Is there a limit to how much insulin you can take?

In this video I share my thoughts on one of the most popular questions we get asked inside The Training Lab. Is there really a limit to how much insulin you can take? Watch this video to find out.

3 Things Every Diabetic Worries About! (& how to fix it)

In this video I talk about the 3 main things every diabetic is scared of. I talk about how they used to scare me and how I beat self-doubt, took action and got rid of the fear. I hope this inspires you to think differently and take ownership of your diabetes.

Can You Take Too Much Insulin?

If you live with type 1 diabetes, your main goal is to keep blood glucose levels within healthy range, that is between 3.9 and 7.1 mmol/L (70 to 130 mg/dL). However, there will come times when you need more insulin than normal to stay within this range.

Quite often, this fluctuation in an individual’s insulin dosing regimen often leafs to fear, confusion and the question ’Am i taking too much insulin?’.

If you want to know the answer check out the useful video below.

Dexcom G6

Dexcom G5

Freestyle Libre

We felt it was time to review these systems following the release of the Dexcom G6 which claims:

• The accuracy is less than 10% MARD for all people aged two years and older.
• Zero finger sticks required.
• Sensor life of 10 days.
• A 28% flatter transmitter profile.
• A new URGENT LOW SOON alert to prevent hypos.
• Alerts can be set by the time of day and day of the week.

As you work your way through this comprehensive review, you will gain valuable insight into which product will suit you best.

Introduction and Criteria

• I co-authored the recent ACDC national CGM guidelines.
• I wrote the detailed guide inside the Training Lab called “Become a CGM Pro.” Well worth checking out, if you haven’t already.
• I have extensively reviewed the Libre, Dexcom G5, Minimed 640G in previous VLOG’s.
• I have been wearing the Dexcom G5 for over two years.
• I educate people with diabetes on all CGM systems in my job as a Diabetes Specialist Dietitian.
• I train health care professionals on how to teach CGM systems.

Let’s get started.

Which sensor is the easiest to insert?

 Key take-homes for sensor insertion:

1. The Libre is the easiest to insert and has the lowest profile. It goes on the arm and has a much smaller adhesive area; this will become important as you read on.
2. The Dexcom G6 new inserter is just as easy to insert as the Libre and it does not hurt, at all. Once the transmitter is on, it is much flatter than the G5, but not quite as low profile at the Libre.
3. The Dexcom G5 manual sensor insertion requires you to push it in, this can hurt a bit. Also, the transmitter does stick out a lot more. This will become important as you will find out.

Which sensor is the most accurate?

Simply, in percentage terms, how far is the blood glucose reading from the sensor glucose reading shown on the display.

For example, if the sensor glucose was reading 10.0mmol/l (180mg/dl), the below blood glucose readings would have these MARD percentages:

• Blood glucose 9.0mmol/l (160mg/dl) = 10% MARD
• Blood Glucose 8.0mmol/l (145mg/dl) = 20% MARD
• Blood Glucose 7.0mmol/l (125mg/dl) = 30% MARD

It is commonly said that if the MARD percentage for the sensor performance over its life (10 days G6, 14 days Libre, 7 days G5) is less than 10%, then the sensor readings can be used to replace finger stick. This table shows the marketed MARDS’s of the sensors, and the calibrations needed to get that accuracy.

A = Adults

P = Paediatrics

The graph below shows the MARD performance of the three sensors over the 10 days of my experiment.

MARD% of the Libre, Dexcom G5 and Dexcom G5 over my 10 days

Key take-homes for MARD:

• All three sensors performed at or better than the marketed MARD.
• The Libre MARD was 8.5% but only lasted 5 days – see later for details on why it came off after only 5 days.
• The Dexcom G6 MARD was 9.1% and lasted the full 10 days. This was achieved with ZERO calibrations! This impressed me.
• The Dexcom G5 MARD was 7.0% and lasted only 7 days. See why it came off shortly.

Please note: MARD is a pretty useless value when it comes to knowing if you can trust the sensor glucose values to make a treatment decision.

Why?

The most critical measure in my opinion, is how often you can safely use the sensor readings to make therapy decisions – treating hypos and giving corrections doses.

The new standards applied to the Dexcom G6 look at this exact point. The standards look at how often the sensor glucose values can be used safely to make therapy decisions.

The assessment is not based on overall MARD percentage. It is on:

• The percentage of sensor glucose readings that are within 15% of the reference glucose measure for sensor reading in the normal and high range.
• For readings in the hypo range, how many sensor readings are within 0.83mmol/l (15mg/dl) of the reference glucose measure.

The criteria in the table below are likely to become the standard for all future CGM and flash glucose systems.

To gain some context, for blood glucose meters to be deemed safe to use, they have to meet ISO standards. They have to have 95% of the blood glucose readings within 15% at all glucose ranges (1)! The blood glucose meters have MARD’s at 4-5%.

Once the accuracy goes outside of 15%, you start to treat hypos that are not hypos or miss them. Also, you begin to over or under correct high glucose levels. In short, you get very erratic control because the sensor is not accurate enough!

This graphic from one of the modules inside Training Lab gives examples of the range allowed in the hypo and high range.

Now this seems like a practical measure that relates to real life.

So, I have accessed the data submitted to FDA to see how the three sensors measure up – Libre (2), Dexcom G5 (3), Dexcom G6 (4).

I have broken this down into three parts:

1. The adult’s data submitted to the FDA
2. The Paediatric data submitted to the FDA
3. Results from my 10-day challenge

Adult data submitted to FDA of CGM within 15% or 0.83mmol/l (15mg/dl) of reference glucose.

Key take-homes:

Hypo range (<4.0mmol/l or < 70mg/dl)

• The Dexcom G6 and G5 are very accurate and get it right 90% of the time.
• Only 1 time out of 10 you might miss a hypo or have hypo treatment when not necessary.
• This is why the FDA and CE mark have approved for TOTAL finger Stick replacement, and the G6 does this with ZERO calibrations. Both systems would meet the future criteria of 85%.
• The Libre gets it right 65% of the time. So, 3-4 times out of 10 you will miss or treat for a hypo incorrectly.
• This is why the FDA and CE mark say you must test blood glucose if the Libre says you are hypo. This is why the Libre is PARTIAL finger stick replacement.
• The Libre would not meet the future criteria of 85%.

Normal range (4.0 – 10.0mmol/l or 70-180mg/dl)

• All three sensors meet the standard of >70% of the time.

High range (> 10.0mmol/l or > 180mg/dl)

• All three sensors meet the standard of >80% of the time.

Paediatric data submitted to FDA of CGM within 15% or 0.83mmol/l (15mg/dl) of reference glucose.

Key take-homes:

Hypo range (<4.0mmol/l or < 70mg/dl)

• The Dexcom G6 and G5 are very accurate and get it right 90% of the time.
• Only 1 time out of 10 you might miss a hypo or have hypo treatment when not necessary.
• This is why the FDA and CE mark have approved for TOTAL finger Stick replacement, and the G6 does this with ZERO calibrations. Both systems would meet the future criteria of 85%.
• The Libre gets it right 65% of the time. So, 3-4 times out of 10 you will miss or treat for a hypo incorrectly.
• This is why the FDA and CE mark say you must test blood glucose if the Libre says you are hypo. This is why the Libre is PARTIAL finger stick replacement.
• The Libre would not meet the future criteria of 85%.

Normal range (4.0 – 10.0mmol/l or 70-180mg/dl)

• All three sensors meet the standard of >70% of the time.

High range (> 10.0mmol/l or > 180mg/dl)

• All three sensors meet the standard of >80% of the time.

My data submitted to FDA of CGM within 15% or 0.83mmol/l (15mg/dl) of reference glucose.

Key take-homes:

Hypo range (<4.0mmol/l or < 70mg/dl)

• The Dexcom G6 and G5 were very accurate, with the G6 hitting 95% accuracy. I am happy to use both the G5 and G6 for total finger stick replacement, especially in the low glucose range.
• Even though the Libre had an overall MARD of 8.5% for the 5 days, the accuracy in the hypo range 70%. With 3 out of 10 readings leading to an incorrect decision. I am not happy to trust the Libre in the lower ranges and would always confirm with a finger stick.

Normal range (4.0 – 10.0mmol/l or 70-180mg/dl)

All three got it right 85% or more of the time. I am happy with this accuracy, even though 1 in 10 times I will get an incorrect correction dose. I feel this is a fair trade-off.

High range (> 10.0mmol/l or > 180mg/dl)

I did not have any readings above 10.0mmol/l in the 10 days. I usually have some. It must be the fact I was completely ON IT – as I knew I was being watched.

Do the sensors stay in place for the marketed time?

See this video for how and when the Libre on day 5 and Dexcom G5 on day 8 came out.

Key take-home messages:

• The Libre has a small adhesive area which caused a problem for me. With my heavy sweating from exercise and saunas, it came out quickly. I had had this problem before and tried many things including rock tape, Skintac, and bands. But for me, none of them seemed to keep in place for the advertised 14 days. This may not be a problem if you do not sweat a lot during exercise or like the sauna.
• The G5 got kicked out by my daughter Grace on day 8. The G6 did not encounter the same problem, which may be due to its flatter profile – 28% is the marketing claim.
• I also noticed the G6 did not get caught on my belt line at the same frequency as the G5.

How does the Urgent Low Soon alert work?

The Dexcom G6 has a new alert that alerts you 20 minutes before hitting 3.1mmol/l (55mg/dl).

Key take-home messages:

• The Urgent Low Soon was very useful for me as I treat hypos below 3.5mmol/l (65mg/dl). Therefore, I could get glucose down my neck before I went hypo.
• I did not get alarm fatigue because it went off just at the right time. Previous systems have used with predictive alarms can become a nuisance. This did not happen with the Urgent Low Soon Alarm.
• For young children and people with hypo unawareness, I do think they might miss a few hypos if they treat at 3.9mmol/l (70mg/dl). It would be helpful if the setting of 3.1mmol/l could be altered to be higher. Maybe 20 minutes before 3.5mmol/l for children and 4.0mmol/l for people with hypo unawareness might do the trick. Maybe Dexcom could make this available in a future software upgrade?

Does Paracetamol cause problems with the Dexcom G6?

The G6 markets that the new technology prevents paracetamol from impacting the glucose readings.

See this video for the paracetamol test I did.

Key take-home messages:

• Paracetamol only seemed to increase the G5 level at one hour slightly, and by three hours there were no issues.
• This may have had minimal impact on me because I weight 100kg and only took 1000mg. If I was a young child taking Calpol, this might be different?

What are the differences in the displays?

The G6 and G5 allow you to change the timeframe on display from 1hr, 3hr, 6hr, 12kh, and 24hr. The Libre keeps the display constant at 8hrs.

This graphic shows the 8 hours Libre display vs. the Dexcom 1-hour display.

Key take-home messages:

• The arrows are determined by 15-minutes’ worth of glucose readings which is adequate most of the time. But during exercise or fast moving glucose, the 5-minute changes are more informative.
• The G6 and G5 allow the display to be changed to 1 hour that shows each dot as the last 5 minutes. This will enable you to see the change before the arrow changes.
• In the above the example you can see the G6 has already flattened in the last 5 minutes. Therefore, I would not have fast acting glucose. The arrow will catch up in 10-minutes time.
• This is an advantage if you want to micromanage your diabetes, and very useful during exercise when glucose changes quickly.

How do the sensors perform in the Sauna?

Check out this video for the sensor’s performance during an infrared sauna.

Key take-home messages:

• All sensors kept transmission during the sauna
• Getting this sweaty regularly does cause problems with adhesive, especially the Libre.

How do the sensors perform during different types of Exercise?

See this video for the sensor’s performance during aerobic and HITT training. and strength training exercise.

See this video for the sensor’s performance during strength training exercise.

Key take-home messages:

• All sensors were accurate during aerobic exercise.
• The G5 and G6 were accurate during HITT exercise. The Libre had fallen out by then.
• The G6 was accurate during strength training. Both the G5 and Libre had come out by then.

How do the systems compare in cost?

See this video for the cost for a discussion of the UK cost. If you are outside the UK, please contact the companies.

Key take-home messages:

• The Libre is cheaper but it’s only partial finger stick replacement, and you do not get alarms and alerts.
• The G6 is cheaper than the G5 by £60 a month, and you get the same accuracy with zero finger sticks
• If you get more than 3 or more accurate weeks per G5 sensor, it’s cheaper to stay with G5:
• 3 weeks = £1666 per year, £138 per month
• 4 weeks = £1450 per year, £120 per month

SUMMING UP

See this video and graphic for my final thoughts on who might suit the different systems.

I hope you have found this product review useful.

I will be changing my order to the Dexcom G6. I am keen to try out a few things in the future:

• Does calibrating make it more accurate?
• The new alarm profiles on the APP

Please share this with friends or healthcare professionals you think will benefit from the information, especially around how to think beyond MARD!

Please leave comments on your experience with any of the products.

Stay Strong,

John Pemberton

Head Coach at Diabetic Muscle and Fitness

Diabetes Specialist Dietitian

References

1. https://www.iso.org/obp/ui/#iso:std:iso:15197:ed-2:v1:en
2. https://www.accessdata.fda.gov/cdrh_docs/pdf16/P160030B.pdf
3. https://www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials/medicaldevices/medicaldevicesadvisorycommittee/clinicalchemistryandclinicaltoxicologydevicespanel/ucm511810.pdf
4. https://s3-us-west-2.amazonaws.com/dexcompdf/G6-CGM-Users-Guide.pdf
5. https://www.ncbi.nlm.nih.gov/pubmed/28137708
6. https://www.ncbi.nlm.nih.gov/pubmed/28137708

The Dexcom G6 is finally here!

The marketing boasts:

• The accuracy is less than 10% MARD for all people aged two years and older.
• Zero finger sticks required because it’s factory calibrated.
• Sensor life of 10 days.
• A 28% flatter transmitter.
• A new URGENT LOW SOON alert to prevent hypos.
• Alerts can are set by the time of day and day of the week.

Interested?

Great! Because Dexcom asked the Diabetic Muscle and Fitness team to attend the pre-launch meeting for bloggers – #DexcomTribe – to get the first look in the UK at the Dexcom G6.

Dexcom asked Diabetic Muscle and Fitness to this premier for a few reasons:

• We are the fastest growing diabetes community, full of people who want to take control of Diabetes.
• We have a resident CGM expert – Head Coach of the Diabetic Muscle and Fitness Online Coaching Academy – John Pemberton.
• John co-authored the recent ACDC national CGM guidelines.
• John wrote the acclaimed guide inside the Training Lab – “Become a CGM Pro.”
• John has extensively reviewed the Libre, Dexcom G5, Minimed 640G in previous VLOG’s – he knows these products inside out.
• John has been wearing the Dexcom G5 for over two years.
• John educates people with diabetes on all CGM systems at one of the UK’s leading paediatric Diabetes Centres.

We have a community of people who are using a wide variety of CGM systems. Including some from the U.S. who have already started in the G6.

So, what did we say?

Yes, of course.

We sent John to Manchester on Saturday the 9th of June to get a sneak preview before the official launch in the UK on the 12th of June.

SPECIAL NOTE!

Diabetic Muscle and Fitness are not getting paid for any of this. The only thing we are receiving is a Dexcom G6 to trial it, “IN ANY WAY WE SEE FIT!”

So, rest assured, there is no conflict of interest. If it’s not up to power, we will say it is, if there are issues, we will tell you.

We have loads of people in our community who love the FreeStyle Libre, who wear their G5 sensors of 4 weeks at a time, and those who love the Minimed 670G. So, we will use this opportunity to educate, inform and help you decide what’s going to suit you best.

Watch this video where John reports on all the marketing claims, and how he is going to put the Dexcom G6 to test, in a unique 10-day challenge. The challenge will involve putting Dexcom G6 head to head with the Dexcom G5 and the Freestyle Libre!

Yes, you heard John correctly! He’s going to hook himself to three CGM systems at once, so you can see what all three systems can do. We have included the summary tables from the video here. These are like gold-dust.

How do the three systems compare on the most important criteria?

When will the new Dexcom G6 URGENT LOW SOON go off?

What do the rate of change arrows mean?

The Diabetic Muscle and Fitness 10-day Continuous Glucose Monitoring (CGM) challenge

Where will you find the 10-day challenge videos?

Right here.

Keep returning to this page when the challenge starts, and you will find the detailed breakdown, day by day.

Day 1: Which sensor is the easiest to insert and why no calibrations?

Day 2: Setting up the alarms, day profiles and URGENT LOW SOON

Day 3: Understanding MARD and a deep dive into the cost

Day 4: Does G6 work with Paracetamol?

Day 5: Which CGM system works the best during strength training?

Day 6: Can the sensors take an ICE bath?

Day 7: Which CGM system works the best during strength training?

Day 8: You can calibrate the G6 if you want to, but when and why?

Day 9: The day before my wedding, can the sensors take the stress?

Day 10: It’s a Wrap, which CGM had the best MARD, the best value for money, which groups of people will prefer which system?

The new videos will appear day by day until you have the full ten. Enjoy.

It doesn’t matter what the circumstance is, whether you’re at a social event, work, making love or, exercising – when blood glucose is outside of normal range, you can be a difficult person to be around.

Just bumping into and spending time with yourself when you’re going through a high or low….

Would you like that person?

I definitely wouldn’t like me!

I often laugh and tell people that diabetes has given me three personalities. One called healthily, one called high and the other called low.

In order to protect yourself from the complications of diabetes, you need to be proactive in managing your condition. Just like I say in my book, The Diabetic Muscle and Fitness Guide,

‘Any area of life you don’t control – someone else will.’

This is so true, especially in relation to diabetes. If you don’t look after your health – you’ll require a team of people to look after it for you.

Knowledge is Power

If you want to get the most out of life, you need to master diabetes and all the aspects that control it: diet, exercise, lifestyle and medication. That’s exactly why I set up the Diabetic Muscle and Fitness Training Lab.

You need to be selfish.

I know this sounds negative, but please hear me out.

When your blood glucose levels aren’t in range, it’s hard to be your true self. Those anxious, short-tempered personalities of diabetes take control and usually end up giving us a bad name. It’s surprising, just how many people are afraid to stand up and manage their diabetes in the public eye.

Do you worry about what other people think?

Ask yourself the following questions…

Are you afraid to inject insulin in public?

Are paranoid about having your CGM device or Insulin Pump on show?

Are you self-conscious to eat or drink something in certain circumstances to treat a hypo?

Would you be embarrassed to ask for money to buy food to treat a hypo if you’d forgotten your wallet?

Do you feel humiliated nipping to the toilet during a family meal to dose your insulin?

Are you mortified checking your blood glucose level before or, during sex?

There is an endless number of scenarios you will have to deal. The worst thing you can do is suffer in silence.

On Saturday past, I was invited out to dinner with a group of old friends. Our table was booked for 7:00 pm at one of my favourite steak restaurants in Belfast City Northern Ireland.

I arrived at the restaurant and realised that I’d forgotten my insulin pen.

DRAMA!?

Not really. The first thing I do in this kind of situation is ask myself two questions,

Q. What can I control?

• Can I ring anyone to bring my insulin? No
• Is there a chemist open nearby? No
• Do they keep insulin in the restaurant? LOL No
• Should I fast and eat nothing? No chance
• Should I just go home and meet them later? No, I want to enjoy myself

Q. What can I cope with?

• Can I eat what I want and cope with being high for a few hours? No
• Should I just stick with meat, veg and water – even though it may make me go high? No

Luckily, I lived only 15-minutes away (30-minute round trip) from the restaurant. Having also arrived 10-mins early I figured I had a window of opportunity to nip home and grab my insulin as most restaurants take around 20-45mins to serve their food. So, I stood up and told everyone I was nipping home to grab my pen, and of course, there were a few sarcastic comments and sighs about being me unorganized…

I understood where the guys were coming from. At the end of the day, they were hungry and worried I was going to hold the meal up. I left my order with one of the party members before I left, advising them to order my meal just after 7:00 pm. This would buy me enough time.

I drove home, grabbed my insulin and was back in the restaurant for 7:23 pm. I promise I kept within the speed limit. (maybe telling a white lie…)

By the time I got back – the food still wasn’t out yet. It’s funny how we all tend to play the worst case scenario in our heads. Everyone was chatting and getting the drinks in. My absence went unnoticed.

Here’s the moral of the story and why you need to be selfish with your diabetes.

I wanted to enjoy myself, and the people at the table deserved me at my best. If I was to sit through the meal, not eat or, eat and cope with the annoying symptoms of hyperglycemia I know for a fact I wouldn’t be a nice guy to be around.

So, for the good of myself and the table. I decided to be selfish and put diabetes first. I’m so glad I did. I was able to relax, enjoy a great meal and empower myself with the confidence that I was in good health.

I urge you to think the same, no matter what your situation…

• If you need to nip home and keep others waiting, do it.
• If you need to inject and correct a high blood sugar with onlookers, do it.
• If you need to leave the table and check your blood glucose, do it.
• If you need to open a tin of drink or, open a noisy packet of sweets in the cinema to treat your hypo, do it.
• If someone gives you a sarcastic remark, go and fix yourself up first, then come back and give them hell! Ha-ha

If you’re not proactive with managing your diabetes – don’t complain about developing complications. You can’t help anyone, or be your best self if you’re stressed out and not feeling good.

There’s nothing that takes up more time and space in your head than a volatile blood high or low blood glucose level.

I hope this article has inspired you to think differently and put yourself first. Protect your health.

Based on my experience coaching 100s of people with diabetes I’m going to confidently speculate that 8/10 people want to get lean and have more visible muscle definition. Do strong abs, great shaped glutes (for the ladies) and well-shaped pecs and arms (for the guys) sound appealing?

Of course they do.

Which is interesting, because out of the two goals, is getting leaner harder than gaining weight and putting on size?

We all know what it it’s like to get lean…

You have to train hard, do plenty of cardio and deal with daily cravings for delicious food like pizza, chocolate and other great tasting desserts.

Whereas, when it comes to putting on muscle mass and getting bigger (which I appreciate isn’t everyone’s goal) – it’s a little easier, as there is way less cravings and lack of energy.

If your goal is to get leaner, would it be fair for me to say that you want to get results as fast as possible?

Who doesn’t?

We all want results tomorrow and we all want a crutch or, some secret pill to help us lose fat faster.

And a whole corner of the supplement store is dedicated to products – “fat burners” – promising to help you do just that.

Question is, can they?

Let’s have a look at the research and look at the practical use of fat burners in people living with diabetes.

What Are Fat Burners?

Let’s be clear at the start: “fat burner” is really an industry term, used to describe nutritional supplements that claim to help you reduce body fat levels at a faster rate.

From a physiological standpoint, what this means is actually a few different processes. You see, the “burning” of fat requires we break it down from storage, release it to make it available for use, and then in fact use it for energy.

The term “fat burner” refers to any compound that can enhance any of these processes, either enhancing the breakdown of fat, increasing the rate at which it is oxidised [the technical term for “burned”], or increasing energy expenditure [often by increasing thermogenesis, or the generation of heat in the body] (1).

Different compounds could do this directly, by acting on a fat cell to increase the release of stored fat, or indirectly, through increasing metabolic or hormonal activity leading to greater heat generation or fat utilisation (1).

But are they even effective, and can fat burners really help you to goal of summer shreds?  If you scrutinise the label of most commercial fat burners, you’ll see many of them boil down to the same few ingredients. Here’s a popular product as an example:

What you’ll see here is typical of most products in the industry as far as ingredients go: caffeine, yohimbine, green coffee extract, and forskolin. Other common compounds in many other products include green tea catechins, in particular EGCG, and bitter orange extract.

What we’re really looking at here is a stimulant. A lot of stimulation at that. So, before you take the plunge and turn yourself into a jittery, anxious mess, shouldn’t we take a pause and ask: are these products even worth it?

Do they work?

Are they safe?

And what kind of impact could they have on diabetic control?

As the main fat burning compounds in use, this article is going to keep the focus on caffeine, EGCG, yohimbine, bitter orange, green coffee extract, and forskolin. Scheduled compounds, like clenbuterol or ephedrine, will also be discussed.

Fat Burning Compounds: Mechanisms, Safety, and Considerations

Let’s start with the compounds with the most research, and the best available evidence overall: caffeine and green tea catechins.

Green Tea Catechins

‘Catechins’, which are polyphenolic compounds [a type of non-nutritive compound with biological activity] found in green tea, are interesting because their effect on fat loss depends on both interactions with caffeine, the type of catechin, the dose used, and also the type of exercise (2).

The first thing to separate out is the type. Most of the research shows that the most potent green tea catechin is epigallocatechin-3-gallate, or EGCG, and lower doses of EGCG have been shown to increase fat burning than total green tea catechins (3; 4). In fact, the total EGCG content within an overall dose of green tea catechins is what you want to look out for.

For example, one study comparing 600mg of EGCG used divided doses of 100mg throughout the day, and the increase in fat burning observed was only not significant (2). In another study, 270mg EGCG given in a single dose to elite male cyclists tested at 60% of their VO2max failed to increase fat oxidation (5).

On the other hand, giving 890mg total decaffeinated green tea catechins containing 366mg EGCG increased fat oxidation by 17% over a 30min test period at 60% VO_2Max in untrained males (3). In another study in untrained men, 571mg decaff green tea catechins, of which 400mg EGCG, increased fat oxidation by 25% from baseline during weekly cycling at 50% VO₂max (4).

There are two points to bear in mind from the above studies. The first is mentioning the training status of the subjects. Basically, the increases in fat burning noted in these studies could reflect an adaptation to aerobic training (4; 6). They got fitter, and better at burning fat.

The other point to note is that studies often used decaff green tea extracts. Now why might this be important? Because it appears that the beneficial effects of EGCG are specifically related to its interactions with caffeine. While green tea naturally contains caffeine, it is nowhere near the doses seen with coffee or energy drinks. In fact, a high habitual caffeine intake negates the effectiveness of green tea catechins and/or EGCG even at various doses of EGCG (7).

For example, combining doses of 270mg, 600mg, 900mg, and 1,200mg EGCG together with 600mg caffeine resulted in no effect on fat oxidation (8). However, some caffeine appears to be beneficial – perhaps reflecting the interactions of the compounds in green tea – as the combination of green tea catechins and lower caffeine levels increases fat burning by 4% more than caffeine alone (9).

Overall, the research shows that for green tea catechins/EGCG to be effective, an inverse relationship with caffeine is preferable, where the dose of green tea catechins/EGCG should exceed caffeine, and daily caffeine intake should remain around 300mg or lower. We’ll come back to this point later as to why this is important for diabetic management.

You could go drowning yourself in green tea every day, to the tune of up to 8 cups, to get the desired dose: supplementing is likely an easier route.

What about caffeine?

Caffeine

Caffeine is probably one of the most researched compounds around, and is the most widely used psychoactive drug in the world – we really love coffee. Caffeine has repeatedly been shown in research to increase sympathetic nervous system activity, boost resting metabolic rate, increase adrenaline output, and increase fat mobilisation (1; 10).

However, note two things about those effects of caffeine. First, they primarily relate to enhanced physical performance, particularly central nervous system drive and adrenaline output.

Secondly, and more importantly, caffeine promotes fat mobilisation, but not necessarily oxidation. In fact, the distinct performance enhancing and fat mobilising effects of caffeine have never been concretely linked to increased fat burning (10).

For example, a study using doses of 100mg, 200mg or 400mg caffeine found an increase in metabolic rate and in fat breakdown, but measurements of energy expenditure in the subjects showed that the increase in energy burning came from equal oxidation of carbohydrate and fat (41). Other studies using very high doses of caffeine – 6mg per kilo bodyweight – also failed to find any increase in fat oxidation during cycle tests for 45-60min at 70% VO₂max (10; 11).

One issue with caffeine in studies may be the timing of intake. For example, in the latter two studies caffeine was given 60-90mins before testing (10; 11). However, another study divided that dose into 3mg/kg 90min prior to testing, followed by another 3mg/kg 30mins after, and found fat oxidation remained elevated both during exercise and up to 2-hours post-training (12).

Another variable you may have noticed thus far is the use of a set VO₂max in studies. Why could this be an issue? Well, if a specific percentage of VO₂max is used, it may not in fact be a uniform intensity for the intervention group due to differences in fitness levels – different subjects may have different thresholds for exercise intensity (13).

Using lactate threshold to define intensity may be more effective, as this is the threshold where aerobic energy systems relying in fat metabolism are operating at their max capacity, and beyond that we shift into anaerobic metabolism and carbohydrate oxidation (13). In a study using 6mg/kg caffeine before 60mins cycling at the lactate threshold, measures of energy expenditure indicated a significant increase in fat oxidation (13).

Ultimately, caffeine is not the fat burner many think it is, and requires higher doses to achieve an effect: the issue is tolerance may negate performance benefits, and more is not better when it comes to caffeine and fat burning.

It appears that caffeine is best used at higher doses, and during submaximal aerobic intensities. However, there are implications for blood sugar management with caffeine, which we’ll consider below. There are also implications for tolerance, and increasing dosage does not overcome tolerance to caffeine.

Yohimbine

Yohimbine is similar to caffeine in that it is a plant alkaloid, occurring naturally in a particular species of tree. It’s also similar in that it can increase levels of adrenaline in the body, however, a word of caution here: if you’re a caffeine-sensitive type, and get the jitters easy with coffee, yohimbine will have you crawling up the walls.

Yohimbine is a compound that acts both directly and indirectly to influence fat oxidation. In its direct effects, yohimbine acts on receptors on fat cells that normally act to suppress fat oxidation and inactivates those receptors (14). In doing so, it allows fat to continue to be oxidised without suppressing those mechanisms.

It also has an indirect effect, similar to caffeine, through increasing adrenaline levels, and adrenaline itself stimulates fat mobilisation and oxidation (15). Yohimbine is popular because the fat cells that it acts on both directly and indirectly through adrenaline are particularly concentrated in the thigh are in women and belly in men, i.e., “stubborn” body fat, and there is research supporting its fat burning effects in women (16), healthy men (17), and athletes (18).

However, a word of caution: yohimbine is highly, highly stimulatory. It’s also noted to have significant side effects – elevated heart rate in particular – and if you’re in any way an anxiety-type, then steer clear. Another issue is that there appears to be significant issues around labelling accuracy on supplements, and wide variability in the precise dose contained in a given product (19).

All in all, while effective, yohimbine simply comes with too much baggage.

Bitter Orange Extract

Bitter oranges contain a compound known as p-synephrine, which can increase metabolic rate in humans (20). It is important to note at this point that bitter oranges are not your average tangerine or satsuma in the shop, and are a rare enough form of citrus fruit with historical use in traditional Chinese medicine (21).

One of the interesting things about p-synephrine is that it increases metabolic rate independent of variables like diet and exercise. For example, one study using a single 50mg dose of p-synephrine found an increase resting metabolic rate by 65kcal over 75min post-ingestion (20).

In terms of underlying mechanisms, p-synephrine is in fact similar to ephedrine, only milder (and legal). It increases adrenaline and dopamine system activity, thereby increasing fat breakdown and metabolic rate (21).

It is also synergistic with caffeine, and of interest to the strength and performance-oriented athletes amongst you, p-synephrine and caffeine have been shown to increase power output in the squat (22). Studies using doses of 49-100mg p-synephrine have found increased energy expenditure, fat mobilisation and fat oxidation, with no adverse effects (23).

Indeed, the longest study in p-synephrine supplementation to date using 49mg doses for 60-days found no adverse effects across cardiovascular, liver, kidney and blood analyses (24).

The human research is thus far overall positive. One trial supplementing 51.5mg p-synephrine twice daily before meals found a reduction in appetite and improved eating control, in addition to increased energy expenditure (20; 24).

With a wide safety margin, p-synephrine is generally considered safe and effective at the doses commonly used (25).

Forskolin

Forskolin at this point remains a very intriguing research compound, but hard to say much more. For the physique-enthusiasts amongst us, we should cross our collective fingers in the hopes of further research into this promising supplement.

Derived from the herb Coleus forskohlii and with traditional use in Ayurvedic medicine, the primary mechanism of action of forskolin is to increase levels of a molecule in our cells called cyclic adenosine monophosphate [cAMP], which is important in regulating energy metabolism (26). Mechanistically, high levels of forskolin can increase the breakdown of fat from storage, however, the doses used to show this effect have not been replicated in humans (27).

The human research is relatively limited to date. A study in overweight women supplemented with a 10% forskolin extract (250mg twice daily) noted a protective effect against weight gain, with insignificant weight loss (28). An interesting randomised, double-blind and placebo controlled trial in overweight and obese men supplemented with 250mg (10% forskolin) twice daily for 12-weeks found a significant increase in lean body mass, reduction in fat mass, and increase in bone mass: all these results were confirmed by DEXA scans (29). There was also an increase in testosterone noted, which could explain the results but despite this being an RCT, and despite the quite profound results, we’re still waiting on this research to be replicated.

So, there’s a few caveats to the research to date. First, overweight and obese persons have lower levels of cAMP, and thus the effects of forskolin supplementation may be more pronounced in these populations (30). Secondly, the effects of increased testosterone may underscore the fat burning effect, as distinct from any direct fat burning effect of forskolin itself, an observation somewhat supported by the difference in the study in women [no significant effect] compared to the study in men [significant effect].

Fascinating compound. More research needed. And it may have caution in diabetics, for reasons explained below.

Green Coffee Extract

Green coffee extract is extracted from unroasted green coffee beans, as the compounds are largely lost in the process of roasting coffee beans (31). Green coffee extract is touted as a fat burning compound but we can be relatively brief with this: the evidence is weak.

A recent meta-analysis confirmed this (31). While there was an overall weight loss effect noted, the trials did not specify dosage used, and had significant methodological limitations which cast doubt on the results (31). Two authors of one study were also affiliated with a company selling a GCE weight loss product (31).

Aside from the methodological limitations of the studies on GCE to date, the results themselves are of questioning clinical relevance (31). Despite this being a common feature of many marketed “fat burner” supplements, all it’s going to give you is expensive urine.

