optimising blood sugars with RD Dikeman
It has been a transformational journey for RD Dikeman since his son Dave was diagnosed with Type 1 Diabetes, both as a parent and for himself as he has implemented a regimen of what he likes to call “meal skipping” (a.k.a. intermittent fasting) guided by his own blood glucose levels.
I came across Dave Dikeman, a young man with Type 1 Diabetes, in Episode 831 of Jimmy Moore’s LLVLC Show. I still remember ten year old Dave saying “finger pricks now or amputations later, the choice is pretty simple”. Dave’s pragmatic attitude to his condition was another light bulb moment in our family’s journey to learning to manage diabetes.
It has also been quite a journey for RD Dikeman, Dave’s dad, who recently posted a few comments on the Optimising Nutrition Facebook Group that I thought were worth capturing.
I’ll tell you a quick story about how this whole low carb thing started.
Dave is near death, in the hospital, diagnosed with T1. The doctor rolls in to meet us. A kindly doctor – no Bernstein – but a very kindly man (he took an injection of insulin to show Dave not to be afraid).
So the doctor is talking to Dave and finds out they both went to the same school. So there’s some kinship. And the doctor recognizes that Dave is a pretty sharp guy and Dave starts asking questions ‘will I die young?’ And Doc is brutally honest ‘you have to control your blood sugars – amputations, blindness and those things are on the table’. And doc starts to give us a lecture on how to do that.
He has an easel and a sharpie. Anyway, he draws a rollercoaster blood sugar graph and he says ‘carbo makes blood sugar go up and insulin go down and you want to be between 80 and 180 (sigh) mg/dL.’
And Dave goes ‘I just won’t eat carbo’. TRUE STORY.!
And ME!! I interrupt and say (throw me down and kerb stomp me everyone) ‘You need carbo for… ENERGY’. LOL!
So I spent the next month force feeding Dave oatmeal. I am heckled daily for this. Every time there is oatmeal. Oatmeal on a TV commercial. Oatmeal at restaurant. Heckled!
About a month later guess who discovered ‘The Bernstein Book‘!!! NOT ME!! It was Roxanne (my wife). So that is two fails for me.
I will say the happiest moment of my life was reading Bernstein’s ‘law of small numbers’. I knew then that we had a way out of this mess.
Being 100% wrong never felt so good. I have a good leader. The whole thing was his idea.
Since then, RD has become passionate about the low carb way of eating and helping other people learn more about diabetes. He is an admin on the Type One Grit Facebook Page which is a great source of support and inspiration for people with Type One Diabetes. He and Dave also produce Dr Bernstein’s Diabetes University which captures nuggets from Dr B on YouTube.
RD lives low carb theory…
I don’t eat any carbohydrate-glucose foods. No sugar, manipulated sugar fruits, grains or starch. Ever. Carbs are only from fibrous veggies and nuts.
…and it seems to be working.
Dr Bernstein’s recommended target blood glucose is 83mg/dL (or 4.6mmol/L) with a recommendation that people with Type 1 Diabetes actively work to keep within a ten point range of this target number (i.e. 73 to 93mg/dL or 4.0 to 5.2mmol/L).
Dr B tells the story of how, back in the day, blood glucose meter sales reps would come to his office. He would get them to demonstrate how it worked by testing it on themselves so he could see their blood glucose number. Sure enough, the blood glucose levels of these healthy young non-diabetic sales reps was always around 83mg/dL.
Since then there has been plenty of research that showing the benefits of having an average blood glucose level of around 83mg/dL including reducing your risk of cancer, obesity, heart disease and a range of other metabolic issues.
Some people operate happily at the lower end of this range, particularly if they are younger and / or insulin sensitive and producing ketones. Generally though, the body of someone with a healthy metabolism will bring them back to a blood sugar of around 83mg/dL (or 4.6mmol/L).
Not too high. Not too low. Just right.
The table below shows a generalised relationship between blood glucose, ketones, HbA1c and the glucose : ketone ratio (GKI). There’s no perfect number for everyone, however typically the lower your HbA1c, without using blood glucose lowering medications, the lower your risk of metabolic syndrome and related diseases (see the Diabetes 102 article for more details).
|ketone||BG (mmol/L)||BG (mg/dL)||GKI||HbA1c||Comment|
RD is not technically diabetic himself however he understands the dangers of high blood glucose levels. RD found that the low carb way of eating helped him lower his own blood glucose, however he still wasn’t consistently achieving Dr Bernstein’s target blood glucose level of 83mg/dL.
What he did find was that when he waited to eat his blood glucose would come down as the body used up the glucose in his blood. Over time RD developed a practice of meal timing guided by his glucose meter that finally enabled him to optimize his own blood glucose levels.
My blood sugar tells me when it’s time to get some insulin sensitizing exercise at the gym also.
I would say if blood sugar is above normal (83 mg/dL) then beta cells are ‘on’ and insulin is a fat storage hormone (obviously other functions).
It’s your table exactly Marty Kendall!
This is the table that RD is excited about (from the using your glucose meter as a fuel gauge article).
|> 7 day average, well slept and low stress||consider delaying eating and / or exercising|
|< 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|
If your glucose is higher than YOUR average then you may not need to eat right now.
If you are insulin resistant, when you do eat, you should focus on foods that won’t spike your blood glucose levels.
Eating when your blood glucose is less than YOUR current average will allow you to progressively lower your blood glucose.
Decreasing average blood glucose = winning!
For most people it will take some time before they can get their blood glucose down to Dr B’s target of 83mg/dL. Using this method RD has been able to decrease his HbA1c from 5.3% to 4.8%.
If your blood glucose is below 73mg/dL (4.0mmol/L) then you may benefit from foods with a higher insulin load to replenish glycogen stores.
The continuous glucose meter plot below shows RD’s blood glucose levels after a few years of implementing Dr Bernstein’s advice in his family. Not bad!
I am able to lower my HbAc1 about 0.1% every six months. It’s not easy.
If you aren’t at mid 4s, look to belly fat and/or treating your body like an amusement park in younger days (guilty!)
One big takeaway from the journey has been how long it takes to heal the metabolism…. not a surprise if you’ve been sabotaging it for decades, I guess.
RD says it’s more than just the exercise. It’s the food and the fasting too.
I worked out plenty in 2006. Same gym.
RD understands that it is important for his long term health to do whatever he can to strip the fat from his body, particularly from his organs.
As we reverse fatty liver and fatty pancreas normal insulin sensitivity can be restored which in turn leads to normal blood glucose levels and normal body weight.
RD doesn’t use the scale to track his health, but rather his blood glucose meter.
I know if I eat too much food or if I stop working out, my blood sugar starts rising and I start to put on weight. This happens even with a low carb diet.
If I fast and work out, my blood sugar returns to normal. I feel better.
So really, I don’t use the (weight) scale, I can use my blood sugar meter instead.
Fixing your metabolism by learning how to eat and losing weight after years of eating the standard… well it takes some time… a few years in my case.
I’m still seeing improvement and motivated. I’m definitely not going back.
For more details on how to use your blood glucose meter as a fuel gauge check out this article.