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how to use your glucose meter as a fuel gauge

  • While reducing carbohydrates is the first priority, high blood glucose levels and insulin resistance can also be a sign that you are eating too much and / or too often.
  • You can use your blood glucose meter as a fuel gauge to help you understand whether your hunger is real and refine your meal timing.
  • Delaying your next meal allows your body to use up the glucose in your blood.
  • Intermittent fasting will allow your the glucose in your blood stream to be replenished from the glycogen stores in your liver and muscle and allow energy to flow from your fat stores.
blood glucose action
>  7 day average, well slept and low stress delay eating and / or exercise
< 7 day average if hungry, enjoy nutrient dense foods that align with your insulin sensitivity
< 73mg/dL (4.0 mmol/L) if hungry, eat higher insulin load foods and delay exercise

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This approach is NOT intended for people who do not produce enough insulin (i.e. type 1 diabetes, type 1.5, LADA and MODY) but rather for people who are insulin resistant and produce large amounts of insulin but still have high blood glucose levels (i.e. type 2 diabetes, hyperinsulinemia and most people who are obese).

reducing insulin

Eating frequently will keep your insulin and blood glucose levels high, particularly if you eat high carbohydrate foods with a high insulin load.

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Reducing meal frequency enables blood glucose and and insulin levels to decrease.

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Insulin keeps fat stores locked in storage.  Reducing insulin levels allows body fat to be released for fuel.[1]

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Decreasing body fat, particularly from the liver, pancreas and kidneys leads to improved insulin sensitivity and normalised blood glucose.[2] [3]

Eating larger meals with more carbohydrate causes your blood glucose to stay higher for longer.   Conversely, having smaller meals with a lower insulin load allows your blood glucose levels will return to baseline faster, and if you’re following this protocol, you’ll be able to eat again sooner.

when to eat

You can use your blood glucose meter to help you know whether your hunger is real and whether or not to skip a meal or two or not eat for the day.

If you have some level of insulin resistance then chances are your blood glucose levels will be higher in the morning due to glycogen being released into the bloodstream as your body prepares for the day (a.k.a. Dawn Phenomenon).  If you are insulin resistant the insulin secreted by your pancreas doesn’t keep up with the release of glucose into the blood stream and hence your blood glucose will be high.

Dr Jason Fung says that the Dawn Phenomenon is your body’s way of purging excess energy.

The Dawn Phenomenon is simply moving sugar from body stores (liver) into the blood. That’s it. If your body stores are filled to bursting, then you will expel as much of that sugar as possible.

By itself it is neither good nor bad. It is simply a marker that your body has too much sugar. Solution? Simple. Either don’t put any sugar in (LCHF) or burn it off (fasting). Even better? LCHF + IF.[4]

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If you test your blood glucose in the morning and it’s higher than your current average then you might want to delay eating until your blood glucose comes back down.  This may mean eating your first meal early afternoon followed by an early dinner (e.g. 16:8 intermittent fasting).   Alternatively, you could skip dinner which would help to lower morning blood glucose and then eat breakfast and lunch.

Other people find it simplest to not eat for the whole day or even two days at a time and then resume normal eating to satiety the rest of the time.  As you get used to it you may want to try longer fasts which will accelerate the healing process.  Over time you’ll find a routine that suits you and be able to calibrate your feeling of hunger and reduce the frequency of testing.

tailored just for you

Many people agree that intermittent fasting is a good idea, but how do you whether you should be doing Michael Mosely’s 5:2 diet, Hugh Jackman’s 6:8, Kiefer’s Carb Back Loading and Carb Nite, Lyle McDonald’s TKD and CKD, Bert Herring’s Fast Five, Ori Hofmekler’s Warrior Diet, or Martin Berham’s Lean Gains?

It can be confusing when there are so many options out there!  How do you know which one is right for you and then how do you know if it’s working?  How can you refine and tweak to to reach your goals?  What if you just really feel hungry!?!?