Ephedrine and ECA

Ephedrine is a plant alkaloid derived from the Chinese herb, Ma Huang, and is about as potent a fat burning compound as you could find: the trade-off is you might have a heart attack. Ephedrine acts by both directly stimulating the production of heat in muscle cells, and by stimulating the breakdown of stored fat (42).

Ephedrine also boosts metabolic rate, an effect which is seen without exercise, in contrast to caffeine which is effective at mobilising stored fat but requires exercise to burn that released fat (42). Combined together, ephedrine and caffeine show distinct fat burning synergy, due to the effect that the class of compound which caffeine is, a methylxanthine, boosts the ability of ephedrine to increase metabolic rate (43).

The stack of ephedrine and caffeine, combined with aspirin, and known as ‘ECA’, is an effective fat burning compound due to the combination of ephedrine and caffeine, although there is evidence that aspirin enhanced the thermogenic response to feeding in obese subjects, but this effect was not found in lean persons (44).

There have been significant concerns, however, raised over the use of ephedrine and ECA: ephedrine and the combination of ephedrine with caffeine have been associated with increased risk for nausea, vomiting, anxiety, heart palpitations, and adverse cardio and cerebrovascular events (45).

So, is it worth it? Like most things, the dose makes the poison: the combination of 20mg ephedrine with 200mg caffeine taken three times per day has been shown to be well tolerated and safe up to 6-months use (46; 47). The issue for diabetics isn’t the tolerability, it’s the fact that ephedrine increases insulin and blood glucose levels (42).

So there are two caveats: one  is that it’s illegal in many jurisdictions now, the other is the effect on blood glucose and insulin. So, yes it can be safe, and it is certainly effective, but may place an added burden on diabetes management.

Clenbuterol

‘Clen’ is possibly one of the most popular fat burning compounds in the physique community for one reason: it works like little else. Clenbuterol is a synthetic drug that is currently illegal in most developed countries, but that hasn’t prevented its popular use.

Clenbuterol leads to significant improvements in body composition not solely attributable to fat burning, but also to lean mass increases (48). In the context of an energy deficit that is a pre-requisite for fat loss, clen preserves lean mass while significantly increasing fat burning (49).

Clen enhances fat burning through the same mechanisms as yohimbine and ephedrine, stimulating fat oxidation (50). It also does not appear to have any impact on blood glucose levels, however, insulin disrupts the signalling of compounds like clenbuterol to fat cells, so there is a potential interaction that could be relevant to timing of use of both insulin and clen (51)

Potent fat burning compound, with the same caveats applying regarding legal status. If using, use wisely: there are plenty of ways to burn fat outside of prison.

Can Diabetics Take Fat Burners?

Ok, so some compounds can be effective – like EGCG and caffeine – and some are a waste of money – like green coffee extract. For those that may be effective, we need to consider the potential interactions of these compounds with diabetes management.

Let’s start with the obvious one: caffeine. Caffeine distinctly does increase blood glucose levels, through a combination of transiently reducing insulin sensitivity and prevent glucose disposal into muscle cells by 24% (32). The main effect of caffeine is interfering with insulin action on glucose disposal, not impacting on insulin secretion itself which is unaffected by caffeine intake (33). Timing caffeine use away from meals would be a good idea to avoid any interaction with post-prandial glucose metabolism.

Consider ephedrine here too: it has dose-dependent increases in insulin and blood glucose, so more is definitely not better, and caution is required when considering its use.

For caffeine, we are talking about caffeine and not coffee as a food supplement. Coffee intake is strongly associated with reduced risk of Type-2 diabetes, an effect which is more attributable to other compounds in coffee as the protective effect is also observed with decaff (34).

Thus, while coffee intake is itself a beneficial food product, it remains inadvisable from a blood sugar management perspective to supplement with isolated caffeine, which will increase blood glucose as a result of impaired glucose disposal (32; 33).

Green tea catechins may in fact benefit diabetics, although it should be noted that the research is in Type-II. A study in Type-II diabetics found 500mg of decaff green tea extract, of which 285mg EGCG, taken 3 times per day resulted in significant improvements in insulin sensitivity [measured via HOMA-IR], reduced insulin concentrations, and reductions in triglycerides over 16-weeks (35). The effect on improved insulin sensitivity is not always observed in Type-II diabetics (36).

However, green tea catechins may improve blood glucose regulation. Green tea catechins have been shown to improve post-meal glycaemic control in pre-diabetics by inhibiting glucose uptake, without impacting on insulin secretion (37). Brewed green tea may also increase glucose disposal and nutrient partitioning in monocytes over adipocytes, although this has yet to be demonstrated in humans (38).

Overall, supplementation with green tea catechins appears to be potentially favourable to diabetes management, without negatively impacting insulin secretion or action.

What about forskolin? There simply is no human evidence, but studies in cell cultures have shown that forskolin stimulates insulin release from pancreatic cells (39). In this context, and without any human research, the advice here would be to err on the side of caution and opt against supplementation with forskolin: we just don’t know what impact it could have on insulin and diabetic control.

A similar position can be taken with yohimbine: rat studies suggest it can increase insulin levels in diabetic rats (40). This was in fact considered a positive, as insulin secretion is suppressed by mechanisms which are inhibited by yohimbine, thus supplementation was normalising insulin function in diabetic rats (40).

Again, we have no human data on the potential interaction, and given the side-effects of yohimbine outweigh the efficacy, from a diabetic management perspective it is best to scratch this off the list.

P-synephrine, on the other hand, does not appear to negatively impact on blood glucose management or insulin function. A safety study looking at the effects of 49mg p-synephrine twice daily found no adverse effects after 60-days on blood chemistry, including blood glucose, albeit this was in non-diabetic subjects.

P-synephrine is considered to have a wide safety margin, and the lack of any observed effect on blood glucose taken with its observed increase in metabolic rate, suggest that this could be supplemented safely in diabetics.

Clenbuterol may have an interaction with insulin, insofar as elevated insulin may suppress activity of the drug: this is highly mechanistic and likely means clen should be taken away from meals.

Practical Application: Fat Burners, Diabetes and Blood Sugar Control

Ok, so we’ve established what works, what doesn’t, and what is safe for use in in the context of diabetic management. Let’s put this together into some action points.

1. Green tea catechins/EGCG and diabetes: Recall that the effectiveness of green tea is dependent on lower caffeine levels. This works nicely for a diabetic looking to enhance fat oxidation, as taking on supplemental caffeine is contraindicated for blood sugar management. So, as a diabetic looking for a fat burning boost, your best bet is to keep caffeine low and opt for more green tea.

Your dose: 500mg EGCG per day, with lower caffeine intake. A cup of coffee a day won’t hurt, but don’t be a habitual high-caffeine consumer or you’ll impair the effects of green tea on fat oxidation.

2. P-synephrine & diabetes: The increase in metabolic rate, fat mobilisation and oxidation, in the context of its established safety and lack of impact on blood glucose make this an attractive supplement.

Your dose: 49-100mg per day, ideally in divided doses separated 6-hours apart.

3. Caffeine, yohimbine, forskolin, green coffee extract and diabetes: Between the negative effects on blood glucose management of isolated caffeine, to the increased blood pressure and anxiety side effects of yohimbine, to the lack of evidence for interactions with forskolin, and lack of evidence overall for GCE, don’t waste your time with these options.

4. Clenbuterol, ephedra-caffiene-asprin (ECA Stack) and diabetes: You’re an adult, you can do as you like but I didn’t tell you one way or the other!

Also, final point to bear in mind: the greatest “fat burner” we know of is a calorie deficit in conjunction with a higher protein diet. Your final consideration is this: diet always comes first to any body composition goal.

How can people living with diabetics control their blood sugar levels when taking over the counter fat burners?

We asked John Pemberton, Head Coach at Diabetic Muscle and Fitness, for his thoughts on fat burners. He gave us options for how to adjust diabetes regimens to manage blood glucose levels when taking fat burners, from his ten years of clinical and coaching experience.

Here are his pearls of wisdom.

The safety and efficacy of the different fat burners have been laid out nicely in this article, and I agree with the conclusions. This was a great read.

I have detailed below some considerations on how to manage blood glucose.

1. Green tea catechins/EGCG with diabetes: EGCG should have very little impact on blood glucose levels, because it does not significantly increase stress hormones (Catecholamine’s & Cortisol). From my coaching, personal and clinical experience, no therapy adjustments are needed, but you always have to monitor and assess, we are all individuals.

a.  On a side note, EGCG is strong polyphenol that has been shown to activate the expression of your “Lean Genes”. By increasing Sirtuin Enzymes in the cells. I have written a comprehensive guide on how to “Activate your Lean Genes” in the Training Lab that covers this in great depth. This moves the conversation past fat burning, into discovering the wide range of benefits Polyphenols have for long-term health and getting a great looking body.

2. P-synephrine with diabetes: Technically you would expect this to raise blood glucose, because it activates the adrenergic receptors, which increase adrenaline, and should therefore lead to the liver pushing lots of glucose into the blood stream. However, the activation of the adrenergic receptors from P-Synephrine is weak, so the glucose impact is usually not an issue. Also, because the half-life is only 2 hours, the impact is very brief.

a.  If you find it increases your glucose level, a small dose of quick acting insulin upon taking P-synephrine will prevent a glucose spike. But like I said, you are unlikely to need this. Monitor first and adapt if needed.

3. Caffeine with diabetes: The drug of choice slurped down every morning by most people. Especially fitness enthusiasts who use it as a “performance enhancer” or “Fat burner”. At doses needed for a “performance” or “fat burning” effect (2-3mg/kg or 1-1.5mg/lb) it is unlikely to increase glucose levels. However, at does above this (5-6mg/kg or 2.5-3mg/lb), you are likely to get a glucose spike from insulin resistance and increase liver output of glucose, which can last 4-6 hours. On a practical note, don’t take a high dosage past 2pm, otherwise you will disrupt your sleep and recovery. How would you manage a high caffeine dose?

a.  If you are doing aerobic exercise such as running, it’s likely your glucose level will stay stable rather than drop. Some use this as hypo prevention strategy.

b.  If you are doing anaerobic exercise such as heavy weights, it’s likely your glucose level will spike more than usual. You may need an insulin before you start your heavy lifting

c.  In the Training Lab, I have developed a guide on how to manage different types of exercise with Diabetes. This covers how to calculate how much insulin to give before anaerobic exercise.

4. Yohimbine with diabetes: Very similar to caffeine, except the exact dosages are a little hit and miss as it’s a plant alkaloid. The potency of the supplement will vary according to manufacturing processes. So, it’s going to be a bit of trial and error, just like everything else with diabetes!

5. Ephedrine & ECA stack with diabetes: This will 100% increase your blood glucose. Unlike P-synephrine, ephedrine is a potent activator of the adrenergic receptors. It will spike adrenaline, which will spike liver output of glucose. Ephedrine has a half-life of 6 hours, so you can expect high glucose level for a long period. From my clinical and coaching experience you will need more insulin, a lot more, for a long period. Here are some options to consider, but always check with you medical team and monitor aggressively.

a. If on an insulin pump increase the basal rate to 150% for 6-8 hours.

b.  If on split background insulin (NPH, Levimer), increase the morning dose by 25-50%.

c.  Increase insulin doses for meals by 25-50%.

d.  Correction doses every 2-3 hours.

5. Clenbuterol with diabetes: Works in a similar way ephedrine, but not as potent. It does however have a half-life of 26 hours! So if it causes your glucose level to rise, you will be on the celling for a long-time. From my experience, the most effective way to manage this is to increase the background insulin. Here are are some options to consider, but always check with you medical team and monitor aggressively.

a.  If on an insulin pump increase the basal rate to 120-130% for 24 hours

b.  Increase background insulin doses by 20-30%.

One final note from me.

You should only be considering “fat burners” if you have optimised;

• You caloric intake according to your fat loss goals.
• You have 7-8 hours quality sleep per night.
• You diet is full of real foods and you’re having 1.8–2.2g/kg protein (0.7 – 1.0g/lb) spread over at least 4 meals.
• You are resistance training at least three times a week.
• You are walking 10,000 steps per day.
• You are accountable to someone for hitting all of these goals.

If you have not got the above on point, you are barking up the wrong tree. Get the basics in place and you will see it’s actually easy to shred body fat.

You would be better advised to spend your money on a high quality coaching program or selection of calorie controlled meals plans that will give you a clear plan of action and keep you accountable by looking after all the essentials! That’s why I created Diabetic Shred – a 112-day fat loss system for men and women living with diabetes. It contains everything you need to know about eating, training and living to get lean. You get weekly meal plans tailored to your metabolism and over 50 challenging workouts.

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38. Ashida, H., Furuyashiki, T., Nagayasu, H., Bessho, H., Sakakibara, H., Hashimoto, T. and Kanazawa, K. (2004). Anti-obesity actions of green tea: Possible involvements in modulation of the glucose uptake system and suppression of the adipogenesis-related transcription factors. BioFactors, 22(1-4), pp.135-140.
39. Hermansen, K. (1985). Forskolin, an Activator of Adenylate Cyclase, Stimulates Pancreatic Insulin, Glucagon, and Somatostatin Release in the Dog: Studies in Vitro*. Endocrinology, 116(6), pp.2251-2258.
40. Sandberg, M., Pettersson, U., Henriksnäs, J. and Jansson, L. (2012). The α2-Adrenoceptor Antagonist Yohimbine Normalizes Increased Islet Blood Flow in GK Rats: A Model of Type 2 Diabetes. Hormone and Metabolic Research, 45(03), pp.252-254.
41. Astrup, A., Toubro, S., Cannon, S., Hein, P. and Madsen, J. (1991). Thermogenic synergism between ephedrine and caffeine in healthy volunteers: A double-blind, placebo-controlled study. Metabolism, 40(3), pp.323-329.
42. Astrup, A., Toubro, S., Christensen, N. and Quaade, F. (1992). Pharmacology of thermogenic drugs. The American Journal of Clinical Nutrition, 55(1), pp.246S-248S.
43. Astrup, A., Toubro, S., Cannon, S., Hein, P. and Madsen, J. (1991). Thermogenic synergism between ephedrine and caffeine in healthy volunteers: A double-blind, placebo-controlled study. Metabolism, 40(3), pp.323-329.
44. Swan, P. (1996). THERMOGENIC RESPONSE TO EPHEDRINE+ CAFFEINE IN OBESE WOMEN WITH DIFFERENT PATTERNS OF REGIONAL ADIPOSITY 259. Medicine &amp Science in Sports &amp Exercise, 28(Supplement), p.44.
45. Shekelle, P., Hardy, M. and Morton, S. (2003). Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance. ACC Current Journal Review, 12(3), p.29.
46. Molnár, D., Török, K., Erhardt, E. and Jeges, S. (2000). Safety and efficacy of treatment with an ephedrine/caffeine mixture. The first double-blind placebo-controlled pilot study in adolescents. International Journal of Obesity, 24(12), pp.1573-1578.
47. Hallas, J., Bjerrum, L., Stovring, H. and Andersen, M. (2008). Use of a Prescribed Ephedrine/Caffeine Combination and the Risk of Serious Cardiovascular Events: A Registry-based Case-Crossover Study. American Journal of Epidemiology, 168(8), pp.966-973.
48. Kamalakkannan, G., Petrilli, C., George, I., LaManca, J., McLaughlin, B., Shane, E., Mancini, D. and Maybaum, S. (2008). Clenbuterol Increases Lean Muscle Mass but Not Endurance in Patients With Chronic Heart Failure. The Journal of Heart and Lung Transplantation, 27(4), pp.457-461.
49. Maltin, C., Delday, M., Watson, J., Heys, S., Nevison, I., Ritchie, I. and Gibson, P. (1993). Clenbuterol, aβ-Adrenoceptor Agonist, Increases Relative Muscle Strength in Orthopaedic Patients. Clinical Science, 84(6), pp.651-654.
50. Kim, Y. and Sainz, R. (1992). β-adrenergic agonists and hypertrophy of skeletal muscles. Life Sciences, 50(6), pp.397-407.
51. Zhang, J., Hupfeld, C., Taylor, S., Olefsky, J. and Tsien, R. (2005). Insulin disrupts β-adrenergic signalling to protein kinase A in adipocytes. Nature, 437(7058), pp.569-573.

Simple, you need to activate your LEAN GENES.

You must have come across similar claims;

“DNA testing is the future.”

“We tailor nutrition to your genes.”

Or maybe,

“We program perfect workout plans for your genome!”

Skeptical?

You should be.

Those claims are talking about genetic determinism. This basically means. You are born with a genetic code that perfectly predicts your future health and physical potential. Also, you can do very little to change your outlook.

You either got it, or you don’t, right?

Wrong. Current science shows the exact opposite. Your genetic code only predicts 20% of your future health (1).  It’s how your genes are activated that makes all the difference, 80% of the difference. This is the field of science called Epigenetics.

Epigenetics is the science looking at the environmental, nutritional and physical factors that influence your genetic expression.

Let me break this down for you.

Imagine your genetic code is a large fridge freezer.

The top part is the fridge, which is full of fresh fruit and vegetables, lean cuts of quality meats, and a host of quality fresh produce. You can consider these your “good” or “LEAN GENES”.

The bottom part is the freezer, containing pizza, chicken nuggets, ready meals, ice cream and a shed load of processed food. You can consider these your “bad” or “fat” genes.

Now it’s true that some people are born with bigger fridges that others (genetic determinism). But that is not the most important thing. The important thing is how you make your daily selections from the fridge or freezer (epigenetics). This is what predicts health, body shape, and insulin sensitivity.

Research shows clearly that if you regularly fire-up your LEAN GENES, you can expect:

• Reduced inflammation (2)
• Reduce Fat storage (3)
• Improve blood glucose control & reduce insulin resistance (4)
• Increase insulin secretion (5)
• DNA repair and protection (6)
• Inhibition of protein degradation (7)
• Increased protein synthesis (8)
• In type 2 muscle fibers, the growth of satellite cells (9)

So basically, looking good, feeling good, on your way to Hollywood!

What happens if people with diabetes turn on their LEAN GENES?

You can expect lower glucose levels, improved pancreatic function and to increase your fat burning potential. As shown in this diagram below taken from a leading research review article (10)!

So, you are probably thinking;

“What daily habits can I employ to make sure I am selecting from the fridge and not the freezer?”

Or in technical speak,

“What nutritional, environmental and physical practices can I adapt to activate the expression of my lean genes?”

It’s great you’re asking that, it means you are in the right place.

As you read this article, you will discover the BIG THREE lifestyle practices you can employ to get all the benefits of activating your Lean Genes.

Let’s begin.

Before we start making changes. It’s essential we understand how the selection process works. What decides if the LEAN GENES (fridge) or fat genes (freezer) are expressed?

There is a wide range of factors, but science is showing clearly that there are a set of MASTER REGULATORS within our cells that control the gene expression process.

What are these MASTER Regulators?

A group of enzymes called the Sirtuin Enzymes. There are seven of them, but Sirtuin 1 and 3 are the most important when it comes to the expression of your LEAN GENES.

The cartoon below shows how the Sirtuin Enzymes (the conductor) create the lean gene activation (beautiful harmonious music from the orchestra).

How do the MASTER REGULATORS alter gene expression?

Simple explanation. The Master Regulators direct the hand into the fridge, so healthy selections are made.

Technical explanation. The Sirtuin enzymes remove acetyl group (deacetylation) from proteins in the cells, which alters the activity of the proteins in favour of expressing your LEAN GENES.

This deacetylation process requires NAD+, so the higher the NAD+, the more effective this process is. See this cartoon showing how the Sirtuin Enzyme removes an Acetyl group of a Histone, allowing the Histone to fire-up LEAN GENE expression.

Make a mental note here.

Anything that increases the NAD+ or Sirtuin enzymes in the cells, enhances Lean Gene activation.

This will help you understand how lifestyle changes activate LEAN Genes.

So, if you are with me so far, you are probably thinking;

“If I increase the number of Master Regulators (Sirtuin Enzymes) in my cells, and make them work more effectively (increase NAD+), I will really fire up may Lean Genes!”

If you are, you are 100% correct. The aim of the game is twofold:

1. Increase the number of Sirtuin Enzymes in your cells.

2. Create conditions (increase NAD+) in the cells that enable the Sirtuin enzymes to work as quickly and effectively as possible.

Now you are clear on the process of activating your LEAN GENES. It’s time to discover how to increase the number Master Regulators, and create a cellular environment that makes them sing!

You are going to do this by employing the principle of Hormesis.

Hormesis is the principle of applying a small stress to the body, the body fights that stress, then adapts the metabolic machinery to be stronger, healthier and more robust.

So next time you can handle a higher stress load and you evolve into a machine that can handle anything!

Just think of Hormesis as;

“What does not kill you makes you stronger!”

There are endless ways to stress the body to get this effect. But I am sure you want the ones that give you the best bang for your buck, right?

Good, because the rest of this article outlines THREE of the most effective Hormesis strategies for activating your LEAN Genes. Three strategies that increase the number of Master Regulators and create the optimal cellular environment to fire up your LEAN GENES.

What are the BIG three?

1. Polyphenols (including Resveratrol)
2. Cold Stress (Energy stress)
3. Fasting (Caloric Restriction)

This diagram presents an overview of how the BIG THREE work and consolidates your knowledge so far!

You can see how the big three increase the Sirtuin Enzymes (Sirt1) directly and/or increase NAD+. There are several metabolic pathways involved, including the AMPK and LKB1 pathways, but you do not need a deep understanding of the pathways.

You just need to know once the Sirtuin Enzymes are activated with NAD+, there is a positive cascade leading to LEAN GENE expression and good health.

Let’s break the big three down.

What are Polyphenols and how do they work by Hormesis?

Polyphenols are the plant’s defense mechanisms, they protect from UV light, insects, microbial infections, and they attract pollinators.

They are compounds that contain at least one aromatic ring and are classified into different groups according to the number of aromatic rings and the structural elements that bind these rings together. Therefore, polyphenols are classified as flavonoids, phenolic acids, lignans, and stilbenes.

When we consume polyphenols, they act by applying a stress to our cells and increase the Sirtuin Enzymes. Because this stress comes from plants, it’s technically known as Xenohormesis.

Polyphenols also have an anti-oxidant effect and help lower blood pressure by dilating blood vessels.

This all sounds great, but what is the evidence to say consuming Polyphenols is beneficial for health?

A review of all the key evidence in 2016 reported (11):

“A multitude of proven benefits for consuming a diet that has a high and diverse intake of polyphenols”

The benefits include;

• Proven long-term benefits

–    Reduced relative risk of cancer by 40%

–    Reduced relative risk of cardiovascular disease by 30%

• Proven short-term benefits:

–    Anticarcinogenic

–    Antiatherogenic

–    Antiulcer

–    Antithrombotic

–    Anti-inflammatory

–    Antiallergenic

–    Anticoagulant

–    Antimicrobial

–    Vasodilatory

The most important thing to understand from the above research is the statement;

“High and diverse intake of polyphenols”

This graphic shows each category of polyphenols has sub-categories, and lots of individual polyphenols. There are literally thousands!

Fortunately, a European Team has identified the 500 most important polyphenols and created a database, the Polyphenol-Explorer. The Polyphenol database allows you to see which foods are bursting with the key polyphenols. I spent hours trawling the database to develop this table that summarizes things nicely.

You should now be starting to realize why you need a high and diverse intake of different foods groups to get your Polyphenols!

The Polyphenol-Explorer database has been independently validated by a huge pan-European study (12). The study also reported usual intakes by the different nations. Do you think consume more than your nations average?

At Diabetic Muscle and Fitness, we have spent months creating a tool that allows you to enter how frequently you eat the Top 100 polyphenol-rich foods. In return for your efforts, you get a report that details;

1. Your overall daily intake in mg.
2. Your intake is broken down into the key food categories.
3. Notification if your intake is low, medium, optimal, or too high in the different food categories.
4. Considerations of how to improve your intake.
5. Top food lists to help you achieve optimal intakes.

Interested?

See the below report from one of our Training Lab members.

You can see his overall intake is medium and there are several food groups with a low intake. Interestingly, he thought he had a “healthy diet”, but this made him realize there was a lot of room for progress.

After chewing over his report, he decided to take on the Diabetic Muscle and Fitness Four-Week Polyphenol Challenge with other community members in the Training Lab.

He used the top foods list we created to improve his polyphenol intake. Below are two of the eight Top Food lists.

Using the 100mg and above list for Teas and Cocoa products,  he decided to introduce Green Matcha Tea and add in a couple of cups of peppermint tea per day.

Using the 150mg and above list for Fruits, he decided to introduce Figs, prunes and plumbs.

He completed the tool again after the four-week challenge and was rewarded with the below report

What an amazing turnaround!

He now has optimal intake overall and most in categories. He has a “high and diverse intake of polyphenols”, so he can expect all the health benefits, as he is regularly firing up his LEAN GENES.

Still some room for improvement in the herbs, spices, and condiments – But nobody is perfect, right?

How do you think you would score?

If you want to find out, access the Training Lab to use the unique tool.

Two final things to consider with polyphenols from the leading research review (11):

1. A healthy gut increases the absorption of polyphenols, and foods high in polyphenols feed a healthy gut. So, look after your gut and you will get the most out of your polyphenol intake. Some simple advice:
2. Eat fermented foods such as sauerkraut and kimchi.
3. Eat at least one fruit and veg from each colour of the rainbow every day.
4. Eat foods high in pre-biotic fibre such as onions, garlic, and leeks.
5. See the Guide in the Training Lab for more detail.

2. Increase the bio-availability of polyphenols with these simple tips:
3. Add lemon juice to tea.
4. Consume fat with vegetables e.g. light frying of onions.
5. Eat high-quality protein (high in Leucine).
6. See the Guide in the Training Lab for more and a more detailed explanation.

Ok, Polyphenols are done, let’s get into cold stress.

Cold Stress

Cold Stress was popularized by Tim Ferris in his book The Four Hour Body, and more recently by Wim Hoff -The Ice Man.

Stories of ice baths, cold packs, Cryotherapy, and cold showers being the fountain of youth.

Promises of rapid fat loss, increased metabolic rate, improved mental health, and building resilience.

Sounds too good to be true, right?

Let’s find out, but first, what does Cold Stress look like?

The Cold Stress Options:

1. Cold shower: Turn the shower to full cold and stand under for 5-15 minutes. Not as easy it sounds. Start with 5 minutes and increase by a minute each time.

2. Cold bath or bin: Submerge up to the neck for 5-15mins. This is actually easier than a shower as you do not get the constant sprinkle of cold on you. Build duration up over time.

3. Cryotherapy: Enter a cold capsule and be blasted by liquid nitrogen for a short time period, usually 2-3 minutes. Much more expensive but very time efficient. Usually 2-3 minutes.

Which is best?

Studies comparing all methods show they elicit the same response, as long as the core temperature drops (13). So, the best for you depends on finance, availability, and your mental strength to withstand the cold for longer durations.

What do the research papers say?

1. Cold stress causes a BIG surge in stress hormones: Noradrenaline increases by 300 -500% and Dopamine by 150-250% (14).

How does this benefit?

• Good for mood: noradrenaline and dopamine electrify the regions of the brain to make you feel good, the same effect induced by caffeine. Interestingly the cold stress response does not go away with daily practice, unlike the quick graduation from a single, to a double, to a triple espresso. Sound familiar?

• Good for the immune system: noradrenaline reduces inflammation by decreasing key inflammatory factors, and increasing beneficial natural killer cells (15). This has been linked with reducing brain inflammation, by better use of Serotonin (happy chemical).

• Good evidence shows cold stress improves arthritis symptoms (16) and lowers incidence of nasty chest infections (17). Interestingly, studies of centenarians (people over 100 years) show INFLAMMATION (low levels that is) is the strongest predictor of living a long and healthy life (18).

This is a big leap I know, but could occasional exposure to cold stress help you live longer and stronger?

2. Cold Stress stimulates heat production and increases metabolic rate by up to 350% (19). This is mediated by two processes.

• Shivering (believe me, this happens!). The muscles twitch rapidly using glucose to produce heat. This creates a serious energy stress and is very much Hormesis.

• Stimulation of brown fat to produce heat by burning fat. Brown fat found in your sternum and collarbone region is special. Why? because it is the only type of tissue that can burn fat purely to produce heat. Consistent exposure to cold stress increases brown fat accumulation over time via the Sirtuin 3 metabolic pathway (20).

This sounds great, as it increases fat burning potential!

However, there is a strange irony with brown fat. The accumulation only happens for LEAN INDIVIDUALS. Unfortunately, brown fat accumulation is virtually non-existent for obese people (21). This is a cruel paradox, and is shown in the graphic below!

3. Cold Stress has been shown to improve our internal anti-oxidant defense systems by 40%, to help fight the damage from everyday inflammation (22). Could cold stress become one of your five a day?

4. Cold stress can improve recovery from training and injury. Amazing, let’s get in the cold bath, right? Not so quick, the devil is in the detail. It all depends on timing and type of training!

• For strength and muscle building training: DO NOT APPLY COLD STRESS IN THE 1 HOUR AFTER TRAINING (the anabolic window). You need the inflammatory response after training to drive muscle growth and strength! Research has shown cold exposure in the hour after strength training slows any gains (23).

• For endurance events and sports specific activities, it’s a different story. Applying cold stress soon after the activity is important. Why? Stopping inflammation is key, so repeated bouts of training can be completed. It is the enzymatic changes and increased number of mitochondria that drive performance improvement for endurance training, not hypertrophy (mostly). Cold stress has also been shown to increase the number of mitochondria (energy-producing cells) in muscles (24). Cold stress has been shown to improve performance markers in elite runners by 20% (25) and increase sprint power of elite cyclists by 5% (26).

This all sounds great, but what about people with Diabetes, any evidence?

As usual NO, but there are no reasons why this would not work for people with Diabetes.

Just a few things to consider:

• The massive increase in noradrenaline may:
• Increase blood glucose during and after.
• If you have a heart condition it can be very dangerous (27), DO NOT DO IT.

• The increased glucose utilization from shivering may make your glucose drop.
• The cold feeling will mask any signs of going hypo.

• You will need to be aware of the last time you gave a bolus of insulin. If in the last 3 hours your response will be much more unpredictable.

My safety advice would be:

1. Make sure glucose is 7mmol/l (125mg/dl) before starting.
2. Measure before and after and 30 minutes after to see the effect.
3. Start with 5 minutes and build up minute by minute.
4. Have someone with you for the first few times.
5. Make sure your last bolus insulin was at least three hours ago.
6. Keep it to three times a week for practicality, and to reduce to risk of too much stress.
7. If you are dieting hard and in a big energy deficit, do not use cold stress. It may be one stress too far and lead to overtraining and illness.

SAFETY WARNING

ALWAYS CHECK WITH YOUR MEDICAL TEAM BEFORE TRYING ANYTHING, ESPECIALLY COLD STRESS

Check with your Doctor before trying anything, especially if you have a heart condition. If you are thinking of doing contrast therapy, from hot to cold and back, this puts the body under increased stress. This has been shown to be an issue for people with poor heart health (28).

So, there you have it. Cold Stress has quite a few potential benefits, but you have to be prepared for a bit of mental torture three times a week to get them!

Diabetes does present a few extra challenges, but you now have the tools to overcome them.

Do you want to join an elite group of people with Diabetes who have taken on the Diabetic Muscle and Fitness Four-week Cold Stress Challenge?

Is so, head over to the Training Lab where the Activate Your LEAN GENES Guide will walk you through it step by step.

Ok, two down, fasting to go!

Why does fasting fire up your LEAN GENES?

There are multiple metabolic pathways that lead to the activation of LEAN GENES whilst fasting. We will keep our focus on the main two. Firstly, fasting directly increases the level of Sirtuin 1 enzymes. Secondly, the caloric restriction leads to the cells using a lot of nutrients, which causes a very high NAD+ level (29).

This combination is a true stress on the body, and leads to serious activation of your LEAN GENES.

The research evidence on the benefits of fasting is vast and beyond dispute (29). Not to mention that it’s been practiced throughout human evolution, is practiced routinely by many religions, AND IT’S WHAT OUR GENES EXPECT REGULARLY TO BE HEALTHY!

In western society we have just forgotten about it.

Why?

Because there is an abundance of food on every street corner and takeaways just the click of an app away. Instead of fasting being imposed on us by seasonal food scarcity. We have to purposefully pursue the practice of fasting to get the benefit!

This is the challenge. We, humans, love immediate gratification, that’s why we love tasty food, we get in the car for all our trips, and we often prioritize being on our phone until late, in place of seven hours quality sleep.

To meet our evolutionary need to fast, we need to understand the benefit, then shape our environment to make occasional fasting a way of life!

We are now clear fasting is beneficial and that our current environment works against us. But what is not so clear is;

“What type of fasting is the best choice for people with diabetes.”

There are several different ways to employ fasting popular types of fasting are:

Intermittent Fasting:

• 20:4 – Eating window 14:00 – 18:00
• 18:6 – Eating window 12:00 – 18:00
• 16:8 – Eating window 10:00 – 18:00
• 14:10 – Eating window 8:00 – 18:00

5:2 Diet – Popularized by Michael Moseley

• 5 days’ maintenance calories
• 2 days 300-500kcal

One or two 24 hours fast a week – Popularised by Brad Pillion – Eat Stop Eat.

• Usual fasting window 20:00 to 20:00

3-7 day prolonged fasts:

• Water only

In my ten years of clinical and coaching experience, there is one clear winner for people with Diabetes. Before I tell you which one, let’s break each of them down.

If you go for 24 hours without eating, once or twice a week, then back to maintenance caloric intake, your basal insulin requirement changes drastically. Even though modern background insulins have improved, they cannot keep up with this fluctuation. People on an insulin pump have a better chance, but they need two or three basal profiles – this requires a high level of daily management.

In my opinion from lots of clinical and coaching experience, the Eat Stop Eat method often leads to erratic blood glucose.

This is a similar story for the 5:2 diet. Changing from maintenance caloric intake to 300-500kcal twice a week will require two different regimens. Not quite as challenging as Eat Stop Eat, but a level of inconsistency that does not match diabetes medications.

If you are considering a 3-7 day fast, please seek medical support.

