Guest Blog Post: Paleo and Type 1 Diabetes

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Guest post by Lindsay Swanson.

This Guest Post includes information that does not conform to the Joslin nutritional guidelines. We have received a number of inquiries about the Paleo diet, and requests for examples of people who follow this diet, so we asked Lindsay to share her experiences.  Her opinions are her own and not those of the Joslin Clinic. 

I was diagnosed with type 1 diabetes when I was 25 years old – a challenging and life changing experience. Looking back, I’m just thankful I survived the diagnosis. Now, I’m thriving with diabetes, and more so in recent years, as a result of transitioning to a paleo lifestyle.

In addition to the technology and medical devices I use to manage my diabetes, I’ve worked diligently over the last three years to overhaul my lifestyle. Through an introduction from a close friend, I decided to try the paleo lifestyle not because of type 1 diabetes, but because of years of undiagnosed chronic GI issues. I didn’t know a lot about it, so the journey began with a lot of reading and research, and the more I read, the more that I realized I firmly believed in the foundation of what paleo is; nourishing my body and mind by eating the foods and nutrients I was intended to.

Step-by-step, I started eliminating different groups of foods, a slow transition over time and I continued to feel increasingly better. I removed grains, then soy, then legumes, then corn, then rice, etc. I started trying different kinds of foods, experimenting in the kitchen, cooking with different methods, and became increasingly passionate about food.

I admit, when I first decided to make this transition living with type 1 diabetes, I was terrified. I had long believed that I had to take at least a minimum amount of insulin to survive and not become ill, via eating moderate amounts of carbohydrates.

I thought I’d be in a constant state of starvation ketones if my insulin intake was reduced. I thought I would be a horrible “paleo person” if I had to treat a low blood sugar with refined sugar. Much to my surprise, my blood sugars completely leveled out, so much so that I rarely need to treat a low blood sugar, and spikes are few and far between.

That said, one of the discoveries I made once I removed refined carbohydrates/grains, was how differently my body reacted to foods than before – meaning, low treatments for me have drastically changed. Bananas, apples, almond milk, kombucha, lara bars, caveman cookies, and other portable paleo foods I carry around are just as sufficient, while providing nutrients at the same time. It still comes down to being prepared and creating a new routine, so yes I carry food with me everywhere I go, it’s just a different kind of food and I have to use it less often.

Most believe when I say “paleo” that I live on meat, which is not at all the case. Probably 75 percent of my diet consists of vegetables and plant based food, some with more carbohydrates depending on my activity level. I eat a lot of fat/protein regularly, examples: avocados, coconut oil (in tea and cooking), grassfed meats, bacon (and the reserved fat), oils, nuts, etc. Dosing for these items is where I get my insulin, about 15 units/day. Depending on the amount and kind of protein I consume, I bolus differently, which much like diabetes is individual and has to be fine-tuned. I never calculate a bolus anymore using the bolus wizard function, I strictly bolus via the easy bolus option in .5 unit increments here or there.

A typical daily meal plan:

  • Breakfast: 1 banana, 2-3 over-easy eggs cooked in reserved bacon fat or coconut oil (alternated with some other source of high fat/high cholesterol protein)
  • Lunch: Vegetable and protein heavy – salad/leftover roasted/grilled vegetables, 1 avocado (almost daily), leftover grilled/baked/pan fried meats. Occasionally fruit
  • Dinner: large salads with tons of vegetables with seafood or meats or veggies/meats separate

On a daily basis, paleo has provided for me, much less thought and mental taxation that came with my diabetes pre-paleo. Diabetes is a very emotional and mental disease for me, and living paleo has lessened that relentless burden tremendously through consistency and stability.

Lindsay Swanson

I had no idea the effects food had on my brain and body until I revamped my lifestyle and conducted a complete overhaul. It is not a diet, it is not a fad, and is by no means temporary. It isn’t just about food, but about total overall health and wellness; hydration, sleep, activity, mental health, etc. It was a tough transition at first, but I’ve learned that preparation is essential.

35 Responses to Guest Blog Post: Paleo and Type 1 Diabetes

  1. Thanks for sharing your experience, Lindsay.

    Stupid question if you don’t mind. Is your total daily insulin about 15 units, or is that 15 units of basal dosing plus extra meal-time dosing?


    • Hello–we forwarded your question to Lindsay, and here’s her response: “My total daily dose of insulin is between 15-18 units, including basal/bolus. Of course it varies with other factors, but that’s typically where I’m at.”

      • Debora says:

        What is your insulin delivery system? I’m on an insulin pump and am slowly adopting paleo. I find that I have reduced my insulin basals significantly. over the past few months, but can’t imagine having to take shots to accomplish the same control.

