It sounds like you are doing great, so congratulations ! In general, I find no fault with your summaries of metabolism, or your conclusions. 5.8 is an excellent HbA1c. You'll know in 3 decades whether it's "good enough" . LOL. However
There are a couple of points that I would like to add:
> Adjusting to the low-carb diet takes some time. See the publications of Volek and Phinney.
>Dr. Bernstein has recommended -maybe on his Webinar- taking glucose during exercise. For him, this might amount to something like 2 grams glucose every half hour of exercise. NOT to correct going low, but to avoid going low. For some of us, this is not so fine-tuned, so it might be more like one tab of glucose (4 g) maybe something like 15-20 minutes before a nice brisk walk. Maybe more glucose later if the walk is long.
> A regular exercise program will of course result in the need to lower one's basal insulin dosage.
Yes, it is ironic that for a diabetic on a low-carb diet, taking glucose is a necessity. My readings on diet suggest to me that attaining a ketogenic state is not even possible for a T1D keeping blood glucose levels low, and correcting with glucose, because taking glucose would quickly catapult one out of ketosis.
Well, enough for now. I completely agree with you on the importance of exercise, and I believe that it sustained me for decades before I discovered Dr. Bernstein, but for me as a T1D for so long a time, I continue, as of now, to consider low-carb as one of the foundations of my self-management.
Janice--- appreciate your feedback here. As you've testified, low-carb diets do seem to work for some people. And as I said, there are those who are just genetically fortunate that they have metabolic strength that others don't, even in the face of extreme duress. Examples:
The list of weird stats like this continues... the point being, most people who continue with low-carb diets fall well outside of the norm for the vast population, as evidenced by the citations I provided. Those who stick with it, despite not really having to (but to each his/her own), are able to do well for reasons that may well be curiously predisposed to not suffering its ill effects.
But of course, this is all entirely besides the point. The take-away from this article is that metabolic health is so disproportionately more influential on long-term health than A1c levels (within reason) that, trying to attain low A1c levels (regardless of whether you're using a low-carb diet is) is effort that may be better put towards getting sufficient exercise.
Very thorough as always, Dan! Thanks for your work. Regarding exercise, there seems to be a lot of confusion in the T1D world about how exercise will affect an individual. Some people report that their BGL drops like a rock, while others report that they stick high. Is this a case of people generally not understanding the difference between aerobic vs anaerobic exercise? Is it really as simple as "anaerobic exercise will reduce your BGL 100% of the time"? Perhaps when people describe "exercise", they are painting with too broad of a brush, considering that could be any number of activities that differ extremely, from a metabolic perspective (e.g. walking vs. sprinting vs. weightlifting).
Thanks for this article. My A1C has been consistently been about 7.2 to 7.7 over the last 10 years and I am an exercise junkie, an exercise addict, a fitness enthusiast. I know my body needs carbs to do three workouts a day. But the diabetes doctors are always trying to get my A1C lower. It is a hard balance but your article was helpful.
Great V02max, matt! Keeping it up as you pass the 50year mark would be monumental. How long with T1D?
As for your A1c, that's where you really get into the weeds on micromanagement---finding those times of day or night when your glucose is just hovering up there without exercising or any other anomalous situation is where I started.
It sounds like you are doing great, so congratulations ! In general, I find no fault with your summaries of metabolism, or your conclusions. 5.8 is an excellent HbA1c. You'll know in 3 decades whether it's "good enough" . LOL. However
There are a couple of points that I would like to add:
> Adjusting to the low-carb diet takes some time. See the publications of Volek and Phinney.
>Dr. Bernstein has recommended -maybe on his Webinar- taking glucose during exercise. For him, this might amount to something like 2 grams glucose every half hour of exercise. NOT to correct going low, but to avoid going low. For some of us, this is not so fine-tuned, so it might be more like one tab of glucose (4 g) maybe something like 15-20 minutes before a nice brisk walk. Maybe more glucose later if the walk is long.