The advantage of using your blood glucose level as a guide versus a regimented intermittent fasting protocol or a fixed calorie intake is that it accounts for your activity as well as your food intake.

Eating is not bad.  In the end it is about balancing your intake with your expenditure which is a challenge with abundant constant hyperpalatable food choices.

This approach helps you to fine tune when and how much you eat to your actual requirements right now.  Not so much that you’ll store fat, but not so little that you’ll down regulate your metabolism.

Your blood glucose meter can help you understand whether your hunger is real and re-calibrate your appetite signals.  If your blood glucose levels are lower than your average then your insulin levels will be decreasing and you’ll be using body fat.  If your blood glucose levels are increasing then you’re likely eating too much, your insulin levels are high and you’ll be storing the excess energy as fat on your body.

When using this approach you’re able to eat to eat to satiety  while keeping in mind that when you eat next will be influenced by whether or not your binge at this meal.  You could even use this approach to make sure you don’t overdo the refueling and keep the insulin load of your meals such that your blood glucose doesn’t go over say 120mg/dL (or 6.7mmol/L).  A blood glucose level over this is a sure sign that your glycogen stores are full and well and truly spilling over into your blood stream.

Many people find that they are able to eat less overall when intermittent fasting compared to trying to eat numerous ‘small’ meals.  Saint Augustine wisely said

“Complete abstinence is easier than perfect moderation.”

I think this also applies to our meal timing and portion sizing.

By choosing to eat only when your blood glucose is below YOUR average blood glucose level you can tailor the approach to your current situation and metabolic health.

Waiting until your blood glucose reaches optimal levels is not going to be realistic for most people.  It’s best to start from where you are now and work towards optimal.

In the study Adherence to hunger training using blood glucose monitoring: a feasibility study[5] the researchers found that participants did much better when they set their own personalised blood glucose target rather than waiting until their blood glucose levels reached some optimal target before eating.  The other noteworthy observation from this study was that people who were obese lost a significant amount of weight!

Overweight participants achieved significant weight loss over the two-week period, with an average loss of 1.5 kg (95 % CI 2.2, 0.9) and a corresponding reduction in BMI of 0.6 kg/m2 (95 % CI 0.3, 0.8), p < 0.001). By contrast, lean participants maintained their weight.

the end game

The long term goal is to achieve an optimal HbA1c of 4.5% which equates to an average blood glucose level of 83mg/dL (or 4.6mmol/L).  There are lots of really good reasons to keep your blood glucose and insulin levels in check such as reducing your risk for cancer…[6]

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…heart attack, stroke[7] and a whole range of western diseases.[8]

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People with Type 1 Diabetes following Dr Bernstein’s protocol try to keep their blood glucose within ten points of the optimal target level of 83mg/dL (4.6 mmol/l).  This means that they will dose with insulin when their blood glucose rises above 93mg/dL (or 5.2 mmol/l) and then eat to bring their glucose levels back up when they drop below 73mg/dL (or 4.0mmol/L).

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Someone who has a functioning pancreas but is struggling with insulin resistance, hyperinsulinemia and / or obesity can use a similar process to manage their blood glucose and insulin levels.  But rather than dosing with insulin to bring their blood glucose down (they typically already have more than enough insulin!) they simply delay eating until they burn through the excess blood glucose.

Waiting to eat until your blood glucose levels are below your recent average will ensure that they decrease over time.  Most glucose meters will display the average glucose level for the last seven, fourteen and thirty days so it is easy to tell what your current target is.

If you’re really eager you could go to the trouble of graphing your blood glucose numbers, but in the end if your seven day average is less than your fourteen day average then you’re moving in the right direction.  Over time you want to see your average blood glucose levels coming down, so if you see them drifting up then you it’s a sign that you need to intensify your fasting somehow.

Normalising blood glucose and insulin will often lead to optimal weight, particularly if you’re insulin resistant.  However some people will still need to pay attention to cutting calories once blood sugar and insulin is normalised.

when not to use this approach

Exercise may raise your blood glucose in the short term due to the body dumping glycogen from your liver into the bloodstream to fuel the exercise.  If you don’t eat as much after exercise your body will have to replenish the glycogen stores from the energy stores on your body.

