The best diet for optimal blood sugar control & health
Videos of the lectures given at the Public Health Collaboration conference 2018 which was held in May over the royal wedding weekend have now been released on You Tube.
You can see my talk, Achieving your optimal blood sugar target, as well as others, on the link below. There are a wide variety of lifestyle topics discussed. Happy viewing.
https://www.youtube.com/results?search_query=public+health+collaboration+conference+2018
An oxymoron I know—the words ‘race’ and ‘me’ aren’t a natural fit. If what I did on Sunday 30 September could be described as racing, I challenge you to find that tortoise and it isn’t the one that beats the hare.
Anyway, here’s how the Great Scottish Run panned out for me. The annual race is the largest running event in Scotland and this year it attracted 30,000 participants in both the 10k and half-marathon.
I started in the pink wave (i.e. the slow coaches) and the start was snail-like thanks to the sheer numbers. No complaints from me there as a slow start is what every expert recommends.
Running over the Kingston Bridge is something else—it presents the views of Glasgow that turn up in black backdrops on TV programmes, in films and books set in the city. You see the armadillo, the Finnieston Crane, the towering Hilton Hotel and the odd church spire or two, silent monuments to the man-made standing either side of the mighty Clyde.
The run always attracts the elites and the fastest man, Chris Thompson, finished in 1.02.07 with the fastest woman at 1.09.15. There was also a proposal at the finish line and the woman said ‘yes’.
As the fastest woman crossed the finishing line, yours truly was still at mile seven chanting the mantra “you can, and you will do this” over and over in a mind versus body competition. Thanks to clever tech, my husband was able to track my progress through the Great Scottish Run app and managed to cheer me on those last 50 metres over the finishing line, two hours and thirteen minutes after I started.
[Instead of missing my triumphant sprint to the end as happened at the last race.]
And the diabetes care? Ahem! Everything I did points to how not to train for a half marathon and what not to do on the day. Dear reader, the furthest I ran in training was seven miles, although I had the odd day where I ran twice as per what ultra-marathon runners do in training. I managed to run the whole thing without even a toilet stop.
On the day, I woke up with super-high blood sugars thanks to a roll I’d eaten the night before. Yes, just one lousy bread roll rocketed my blood sugar levels through the night and my first test of the day was 18.6. I took one and a half units of fast-acting insulin and my basal dose, minus two units.
Super-high sugar levels made me wary of eating before the race, but I did have a Trek protein flapjack one hour before. Ping! As the race was about to start, my blood sugar levels went up again to 16.6. I knew I couldn’t start running on that, so I took one unit of fast-acting insulin and crossed my fingers.
I took my insulin pen with me, jelly babies and the FreeStyle Libre sensor—and, er, didn’t use it at all on the way round. I couldn’t be bothered routing around in my little pack to find it, and there is something to be said for relying on the feedback your body gives you. At the seven-mile mark, I decided I’d better eat a jelly baby or two, and at the nine-mile point, I accepted a gel from the SIS stall. From then on, I ate eight jelly babies spaced out for the rest of the run.
Blood test at the end said 8.3, rising to 11.1 an hour later and then plunging to 5.4 half an hour after that, at which point I ate a meal roughly 50/50 protein and carbs.
Lessons for another time? Do more blood tests during the race. Ignore the carb loading advice for the night before (or don’t do it with bread or flapjacks) and watch out for adrenaline. The nerves kicked in an hour before the run and that might have contributed to those high sugar levels, so the next time I might not lower the basal insulin rate as much…
But wait! There’s not going to be a next time, is there Emma?! Confession—having sworn I wouldn’t do it again, I’ve changed my mind. The Glasgow half-marathon is so atmospheric you can’t help but be swept up in running fever. Crowds cheer you almost all the way round armed with witty signs—my favourite was the one telling us we were getting in good practice for the zombie apocalypse—and the sense of achievement you experience at the end is… Indescribable.
And seeing as I proved I can do a half-marathon without ever running more than seven miles in training, the idea of doing it again next year appeals.
