Great article which raises many viable viewpoints. MDI as a preference with good consistent results 5.8 - 6.0 ac1, with low variability. Pumps have many benefits for a large subset of folks..just not everyone
Very interesting article. I am Type 1 and 68 years of age. I have Peripheral Neuropathy despite having normal A1Cs. I keep my blood sugars in as tight a range as possible. I have been told by three neurologists that even if my BS are within a non diabetic range, I can still develop PN. So discouraging. I am on multiple injections daily. Tresiba 6 U daily. I’ve had to decrease it to 4U over the summer. Fiasp 5 U in the am, depending on my food intake and 1 U of R to cover Amy protein. This is a tough disease.
Love all of your articles, can't believe this is free, very informative, this is no exception. All of them hit straight to the core. Love Steve Jobs reference. I'd call your efforts on this substack Steve Jobs-esque, lol.
But are low-carb diets really legacy? I have T1D for 26 years (essentially all my life), but I never really tried going super low carb until recently. And it was amazing when it came to BG values. It's definitely not something pleasant to follow but it does help tremendously. Your base BG level drops significantly as well as insulin consumption which leads to almost 0 swings, I felt like a healthy person because my blood glucose would mostly stay below 6 mmol/l (108 mg/dl) and quite stable. Combine this with exercise and it's very poweful although exercising became a bit harder the more time passed without consuming higher amount of carbs which I was used to, so I went back after a month... Maybe I just needed more time to adjust, will try again but low-carb definitely has great potential for me I think, I just need more experimentation.
I feel like your expression “The more things change, the more they stay the same.” really fits here. Since 1920s for type 1 diabetes all we basically have is insulin, yet still the most effective way is what people did before we got insulin - restrictive diets. Of course not to the same extent and insulin-diet combo helps tremendously but still it's not a 100% saviour and the greatest results for your overall well-being is to use the least amount of artificial insulin possible, not to mention all the other things we have now which are even less meaningful - CGMs (although very useful but still you can do away without if you really wanted, also the question rises how much negative effects it brings because of constant monitoring and stress because of it - sometimes you get caught in a fighting loop as I would call it, when not knowing would be even better for your values - I definitely experience this sometimes), pumps, automation.
Low-carb diets have been a hotly discussed topic in general health, not just T1D. Studies have shown that "low-calorie" diets are more beneficial to health for all animals, including humans.
The problem is that there's a trade-off between carb intake and carb expenditure--also called "energy balance." And this is where metabolic health comes into play. To build a healthy metabolism, one needs to develop lots of really good, strong, efficient mitochondria, and those organelles grow in response to exercise (primarily). And, as you yourself discovered, it's hard to exercise without more carbs, because that's the fuel that muscles use to generate energy. And because the mitochondria is the engine that converts the fuel (glucose) into energy (ATP), and the byproduct of that process is lactate, and lactate is the primary molecular catalyst for building new mitochondria.
We now have a virtuous cycle: Exercise requires more glucose, which generates energy to allow for more exercise, which increases both the number and efficiency of mitochondria, allowing for a healthier body writ large.
The problem with low-carb diets is that people generally can't or don't exercise, which has a greater effect on long-term all-cause mortality than almost anything else. Decades of peer-reviewed studies cover hundreds of thousands of people (totally well over millions) have shown the positive effects of a healthy metabolism lead to a greater reduction of all-cause mortality than the risk associated with higher glucose levels. Citations are in my article T1D and Health: How Long Will You Live?
This is why Dr. Bernstein's book was so controversial-- yes, one CAN achieve lower A1c levels via a lot-carb diets, PRESUMING that one can actually stick with it over time, which studies show is extremely difficult for most people. But it comes at the cost of neglecting to get sufficient exercise, thereby failing to achieve the metabolic health that can lead to lower health risks.
Glycemic control is hard for T1Ds, no one is questioning that. There are two (general) approaches. Carb restriction, or exercise -- both reduce blood glucose levels. Maintaining a low-carb diet is really hard, but so is achieving healthy exercise regimens. It's nearly impossible to do both. So, it's now a trade-off.
Given the far superior health outcomes that come with exercise, most (quality) T1D educators say that one should try to achieve an appropriate energy balance to get sufficient exercise first, which requires far more carbs/day than what would be prescribed in a typical low-carb diet. If one does not exercise, then the fall-back approach would be to reduce carb intake.