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  3. Ekaterina says:

    Dear Linsday,
    I am very happy to hear about your experiences with paleo diet. I have been managing my son’s type 1 diabetes with low carb, gluten and grain free diet for the last 4 years. He has been insulin independent for first 3 years and now he is using very little insulin, while his blood sugar remains stable.
    Here is a link to our recent interview
    Best regards.

  4. vic says:

    We’re continuously helping people with diabetes.
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  5. Md Raju Mia says:

    Please tell me, how many types of diabetes?

    • There are two main types- type 1 which is an autoimmune disease where the body’s ability to make insulin is destroyed and Type 2 is a combination of the body becoming somewhat resistant to insulin and not able to make enough insulin to compensate. There are other genetic variations of diabetes known as MODY, and gestational diabetes can occur during some pregnancies. But the two most common types are type 1 and type 2.

  6. Rosina Lucibello says:

    Thanks for sharing your paleo/type 1 story. As a type 1, I find it tricky with exercising and low blood sugars. how do you deal with that? I know you mentioned the foods you eat when you do need a low rescue, but was wondering if you have a pre-workout snack that you find works well in keeping you sustained during exercise. thanks again for sharing your story–

  7. Carol Davison says:

    I’d like to know how much insulin you are taking per meal. I guess you would take a unit for each piece of fruit but I do not see many other carbs. in your meal.
    I have just been diagnosed with type 1 at 38 and I am afraid to eat little/no carbs with meals, so I am adding them in (usually its rice/fruit or yoghurt). I was Paleo before the DKA diagnosis but not anymore.
    I had a nurse recently tell me if I didn’t eat crabs I would lose weight and I had already lost enough by being in DKA.
    Any thoughts?
    Thanks in advance,

    • Sam says:

      I don’t think you have to worry about eating too little carbs as long as you’re adjusting the insulin accordingly. I’ve had type 1 diabetes for 11 years now, and just recently started paleo (vegetarian version; no meat or fish). In my experience, diabetes is a lot easier to handle when you’re low carb. No more drastic blood sugar swings that come with high carb foods. And I don’t think you’d lose weight if you’re eating enough and eating healthy and taking whatever amount of insulin you need, even if it’s a very small amount because of low carb. Your body will take care of the rest, in my opinion. Then again, I’m not a doctor. Just learned from personal experience.

      • Joe Hirsch says:

        Sam, maybe you can look at my posts at the bottom. I have basically personally eaten paleo plus safe starches (potatos and rice for me. Wheat, corn, rye, beans all make me feel sick, cause sinus congestion). Personally I feel best on about 100 grams of carbs a day (about 20% of total calories).

        To get my 9 year old son’s calories up I added a lot of fat to his diet, but tried to stay under 30% carbs, (90-110 grams a day) but he developed difficult patterns where he rises very late after meals, (not super high, rarely over 200) but he is getting so much insulin because the high fat content seems to delay carbs so much and also when the fatty acids enter the bloodstream I am told that they make you less sensitive to insulin, so in effect he seems to become resistant to his basal 2.5+ hours after meals.

        His carb ratios have plummeted in a year on 25% carbs from 25:1 to about 14:1 at 6 months to about 11:1 at one year. That is OK, but since he is needing much more insulin to cover carbs with fat than he did with carbs alone, and the effect of fat is very slow, activity will circulate his insulin so fast that he will often go low if he gets active within an hour after a meal! His average blood sugar is lowest in the first 90 minutes after his 3 meals where he is averaging under 100, and he is averaging maybe 135 the rest of the time (1.5-4 hours after meals). Night time is about 125 but with night time hormone surges I sometimes have to do 1 or 2 corrections at night.

        So have you experienced either issue, lower carb ratios or lows before highs with a higher fat diet? Again it took a full year for it to manifest itself and I have been told that it is due to muscles loading up on fatty acids instead of glycogen, so they just stop burning glucose for fuel any more, and as a result while the insulin can try to throw the glucose into the liver or muscles it basically just keeps popping back out again.

  8. Holly says:

    Im also a type 1 diabetic and started the Paleo diet 3 weeks ago. I eat around 50 grams of carbs a day (Mostly from fruit) and in those three weeks I have lost 12 pounds. I have had to drastically lower my pump settings and rarely take a bolus with meals.

  9. Carrie Townes says:

    I’m a 15 year old girl that’s trying to figure out what to do to help my father. He is a vegetarian but he would sneak and eat but I think that’s why . and he doesn’t exercise that much. but I want to know what I could cook to help him make better choices,and to keep me and my sister from getting diabetes. please help!

  10. Rob Irwin says:

    Been somewhat paleo and extremely ketogenic / Atkins / low-carb high fat for a year now. Been diabetic for 35 years, and this past year is the first remotely healthy year I’ve had in living memory. Blood sugars stable, lost a lot of weight, insulin about a quarter of what it used to be. Eat no bread, rice, pasta, sugars, almost no fruit apart from a few berries very infrequently. Choosing to do the paleo aspect of no additives either, but probably not directly related to diabetes. I eat lots of fish, eggs, meat, green vegetables.