The half-marathon training continues… limps on, more like. My body repeatedly tells my brain this was not wise. Sheer stubbornness forces me on.
It heartened me to read of another type 1 saying her training veered between 20-mile runs that went well and three-mile runs that floored her. We juggle not only the effort of running with balancing blood glucose levels.
Too high and running turns into an activity that resembles wading through waist high treacle. Too low, and your calves seize up as your body goes on a glycogen hunt. Either way, both states bring you to a grinding halt.
The magic formula that is running with diabetes is akin to Google’s most complicated search algorithm. Factor in sleep, the previous few days’ average blood glucose levels, where you are in your cycle (if you’re a woman), what you’ve eaten, how much insulin you have on board, how much food you need before running, what foods provide the best fuel sources, how far your blood glucose levels drop and by what time spent running…
If you can work it out, you’re better at this lark than I am.
Exercise affects us not just at the time but for up to 24 hours afterwards. And if you’re exercising for more than an hour at a time, it becomes trickier to work out what you need to do with insulin and food.
Bouts of activity that last half an hour to 45 minutes are relatively easy to manage. If you want to do more exercise than this, you can break your activities up—a walk in the morning and an easy jog in the evening, say. And plenty of Pilates and yoga thrown in for those nice stretch and flexibility benefits.
My vow is post September 30, I’m never doing a run longer than a 10k and my weekly runs won’t add up to more than nine miles, if that. Dear reader, I make myself accountable here.
Meanwhile, September 30 (the half-marathon date) hurtles ever nearer. Yikes!
Ah, Instagram abounds with diabetics who perform superhuman feats of athleticism while battling their blood sugar levels at the same time.
Not me. I’m here as your bog-standard ordinary gel whose only prize ever will be persistence. Did you note I got a massive disclaimer in there before going on to write about my latest race?! I like to make sure I’ve lowered the audience’s expectations before I start.
Anyhoos, for those of you still reading, here it is. On Sunday, I ran another 10k in preparation for the BIG ONE (the half-marathon) next month. Conditions were much more promising than the last time. Back in June, Scotland experienced an unprecedented spell of warm weather. Plus, that course was hilly. And I woke up that morning with a blood glucose reading of 13.1.
In theory, the Paisley 10k should have heralded a vast improvement. I’ve been running for longer, the back-to-usual Scottish summer conditions (dreich, grey and cool) were present, and the course is flatter.
Still sensing that disclaimer?
Bah, humbug dear readers. I added three minutes to my previous time. Not only that, the online system was cruel enough to remember I took part in the Paisley 10k ten years ago when I achieved my personal best. There it was, my 2008 time taunting me with its nine minutes faster brilliance.
For those who want the numbers, I awoke on Sunday morning with a blood sugar of 8.5 (I’d knocked one unit off my basal rate the night before). Half an hour before the race, I was 8.1. I ate half a Hike bar before starting (10-15g carbs) and I finished the race at 11.1, possibly because I put on a sprint finish. Nothing like pretending your race pace is much faster than it really is.
I didn’t take insulin afterwards, ate the second half of the Hike bar and went off for a session in the sauna. An hour later, my blood sugar level was 4.9. A massive portion of battered fish and mushy peas later (I know, NOT low-carb), further low blood sugars and indigestion kicked in*… 3.3 one hour after the meal, 5.8 two and half hours later.
Lessons to take—eat more. Try something other than a Hike bar. Drop the daytime basal injection rate. Keep practising. Keep experimenting. Expect fluctuations and weirdness.
Mass running events are special though. I’d recommend everyone takes part in at least one if they are able to—and these days there are loads of 5ks and even 3ks you can do. You see all shapes, sizes and abilities (and the two former don’t predict the latter), the crowds cheer you like a champ and even a slowcoach like me will overtake enough people to feel gratified**. The runners’ high exists.
Now, time to take off my medal. It is two days later after all.
And now for something completely different… Last week, headline news suggested low-carb diets were dangerous—more likely to lead to an earlier death.