You will need a planned gradual reduction in background insulin or medications. You will need to understand the difference between nutritional ketosis and diabetic ketoacidosis. You will need to stop resistance training. Finally, you will need a crazy level of grit and determination.

You may have guessed by now. The best choice is Intermittent Fasting.

Why?

Matching diabetes medications (especially insulin) to metabolism requires one thing, CONSISTENCY. Intermittent Fasting provides a level of consistency from day to day that allows diabetes medications to be matched very effectively.

I have helped countless people with diabetes get the benefit from intermittent fasting with very few blood glucose issues.

Here are my top tips:

1. An 18 (fast) 6(eat) regimen you can improve your hba1c. If you stop eating at 6 pm then your quick acting insulin is out of your system by 10 pm (bedtime). If you get your glucose in the target before bed and your background insulin set correctly, you get the next 18 hours target range.

2. You may need a small correction dose of insulin first thing in the morning if you experience dawn phenomenon.

3. Train at 4 or 5 pm after you have eaten so you have the energy to smash a tough session. Fasted sessions can be challenging.

4. You may need a reduced dose of background insulin in the morning If you take a split dose or you are on an insulin pump. Why? Your liver glucose output drops in favour of burning fat as the fasting period goes on.

This sounds GREAT, so I should use Intermittent Fasting all the time, right?

Not quite. There are times when Intermittent Fasting will be beneficial, and other times detrimental.

When Fasting is beneficial?

• Maintaining current physique or slow body fat loss phase.
• Time pressures.
• Training intensity is not of primary importance.
• Issues with post-breakfast glucose spikes.

Intermittent Fasting will not be optimal when you need to spread out protein feeds, and prioritize recovery from training:

• Gaining size and strength.
• Training twice per day.
• Heavy periods of training requiring on point pre and post nutrition.
• Physique contest preparation.

We have had some amazing results in the Training Lab from those who have taken on the Diabetic Muscle and Fitness Four-Week Intermittent Fasting Challenge.

The Challenge takes you from a 14:10 to a 20:4 over four weeks. It also provides you with a detailed guide on how to adjust medication to manage blood glucose control. Obviously, you need to agree on any medication changes with your Health Care Professional.

Let’s recap on what we now know.

Our Genes only determine 20% of our health, the most important thing is which ones we turn on. Simply, it’s not the size of your fridge or freezer that counts, but the selections you make from them.

The Sirtuin enzymes are the master regulators that fire-up your lean genes by a process of deacetylation. Simply, the Sirtuin enzymes are the conductor and the Lean Genes are the Orchestra.

Hormesis is the process that stimulates the Sirtuin enzymes and elevates the level of NAD+ in the cell to fully activate your Lean Genes. Simply, what does not kill you makes you stronger.

The big three for activating your Lean genes are:

• Polyphenols – High and diverse intake.
• Cold Stress – Fat burning and mood elevation.
• Intermittent Fasting – Consistency is key.

The Training Lab is the place to go for:

• A detailed video guide and practical handbook to further your knowledge.
• The unique Diabetic Muscle and Fitness Four-Week Challenges to convert understanding into real learning by taking ACTION.
• A Community of like-minded people to learn from and get accountable for.

I hope you enjoyed this article. If so, please share with friends who have Diabetes.

John Pemberton

Head Coach at Diabetic Muscle and Fitness

Diabetes Specialist Dietitian/Educator

References

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2. Adipocyte. 2013 Apr 1;2(2):113-8

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3. Nature (2007) 450, 712-6
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5. Aging Cell (2015) 14, 511-523
6. Eur J Cell Bilogy (2009) 88, 35-44
7. Cell Stem Cell (2015) 16, 171-83

10. World J Diabetes (2014), 15; 5(6): 894-900
11. Nutrients 2016, 8, 78
12. Eur J Nutr (2016) 55:1359–1375
13. http://www.tandfonline.com/doi/full/10.1080/00365510701516350
14. https://link.springer.com/article/10.1007/s004210050065
15. https://www.ncbi.nlm.nih.gov/pubmed/1845768
16. https://www.ncbi.nlm.nih.gov/pubmed/16870097
17. http://www.sciencedirect.com/science/article/pii/S0306987703002706
18. http://physiolgenomics.physiology.org/content/24/1/13.long
19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726172/
20. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0046352
21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338605/
22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726172/
23. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0046352
24. http://onlinelibrary.wiley.com/doi/10.1113/JP270570/epdf
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26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3233540/
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29. Physiol Rev . 2012 July ; 92(3): 1479–151

You should be expecting an article full of miracle diets, sexy new supplements, or juice cleanses.

Sorry to disappoint.

At Diabetic Muscle and Fitness, we only deal with strategies that are backed by science and have a consistent track record with our weight loss clients.

So ask yourself:

Do I want to kick-start my fat shredding efforts by losing 15 pounds in 28 days?

Do I want to use tried and tested strategies?

Do I want to know how to easily implement these strategies?

I thought so.

As you read this article you will discover the simple 5 step process. When you follow these you can expect to shred 15 pounds of body fat in 28 days!

Special note. We are not saying these 5 steps will lead to 15 pounds of fat loss every 28 days. We are saying for the first 28 days, i.e. YOUR FAT LOSS ACCELERATION PERIOD.

After 28 days your fat loss will slow, but by then you will have new habits, and there will be no looking back.

Ready to find out how to lose 15 pounds in 28 days?

Let’s go.

Step 1: Be in a 1,000 – 1,500kcal daily energy deficit for the first 28 days.

There is no such thing as a free lunch when it comes to shredding fat. If you want to lose the flab, you need to be in a negative energy balance.

Normally you would only want a 500kcal daily negative energy balance for a weekly loss of 1-2 pounds. But in the first 28-day fat loss acceleration phase, you need a greater daily deficit of 1,000 – 1,500kcal. This will shred 3-4 pounds of fat every week, for the first four weeks.

As a general guide, if you are a female, your daily maintenance kcal will be about 2,000 kcal per day. Therefore you would need to restrict daily kcal to 800-1000kcal. No lower than 800kcal.

As a general guide, if you are a male, your daily maintenance kcal will be about 2,500 kcal per day. Therefore you would need to restrict daily kcal to 1000-1200kcal. No lower than 1000kcal.

The above examples are GENERAL estimates. You can go to an online nutritional requirements calculator to work out your specific daily maintenance kcal – like this one.

Better still, get a coach who can calculate your nutrition requirements, taking into consideration your weight loss history.

Should you go Low Carb or Low Fat?

The answer is: IT DOES NOT MATTER.

The definitive study, DIETFITS, has just answered this very question. Stanford University recruited 609 people into a year-long study. Half of them followed a Low Carb diet, less than 20g of carbs per day, and the other half a Low-Fat diet, less than 20g of fat per day (1).

Which group lost the most after a year?

Both groups lost on average 13 pounds over the year. This is 2 pounds less than you will in 28 days.

In both the Low Carb and Low Fat groups, the people who followed the diet to the letter every day lost up to 60 pounds. Those who did not follow the diet gained up to 20 pounds.

This study should tell you one thing.

Fat loss is achieved by hitting a consistent daily kcal deficit.

So sustainable success comes from following the type of diet you enjoy and can stick to for the long term.

For the people with Diabetes who dose insulin for their meals, you will need a dosing method that fits your chosen diet type. You can learn how to do this by reading this article.

This being said, you will be well-served following the 80:20 rule: 80% of your diet should be real quality food such as quality cuts of meat, fruits & vegetables, nuts, and beans, leaving 20% for “junk food”.

In fact, with such a low daily kcal intake for the first 28 days, you would benefit from following the 90:10 rule. This will ensure you get adequate vitamins and minerals.

After the 28 days, you can relax, reducing the daily deficit back to between 500-700kcal each day. This will prevent your metabolism from slowing, and stop you from dreaming and daydreaming about never being allowed chocolate biscuits ever again!

Step 2: Protein intake of 0.7 – 1.0 grams per pound of body weight (1.4 – 2.2g per kilogram)

For shredding fat, we have just discussed it does not matter if it’s low carb, low fat, or somewhere in-between. However, consuming enough protein DOES MATTER.

Why?

Three reasons backed by science (2):

First, protein provides the building blocks necessary to preserve lean muscle tissue from the resistance training you will be doing.

Second, of all the macronutrients, protein keeps hunger at bay, by keeping you feeling fuller for longer. Keeping your protein intake high is essential to manage the food cravings during the 28-days.

Finally, to digest protein, your body has to work very hard. This will go towards your daily negative energy balance.

To get the most out of your protein intake, it is best to spread it out over 3-5 meals with at least 20-30g at each meal.

• 3-4 eggs
• Tin of fish
• Palm size of chicken or meat
• 150-200g cottage cheese
• 400g mixed beans and legumes
• 25-40g protein powder (Whey, Pea, Hemp, Cricket)

For most people, this means changing your breakfast to include a protein source.

Step 3: Resistance training three times per week and 10,000 steps per day.

What will happen if you put your body into a 1000-1500kcal daily energy deficit without resistance training?

You guessed it.

You will lose lean muscle mass – exactly what you do not want.

To maintain your precious lean muscle mass, you must put your muscles under stress. This sends the message to prioritize keeping muscle tissue. What will be burned instead of muscle? Your fat, exactly what you want!

The best approach is to resistance train three times a week, using large muscle group exercises. For the maximum effect you should incorporate exercises from each of the five key movement patterns: Squat, Push, Pull, Hip Hinge and Walk.

Your program should ensure progressive overload to ensure adequate stress is put on the muscles.

If you are not sure how to create a resistance training program, you should seriously download our infamous Diabetic SHRED Program.

But what about cardio, you surely need cardio to lose 15 pounds in 28 days?

In a word, NO!

It is the daily energy deficit that will drive the fat loss. So it is more important to keep your overall daily activity level high. Doing 15-30 minutes cardio 2-3 times a week will not do that.

What will?

Keeping your daily step count at 10,000 will ensure your energy usage remains high 24/7!

Not just when you put your lycra on.

Step 4: Get 7-9 hours quality sleep each night.

Pay attention Simon Cowell. Sleep is the X-factor.

Without a doubt, not getting enough quality sleep is one of the main reasons for failure where fat loss is concerned.

Why?

Sleep is when your body recovers both physically and mentally, and re-sets ready for the next day.

After a poor night’s sleep, your stress hormone cortisol increases, your hunger hormone ghrelin increases, and your insulin resistance increases, by up to 20%!

Just imagine what this does to your glucose control.

If that were not enough, your positive mood hormones Serotonin and Dopamine decrease.

Combined, this leads to poor food choices, not going to the gym, failing to hit 10,000 steps per day, and no interest in tracking your progress!

So sleep can either be your X-factor, or your reason for failure.

These simple tips are taken from one of our other popular articles on the seven tactics to revolutionize your sleep,

1. No blue light technology after 8 pm (SMART phone, laptop, tablet)
2. No caffeine after 2 pm
3. No intense training after 7 pm
4. Keep your bedroom blacked out
5. Have your sleeping temperature at 18-21 degrees Celsius (60-68 degrees Fahrenheit)

Step 5: What gets measured gets managed – if you are held accountable.

On average people underreport their food intake by 25-50%. We never report that handful of crisps, that slice of cake, or that latte. We are very good at fooling ourselves and others.

When you go to the gym, do you ask questions such as:

What weight did I do last week?

How many reps did I do?

What exercise was meant to be next?

This is why measuring and monitoring is ABSOLUTELY VITAL.

The method you use is not that important, just that it works for you.

For nutrition:

You could track macros by using MyFitnessPal or Cronometer.

You could use a hand portion guide.

You could invest in a personalised meal plan.

Whatever works for you.

For counting steps, you could use a Garmin, a Fitbit, or any other tracker.

For logging gym sessions you could use notes on your phone, write down the routine on paper, or you use an online tool with a coach such as Fitbot.

If you are measuring, you are half way there!

What’s the second half?

Monitoring and accountability.

Generally speaking, we are not very good at holding ourselves accountable.

Ever heard yourself saying?

I will just miss the gym today because I am busy, but I will definitely go tomorrow.

I will eat this donut now, but I promise I will make up for it tomorrow.

Does tomorrow ever come?

This is why you need to make yourself accountable. There are loads of way to create accountability.

Social Media – Post about your 28 days Fat Acceleration Phase, and update it daily – there is always someone stalking you!

Fat shredding partners – do it in a group of two or more. Why not have a betting pool where the biggest loser is the biggest winner?

Online accountability such as Stickk – create your own financial disincentive, by pledging to donate money to a cause you HATE, if you do not achieve your goal!

Hire a coach – pay for professional support, education, and accountability. Hire someone who is an expert in what you are trying to achieve. This will save you time, money and heartache in the long term. This is why top performers in all fields from sports and business hire coaches. It’s the fast track to guaranteed success.

Have you ever hired a coach before?

Maybe that’s why you’re reading this?

Let’s wrap this up.

You are now aware it is possible to lose 15 pounds of Pure Fat in a 28-day fat shredding acceleration phase. But after 28 days the fat loss will slow, and your daily kcal restriction will need to be more conservative for long-term success.

You have been through the simple 5 step plan you need to follow. You have identified the key actions you need to take.

You understand that measuring, monitoring and getting accountable are the keys to ensuring success.

All that’s left to do is to take action!

Oh and by the way, if you want to make the challenge easier and more enjoyable. You would be wise to arm yourself with a selection of delicious calorie controlled diabetic friendly meal plans. If your serious about dropping body fat and staying lean for the rest of your life you need to check out The Ultra Lean Diabetic Cookbook. 

Please share this article if you found it useful.

References

(1) https://jamanetwork.com/journals/jama/article-abstract/2673150?redirect=true

(2) https://jissn.biomedcentral.com/articles/10.1186/s12970-017-0174-y

• My friend eats way more than me, but he never gains weight!
• I eat the exact same calories as my work colleague, but she loses more weight than I do!
• Every time I diet and lose weight, I always regain it, even though I eat healthy.
• Is it because I have diabetes and they don’t?

If so, I bet your friends, dietitian, doctor, partner and work colleagues say…

• You must be eating more than you’re saying.
• There’s no such thing as a “slow metabolism”.
• You’re not trying hard enough.
• It’s because of the diabetes medication, especially insulin, it’s working against you.

Are you feeling a little frustrated by it all?

Want to understand what’s going on?

Want to discover how to break the yo-yo dieting cycle?

As you read this article, you will start to realise you were right about a few things,

• You will have a “slower metabolism” after losing weight, especially if you dieted without strength training.
• You find it harder to maintain the same weight as your naturally lean friends.
• Diabetes medication may be adding to your challenge.

Want to know how to overcome these challenges?

Let’s go…

I’ve distilled ten years of clinical experience as a Diabetes Educator and body transformation coach into 10 fundamental principles every person living with diabetes must follow in order to lose body fat and keep off it for good.

1. There is no ‘BEST’ fat loss regime.

If you consume fewer calories than you expend, you will lose weight _{(1, 5).} You can lose weight equally effectively with the Zone diet, Atkins diet, Ornish diet, or anything else if you achieve a consistent kcal deficit _(1,5).

But clinical experience has highlighted a special consideration when it comes to Diabetes. You must pay attention to macronutrient consistency (carbs, fat, and protein), to ensure glucose stability. If you have diabetes you can choose any diet type you prefer, but you must be macronutrient consistent from meal to meal, and day to day.

2. The best diet regimen is the one you can stick to properly, for the longest _{(1, 2, 5).}

This varies from person to person based on the food preference, psychology (all or nothing person vs. person of moderation), environment, food availability, social support, and accountability. So pick the diet type that is easiest for you follow, and suits your lifestyle.

If you don’t know how to build your own diet check out these two articles.

THE BIKINI BODY DIET PLAN FOR WOMEN WITH DIABETES | CALORIES, MACROS AND SUPPLEMENTS.

THE ULTIMATE MUSCLE BUILDING & FAT LOSS DIET PLAN FOR MEN WITH DIABETES | CALORIES, MACROS AND SUPPLEMENTS.

3. You must proactively adjust your diabetes medication as you lose weight.

This prevents too many hypos and consuming extra kcal that set you back. It’s not usually the 15 grams of quick acting carbs that’s the problem. It’s raiding the fridge due to an insatiable hunger.

4. If you adhere strictly to the plan, you can lose weight consistently for the first 6 months.

Usually about 10% of body weight. So if 200 pounds, lose 20 pounds. If 70kg, lose 7kg.

5. Expect a plateau at around 6 to 12 months in. _{(2, 5).}

6.At 12-24 months’ weight is usually regained, often back to where it started for 80-90% of people. ₍₂₎

This was shown clearly in a Randomised Control Trial that had 811 people follow an energy-restricted diet strictly, for two years. They found the 80% who stuck to the diet (20% dropped out) lost an average of 6.6kg in the first year, but regained 1.2kg by the end of the second year, to lose 4.2kg.

Only 15% or the study participants kept 10% of body weight off at the two-year point. Even though they were supposedly in an energy restriction according to the standard metabolic formulas. ₍₅₎

Sound familiar?

7. The only people who keep weight off at 24 months are those who significantly increase their physical activity level _(3).

Increase to a level way above that of the average person, and much more than they did previously. In short, you must increase your activity level for life, not just for 6 to 12-weeks diet period, if you want to keep the weight off for good. ₍₄₎

8. Be slow, diligent and tactful.

Semi-starvation is the guaranteed way to fast-track weight regain.

You must lose weight slowly, so the vast majority of the loss is fat.

This is best achieved by consistently being in a 500-700kcal daily deficit over a long period of time. Not a 1000-1500kcal daily deficit for a couple of months, following the latest detox or juice cleansing diet.

Second, you must challenge your body by resistance training. This will make sure your lean muscle is retained. This will give you the greatest chance of keeping the fat off in the long term.

So that begs the question:

WTF happens at six months?

You may be thinking…

” I am still in a calorie deficit because I am following the diet prescribed by the Dietitian, Personal Trainer, Doctor, or Online Guru. They have worked out my kcal requirement correctly, right?”

“Why am I not continuing to lose weight, and when I go back up to maintenance calories, why do I start regaining the weight I have lost?”

Ready for it…

When you lose 10% of body weight, your daily calorie burn drops by 25%. ₍₂₎

If you use the standard metabolic equations for working out calorie requirements, and factored in the initial weight loss, the drop in calorie burn should only be 10%. ₍₂₎

So where is the extra 15% drop coming from?

Consider this:

When you lose 10% of your body weight, key hormones that determine basal metabolic rate plummet, such as thyroid hormone. Also, hormones, such as Leptin, that tell your brain your body has plenty of energy supplies drop ₍₂₎.

In short, your hormones work against you losing any more weight.

Secondly:

Your level of NEAT (Non-Exercise Activity Thermogenesis) drops off the face of the earth. You stop fidgeting, getting up to go to the toilet, laughing, wriggling around and taking the stairs. The reduction in NEAT accounts for 80% of the problem ₍₂₎.

Here is the nasty truth that you have always probably known, despite being told otherwise.

If you have lost 10% body fat and achieved the same weight as your friend, this reduction of 20-25% in daily calorie burn is persistent, for the very long term.

This means you will have to eat 20-25% less than your friend, who has always been that weight, to maintain the same weight.

Studies have followed people who have managed to maintain their 10% weight over the long term, to see if their metabolism re-boots, to blast away the 20-25% disadvantage.

Guess what?

The people who had lost 10% or more and kept it off still burned 20-25% less energy than the same weight person who was always that weight. ₍₆₎ They only managed to keep it off by having a much higher activity level, and being conscious of their food intake.

Let’s put this into a real-life example.

John weighs 100kg (220lb) and his daily maintenance kcal requirement is 3000kcal.

He wants to lose 10% (10kg, 22lb) of weight over six months. He plans to do this with a 700kcal daily deficit for six months, therefore he plans to keep to 2300kcal.

For the first three months, he loses weight at a rate of 0.5 – 0.75kg (1.0-1.5lb) per week.

Total loss for the first three months is 7kg (15lb).

But after three months survival mode kicks in, he only loses 0.25-0.5kg (0.5-0.75lb) per week.

Total loss for months three to six is only 3kg (7lb).

He has reached his 10kg (22lb) target, but his weight loss has flatlined.

If only taking his weight loss into account when calculating his energy requirement, his new maintenance kcal at 90kg (200lb) should only be 10% less, which would be 2700kcal. So theoretically, he should still be in a 400kcal daily deficit, as he is only consuming 2300kcal per day.

But in reality, his new maintenance kcal is 25% less than when he weighed 100kg (220lb), so it’s actually 2250kcal – a whopping 450kcal less than predicted; as he is consuming 2300kcal, it makes sense why he has hit a plateau.

To rub salt in the wound, John’s best mate Phil, who has always weighed 90kg (200lb) has a maintenance kcal of 2700kcal.

So Phil can enjoy an extra 450kcal each day and not gain any weight.

To gain some perspective 450kcals would equate to…

3,150kcal per week – X2 Large Dominos Pizzas and a 2-litre bottle of coke.

12,600kcal per month – X8 Large Dominos Pizzas and x4 2-litre bottles of coke.

151,200kcal per year – X96 Large Dominos Pizzas and x48 2-litre bottles of coke.

A pretty good reason to get annoyed at your naturally lean friends. Don’t you think?

This is also why people dieting for physique contests and bodybuilding shows need to drop kcal intake more than expected in the late stages of prep. After three months of dieting, things start to get really tough, and daily intake has to drop lower than predicted by the standard metabolic equations.

You may be thinking?

That’s unfair!

Why would evolution do this to us?

Simply, it’s a survival mechanism that was fit for purpose a few hundred years ago.

Not so long ago, a weight loss of 10% signified starvation and imminent death.

But in today’s environment of unlimited food availability, this protective mechanism is no longer needed, but unfortunately our biology has not caught up.

Now you know this, you have two choices.

First option:

Take the mind-set of poor me, my lean friends can eat more than me, it’s unfair, everything is against me, I might as well not even bother…

or

Second option:

Reframe your mind-set to appreciate what an amazing adaptive machine the human body is. If you were born a few hundred years ago, this would have been a lifesaver.

Now you’re informed, it’s time to be a little more creative. The challenge is real, bring it on!

If you have chosen option one, stop reading right now, and take a long think about how your mind-set and perceptions are holding you back. If you opted for number two, carry on reading to discover the top tips to overcome the 20-25% challenge.

I’ve outlined below 10 incredibly useful tactics I use with all our diabetic coaching clients inside the Diabetic Muscle and Fitness Online Coaching Academy to increase NEAT and halt fat re-grain.

Check these out…

1.  Consume 1.5-2.2g/kg (0.7-1.0g/lb) of protein daily.

• This is proven to reduce hunger and preserve lean muscle tissue.
• Be sure to spread your intake over three to five feedings a day.
• If you have type 1 diabetes, you will need to factor protein intake into your mealtime insulin dosing regimen. If you’re not sure how to do that – check out this article.

Arming yourself with a selection of delicious diabetic friendly meal plans can really help! If your serious about dropping body fat and staying lean for the rest of your life you need to check out The Ultra Lean Diabetic Cookbook. 

2. Strength Train at least three times per week to prevent the loss of lean muscle mass.

This is the silver bullet in preventing weight regain. If you preserve your lean muscle mass when losing weight, the chances of fat regain are much lower.

3. Get an activity tracker and ensure at least 10,000 steps per day.

This will help you become conscious of your body trying to drive NEAT down.

4. After losing 10% of weight, increase your daily calorie intake slowly to find your new maintenance level.

Do not jump straight into a bulking phase and eat 200-300kcal more than what you think is your maintenance kcal level. I can guarantee you will overshoot by 800kcal per day.

You must find your new maintenance kcal intake by increasing kcal slowly and monitoring your weight. This is essentially the concept of reverse dieting, a topic for another day.

It is also essential to have some way of tracking food intake. If you’re not assessing, you’re guessing:

• Apps such as MyFitnessPal or Chronometer.
• Follow a meal plan specifically designed for your needs.
• Get good at flexible eating and swapping foods of similar kcal value.

5. Get your diabetes under control.

Taking too many hypos will lead to increased calorie intake that makes overcoming this 25% challenge very difficult. Here are some useful coaching tips.

• Get a plan that is consistent with macronutrients (carbs, fat, and protein), so you can easily match your diabetes medication to your meals.
• Test your basal insulin to make sure you’re not taking too much. I wrote about how to do this here.
• Test your mealtime insulin dosing regimen to make sure you are not overdosing. I wrote about how to do this here.

What if I have Type 2 diabetes?

If you have type 2 diabetes and take insulin secretagogues like Gliclazide, you may need to reduce the dose as you increase your activity and lose weight.

Always adjust your medication to compensate for exercise rather than consuming extra carbohydrate.

6. Build habits on a weekly basis to keep calories down and activity high.

For example:

• Strict ban on using any lifts.
• Do an online shop which limits foods that will sabotage your efforts.
• Cycle to work.
• Get off one or two bus/train stops early.
• Have walking meetings (use a Dictaphone).
• Ban snack food from the work coffee and tea station.
• Taste the Rainbow! Have one fruit and veg from each colour of the rainbow every day.

7. Respect the fact your food portions will need to be 25% smaller than your friends’ who have never been overweight.

This is very important when eating out.

8. Get a credible coach & mentor who can:

• Create a plan in light of the 25% disadvantage.
• Keep you accountable to your goals.
• Offer creative solutions to keep you on track.
• Understands how to integrate diabetes management with all of this.

9. Get a reliable workout buddy to prevent you from skipping exercise.

It really helps if they are a little stronger and more experienced than you.

10. Join an online community who can offer support, creative solutions, and accountability:

You’re more than welcome to join the Diabetic Muscle and Fitness Facebook Group, interact, learn and keep yourself accountable. There are thousands of people just like you inside.

Join here 

TAKE HOME

1. If you want to lose 10% of weight and keep it off, you will be at a 25% disadvantage compared to a friend who is at the same weight naturally.
2. Change your mind-set, environment, and habits to make up for the 25%.
3. Get accountable.
4. Get professional support from someone who can help you integrate your diabetes with a long-term weight loss plan.

If you found this article useful please feel free to share it with people you think it may help.

References

1. https://www.ncbi.nlm.nih.gov/pubmed/15632335
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673773/
3. https://www.ncbi.nlm.nih.gov/pubmed/18223628
4. https://www.ncbi.nlm.nih.gov/pubmed/21030947
5. http://www.nejm.org/doi/full/10.1056/NEJMoa0804748
6. https://www.ncbi.nlm.nih.gov/pubmed/18842775

THREE KEY WAYS TO ACHIEVE PERFECT BLOOD GLUCOSE LEVELS AFTER EATING

How do you know if your mealtime insulin dosing method is accurate?

• Do you sometimes go high after eating?
• Do you sometimes go low?
• Do you have both highs and lows from day to day?

Frustrated by it all? ThIS article discusses how you can test the accuracy of your mealtime insulin dosing method, identify inaccuracies and put a solution in place, if needs be.

Please remember, it’s your responsibility to discuss any changes to your insulin regimen with your medical team. This is for information purposes only.

In order to test the accuracy of your mealtime insulin doses we need to breakdown the assessment into three simple steps:

1. Preparing for the test.
2. Completing the test.
3. Reviewing your results and making valid changes.

Before we get started, you must consider what type of diet you currently follow.

Are you following a…

• Low carb approach?
• Zone style approach?
• KETO approach?
• High carb approach?

Or,

• Are you doing what most people do, chopping and changing from meal to meal and day to day?

This last question is the most important one you can ever ask because:

If you are chopping and changing your macronutrient intake (carbs, fats, and protein) from meal to meal and day to day, you will NEVER get consistent results from your mealtime insulin doses.

Does this sound like you?

If so, you have two options:

1. Carry on as you are, stop reading this article, and expect the same results you’ve always had – Blood glucose levels all over the place after meals.

Or,

2. Be more consistent with your macronutrient intake. It does not matter if it’s low carb, high carb, KETO, Zone etc. – Consistency is what matters.

If you have chosen option two, or if you are already following a consistent macronutrient intake, this three-step methodology will work for you.

For accuracy – you will need to repeat the test twice at each meal time to ensure what you see is not an anomaly. Therefore, you need to identify two rest days or two training days.

And yes, you would be right in thinking the day where you do 60-minutes HIIT  may require a different post-exercise meal insulin vs. a 45-minute strength session at medium intensity.

But, for now, let’s keep things simple and look at exercise days and rest days. You will need two of each.

STEP 1: PREPARING FOR THE TEST

In order to make the test fair, you must meet the following conditions before testing your blood glucose level before the mealtime you are testing.

1. Consume your last meal and give your last insulin dose at least 4 hours before.

2. Your last meal should have no more than 30g fat – otherwise, you run the risk of delayed hyperglycaemia.

3. No correction insulin in the four hours before.

4. No snacks within four hours.

What if I go Hypo during the test?

If you go hypo you will need to eat and re-do the test another day.

STEP 2: DURING THE TEST

Calculate your insulin dose using your usual method. Usually, this is carbohydrate counting and applying an insulin to carbohydrate ratio, although you may also count protein and use a similar ratio. A popular method is to count 50% of protein applying the same insulin to carbohydrate ratio. Be sure to weigh your food to get an accurate count.

Do not include a correction dose of insulin, you only want to be testing the insulin for the meal.

Give the insulin 15 minutes before eating.

Maintain normal activities – No sex, masturbation, running, etc…

Test your glucose at the following points:

• Just before eating,
• Two hours after eating,
• Four hours after eating.

If you have CGM this is golden, you will get the full picture.

Again, you need at least two tests of the mealtime before considering making a change.

TWO OF THE SAME DAYS – Two rest days, or two exercise days – DO NOT MIX THESE UP!

STEP 3: DURING THE TEST

You must speak to your medical team before implementing any of this.

WHAT TO DO IF BLOOD GLUCOSE INCREASES DURING THE TEST.

 

If your blood glucose level goes up by more than 2 mmol/l (36mg/dl) from before the test to four hours after – on both occasions:

Consider adjusting the insulin to carbohydrate ratio to give 10-20% more insulin. How you do this depends on which side of the ratio you change. If you change the carbohydrate side of the ratio, then reduce the carbohydrate by 10-20%.

For example, if your current ratio is 1 Unit : 10g carbs, change to 1 Unit : 9g carbs (10%) or 1 Unit : 8g carbs (20%)

But if you change the insulin side of the ratio, then increase by 10-20%.

For example, if 1.0 Unit : 10g carbs, change to 1.1 Unit : 10g carbs (10%) or 1.2 Unit : 10g carbs (20%).

If your blood glucose level goes up by more than 2 mmol/l (36mg/dl) from before the test to two hours, but is back within 2 mmol/l (35mg/dl) after four hours – on both occasions:

Consider delivering the insulin earlier than 15 minutes before eating. You could even try 30 minutes before.

WHAT TO DO IF BLOOD GLUCOSE DECREASES DURING THE TEST.

 

If your blood glucose level drops by more than 2 mmol/l (36mg/dl) from before the test to two hours after – on both occasions:

Consider adjusting the insulin to carbohydrate ratio to give 20% less insulin. How you do this depends on which side of the ratio you change. If you change the carbohydrate side of the ratio, then increase the carbohydrate by 20%.

For example,

If 1 Unit : 10g carbs, change to 1 Unit : 12g carbs (20%).

But if you change the insulin side of the ratio, then reduce by 20%.

For example,

If 1.0 Unit : 10g carbs, change to 0.8 Units : 10g carbs (20%).

If your blood glucose level lowers by more than 2mmol/l (36mg/dl) from before the test to four hours after – on both occasions:

Consider adjusting the insulin to carbohydrate ratio to give 10% less insulin. How you do this depends on which side of the ratio you change.

If you change the carbohydrate side of the ratio, then increase the carbohydrate by 10%.

For example,

If 1 Unit:10g carbs, change to 1 Unit : 11g carbs(10%).

But if you change the insulin side of the ratio, then reduce by 10%.

For example,

if 1 Unit:10g carbs, change to 0.9 Units : 10g carbs (10%).

Obviously, you may need different mealtime insulin dosing method for exercise and non-exercise days.

You may even have different methods for HIIT vs. Strength days – depending on your level of need, and OCD (like me).

Round Up: Five Key Tips That Help Ensure Consistent After-meal Blood Glucose Readings.

1. Keep your macronutrient meal amounts consistent from meal to meal and day to day.

2. Respect the fact that your mealtime insulin dosing method will be different on rest days and workout days.

3. If your meal contains over 30g fat and at least 30g carbs, there is a risk of delayed high glucose levels. For this, you will need extra insulin and to split the insulin dose.

4. Try to deliver mealtime insulin 15 minutes before eating, if not earlier.

5. Occasionally weigh your food to make sure your carbohydrate (and maybe protein) counting is accurate.

If you found this article useful you’ll gain even more value inside our exclusive members’ area – The Training Lab. There is an insane amount of high-quality content in there waiting for you. It will add immense value to your diabetes management, health, muscle building and fat loss efforts.

For example, if you want to learn how to add extra insulin, and split your dose for high fat and protein meals, you need to check out our two most sought after education guides.

1. Become a Bolus Wizard.
2. The Definitive Guide to Insulin Dosing for Carbohydrate, Fat and Protein.

CHECK OUT WHAT PEOPLE ARE SAYING ABOUT THE TRAINING LAB?

Click here and Join today and claim 2 months free membership, a free training tee and Diabetic Muscle and Fitness protein shaker!

If you want to build a great looking body you’re going to have to respect a number of fundamental principles, these include…

Controlling your calorie intake, regular strength training, keeping active (outside the gym), getting high quality rest and following a healthy lifestyle.

These are all compulsory. whether you’re diabetic or not. However, people with diabetes have an extra responsibility that overrules all of these factors.

You can be incredibly precise with your calorie intake, disciplined with your training, physical activity and sleep schedules, but if you don’t dose your insulin correctly in relation to all of these factors, then your efforts to get in shape will be futile.

If you want to build your best body yet, you need to be disciplined and knowledgeable when it comes to dosing insulin and managing your diabetes. This is an area almost every hard training diabetic I have come across fails on.