There will be times when you’re really hungry or it will be appropriate to eat for social reasons such as a party, family gathering etc.  Periodic feasting is a normal part of our culture.  This system would help you to get back on track and work around these times.

You should also keep in mind that there are other things that affect blood glucose including stress, sleep, sickness, hormones and exercise that you will need to manage and be mindful of when deciding whether to delay a meal due to your blood glucose being high.

Fasting may not be ideal if you’re already stressed, sick, not sleeping well and / or are pushing the exercise envelope.  During these times it maybe better to focus on life maintenance and listen to your appetite.

Dr Jason Fung pointed out:

Medications and insulin obviously would gum up the entire system. The other thing would be stress (cortisol) also increases blood sugars. 

If you could control for those two things, then this would definitely be an idea worth testing.   

I like the idea of varying the fasting period.   I think that intermittency is a key component to success.

So if you are taking insulin or other blood glucose lowering medications you will need to make sure they are reduced so you are not having to eat to raise your blood glucose because of the medication.

The problem with injected insulin or many other diabetes medications is that, while it may help to reduce blood glucose levels, it also drives the energy back into the cells rather than allowing the stored energy to flow out of storage.  The more you reduce insulin (injected or produced from your own pancreas) the quicker the healing can occur.  However the same time it would be prudent to reduce medications progressively to prevent your blood glucose levels from going too high.[10]

High blood glucose levels can be a sign that you’re stressed, exhausted or your hormones are out of whack (including time of the month for females), all of which will lead to insulin resistance.  You can use Heart Rate Variability to track your stress and exhaustion with an app such as Elite HRV which enables you to see when you’re exhausted and need to back off and rest.

If you just don’t feel like fasting and your blood glucose levels are high it’s probably a sign that you need to rest, relax, sleep, meditate, see some real sunlight during the day and stop gazing into the iPad before you go to bed.   Using f.lux on your computer or blue blocking glasses after sunset is worth considering.

While longer therapeutic fasts can be beneficial, a shorter feast / fast cycle that brings your blood glucose level down to below your average is likely to be more useful to improve your metabolism while reducing the extreme swings in water weight or any concerns that you’re not getting adequate protein to support lean body mass.

ketones and the glucose: ketone index (GKI)

The simplest approach is just to measure your blood glucose levels when you feel hungry and not eat until they drop below your target level.  You could still use this approach even once you have improved your insulin sensitivity to lose weight by targeting even lower blood glucose levels before eating.

Monitoring your blood glucose will work whether you are insulin sensitive or insulin resistant, obese or normal weight.  The body does an amazing job of replenishing your glycogen stores and stabilising your blood glucose whether it be from carbohydrates, gluconeogenesis from amino acids or even gluconeogenesis of fat once you are highly insulin sensitive.

Once you are starting to get your blood glucose levels under control you could start to track your ketones or the glucose: ketone index (GKI).  Decreasing glucose along with rising ketones is a sign that your glycogen stores are being depleted and you your hunger is legitimate.[11]

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If your average glucose is under 90mg/dL (5.0mmol/L) then you could even start tracking the ratio between your glucose and ketones (GKI)[12] and delay eating until your GKI is under a certain level.

Alternatively you could simply not eat until your ketone levels were greater than a certain level.  You could start with a target ketone level of 0.4mmol/L and keep winding that up till you achieve your desired results.  However testing blood ketones every time you feel hungry could be a costly exercise.

While all these things are important and useful, make sure to use them as tools to help you live life rather than taking over your life and stressing you out.  Your goals need to be realistic and tailored to your situation.  Hopefully in time this ‘hunger training’ approach will help you build new habits around eating which will mean you won’t need to rely as much on the testing.

fast well, feast well

Keep in mind If you are eating less food less often you will need to maximise nutrient density when you do eat, including ensuring that you are getting adequate protein to maintain lean muscle mass over the long term.