As it’s a rare week, some nutritional or lifestyle study doesn’t hit the news, I sighed. “Oh, whatever.”
I don’t have the skills or knowledge to interpret the data, but two websites I trust have commented on the studies (and more importantly, the way they were reported). You can read them here:
https://www.dietdoctor.com/all-over-media-low-carb-diets-could-shorten-life
*Was worth it.
**One of whom wore a tee shirt saying Vegan Runners. Just sayin’.
“Stone the crows, Emma! Wouldn’t have thought excessive temperatures would be the weather issue throwing a spanner in the half-marathon training, hmm?”
Good people, the woman who signed up for the Glasgow half-marathon in January uttered various predictions about running in Scotland. Most of them involved rain. As it turns out, my lightweight shower-proof coat has needed minimal use. Instead, I’m reaching for the sun cream and hugging the walls in a bid to stay in the shadows as I pound the pavements.
Smell that sizzling tarmac! Scotland has just reported its hottest June ever. Let’s give a shout-out to the poor polar bears in Aviemore.
Fortunately, I’ve discovered I can run in the heat. Again, not something I’ve had the chance to test out much over the years. When I trained for a half-marathon ten years ago, there were two hot days in May. I ran during them and hated it.
But now? I’m okay. Running’s so bloomin’ difficult for me, the heat isn’t the thing that’s bothersome. It’s still the breathing, the adjusting of blood sugar levels to minimise low or high blood sugars and my reluctance to build up my miles
My half-marathon is three months away. I’ve yet to go farther than six miles. Most training plans are for 12 weeks, so there’s still plenty of time to add them up. I’ve found my ‘pace’, a super-slow snail-like jog. I’m hoping my general fitness will stand me in good stead, so that if the pre-race miles don’t stack up, those walking miles will cover ‘em.
I ought to join a running group too. Nothing like surrounding yourself with like-minded idiots people to spur one on. And they might know some different routes. I run the same roads all the time, favouring the reassurance of knowing at what point I draw on my reserves of energy and where I get excited because the end’s in sight.
Last week, when it was very hot (32 degrees), I exchanged outdoor for indoor exercise. I found an indoor jogging work-out on YouTube. “T’uh!” smug self said, “This’ll be easier than running out there in that heat.”
Not so! Ten minutes in and I decided I’d have been better off running outside in the blazing sunshine.
The heatwave here is set to continue. I’ll be training in high temperatures for a little while yet. Again, I’m hoping this magically builds up my fitness so that when I do talk myself into running more than six miles, it’ll be easy.
I was delighted to attend and speak at the third PHC conference in London this year. We met at the Royal College of General Practitioners in London on the sweltering weekend of the Royal Wedding. Apart from superb international speakers we were treated to low carb, high protein food, such as one would typically eat on a ketogenic diet. Instead of picking at our dinners as we often have to do with mass catering we could eat the whole lot. Great!
Dr Peter Brukner from Australia started off the weekend with a review of what was happening in the low carb world. There are more and more reports coming out describing the advantages of ketogenic and low carb diets to different groups of people but the establishment are fighting back viciously as can be seen by the attack on Professor Tim Noakes in South Africa. Indeed if his defence lawyers and expert witnesses had not worked for free he would be bankrupt. This is a terrible way to wage war on doctors who are acting in the best interests of their patients.
Dr Aseem Malhotra also described bullying tactics that had been used against him when he was a junior doctor and first becoming publicly engaged in the low carb debate. I have been subjected to this as well. Professor Iain Broom showed that the proof that low carb diets are superior to low fat diets goes back 40 years.
Dr Zoe Harcombe gave us an explanation of how the calories in- calories out idea just doesn’t add up. The well known formulas about how many calories you need to avoid to lose weight don’t work in practice because of the complex compensatory mechanisms we have to avoid death from starvation. How you put this over to patients and give them useful strategies for weight loss and blood sugar control was explored by Dr Trudi Deakin.