They know how to train and eat, but when it comes to managing their blood sugars, bolus and basal insulin they are sunk! As a result, they never reach their true muscle building and fat loss potential and end up going round in circles trying one diet/training regime to the next without actually looking at the root of the problem, which is ignorance and lack of knowledge on insulin dosing.

Think about it.

Dose too much – you’ll end up going hypo and have to consume what’s available, which could add a tonne of unwanted calories, never mind straining your central nervous system, which can have detrimental effect on mood and exercise performance.

Vice versa, don’t inject enough insulin and you’ll end up going hyperglycaemic, which is highly catabolic, detrimental to health and the last time I checked…doesn’t really feel that good!

I asked our head coach John Pemberton, who runs the Diabetic Muscle & Fitness Elite Physique Coaching program and who also happens to be one of the UK’s leading diabetes dieticians, to share his views on how people with diabetes can learn to dose their insulin more accurately for better fat loss and muscle.

Check out he had to say in the article below.

Get a pen and paper ready. As you absorb the latest information in this article, you will quickly become more advanced than the vast majority of Diabetes Dietitians.

Yours in Strength,

Phil Graham

Unfortunately, people with type 1 diabetes are taught (previously by me) that calculating insulin at meal times is simple:

1. Add up the carbohydrate of the meal.
2. Apply your carb ratio.
3. Deliver the insulin.
4. Your blood glucose level will remain in target for the next four hours.

Carbohydrate is the only macronutrient that increases blood glucose after eating, right?

You know this isn’t true. It’s not as simple as just calculating carbs.

How many times have you experienced random high and low blood glucose levels after eating, even though you thought you accounted for every last carb?

Take, for instance, the latest research¹ on how much extra insulin is needed for a 70g carbs pizza base vs. a 70g carb pizza with extra cheese and meat.

How much extra insulin do you think was needed?

Wait for it…

65% extra insulin on average, and some people needed up to 124% extra!

Yes! That means you need to think outside the box of just counting carbs. Once you realise this you will gain significantly more control over your diabetes. Let’s break it down.

First things first, have you heard of any of the following?

• The Warsaw Fat and Protein Unit System.
• The Food Insulin Index.
• The Bell (2015) Systematic Review insulin dose algorithm.

Maybe not?

Don’t worry. I hadn’t either, and embarrassingly, even during my time working as a Diabetes Specialist Dietitian for the National Health Service.

Initially I employed the counting carbs-only approach for the first five years of my Type 1 journey (still working as Diabetes Dietitian), and found it to be successful 75% of the time.

This may sound ok, but I was experiencing unexpected highs and lows which I didn’t appreciate.

Despite doing everything right, I wasn’t confident in controlling my diabetes.

Are you in the same boat?

If so, what have you done about it?

Nothing?

Well, I’m here to tell you –  it is time to move past the “You must not be counting your carbs correctly!” answer you’ll get from your diabetes specialist or dietician.

When I realised things weren’t working for me, I invested myself heavily into the research and physiology textbooks in search of answers. I wanted to devise a set of flexible insulin dosing strategies that would put me and any other fitness fanatics with type 1 diabetes in full control of their physique and fitness goals.

This is something that would help you, right?

How easy would it be to choose the right insulin dose if all you had to do was?

1. Enter your carb, fat and protein grams into a calculator.
2. Observe the different insulin doses suggested by the four main systems.
3. Choose the insulin dose based on your current goals, gaining, leaning, maintaining.

Keep reading and I will tell you where you can go to find such a revolutionary calculator. But before that, let’s look at what the research and textbooks tell us.

I am not going to bore you with all the details of reading 100s of articles, 1000s of hours of personal trial and error, and 100s of patients trailing different methods in my clinical practice.

I’ve done all the hard work for you. Let me take you right to the juicy stuff. You ready?

Say hello to Kristine Bell, a Type 1 diabetes researcher in Australia. She authored what I consider to be one of the most important Type 1 Diabetes articles: the most comprehensive evidence review on the effect of carbohydrate, fat, protein and glycaemic index on after-meal glucose levels.²

Finally, a team of experts took the time to pull together the best research to explain the physiology, and most importantly to offer solutions. This is a landmark paper for people with Type 1 Diabetes.  Why?

The paper highlights the physiology behind, and the best techniques to prevent, your glucose level going out of range after eating. Here are a few of the highlights to whet your appetite:

• Glucose soaring after eating carbs that get absorbed quickly (high glycaemic index). This is because even though we have “quick acting” insulin, it’s not as quick as that breakfast cereal or bagel! Breakfast is usually to worst for post-meal spikes, right? Here some pearls that will keep those post-meal levels in check.

• Takeaway 1: Give your insulin 15-30 minutes before food! How about even earlier, how does 40 minutes sound if your glucose level at 12mmol/l (215mg/dl) pre-meal? This will keep those post-meal spikes in check!

• Takeaway 2: Ever heard of a Super Bolus? If you are on an insulin pump, try borrowing from the basal by doing a temporary basal rate, and then add it to the meal insulin. I have seen this destroy after-meal highs, it’s something I use every day.

• Glucose level going high and staying high four to ten hours after eating a meal containing large amounts of fat or protein. Do you think this is due to excess protein being converted to glucose? It’s actually due to excess protein causing pancreatic glucagon release, which goes to liver and floods the bloodstream with glucose; not forgetting the prolonged insulin resistance caused from a high fat intake. What’s the answer?

• Takeaway 3: If you are on a pump you need to increase the meal insulin way above that suggested by the carbs alone, and use a dual/extended bolus option to spread it out! How much extra? How long to extend?
  • Start with 25% extra and increase from monitoring
  • Start with a 50/50 split of the bolus and extend the second 50% for 2 hours bolus
  • Monitor and make adjustments as needed. I need 50% extra insulin when I have Pizza. I bolus 60% upfront and the remaining 40% over three hours. I do love a stuffed crust!

• Takeaway 4: If you are on multiple daily injections you also need to increase the meal insulin way above that suggested by the carbs alone. But you need to do two injections to cover the delayed rise.
  • Start with 25% extra and increase from monitoring
  • Start with the first 50% of the insulin before the meal, and give the other 50% in 60-90 minutes time.

You may be thinking,

“All these techniques are for high carbohydrate diets, what about the low carb diet, how should you calculate meal insulin?”

Some key takeaways for the low carb crowd:

• Takeaway 5: The amount of insulin required to cover the glucose raising properties of protein is less when eaten with very low carbs. So you will need a very small insulin dose at mealtimes to cover protein if you go very low carb or KETO. From clinical experience a lot of people find success with counting 25-50% of the protein and applying their carb ratio to get an effective dose. But this requires some trial and error.

What about the fitness fanatics and physique competitors who go from high carb when gaining mass, to low carb when shredding fat?

They need to be adept at counting macros and switching up their insulin dosing strategy as they manipulate their macros. This takes time, experience and plenty of trial and error.

By now you’ve probably realised how much valuable information is inside this paper?

You would be 100% correct.

However, there is one big problem…

It is written in a very scientific way – making it incredibly difficult to understand for the average layman. It certainly doesn’t have videos and tools to bring it to life. This is where I come in.

I have condensed thousands of hours studying the amazing work of Kristine Bell and summarised it into a BREAKTHROUGH course hosted inside the Diabetes and Muscle Fitness Training Lab.

What is it called? What does it entail? I hear you ask…

“Becoming a Bolus Wizard”

This eleven module video course will be the best five hours you have ever invested in your Diabetes. It starts you at the basics to cement your foundational knowledge. It will then advance your knowledge to a point where you can start to apply:

• The Warsaw Fat and Protein Unit System
• The Food Insulin Index
• The Bell (2015) Systematic Review insulin dose algorithm
• Super Bolus
• Glycaemic Index
• Personalised Nutrition

Not only does the course have an interactive workbook, but it has that bolus calculator I mentioned earlier – the calculator that allows you to simply enter your meal details, and hey presto, you have all the insulin dosing systems at your fingertips.

Sound like a one-stop shop?

It is truly a unique resource that I am very proud of and has taken an immense amount of work. I am excited to be sharing it with you, so you can take control of your diabetes and build the body you’ve always dreamed of.

I guarantee you will be 100% satisfied, why? Because hundreds of people with type 1 Diabetes have already benefitted from the course and calculator. Take Andy for example, Type 1D of 20 years.

“For years I was taught it was only carbs I needed to account for. I knew this was too simplistic, but what else was there to know? My healthcare professional kept telling  me it was only carbs. The course built my knowledge, instilling the basics, then I started bolusing for protein. What a game changer, Type 1 Diabetes is no longer a mystery!”

After absorbing this article, you are now aware you need to broaden your insulin dosing horizons. Imagine completing the modules inside Becoming a Bolus Wizard , using the calculator and dominating your diabetes control.

I’m not saying you have to join the lab and read through my course.

You could do all the research yourself, but do you have a few thousand hours to spare?

How about five hours?

If you want to learn faster, more effectively and get better diabetes control, there is only one thing to do.

1. Become a member of the Training Lab. (you get a free T-shirt and shaker when you join)
2. Watch the videos
3. Complete the modules
4. Download the workbook and test your new found knowledge
5. Use the calculator
6. Dominate your diabetes game

You will be joining a community of people with Type 1 Diabetes who are positive about diabetes, who are training for strength and physique, and who inspire you to be more.

Are you are the type of person that wants great detail and the research behind all the insulin dosing strategies?

If so the Training Lab also has the most detailed guide available:

“The Definitive Guide to insulin dosing for carbohydrate, fat and protein”

Be warned, this goes deep!

Ever heard of “you are the average of the five people you associate most with?” Upgrade your circle of positive influence, and join the Diabetic Muscle and Fitness Training Lab.

I hope this article helped you!

See you on the inside.

References

1. Bell et al. (2016) Optimized Mealtime Insulin Dosing for Fat and Protein in Type 1 Diabetes: Application of a Model-Based Approach to Derive Insulin Doses for Open-Loop Diabetes Management. 

2. Bell KJ, et al. (2015) Impact of fat, protein, and glycaemic index on postprandial glucose control in type 1 diabetes: implications for intensive diabetes management in the continuous glucose monitoring era.

WHY IS MY BLOOD GLUCOSE HIGH IN THE MORNING EVEN WHEN I GO TO BED IN RANGE?

Are you are waking up to high blood glucose levels, even though you went to bed in target?

Worried you might be going hypo in the night?

Do you increase or reduce background insulin?

Is it Dawn Phenomenon or Somogyi Phenomenon?

Here are three simple steps to know if it’s dawn phenomenon or Somogyi phenomenon:

1. Have last meal at 6 pm and make it a normal meal not too high in fat.
2. Ensure BG is on target before bed -after 10 pm -with no supper or bolus insulin.
3. Test BG at 3 am and waking.

If your blood glucose rises overnight from 3 am to waking with no hypo, it’s dawn phenomenon (I will discuss Somogyi shortly). – If you have CGM this is easy to see.

Check this two to three times to confirm it’s not a one-off.

 

Take your records to your medical team so that you can show you have confirmed it BEFORE your appointment, otherwise they will ask you to go away and do this. This will save you 6 months waiting time.

WHAT IS DAWN PHENOMENON?

Dawn phenomenon is caused by a big stress hormone splurge from 3 am to 8 am. This splurge causes the liver to pump out more glucose and your cells to become insulin resistant.

The result is a high overnight/early hours glucose level, even though you went to bed with a target level.

If you have proved it’s Dawn Phenomenon, here are a few important factors to consider…

If you keep increasing your Lantus, Tresiba or any other long-acting 24-36 hour insulin, you will get in target morning glucose levels.

However,

• You will be at major risk of hypos during the day (too high background dose).
• You will gain fat like lightning and struggle to lose it, because too much insulin around all day keeps fat burning low, and storage high.
• Your glucose will drop rapidly when you exercise, leading to consumption of many extra carbs to train, not ideal for a shredding phase of training.

Unfortunately increasing the Lantus/Tresiba/long-acting is what a lot of medical teams suggest – QUESTION THIS DOGMA!

Here are some tried and tested options to discuss with your medical team.

If so potential solutions could entail…

1. Insulin Pump: This allows a higher basal rate during the night; that is if you can access a pump in your country, and you do not mind being attached to a pump. You will have a higher hourly basal rate from 2-6am – this works very well.
2. Resorting to an older insulin such as Insulatard (an NPH insulin) for background insulin overnight. It peaks 4-8hrs after administration. So if given at 10 pm, it peaks at 2-6am – to combat dawn phenomenon. Then have another dose of insulatard in the morning or a Levimer for background for the day.
3. Setting an alarm for 3 am every day and bolus quick acting insulin to combat the rise. Start with a small dose and build up until you have it sorted; not a solution for life, but maybe a solution for the short-term until you get options 1 or 2 sorted.

All valid suggestions with pros and cons. Speak to your medical team to discuss options

WHAT ABOUT SOMOGYI PHENOMENON?

If you take a hypo at 3 am during your three steps, it maybe Somogyi. You will need to confirm this with CGM.

Why?

Because if you test BG at 3 am and it’s low – what are you going to do? Have glucose and maybe stuff your face in the fridge! So this will nullify any identification of Somogyi.

Somogyi Phenomenon is very RARE, as shown in the review below, and CGM case studies. A lot of people THINK they have it, but CGM almost always proves it as Dawn Phenomenon – But you’re maybe the exception!

 

CGM diagnostic studies have failed to find any instances of…

• Somogyi.https://www.ncbi.nlm.nih.gov/m/pubmed/17652003/
• Review: https://emedicine.medscape.com/article/125432-overview#a4

If you are one of these very rare people with Somogyi Phenomenon, and you have definitely confirmed it with CGM – then the therapy change is a reduction in overnight basal insulin. There is a ton more of useful information just like this inside the Diabetic Muscle and Fitness Training Lab. 

Join today and claim 2 months free membership, a free training tee and Diabetic Muscle and Fitness protein shaker!

CHECK OUT WHAT PEOPLE ARE SAYING ABOUT THE TRAINING LAB?

References 

1. Nocturnal hypoglycaemias in type 1 diabetic patients: what can we learn with continuous glucose monitoring? Guillod L, et al. Diabetes Metab. 2007.
2. Somogyi Phenomenon Lit Review – https://emedicine.medscape.com/article/125432-overview#a4

LEARN HOW TO DIAL IN YOUR BACKGROUND INSULIN AND WAKE UP WITH PERFECT BLOOD GLUCOSE LEVELS EVERY DAY – WITH THESE THREE  STEPS.

How do you know if your basal insulin is set correctly?

Do you sometimes wake up high?

Do you sometimes wake up low?

Do you have both highs and lows for day to day?

Frustrated by it all?

This article discusses how you can test the appropriateness of your background insulin dose, identify inaccuracies and put a solution in place if needs be.

Please remember, it’s your responsibility to discuss any changes to your insulin regimen with your medical team. This is for information purposes only.

In order to test the accuracy of your basal insulin dose we need to break the assessment down into three simple steps:

1. Preparing for the test.
2. Completing the test.
3. Reviewing your results and making valid changes.

Before we get started, you must consider what type of day you are testing on.

Are you testing on a training or non-training day?

This is important because it is highly likely you will need slightly less basal (overnight) insulin on an exercise day compared to a rest day. If you keep your basal insulin dose consistent across training and non-training days you need to be mindful that you are at a greater risk of hypoglycaemia and must have the necessary prevention strategies in place.

For accuracy – you will need to repeat the test twice to ensure what you see is not an anomaly. Therefore, you need to identify two rest days or two training days.

And yes, you are right in what you are thinking. A 60-minute HIIT session will require different background insulin overnight vs. a 45-minute strength session at medium intensity?

Let’s keep things simple and look at exercise days and rest days. You will need two of each.

STEP 1: PREPARING FOR THE TEST

Below are the conditions you need to meet before testing your glucose level at 23:00 to start the test:

1. Consume your last meal and mealtime insulin of the day at 19:00 – At least 4 hours before.

2. Your final meal should have no more than 30g fat – otherwise, you run the risk of delayed hyperglycaemia.

3. No correction insulin after 19:00.

4. No food to be consumed after 19:00 – this includes protein supplements before bed.

All of these measures ensure a fair test. Obviously, if you go hypo you will need to eat and re-do the test another day.

STEP 2: DURING THE TEST

Just sleep with nothing else going – No sex, masturbation, late night food cupboard raiding etc.

Test your glucose at around 23:00, 02:30 and then upon waking.

If you have CGM this is golden, no broken sleep for you!

Again, you need at least two nights data before considering making a change.

TWO OF THE SAME NIGHTS – Two rest days, or two exercise days – DO NOT MIX THESE UP!

STEP 3: REVIEWING RESULTS AND MAKING CHANGES.

You must SPEAK TO YOUR MEDICAL TEAM before implementing any of this.

WHAT TO DO IF BLOOD GLUCOSE INCREASES DURING THE TEST.

If your blood glucose level goes up from 23:00 to 02:30 and from 02:30 to wake – on both occasions:

Consider increasing your background insulin by 20% For example, 10 units Lantus up to 12 units.

If you are on a pump just increase the basal rates during the time-tested by 10-20%, e.g. if basal rates are 0.500 units per hour, increase to 0.550 or 0.600 units per hour.

If the blood glucose level stays stable from 23:00 to 02:30 and increases from 02:30 to wake – on both occasions:

This is known as dawn phenomenon. After reading the rest of this post you might want to read Why Is My Blood Glucose High Every Morning When I Go To Bed In Range?

If you are on a pump just increase the basal rates during the time-tested by 10-20%, e.g. if basal rates are 0.500 units per hour, increase to 0.550 or 0.600 units per hour from 02:00 (90 minutes before the rise begins – easier to see if you have CGM.)

If the glucose level rises from 23:00 to 02:30 and stays stable from 02:30 to wake – on both occasions:

Consider increasing background insulin by 10% e.g. if was 10units Lantus to 11 units.

If you are on a pump just increase the basal rates during the time-tested by 10-20%, e.g. if basal rates are 0.500 units per hour, increase to 0.550 or 0.600 units per hour from 23:00 to 02:00 (90 minutes before the rise begins – easier to see if you have CGM.)

WHAT TO DO IF BLOOD GLUCOSE DROPS DURING THE TEST?

If blood glucose level goes down from 23:00 to 02:30 and from 02:30 to wake – on both occasions:

Consider reducing background insulin by 20% e.g. if was 10 units Lantus to 8 units.

If you are on a pump just decrease the basal rates during the time-tested by 10-20%, e.g. if basal rates are 0.500 units per hour, decrease to 0.450 or 0.400 units per hour.

If the glucose level stays stable from 23:00 to 02:30 and decreases from 02:30 to wake – on both occasions:

Consider reducing background insulin by 10% e.g. if was 10units Lantus to 9 units.

If you are on a pump just decrease the basal rates during the time-tested by 10-20%, e.g. if basal rates are 0.500 units per hour, decrease to 0.450 or 0.400 units per hour from 02:00 (90 minutes before the drop begins – easier to see if you have CGM.

If the glucose level drops from 23:00 to 02:30 and stays stable from 02:30 to wake – on both occasions:

Consider increasing background insulin by 10% e.g. if was 10 units Lantus to 9 units.

If you are on a pump just decrease the basal rates during the time-tested by 10-20%, e.g. if basal rates are 0.500 units per hour, decrease to 0.450 or 0.500 units per hour from 23:00 to 02:00 (90 minutes before the rise begins – easier to see if you have CGM.

Obviously, you may need different overnight background / basal for exercise and non-exercise days.

You may even have different amounts of HIIT vs. Strength days – depending on your level of need, and OCD (like me).

Or, you may just decide to keep it super simple and workout your background / basal need on your rest day. Then when you exercise just have 20g of protein before bed to stop the overnight hypo (by increasing glucagon) and provide amino acids for muscle building during the night.

Either way, here are five key tips that will help keep your background / basal insulin needs fairly equal:

1. Complete at least 10,000 steps per day.

2. Keep your meal macronutrients fairly consistent.

3. When dieting to lose fat realize your background / basal requirement will drop as lower liver glycogen.

4. If you’re trying to gain MASS and in a kcal surplus your background / basal will increase.

5. Keep your sleep consistent at 7.5-8hrs. Bear in mind, when sleep deprived insulin resistance increases leading to worsened control.

If you found this article useful you’ll gain even more value inside our exclusive member’s area – The Training Lab. There is an insane amount of high-quality content in there waiting for you. It will add immense value to your diabetes management, health, muscle building and fat loss efforts.

Join today and claim 2 months free membership, a free training tee and Diabetic Muscle and Fitness protein shaker!

It’s hard to think clearly, have great ideas and take effective action when you’re out of shape, not managing your diabetes, stressed and ill. Align yourself with the fact your body is the vehicle that gets you from where you are (now) to where you want to be.

A healthy body gives you the energy and capacity to love, work hard and build the life you want. There’s no benefit in playing the victim and making excuses. Step up and take ownership of your diabetes. You have more control than you think.

Check out these 21 gems of wisdom to improve your diabetic control in 2018.

1. If your blood glucose levels read high or low it doesn’t mean you’re useless, failing or going to die a horrible death. They’re just numbers – treat them as data and feedback for you to take action. Your blood glucose readings are your friend.

2. You need to bolus for protein, especially beef, whey protein and other sources of dairy. These tend to increase blood glucose levels the most.

3. Purposely putting yourself into hyperglycemia to lose body fat is unwise. You’ll ruin your health and burn off valuable muscle tissue – which increases your body fat percentage. Seriously stupid.

4. Strength training and building muscle is one of the best investments a diabetic can make. Muscle is the largest storage tank for glucose.

5. Sleep is a prerequisite to good quality diabetes management. Aim for 7-8 hours every night. If you fall short, try to make it up with naps or binge sleep at the weekend when your workload calms down.

6. Diet soft drinks will not give you cancer. The majority of people who make this claim have misinterpreted the research and fallen prey to sensationalist headlines designed to shock the masses. Low calorie soft drinks don’t influence blood glucose levels, settle a sweet tooth and support weight loss.

7. Dietary and training adjustments are necessary because energy needs change as we progress. If you don’t know how to change your diet and training up – hire a coach! Or check out the likes of Diabetic Shred

8. It’s perfectly normal to gain weight when starting insulin therapy for the first time. A large proportion of this weight gain is water and stored carbohydrate NOT body fat. The only time you’ll gain body fat is when you eat above and beyond your energy needs. If you can’t get your head around that – read this article for women and this one for men.

9. You don’t have a slow metabolism. Just a fast appetite.

10. Logging the right data can prove invaluable to your ongoing progress. Log objective measures, such as body weight, adherence to diet, which can be interconnected with subjective measures, such as blood sugar control, mood, hunger and energy.

11. Hire a coach! It will save you a lot of time, money and effort. I can’t stress this enough!

12. Undoing something isn’t as easy as pressing CTRL + Z – Undoing something that’s taken months or years to do, isn’t easy to stop or change. You are 100% responsible for managing your diabetes.

13. Do you dedicate time to studying diabetes and all the factors involved in controlling it? If not, why not? Don’t complain about badly controlled diabetes if you haven’t put the work into understanding it. That’s why we created the Training Lab.

14. There are things you’re doing right now that are not conducive to your goal. I don’t know what these things are for you, but everyone has them. Just be aware that if you want to change you’re going to have to stop doing things you might currently enjoy doing, (bad habits). So — no, you can’t have it all.

15. Carry a spare everything (diabetes-wise) in your car.

16. Never leave the house without hypo prevention. The best hypo prevention is a non-diet fizzy drink like coca cola or high energy sports drink (minus the caffeine).

17. Quiz your doctor on things you don’t understand – you deserve to know. Why is this drug a better choice for me than this? Why can’t I get access? Can you double-check? What are the implications? What is the evidence behind your claims?

18. Will there be a cure for diabetes? Who knows? Regardless, focus on the now and keep your blood sugars as well controlled as possible.

19. There is no such thing as a good or bad food – just good or bad diets.

20. Invest in personal development books, courses and mentors. Learning how to manage and dissolve stress is a lifesaver.

21. Surround yourself with like-minded people who want to dominate diabetes and get more out of life. Just like everyone inside the Diabetic Muscle and Fitness private Facebook group.

I hope you got value from all of these.

You don’t live with diabetes alone.

We’re with you every step of the way in 2018.

Respect!

Phil Graham

2. Persuasion is the best way to win an argument.

3. The reason why success often doesn’t feel as good as it should do is because your idea of ‘success’ is based on what you want other people to think about you, rather than doing it for yourself. If you’ve had success this year, great! But, in order to keep advancing and developing make sure you evaluate yourself and commit to developing all the other areas of your life. This allows you to go to the next level. If you’re sitting down to plan your 2018 over the next few days, then do yourself a favour and set goals that serve you! At the end of the day, no one really cares how successful you are. Don’t waste your entire year trying to fit in again!

4. A great way to tell you’re not being true to yourself is when you say things likes, “I have to, should do…”

5. It’s wise to do things because of priority NOT history.

6. Pride gets in the way of mastery. Really cocky = tragedy.

7. It is easy to get complacent and find yourself doing low-value s**t if you do not plan your day or have a vision (goals).

8. Important distinction. At the level of the soul, we are the same. At the level of the physical senses and awareness, we are not.

9. Opinions are the cheapest opinions on earth – especially those that circulate the most. By the time the truth reaches – the lies have spread around the world.

10. The minute you put someone on a pedestal you blind yourself to their downsides. Everyone has another side, a dark side – including you!

11. Anything you repress always surfaces at some stage. It’s wise to dissolve your drama, understand how it served you and affirm it- rather than live through it.

12. In order to really not give a f**k what other people think, you need to know and love yourself. You’re the author of the most important story in the world – your life.

13. It’s ok to turn your phone off and shut your inbox down. Your social media and email accounts aren’t going to vanish and will be waiting for your patiently when you return.

14. For the amount of people that love you – there will be an equal amount of people that dislike you. So what! Live with it and stop trying to please everyone.

15. It is wise to have an inner vision rather than conform. Be …’in the world, not of the world.’ (John 17:16)

16. You will merge and unmerge with people over the course of your life. Learn from every relationship and embed the new found knowledge into the next relationship.

17. Expect people to be disloyal, dishonest and at times an enemy – People only live according to what they perceive is the best option for them. They did what they felt was best for them at the particular time. Don’t hold a grudge over that – you’ll only get ill.

18. 5 ways to embrace your entrepreneurial spirit. 1. Find something you really love doing. 2. Solve a problem that hasn’t been solved. 3. Be able to build the solution yourself. 4. Know when to be patient and when to act fast. 5. Manage your emotions.

19. Stop getting attached to the fantasy of being a success 24/7. If you’re attached to success you’re on your way down. Futile. The majority of your current success is a result of hitting rock bottom.

20. You get most creative when you’re challenged. Invite criticism. It’s kinda useful.

21. 1 true friend is better than 10,000 fake ones. Stop sweating over how many people follow you on social media.

I hope you found immense value in my life lessons from 2017.

Let’s smash 2018 together!

Life is beautiful.

Phil Graham

3814 words, 30-minute read.

KEY POINTS

• Whey protein is the least important thing you need to worry about when it comes to building a better looking body.
• Certain types of whey protein are overpriced and aren’t worth the money.
• Whey protein will not ruin your kidneys or liver.
• Whey protein can affect your blood glucose levels and needs to be accounted for with the appropriate level of medication.

Does whey protein live up to the hype for people with diabetes?

Can I take whey protein safely if I have Diabetes? What about my kidneys?

Am I wasting my money on another marketing scam?

My health care professional says I do not need protein supplements, do they really know, or are they playing it safe?

All my gym buddies take whey and getting results, but they don’t have diabetes, will it work for me?

These are questions I hear all the time in my clinical Diabetes practice. Mainly by young men and women who are starting at the gym and want to build a great physique. They want to maximise their gym efforts by supplementing with whey protein. But they are concerned with safety, effect on blood glucose, and their finances. Sound familiar?

There are some amazing articles online that have every last detail on whey protein. But I am guessing you do not want every last detail, right?

If you want the most potent information, in an easy to understand format, that is specific to diabetes? This article is perfect for you.

Not only that, it details the best practical strategies, taken straight from the pioneering Diabetic Muscle and Fitness Training Lab . These strategies are guaranteed to put you in control of your blood glucose level, and get the most out of whey protein.

Oh, one more thing, I guess you want a diabetes specific guide for how to choose the right whey? Don’t worry this article covers that to.

Ready?

Let’s go.

Before we get into the specifics, let’s zoom out to get some perspective.

How important do you think whey protein is in the grand scheme of losing weight and building a better body with diabetes?

Very Important?

Sort of important?

Not so important?

Check out the Diabetic Muscle and Fitness Pyramid below.

As you can see Phil Graham has outlined very clearly the most important dietary factors when it comes to building a better body with diabetes.

• A high value on fitness and diabetes management. (Your WHY)
• Excellent blood glucose control.
• Dietary adherence.
• Appropriate calorie intake for your set goal.
• Adequate essential macronutrient intake – especially protein which, according to the well-researched Diabetic Muscle and Fitness Guide, should fall into the following ranges:
• Fat Loss Protein Recommendations: 1.7 – 2.0g/kg (0.8 – 0.9g/lb) of lean body mass.
• Mass Gain Protein Recommendations:4 – 1.7g/kg (0.6-0.8g/lb) of lean body mass.

• Dietary Timing
• Micronutrient, fibre and water

Then…

Last, but not least – Supplements.

I would argue there are other more important factors before supplements – all of which are outlined in the Diabetic Muscle and Fitness Guide. These include

• Progressive Muscular Overload.
• Fatigue/Stress management and Sleep.

As you can see there are many more important factors to consider than the newest whey protein on the market.

Supplements and esoteric practices have at best, a 5-10% impact on your muscle building and fat loss efforts.

How many times have you jumped down the rabbit hole and spent madly on the next breakthrough supplement?

Many times?

Me too!

Before you do it again, ask yourself the following questions:

1. Is my diabetes control on point?
2. Do I have a HbA1c of 6.5% (48mmol/mol) or less, with less than five hypos a week?
3. Am I consistently getting 7-9 hours sleep every night?
4. Am I hitting my protein targets?
5. Are my food choices real or fake?
6. Am I managing stress well?

It is easy to jump to the quick fix, after all that’s how our brains are wired. Resist, get the fundamentals sorted first.

Need some help? That’s why the Diabetes Muscle and Fitness Training Lab was started.

To provide you with evidenced based knowledge that is converted into daily strategies. Most importantly, the community is full of people with diabetes who have, or are working towards, a great physique.

If you’re not in our Facebook group already – take two seconds and join here. Then come back to read the rest of this article.

Once you have the fundamentals in place. Let’s see what benefits whey protein has to offer people with Diabetes.

What is whey protein?

How is it manufactured?

Whey is the water soluble protein in dairy, its fat-soluble sibling is casein.

Whey is technically the group of milk protein polypeptides (lots of amino acids bonded together) left in the liquid portion. Once dried it’s put in a tub and sold off the shelf as whey protein powder.

Whey has a variety of polypeptides that come in different amino acid combinations and structures.  They include ß-Lactoglobulin (BCAA rich), Alpha-Lactalbumin (L-Leucine rich), Immunoglobulin’s (L-Cysteine rich), Glycomacropeptides (hunger suppressing), which all have unique bioactive properties. Whey has all the essential amino acids (EAA) and a high content of branch chain amino acids (BCAA). It has the closest amino acid makeup to skeletal muscle, and gets absorbed rapidly.

This gives whey the potential of driving muscle protein synthesis, as it provides all the building blocks, in the right amounts.

Does this potential get realised?

Keep reading and you will find out.

But before that, what are the whey protein options you see on the shelf?

Do you know the key differences, and which is best for you? Don’t worry, you soon will.

Once separated from casein, whey undergoes a variety of purification processes, leaving it in one of three forms:

• Whey Protein Concentrate– Contains between 30-80% protein depending on manufacturer. This is the cheapest because it contains a small amount of fat and lactose. If you want the best bang for your buck, and you are not concerned with a little fat and lactose, this is perfect for you. Look for whey concentrate that is 70-80% protein by weight. This will ensure you get a good protein content, and not a mass gaining blend full of fast acting carbohydrate. It should be per 100g:

• • 70-80g of protein
  • Total carbohydrate less than 10g
  • Total fat less than 10g
  • As few additives and ingredients as possible
  • Cost between $15-$26 (£12-£20) per 100g

Below is a comparison of some of the popular whey protein concentrates, in protein content order. Notice a few things as you look at them.

• The names can be deceiving, 100% Whey!
• Cost range from $15-$26 (£12-£20)
• Differences in fat and protein content

Also remember a typical serving is 25-50g, so the fat and carb content are a quarter to half of what is shown in the table.

Key Questions to consider when selecting whey concentrate with Diabetes:

• How much impact will 3-6g carbohydrate have on my blood glucose level?

• How does an extra 4-8g of fat impact on my overall daily calorie intake?

• Do I have an unfavourable reaction to milk proteins or lactose?

Do I want flavourings added or not?

Source: http://compareproteins.co.uk/

Bottom line: If you ensure the protein is at least 70g per 100g weight, you are not going to get a huge amount of fat and protein per serving.

• Whey protein isolate– is the result of further purification, to remove almost all the fat and lactose. Look for whey isolates that have more than 80% protein by weight. To ensure getting a good whey isolate, and not a glucose busting mass mix, it should be per 100g:

• • 80g or more protein
  • Total carbohydrate less than 5g
  • Total fat less than 6g
  • As few additives and ingredients as possible
  • Cost between $22-$46 (£17 – £35) per 100g

Below is a comparison table of some of the popular whey protein isolates. They are in order of protein content. The real questions you need to ask yourself are:

• What’s the benefit of a 97g vs. 90g vs. 80g whey isolate?

• Is a difference in carb and fat content per 25-50g serving of 0.25-2.0g a deal breaker?

• Do I want flavoured or unflavoured?

Do I have issues with a tiny amount of lactose or milk proteins?

Source: http://compareproteins.co.uk/

Bottom line: Don’t be dragged into the hype that 97% pure protein is massively better than 90%! If you have lactose intolerance then you may need the 97% stuff, otherwise, save your hard earned cash!