 

Best of luck if you chose to try this approach.  I look forward to hearing how you go.  Be sure to share your experience in the comments below.

 

references

[1] http://bja.oxfordjournals.org/content/85/1/69.long

[2] https://intensivedietarymanagement.com/fatty-pancreas-t2d-9/

[3] http://care.diabetesjournals.org/content/early/2015/11/29/dc15-0750?patientinform-links=yes&legid=diacare;dc15-0750v1

[4] https://intensivedietarymanagement.com/dawn-phenomenon-t2d-8/

[5] http://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-015-0017-2

[6] http://onlinelibrary.wiley.com/doi/10.1002/ijc.29917/epdf

[7] http://cardiab.biomedcentral.com/articles/10.1186/1475-2840-12-164

[8] http://diabesity.ejournals.ca/index.php/diabesity/article/view/19

[9] http://lowcarbbetterhealth.blogspot.com.au/2016/02/day-37-2016-weight-loss-and-blood.html

[10] https://optimisingnutrition.com/2015/08/17/balancing-diet-and-diabetes-medications/

[11] http://www.nature.com/articles/ncomms10580.epdf?shared_access_token=MUKioJXu6KVY753YIDoPVNRgN0jAjWel9jnR3ZoTv0NZFUsLxRRWAKMsrNHEbSj2q0khGxVdwhqgBvlELqp6rtnjRj5ppdqpqF9VFYO_6UzYPSf3Z5ZW4kFdG4GQIZ71IGlh7tQHXrGHJ2Nz7rN5iw-9csWuhb9uHxuz_-28FyOP6Tcmjd1H9Uxq9OwlIQTy

[12] https://optimisingnutrition.com/2015/07/20/the-glucose-ketone-relationship/

 

44 thoughts on “how to use your glucose meter as a fuel gauge”

    1. That’s the point of using your current average blood glucose level. You start from where you are currently at. By eating only when your blood glucose us less than YOUR average you will make sure you are not over eating,

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      1. I just use the average on my meter. I was also entering it into a spreadsheet for a while but it’s hard to do every day and takes time. Using the blood glucose meter is instant and current.

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      2. If insulin is perpetually elevated the blood sugar would still appear relatively low. For people with metabolic syndrome a blood sugar of 90-100 might appear “not too bad” for them but could just be suppressed by their high basal insulin levels. This is why I think testing ketones is more useful. Higher ketones I think means low basal insulin levels in your body. Sometimes a slightly higher blood sugar of 100-120ish for a person with the metabolic syndrome who is attempting to improve via IF is more showing that basal insulin is coming down. The trouble with BG is that it could be high for many reasons, low for many reasons and it could be in flux either rising or falling. Insulin is the real issue and a BG meter does not tell you anything about insulin as most obese people although chronically hyperinsulinemic (they have body fat so they have too much insulin in their system) are not always diabetic! They may get T2 later in their lives but young obese people maintain normal or very close to normal Bs. Doesn’t mean they are healthy. They are insulin resistant and produce ever more insulin to maintain relatively normal BG. This is pre-pre-diabetic. It is my opinion that anyone obese is pre-pre-diabetic, even if they have normal blood sugars. I am not fat shaming. I am post obese myself. All the people who said “you are not unhealthy” and “you are the way God made you” and “we are all different” were totally wrong.

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      3. I agree Danyelle. If you do have high blood glucose levels I think it’s useful to use IF or LCHF to get those down to normal levels. I mentioned in the article, once you get your BGs to normal you can add ketones or better yet track your glucose : ketone ratio which is a really useful estimation of your insulin levels, not just blood glucose.