In short, don't take in more carbs that you can't burn off via exercise, but don't starve yourself of carbs just for the sake of doing so. Err on the side of higher carbs if you can exercise. The healthier metabolic health outcome is more beneficial.
Cinnamon as a supplement gets ragged on pretty hard in the T1D community for obvious reasons. I am coming from a place of genuine curiosity when I ask: is it really completely useless for a T1D? There seem to be a lot of studies that point toward the fact that cinnamon extract can be beneficial for insulin resistance. Is this a case of malinformation? Does cinnamon really have zero utility for T1Ds, or is it simply that T1Ds are tired of hearing people suggest cinnamon as a cure, and so we throw it out entirely, ignoring any potential benefits (however small they might be)? Would love to hear your thoughts on it, as I haven't read the literature about it as deeply as I'm sure you have.
That article was written by the people who conducted a study on adolescent T1Ds and they found there was no evidence of any benefit. In the intro paragraphs, they cite the research on T2Ds and others where the investigators found some benefit in a variety of pathways that ultimately lead to the metabolic mechanisms that regulate glucose levels. However, it's not been easy to replicate these results in other trials, leading many to ultimately conclude that whatever the mechanisms are that may be helpful for some are too erratic and unpredictable to confer to the population.
Though it shouldn't be surprising, this is not an unusual phenomenon---the mechanism of action for many drugs (or foods, nutrients, activities, etc.) is often similar to what's happening with cinnamon: sometimes there's signal, but it's often too buried by noise and too erratic and unpredictable to establish a recommended therapy (dose, frequency, benefit, harms, etc.). A lot of psychiatric medications face this problem, for example.
As for why whatever mysterious effects that cinnamon may have with some people do not seem to effect T1Ds at all is likely because whatever the benefit there may be, it's so minimal that it's entirely lost within the enormous glucose hurricanes that happen within our bodies on a regular basis. For there to be any material effect, the dose would have to be elevated to such high proportions that it would cause significant toxicity.
Great article which raises many viable viewpoints. MDI as a preference with good consistent results 5.8 - 6.0 ac1, with low variability. Pumps have many benefits for a large subset of folks..just not everyone
Very interesting article. I am Type 1 and 68 years of age. I have Peripheral Neuropathy despite having normal A1Cs. I keep my blood sugars in as tight a range as possible. I have been told by three neurologists that even if my BS are within a non diabetic range, I can still develop PN. So discouraging. I am on multiple injections daily. Tresiba 6 U daily. I’ve had to decrease it to 4U over the summer. Fiasp 5 U in the am, depending on my food intake and 1 U of R to cover Amy protein. This is a tough disease.
Love all of your articles, can't believe this is free, very informative, this is no exception. All of them hit straight to the core. Love Steve Jobs reference. I'd call your efforts on this substack Steve Jobs-esque, lol.
But are low-carb diets really legacy? I have T1D for 26 years (essentially all my life), but I never really tried going super low carb until recently. And it was amazing when it came to BG values. It's definitely not something pleasant to follow but it does help tremendously. Your base BG level drops significantly as well as insulin consumption which leads to almost 0 swings, I felt like a healthy person because my blood glucose would mostly stay below 6 mmol/l (108 mg/dl) and quite stable. Combine this with exercise and it's very poweful although exercising became a bit harder the more time passed without consuming higher amount of carbs which I was used to, so I went back after a month... Maybe I just needed more time to adjust, will try again but low-carb definitely has great potential for me I think, I just need more experimentation.
I feel like your expression “The more things change, the more they stay the same.” really fits here. Since 1920s for type 1 diabetes all we basically have is insulin, yet still the most effective way is what people did before we got insulin - restrictive diets. Of course not to the same extent and insulin-diet combo helps tremendously but still it's not a 100% saviour and the greatest results for your overall well-being is to use the least amount of artificial insulin possible, not to mention all the other things we have now which are even less meaningful - CGMs (although very useful but still you can do away without if you really wanted, also the question rises how much negative effects it brings because of constant monitoring and stress because of it - sometimes you get caught in a fighting loop as I would call it, when not knowing would be even better for your values - I definitely experience this sometimes), pumps, automation.
Low-carb diets have been a hotly discussed topic in general health, not just T1D. Studies have shown that "low-calorie" diets are more beneficial to health for all animals, including humans.