• Whey protein hyrdrolysate– is the most purified form, following partial hydrolysis of large polypeptides into di-peptides and free amino acids. This does lead to some loss of the sulphur rich amino acids, such as L-Cysteine, and makes it taste very bitter. This form is ideal for people who have allergies to milk proteins or digestive issues, such as infants and people with Chron’s disease. Adults with intact digestive systems tolerate whey concentrate and isolate very well. Their pockets tolerate it even better! If you have digestive issues, a good whey hyrdrolysate should be per 100g:

• • 90g or more protein
  • Total carbohydrate less than 1g
  • Total fat less than 2g
  • As few additives and ingredients as possible
  • Cost $33-$66 (£25-50) per 100g

Bottom line: 99% of adults have the digestive capability to process whey concentrate and isolate. So only go for whey hyrdrolysate if you have specific digestive issue, or have not managed well with isolate.

How do you know if you are buying a quality product that has been rigorously tested?

This is a great question.  Regulations on supplement manufacturers vary from country to country. Enforcement of them over the internet is virtually non-existent.

My suggestion is to head over to Labdoor.com, they independently test and score whey protein, among many other supplements. You can filter your criteria by cost, quality and several other useful metrics.

If you want to compare brands and costs, go to http://compareproteins.co.uk/. You can filter your search by protein content, and almost any variable you can think of.

Whey protein’s effect on muscle protein synthesis and insulin requirement.

Whey protein spikes amino acid levels in the blood within 40-60minutes, most importantly, it spikes L-Leucine. Research (1) shows this spike in L-Leucine is accompanied by an increase insulin production in non-diabetics, and an elevation of protein synthesis by 30%, when compared to casein and animal protein in the first three hours. But, total protein accumulation is equal between all sources at seven hours.

There are a few important take-homes:

• If you are training twice a day, whey protein may well offer an advantage in protein synthesis.

• If you choose whey protein with Type 1 Diabetes, you are going to need more insulin than expected due to a spike in L-Leucine. If you don’t, you will miss that 30% increase in muscle protein synthesis, and have a high glucose level!

Inside the Diabetic Muscle and Fitness Training Lab we have a highly detailed execution guide called ‘Becoming a Bolus Wizard’ that covers everything you need to know about insulin dosing at meal times. There is a module and calculator showing you how to dose insulin accurately to cover protein. Gain 2 Months Free Access to the Training Lab (+ a free t shirt and protein shaker) by clicking here.

• If you choose whey protein with Type 2 diabetes, the effect on your blood glucose level could go either way. If you still have adequate beta-cell function in your pancreas, the L-Leucine spike will trigger a surge of insulin. This has been shown to reduce after eating glucose levels by 20%. However, if your Beta-call function is exhausted, you may require extra insulin if you are injecting.

Whey protein: Does it increase strength and improve body composition? 

Ever seen a claim such as:

“Whey protein, scientifically proven to increase muscle mass whilst shredding fat!”

This type of headline is from studies where protein intake is sub-optimal. When protein intake is consumed at 1.5-2.0g/kg/day, the muscle gains from additional whey disappear.

But if you are struggling to hit your daily protein requirement, whey protein is a great option for you.

Whey protein – Does it have an antioxidant effect?

Diabetes is unique in that it poses a huge oxidative stress challenge to the body. Constant fluctuations in blood glucose levels decrease cellular antioxidant levels, which in turn increase the oxidative load on the body (2).

What is oxidative stress, and how do antioxidants work?

Although your body needs oxygen to survive, it is oxygen that can lead to oxidative stress in the body. As you breathe oxygen to produce energy, there are by-products created called FREE RADICALS.

If theses FREE RADICALS are not neutralised, they cause damage to cell membranes, proteins and genes, by a process called oxidative stress.

Imagine you start a little fire to keep warm whilst camping in dry bush land. You need the fire for your survival, but you would surely put the fire out before you went to bed, right?

Of course you would. The water you extinguish the fire with, is that same principal of how antioxidants work. Antioxidants are forever neutralising free radicals before they can cause oxidative stress.

Now imagine one night you left the fire flickering and fell asleep, what’s the risk? Complete bush fire! Probably not, it would not go up that night, but if you do this often enough, eventually a massive bush fire is guaranteed!

Those bush fires in the body are caused by persistent oxidative stress with little antioxidant neutralisation. If this goes on uncontrolled for years, the risk of cancer, heart disease and Alzheimer’s increases massively. As for building muscle, very little progress!

You might be thinking, the solution is easy, just throw back some vitamin C and a load of other antioxidant pills, right? 100% not right!

The most powerful antioxidants are already present in the body. One of the most potent being Glutathione. Glutathione is responsible for 24/7 protection in all your cells, by neutralising free radicals.

Therefore, it is more important to supply an abundance of building blocks needed to re-generate Glutathione. That’s where L-Cysteine come in. This amino acid is the rate-limiting factor for the regeneration of Glutathione.

As whey is very high in L-Cysteine, it may have potential in preventing oxidative stress.

Worth investigating, don’t you agree?

Animal studies (3) have shown the addition of whey protein reduces inflammation, elevates glutathione stores, lowers HbA1c and reduces insulin resistance.

I hear you, you are not animal, what about human research?

Human research is lacking in terms of mechanistic proof of the antioxidant effect. But at the very least there some human trials showing cardio protective effects for people with type 2 diabetes when supplemented with whey protein (4).

Whey protein: Does it cure Non-alcoholic Fatty Liver Disease (NAFLD)?

NAFLD is very common in people with type 2 diabetes, and a serious health risk. One study (5) showed up to 75% of insulin naive type 2’s had the clinical markers of NAFLD. It was suggested insulin resistance is the main culprit. The same study showed the type 1 diabetes population had no increased risk, further adding weight to insulin resistance being the main factor.

A Study (6) supplementing NAFLD subjects with 20g whey protein per day over 12 weeks showed an improvement in liver function, elevated liver glutathione levels, reduction in liver fat mass, and improvement in body composition. The benefit is thought to be due to the increase in L-Cysteine from the Whey protein.

Does whey protein cause kidney damage in people with diabetes?

Are your kidneys not in poor health?

Do you have chronic kidney disease stage 3 or higher?

If you answer yes to either of these two, then check with your health care professional before adding extra protein to your diet. It may make it worse.

If you answered no to both, then a higher protein intake does not pose an issue (7). If unsure, always check with your healthcare provider.

When is the best time to take whey protein if you live with diabetes?

Are you meeting your daily protein intake for your phase of training?

If you are, there is little benefit to be gained by adding in extra whey protein. You will be wasting your money by downing multiple shakes before and after training.

However,

Are you are planning on training twice a day, training fasted first thing, or are you not meeting your daily protein needs?

If yes, then having 20g whey protein before (8), and certainly in the one hour after, will ensure adequate amino acid supply. Especially the L-Leucine spike to drive muscle protein synthesis.

Let’s whey all this up.

What are the most important factors for building muscle and a great looking physique with diabetes?

That’s right, those first and second order factors in the Diabetes Pyramid of Muscle Building:

• Blood glucose control
• Consistent calories intake
• Progressive overload
• Sleep
• Adequate total protein intake according to phase of training
• Diet quality
• Allostatic load (stress management)

When you have these checked off, then consider whey protein. Let’s summarise the potential benefits for different types of diabetes.

People with Type 1 Diabetes who may benefit from supplemental whey protein:

1. Those with sub-optimal dietary protein intake <1.2/kg/day.
2. Those who train twice per day.
3. Those who struggle to meet protein requirements through real food due to time.
4. Those who are leaning down and need to hit 2.0g/kg/day.

People with Type 2 Diabetes who may benefit from supplemental whey protein:

1. Those with sub-optimal dietary protein intake <1.2/kg/day.
2. Those who train twice per day.
3. Those who struggle to meet protein requirements through real food due to time.
4. Those who are leaning down and need to hit 2.0g/kg.
5. Those who have NAFLD if substituted for other calorie sources.

Key things to pay special attention to:

1. Whey protein will require more insulin than expected due to L-Leucine content. Very important for people with type 1 diabetes, and people with type 2 diabetes who have exhausted beta-cell pancreatic function.

2. If you have chronic kidney disease stage 3 or above, it is not advisable to have extra protein. Check with your healthcare professional.

What to consider when choosing a Whey protein:

1. Do I have lactose intolerance or milk protein allergy?

• If yes, go for a 97% whey isolate or hyrdrolysate
• If no, then go for a whey concentrate or isolate.

2. Does it matter if per serving, the carb and fat content is 3-6g?

• If yes, choose a whey isolate >90%
• If not, choose a 70-80% whey concentrate

3. Is cost a major consideration?

• If yes, choose a 70-80% whey concentrate
• If no, choose a whey isolate >90%

There are a host of other considerations depending on the type of person you are:

1. Grass fed animals vs. not grass fed
2. Added sweeteners vs. no added sweeteners
3. Flavourings vs. no added flavourings

For these, it is over to you to check the labels!

If this article has helped you, please share it on your social and educate other people with diabetes.

There’s More!

Believe it or not. This article is only a condensed version of the main Whey Protein and Diabetes article inside The Training Lab.

If you found this article useful – you’ll gain even MORE VALUE information inside The Training Lab. There is an insane amount of regularly updated high quality content inside the Lab waiting for you. It will add immense value to your diabetes management, health, muscle building and fat loss efforts.

You won’t find content like this anywhere else on the internet.

Join today and claim 2 months free membership, a free training tee and Diabetic Muscle and Fitness protein shaker!

References

1. Reitelseder, S. et al (2011) Whey and casein labeled with L-[1-13C]leucine and muscle protein synthesis: effect of resistance exercise and protein ingestion. Am J Physiol Endocrinol Metab. 2011 Jan;300(1):E231-42. doi: 10.1152/ajpendo.00513.2010.

2. Asmat, U. (2015) Diabetes mellitus and oxidative stress—A concise review. Saudi Pharmaceutical Journal Volume 24, Issue 5, September 2016, Pages 547-553

https://doi.org/10.1016/j.jsps.2015.03.013

3. Jain, S.K. (2009) L-cysteine supplementation lowers blood glucose, glycated hemoglobin, CRP, MCP-1, and oxidative stress and inhibits NF-kappaB activation in the livers of Zucker diabetic rats. Free Radic Biol Med. 2009 Jun 15;46(12):1633-8. doi: 10.1016/j.freeradbiomed.2009.03.014.

4. Ballard, K.D. et al (2013) Acute effects of ingestion of a novel whey-derived extract on vascular endothelial function in overweight, middle-aged men and women. Br J Nutr. 2013 Mar 14;109(5):882-93. doi: 10.1017/S0007114512002061.

5. Cusi, K. (2017) Non-alcoholic fatty liver disease (NAFLD) prevalence and its metabolic associations in patients with type 1 diabetes and type 2 diabetes. Diabetes Obes Metab. 2017 Apr 17. doi: 10.1111/dom.12973.

6. Frestedt, J.L (2008) A whey-protein supplement increases fat loss and spares lean muscle in obese subjects: a randomized human clinical study Nutr Metab (Lond). 2008; 5: 8. doi: 10.1186/1743-7075-5-8

7. Chitapanarux, T. et al (2009) Open-labeled pilot study of cysteine-rich whey protein isolate supplementation for nonalcoholic steatohepatitis patients. J Gastroenterol Hepatol. 2009 Jun;24(6):1045-50. doi: 10.1111/j.1440-1746.2009.05865.x.

8. Friedman, A. N. (2004) High-protein diets: potential effects on the kidney in renal health and disease. Am J Kidney Dis.2004 Dec;44(6):950-62.

1175 words, 10-minute read.

KEY POINTS

• What defines a hypo for you is personal preference.
• The lower your A1C target – the lower your hypo target needs to be. Enforce a technology ban at a certain time every night.
• 4.0 mmol/l (70mg/dl) is the hypo target for most international federations and guidance aiming for tighter control of A1C of 6.5% (42mmol/l) – (NICE, ADA, ISPAD)

Do you even know YOUR Hypo treatment level?

What defines a hypo for you is personal preference, and also what you and your medical team believe and prescribe.

The following is for information purposes only, and for you to make informed decisions based on the evidence, rather than anyone’s opinion (mine included – I am an educator, not a guru, just someone who likes to question DOGMA of the day).

Let’s start with people without diabetes who have ideal blood glucose levels, for good health.

They run between 3.5mmol/l – 6.7mmol/l (65-120mg/dl) all the time.

A medically defined episode of hypoglycemia is defined as less than 2.8mmol/l (50mg/dl). These are the kind of hypos that damage the brain.

Hence why the healthy non-diabetic has an A1C of 4-5% (68 mg/dl (3.8 mmol/L) to 97 mg/dL (5.4 mmol/L) and has virtually no issues with AGE (Advanced Glycation End Products), and complications such as kidneys, eyes, feet etc.

So the aim for the person with diabetes is to run as close to that as possible, with as few hypos as possible. This would be the lowest risk of long-term complications. The table below outlines the best glucose range to aim for.

Obviously, the other side of the coin is running too low too, too often. You lose hypo warning signs, deprive the brain of glucose for fuel and can cause some brain issues.

IT’S A CASE OF BALANCE THAT EACH PERSON NEEDS TO CONSIDER INDIVIDUALLY.

With the above in mind, the authorities/teams/individuals choose a hypo limit with the aim of reducing complications but staying away from too many hypos. This lower limit varies for different organizations and medical teams, and changes depend on the person with diabetes.

The bottom level of the target (hypo limit) usually comes in a few flavours depending on the person prescribing and the individual circumstances.

7.0mmol/l (125mg/dl) = People who are hypo unaware and need to regain their symptoms. Once symptoms have regained this needs to drop down!

5.0mmol/l (90mg/dl) = The ultra-conservative medical teams are anxious about hypos for their patients primarily and the cost of a bit higher long-term complications.

4.5mmol/l (80mg/dl) = The conservative medical teams who are anxious about hypos for their patients and a slight cost of a bit higher long-term complications.

4.0mmol/l (70mg/dl) = Most international guidance and federations aiming for tighter control of A1C of 6.5% (42mmol/l) – (NICE, ADA, ISPAD)

In my opinion, this a good balance for the AVERAGE PERSON WITH DIABETES, BUT ARE YOU AND YOUR EDUCATION AND MANAGEMENT AVERAGE?

3.5mmol/l (65mg/dl) = More aggressive organizations and individuals who teach micro adjustments, full-lifestyle knowledge, and trust in their patients to manage glucose tightly, aiming for A1C 6.0% or less (DAFNE, low carb movements, educational programs aiming to reduce long-term complications)

3.5mmol/l (65mg/dl) = This is where Diabetic Muscle and Fitness places itself.

WHY?

If you have joined the Training Lab (our Private Members Club), you possess a number of key values the average person living with diabetes does not. These include…

1. A passion for learning all you can about diabetes in order to live the best life possible. Complication free.

2. The curiosity to ask great questions about WHY to do something.

3. You are willing to experiment and find out what’s right for you as an individual, rather than being caught in the crowd and groupthink.

4. You want to lose body fat and build as much muscle as physically possible.

Some interesting points to consider:

1. If you have been treating 4.5mmol/l (80mg/dl) as your hypo limit (giving glucose to come above), your body adapts, so if you go lower than this you will feel hypo. This does change with time if you decide to lower your bottom target.

2. If you use 3.5mmol/l (65mg/dl) as your bottom target BUT your daily management behaviors are “let’s say suspect at best” i.e. you don’t dose your insulin properly, you test less than 4 times a day, you don’t plan for exercise properly – YOU ARE GOING TO HAVE HYPO ISSUES. Take action, choose a higher limit.

3. If you have CGM and you follow great daily management behaviours i.e. you make micro adjustments and stay within targets, and use alarms to help you, WHY would you keep glucose above 5.0mmol/l (80mg/dl) all the time and treat anything below with quick acting glucose? IMO that’s inviting long-term complications.

Here are some useful questions to ask yourself, and possibly your team when thinking about when to treat.

1. Am I hypo unaware and do I have more than 4-5 hypos a week?

2. What do I want my average blood glucose levels to be each week and consequently my Hba1c?

The lower you want it, the lower your hypo target needs to be (see the table). I personally aim for <6.5mmol/l average to keep A1C <6.0%.

3. Do I wear CGM and use it to my full advantage (using trend arrows and alarms). Inside the Training Lab, we have an incredibly detailed 4-hour execution guide on how to Become a CGM PRO. The membership is worth it just to hear this one module (not to mention the many more)

4. Are my daily management behaviours on point?

5. Do I dose my insulin properly? Am I using any tried and tested techniques? Or just winging it? If you want to learn highly effective insulin dosing tactics used by the likes of myself and many another super-educated type 1 fitness enthusiasts, check out the ‘Becoming a Bolus Wizard’ inside the Training Lab.

6. Do I plan for my exercise and know how to manage the different types? Inside the Training Lab we have a 3-hour execution guide on Diabetes and Exercise Management.

7. Do I test my blood glucose levels at least 4-6 times per day?

8. Do I review my glucose patterns every 1-2 weeks to identify issues and make a change? – e.g. using Diasend or some other software.

9. Do I engage in learning more about how to manage diabetes and how my body works? If you’ve read this far – YOU CAN ANSWER YES!

If you found this article useful – you’ll gain even more value inside our exclusive members’ area – The Training Lab. There is an insane amount of high-quality content in there waiting for you. It will add immense value to your diabetes management, health, muscle building and fat loss efforts.

Join today and claim 2 months free membership, a free training tee and Diabetic Muscle and Fitness protein shaker!

1094 words, 10-minute read.

Key Points

• There is no doubt about it – Sleep is a prerequisite to high-performance living. Skip it at your peril.
• Sleep in the darkest environment possible.
• Enforce a technology ban at a certain time every night.
• Take advantage of modern-day apps that filter blue light, if you need to work on a computer late in the evening.
• Do your best to avoid strength training right before bed.

‘I’ll sleep when I’m dead’…

LOL – Good luck – you’ll die quicker without it!

Sleep is a prerequisite to high-performance living.

Sleep hygiene, as the name implies, equates to ‘clean uninterrupted flawless sleep’.

In order to achieve good sleep hygiene, you must focus on building consistent habits and practices that are conducive to sleeping well.

Most people’s sleep environment is far from optimal.

Whilst some sleep disorders are outside your control such as shift work, sleep apnea and the neighbour’s dog barking its f****ing head off, there are many other factors negatively affecting sleep but which develop from environmental factors within our control.

Check out these 7 key tips you can use (as of today) to improve and maintain your sleep hygiene.

1. Buy a pair of blackout blinds and don’t sleep with the light on.

Make your sleep environment like a bat cave.

The hormone melatonin is linked to a series of biological processes that recur naturally on a twenty-four-hour cycle, even in the absence of light fluctuations known as the circadian rhythm. These include darkness related behaviours such as sleep initiation and a decrease in body temperature and mental alertness.

The production of melatonin is primarily controlled by an enzyme called AANAT. The production of melatonin is blocked by light very quickly, as AANAT activity decreases by 50% every 3 minutes after the introduction of light. This is why exposure to light is so detrimental to you getting a good night’s sleep. Melatonin is great at getting you to sleep, but won’t keep you asleep once you’re there.

It is important to stress that, whilst melatonin prepares the body for sleep and helps to maintain sleep once it is initiated, it is not a sleep hormone/sedative or hypnotic.

2. If toilet breaks are interfering with your sleep during a fat loss phase, consume the bulk of your carbohydrates and sodium towards bedtime.

This useful strategy is more typically used with athletes and individuals taking part in physique competitions.

Anyone who has dieted to an ultra-low level of body fat is susceptible to more toilet trips during the middle of the night. These can result from several factors, such as lower levels of muscle glycogen (stored carbohydrate), loss of sodium loss through sweating and increased use of stimulants with diuretic properties like caffeine, green tea, and coffee etc.

Both carbohydrates and sodium are osmolytes, meaning they attract and retain water.

Carbohydrates retain x4 times their weight in water, whilst sodium retains an astonishing x50 times its weight. Carbohydrates are typically eaten in larger amounts compared to sodium, meaning more can be consumed.

Although there appears to be no current research on this strategy, if you consumed the bulk of your carbohydrate and sodium later in the evening it would help retain fluid before bed, and so potentially reduce the number of toilet breaks throughout the night.

Anecdotally, having worked with many bodybuilders and physique competitors, this strategy has worked well for many. The effects are more noticeable with high carb/sodium-rich cheat meals like pizza consumed before bed. However,  this may prove problematic for blood glucose management.

That being said, brief awakenings happen.

Sleep is cyclical, so waking up very briefly during the night is to be expected. Sometimes you’ll be more aware of it than other times, especially if your cortisol is high, but follow the rules of step one and you should get back to sleep.

3. Eliminate Blue Light.

Electronic devices such as phones, TVs and computers all have screens which emit predominantly blue light.

If you can’t get a blue light filter on your phone (most major operating systems are bringing them in) minimise the amount of time you spend looking at it, and completely stop looking at screens at least an hour before bed to give the melatonin concentration time to build up.

Check out these apps which automatically pull blue light from your screen, come evening time, in preparation for bedtime.

Mac Users -> https://justgetflux.com/

Android Users -> https://play.google.com/store/apps/details?id=com.urbandroid.lux&hl=en_GB

The iPhone has a built-in nighttime setting – set it to a time that suits you.

4. Avoid Caffeine after 5-6 pm.

Caffeine is a stimulant – it will keep you awake, plain and simple.

It has the ability to reduce or eliminate the feelings of fatigue by blocking adenosine receptors. As adenosine is involved in the initiation of ‘deep’ sleep, this is not a great thing to happen before you go to bed.

Individual clearance of caffeine varies, with some studies showing a half-life (concentration dropping by 50%) of between 1.5 – 9.5 hours. With that in mind, monitor your caffeine intake and eliminate it in the afternoon to ensure you can achieve proper deep sleep.

De-caff, unfortunately, might have to be an option! The struggle is real.

5. Avoid High-Intensity Exercise Before Bed.

High-intensity exercise, like weight training or interval training, stimulates the production of various stress hormones, all of which serve the purpose of increasing mental clarity and awareness.

Performing such activities within a few hours before bed is not ideal, and will, without question, reduce sleep quality. The best time to train in my honest opinion is first thing in the morning. The stress hormone response dampens across the day and reaches its lowest point later in the evening, naturally in line with a working day, like it should.

6. Avoid Evening Naps

While napping can prove useful during the day, napping within a few hours of going to bed is a bad idea.

How many times have you tried this and then found returning to sleep difficult?

Doing a lot of travel, I’ve found the best thing to do in this case is either:

A) go to bed super early and wake up when you wake up, and proceed with your day,

or,

B) hold off sleeping (without stimulants) until you reach a state of exhaustion.

These simple strategies will allow you to get the most out of your sleep!

7. Chill the F**K out

Horror movies and anxiety before bed aren’t a good mix.

They stress the system and drive up the production of stress hormones which, as mentioned earlier, increase mental alertness and prevent you from falling asleep. Your body doesn’t know the difference between a real vs perceived threat.

Take time to unwind before bed, read, meditate or make love to your significant other.

Avoid spiking your heart rate and priming your system for fight or flight.

So there you have it,

“Sleep hygiene is the key to sweet dreams”

Don’t use the bed for anything but sleep (and sex!)

Want to learn more? 

If you found this article interesting. You’ll love The Definitive Guide to Sleeping Better for Health, Strength and a Better Looking Physique inside the Diabetic Muscle and Fitness Training Lab. The guide goes into super depth on the science of sleep and includes over 4 hours of video presentations, detailed articles and multiple resources to help you sleep better.

It will add immense value to your diabetes management, health, muscle building and fat loss efforts. Click here to join today and claim 2 months free membership and a free training tee and Diabetic Muscle and Fitness protein shaker!

Written by Phil Graham

Founder of Diabetic Muscle and Fitness

Sports Nutritionist, Strength Coach, and Fitness Educator

Type 1 Diabetic for 12 years

Insulin sensitivity varies between individuals and is reduced in people with diabetes.

Medication aside, lifestyle plays an important role in helping boost insulin sensitivity and prevent impaired tissue responses (insulin resistance), which, in turn, supports blood glucose disposal and improves diabetes management.

Lifestyle choices do this in a number of ways:

• Strength training increases muscle mass which serves as a major storage house for glucose.
• Walking and other forms of low-intensity exercise can reduce blood glucose.
• Stress management including meditation and a good quality sleep pattern help control excess production of counterregulatory stress hormones, such as cortisol and adrenaline, which increase blood glucose levels.

All of the above help improve the action of diabetes medication and whatever is left of natural insulin production. Obviously, the effects of each lifestyle factor will vary depending on how often they are conducted, their intensity and, of course, inter-individual physiology and genetics.

Treat this article like an accountability checklist.

If you live with diabetes and aren’t following any of the five lifestyle behaviours listed, you might be missing a few tricks for improving health, managing your diabetes and building that body you always wanted.

Daily Routine #1 – Perform at least 20-45 mins of Anaerobic Exercise Every Single Day.

Anaerobic exercise is defined as physical exercise that is intense enough to generate lactate.

You know you have generated lactate when you start feeling a burning sensation in your muscles. High rep squats and sprint intervals get you burning pretty quick. Strength training and high-intensity interval training are prime examples of anaerobic exercise.

The human body responds differently when trained with anaerobic exercise compared to aerobic exercise. The adaptions that occur to the muscle energy systems are of particular interest and benefit to people with diabetes.

Anaerobic training increases insulin sensitivity and stimulates skeletal muscle tissue to absorb glucose from the bloodstream independently of insulin. This is achieved through the stimulation of specific Glucose transporters called GLUT-4. The more anaerobic work a muscle fiber has to contend with, the greater number of GLUT-4 rise to the surface of a muscle cell for the purpose of glucose extraction. Once glucose is absorbed from the bloodstream it is stored as muscle glycogen.

Increased insulin sensitivity is just one of the many benefits of anaerobic exercise. There are plenty more, which I will cover another time.

How often and how much anaerobic training should I perform ?

Perform anaerobic training at least 3 times per week in the form of:

• 20-60 mins of Strength Training – Whole body, Body Part Splits etc.
• 10-20 mins High-Intensity Interval Training – Skipping, Spinning, Battle Ropes, Sprints etc.

All of these training bouts will improve glucose uptake and improve blood glucose management in people living with diabetes.

Daily Routine #2 – Get and Stay Lean.

It is well established that high levels of body fat result from living in a calorie surplus for a prolonged amount of time. Excess body fat accumulation is not only unsightly but highly inflammatory and detrimental to the effectiveness of your insulin.

Also proven is the fact that the biological response of target tissues to the actions of insulin (insulin sensitivity) are majorly affected by adiposity, or the amount of body fat one carries. ¹

The leaner you are, the better your insulin will work. Period.

5 Top Tips for getting lean with diabetes.

• Create a calorie deficit by sensibly increasing your physical activity and reducing food intake in a controlled way.
• Strength train at least 4-5 times per week.
• Manage your diabetes.
• Achieve at least 7 hours sleep each night.
• Aim to lose between 0.5-1% of your body weight each week.

If you are not sure about how to eat to get lean with diabetes, then reread these two articles

Men, Read this > The Ultimate Muscle Building Diet Plan for Men with Diabetes

Women, Read this > The Bikini Body Diet Plan for Women with Diabetes 

Daily Routine #3 – Have A Toolbox of De-Stressing Activities  

In today’s modern day age, we are increasingly exposed to more chronic stress than ever before.

Mobile phones,

Social media,

Traffic,

Bills,

Etc.

Stress stimulates a flight or fight response within the body, a physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival. The body responds to stress by activating the sympathetic branch of the central nervous system. Stress increases muscle tone, constricts blood vessels and increases the production of counterregulatory stress hormones which increase blood glucose.

In small doses stress is healthy. It can save your life.

However, excessive stress is unhealthy and works against diabetes management.²

The greater and more prolonged the stress, the more insulin is required to balance blood glucose. It is well established that stress can influence whole-body glucose metabolism and promote insulin resistance. ^2,3

Any forms of stress management, like meditation, massage, yoga, breathing exercises, or personal development, are worthwhile if they help reduce stress. Reducing your daily stress is a surefire way to improve insulin sensitivity and reduce incidents of high blood glucose.

Even Apple have cottoned on to this with their new ‘take a minute to breathe’ reminder on their Apple Watch.

Daily Routine #4 – Have A Structured Sleeping Plan  

Sleep could also be considered a form of stress management, especially for individuals who are highly active and live with diabetes.

I hate to tell you the obvious but sleep is essential for good health and diabetes management.

Many laboratory and epidemiological studies suggest that sleep loss may play a role in the increased prevalence of insulin resistance and diabetes.^4,5,6,7

One of the best pieces of advice is to set a fixed bedtime and wake time. Not only does this provide structure for your day, but it ensures you get enough restorative sleep for health and optimal diabetes management.

Again, the major tech company Apple and their recent focus on health tech apps have included a set wake/bedtime function in their alarm clock.

At Diabetic Muscle and Fitness, we take sleep seriously. We even developed a 3.5+ hour video module on sleep optimization for improving hormone profiles and body composition. You can find it inside our highly interactive members’ site – The Diabetic Muscle and Fitness Training Lab.

Daily Routine #5 – Perform Aerobic Exercise Daily.

Aerobic exercise such as a light jogging or a brisk walk can increase glucose disposal and lower blood glucose levels – independently of insulin.

One of the main reasons aerobic exercise lowers blood glucose levels so well is due to the fact that there is little to no counterregulatory hormone response like that which occurs during high-intensity anaerobic exercise.

Please bear in mind, it is important to monitor insulin intake around aerobic exercise in order to avoid hypoglycemia.

I highly recommend buying an activity monitor like a Fitbit, Apple watch or Garmin. These are awesome for building the habit of doing more aerobic exercise throughout your day.

Take Home

Each and every daily routine I’ve shared in this article will improve insulin action and help your body clear glucose easier. Each and every one of these routines is a prerequisite for a great looking body and high levels of mental and physical performance.

Identify which areas you need to work on and, Get to it!

If you found the above article useful and have just realized you need to get more accountable and follow a structured lifestyle plan that encompasses all the elements of building a better body, that is, diabetes management, diet, training, lifestyle and sleep, then check out Diabetic Shred.  It includes 16 weeks ‘done for you’ anaerobic strength training plans (+ cardio), diet, supplements and lifestyle strategies to build a healthier better-looking body.

References

1. Wilcox G. Insulin and insulin resistance. Clin Biochem Rev. 2005 May; 26(2):19-39.
2. Li L et al. Acute psychological stress results in the rapid development of insulin resistance. J Endocrinol.2013 Apr 15;217(2):175-84.
3. Nolan et al. Insulin Resistance as a Physiological Defense Against Metabolic Stress: Implications for the Management of Subsets of Type 2 Diabetes. Diabetes Mar 2015, 64 (3) 673-686;
4. Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR. Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry. 2002;59:131–6.
5. Ayas NT, White DP, Manson JE, et al. A prospective study of sleep duration and coronary heart disease in women. Arch Intern Med. 2003;163:205–9.
6. Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med. 2002;165:670–6.
7. Punjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE. Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol. 2004;160:521–30.

Are you using a diabetes device that has the ROCHE Bolus Advisor Algorithm?

• ROCHE Expert Meter for Multiple Daily Injections
• ROCHE Combo Insulin Pump
• ROCHE Insight Pump

If so, this is a must-read for you.

To get specific, you need to know:

• How it is different from the other bolus calculators when determining Active insulin.
• How this difference significantly changes the correction you get in-between meals.
• How you can change the Advice Options to get the most effective correction doses.

A quick recap of the first article, ‘WTF is Active Insulin?’

• All other bolus calculators except ROCHE count both insulin for the food (Meal Centric Insulin) and insulin to correct high glucose levels (Glucose Centric insulin) as IOB.
• This causes a major problem when trying to correct a high blood glucose level in-between meals because the calculators think the IOB will bring the glucose level down. It does not – realise that most of the IOB are accounted for by the food that has not been absorbed from the stomach yet.
• To counter this it is wise to set the IOB time at 2.5-3 hrs, so corrections are permitted by the calculator. This does cause issues when exercising, but it is the best compromise.

You will be glad to know the ROCHE Bolus Advisor algorithm is much more sophisticated than the other calculator’s basic approach.

The main differences are:

1. Only correction insulin (glucose centric insulin) is recorded as IOB. This works very similar to IOB for other calculators in that it prevents insulin stacking. But it prevents stacking the right way, because it only counts correction insulin and understands the insulin for the food has already been accounted for! Simple, but genius!
2. The insulin delivered for the meal (meal centric insulin) is accounted for by setting four simple parameters.
3. Meal Rise – the expected small rise in blood glucose after eating.
4. Off-set time – How long the peak of the small rise should last for.
5. Acting time – How long the drop back to target will take after eating.
6. Snack Size – What amount of carbohydrate would make the Meal Rise happen.

The graph below is the same one from the first article and shows a clear difference in the amount of correction insulin the different types of calculators would give one hour after eating. The red arrow shows the ROCHE would correct to 10mmol/l (a 4.0mmol/l meal-rise) and give 3.0 units’ correction, whereas the other calculators (IOB set at 4 hours) would give nothing.

John has a carb ratio of 1 unit: 10g CHO and eats 70g = 7 units

John has a target BG of 6.0 and his BG is 6.0 he has a sensitivity factor of 2.0 = O units

Do you think you would need a correction if your glucose had increased from 6.0mmol/l to 16.0mmol/l after one hour?

What could have happened?

• You underestimated your carbs and insulin dose for the meal.
• There was a load of fat and protein spiking the glucose level.
• The chef used a very sugary sauce.
• You pulled the injection out too early and a unit or two dribbled out.

It does not matter which one it is, they all need the same thing, MORE INSULIN! But you would only get that with the ROCHE Bolus Advisor.

You may be saying, I never test my glucose after one hour, and I certainly would not be correcting at that time.

Ok, what about this one?