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  1. This comment from Raymund Edwards is worth repeating:

    “I FAST two days most weeks (last week I did 4) I consider up till 7 DAYS an intermittent FAST , over 7 days I consider a Therapeutic FAST ( I have done three of these , 12 DAYS , 21 DAYS and 43 DAYS – you get good at it by doing it)

    I do the short fasts every week mostly and longer fasts twice a year (that is 7 days or over)

    FASTING DAY = no breakfast go to bed FASTED
    FEEDING DAY = protein rich breakfast

    I FAST WELL (no breakfast go to bed FASTED)
    and I FEED WELL (focus on proteins and nutrients)

    FAST is about ketones and their signalling (get them HIGH) in context of LOW BG and INSULIN.

    FEEDING is about amino acids and their signaling .

    imv FASTING is FASTING (what people call IF is just skipping meals) in consecutive days fast – ketones very soon go over 5 /6 ( and even 7 – 8+)

    THAT is FASTING !!

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  2. Great article! Thanks Marty and all responders.

    I finally got a ketone/glucose metre (but only the ketone strips at this point).. I have just “fed” after a 3 day fast but my ketones only got up to .8mml even though I’ve been low carb for several months. 30min after my meal my ketones were at .5mml still.. I thought it would have been better than that whilst fasting and worse after eating.. Look forward to getting some glucose strips for my next fast..
    Cheers

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  3. Deb–I’ve been keto-adapted for a couple of years, and when a snow storm blew over our town, my ketones DROPPED into the non-therapeutic range! We’re talkin’ .2 and .1–it happens sometimes, and without explanation. My only excuse was weather-related, which is backed up by Dr. Bernstein, who says that low pressure fronts cause the blood vessels to expand, leading to more total blood volume (and more sugar in that blood). I no longer sweat the weather–instead, I just keep on chugging with my meter, cooking and eating the foods that don’t cause much rise, fall reliably back to baseline, and give me the ketone levels I expect (usually 1.0 and above).

    Now Marty’s given me another use for my meter. If you were to combine Marty’s method above with his low-insulinogenic recipes, you’re sure to come out a winner!

    My problem: I fall asleep around 8 each evening, so delaying dinner is problematic, since I check my blood 1 hr. and 2 hrs. post-meal. The final blood check (and ketone check) would have to happen while I was asleep. I choose to delay (or skip) breakfast instead. Now I can put Marty’s method in place as another tool in my arsenal.

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    1. The weather thing is interesting. There’s been lots of talk lately about cold thermogenesis etc on metabolism.
      I also wouldn’t use this approach to delay your meal late into the night. Maybe skip dinner or breakfast and see how it goes.

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  4. Marty, you know from my comments on FB that I’m concerned that this approach, when not used by diabetics (who it seems to be designed around) may be, or cause, disordered eating.
    And maybe I’m just prejudiced against it for that reason, but for me, I usually eat “lunch” (first meal of the day) after exercising. Exercising always affects my BG the same – BG stays stable or even goes up a few points (no surprise, glucose demand from exercising). I usually eat my first meal after exercising each day, and I am hungry to very hungry at that time. My BG meter tells me I have “adequate” BG, but so what? I’m physically hungry at that point. And, I’m in my eating window, coming off a 16-hour fast with exercise at the back end of it. It seems to me that waiting an hour or two (or -?), at great personal discomfort, is questionable value. This is especially true considering that, for me, eating at this point (LCHF) then always makes my BG go DOWN in the subsequent hours.
    Strong physical hunger to me simply trumps this approach, at least in the context of being LCHF long-term.
    So maybe this approach is not for everyone. Just sharing my own experience here. But, cheers and more power to those people empowered to improve their health with this approach.

    Liked by 1 person

    1. Thanks Wendy. Fasting is certainly not for everyone. And the idea of this approach is to slowly and incrementally bring glucose levels down rather launching into a dramatic long fast that may be unrealistic. As noted in the article exercise will affect your blood glucose levels as will stress, sleep and a bunch of other things that are more important than intermittent fasting. Definitely important not to use it as an approach to starvation, but I do think paying attention to the blood glucose meter makes more sense than calories or scale weight.

