after work. I only eat 1 meal a day (lunch).

Keeping your dawn phenomenon BG rise in the 10-20 point range, will improve your entire day. Dawn phenomenon is sort of like A1C except A1C rates your last 90 days with heavier emphasis in the past 2 weeks. Dawn phenomenon for me is based on the what I have had to eat over the past 3 days, with the latest meal causing the biggest rise. To keep my DP below 20 points of BG, I need to skip dinner and not sin in the past 2 days. My diet has some variations but leans heavily toward low carb, high fat.

This works for me, but as we are all different, you may glean something out of my habits that you may want to try for a few days.

Thankyou @Terry4 !

And yes, our approaches to food do sound very similar, not to say I never eat higher GI foods, just not as my regular foods. I go for a bit of salad with dinner but otherwise just straight carnivore. I’m a never say never kind of person though so I absolutely make the occasional pizza/similar treat.

I am in Australia so I’m just converting everyone’s points, to mmol/l, when I’m not being an idiot with what I eat and paying attention to my dawn phenomenon I stay between 4.3-5.5mmol / 77-100 mg/dl very easily. I haven’t paid much attention to SD yet, but it seems like I should haha, I do indulge once a week or so and just came off a couple of rough weeks travelling/tending to affairs after a death in my family, but I’m at 31mg/dl SD for the last week, will keep an eye on that, thankyou for the tip.

Yes, I do have a G6 (current sensor is a 9117 ftw haha), I left hospital with it. I hadn’t thought to reduce basal to do exercise, just reducing from what exercise changes in my insulin sensitivity in general. I am currently taking basal at 10am/10pm of 10 units each time (Optisulin if that matters), when I’m in a good routine I skip my morning basal and let my BGL rise then exercise it off, but still find I’d need to be supplementing with carbs to get through what I’d like to do exercise-wise. I just bolus to correct gluconeogenesis or for treats (Fiasp).

I appreciate that, I’m really just following on from what I was already doing, but I have much more purpose to be more careful with what I eat, and not slacking off with exercise now. It’s nice to find like-minded people!

Many thanks for the recommendations, I will take a look, they sound like a good start.

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Thanks @Marilyn6, for the welcome and the warning. I’m sorry to hear you’ve had such a rough time, that sounds very challenging but I’m glad you figured it out! I’ve been carnivore for a long time, my cholesterol is high but that doesn’t bother me (so much of our bodies is made of cholesterol). I’m just looking into where I can get that test to see if my LDL is type A or type B (big or small, can never remember which is A or B) to clarify if it’s something I need to actually worry about. Is that something you looked into also?

I’ve come across Cyrus Khambatta so I’ve been aware of this strategy. I think the best approach isn’t necessarily the same for everyone and this is likely to be down to our ethnicity, genetics and epigenetics. I’ve always felt that a more carnivore diet really fits in well with my northern European background, and I feel a great deal better on meat and dairy than when I eat more fruit and veg. I definitely experience carb cravings if I do eat fruit or very carby veg, so I suspect that feeling more content on meat is an ingrained pattern from generations of a meat and potatoes culture that my ancestors enjoyed that suits the evolution of my bloodline. Perhaps it might be the same way with your background and a plant-based approach? If something does go awry it’s great to know there are alternatives that work for you and others to explore, so thankyou, I appreciate it.

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Ah thankyou @Eric2, this is exactly the kind of information I was hoping to glean from this thread! The info on being out of breath is so helpful considering the probable lack of consumer grade tools for measuring VO2/VCO2, so thankyou, I will start assessing how I feel when my BGL starts tanking to get a clearer understanding of that experience (or try to remember how I felt 15m before I see it on the graph, eek).

I suspect I will need to hit the gummi bears before I start to enjoy a sustained bout with the treadmill, or move to LISS possibly, that’s wild to think how little BG is in our blood when in normal range.

Thanks very much!

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Yep, I’m MDI too. I have never needed health insurance before (ah, the Lucky Country) and a pump is out of the question without it here, so I’m investigating that scenario, but have heard much to warn me off getting one, I’m not sure just yet. I don’t take much bolus, half a unit here and there (Fiasp) to counter gluconeogenesis, though I’m hoping to reduce that further/entirely with swapping high protein for high(er) fat. I am near to OMAD, dinner is our main meal at home, but I will eat something in the afternoon, around the 200-300kcal range when I start feeling a bit snacky, and drink cream and milk in my decaf throughout the day.

