Exercise can be tricky with Type 1 diabetes, and we never cease to be amazed and inspired by the T1D athletes pushing the limits of what we might have thought was possible.
When Natalia Román López first perceived the symptoms of acute hyperglycemia that would eventually lead to her diagnosis with Type 1 diabetes, she was high among the peaks and glaciers of Northern Italy, on a 10-day backcountry skiing trip. And just weeks after her diagnosis, she was back in the mountains again—on an even more remote trip.
“I don’t feel that now, after Type 1, I have any limits that I didn’t have before.”
I first met Natalia Román López on a diabetes forum dedicated to low-carb diets; she was discussing her approach to the Tour de Monte Rosa, a 170km (~105 mile) race up and down the mountains of Switzerland. Frankly, I think that anyone that can compete in such an event is extraordinary—but doing it with Type 1 diabetes is something else entirely.
Natalia has started a new blog named Permanent Movement to document some of her exploits. It’s a must-read for me, with details on her glucose management decorated with her photos of untracked alpine beauty. She hopes to “tell a story that mixes endurance mountain sports, very low-carb nutrition, and Type 1 diabetes.”
It’s a small percentage of people that have exactly those interests, perhaps, but I think her story can also be appreciated by those of us with more modest athletic goals. Suboptimal diet and insulin dosing decisions can turn a literal walk in the park into a blood sugar rollercoaster—and I think we all have something to learn from a woman that can run a hundred miles with steady blood sugars.
Natalia was diagnosed with T1D as an adult. Her diabetes story begins at high altitude, where the classic symptoms of severe hyperglycemia popped up during an intense skiing trip.
“It was crazy. I was so thirsty! I was so desperate, I was eating snow. I thought I had a mouth infection! And I was peeing as much as I was drinking, which I thought was a good thing, because I’d be worried if I wasn’t. And then my friends got worried, because I couldn’t see the same things far off that they could.
“This was in Italy, and I was carb-loading every night for dinner. I have some clear memories of waking up at 3 am and opening my eyes not knowing which was more urgent, drinking or peeing.”
She made it through her skiing adventure without needing help (or medical evacuation), but when she got back to work her co-workers could immediately tell that something was seriously wrong.
“Everybody was like, ‘what’s wrong with you? You’re so thin!’ I checked my weight, and had lost 10 kilograms or more. I could see my spine in the mirror.
“The problem is I could never connect the symptoms because they were too random. I thought I might die by the end of the week!”
When she finally made it to her doctor’s office, the diagnosis with Type 1 diabetes was easy—a little bit too easy, maybe. Natalia’s doctor gave her a shot of insulin, a prescription for more, and sent her on her way. “They told me to go back to normal life quite quickly. It’s insane, right?”
And so Natalia went back to her normal life, which for her meant more cardiovascular adventures up in the mountains. Nobody had bothered to tell that she might want to make some adjustments, like, say, thinking carefully about her diet, or cutting her basal insulin on a day spent skiing up a mountain.
“I had really blind faith in my diabetes team—why would you doubt them? You’re flooded with new information, you want to do things right. I didn’t doubt for a second.”
She spent her first summer with diabetes racing as hard as she ever had, but her usual high-carb diet didn’t do her any favors.
“I would have about 100g of carbs, and I would cut my insulin massively. And maybe 30 minutes later I’d get started, and within 15 minutes I’d have a massive hypo, massive. I felt like shit. It was horrible. And I was getting more and more frustrated.”
Her frustration led Natalia to take her glucose management more and more seriously. “I was going to the restaurant and asking them to weigh potatoes by the gram.” Eventually, with some help from her friends, she hit on the central appeal of the low-carb diet for people with diabetes.
“It sounds so logical. My blood sugar goes up. What makes it go up? Carbs, basically. Well, why eat the carbs?
“I first reduced my carbs to 70 grams per day. I saw a huge improvement, clear success, mission accomplished. And I just thought – hey, why not cut down to like 20?
That’s where she is today, eating a very low-carb ketogenic diet, and enjoying superb blood sugar control. The CGM graph you see here was taken during a typical exercise day, several hours trudging uphill at an extreme incline.
“Yeah, I’m fucking proud. I take it very seriously. My only goal when it comes to this way of eating is blood glucose control. All the rest is secondary.
Even so, there have been secondary benefits to fat metabolism, as Natalia discovered when she did her first race—60 kilometers, more than a marathon—on keto:
“I started the race, and decided that I would eat when I got hungry. And I did the whole race, 8 hours, without eating. And during the second half of the race, I passed about 80 other people. It’s a cool feeling. It’s not just not crashing – the second half of the race was as strong or even stronger than the first half. I also noticed that either I recover much faster, or I get way less tired, or a combination of the two.”
Along the way, she’s also made a believer of her initially skeptical endocrinologist.
“My endo has gone on a positive journey. At first, she thought I would die of DKA or hypoglycemia. And if it wasn’t for the CGM, they would still be claiming that I achieved what I achieved with massive lows. Then the next time she was concerned by my cholesterol. Three months later, she said “It’s all good. Just tell me how you do things!”
“But what really breaks my heart is that I keep hearing that I’m an exception. That “this works for you.” They don’t have a single other patient that has such numbers, but anyone can eat the way I’ve been eating.”
While Natalia’s story is exceptional in many ways, the lessons are applicable for anyone with diabetes. Check out her website for a little inspiration.