      Liked by 1 person

    1. Depends what your goal in doing the blood glucose measurements is. Taking your waking blood glucose is a good way to keep track of your overall insulin sensitivity. If you’re following this protocol you’d be taking glucose readings before your meals. If you wanted to find out whether what you just ate worked for you you would take a measurement an hour or two after your meal (obviously the lower the better). If you’re gunning for this approach the aim is for the overall average to be coming down over time.

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  5. Today on LC Conversations over at JM’s, they discussed hunger as a mood. I struggle with hunger out of boredom, but remind myself to go find something to do instead of standing in front of the open fridge looking for something to eat. Am I really hungry? My stomach says no, my meter says no, but my head says YES! So I go scrub, vacuum, or iron something…

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  6. Anyone in Aus – went to buy Glucose strips for my Optium Neo the other day and was asked for Medicare card.. was a bit confused, guess there is a “diabetes database” or something.. anyway, they were too expensive, so didn’t’ get them.. Do you have a fav place to buy the strips on line as I’m in a Regional Area. Will be in Adelaide in a few weeks if there is a chemist anyone there..
    Cheers

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    1. Deb, there is a Govt. subsidised scheme called National Diabetes Services Scheme which provides strips etc for diabetics at a cheaper price. So that would have been why they asked for a Medicare card or there is a NDSS card which has to be presented to get the cheaper price. The ketone strips are not subsidised and they are nearly a dollar each!

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  7. I’ve come across this new product called keyasmart. Blood glucose plus keytone both from same strip.
    Check it out at keyasmart.com

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  8. Marty, following on from our comments exchange just now on Reversing Diabetes, I didn’t want to totally hijack that thread so continuing here..😊

    I’m told by my (progressive) GP here that I am not T2DM …..yet.
    Looking at the work of Kraft which Ivor Cummins has so wonderfully brought to light, I would say I am definitely diabetic… what say you please looking at these my latest path results?
    HbA1c: 5.6
    Glucose fasting: 6.3
    Insulin fasting: 18.0 (down from all time high 35.3 July 2014)
    Trig: 3.25
    Cholesterol also problematic.

    TIA,thanks kindly
    Eileen Janeke

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    1. Eileen, no you haven’t🙂 My mom is 75 and she brought her blood sugar under control (HbA1c from 11 to 6.3, still a bit to go) with LCHF and a little bit of fasting within 3 months. She’s feeling so much better, more energy, clearer thinking. We thought she was going senile when she really suffered from glucose-induced brain fog!

      Liked by 1 person

  9. Hi Marty, I’m so pleased to have come across your blog. This is such interesting information. Awesome stuff. A question: when you’re talking about your ‘average’ blood glucose level; what time of the day or how many hours before or after food are you measuring this? Thanks for clarifying. Katrin, Canberra.

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    1. For me it’s just the average on my meter. I test a few times a day. It’s useful to eating in the morning and before or after meals. No need to get caught up on the number or timing though, just make sure the trend is in the right direction. So glad you like the blog and it resonates with people!

      Liked by 1 person

  10. Just discovered this post and although I’m not diabetic I just started taking my wake up blood glucose reading to determine how much my body is healing. I typically do a 3-4 day fat fast (~350 calories per day) every other week. I alternate those weeks with weeks that have two 24 hour fasts and one 42 hour fast. If I changed things based on my BG reading, how would it work exactly? I only do a reading once a day. If my reading is higher than my average I don’t eat for that whole day? Then I’d assume the next day I’d likely be below my average so I’d eat two meals that day? Am I understanding that correctly? I’d assume this method then wouldn’t have me doing multi-day fasts, correct?

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    1. I don’t think the exact routine matters as long as your glucose or weight at the end of the fasting period is lower than the period before. If you are not going in the right direction you would try to eat less when you do eat, extend the fasting period or fast more frequently. That way you can find the routine that suits you best. If you only want to test once per day you would make the decision to fast based on your glucose or weight at the same time each morning.

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  11. Thank you for this information. FYI: There is a typo “….People with Type 1 Diabetes following Dr Bernstein’s protocol try to keep heir…”

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