That’s so interesting about the dawn phenomenon, I had no idea there’s a means to reducing or even avoiding it, thankyou! I think we are similar in the variations possibly i.e. I have the cbfs for restrictions at times, or sometimes I just eat something that’s outside my normal routine if I feel like it. I like to think my body tells me what it needs so if I have a hankering for something I’ll do it. I’ve been countering the DP by taking splitting my basal across night and morning (I find it wears off after about 8 hours anyway), but this will be very interesting to see if I can lower that morning dose. I find I can replace that dose with exercise also once I let it my BLS rise enough, perhaps I could also split my exercise into a couple of sessions per day to mitigate my BGL falling off a cliff and still hit the energy expenditure I like to get to. Or smash some juice if I want to go for longer…

Many thanks for your insights, very much appreciated!

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I gave up on basal insulin as soon as I went on a CGM and could prove to my endo that basal insulin was causing me nightly lows. Pre-CGM, for years I would tell my endo basal insulin was totally responsible for my nighttime lows and she would have none of it.

After getting off of basal, it was pretty easy to flatline my bg’s, especially since there was one less variable to consider.

As a test, you may want to one-time skip dinner 2 days in a row, 3 would be perfect not to start a habit you can’t socially maintain with your family but to determine how hard your dinner is hitting your DP. From there you may be able to swap out a few of your dinner foods or move the worst offenders to an earlier meal.

One think to keep in mind when on MDI or pumping for those diagnosed LADA or like me T2 - The loss of Beta cells (T1) or function (T2) does not usually happen rapidly. This means a need to be constantly on top of BG levels, changing, tweaking both basal and bolus insulin. Not big changes, small changes.

Before I was on MDI using a long insulin, Lantus, I would adjust up or down 1 to 2 units, maintaining that dosage for a few days. Depending upon meter readings would stay, revert or increase.

One thing I have learned about managing blood glucose levels for what every type diabetes mellitus is, it varies by the individual. The endocrine system is quite complex and that is compounded by unique variants of each person.

I may tell you what works for me, but I will never say it is the only way.

I never stop trying to understand the foibles. Here’s one. I can ride 3 hours on the road, with a slight rise and then a slow drop. When I do stationary rides, BG falls much faster. By 30 minutes I either have to stop or fuel. If I stop, there will be a slow rise of BG while resting. What is that about? No clue.

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That’s actually a very good number. You may be able to lower it some simply by maintaining an awareness of it. I’ve found that being aware of the data (like average BG and SD) subconsciously influences my behavior. Your results will vary.

I’m happy to see that you’ve received replies more specific to your exercise questions. Managing diabetes is so much about balance; you’ve struck a nice balance between many competing factors already. Keep up the good work!

Samantha, I wasn’t worried about my cholesterol either, especially since there was a new book written by a Harvard graduate, which said that our thinking about cholesterol wasn’t correct. He went on to misquote several cardiologists, who spoke out later about being misquoted. I ignored my LDL level even when it went up to 216, because my HDL was 100 and my triglycerides were 36. I thought I was in the clear. It wasn’t until I was beginning a hike, and realized I was suddenly fatigued and my arms were unusually heavy, that I knew something was very wrong. I went straight to the ER.

I was aware of someone who had been on the Bernstein diet who had a stroke and a heart attack on the same day and died, so although I was shocked, that warning was in my mind. I ended up with two stents.

I have a Welsh and English background. I grew up eating meat as most Americans do, but I did not love it. I loved dairy and eggs though. Vegetables were ok, but not great. I liked grains and still do.

My LDL consists of mostly large fluffy particles, which was another reason I believed that high LDL couldn’t hurt me. How wrong I was. I am getting my levels broken down again this week, because I am interested in the information. I also want to know what my ApoB level is. My cardiologist used to look deeper into his patient’s particle levels, but eventually realized that plaque was caused by high LDL levels, no matter what the particles are. My LDL is now down to 68-70 without a statin.

People like to say that cholesterol doesn’t matter
because 50% of people who have had heart attacks or stents had low cholesterol. That isn’t really true, because once a person gets stents or has had a heart attack, their LDL falls to normal levels. It doesn’t mean that their cholesterol levels were low before they had the heart attack or stents. When people die from a sudden heart attack, their levels of cholesterol are not checked until death, so of course their levels are then normal. My LDL number came right down with stents.