IN the second graph below your glucose has risen from 6.0mmol/l to 22.0mmol/l two hours after eating. With all other calculators (IOB set at 4 hours) you would only correct down to 13.0mmol/l (a 4.5unit correction as sensitivity is 2.0mmol/l), whereas the ROCHE would correct down to 7.0mmol/l (a 7.5 unit correction).

John has a carb ratio of 1 unit: 10g CHO and eats 70g = 7 units

John has a target BG of 6.0 and his BG is 6.0 he has a sensitivity factor of 2.0 = O units

Why would your glucose be this high?

Same as before, there are loads of reasons, the main one being an underestimation of food intake.

Therefore, YOU NEED THE EXTRA CORRECTION.

Hopefully, by now you are starting to see the ROCHE Bolus Advisor is much more effective at correcting in-between meals.

But, this is where the fun starts. You can adjust each of the advice options in the bolus advisor to match how you manage your diabetes.

I could go into War and Peace on this, but I do not want to bore you, so I will just hit you with the highlights.

If you want more aggressive corrections in-between meals for tight control and you follow gold standard diabetes habits, such as bolus 20 min before meals, count food accurately, good injection technique etc, you will want:

• A short Meal-Rise
• A short Off-Set Time
• A short Acting Time
• A high Snack Size

If you want less aggressive corrections in-between meals because you bolus at or after meals, and you have no hypo awareness, you will want:

• A high Meal-Rise
• A long Off-Set Time
• A long Acting Time
• A low Snack Size

The grid below provides some guidelines.

ALWAYS CHECK WITH YOUR HEALTH CARE PROFESSIONAL BEFORE MAKING ANY THERAPY CHANGES.

Using IOB for exercise management with ROCHE.

This is the downside of using the ROCHE Bolus Advisor Algorithm.

We know the actual duration of insulin is 4-6 hours and we know the ROCHE only counts correction insulin (Glucose Centric insulin) as IOB. Therefore, you could give 10units for food and go to exercise in one hour’s time.

The pump or meter will say 0 units IOB. This could lead you into a false sense of security because, although the insulin is dealing with food, the increased sensitivity to insulin during exercise will make that 10 units double as effective. So you guessed it, big hypo risk.

You are now aware of it, so the simple point to remember about the ROCHE Bolus Advisor thing is:

The ROCHE Bolus Advisor Algorithm is the best on the market for determining effective corrections in-between meals and at meal times. But, it is useless for knowing how much IOB you have when making exercise plans.

If you are forewarned, you are forearmed.

Well, that’s the end of the IOB series. If you have got this far, I assure you, you know now as much as (probably more than) any healthcare professional on this subject.

Until next time!

ALWAYS CHECK WITH MEDICAL TEAM BEFORE MAKING ANY CHANGES.

If you found this article useful you’ll learn much more from our 200+ page Guide on Insulin Dosing found inside  The Diabetic Muscle and Fitness Training Lab.

First, let’s get clear on the roles and importance of health and sports supplements in your diet and training efforts.

Supplements are the least important in your muscle building and fat loss goals. This is outlined clearly in the Diabetic Muscle and Fitness Nutrition Pyramid below.

There are many effective and safe supplement options for people with diabetes; prime examples include whey protein and creatine monohydrate.

On the other hand, there are a number of supplements that are dangerous for people with diabetes.

Check out the video below and find out what the three most dangerous supplements are for people with diabetes …

You might be taking one of them!

If you liked this video and want to learn more about exercising with diabetes. You need to check out the Diabetic Muscle and Fitness Training Lab.

It contains a vault of in-depth knowledge and resources you can’t find anywhere else on the internet. You’ll gain valuable new found knowledge on diabetes, nutrition, training, mindset and more.

Join 1000s of other diabetics just like you and start building muscle, shredding body fat and build the best version of you.

The success of your diabetes control is directly proportionate to your mind-set. In this video, I share three incredibly useful mind-set tactics for better diabetes management.

Self-Control Is Strength

Right Thought Is Mastery

Calmness Is Power.

Implement them and let me know how you get on!

If you liked this video and want to learn more about exercising with diabetes. You need to check out the Diabetic Muscle and Fitness Training Lab.

It contains a vault of in-depth knowledge and resources you can’t find anywhere else on the internet. You’ll gain valuable new found knowledge on diabetes, nutrition, training, mind-set and more.

Join 1000s of other diabetics just like you and start building muscle, shredding body fat and build the best version of you.

Your blood sugar levels have been sitting perfectly all day.

You’ve just dosed your insulin for your pre-training meal and your blood sugars are at an acceptable level before you start training.

You finish training only to discover your blood glucose levels have doubled.

But, you didn’t eat or drink anything?

WTF? What’s the deal?

Watch the video below to find out.

If you liked this video and want to learn more about exercising with diabetes. You need to check out the Diabetic Muscle and Fitness Training Lab.

It contains a vault of in-depth knowledge and resources you can’t find anywhere else on the internet. You’ll gain valuable new found knowledge on diabetes, nutrition, training, mind-set and more.

Join 1000s of other diabetics just like you and start building muscle, shredding body fat and build the best version of you.

It’s not, there is a time and place for low carbohydrate eating. But, in the context of people who lift x3-7 times per week (like you guys) Carbohydrates are pretty darn important, for feeling muscle performance.

In this video, I explain how people with diabetes can eat carbs, get lean, build muscle and still control their diabetes.

If you liked this video and want to learn more about exercising with diabetes. You need to check out the Diabetic Muscle and Fitness Training Lab.

It contains a vault of in-depth knowledge and resources you can’t find anywhere else on the internet. You’ll gain valuable new found knowledge on diabetes, nutrition, training, mind-set and more.

Join 1000s of other diabetics just like you and start building muscle, shredding body fat and build the best version of you.

Living with diabetes is a huge responsibility. It takes time to know your body and acquire the vital skills and understanding necessary to achieve solid control.

In this video, I explain why mind-set is crucial to diabetes success and how to shift yourself into a new paradigm of thinking for better glucose control and improved quality of life.

This videos goes pretty deep and may hit a nerve with you. It will definitely increase your self-awareness.

Watch the video in private and give it your full attention.

If you liked this video and want to learn more about exercising with diabetes, you need to check out the Diabetic Muscle and Fitness Training Lab.

It contains a vault of in-depth knowledge and resources you can’t find anywhere else on the internet. You’ll gain valuable new found knowledge on diabetes, nutrition, training, mind-set and more.

Join 1000s of other diabetics just like you and start building muscle, shredding body fat and build the best version of you.

Do you think it will work with Diabetes?

If so this quick read is a must for you.

Let’s start by classifying some key terms.

Nutritional Ketosis:

1. Purposeful reduction of carbohydrate to less than 50g. Protein ~0.7 – 1.5g/kg and, ~70-80% of energy intake through fat.
2. Purposeful reduction of insulin, BUT still taking background insulin and usually small boluses for protein. YOU STILL TAKE INSULIN. There is enough insulin to prevent excessive ketone production and therefore stops acidic blood which is the main issue with DKA.
3. Blood ketones ~0.6-3.0mmol/l (can go up to 7mmol/l if extremely strict with the diet and in a negative energy balance, but unusual) – because the liver has to convert fat into ketones to provide fuel for the brain and muscles, because fat in its original state cannot be burned quick enough to provide the requisite energy.
4. Most people following a diet they believe to be KETO are not in nutritional ketosis, especially type 1 diabetics, because their circulating background insulin is higher than people without. The only way to know is to test blood ketones daily to see if in the sweet spot of ~0.6-3.0mmol/l. It’s easy to knock out of nutritional ketosis from treating hypos, eating too much protein, having a background insulin too high. Don’t fool yourself thinking you are there. Keeping in nutritional ketosis is as much art as it is science!
5. A normal blood PH (measure of acidity)

Diabetic Ketoacidosis (DKA)

1. Lack of insulin or, no insulin in the body.

Can be from:

1. The person not taking purposefully, (teenagers mainly)
2. Insulin is faulty and the person does not know.
3. Severe illness when insulin requirements ramp up massively.

2. Blood ketones greater than 7mmol/with a very acidic PH in the blood.

Risk of death if insulin is not given quickly, requires hospital treatment.

PROS of Nutritional Ketosis (Keto)

1. Will get a very good HbA1c – low carb = low fluctuation.
2. Some people find a ketones level of ~0.6 – 3.0mmol/l helps curb appetite and support fat loss efforts.
3. Often people like the tight feeling of not carrying extra water that is accompanied with high glycogen stores in the muscle and liver.
4. Can help with keeping to a calorie deficit because the food choice is very limited.
5. Can be effective for long distance and ultra-long distance endurance events – iron man etc. due to the energy systems involved.

CONS of Nutritional Ketosis (Keto)

1. Highly Restrictive Diet. A challenge for most usual social occasions unless you are in a keto community.
2. Reduced performance. Particularly, for individuals participating in activities that require fast energy burn, team sports, bodybuilding, 10k run, track cycling. Due to the carbohydrate-dependent (glycolytic) nature of the activities, individuals consuming a keto-based diet will not be able to perform OPTIMALLY. They will still be able to perform well, but not OPTIMALLY, because they do not have the glycogen (stored carbohydrate) to fuel those activities.
3. Electrolyte deficiencies in potassium, magnesium, and sodium can be common, especially in the early stages. Supplementation is worthwhile.
4. If you aim is to gain muscle mass and size, the results will be slower. This is because the protein intake has to be capped at 1.5g/kg, full muscle glycogen stores significantly greater muscle protein synthesis, and you will not be able to push out those last few reps to get as much progressive overload.
5. Dyslipidaemia – Unfavourable fatty acid levels in the blood. If you are genetically susceptible and choose saturated fats primarily, your LDL cholesterol may rise high, which is negative if the particle number increases. Choosing monounsaturated fat options can help prevent this – macadamia nut oil, olive oil and avocados etc.
6. Potential to downregulate thyroid function, especially reverse T3. It is important to monitor this Biomarker when on a ketogenic diet.

Personal Case Studies

Phil Graham – Founder Diabetic Muscle and Fitness

The idea of eating fatty foods like bacon, whole eggs, steak, chicken with the skin on, nuts, whole butter and cream, whilst getting lean sounded too good to be true. I was desperate to experiment.

In 2014 I went all in and lived the ketogenic life for 6 months in between Magazine Photoshoots and Bodybuilding Contests.

At the time, my body fat wasn’t high. In fact, it was relatively low. I was just after competing and wanted to use the ketogenic diet to maintain low levels of body fat between my events.

I had experience of eating low carb before, especially in the final weeks leading up to my contests, where calories were ultra-low. Carbs were the main macronutrient I cut out. I always liked the dry look low carb eating brought to my physique. For those of you not familiar with bodybuilding language. ‘Dry’ simply refers to low levels of water retention and bloat.

The ketogenic diet took my lower carb experiences a step further. I kept my intake strictly under <50g CHO for 6 months flat with the odd refeed day every once in a while (when I felt like it).

Let me bullet point my experience.

• My blood glucose control was the best ever. My HBA1C was 5.5%.
• My blood glucose levels would go high the odd time. This was mostly due to acute periods of stress from training and after consuming red meat. Regardless, I always corrected.
• The food choices were awesome (at the start), but I admit I did get bored quickly. The last 3 months were a mental challenge. I missed fruit, oats, bread and milk massively.
• My performance dropped. I struggled to get a pump when weight training.
• My muscles did not look as full and pronounced.
• Social events were awkward. I felt awkward going to dinner parties or just out for dinner. I always had to ask, ‘What had my meat been cooked in?’, ‘May I have the sauce separate please?’ etc.
• My hunger was blunted to a degree. But, in no way did the ketogenic diet bulletproof my hunger in the long term.
• I took one full day to refeed carbs when I felt I needed it. Getting back into ketosis after this was relatively easy. I did look forward to the carb refeeds.

I personally do not recommend Ketogenic dieting for highly active people with type 1 diabetes who have a goal of building muscle and strength. It can be used in the short term to drop some body fat. But, don’t expect miracles.

 

John Pemberton – Head Coach Diabetic Muscle and Fitness

I followed KETO for 6 months in 2016 and results were:

1. HbA1c 5.3% – the best it’s ever been.
2. Low frequency of hypos because just had background insulin covering most of needs (80%) with small boluses for protein (20%)
3. Weight stable at 92kg with a ripped look at 6% body fat. Good for the beach.
4. Gym performance average, 1 RM decreased as did my 4-8RM – I did not like this.
5. My LDL rose from 2.5 to 5.5 but after changing to monounsaturated fats back to 3.5 (my dad has cholesterol of 9.0 so likely a genetic issue)

Contrary, following a 35% protein, 40% carb, 25% fat for the last year led to the following observation:

1. HbA1c 6.0% – a slight increase but still in a very good range
2. More hypos because of bigger insulin doses at meal times and therefore more unpredictability, but still only 3-4 a week, which I can manage with some dextrose.
3. Weight 102kg at 9% body fat – gained 8-9kg lean tissue (probably 2-3kg water and glycogen).
4. Big improvement in 1 rep max (RM) and 4-8RM on all lifts
5. Can engage easily in social functions, rather than glugging olive oil at the back. This was due to my lack of imagination with food choices. I am a simple man.
6. Not always looking as ripped by the end of the day – water accumulation.

I think the best questions you can ask yourself when considering starting a Ketogenic diet are:

1. Are my aims gains and high energy performance, and am I happy to put more effort into diabetes management?

If so, KETO is probably not for you. You need more carbs.

or

2. Is my focus optimal on diabetes control with less requirement for management, whilst knowing my physique progress will not be optimal but can still perform?

If so KETO may be worth a trial for you.

There is no right or wrong answer, just the one that suits you.

Just be sure to do your homework before you try, and consult with a professional who has experience in type 1 and KETO.

If you liked this article and want to learn more about nutrition and living with diabetes, you need to check out the Diabetic Muscle and Fitness Training Lab.

It contains a vault of in-depth knowledge and resources you can’t find anywhere else on the internet. You’ll gain valuable new found knowledge on diabetes, nutrition, training, mind-set and more.

Join 1000s of other diabetics just like you. Ask questions, learn and start building the body you have always dreamed of. 

Is IF safe for people with diabetes?

Will IF get results for people with diabetes?

IF is becoming very popular. There are a wide range of different fasting methods, some of the most popular include:

• Eat Stop Eat
• 5:2 Diet (participants limit their calorie intake on two days per week)
• 16:8 diet
• 18:6 diet

Generally speaking, IF works well for people who are looking to lose body fat, fast-paced individuals who struggle to get the time to eat multiple meals per day and people with diabetes wanting to improve their HBA1C

In respect to diabetes management

The typical Intermittent 18 hour fast followed by a 6 hour eating window can help improve HBA1C levels.

If you stop eating at 6:00 pm your quick acting insulin is pretty much out of your system by 10:00pm (bedtime). Provided your blood glucose is within target range and your background insulin is dosed correctly, your next 18 hours (until 12:00pm the next day) will sit well inside range. Solid diabetes control means a good HBA1C and less likelihood of complications.

Other intermittent fasting methods like the 16 hour (fast)/8 hour (eat) window also work well.

If you have a bit of dawn phenomenon you may need a unit or two of quick acting insulin to prevent high blood glucose. How much insulin you need to take is largely based on your calorie needs for your specific goal, stress, level of activity and some trial and error.

In respect to fat loss

The latest consensus statement from the ISSN on body comp and diets (which we have reviewed extensively inside the Training Lab)  concludes IF has no significant benefits on body composition over other methods that drive a daily calorie deficit.

The basic concept of Intermittent Fasting is grounded on the limited feeding window of 6 to 8 hours. This narrow eating window makes it harder to overeat calories and easier to stay within a calorie deficit.

When you fast, key stress hormones like cortisol and adrenaline increase in the circulation. These hormones have the ability to downregulate digestion, blunt appetite and assist with generating and maintaining a calorie deficit.

If you train at 4:00 or 5:00pm you should have enough energy stored in your system to perform. However, morning sessions may be challenging. You may want to shift your eating window to facilitate better performance. There is a large degree of trial in error when it comes to finding the perfect fasting/eating window.

Key factors like career, training times and social life will dictate the timing of your fast/feeding periods.

The idea of fasting all day then looking forward to a large feast later on can be quite exciting and, in many ways, improve dietary adherence in certain individuals.

However, there is a possibility Intermittent Fasting may increase muscle loss

There is a theoretical risk of a little more muscle mass loss due to less frequent protein feeding and less muscle protein synthesis. However, the research on non-diabetics has not found this, but no research on type 1 diabetes exists at present.

The lower your calorie intake, the greater the risk of muscle loss.

It may be worthwhile to resort to 20-40g protein meals every 4 hours in the final stages of your fat loss phase when calories are at their all-time lowest.

Intermittent Fasting may not be the best approach for individuals looking to bulk up or pursue intense phases of training.

Here are Three Reasons Why…

1. If your goal is to gain size you want maximum muscle protein synthesis, driven by hard training and frequent protein feeding. Frequent protein feedings x4-6 per day work best. This is simply not possible if you are only eating during 6 hours a day.

You can ramp up your calorie intake with low volume high-calorie food choices like oils, nut butter etc.

2. To achieve a calorie surplus you need more time to eat than 6-8 hours a day, closer to 12. There is only so much you can eat within a given time period without feeling overfed and bloated.

This is especially true with diabetes as you need to give the bolus insulin a chance to catch up with high food intake.

3. To gain size or improve strength, you need to train hard and ensure progressive overload. To train hard you need pre-workout nutrition on point, and post-workout nutrition on point, especially if you are training twice a day. Eating for only 6-8 hours each day may compromise this.

In closing,

Intermittent fasting may be beneficial for individuals chasing:

1. Tight diabetes control.
2. Fat loss.
3. Bodyweight Maintenance.

Intermittent fasting may not be optimal for:

1. Gaining mass and strength.
2. Individuals who strength train twice a day.
3. Heavy periods of training requiring on point pre- and post-nutrition such as professional sport or weight restricted events.

Take Home

Intermittent fasting works. It can help you lose body fat, improve blood glucose management and assist with dietary adherence.

The simplicity of fasting is attractive, but there are possible downsides if healthy eating and exercise are neglected.

Intermittent fasting is not the best or only way to lose body fat. IF is merely another diet strategy for individuals looking to lose body fat.

Provided you can stick to it long term, and it gets the results you are after, then you may be on to a winner.

If you liked this article and want to learn more about nutrition and living with diabetes. You need to check out the Diabetic Muscle and Fitness Training Lab.

It contains a vault of in-depth knowledge and resources you can’t find anywhere else on the internet, you’ll gain valuable new found knowledge on diabetes, nutrition, training, mind-set and more.

Join 1000s of other diabetics just like you. Ask questions, learn and start building the body you have always dreamed of. 

Most adults only get their HbA1c checked once a year, sound familiar?

This means you have an idea how things have been going for the previous 90 days, BUT WHAT ABOUT THE OTHER 275 DAYS?

The most effective way of keeping on top of your diabetes control is by regularly checking your AVERAGE BLOOD GLUCOSE (BG).

How often do you check yours?

Do you know how to use the results to predict HbA1c?

Check out the table below. It actually was taken from one of our most popular Diabetes Performance modules inside The Diabetic Muscle and Fitness Training Lab. 

The table shows where your HbA1c will be very close to, depending on what level your average BG has been at for 90 days. The table also shows the benefits and consequences of having different levels of control for LONG PERIODS OF TIME.

What has your average BG been for the:

• Last 90 days?
• Last 30 days?
• Last 14 days?

If you are currently in the red zone – Don’t Freak Out!

This article is your WAKE UP CALL. It’s time to take action. You can change this around very quickly, that is the beauty of using average BG to guide you.

How Do I Achieve Better Average Blood Glucose Levels?

Make small incremental changes to your daily diabetes habits and regimen. You can evaluate your progress by tracking the change in average BG every two weeks.

Top Diabetes Management Tips Based on 1000s of Hours Spent In Clinical Practice

• Test BG at least five times per day – this allows you to correct high glucose levels more often.
• Aim to be in target before bed, this means 8 hours per day of in target levels.
• Bolus 15-30 minutes before food to prevent high glucose levels after, remember BIFF:

• Blood Test,
• Insulin dose,
• Fifteen minutes wait,
• Food, eat it.

• Keep to 3-4 meals per day, spread equally with 3-4 hours in-between.
• This matches with the action of quick acting insulin (Apidra, NovoRpaid, Fiasp, Humalog) perfectly.
• Frequent snacking makes in target glucose control very difficult

• Eat mixed macronutrient meals. Avoid carb only snacks, unless using for exercise management.

• Review the patterns of your glucose trends every 14 days to identify where you need to change your habits and diabetes regimen.
• Use a written log, there is a lot to be said for writing it down. Why? You process and identify patterns as you write.

• Use an online platform where you can upload your meter, pump an CGM devices:
• Diasend & Glooko
• They are both the same platform – they have just merged.

I personally use this platform and love it. I have even made guides and videos of how to set up an account, how to review control, and how to make changes in my day job as a Diabetes Specialist Dietitian. You can access these guides and videos at http://www.bch.nhs.uk/diasend

• Use APPS such as MySugar and Diabetes:M 
• If you are struggling to identify solutions and find it hard to make changes, GET PROFESSIONAL HELP

Your diabetes team or a professional with the requisite skills and qualifications should be able to guide and empower you.

If they just tell you WHAT TO DO without teaching you how to do it, they are not setting you up for long-term success!

I work on the premise that as long as my average BG is less than 8.0mmol/l (145mg/dl) I am ALL GOOD.

If it’s above there, I need to focus on improving my control.

A special note: it’s no good having an average BG of 6.0mmol/l (110mg/dl) if it means you are hypo all the time.

Research suggests having 3-4 mild hypos a week that you can treat yourself is usual for people with good control. ¹ But if more than this you are at risk of becoming hypo unaware. This research is from people on MDI and pumps who adjust their doses based on food intake and activity.

Being hypo unaware will mean you will not be able to drive (in the UK and most places if your physician knows or you call out an ambulance), and you will be at much higher risk of having a severe hypo. THIS IS NOT a worthwhile trade-off for a HbA1c of 5.0%!

It’s all about balance.

Everyone is different, so set your target according to your circumstances.

As a general rule these are two good markers to aim for:

1. Average BG less than 8.0mmol/l (145mg/dl).
2. Less than 3-4 mild hypos per week, BUT no severe hypos and you can detect your hypos.

Checking average BG every 14 days will mean you stay in control and catch issues early! A Wiseman one told me: “If you’re not assessing, you’re guessing!”

Hope that helps!

If you liked this article want to learn more about insulin dosing strategies for better diabetes management check out the Diabetic Muscle and Fitness Training Lab.

It contains a vault of in-depth knowledge and resources you can’t find anywhere else on the internet.

Join 1000s of other diabetics just like you. Ask questions, learn and start building the body you have always dreamed of. 

Written by Head Coach at Diabetic Muscle and Fitness, John Pemberton – Diabetes Specialist Dietitian/Educator.

References

1. http://www.dafne.uk.com/417.html

• APP’s: MySugar, Diabetes:M, Dario etc.
• Glucose meters: Insulinx, Freestyle Libre etc.
• Pumps: Omnipod, Medtronic, Animas, all others except ROCHE pumps.

If so you need to know about Active Insulin, or as it’s commonly known, Insulin on Board (IOB).

To get specific, you need to know:

• How many hours IOB should be set at, so your calculator gives the right correction doses.
• How you can use IOB to improve blood glucose control around exercise.
• How different devices calculate IOB differently and how this can impact your glucose control.

These are all things I wanted to know when I was choosing an insulin pump six years ago. But no one knew the answer, well not a satisfactory one anyway. So I undertook a journey of delving through John Walsh’s “Pumping Insulin”, Gary Scheiner’s “Think like a pancreas” and read all the manufacturers’ operation manuals to find out.

At its most basic level, IOB refers to how much insulin from the bolus you have recently delivered is still working in the body.  Most devices use a linear model to determine how the IOB degrades in your body over time.

Simply if IOB is set at 4 hours and 4 units are administered the device will think:

• Just after bolus there are 4 units left
• After 1 hour 3 units left
• After 2 hours 2units left
• After 3 hours 1 unit left
• After 4 hours 0 units left.

Some devices such as Medtronic use a curvilinear approach BUT this is very similar to the linear model. Most manufacturers set IOB at 4 hours (range 2-8 hours) as default, and most diabetes services suggest starting at 4 hours.

But is this the best setting for you?

The IOB information can be used in two main ways:

1. For blood glucose meters, APPS, and pumps to prevent the user from delivering too much correction insulin for a high glucose level in the 1-4 hours after eating.

I shall show you the maths in a minute.

2. For the user to see how much insulin is still working from the previous bolus when the user is about to undertake an activity.

This helps determine if they need to do a bolus or not for intense (anaerobic) activity, or if they need more carbohydrate than usual for endurance (aerobic) or even intermittent (team sports) activity.

It is very useful here to stop and think about the main reason you want to use IOB.

• To help workout correction doses between meals using the calculator in your APP/device?

Or,

• To use to help guide exercise decisions by knowing how much IOB you have, and therefore your hypo risk?

You may be wondering why you need to choose. It will become clear as you read on.

Before we go any further I want to clarify I am talking about the quick acting insulin’s: NovoRapid, Humalog, Apidra, Fiasp.

If you look at their profile:

• Peak action is about one hour
• The total duration of action is 4-6 hours depending on the volume of the dose.

o     A high dose: 0.25u/kg – for me weighing 100kg would be 25 units and would last 6 hrs.

o    A smaller dose of 0.1u/kg – for weighing 100kg would be 10 units and would last 4 hrs.

Make a special note that the above is from published studies on insulin action and it’s very consistent for people with type 1 diabetes.  However, that does not mean you should set IOB in your device at 4-6 hours.

Remember, fast acting insulin does actually last 4-6 hours in the body.

How does IOB prevent over corrections between meals?

Have you ever gone to correct a high glucose one, two or three hours after eating, and your device says no correction, even though you know you need one?

Sound familiar?

This sections will explain why, and offer some solutions.

Most diabetes technology (Except ROCHE devices: ROCHE pumps and Expert meter – which I will address in a future post) use IOB to prevent over correcting in-between meals. They do this by registering how much insulin was given for the carbs and correction at the last meal and then using an algorithm for IOB to predict how much is still working in the body. This amount left as IOB is then deducted from the potential correction required. Remember these algorithms are linear in nature as described above, and most IOB is set at 4hrs.

Examples for mmol/l and mg/dl below:

Mmol/l – A bolus of 10 units was given 2 hours ago for 100g carbs at 1u:10g, so via the algorithm the device thinks there is still 5 units IOB after two hours (set at 4 hours). The person’s Sensitivity factor is 1u reduced BG by 2mmol/l – therefore the device thinks that potentially the glucose could drop by 10mmol/l.

Current BG 15.0mmol/l – target is 5.0mmol/l = it needs to drop by 10.0mmol/l and sensitivity factor is 1u:2mmol/l – therefore 5units correction needed. But, there is 5 units IOB so no correction is offered.

Can this be right, no correction for a BG of 15mmol/l at 2 hours!

Mg/dl – A bolus of 10units was given 2 hours ago for 100g carbs at 1u:10g, so via the algorithm the device thinks there is still 5 units IOB (set at 4 hours). The person’s Sensitivity factor is 1u:36mg/dl – therefore the device thinks that potentially the glucose could drop by 180mg/l.

Current BG 270mgl/dl – target is 90mg/dl = it needs to drop by 180mg/dl and sensitivity factor is 1u:36mg/dl – therefore 5units correction needed. But, there is 5 units IOB so no correction is offered.

Can this be right, no correction for a BG of 270mg/dl at 2 hours!

Here’s the reason why THIS IS A MASSIVE PROBLEM:

The devices do not understand the 5 units IOB are actually accounted for by the 50g of carbs still sat in the stomach, waiting to be digested. Therefore, no correction is given and the glucose is still high in another two hours’ time.

The picture below shows that no correction would be offered for BG of 22.00mmol/l (396mg/dl) one hour after eating because IOB is set at 4 hours, and the device still thinks that the 5 units IOB could bring the glucose down by 10mmol/l (180mg/dl), because the Sensitivity factor is 2.0mmol/l (36mg/dl).

What it should be thinking is the 5 units is accounted for by the 50g of carbohydrate still waiting to be digested in John’s stomach.

Pic 1:

The next shows that only 4.5 units correction would be offered for BG of 22.0mmol/l ( (288mg/dl) two hours after eating because IOB is set at 4 hours, and the device still thinks that the 3.5 units IOB could bring the glucose down by 7mmol/l (126mg/dl), because the Sensitivity factor is 2.0mmol/l (36mg/dl).

What it should be thinking is the 3.5 units is accounted for by the 35g of carbohydrate still waiting to be digested in John’s stomach.

Pic 2:

Pictures 1 and 2 show how a correction will only be offered to correct to the outer edge of the triangle, where the IOB degrades in a linear fashion, where the outer edge of IOB is determined by the hours the IOB is set at.

See picture 3 below, where it shows the outer edge where IOB is set at 2-5 hours. This graph also gives a good hint as to why the ROHCE devices have a much better algorithm when it comes to correcting high glucose levels.

Pic 3

The simple take-home for this graph is:

• The shorter the IOB, the more aggressive the corrections.
• The longer the IOB the less aggressive the corrections.

Where should it be set?

• 4 hours for most people is too long and means they do not get the necessary corrections in-between meals. However, if you are a hypo risk person maybe this would be safe for you, but it would lead to higher hba1c.
• 2 hours is probably too short as, if a correction is done at 2 hours the pump will think no IOB and give the full dose to bring to target. You may miss out on a bit of protection.
• The sweet spot is 2.5 to 3 hours, 2.5 is more aggressive, 3 hours more conservative. Some devices only do hourly options.

A few important points are the type of behaviours that do better with shorter IOB times and those for longer IOB times:

Shorter IOB times 2-3 hours:

• Low carb diets
• Bolus 15 mins before meals
• Choose Low Glycaemic index carbs
• Have good hypo awareness

Longer IOB times 3-4 hours:

• Bolus after meals
• Choose High Glycaemic index carbs
• Hypo unaware

ALWAYS CHECK WITH YOUR MEDICAL TEAM BEFORE CHANGING ANYTHING. 

Using IOB for exercise management.

Here lies the conundrum. We know the actual duration of insulin is 4-6 hours but we have to set IOB to 2.5 – 3hrs so it allows effective corrections. This means if set at 2.5 hours and you exercise at 3 hours after eating, you look at IOB and it says 0units – you think great no bolus insulin to consider, crack on…

This often leads to a hypo if doing aerobic activity, because there is some insulin still working for the previous bolus. If you knew there was still 1.5 units in the body, you would have had more carbs.

This often leads to hypo if doing aerobic activity, because there is some insulin still working for the previous bolus. If you knew there was still 1.5 units in the body, you would not have given the extra 1 unit you thought you needed to prevent a BG spike.

If IOB was set at 4-6 hours it would let you know how much is really still working, which is great for exercise, BUT you would never be able to correct between meals.

So the real question to ask is what you want to primarily use IOB for, correcting, or for exercise?

If for correcting primarily:

• Set IOB at 2.5-3 hours to allow effective corrections.
• Be aware when exercising 2.5-4 hours after a bolus there will be IOB but the device will read 0units. But there will be insulin still working that needs considering in your exercise plans.

If for exercise primarily:

• Set IOB at 4-5 hours and this will be a good estimate of how much is still working in the body.
• Override the correction suggestions by the device to give more correction, or calculate your doses manually using your sensitivity factor.

If for both:

• Set at 3 hours and you get a half-way house for both corrections and exercise. This could be the most sensible option, but could also get the worst of both worlds.

The way the ROCHE meters and pumps calculate IOB is much better and allows very sensible and effective correction doses, BUT is useless for exercise, as you cannot see the IOB effectively. Another article, for another time.

Hope this has helped.

ALWAYS CHECK WITH YOUR MEDICAL TEAM BEFORE CHANGING ANYTHING. 

If you liked this article and want to learn more about insulin dosing strategies for better diabetes, then check out the Diabetic Muscle and Fitness Training Lab.

It contains a vault of in-depth knowledge and resources you can’t find anywhere else on the internet.

Join 1000s of other diabetics just like you. Ask questions, learn and start building the body you have always dreamed of.

Written by Head Coach at Diabetic Muscle and Fitness, John Pemberton – Diabetes Specialist Dietitian/Educator.

In this video, I outline the 5 BIGGEST REASONS your blood glucose levels are going hypoglycemic before, during and after exercise.

Watch the video below to find out.

If you liked this video and want to learn more about exercising with diabetes, you need to check out the Diabetic Muscle and Fitness Training Lab.

It contains a vault of in-depth knowledge and resources you can’t find anywhere else on the internet. You’ll gain valuable new found knowledge on diabetes, nutrition, training, mind-set and more.

Join 1000s of other diabetics just like you and start building muscle, shredding body fat and build the best version of you.

How important is it?

Does Whey Spike Blood glucose levels?

Is whey bad for people with diabetes?

Will whey ruin your kidneys?

What does the research say about blood glucose, whey and diabetes?

How to incorporate whey protein into your diabetes bodybuilding diet plan?

Watch the video below to find out.

If you liked this video and want to learn more about nutrition and living with diabetes, you need to check out the Diabetic Muscle and Fitness Training Lab.

It contains a vault of in-depth knowledge and resources you can’t find anywhere else on the internet. You’ll gain valuable new found knowledge on diabetes, nutrition, training, mind-set and more.

Join 1000s of other diabetics just like you and start building muscle, shredding body fat and build the best version of you.

28

Q.Where are you from?

Bangor, North Wales

Q.What do you do with your time? (Job, Pastimes, Family life etc.)

I run an online community group focused on making women feel strong and confident in their own skin.  I am also a coach at UN1T in London as well as a fitness and commercial model

Q.Tell us about your diagnosis? How did you know something was wrong?

I was diagnosed at 14 years old.  I lost a considerable amount of weight and after several trips to the bathroom my mum took me to hospital.  My brother is also a type 1 diabetic so she knew what warning signs to look out for.

Q.Pens or Pump? Any preference? 