Food addiction is a real issue, at least it is for the majority of the audience in attendance, who answered the sort of questions usually posed by psychiatrists when they are evaluating drug addiction. Unlike drugs, food can’t entirely be avoided but ketogenic diets are one tool that can be used to break unhealthy food dependence. This worked for presenter Dr Jen Unwin who at one point had a really big thing for Caramac bars. I haven’t seen these in years but they did have a unique taste.
Dr David Unwin showed clearly that fatty liver is easily treatable with a low carb diet.
Dr Joanne McCormick describes how her fortnightly patient group meetings are making change accessible for her patients and how many GPs in the audience could broach the subject in a ten minute consultation.
The website Diabetes.co.uk will shortly be starting up a type one educational programme online that all are welcome to join. I discussed the issue of what blood sugar targets are suitable for different people and how they can achieve this with dietary and insulin adjustment.
Dr David Cavan spoke about reversing diabetes in patients in Bermuda. Although Bermuda looks idyllic the reality is that good quality food is about five times as expensive in the UK as it is all shipped in. Many inhabitants work their socks off but barely cover their costs and cheap sugared drinks and buns are their staple diet. Despite these setbacks he managed to persuade a lot of diabetic patients to ditch the carbs and this had favourable results even after the educational programme had stopped.
A cardiologist Dr Scott Murray described the effects of metabolic syndrome on the heart and really why sticking stents in diseased arteries is too little, too late. He is convinced dietary change is needed to reverse and prevent heart disease. This is the first time I have been told that certain types of heart failure and atrial fibrillation are direct effects of metabolic syndrome on the heart.
The importance of exercise for physical and mental well being was not neglected and we had Dr Zoe Williams describing the great benefits that even the minimum recommended exercise can produce.
Dr Simon Tobin and Tom Williams spoke enthusiastically about Parkrun. This is a free event that runs every Saturday morning in parks all over the world. You can choose to walk, jog or run the course.
Claire McDonnell-Liu is the mother of two children who have greatly benefited from a ketogenic diet. The conditions are urticaria and epilepsy. Although NHS dieticians do help families with childhood epilepsy who want to use a ketogenic diet, they can’t do it unless drugs have failed, as this is NICE guidance. I wonder how many children would benefit in fit reduction without side effects of drugs if this guidance was changed?
This was a fabulous conference with a positive enthusiastic vibrancy. Thanks to Sam Feltham for organising this event especially since he has become a new dad as well.
The Public Health Collaboration are putting all the talks on You Tube.
I was interviewed about diabetes and women’s health issues for Diabetes.co.uk and Diet Doctor and these interviews and many others will be available for you all to see to improve your lives with diabetes.
Is anyone’s week of that much interest to anyone else? Blogging demands a certain conceit – that yes, your activities and opinions are either interesting or useful to others*. I’m HUGELY entertaining, but only really to myself. Sometimes, my mum and husband laugh along too, if they are feeling kind.
Nevertheless, I experimented with this blog form elsewhere and decided to run with it on the Diabetes Diet. So, this week I’m…
Trying out new recipes. Like most folk, I’ve been stuck in the same ol’ recipe rut for a while. Prawn cocktail Monday, seabass with avocado Tuesday, sausages at some point. (Well, they are so flippin’ good.) I decided to try out lots of new recipes recently, and I’ve enjoyed the process.
Some of them worked wonderfully – steaming seabass and dressing it with ginger, soy sauce, sliced chillies and sesame oil gave me something new to do with fish. And the crust-less pizza was fun too. 
I tried Good Food magazine’s budget-friendly pot roast recipe, using silverside of beef, carrots, celery and stock, which would have been good if I hadn’t overcooked it.
It was as tough as old boots. My jaw still aches remembering the workout it got. Still, the gravy and the veg that came with it was MARVELLOUS!
Re-discovering running. I started running 13 years ago, did it regularly, entered a lot of 10k runs and even a half-marathon, and then lost the love. It was hard, it needed a massive amount of willpower to make myself get out there and do it, and it was dull, dull, dull. Seriously, there are good reasons why runners look so miserable. Then, four weeks ago, I decided to go for a run anyway.