Also during the time that my husband and I were low carbing, I would faint from low blood pressure and would get complicated migraines, which entirely went away once I started eating a diet of plant based carbs. Also, my husband had esophageal cancer and prostate cancer while I had the beginnings of bladder cancer while low carbing. I also had chronic fatigue.

We both feel so much better now. Even my husband, whose ancestors came from Germany, is experiencing much better health. His dad died at 74 and his brother at 65. Both ate a lot of meat and dairy with every meal.

People with diabetes need to remember that we need to be aware of the health of the whole body, not just glucose levels. I learned the hard way. I live what I consider a healthy life now. Also I live a life in which I don’t hurt animals. Factory farming is so horrendous for the animals, and something that hurts me morally and spiritually, and of course the environment suffers too.

I have a great deal of respect for Dr. Bernstein, but his woe certainly doesn’t work for everyone.

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I find eaxecise easier since I startedmastering diabetes because I don’t drop low, as easily esp if I eat before exercise however after an hour or more I will crash. I use carb gels during exercise to combat it. My cholesterol was also rising after many years of normal to low cholesterol numbers. I also have a slow heart rate. Since I finally took the plunge and Went all in in on MD, my heart rate is normal again of course I also eat more salt than I used to so, it could be that

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Yeah I had the exact same problem and reduced my night time basal by half a couple of days into using it because of the lows. After I while I realised if I take my usual half at night, then the other half in the morning I could combat the DPs so I still find it useful for now, but will be curious to see how I go when I get it together to go more fat based rather than protein. My specialist and educator are very hands off, they’d rather I’d figure out how to stay in range on my own than tell me what to do. The outpatient dietician was completely useless, and could only answer off the 60% carbs script. Idk, I find it hard to take diet advice from someone who’s overweight also… you know? I know there can be reasons, it’s just not encouraging.

When things settle down for a few days (I’m travelling/doing a bunch of long day trips over the next couple of months with next to no notice) I will absolutely test this out. I appreciate you breaking down the protocol for me, thanks! I’m ok with eating differently from my family/just enjoying a decaf instead of a meal. Tbh I still need to do rigid testing to establish my I:C ratio and carb absorption. I assume elsewhere in the world you’re guided through this by professionals but mine never mentioned any of this stuff, so I’m just figuring it out on my own.

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Yeah I’m T1 LADA, my C-Peptide was something like 0.34, so my beta cells are toast afaik. I’m taking berberine which helps with insulin sensitivity and apparently can help revive beta cells, but I imagine that wouldn’t stop the auto-immune attack on them. I do notice a difference when I take it though. I had some minor kidney damage from the DKA, but my kidney function has been slowly improving so I’m hopeful it’s fully restored within the next few months. That’s the only thing stopping me going hard on the berberine.

I adjust my basal whenever it seems to need tweaking, for sure. And yeah, we’re definitely all different!

Maybe with your ride there might be additional adrenalin or cortisol pumping up your BG just from situational awareness, whereas with a stationary ride you don’t have any of that concern for safety keeping you alert, so your brain isn’t working as hard, so you there’s no need to bolster your BG during the ride and you just burn what you have…? I know for me I completely switch off my brain on any cardio machine, which is why I enjoy them as I’m pretty cerebral and prefer to make my body work hard and switch upstairs off for that therapeutic benefit. Where I live if I was to take a jog outside I’d have to be aware of potholes and snakes, or potholes and trucks if I was riding, and that stress takes the fun out of it for me, but may well even out my BG… interesting.

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Oh sweet, that’s great to know, thankyou! I will keep an eye on it now for sure.

Thankyou, and me too, but every answer has been helpful, I’ve learned something from everyone who has taken the time and effort to answer, which I really appreciate. What a wonderful community!

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No, not true. Most of us here under tight control are guided by our CGM and often have to fight with our professionals as they will never know our bodies, as well as we, know them ourselves… We eat, dose, and exercise based on our CGM trends. If you are not on a CGM you should consider getting one or at the very least borrowing one for a couple of months and it will rapidly become your very best friend. With what you have told us so far, a CGM would tell you all you need to know over a very short period of time to tweak your lifestyle to the BG’s and Time in range that you are most comfortable with.

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