    If you read the Dr Bernstein Diabetes solution book he’ll basically recommend the same extremely low carb diet. The standard eat-sugar, counteract it with insulin thing simply does not work.Small inputs, small corrections works, large inputs and large corrections with insulin is simply a disaster. Also, many fats are healthy.

    Spent years being insulted by doctors accusing me of eating cake/cookies when I was doing my damnedest to follow the official diet to the letter. the problem is, the standard high carb diet does not work. Dump it or you’ll go blind and lose your feet people.

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  12. Sarah s says:

    I’m a type 1 Diabetic for 25 years now (I’m 33) and am researching the Paleo diet. I’m curious what kinds of foods to eat when a low blood sugar occurs. Also what kinds of foods to eat before working out, which is when I usually go low. I realize the first few weeks will be a challenge with adjusting my insulin (I’m on the pump) so any advice is welcome.

    • Courtney says:

      I would eat a banana, pineapple, make paleo cookies also help. Hopefully if you start it, you won’t have as many lows.

  13. Thomas says:

    So you eat like 1200kcal while you should eat much more. Imo the best way to manage diabetes is with normal fat (25-40%) and carbs (40-55%). Your diet is big time a starvation. Type 1 diabetes especially is not about carbs. It’s about wrong fats and nutrient defiencys.

    You should get rid of all vegetable fats, including avocado & olive oil.

    I’m just saying, you aint gonna improve your condition, gonna get worse much more like getting better anymore.

    • T1 Hozier says:

      Hey Thomas,

      Your’s is the only negative comment I can find in here. Care to explain?

      I am thinking of starting on this diet, please share if you have any thoughts.

  14. Fiona H says:

    Hi, I’ve been type 1 for 44 years. I also have hypothyroidism (about 8 years ago diagnosed) and last October I was diagnosed with Hashimotos so I have a few health issues! I’ve recently cut gluten from my diet and I’m seriously thinking about the Paleo diet. I’m overweight but i haven’t been able to lose any for quite a long time. It’s going to be quite a challenge as I was brought up thinking I had to have carbs every meal. Are there any ideas on how I can transition myself into this new and challenging way of life? Or do I just jump in and go for it?

    • Joe Hirsch says:

      I would like to advise that after 8 months on 25% carb diet, my son came out of his honeymoon period and now needs more insulin to cover the effects of fat after a meal than to cover carbs. Basically the fat entering the system makes you insulin resistant 2-6 hours after eating it so your basal is unsufficient and you have to cover it with more bolus corrections. Also you can’t bolus upfront for fat because you will go low in the first 2 hours after eating-because the fat effect comes in much later (and different for each time of day, breakfast is earlier, lunch and dinner will often be affected by fat 3-5 hours later, so unless you can split your insulin or use an extended bolus it will drive you crazy. It is also IMPOSSIBLE without a cgm because you may see that you at 80 2 hours after dinner but 175 4 hours later. If you add bolus based on the 175 you would be very low at 2 hours. I know people who eat 60% fat 25% carbs with T1D and with no honeymoon left and they add insulin for 8 hours after a high fat meal. They have bolus running and overlapping all the time. The payoff is VERY slow rising and mild peaks. The bad part is you can’t EVER go swimming or doing any significant exercise if you use one injection of fast acting up-front because it is WAY too strong in the first 2 hours due to the slowed absorption because of the high fat.

  15. Sarah says:

    I have been told to lose weight when I was put on massive amounts of medforman and b vita I did get leg cramps I need help for a diet that has No bread lactos and slight celiac doctors yell at me for the weight . I see the diebetic diet to much carbs not sure how many to have. Scared for life if not getting controled. There has to be something I can follow any help appriciated

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  17. Joe Hirsch says:

    My 9 year old son is T1D for a year now, just out of honeymoon. I myself had eaten “moderate carb” paleo with about 25% of calories coming from starches though excluding most grains.

    So I tried to put my son on a 25% carb diet. In part he had become averse to carbs because of how he had felt prior to dx. I started with about 100 grams of carbs a day and added in a wide variety of saturated and monounsaturated fat wherever I could. It worked amazingly in the honeymoon, with virtually no spikes (never seen a 240) or lows (maybe 3 treated lows) We use dexcom and he averaged about 115 bg for the first year, and 4 straight 5.9 A1Cs

    Now here is the horrible part now that we have finished the honeymoon. The high fat content of his diet (about 60%) seems to have gradually made him insulin resistant by loading his muscles with fatty acids rather than glycogen. This is known as physiological insulin resistance. At 6 months, after about 2 months of higher fat his carb ratios all dropped to half. They dropped again to half after a year and now for a 60 pound boy, he needs about 1 unit per 10 grams of carbs. HOWEVER he is not resistant to basal or corrections. A half unit correction will drop him 60 points but only “cover” about 5 grams of carbs! It used to cover 15 and even though that was in the honeymoon, it is a typical carb ratio for a kid his size. So he needs triple the insulin to cover carbs as an average kid his size.