Pens.  I’m very active and have always found pens more convenient.

Q.How often do you check your blood glucose?

I’m quite an avid checker of my blood glucose levels, 6-7 times a day.  I’ve always been very active and for me to gauge my best control I like to know exactly where I’m sitting

Q.Recent A1C?    

136

Q.How often do you train?

I train 5-6 days a week

Q.What is your daily calorie and macro breakdown? Outline a typical day’s diet for us?

My daily expenditure is high so my normal calories sit anywhere between 3400-4000 calories a day.  I aim for about 220g of protein daily, I used to obsess about numbers and macros; however I’m much more flexible with it these days.

Q.What food do you love, but messes with your blood sugar the most?

I’m a sucker for ice cream, however it always makes my control shakey for a good few hours!

Q.Current workout split?

I used to be very regimented on a push, pull leg day split; however I’ve now started to take a real interest in mobility and building an “engine”. I’m in a lucky position in London where I can train amongst some of the best trainers and studios in London.  Two strong conditioning classes a week on top of a solid strength programme to follow keeps the wheels moving.

Q.Have you any body composition or performance goals over the next 12 months?

My main focus for the next 12 months is mobility, I’ve neglected it for too many years and it needs to be a priority.

Q.3 Things diabetes has taught you in life?

Diabetes has taught me to have patience, a greater understanding as to what I’m capable of when I look after myself and an appreciation of what it is to lead a healthy balanced life.

Q.Top 3 tips for managing diabetes?

Test frequently when training, less insulin less problems, pay close attention to your glucose levels in the morning and what effect the dawn phenomenon is potentially having.

Q.Biggest fitness myth dispelled?

I work closely with women and I’m a huge advocate for strength training for fat loss.  The idea that women can’t train in the same way as men is not only outdated but insulting!

Q.What is the single best piece of mind-set advice you could give someone who’s been newly diagnosed with diabetes? 

It will take time to adjust at first, your body will be responding in ways you didn’t think were possible.  Remember you have a community of other people in the same boat as you and you are not alone.  Reach out to other diabetics, you’ll be part of a community that not only looks out for each other but will go out of their way for you.

Q.Can you give a short concise review of the Diabetic Muscle and Fitness Guide and outline what was your biggest takeaway? 

The book not only gives you a better understanding as to what the condition entails but most importantly it busts some of the biggest myths about Diabetes.  New to training, or training for years, this book really is a must.  Even if you’re a trainer and you don’t have diabetic clients it is essential you read this to get a better understanding of the condition.

Instagram: @mathewlcarter

https://mathewlewis-carter.com

26 years old.

Q.Where are you from?

Adelaide, Australia.

Q.What do you do with your time? (Job, Pastimes, Family life etc.)

I work full-time as a Contracts Administrator for a Not-For-Profit organisation who look after people with disabilities. I manage the Government funding to ensure people get the right services they are entitled to. In my spare time I enjoy walking my dogs, going to the gym with friends and on hikes outdoors. I’m an only child and currently live at home with my parents (my Dad also has type 1 diabetes).

Q.Tell us about your diagnosis? How did you know something was wrong?

I was overseas in London when I was diagnosed at 25 years of age. I had quit my job in Australia, sold my car and packed my bags to go travel in Europe and the plan was to get a job in London and work for a few years. After a few weeks I started to feel really tired and extremely thirsty. I remember my eyesight started to get blurry and I couldn’t sleep through the night without having to go to the toilet 5 times because I was drinking so much! Finally, I Skyped with my parents back home and my Dad told me to go to a hospital immediately. My sugar level was 32.8 when I was admitted for 4 days because I had gone into slight DKA. I flew home to Australia a week later.

Q.Pens or Pump? Any preference?

I’m currently on Pens (Lantus & Novorapid) because I am recently diagnosed I’m still in the “honeymoon” phase and the Pens work well for me. However, my Dad is on a Pump which works really well for him. I just don’t like the idea of having something attached to me but maybe I will change my mind in a few years.

Q.How often do you check your blood glucose?

Sometimes I use the Freestyle Libre which is a flash glucose monitoring system, when I have one of those sensors in I will check my sugar levels up to 20 times per day! I find it really helpful being so newly diagnosed because it helps me track how different foods/exercises affect my levels and I don’t have to prick my fingers. When I’m not wearing a sensor I use the Accuchek Mobile blood glucose monitoring device and probably check 5-6 times per day. In the morning, before lunch, before the gym, after the gym, before bed and maybe before driving depending on how I feel and when was the last time I checked.

Q.Recent A1C?

My last A1C was 6.3.

Q.How often do you train?

I try to train at least 3-4 times per week in the gym and I like to go for walks/runs at least twice a week as well.

Q.What is your daily calorie and macro breakdown? Outline a typical days diet for us?

I don’t currently count my calories or macros but on a typical weekday I would start my morning with 45g of rolled oats mixed with water. Then I have a banana and nut bar for morning tea. For lunch I have a chicken and lettuce sandwich made with low carb bread (about 21g). For afternoon tea I have an handful of almonds and maybe some carrot sticks and dip. Then dinner is usually meat (chicken, beef or pork) with some steamed veggies or salad. If I am planning to go to the gym I make sure I have some carbohydrates with my dinner, that might be potato or pumpkin. If I don’t, I make sure I have some glucose tablets before my workout.

Q.What food do you love, but messes with your blood sugar the most?

Definitely chocolate. I have a sweet tooth and I love nutella but I find it difficult sometimes because the sugar in the chocolate will spike my sugar levels and then the fat will keep them up and if I have too much insulin it will later come crashing back down. I try to have a little bit of chocolate in moderation to avoid this but it’s hard to stop after only a few mouthfuls!

Q.Current workout split?

Back/bis
Chest/tris
Legs/abs
Shoulders

Q.Have you any body composition or performance goals over the next 12 months?

I don’t plan on competing again in the next 12 months but my goal over the year is to increase my muscle definition (focusing on my shoulders and abs) and of course get leaner in time for Summer. I’m currently trying to find the right balance between increasing my cardio and keeping my sugar levels from going too low afterwards. I find training weights does not have much of an effect on my levels unlike cardio.

Q.3 Things diabetes has taught you in life?

Appreciation – I never realised how much I took my health and my pancreas for granted. It has really helped open my eyes and realise that there are a lot of people in this world dealing with their own struggles and not all of them are visible.

Don’t worry about the small stuff. It has really changed my priorities and outlook on life. There is no point stressing over the little things when you never know what might happen next. Try to live in the moment and remember to have fun.

A lot of people are ill-informed when it comes to diabetes and will say silly things which can sometimes be hurtful without even realising.

Q.Top 3 tips for managing diabetes?

Try not to get overwhelmed. As someone who was recently this is really important, remember that you are trying you’re best and it’s all about trial and error. Don’t be too hard on yourself.

Diabetes loves routine. Try to eat at regular times and don’t skip meals. It’s also important to get enough sleep and, of course, stay active.

Pay attention to how your body reacts to things. Everyone is different and you need to learn how your body responds to food, exercise and other factors that can affect your blood sugar level. This will help you gain better control.

Q.Biggest fitness myth dispelled?

Lifting weights will make you look like a man! That is honestly the most ridiculous thing I have heard. Weight training results in stronger muscles which increases bone density and muscle strength which can reduce back and knee pain by building muscle around those areas.

Q.What is the single best piece of mind-set advice you could give someone who’s been newly diagnosed with diabetes?

Your life is not over! Yes, it is absolutely life-changing but it’s something that can be managed. I think it’s extremely important to surround yourself by people who are going to be supportive. Taking care of yourself has suddenly got a whole new meaning and it’s so easy to get depressed so you need a good support network around you. Make sure you still do the things you enjoy and try not to let it hold you back, just make sure you are well prepared whenever you go out.

Q.Can you give a short concise review of the Diabetic Muscle and Fitness Guide and outline what was your biggest takeaway? 

I love this Guide! It gives me the hope and determination I need to know that just because I now have type 1 diabetes, that doesn’t mean I can’t be fit and get back into the best shape I have ever been in! This guide is a great resource and my biggest takeaway is that consistency is key. You’re not going to get the results you want without good control of your sugar levels.

Social Media

https://www.instagram.com/healthier_lyfe/

25

Q.Where are you from?

Belfast, Ireland.

Q.What do you do with your time? (Job, Pastimes, Family life etc.)

For the past two years I have been working as a Classroom assistant for the SEN department in De La Salle College in West Belfast.  It’s a rewarding and challenging job working with children who have mental or physical disabilities (worked with a few diabetics, helping them understand carb counting and insulin ratios) and need a more individual approach to education.
I am a sports and exercise degree graduate from Exeter University.  I am looking to pursue a career in strength and conditioning.
Come from a fantastic family, my parents, Eileen & Peter who have been my rock and supported me through everything from administering my first insulin injection when I was 5 to sorting out my student finance and doing endless dishes, thanks Mum!
I also have a younger brother Lee who is 19 and is always there for advice or a game of Fifa!
My girlfriend Niamh needs a mention, I owe her so much to her for her support and saving me from numerous hypos. Especially those holiday ones. Going out together for over 5 years she’s been there for me and always carries my spare needles and fast acting carbohydrates.
For the past 4 years I have been personal training. Since gaining my level 3 Personal training cert I have been reading, attending seminars, asking questions and implementing my own training philosophy.  I’ve learned from the greats. Louie Simmons, Dan John, Travis Mash, Glenn Pendlay, Marcus Filly, Kirksman Tao and Pat Mendes to name a few.  You can check out some of my results and training highlights from my Facebook page and instagram account which i’ll link at the end.
Movement is my passion. Lifting things from the ground and putting it above your head is an art. In my opinion everyone should try it! The benefits are endless and it has changed my whole approach to training.
 

Q.Tell us about your diagnosis? How did you know something was wrong?

Let’s rewind 20 years ago.  I was like any kid. Out playing, exploring and drinking copious amounts of Coca cola. For a few days I was super thirsty. Constantly coming in to my house to drink anything I could get my hands on, Coke was usually the drink of choice. My mum and Aunt were present at the time. They knew something wasn’t quite right. My uncle Michael, who was a paramedic, came to pick my aunt up. I came into the house and went straight for a pint glass and a beverage. He saw how quickly I drank the pint of coke and the abnormal colour of my skin, he thought it best to take me to my local GP. My mum ended up taking me that very day and I was admitted to hospital on the 17^th December 1996. I can remember this like it was yesterday. I can also remember my blood glucose. The very first time it was taken, 64.7mmol. DIABETIC. I went on to spend the next two weeks in hospital.
Q.Pens or Pump? Any preference?

Pens, I’m on Lilly Humalog Kwikpen for my fast acting insulin and Lantus solostar for my long acting insulin. I’m open to try the Pump, but at the minute everything is fantastic with the pens and my routine.

Q.How often do you check your blood glucose?

I check my blood glucose at the very minimum 8 times a day: morning, before snack, before lunch, pre-training, post-training, before dinner, before snack and before bed are my usual times.
You can never check too often!
Q.Recent A1C? 

7.2mmol
My worst was when I was 15, 19.3mmol. A turning point in my life. I was told control these or face amputation. Bit extreme but it worked.

Q.How often do you train?

I do some sort of movement every day. When training for competition I’d train 5 days a week. Off season, at the minute I’m following 2 days on one day off!

Q.What is your daily calorie and macro breakdown?

I’m going on holiday in two weeks, so my current calorie breakdown is 2800 calories a day.
I’m on 300 grams of Carbohydrates, 180 grams of Protein and 80 grams of Fat

I’ve tried every dieting technique known to man and flexible dieting with a macronutrient breakdown is my favourite. I also use this technique for my clients. Using this technique goes hand-in-hand with being diabetic, especially being able to use carb counting and insulin ratios. A must learn for all diabetics in my opinion.

Q.What food do you love, but messes with your blood sugar the most?

None, I’m in complete control of my food and blood sugars. I never restrict. Being able to count carbs and take insulin according to what I’ve eaten allows me to be one step ahead of my diabetes. I’m fond of a treat every day; be it ice cream, donuts, biscuits or, my Achilles heel, 300 grams of coco pops. I make sure it fits my macronutrients and carb count so I know exactly how much insulin I have to take.

Q. Have you any body composition or performance goals over the next 12 months?

I train for the supertotal. Snatch, clean and jerk, squat, bench and deadlift.

Current workout split –

Monday: heavy back squats, push press and muscular imbalance work with light conditioning.
Tuesday: Clean and jerks and heavy conditioning,
Wednesday: I like to get on the rings for some muscle up and flow work.
Thursday: Snatch and heavy bench
Saturday: Front squat, deadlift and heavy farmers walks.

I have a few goals for the coming 12 months. September 9th i will be looking to hit a 240kg total at 77kg at the Northern Ireland Autumn Weightlifting open. I am currently on the Northern Ireland weightlifting team and looking to make the cut for the Commonwealth games next summer in Australia.
I also want a 160kg clean and jerk, 240kg back squat, 260 kg deadlift. All at a bodyweight 80kg.
I will also attain my Strength and conditioning certs this year.

Q.3 Things diabetes has taught you in life?
1) Patience, you don’t learn all this overnight.
2) Diabetes is not a one-size-fits-all condition – what works for me might not work for you.
3) The carb value of every food under the sun.

Q.Top 3 tips for managing diabetes?

1) Always check your blood! I cannot stress this enough. The better range you have of your blood sugars then the easier it will be to keep those highs and lows at bay!
2) Educate yourself, find what works for you. Read books (Phil Graham’s Diabetic muscle and fitness guide is a great place to start), forums and ask as many questions as you can.
3) Learn how to carbohydrate count. Weigh your food and get your carb to insulin ratio. This will allow greater control of your blood sugars

Q.Biggest fitness myth dispelled?

Isolating muscles in my opinion should be done rarely.
Use whole body lifts. Try this template out for a few weeks and send me your praises through to the email, when your athletic body goals come through…
Day 1 -Back Squat  10 Rep Max
Loaded carries

Day 2- Strict press 5 Rep Max
Chin-ups max reps
Sprints

Day 3 – Front squat 8 Rep Max
Prowler pushes 400m bodyweight

Day 4 – Behind Neck Push press 5 Rep Max
Below knee rack pull 3 Rep Max
Kettlebell swing tabata

Q. What is the single best piece of mind-set advice you could give someone who’s been newly diagnosed with diabetes? 

Accept things will never be perfect. When things go wrong, learn from it. Perfect control doesn’t happen overnight. It takes time and patience.  Don’t stress when you lose control, ask why this is happening and how can I make it better.

The Diabetic Muscle & Fitness Guide is an essential must read for everyone!
The book goes into fantastic detail on the science of diabetes, exercise and nutrition. The information is clear and easy to understand. The use of graphs, tables and charts are fantastic. The chapters on Mindset with strategies on how to change your perception of diabetes, lifestyle management which highlights everything you can do outside of the gym to promote mind and body development and diabetic tips which should be read by everyone, including medical professionals.
To finally have this material in paperback is an amazing feeling and I cannot thank Phil enough for this, he has left no stone unturned. For newly diagnosed diabetics this will answer any questions you have about your condition. 5/5,

Your the man Phil,
Mark.

Facebook page – Mark Scott Elite Performance
Instagram – scottyyydoo

28

Q. Where are you from?

Belfast

Q. What do you do with your time? (Job, Pastimes, Family life etc.)

I work as a heating engineer for Carillon energy services, working on gas, oil and plumbing jobs and have done for 12 years

Q. Tell us about your diagnosis? How did you know something was wrong?

I knew something was wrong when, whether I was alone or working, my heart would be beating very fast, I became very anxious and would go into a cold sweat. I went to my local doctors to see what was wrong, they said it was anxiety and gave me anxiety tablets. I went back a week later with the symptoms even worse, they just upped the dosage without further tests, again one week went on and it had gotten worse, I was drinking loads of water, (although that wasn’t unusual for me), I became extremely weak and was unable to work, because I felt weak/tired; I would then buy sugary energy drinks as I thought they would help…little did I know! So it then came to the stage where my vision was extremely blurry so I rang in sick to work and was going to go to hospital but went to see my mum first, when she just happened to be in my granny’s, who had only been diagnosed with type 2 diabetes a few weeks. When I described how I was feeling it all clicked together and my granda told me to use the blood glucose tester and there, lo and behold, it came up a code. When I referred to it in the book it explained that I needed to go to hospital asap! My bloods were low 40s and said I was close to going into diabetic coma.

Q. Pens or Pump? Any preference?

Pens I use are mainly Novorapid and Lantus at night, so not yet trying any other forms of insulin as I’m happy with how I get on with these pens

Q. How often do you check your blood glucose?

Quite often! Probably between 10-15 times daily

Q. Recent A1C?

Recent A1C was 7.1

Q. How often do you train?

I train 5-6 times per week.

Q. What is your daily calorie and macro breakdown? Outline a typical day’s diet for us?

Typical day of eating would work out between 3000-3300 calories, in and around 190 protein, 400-500 carbs and 60-70 fat

Breakfast typically try to have something small and fast as long as I can, so would have a protein/oats bar

Lunch would typically be low calorie bread (Brennan’s be good) with hard and low fat cheese, 8 rounds of bread, probably my biggest meal of the day

Dinner would be packet of basmati rice, tuna in brine and red sauce

Then I would snack a lot as I find it easier to control my bloods, snacks would include a second protein bar, weetos, weetabix, cheerios or coco pops cereal with unsweetened almond milk, chocolate or other flavoured rice cakes and oats

Q. What food do you love, but messes with your blood sugar the most?

Foods I love which mess with my blood sugars the most would be sugary cereal in large amounts, pizza and ice cream as it can take quite a while for the carbs to kick in.

Q. Current workout split?

Current workout split is Monday – legs, Tuesday – chest, Wednesday – back, Thursday – rest or just some cardio – Friday shoulders – Saturday arms, Thursday or Friday can switch between which day is restday.

Q. Have you any body composition or performance goals over the next 12 months?

Body goals for the next 12 months is going to be focused or wider shoulders and wider back! I feel my chest is my strong point and need to work on shoulders and back to enhance the v taper look

Q. 3 Things diabetes has taught you in life?

3 things having type 1 diabetes has taught me would be to love the life you have, no matter what condition you have or situation you’re in, as no one person is the same but lots of people can have the same attitude towards enjoying life

Second thing would be to track your foods and for me, to maintain a diet/lifestyle that can be a routine which helps maintain good sugar levels and to not be too restrictive in what you can eat and to just focus more on timing of certain foods, which you know will affect your sugars the most

Last thing would be that it has actually taught me to be more open to people that I let into my life as it is crucial that people close to me understand my condition and what to do if I’m ever in a situation where I’m hyperglycaemic or hypoglycaemic

Q. Top 3 tips for managing diabetes?

Top 3 tips for managing diabetes would be to track your food, i.e. Myfitnesspal

Have a routine in food and in life

Try to always have a positive mindset, nothing worse than if you aren’t motivated or don’t feel positive, than eating your way into high blood sugars causing you to constantly feel bad and down.

Q. Biggest fitness myth dispelled?

Biggest fitness myth would be meal timing and having to eat 6 small meals per day

Basically consistency is key, each person is different but if each person is consistent, results will come

Q. What is the single best piece of mind-set advice you could give someone who’s been newly diagnosed with diabetes?

Advice to someone newly diagnosed with type 1 diabetes would be to stay calm, learn about food, and in particular carbs!, as once you start to learn this, every day it will gradually get easier and easier.

34

Q. Where are you from?

Isle of White

Q. What do you do with your time? (Job, Pastimes, Family life etc.)

I’m a gym owner, personal trainer, Les Mills instructor, Toned figure and Bikini competitor. I’m also mum to a 4-year-old girl and have a husband.

Q. Tell us about your diagnosis? How did you know something was wrong?

I was 16 years old doing my GCSE exams at school, my mum noticed me guzzling loads of water and sleeping loads and had a massive weight loss, she took me to doctors who sent me straight to hospital where I stayed for a few days until I was brave enough to inject myself.

Q. Pens or Pump? Any preference?

 Pump, Omni pod wireless are so  good!

Q. How often do you check your blood glucose?

4-6 times a day

Q. Recent A1C? 

  7.6

Q.How often do you train?

I train in the gym with weights splitting muscle groups 4\5 times a week and I also teach 3 Les Mills classes per week.

Q. What is your daily calorie and macro breakdown?

At present I don’t count calories or macros, mainly because I do this for 6 months of the year when in prep. The other 6 months I like to relax slightly, I eat healthy with treats.

Q. What food do you love, but messes with your blood sugar the most?

Pizza

Q. Have you any body composition or performance goals over the next 12 months?

Yes I’m going to Italy to compete for the IBFA worlds and universe in July 2018 and cannot wait. I want to get as lean as I can for show day but until prep starts I really want to grow some bigger shoulders, biceps and hamstrings!

Q. 3 Things diabetes has taught you in life?

Not to let it stop you doing what you want to do, it’s not the end of the world – I can still see, hear and walk and am healthy in all other ways,  but you can get tired easily, sick easily and quite low.

Q. Top 3 tips for managing diabetes?

Test sugar as much as you can,

Attend appointments for diabetes, eyes and limbs on a regular basis

Keep moving!

Q. Biggest fitness myth dispelled?

 I’m diabetic I can’t exercise.

Q. What is the single best piece of mind-set advice you could give someone who’s been newly diagnosed with diabetes? 

You control diabetes it doesn’t control you!

FACEBOOK:    KERRY BEXON (PERSONAL TRAINER)

INSTAGRAM:  KERRY_BEXON

Q.Age

25

Q.Where are you from?

Northern Ireland, Dromore, Co.Down

Q.What do you do with your time? (Job, Pastimes, Family life etc.)

I am a trainee Irish Chartered Accountant due to sit my finals August 2017. I spend the majority of my time working on myself and building my future. I love training and because I sit behind a desk all day I really enjoy getting up early heading to the gym before work for some cardio and light training then I will head after work in the evening for a heavier session. My job and hobby are very different I enjoy the ability to work my mind and body to the level I have achieved thus far (more to come in both aspects).

 Q.Tell us about your diagnosis? How did you know something was wrong?

I was diagnosed when I was very young 18 months to be precise. My mother noticed my uncontrollable urinating and constantly crying for water or fluid of some sort. I am sure it was very difficult for them to get me diagnosed at such a young age.

Q.Pens or Pump? Any preference? 

I believe I am in complete control using the pens. I know the pump is great but I can’t see how it can take into account all variables, especially with the rigorous exercise I do. Also the whole idea of something attached onto my body just doesn’t work for me.

Q.How often do you check your blood glucose?

Frankly I couldn’t put an exact number on it as it varies from day to day minimum I would say 10 times in a day.

Q.Recent A1C?    

6.3 Feb 2017

Q.How often do you train?

 I train twice daily but have become more comfortable in letting the odd morning session slip. On Sundays I tend to take a complete recovery day if I require it – I listen to my body.

Q.What is your daily calorie and macro breakdown? Outline a typical day’s diet for us?

During the off season I don’t tend to measure my calories unless I am aiming for a goal. As time has gone on I have been able to eyeball my food more and more accurately. A rough guide of Macros would be that I ensure I get over 350g protein per day and eat carbs just as I feel I need them. Keep them low enough, no more than 200g a day, until I splurge a little on a Saturday when I train legs. The only fats I ensure to take are healthy fats from Udos Oil which I religiously take every morning.

Q.What food do you love, but messes with your blood sugar the most?

Breakfast cereal would be my biggest craving during prep. I don’t even eat it unless I go low during the off season or get very hungry in the evening after training. This is maybe why I crave it so much during contest prep.

Q.Current workout split?

Monday – AM Cardio Core training. PM Chest/Biceps or Back/Triceps

Tuesday – AM Cardio Core training. PM Chest/Biceps or Back/Triceps (dependant on Monday)

Wednesday – AM Cardio Core training. Some blood flow work on my quads and hamstrings.

Thursday – AM Cardio Core training. Back/Biceps or Chest/Triceps

Friday – AM Cardio Core training. Back/Biceps or Chest/Triceps (dependant on Thursday)

Saturday – Heavy Legs.

Sunday – Rest but if I feel a body part wasn’t worked enough during the week and feels ok to train it the odd weekend I would train it again.

The above is not written in stone, I will swap it around change things up here and there dependant on how I feel.

Q.Have you any body composition or performance goals over the next 12 months?

Reduce my training down to around “3 days on 1 day off” situation. Gradually reduce the cardio down to 3 days a week. I train so much because I enjoy it but I know in order to grow I will need to let the body recover more even if I feel I could go again and again. The main goal is to keep my weight in check this off season, ensuring I don’t pile on a lot of useless weight which is only putting strain on my heart.

Q.3 Things diabetes has taught you in life?

No matter how good you think you are at controlling things you can always get thrown a curve ball.

Consistency is the best way to achieve goals.

Only you can reduce the strain of your condition on your life and the ones around you.

Q.Top 3 tips for managing diabetes?

Test Regularly.

Get to know your body and don’t always just take what the doctor is saying as gospel.

Ensure to adjust any abnormal glucose levels in increments. If low small sips of Lucozade (not anymore, though, since they removed the glucose lol) until a good level is reached. If high, it is dependent on the extent this is where you need to know your body.

Q.Biggest fitness myth dispelled?

Having diabetes gives us a competitive advantage. You try telling me that when I’m 2 weeks out from a show, my head’s gone and my bloods go low. Takes great determination and concentration to try avoid going mad and eating the house down.

Q.What is the single best piece of mind-set advice you could give someone who’s been newly diagnosed with diabetes? 

Don’t panic. You won’t learn how to control it overnight, that will only come with time. Know that everything you did before you were diagnosed is obtainable again, you just need to work that little harder.

Q.Can you give a short concise review of the Diabetic Muscle and Fitness Guide and outline what was your biggest takeaway?

What Phil Graham has put together for the diabetic community is nothing short of remarkable, giving clear understanding of how our bodies work in relation to hormones and insulin regulation.

I’m terrible at reviewing stuff bud and still yet to get deep into the book as I am revising for the chartered exams atm.

Instagram – Jamesgibson19791

Facebook – james.gibson.96

Calories influence energy levels and body fat.

Protein influences everything from muscle growth, appetite control right through to hormone production.

Fiber feeds the bacteria in our guts which play a role in the health of our immune system.

Carbs influence blood glucose and exercise performance.

Vitamin C protects against the damaging effects of high blood glucose and oxidative damage.

Salt influences water retention.

etc… We could go on forever.

The nutritional components of food serve many different roles within the human body.

This article aims to highlight 5 key nutritional aspects of food which have been shown to improve the action (or sensitivity) of insulin, resulting in improved blood glucose management in people with diabetes.

Before we go into details – it is important to understand a few key terms surrounding insulin and diabetes.

Key Terms

Insulin is a key hormone involved in the use and storage of fuels within the body.

Insulin sensitivity refers to how effective the hormone insulin is at doing its job in the body. This varies between individuals and is reduced in people with diabetes.

Insulin resistance is when muscle, liver and fat cells do not use insulin properly. As a result, glucose builds up in the blood, overflows into the urine and is excreted out of the body, never fulfilling its role as the body’s main source of fuel.

Diabetes is a group of metabolic diseases characterized by different degrees of insulin resistance, where not enough insulin is produced, or the current insulin produced does not work effectively.

Disorders in insulin production and signalling can have widespread and devastating effects on the body’s organs and tissues if left uncontrolled. Therefore, it is important that people with type 1 diabetes (who produce next to no insulin) have an uninterrupted supply of high-quality insulin medication to replicate their own natural insulin production.

Individuals with type 2 diabetes may also need to take medication to improve the effectiveness of their natural insulin production.

In both cases of diabetes, certain lifestyle factors are advised to support medication therapy. Nutrition is one of them.

5 Incredibly Powerful Eating Tips That Boost Insulin Sensitivity Naturally

Consume Foods That Have Been Scientifically Proven to Boost Insulin Sensitivity.

Scientific research has demonstrated foods like vinegar, lemon, lime, walnuts, almonds, green tea, cinnamon, and turmeric have insulin-sensitizing properties. Including nutrient-dense foods like these in your diet may help improve the body’s sensitivity to insulin and ability to store consumed carbohydrates within muscle glycogen stores instead of as fat. That’s why I included all these kinds of foods inside the Ultra Lean and Muscle Building Cookbooks. If you haven’t checked these cookbooks out already, you’re missing out on over 200+ mouth-watering diabetic friendly recipe ideas that will help you get you in shape without giving up the foods you love.

  Consider Supplementing with Magnesium and Vitamin D.

Magnesium and vitamin D have been shown to improve the body’s sensitivity to insulin. Low magnesium levels are common in people with Type 1 and Type 2 diabetes.

Magnesium is an essential dietary mineral and the second most prevalent electrolyte in the body besides sodium. Magnesium has a strong relationship with insulin and thus plays an important role in carbohydrate metabolism _1,2.

Research has shown that subjects who supplemented with oral magnesium improved their fasting blood glucose levels and increased their insulin sensitivity.³

The standard dose for magnesium supplementation is 200-400mg.⁴

Vitamin D is a fat-soluble nutrient essential for human survival.

Vitamin D is known to aid in improving insulin receptor function, prevent islet cell death, as well as improve beta cell function.

Research in both type 1 and type 2 diabetes have shown positive results in that supplementing with vitamin D has the potential to lower haemoglobin A1c compared to baseline.^5,6 Much of this may in part be due to improving insulin resistance.

Individuals with diabetes should get a 25(OH)D blood test to assess their current vitamin D status. The Vitamin D Council recommends a blood level between 50–80 ng/mL year round.

If needed, 1,000-2,000 IU (25–50 mcg) of Vitamin D per day is more than adequate. ⁷

Both magnesium and vitamin D may be consumed via supplements. However, they can also be obtained from food.

Magnesium rich foods include green leafy vegetables, pumpkin seeds, cashews, and broccoli.

Vitamin D is easily received by getting sun exposure daily; however, people who live further away from the equator or experience harsh, cold winters are at a disadvantage and may need an additional vitamin D supplement. Also, foods such as fatty fish like salmon, dairy, eggs, and cod liver oil may be consumed to achieve adequate vitamin D levels.

 Prioritize the Essential Fatty Acids, especially Omega-3.

The human body can synthesize most of its fat needs from the diet. However, there are two essential fatty acids, known as Omega 6 (linoleic acid) and Omega 3 (alpha-linolenic acid) which cannot be produced in the body and must be consumed from food. Both of these fats can be found in plant and animal foods.

Consuming a healthy balance of omega-6s and omega-3s is very important for human health.

However, in today’s modern society many populations at risk of obesity and diabetes have an imbalance in their consumption of omega 3s and 6s, whereby too much omega 6 is consumed at the expense of omega 3.

While both of these fatty acids are essential for good health, the stark imbalance is pro-inflammatory and detrimental to insulin sensitivity. The imbalance is a result of the world’s growing food intake, particularly increased consumption of processed food cooked in processed polyunsaturated fats like sunflower oil.

The first line of defence in rectifying this imbalance involves eating fewer calories and improving energy balance with physical activity. The next step is to increase omega 3 consumption from cold water fatty fish or use of high-quality Omega 3 food supplements.

Ideally, 340-453g (12–16 oz.) of cold-water, fatty fish such as salmon, sardines, and mackerel each week, if personal taste allows for it. Otherwise a good quality fish oil supplement.

 Avoid Trans Fats.

There is nothing positive or healthy about man-made trans fats. They are well established to cause insulin resistance, resulting in a decrease in insulin sensitivity. Additionally, trans fat may increase abdominal fat storage.

Food products that contain trans fat include, cakes, vegetable oils and margarine. Substitute these common cooking products for healthier oils like olive oil, avocado oil, coconut oil or real butter.

Trans fats are mentioned on nutrition labels.

Strive to purchase and consume foods that contain 0g Trans Fats.

Food over Macronutrients.  

Carbohydrates have the greatest effect on blood glucose levels, protein has a moderate effect and fat a relatively small effect.

However, when it comes to mealtimes, we mostly consume mixed macronutrient meals comprised of different food sources.

Think about it. You rarely eat a potato on its own. Rather, a combination of potato (carbs), meat or fish (protein) and a good dab of butter (as fat).

If you keep consistent with the amounts of carbs, fat and protein at meal times, you’ll have a much better chance at working out a reliable insulin to carb ratio.

This is great, but what happens when you make an extreme change and decide to consume a food dominant in one macronutrient? Or, vary the composition of your set meal in favour of a certain macronutrient such as a pepperoni pizza which is super high in fat?

When the time comes, you must be willing to increase or decrease your insulin accordingly. This requires an in-depth understanding of how to dose and spread your insulin for mixed and, or, single macronutrient-based meals.

Dosing your insulin accurately is extremely important for avoiding hyperglycemia and further insulin resistance.

Want to put this learning into practice?

I’ve taken all of these principles and incorporate them into Diabetic Shred Guide – a 112-day fat loss system for men and women living with diabetes. It contains everything you need to know about eating, training and living to get lean. You get weekly meal plans tailored to your metabolism and over 50 challenging workouts.

If you want to learn more about flexible dieting you can check out my body transformation diet and training guides created exclusively for people with diabetes.

Diabetic Shred –  112-day Advanced Body Transformation Guide Built for FAT LOSS.

References

1. Paolisso G, Scheen A, D’Onofrio F, Lefebvre P: Magnesium and glucose homeostasis. Diabetologia33:511–514, 1990
2. Nadler JL, Buchanan T, Natarajan R, Antonipillai I, Bergman R, Rude R: Magnesium deficiency produces insulin resistance and increased thromboxane synthesis. Hypertension21:1024–1029,
3. Mooren FC, Kruger K, Volker K, Golf SW, Wadepuhl M, Kraus A. Oral magnesium supplementation reduces insulin resistance in non-diabetic subjects-A RCT. Diabetes, Obesity, and Metabolism. 2011;13(3);281-284
4. http://www.nap.edu/read/5776/chapter/8#223
5. Aljabri KS, Bokhari SA, Khan MJ. Glycemic changes after vitamin D supplementation in patients with type 1 diabetes mellitus and vitamin D deficiency. Ann Saudi Med. 2010;30(6):454-458.
6. Mitri J, Muraru MD, Pittas AG. Vitamin D and type 2 diabetes: a systematic review. Eur J Clin Nutr. 2011.65(9):1005-15.
7. Example.com The Supplement-Goals Reference Guide

 32

         Q.Where are you from?

