Ken’s Type-1 Diabetes Journey Part 5: Living With Type-1 Diabetes
As mentioned in “Part 2: Disclaimer”, this is not medical advice. This writing is simply to share what I have learned while managing my own personal Type-1 diabetes.
Type-1 diabetes has a very bad reputation, and rightfully so. The diabetic individual must take over the control of a complicated, vital bodily function that is normally fully automatic. That control task is a perpetual, never ending requirement. It is like having to always be conscious to breathe. It is this dedication to diligent control that gives Type-1 diabetes its bad reputation. Faithfully executing control, however, can actually result in above average health, because diligent testing and logging gives the diabetic individual direct insight on nutrition that non-diabetics do not get to see. Not faithfully executing diligent control, slip-ups and “cheats”, however can have a myriad of catastrophic results. For example, allowing blood sugars to ride high or recurring spikes damages blood vessels, causing them to rupture and leak. This is most noticeable in the eye as the leaking blood obscures vision. Common treatment is surgery to cauterize the failed blood vessels, stopping the leak and restoring vision - somewhat. This is still a catastrophic failure, however, because the function of that vessel is lost and that portion of the retina is damaged. The result is an incremental, steady decline in vision. This is called diabetic retinopathy; however failed blood vessels occur equally throughout the body, degrading all the organs just the same as the eyes. These failures are additive and notches away your health and your life.
The good news is that you can learn to control Type-1 diabetes just as one learns to walk, speak or ride a bicycle. Once you learn it, it feels perfectly natural. In that light, Type-1 diabetes is not a “disease”; it is more like an amputee as the pancreas beta cells have been “amputated”. This does not make you “diseased” and certainly not debilitated. If a person has an accident where their hand, foot or limb is amputated, they are not “diseased”. They do have to learn to compensate for the loss, but that process can and often does result in performance and abilities even beyond “normal”. The list of extreme amputee achievers seems boundless. Comparatively, a Type-1 diabetics pancreas beta cells are effectively amputated and the prosthetic is a glucometer, log and insulin injections. If you are a diabetic or abnormal in any way, just keep in mind that if this makes you feel like a freak, remember that by definition, Superman is a freak!
I consider managing Type-1 diabetes is somewhat like “walking a tight-rope” because it is a 24/7 effort to maintain blood-sugar between 70 and 100 mg/dl. Blood sugar is never steady-state; it is either rising or falling every minute of the day. The control objective is to counter rising blood sugar with insulin, and falling blood sugar with food. The rate of blood sugar rise is dependent on the type of food and the rate of blood sugar fall is dependent on the insulin. The goal is to match the rise from the food with the fall from the insulin. Perfect control is when the insulin curve exactly mirrors the food curve. For example, in Figure 1 below, the vertical axis is blood sugar and the horizontal axis is time. The blue line is the blood sugar rise from a particular food. The red line is the injected insulin’s blood sugar lowering effect. The green line is the resulting blood sugar. Notice the red insulin line effectively subtracts blood sugar from the food. Matching the curves, in equally opposing magnitude, results in stable blood sugar. Consider if the insulin line remained zero. Without insulin, the blood sugar line would simply follow the food rise, except without insulin, it would not come down. Also consider if the food calories are insufficient or not present. Without food calories opposing the insulin, blood sugar rapidly drops to dangerous, life threatening levels.
Now, notice what happens if the food and insulin curves do not match.
In Figure 2, the insulin response is still equal to the food response except it is delayed in timing. Notice the resulting blood sugar spike. (Note: this is a very common occurrence with non-diabetics who suffer from insulin resistance, which includes the vast majority of Americans.) The opposite effect occurs when the food response is delayed in timing with the insulin, resulting in a drop in blood sugar as shown in Figure 3 below.
The perfectly mirrored food and insulin curve of figure 1 is for illustrative purposes only. Realistically, different foods have different curves, for example fruit has a relatively fast rise, short duration and fast fall. Different fruits all have different curves. Starches have just a bit slower rise than fruit with considerably longer duration and slower fall. Different starches likewise have different curves. Vegetables have a similar rise, duration and fall rate as starches, but a very low rise level (amplitude). You can combine each of these foods, adjusting the proportion of each to create just the right curve to match the insulin. You can also adjust the timing of the insulin dose to line up the starting point of the insulin to a meal. Most fruits are faster than the insulin, so you can inject the insulin early so the starting point lines up. Figure 4 illustrates the relationships.
This may seem complicated, and it is, which is why no one can manage it for you. You have to learn all of the curves from your logging (though graphs are not necessary for the log, just the data). There are a myriad of variables, such as your activity, environment and more that affects the food and insulin curves continuously modulating them from day to day and month to month, making the log so invaluable. The logged data should include food calories broken down by food type and calories from carbohydrates, protein and fat, blood glucose reading and insulin dose. I arrange my log in rows by date and time of entry. Entries are made at every meal and several times in between. The food calories are derived from a nutrition facts sheet calculated from the measured weight of each food. Over the years, I have learned to estimate the weight sufficiently and undershoot just slightly to ensure my blood sugar will dip. The dip is then filled in with a few ounces of fruit. I find apple to work the best. I find this method to be the easiest way to fine-tune blood sugars in the face of all of life’s variables.
