Rien

Hi Ken, Thanks for your informing and inspiring comments. What is your view on the way Dr McDougall treats his diabetic patients? From what I have gleaned he seems to consider that a fasting glucose of less than 140mg/dl (8 mmol/l) is to be avoided, and that blood glucose should range between 140 and 220 mg/dl (8-12 mmol/l) all day. He seems to say that it’s quite OK to take one lantus injection per day, and not inject any mealtime insulin. Possibly his diet (no fat) protects against the ravages of diabetes. I think you said you spent time with the doctor on one of his intensives, and I wonder whether he elaborated on this. After my latest endo session, I’m a bit conflicted as to the risks and benefits of aggressively keeping blood glucose as close to 4.6 mmol/l (80 mg/dl) as possible. I’m looking forward to your take on this. Rien.

I have followed Ken’s no fat and the ‘both-ends’ blood sugar control technique. My last A1C was 5.2%. The endo was very angry, and gave me a stern lecture about how I was imperilling my life. Too bad ;) ! If I eat the slightest bit of fat, eg some peanut butter on a piece of toast, my sugar will be elevated for at least 24 hours. I am not as religious as Ken about this. I eat a third of a cup of oats in the morning. But I do avoid anything with oil in the ingredients. I have eased off a little on the effort to flatten the BGL spikes after a meal. After breakfast it may go to 10 mmol/L (180 mg/dl). I do this so I can do my daily 30km bike ride withouth having to worry about hypos. At the end of the ride my sugar is around 5 mmol/L, which I’m happy with. Could Ken and perhaps other T1Ds quantify insulin resistance in units of insulin injected? I know no real life diabetics I can compare myself to. At present I inject 8 units of long acting Levemir a day, and about 8 units of fast acting Novorapid (1 for breakfast, 3 for lunch and 4 for dinner). Thanks, Rien.

Hi Ken, Thanks for your extensive and informative response. You have definitely challenged me to get rid of my post-meal spikes, and achieve a better sync. My endocrinologist is going to be so unhappy!? I will start this new challenge today, probably with the midday meal first. Diabetes never gets boring! I mean this in a positive way. I'll just have to work out the practical details. Fortunately I have the Libre flash glucose monitor. It shows me my sugar at any time, a graph, and a trend indicating how fast my sugar is rising or falling, or steady. The bike ride will take some logistics. At present my sugar before breakfast is around 4.6 mmol/L (83 mg/dl). I eat, then ride. During the ride bgl goes up to about 9 mmol/L (162 mg/dl). By the time I get home two hours later it is back to 4.6 mmol/L (83 mg/dl). I do not inject rapid at present, and will have to think carefully how I will flatten that spike. Sorry about the jargon, bolus means rapid insulin (Novorapid in my case), as opposed to basal (Levemir). I was on Lantus, but it got me in trouble a few times. When I manage to inject into a blood vessel or a skinny spot, instead of slow acting, it becomes fast acting. Scary. I am very grateful to you for your blog. It prompted me 18 months ago to switch to a plant based starchivore way of life. It has been a wonderful journey, and I feel absolutely great. I have been worried about the spikes, but my endo assures me they will do no damage. I do not quite believe her in that respect. I will keep you informed about my progress. Thanks again, Rien Hofman.

Great post, Ken! I'd love to know your opinion about how to factor exercise into your control system. I'm a T1D, plant based whole foods low fat McDougall style. My A1c hovers around the 5.6 - 5.8%, total cholesterol is about 120 mg/dl. I too have a doctor who tells me my A1c is too low and dangerous. I'd like to get my A1c to the low fives. I haven't needed to bolus since being plant based. I take 4 units of Levemir at breakfast, and 2 units at the evening meal. I walk 6km (1 hour) before breakfast, and ride my bicycle for 2 hours after breakfast, every day. If I don't exercise, I need 30 units of Levemir instead of 6. Fasting bgl is around 90 mg/dl. After meals, I do get a spike, up to 220 mg/dl. Three hours later it is down to the 70s. That's the effect of both the tiny bit of Levemir and exercise. I would like to flatten the post meal spikes, but am concerned about exacerbating the exercise effect with rapid insulin, which would guarantee hypos every time. One option would be to eat smaller meals more frequently. Do you have experience with regular exercise in your regimen? I would love to know your take on this. Regards, Rien in Australia.