- While reducing carbohydrates is the first priority for someone with diabetes, high blood sugar levels and insulin resistance can also be a sign that you are eating too much and / or too often.
- You can use your blood sugar meter as a fuel gauge to help you understand whether your hunger is real and refine your meal timing to achieve blood sugar levels closer to optimal.
- Delaying your next meal allows your body to use up the glucose stored in your liver and blood.
- Intermittent fasting will allow the glucose in your blood stream to be replenished from the glycogen stores in your liver and muscle, rather than more food, and allow energy to flow from your fat stores.
The table outlines a protocol that will help you to use your blood sugar meter as a fuel gauge.
|> 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|
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 sugar levels (i.e. pre-diabetes and type 2 diabetes).
Reducing meal frequency enables blood sugar and insulin levels to decrease.
High levels of insulin keeps fat stores locked in storage and glycogen stored in the liver. Once our fat stores can’t take any more fat they become insulin resistant which makes it harder for insulin to get into the fat cells, but then the pancreas ramps up insulin production trying to clear the high blood glucose levels in the blood and to keep the glucagon stores in the liver.
Reducing insulin levels allows the liver glycogen stores to be emptied, then the body finally turns to body fat for fuel.
Eating larger meals with more carbohydrate causes your blood sugar to stay higher for longer. Conversely, having smaller meals with a lower insulin load allows your blood sugar to return to baseline faster.
when to eat
You can use your blood sugar 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 sugar levels will be higher in the morning due to liver glycogen being released 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 sugar 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.
What is the solution? Simple. Either don’t put any sugar in (LCHF) or burn it off (fasting). Even better? LCHF + IF.
If you test your blood sugar in the morning and it’s higher than your current average then you might want to delay eating until your blood sugar comes back down. This may mean eating your first meal early afternoon followed by an early dinner (i.e. 16:8 intermittent fasting). Alternatively, you could skip dinner, which would help to lower morning blood sugar 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?
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 reach your goals? What if you just really feel hungry but it’s not “time to eat” yet!?!?
The advantage of using your blood sugar level as a guide versus a regimented intermittent fasting protocol or a fixed calorie intake is that it accounts for the energy your burn as well as what you’re eating.
Eating is not bad. In the end it is about balancing your intake with your expenditure which can be a challenge when we are surrounded by cheap hyperpalatable foods.
This approach helps you to fine tune when and how much you eat to your actual requirements.
Your blood sugar 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 sugar levels are increasing then you’re likely eating too much and / or too often which will drive high insulin levels which means you’ll be storing 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 refuelling and keep the insulin load of your meals such that your blood sugar doesn’t go over say 120 mg/dL (or 6.7 mmol/L). A blood sugar 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.
Waiting until your blood sugar 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 sugar monitoring: a feasibility study the researchers found that participants did much better when they set their own personalised blood sugar target rather than waiting until their blood sugar 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 by using their blood glucose levels to guide when they should eat!
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 sugar level of 83 mg/dL (or 4.6 mmol/L).
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 83 mg/dL (4.6 mmol/l). This means that they will dose with insulin when their blood glucose rises above 93 mg/dL (or 5.2 mmol/l) and then eat to bring their glucose levels back up when they drop below 73mg/dL (or 4.0 mmol/L).
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 sugar 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 sugar 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 your blood sugar and insulin is normalised.
when not to use this approach
Exercise may raise your blood sugar in the short term due to the body dumping glycogen from your liver into the bloodstream for fuel. If you don’t eat as much before or 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 sugar 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 sugar 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 may be better to focus on life maintenance and listen to your appetite.
The problem with injected insulin or many other diabetes medications is that, while it may help to reduce blood sugar 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, at the same time it would be prudent to reduce medications progressively to prevent your blood glucose levels from going too low.
High blood sugar 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 sugar 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 sugar levels 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 sugar 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 sugar 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 sugar 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, your insulin levels are reducing and you your hunger is legitimate.
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 0.4 mmol/L and keep winding that up till you achieve your desired results. However testing blood ketones every time you feel hungry could be expensive.
There is no need to worry about ketones and the GKI though if your average glucose is above 90mg/dL (5.0 mmol/L) because it’s likely that your insulin will be high and your ketones still low.
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 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.
post last updated May 2017