    Now I could deal with that, so what, he needs more carbs, but now he needs so much insulin that he will go low in the first hour to 90 minutes after a meal even if we have the right dose to have his blood sugar correct 4 hours later! So my son can not PLAY or ride a bike or swim for at least an hour after lunch or dinner because he will go low due to the fact that the bolus to cover his meal is so strong early. I have tried splitting boluses though that creates overlap with other meals and into sleep hours. He ate lunch and bolused AFTER today and 2.5 hours later he was at a 75 blood sugar after a short walk, but he came all the way back up to 105 at the 4 hours mark which was where he started.

    For dinners even with a split bolus he will often run flat under 100 for 3 hours before rising because the high fat content is delaying absorption so much and the fat also seems to enter his system and make him less sensitive to his basal so he will peal 3-4 hours after many meals.

    It is an utter nightmare dealing with high fat and 20-30% carbs. Maybe it works great if you are very low carbs, like 25-50 grams a day, but the problems I have encountered dealing with the insulin resistance and “low before high” from a high fat diet have become a nightmare.

  18. Joe Hirsch says:

    I would like to add that I have no fear of saturated animal fat, or monounsaturated fats, or eating a fat based diet in general for purposes of health, but it turns muscles into fat burning organs which actually stop synthesizing glucose burning enzymes and stop storing glycogen. It creates backwards patterns for blood sugar management because fast acting insulin is so much faster than the rise in blood sugar from the fat based meal. On the good side, we still almost never go over 200 and don’t typically have “late” lows but on the bad side activity lows after mealtime insulin make it hard to have an active life.

  19. Joe Hirsch says:

    Keep in mind too that since the OP was dx’ed at 25, she very likely is LADA and will retain honeymoon levels of insulin for several years still. I don’t know if that is true in her case but it is typical of T1D friends I have met who were dx’d in their 20s or 30s-they still wake up around 100 every morning with little basal, and still can correct blood sugar from their own insulin, and still have not developed the alpha cell disfunction that will eventually prevent their body from counter-regulating lows on its own, and they still likely have normal amylin to block super spikes after meals.

  20. Melissa says:

    I was diagnosed with LADA type 1 diabetes 10 yrs ago when I was 26. I have had very poor BSL control and been in hospital with DKA 3x times in the last 4x years. The most recent DKA episode being only a few weeks ago. I was 90 kg in hospital and was told by the diabetes educator to eat much more carbs as I was not having enough and so was producing keytones. I did as I was advised and in only a few weeks I have put on 15kilos. This cannot be the answer surely? Anyways I had a chat with my Aunty who is on paleo lifestyle and my uncle who was overweight and very lethargic has lost weight and never looked better and so I am certainly thinking of giving it a shot. If I was to continue following diabetes expert advice I am seriously concerned I will not be around to see my beautiful 8 yr old daughter grow up. WISH ME LUCK!

  21. Matt says:

    Great to see other type 1 diabetics seeking answers outside of mainstream doctor suggestions.

    I am also a type 1 diabetic and have been insulin free for nearly 2.5 years by following a strict plant-based diet.

    If you are interested, check out my blog to read about my story.

  22. angie says:

    Thank you for this great post. I have a son, 11, diagnosed with Type 1 Diabetes about 4 months ago. We have been eating Paleo for three years and since his diagnoses we have started buying some sugar foods (to treat lows) and he has some bread and wheat per doctors orders. Frustrating when your son doesn’t like sugar and doesn’t eat wheat, corn,nosy etc. to get this dx and have the stereotypical sugar and sweets comments. He only needs about 12 units of insulin per day; 8 of which is long acting and his first A1c was 7:1 which now after adding those foods it’s at over 8. Your study was helpful and I am going to go back and re evaluate his charts. Thank you!

  23. alan nove says:

    My Grand-daughter (13 yrs old) has type 1 diabetes, and still in her honeymoon phase. Would like your thoughts on getting her into LCHF diet to reduce stress on her pancreas, and maybe making her life more normal.

    She has doctor here in Anchorage who would work with another knowledgeable doctor – I believe.

    One thing, she is very very thin, as went into coma from starving before discovered that she was type 1 diabetic.

    Please respond if you can assist or you know someone who can. We are happy to take her to any doctor anywhere for help.


  24. Kathryn Morris says:

    Why do Paleo recipes not have the calorie, carbohydrate, etc count?

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