The problem is that there's a trade-off between carb intake and carb expenditure--also called "energy balance." And this is where metabolic health comes into play. To build a healthy metabolism, one needs to develop lots of really good, strong, efficient mitochondria, and those organelles grow in response to exercise (primarily). And, as you yourself discovered, it's hard to exercise without more carbs, because that's the fuel that muscles use to generate energy. And because the mitochondria is the engine that converts the fuel (glucose) into energy (ATP), and the byproduct of that process is lactate, and lactate is the primary molecular catalyst for building new mitochondria.
We now have a virtuous cycle: Exercise requires more glucose, which generates energy to allow for more exercise, which increases both the number and efficiency of mitochondria, allowing for a healthier body writ large.
The problem with low-carb diets is that people generally can't or don't exercise, which has a greater effect on long-term all-cause mortality than almost anything else. Decades of peer-reviewed studies cover hundreds of thousands of people (totally well over millions) have shown the positive effects of a healthy metabolism lead to a greater reduction of all-cause mortality than the risk associated with higher glucose levels. Citations are in my article T1D and Health: How Long Will You Live?
(https://danheller.substack.com/p/t1d-and-health-how-long-will-you-live)
This is why Dr. Bernstein's book was so controversial-- yes, one CAN achieve lower A1c levels via a lot-carb diets, PRESUMING that one can actually stick with it over time, which studies show is extremely difficult for most people. But it comes at the cost of neglecting to get sufficient exercise, thereby failing to achieve the metabolic health that can lead to lower health risks.
Glycemic control is hard for T1Ds, no one is questioning that. There are two (general) approaches. Carb restriction, or exercise -- both reduce blood glucose levels. Maintaining a low-carb diet is really hard, but so is achieving healthy exercise regimens. It's nearly impossible to do both. So, it's now a trade-off.
Given the far superior health outcomes that come with exercise, most (quality) T1D educators say that one should try to achieve an appropriate energy balance to get sufficient exercise first, which requires far more carbs/day than what would be prescribed in a typical low-carb diet. If one does not exercise, then the fall-back approach would be to reduce carb intake.
In short, don't take in more carbs that you can't burn off via exercise, but don't starve yourself of carbs just for the sake of doing so. Err on the side of higher carbs if you can exercise. The healthier metabolic health outcome is more beneficial.
Cinnamon as a supplement gets ragged on pretty hard in the T1D community for obvious reasons. I am coming from a place of genuine curiosity when I ask: is it really completely useless for a T1D? There seem to be a lot of studies that point toward the fact that cinnamon extract can be beneficial for insulin resistance. Is this a case of malinformation? Does cinnamon really have zero utility for T1Ds, or is it simply that T1Ds are tired of hearing people suggest cinnamon as a cure, and so we throw it out entirely, ignoring any potential benefits (however small they might be)? Would love to hear your thoughts on it, as I haven't read the literature about it as deeply as I'm sure you have.
insofar as T1D is concerned, see this study: https://diabetesjournals.org/care/article/30/4/813/25739/The-Effect-of-Cinnamon-on-A1C-Among-Adolescents
That article was written by the people who conducted a study on adolescent T1Ds and they found there was no evidence of any benefit. In the intro paragraphs, they cite the research on T2Ds and others where the investigators found some benefit in a variety of pathways that ultimately lead to the metabolic mechanisms that regulate glucose levels. However, it's not been easy to replicate these results in other trials, leading many to ultimately conclude that whatever the mechanisms are that may be helpful for some are too erratic and unpredictable to confer to the population.
Though it shouldn't be surprising, this is not an unusual phenomenon---the mechanism of action for many drugs (or foods, nutrients, activities, etc.) is often similar to what's happening with cinnamon: sometimes there's signal, but it's often too buried by noise and too erratic and unpredictable to establish a recommended therapy (dose, frequency, benefit, harms, etc.). A lot of psychiatric medications face this problem, for example.
As for why whatever mysterious effects that cinnamon may have with some people do not seem to effect T1Ds at all is likely because whatever the benefit there may be, it's so minimal that it's entirely lost within the enormous glucose hurricanes that happen within our bodies on a regular basis. For there to be any material effect, the dose would have to be elevated to such high proportions that it would cause significant toxicity.
Great job! Love reading this, I've been taking insulin for 50 years
Scotty King
Thanks for sharing that New York Times article. It is indeed very visual and very scary.