Just to see if I still could.
And I could! Two days later, I thought I’d try again. I still could! And here I am, four weeks later going for a run every two days, and LOOKING FORWARD TO IT.
What’s different this time? I run so slowly, your granny could probably overtake me. If you take it super-slow, you don’t get that nasty struggling with the breathing thing. Or the lead-like calves. And I listen to a podcast while I do it. Anything comedic is a good bet, though you try listening to Radio 4’s News Quiz as they tear into our politicians and Donald Trump, and run at the same time. Laughing like a loon and heavy breathing is HARD.
Adjusting to the dark nights. For those of you outside of Scotland, by the start of November, it’s dark by 5pm (and it’s only going to get worse). You can do worthy things, such as making sure you do get some daylight at lunchtime if possible. On the other hand, it’s a great excuse to park your a**e on the sofa and binge-watch your way through Stranger Things 2.
*The stats for any blog serve as a great reality check, should you ever find yourself under the illusion that your opinions/activities ARE fascinating to anyone else…
Some people claim that as a type 1 diabetic, you can’t follow a low-carb diet and exercise. Is this the case*?
For most type 2 diabetics, the advice doesn’t apply. If you don’t take insulin or any blood-glucose level lowering medication, you’re not going to suffer from hypos, where blood sugars dip too low. A low blood sugar is usually defined as below 4mmol (or 70mg/dl in the States). There are no problems following a low-carb diet and exercising.
What happens to you as a type 1 diabetic when you exercise?
Exercise or activity can lower your blood sugar levels. It can also raise them too, just to make life extra complicated. Many people find that intense exercise, such as high-intensity interval training, will temporarily increase blood sugar levels. But the same thing can happen with any activity that makes you huff and puff—a perceived exertion level of hard (15-17 out of 20 on the Borg Scale).
What happens to blood glucose levels also depends on how long you exercise for. Shorter periods of exercise and activity (less than 45 minutes) will not have as much effect as an activity that lasts longer than an hour. Timing is also crucial. When I want to go on a long walk (90 minutes), I usually schedule it for the morning or just after lunch. If I do this, I’m less likely to experience low blood sugars. In the morning, my body is fighting the cortisol spike that raises blood sugar levels. If I go for a walk right after lunch, I don’t take any insulin with my low-carb meal. A long walk will have the same effect as insulin. This might not work if I ate a high-carb meal.
I’m more likely to experience low blood sugars if I exercise in the early evening when my insulin sensitivity is greater anyway.
If you know you are going to exercise or be more active than usual, you can lower your basal rate to compensate. With a pump, you can also put on a temporary basal rate reduction an hour or so before you start, keep that on during exercise and for an hour or so afterwards. Or you can switch to a different basal programme for the day.
You will also need to keep an eye on blood sugar levels over the next 24 hours. High-intensity interval training, for example, can lead to a temporary increase, but then a drop in blood sugar levels the next day.
One final point is adaptability. When we first try out a new exercise or activity, it often feels really hard. If you keep it up for a few weeks, what felt difficult soon becomes okay as your body become more efficient. So, a 30-minute spin class, for example, that might have given you a dramatic blood sugar level drop the first time you did it, has minimal effects five weeks later.
There are so many variables to type 1 diabetes, blanket statements such as “you can’t exercise and eat low-carb” do not apply to everyone. It’s challenging, yes, but if you know your body, you’ll know what exercise and activity you can do, when you can do it and how much to do if you want to avoid hypos. Like everything else, personal experience and logging what happens to you during exercise will help.
*The usual disclaimer applies. My opinions don’t constitute advice for other people. If you want to exercise and follow a low-carb diet, you will need to experiment to find out what works for you. If you go to classes or use a gym, make sure the instructors are aware that you have type 1 diabetes and always carry your testing equipment and fast-acting carbs, such as jelly babies, with you.
Diabetes Diet 