The most disruptive foods are meats (anything that came from an animal) and fats (from any source). Meats and fats all have a deceptively slow rise, typically 24 to 48 hours, and a very long duration, typically 4 days to a week and a very slow fall, typically another week. Such a long rise, duration and fall makes tracking very difficult. Due to the effect mechanism, the meat and fat curves add together and cumulate with each ingestion. Since the meat or fat curve lasts for a week, another meal with meat or fat will add to the first meal – days ago. The result is a perpetually high blood sugar level that effectively doesn’t have a curve that matches with the insulin. This results in blood sugars swinging high and low without an easy means to mirror the curves. This is why the insulin pump is so popular with Type-1 diabetics who are on the Standard American Diet – or any diet that includes any animal products, oils or fats. The pump can be programmed to equate hundreds of injections per day to help match the injection rate to the high continuous insulin requirement. Without the meat and fat, however, it is easy to control blood sugar with dramatically less insulin and fewer injections per day. A pump is simply not needed.
The reason meat and fat causes such a slow curve is because it doesn’t really add sugar to the blood stream – it does something much worse. Instead, it inhibits the uptake of glucose by the mitochondria (your body’s engines) so the glucose (your body’s fuel) builds up in the blood stream. This means that while your blood stream is full of glucose, your body is starving. More insulin is then required to get the glucose into the cells and to the mitochondria. This impediment is called insulin resistance. The delay of glucose uptake inflicted by Insulin resistance also causes blood sugar spikes from foods such as fruits, starches, etc. Even with large doses of insulin, spikes still occur because of the insulin resistance induced delay in glucose uptake. (As illustrated in Figure 2 above.)
Without insulin resistance, your energy builds to astonishing levels because the fuel (glucose) is readily burned without delay or impediment. If you ever wanted to be an athlete, having very low insulin resistance makes any athletic effort blissfully easy. It makes muscle mass and strength building easier and recovery from injury, illness, inflammation, etc. much faster because all of the mechanisms in your body require glucose for fuel. The easier the glucose flows into the cells the better everything works. From my experience, the lower the fat intake the better. There does not appear to be a too low limit, simply because even the lowest fat food still has plenty fat. High fat foods, such as nuts, avocados, etc. have entirely too much fat, even in small amounts. Keeping the fat intake between 3.5% to a maximum of 10% makes the food / insulin mirroring the easiest, requires the least amount of insulin and fewest number of doses, makes energy levels the highest, muscle growth the greatest and feel-good levels beyond imagination.
I would have to say that my life with Type-1 diabetes has been good. It has not restricted my life in any way. I have been able to do anything I want. I have never sat on the side lines for anything because of my diabetes. While management is very consuming – actually perpetual, it is very well worth it. The management effort has shed light on nutrition that I do not believe I would have ever received without it. For that, I am eternally grateful.
My life as a Type-1 diabetic is not so different as anyone else. Differences only include diet, frequent glucometer testing, logging, insulin injections and keeping emergency snacks, such as apple juice, fruit bars and/or rice bars, on hand at all times for hypoglycemia control. Everywhere I go, my glucometer, and emergency snacks are always on my person or within reach at all times.This is where the “tight-rope” analogy is the most apparent. Many doctors advise Type-1 diabetics to maintain their blood sugars above 150 mg/dl at all times as a hypoglycemia safety buffer. This “buffer” however is damaging in itself, so I have always strived for the normal range of 70 – 100 mg/dl. This makes that “tight-rope” much thinner, but it also keeps my diligence level higher and health much, much higher. Just know that a blood-sugar crash can happen quickly and mental capacity decline to incapacitating levels very fast, so you can’t wait to fix it.
The greatest issue is social because social events often include food. However, I no longer count that as diabetes related, because if I were suddenly completely cured, I would make no change to my diet. After getting a taste of what feel-good really feels like, I never want to give that up. Regarding diet and social pressures; the diabetes was actually a benefit as I could say that eating that (anything not low-fat, WFPB) would interfere with my diabetes management. In reality, this is true for everyone. Animal products and fat increases insulin resistance in everyone exactly the same as a Type-1 diabetic. The only difference is that the Type-1 diabetic must manually deal with the tenuous, difficult insulin management manually whereas the non-diabetic’s pancreas must struggle with the same daunting, damaging task.
Doctor visits used to be difficult because my Type-1 diabetes management methods were in polar conflict with established standards - especially diet. Interestingly, the pressure of the conflicts remained even though test results were always excellent and none of the predicted diabetic related issues were ever realized. Since becoming Doctor Carney’s patient, however, those conflicts are now history!
If you are a Type-1 diabetic, I am inclined to say Congratulations! Manage it faithfully, diligently and relentlessly and above all, learn from it and you will enjoy a very long, exciting, vibrant life!