> A regular exercise program will of course result in the need to lower one's basal insulin dosage.
Yes, it is ironic that for a diabetic on a low-carb diet, taking glucose is a necessity. My readings on diet suggest to me that attaining a ketogenic state is not even possible for a T1D keeping blood glucose levels low, and correcting with glucose, because taking glucose would quickly catapult one out of ketosis.
Well, enough for now. I completely agree with you on the importance of exercise, and I believe that it sustained me for decades before I discovered Dr. Bernstein, but for me as a T1D for so long a time, I continue, as of now, to consider low-carb as one of the foundations of my self-management.
Janice--- appreciate your feedback here. As you've testified, low-carb diets do seem to work for some people. And as I said, there are those who are just genetically fortunate that they have metabolic strength that others don't, even in the face of extreme duress. Examples:
There is a phenomenon called "metabolically healthy obesity" (https://academic.oup.com/edrv/article/41/3/bnaa004/5780090), which seems to benefit a non-insignificant percentage of Americans. Another study (https://www.jci.org/articles/view/129186) shows that 5% of Obese people may be metabolically healthy because they show no signs of insulin resistance.
15% of people are immune from poison oak/ivy (https://www.webmd.com/skin-problems-and-treatments/understanding-poison-ivy-oak-sumac-basics)
10% of people are immune from AIDS (https://en.wikipedia.org/wiki/Innate_resistance_to_HIV).
20% of people are immune from COVID (https://www.universityofcalifornia.edu/news/why-dont-some-people-get-sick-covid-19-gene-mutation-may-be-work)
The list of weird stats like this continues... the point being, most people who continue with low-carb diets fall well outside of the norm for the vast population, as evidenced by the citations I provided. Those who stick with it, despite not really having to (but to each his/her own), are able to do well for reasons that may well be curiously predisposed to not suffering its ill effects.
But of course, this is all entirely besides the point. The take-away from this article is that metabolic health is so disproportionately more influential on long-term health than A1c levels (within reason) that, trying to attain low A1c levels (regardless of whether you're using a low-carb diet is) is effort that may be better put towards getting sufficient exercise.
Very thorough as always, Dan! Thanks for your work. Regarding exercise, there seems to be a lot of confusion in the T1D world about how exercise will affect an individual. Some people report that their BGL drops like a rock, while others report that they stick high. Is this a case of people generally not understanding the difference between aerobic vs anaerobic exercise? Is it really as simple as "anaerobic exercise will reduce your BGL 100% of the time"? Perhaps when people describe "exercise", they are painting with too broad of a brush, considering that could be any number of activities that differ extremely, from a metabolic perspective (e.g. walking vs. sprinting vs. weightlifting).
Excellent article - now I understand why my endo tells me to never ever do a keto diet!
Thanks much
Thanks for this article. My A1C has been consistently been about 7.2 to 7.7 over the last 10 years and I am an exercise junkie, an exercise addict, a fitness enthusiast. I know my body needs carbs to do three workouts a day. But the diabetes doctors are always trying to get my A1C lower. It is a hard balance but your article was helpful.
My Garmin watch says my VO2 Max is about 50 and my fitness age is 38.5 and I am 46 years young. I wear a CGM Dexcom G6 as well…..
Great V02max, matt! Keeping it up as you pass the 50year mark would be monumental. How long with T1D?
As for your A1c, that's where you really get into the weeds on micromanagement---finding those times of day or night when your glucose is just hovering up there without exercising or any other anomalous situation is where I started.
I have had T1D for roughly 15 years
Hello Dan. I AGREE 10,000%. I’ve had T1D for over 50 years. The metabolic health is key! Can I do that VO2 test through an iPhone?
You need your heart rate, so if you have an iphone, an apple watch would be ideal. My article explains how to see your V02max.
Other watches and heart-monitors also suffice, though they will come with their own apps, but those are just fine.
Ok, thank you.