Charleston SC

        Q.What do you do with your time? (Job, Pastimes, Family life etc.)

Chiropractor (Own Mobility Spine and Rehab) Former professor at College of Charleston, ALLMAX Nutrition – Content contribution and athlete.

       Q.Tell us about your diagnosis?

When it started, I was actually in college. I was playing college football at Michigan State University, which is a Division One program, and it requires a lot from you, physically. Somewhere towards the end of my sophomore year, into my junior year, I just started feeling off. I didn’t feel right. I was really tired, lethargic. I was losing weight despite eating more food than anyone on the team, (lineman included.) I saw doctors here and there, they didn’t really know what was going on at the time. By my senior season, when things had gotten pretty bad, I had lost 20-something pounds, looked anorexic and was constantly thirsty. I was diagnosed shortly after playing in a bowl game…..Team Doc ordered fasting bloods and I was in the 400s….he called me the next day and said you need to go to the emergency room right now. I was in the middle of a summer job sweeping up some floors…. at that point I could barely sweep 10 feet without feeling out of breath, sick and in need of a break. Once I arrived at the hospital my blood sugar was approaching 800. They kept me in the ICU for a couple days before discharging me.

Q.Pens or Pump? Any preference?

NO preference but I have never used the pump and feel the pens create more awareness of what you are eating, e.g. I’m less likely to have seconds if I have to pull everything out and shoot lol.

         Q.How often do you check your blood glucose?

I check blood glucose before every meal so 6-7 times a day for that along with intermittent checks post odd meals, strange feelings, or new activities so probably between 6 and 12 times a day.

         Q.Recent A1C? 

Recent A1C 5.4 at one point I had an A1C of 4.8.

         Q.How often do you train?

At present, I am training three to four days a week and focusing on work and content creation. However, for the majority of the year, I train 5-6 days a week.

         Q.What is your daily calorie and macro breakdown?

Average calories when not competing probably range between 3k-4k calories, macros at 40p/40c/20f

        Q.What food do you love, but messes with your blood sugar the most?

Pasta because of the carb and sugar variance in the sauces.

        Q.Current workout split?

• Quads/ Calfs
• Chest/ Triceps
• Shoulders/ Arms
• Back/ Hamstrings

         Q.Have you any body composition or performance goals over the next 12 months?

Gain density in chest and quads.

          Q.3 Things diabetes has taught you in life?

1. Life can change in an Instant – Be grateful
2. The majority of diabetics are ill-prepared or not informed to manage it properly.
3. To not be afraid to share what makes me different, as people are very supportive – Everyone has their own “Stuff”
4. To look at everything in life as a blessing as it either slows you or grows you and Type 1 has caused me to grow emotionally, physically and spiritually.

         Q.Top 3 tips for managing diabetes?

1. Know exactly what you are eating….no guessing.
2. Check often.
3. Be consistent by building daily habits.

       Q.Biggest fitness myth dispelled?

You are limited in your ability to be a great athlete as a Type 1!!!

       Q.What is the single best piece of mind-set advice you could give someone who’s been newly diagnosed with diabetes? 

Don’t be afraid to LEARN LEARN LEARN…. information and opinions are always changing. You don’t have to go it alone. Find a mentor and study from those who have been successful.

Can you give a short concise review of the Diabetic Muscle and Fitness Guide and outline what was your biggest takeaway.

Currently, in the early stages of the book but thus far I love the layout, the differentiation between type one and two, the depth of the science and the fact that almost EVERYTHING I would want to highlight is bolded and made large.

 Get in Touch

Instagram @BrettKahn

Coaching contact: KahncretePhysique@Gmail.com

It’s beautiful.

What else feels this good right after a long day at work, and hard gym session?

The warm plates are sitting out, the food is on the table and your family (or better half) mumbles with a half-eaten piece of pizza in their mouth, ‘Sit down and have a few pieces, there’s dessert too.’

You really wish you could, but there’s one big problem…

You are 2 weeks into your new fat loss diet and want to be in the shape of your life for once.

You know this type of food isn’t going to help you. It’s one of the reasons you need to lose weight in first place.

Add to that, you know this food and diabetes don’t get along. You’re anxious about the amount of insulin you are going to inject for the massive blood sugar spike you are about to experience.

But, in the famous lyrics of R.Kelly – Bump N’ Grind. Your mind is telling you no, but your body is telling you YES!

See, our food environment is a pretty big deal.

As humans, we make hundreds of decisions about food every single day¹. This tends to get more challenging when you start dieting and get ‘hangry.’

When you live with your family, a partner or friends you are exposing yourself to their way of eating. This can be a problem…

Like I say in my book if you live with three other people who eat crap and don’t value a lean healthy body, there is a high probability that you will become the fourth person in the group.

Cooking and eating food has a massive social element that many people overlook. This is one of the biggest challenges when it comes to food environment.

Just think of how awkward the following circumstances can be when you are trying to diet.

• Being asked out to a buffet meal with friends and family.
• Cuddled up on the couch for a movie with a brand new date who brought you a share size bag of M&M’s to enjoy.
• Eating at a restaurant with a group of friends and the breadboard comes out.

Then there are other factors like convenience and prevalence of junk food in your fridge or naughty cupboard.

IT’S EASY TO FEEL GUILTY

… when you turn down someone’s cooking efforts, the surprise pizza order or that share size bag of M&M’s.

It’s easy to become overwhelmed, give in and say, ‘I’ll start back on the diet tomorrow,’ which, of course, rarely ever happens.

Willpower Has a Fuse

It can run out, especially when you are under stress, and have to make hundreds of decisions about food on a daily basis.

When you’re tired and running low on calories, you are much less likely to exert willpower and far more likely to jeopardize your fat loss efforts by indulging in excess calories. Especially, if they are ‘offered on a plate’ or just down the stairs.

This relates to the model of behaviour known as “Ego depletion” ²

A large amount of scientific evidence (meta-analysis) by Hagger et al in 2010 showed that:

• Ego depletion significantly affected self-control task performance.
• Ego depletion was significantly affected by the degree of effort, perceived difficulty, perceived negative effects and subjective fatigue.
• Low blood glucose levels affected ego depletion negatively.

Given the fact that willpower is a limited resource,

it makes sense to elevate your food environment and improve it by either removing unhelpful food choices that are contradictory to your end goal or simply not putting yourself there in the first place.

Changing Your Environment Can Help

Let’s take the same situation you were in earlier on, but this time you don’t smell pizza or brownie, nor get tempted to ‘have a piece’ because you know your family, or better half sits down at the same time every single week to eat a takeaway.

Eating a filling meal before you arrive home grants you permission to use the, ‘I’ve eaten already’ excuse.

Or, if you live with a partner, you could tactfully plan your daily calories around the takeaway meal using an intermittent fasting style approach, backloading your calories into the evening. Another solution would be to ask your better half to have a friend round to eat with.

Losing body fat is a process that requires food restriction.

Sacrifices have to be made if you want to look a certain way or want to hit a target bodyweight. If your friends and family can’t support your goal, educate them on why you’re doing it and how it will improve your quality of life. In turn, letting you live life to the fullest.

If they can’t accept that, stick to your guns.

No one needs to eat pizza and brownies to fit in.

Having competed as a bodybuilder for many years I know too well how to enhance my food environment for muscle gains and fat loss.

Try any of these tactics if you suspect your environment is holding you back

• Empty your naughty food cupboard of sweets and confectionary. Out of sight, out of mind. Just make sure you keep some fast-acting sugars for hypo prevention. Sports drinks are perfect as they are the least likely food product to be consumed when you are bored or hungry.

• Diet soft drinks are great for killing a sugar craving and support fat loss due to their zero calorie content.

• Equip yourself with great tasting diabetic friendly recipe and snack ideas. That’s why I created the Ultra Lean Diabetic Cookbook – it’s loaded with 100 delicious diabetic friendly recipes you will love including Tortilla Pizzas, Protein pancakes and much more. All the calories and macronutrients are outlined for you – they even come with a Myfitness pal barcode for easy food tracking.

• If you use flexible dieting as an eating strategy, keep all junk food in opaque tins at the top of a cupboard so they are hard to see and reach.

• When the share board comes out, excuse yourself and nip out to the toilet. Tell the table to “eat away” and by the time you get back most of it will be gone.

• Avoid going shopping when hungry.

• Avoid hoarding junk food when it is on offer at your local supermarket. Before you place it in your trolley, ask yourself, ‘Do I need it?’

• Don’t walk down the sweetie isle when dieting. That’s just torture.

• Don’t watch Man Vs. Food or any form of bakery program when dieting. It might push you over the edge and cause you to say, ‘F**k it, let’s eat!’

• Increase your protein, and fiber intake when dieting to keep hunger under control.

• Coffee (pre 5 pm) can help suppress appetite.

• Master your insulin dosing. Be mindful that a hypo will require you to eat. Keep your food environment in mind and do your best to consume straight sources of glucose rather than cakes and crisps which contain a lot of excess calories.

• Sugar-free jelly is ultra-low in calories and provides a temporary fill me up.

• You can also use the good old diabetes excuse and tell people that junk food doesn’t have a place in your diet. Obviously, make sure your friends and family know what a hypo is and what foods are best to treat it.

There are many other strategies you can use, but these are great examples.

While you are here, make sure to check out the Diabetic Shred Guide a 112-day fat loss system for men and women living with diabetes. It contains everything you need to know about eating, training and living to get lean. You get weekly meal plans tailored to your metabolism and over 50 challenging workouts.

• Insulin and amino acids play an important role in assisting with muscle growth.
• Glucose and amino acids are both insulinogenic and have the potential to increase blood glucose.
• When glucose and amino acids are consumed together they require more insulin, than if consumed alone.
• Adequate medication must be given to accommodate the blood glucose increasing effects of these two macronutrients.
• Hyperglycaemia is highly detrimental to muscle protein synthesis.
• Besides focusing on carbs and protein alone, it’s important to see the bigger picture and consider all the other important factors that influence rate of muscle growth, of which there are many.

What you’re in for?

• 600 Words
• Reading Time ~ 8 minutes

  SHOULD TYPE 1 DIABETICS EAT CARBS AND PROTEIN TOGETHER IN AN ATTEMPT TO BUILD MORE MUSCLE?

Insulin is considered an anabolic (constructive) hormone. When protein is consumed the B-cells of the pancreas secrete insulin to shuttle amino acids into cells for anabolism. Insulin has been shown to play a role in the creation of new proteins across the body as well as inhibiting muscle protein breakdown ¹.

All the amino acids that make up protein impact insulin secretion differently. Certain amino acids are more potent at stimulating insulin secretion than others, especially leucine ². This explains why whey protein, one of the richest sources of leucine, increases insulin secretion more than any other protein source ³ , and, why the food insulin index considers the insulin requirement for foods as a whole (inc. protein and fat) rather than just their carbohydrate content ⁴.

The synergistic combo of glucose and amino acids signifies a high energy state (compared to one macro nutrient alone) leading to elevated insulin secretion. This is what promotes anabolism, glycogen storage and synthesis of fat tissue (if excess energy is available). Eating protein alone would not yield as much of an insulinogenic or anabolic response compared to a matched meal of protein and carbs.

Besides focusing on carbs and protein alone, it’s important to see the bigger picture and consider all the other important factors that influence rate of muscle growth including, but not limited to,

• Overall diabetes management
• Overall calorie intake
• Body composition
• Stress
• Sleep
• Training frequency
• Progressive overload
• Use of ergogenic aids (PED, Supplements like creatine etc.)
• Other diseases and illness

Should type 1 diabetics pair carbs with protein to maximize protein’s anabolic effect?

The most popular approach to mealtime insulin dosing is counting carbohydrate and applying an insulin to carbohydrates ratio. Most people with type 1 diabetes believe they are only giving insulin for the carbohydrate; however, the insulin dose calculated from the Insulin to carbohydrate ratio actually takes into account the insulin requirement for usual protein portions. Carbs and protein are rarely consumed in isolation. It is much more likely that both macronutrients will accompany each other at mealtimes ⁵.

Provided essential amino acid needs are met across the day, the primary responsibility for someone living with type 1 diabetes is to dose enough exogenous insulin to accommodate any increase in blood glucose.

References

1. K N Frayn and P F Maycock. Regulation of protein metabolism by a physiological concentration of insulin in mouse soleus and extensor digitorum longus muscles. Effects of starvation and scald injury. Biochem J. 1979 Nov 15; 184(2): 323–330. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1161767/
2. Gannon MC, Nuttall FQ. Amino acid ingestion and glucose metabolism–a review. IUBMB Life. 2010 Sep;62(9):660-8. doi: 10.1002/iub.375. https://www.ncbi.nlm.nih.gov/pubmed/20882645
3. Nilsson M, Stenberg M, Frid AH, Holst JJ, Björck IM. Glycemia and insulinemia in healthy subjects after lactose-equivalent meals of milk and other food proteins: the role of plasma amino acids and incretins. The American Journal of Clinical Nutrition. 2004; 80: 1246-53.
4. Bell, K. et al (2016) Algorithms to Improve the Prediction of Postprandial Insulinemia in Response to Common Foods. Nutrients 2016, 8, 210; doi:10.3390/nu8040210
5. Smart CEM, Evans M, O’Connell SM, et al. Both dietary protein and fat increase postprandial glucose excursions in children with type 1 diabetes, and the effect is additive. Diabetes Care 2013;36:3897–3902

It’s imperative to know what diabetes is and the fundamentals of diet, exercise, lifestyle, and medication management. Here are five important points a healthcare or fitness professional should understand before engaging with T1D individuals involved in sport or fitness.

1. High-intensity exercise like weight training can increase blood glucose levels, even without the consumption of carbohydrates. This is a result of counter-regulatory stress hormones that increase in circulation as a result of high-intensity exercise. It is imperative that such increases in blood glucose are anticipated and dealt with.

2. Low-intensity exercise like cardio has the potential to lower blood glucose and cause hypoglycemia.

3. The psychological aspect of managing diabetes is undervalued and not talked about enough. If T1D athletes and fitness enthusiasts were to place a higher value on their diabetes management, they would excel in their fitness or sporting efforts. Poorly managed diabetes will have a highly detrimental effect on muscle building, fat loss, and sporting performance.

4. Whey protein and supplements like caffeine have the potential to increase blood glucose levels and may require insulin.

5. People with diabetes are more susceptible to podiatry problems, which can have implications for exercise program design.

• Women with Diabetes can develop a great looking body, they just need to think differently, and require unique information and support.
• Improving your body is more challenging if you have diabetes. There are many important nutrition considerations.
• The best fat loss and body sculpting diet plan for females with diabetes is the one that fits your lifestyle and isn’t difficult to manage from a diabetes perspective.
• Improving your body involves set periods of eating a calorie surplus and deficit.
• 99% of women looking to lose fat and develop their shape prioritise the wrong things when it comes to diet.
• If you don’t assess your diet you won’t reach your ideal shape.
• You need fewer supplements than you think. Women do well with whey and creatine, and these are valid options for people with diabetes.

What you’re in for?

4,000 Words

Reading Time ~ 22 minutes

Before we begin, let’s get straight with each other why you’re reading this exact article.

You’re a female living with diabetes who wants to look better naked and buy a completely new wardrobe?

You’ve tried to lose weight and get in shape countless times but you still aren’t happy.

No matter how many diets you have tried, you keep asking yourself,

‘What do I need to eat?’

‘How much do I need to eat?’

‘Am I allowed to eat this? Am I allowed to eat that?’

‘What should I do for this night out I have coming up, will my diet fail?’

‘Why am I constantly hungry?’

‘Is diabetes the reason I’m struggling to lose weight and get in shape?’

‘Dieting downright sucks and I have no hope of building a body that men will bow down to.’

Ok, Stop.

Panic over.

If you have struggled to find decent diet information for creating a better-looking body with diabetes, you’ve come to the right place.

This article is grounded on ten years of academic learning, 1000s of blood glucose tests, 1000s of hours in the gym and over 700 client transformations.

You will learn many new things and discover various aspects you haven’t considered before. You’ll walk away equipped with the right knowledge to make massive changes and create the body you always desired.

I’m all for creating a great looking body as fast as possible. However, to achieve this, your diet MUST be set up correctly.

There is a fine line between…

• Eating too much vs. eating too little.
• Taking too much insulin vs. taking too little.
• Training too much vs. training too little.

Overlook one detail and you run the risk of burning out, losing shape, gaining waist inches and looking the same (or worse) from year to year.

Sound familiar?

Let’s look at how we can fix it.

In order to build a great looking body, you’ll need to build muscle and lose body fat.

Nutrition, in conjunction with a well-structured training program and dedicated periods of rest are essential in every woman’s journey to creating the perfect looking body.

This article focuses on the nutritional aspect of developing a great looking body.  If you want to learn more about the training, make sure you read this article after.

___

The diabetic body is governed by a different set of rules and requires a much more tactful approach to diet than would be advised by the mainstream fitness media or your local gym hero.

___

Let’s look at the challenges females with diabetes face in their quest to build a better-looking body.

• Increased levels of muscle protein breakdown.
• Reduced strength.
• Decreased joint and muscle mobility due to glycation.
• Increased potential for injury.
• Increased fatigue.

These challenges are real.

However, they only become a serious problem to creating a great body when blood glucose levels are not controlled. You can safely say diabetes is not an advantage, BUT, with the right knowledge, plans and guidance, diabetes DOES NOT have to be a disadvantage.

The more you know about diet, the better you will control your blood glucose levels.

GETTING STARTED:

THE BODY SCULPTING DIET PLAN FOR FEMALES WITH DIABETES.

When it comes to creating your own diabetic fat loss diet plan a number of factors need to be considered. Some are more important than others and must take priority. It’s easy to get excited and place more attention on the small details like the newest supplement, diabetic special food or the best time to consume your whey protein, rather than prioritizing the more important (yet sometimes boring) aspects like the ‘WHY’ behind eating better, overall, calorie intake or diabetes management.

THE DIABETIC MUSCLE AND FITNESS NUTRITION PYRAMID

The Diabetic Muscle and Fitness Nutrition Pyramid (pictured below) outlines all the nutritional aspects of building a successful fat loss diet for females living with diabetes. The most important factors are at the bottom and the least important factors are at the top.

Structure your nutrition like this and you can guarantee high-quality results.

This is the exact hierarchy of importance I have incorporated into my 112-Day Female Focused Fat Loss Transformation Guide for Females. 

1. PERSONAL VALUES FOR HEALTH AND FITNESS.

Your personal values for health and fitness are your WHY behind your HOW TO.

Find as many reasons as you can to support why improving your diet will enhance the quality of your life. These answers are the driving force behind your daily attitude and actions.

Confidence, better sex, tastier fashion, job opportunity, and improved quality of life are all obvious benefits of losing fat.

2. DIABETES MANAGEMENT.

Even if a diet is comprised of the best quality and freshest food or most expensive supplements on the planet, poorly controlled diabetes can predispose individuals to malnutrition, a condition where the cells of the body cannot utilise fuel properly.

Malnutrition resulting from poorly uncontrolled diabetes adversely affects body function, well-being, predisposes individuals to disease and delays recovery from illness.

Your diabetes must be exceptionally well controlled in order to reap the full benefits of healthy eating.

3. ADHERENCE.

Whether your goal is to shred pounds of body fat, create a perfect body shape or maintain body weight, your diet plan must be able to accommodate social occasions, days off, and the odd slice of pizza when you fancy it. Yes, a diabetic just said pizza.

The best body sculpting diet plans for females with diabetes incorporate a little give and take. If set up correctly, the total number of calories you consume will allow you to achieve your goal without restricting the foods you love.

Eating ‘clean’ doesn’t mean you’re doing things optimally. This is especially true if you find yourself craving the foods and macronutrients you restricted.

What good is a diet that drives you crazy?

You’ll struggle to get results, never mind maintain them.

Besides being ultra consistent with your calorie intake and essential nutrient targets, the secret to developing a better-looking body is eating a diet you enjoy. Adherence is everything. This viewpoint is also supported by the Journal of the American Medical Association who researched pretty much every fat loss diet on the planet and found ‘adherence’ was the most significant factor behind a diet’s success ⁹.

How many massively restrictive diets have you started, only to stop once your burst of enthusiasm has been replaced by pure monotony? Time to re-think things?

As for training. It’s only the fun part.

I take dietary adherence seriously. I’ve even incorporated detailed instructions and principles on how you can eat the foods you love, and still get in amazing shape in my breakthrough fat loss diet and training guide for females living with diabetes. 

Forget overly restrictive, dull, boring chicken, broccoli and rice diets, carb cycling, detoxes and super expensive supplements.

Focus on sustainability and killer consistency.

Once you’ve identified the goal of fat loss you will need set yourself a time frame, measure your progress and get accountable.

1. SET A TIME FRAME

You need to set yourself an adequate time frame for getting in shape.

How long will depend on how much progress you want to make.

There is a huge difference between,

• Losing 10lbs of fat vs. 100lbs

While developing a great looking physique takes years, generally speaking, 16 weeks is enough time to make significant body transformation changes. This is the exact length of Diabetic Shred – the breakthrough fat loss diet and training plan for women with diabetes.

2. MEASURE YOUR PROGRESS

If you aren’t assessing you’re just guessing.

To get the most out of your body sculpting diet plan, you must learn to evaluate and measure your food intake.

“Tracking food may seem like a mundane task”

Think again, tracking allows you to build portion control habits, and eat more flexibly in relation to your body transformation goals.

Fat loss requires eating less than you burn off. Overeating will hinder your fat loss efforts, while under eating will increase your chances of muscle loss and fatigue.

Far too often people blindly drop their calories and increase their training when there is no need. You must adjust when the time is right. How will you know? Tracking of course!

Having worked with 100s of females in the pursuit of getting a great looking body, I know too well how confusing it can be when it comes to making decisions about when to cut calories and where from. I paid great attention to this dilemma when developing Diabetic Shred.

The plateau is usually the time when people give up on their goals. Diabetic Shred outlines a crystal clear decision process for when and where to adjust your calories, once you hit a plateau.

Having a clear set of questions and actions like this saves hassle, gets better results, and most importantly keeps you progressing not quitting!

3. GET ACCOUNTABLE

To get the most out of your body sculpting diet plan, you must get accountable.

Hiring a coach or personal trainer with a proven track record who understands diabetes management will be worth its weight in gold, especially if it is your first time getting serious.

A good coach will give you that much-needed push during training, along with good honest critical feedback on your development and shape.

Now let’s get into the nitty gritty of nutrition and talk calories, carbs, protein, dietary fat and supplements.

4. Energy Balance

The first place to start when building your diet plan is calories.

Calories play a crucial role in everyone’s attempts to get a great looking body¹.

If your goal is to lose body fat or develop your shape, you must first establish how many calories you need to maintain your current bodyweight, and then work from there.

How do I work out my maintenance calories?

Record your body weight and calorie consumption over 14 days. Total the values up and divide each of them by 14 to get your fortnightly calorie and body weight average. Compare this value to your starting body weight…

• If your body weight has gone up, this indicates a calorie surplus.
• If your body weight has gone down, this indicates a calorie deficit.
• If your body weight has remained the same, this indicates maintenance calories.

Oh, and if the idea of weighing yourself seems daunting, here are some useful tips on how to weigh yourself properly.

Another way to calculate maintenance calories is by using a calorie calculation.

These aren’t 100% bulletproof, but they do get you on the right path.

Once you’ve established a maintenance level of calories, you’ll need to adjust it to your goal.

Generally speaking, for fat Loss – eat slightly fewer calories than you need to maintain your body weight.

 5. MACRONUTRIENTS.

Everyone gets confused about macros. It’s no surprise considering the vast amount of conflicting and over-complicated information found online and in the papers.

Low carb,

High carb,

High fat,

Low fat.

Which macro split is best for diabetes?

Here’s what you need to know about macros…

Certain macro nutrients are essential, others not.

Protein and the essential fatty acids (Omega-3 and Omega-6) need to be consumed via the diet.

Carbohydrates and other forms of fat are non-essential as the body can produce them by itself.

The best diet contains all the macronutrients in the right amounts specific to your overall calorie goal for fat loss, shape development or body weight maintenance.

What ratio of macronutrients you decide to eat is largely down to personal preference once you have met your essential needs for protein, essential fatty acids and carbohydrates for hypo treatment/prevention purposes.

How much protein do I need?

To keep it simple, 1.4-2.0g per Kg (0.6-1.0g per lb) of protein for the majority of people reading this.

In other words, if you weigh 67kg (147lb) you would consume 90-150g of protein per day. Split equally over 3-5 servings of 20-40g each day.

How much fat do I need?

Generally speaking, consuming 20-30% of your calories from fat is a great place to start. You might consume different amounts each day. However, over a period of weeks/months – they should average out.

In respect to your overall fat intake, certain types of dietary fat are essential, others not.

Omega-3s are essential long-chain polyunsaturated fatty acids that need to be supplied through the diet

There are three types of omega-3s involved in human physiology: ALA, EPA & DHA. Predominantly of marine origin, EPA and DHA are better than ALA found in plant oils, due to their greater bioavailability ^2,3.

Consuming fatty fish and fish oil supplements has been shown to improve dozens of aspects of health and disease, including insulin sensitivity, blood lipids, depression, inflammation and blood pressure, to name a few ^2,3,4,5,6.

Taking the different government and health organisations’ recommendations into account, 1-3 g of combined EPA-DHA per day suffices. The upper dose of 3g would be more suitable for people with diabetes due to the predisposition of a high triglyceride level and elevated blood pressure.

1 gram of fish oil is the equivalent to around 3 fish oil capsules per day or three to four 112g portions per week of oily fish like salmon, mackerel or sardines.

You’ll want to check how much Omega 3 you can take with your health care professional if you’re taking blood thinning medication.

How many carbs do I need?

Carbohydrate should make up the remainder of your calorie intake once you have calculated your calorie intake for protein and fat. The more carbs you eat, the less fat you’ll eat, and vice versa. The more dietary fat you eat, the fewer carbs you’ll consume.

Think of carbohydrate as a performance fuel, not a recovery fuel. The more training you do, the more you’ll need.

Do I need to go low carb if I live with diabetes?

Not necessarily.

If you are highly active and strength train 3-6 times per week, carbohydrates will help fuel your exercise performance and provide your body with a better training stimulus.

The fibre aspect of carbohydrates has also been shown to play a key role in the health of our microbiome, which has now been repeatedly shown to play a key role in body weight management ^7,8.

Carbs provide a range of different vitamins and minerals. They also taste great and help with dietary adherence.

Provided you manage your blood glucose levels and account for the calories you consume from carbohydrate, there is no reason to exclude them. On a side note, you must account for the carbohydrate calories you use to treat hypoglycaemia. This may vary from day to day.

If you”re like most women with diabetes, trying to figure all this out can get pretty overwhelming. One of the easiest ways to overcome this is to follow simple recipe plans. That’s why I created the Ultra Lean Diabetic Cookbook – it’s jam packed with 100 delicious diabetic friendly recipes. All the calories and macronutrients are outlined for you – they even come with a Myfitness pal barcode for easy food tracking.

6. NUTRIENT TIMING

Nutrient timing is more important for people with diabetes, especially when it comes to preventing/treating hypoglycaemia or preventing hyperglycaemia.

Refer to the infographic below and review when nutrient timing is Very Important, Worth Considering and Not Important. It’s the perfect size for Instagram, so please do feel free to share on social media (remember to tag us)

Getting your nutrition timed right has favourable effects on body composition, mood, and diabetes management. However, it should never be prioritised over the more important levels of the pyramid such as energy balance and macro nutrients.

A prime example of this would be the ‘no carbs after 6 dogma.’

In terms of meal frequency, 2-4 meals for fat loss and 3-5 if developing shape.

7. MICRONUTRIENTS/FIBER/WATER.

The topic of micro-nutrition may sound mind-numbing but you can’t overlook it.

Long-term micronutrient deficiencies will have a detrimental impact on your health and ability to perform/recover optimally from your training efforts.

Micronutrient deficiencies can result from prolonged period of low-calorie dieting and poorly controlled diabetes. A varied diet is a great way to get a range of micronutrients in

If you have any problems with energy levels, hunger, skin, or problems sleeping, you might be short of a few vitamins or minerals. Rather than assuming, the best way to check for micronutrient deficiencies is by getting a blood test done.

Fiber Intake

First of all, it is worth noting fiber is not an essential nutrient.

1. It makes you feel fuller (helps with fat loss)
2. Slows gastric emptying and nutrient absorption (can help with blood glucose management)
3. Decreases blood cholesterol
4. Decreases mineral absorption
5. Provides food for the bacteria in our guts which are shown to play a massive role in health and obesity prevention.
6. Helps you go to the toilet.

High-fiber foods like fruits and vegetables contain lots of other nutrients (vitamins and minerals) that are important to health.

If your fiber intake is low, don’t start ploughing it down. The body, particularly the bacteria within your gut need a little time to adapt. Otherwise, you’ll be pretty bloated and be blowing a lot of gas.

Provided you don’t suffer from IBS or any other serious bowel condition, 30-40g of fiber is a great target to shoot for daily.

Water Intake

Water is important for all things health, muscle building and exercise performance. There isn’t really a fixed water goal you should work to, per say, as hydration needs vary widely with body weight, sweat rates and frequency of hyperglycaemia.

Generally speaking,

• Aim for at least 5 clear urinations a day.
• Make sure you’re not dehydrated before training.
• Hydrate yourself well both during and after hyperglycaemia.
• Your hydration needs will increase if you are using the likes of creatine.

  8. SUPPLEMENTS.

When it comes to supplements, let’s get five things straight.

1. Supplements are the least important part of the nutrition pyramid.
2. Supplements can be a great nutritional insurance to someone living with diabetes. However, they will not mop up the damage caused by poorly controlled diabetes.
3. Supplements are a healthy addition to a good diet plan, but they will not make up for a poor one.
4. Generally speaking, supplements are not needed. Unless you don’t eat oily fish or natural sources of omega 3.
5. Supplements are never to be seen as shortcuts.

What supplements do I need?

Generally speaking, protein powder is a convenient easily digested source of high-quality protein, creatine along with caffeine are useful for boosting strength and cognition, Vitamin D is good for health if you live in a dull climate, fish oil seems to improve many elements of health – which makes all of these a worthwhile investment.

Since I consider the subject of supplements such a non-important topic, I’ll cover them in greater detail in a separate article, as I don’t want them distracting from the more important parts of this article.

In fact, I guarantee some people will have skipped everything I’ve said up until now. If you have – go back and start afresh.

If you’ve read the whole way up until here. Great!

Respect the hierarchy of importance for each element outlined in the Diabetic Muscle and Fitness nutrition pyramid, get focused on creating healthy habits over the long term, assessing your progress and just eat real food.

TAKE HOME

Before you pay for another month of gym membership ladies please consider these key principles for losing fat with diabetes.

• Proper female fat loss nutrition is about understanding how to eat healthily and sustainably towards your goals. All diet plans work (for a while), use them as a template from which you can adjust according to your results and personal circumstances.

• Never hop from diet to diet. It’s best to measure progress after about 2 to 4 weeks and then continually adjust.

• The ultimate nutritional approach to sculpt a great body will always be calorie controlled and nutrient dense, along with a diet that supports exercise performance and recovery.

• To get the best possible results your diabetes must be extremely well-managed through regular blood glucose testing and appropriate amounts of medication. This is essential for the proper absorption and metabolism of nutrients from food.

Since you have made it to the end of this blog, you are obviously serious about losing fat and building a new wardrobe (ha).

I hope you take action on what you’ve learnt!

If the idea of building your own diet and training seems too daunting for you,

here’s an 85% off coupon for what many diabetic women have coined the world’s Best Female Diabetic Body Transformation Diet and Training Plan.

Everything is done for you!

Join over 3500+ women who are currently following the plan and creating a better body and life for themselves.

The best thing about it?

It only costs a fraction of a typical 1-hour personal training session. You get 112 days’ worth of first class diet and training content that isn’t available anywhere else in the world, bar here!

IF YOUR GOAL IS FAT LOSS GET DIABETIC SHRED

REFERENCES

1. The poor, misunderstood calorie: calories proper: Volume 1 Lagakos Ph.D., Dr. William
2. https://www.ncbi.nlm.nih.gov/pubmed/28289069
3. https://www.ncbi.nlm.nih.gov/pubmed/23794360
4. https://www.ncbi.nlm.nih.gov/pubmed/25278765
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4013121/
6. https://www.ncbi.nlm.nih.gov/pubmed/24117792
7. Le Chatelier, T. Nielsen, J. Qin, E. Prifti, F. Hildebrand, G. Falony, et al. Richness of human gut microbiome correlates with metabolic markers Nature, 500 (2013), pp. 541-546.
8. -P. Furet, L.-C. Kong, J. Tap, C. Poitou, A. Basdevant, J.-L. Bouillot, et al. Differential adaptation of human gut microbiota to bariatric surgery-induced weight loss: links with
9. Pagoto, Sherry L, Appelhans, Bradley M. A. Call for an End to the Diet Debates

If you’re into health and fitness you will have heard of Intermittent fasting at some point.

Intermittent fasting is a dieting strategy used by athletes, celebrities, and high performance entrepreneurs to improve health, body composition and mental clarity.

Like any diet, intermittent fasting works as long as you can sustain it.

The concept behind intermittent fasting is simple.

It involves,

• Periodic bouts of fasting (i.e. going without food and calorie dense drinks)
• Which leads to reduced meal frequency and a smaller time frame to eat.
• This gives the dieter an opportunity to eat larger, more filling and satisfying meals in the specific limited time window.
• Since you can only eat so much at one meal, fewer calories are consumed.
• This helps prevent fat gain and speeds fat loss (provided your calories are set at the right point) – for how to set your calorie baseline read here for men and for women here.
• Eating windows can range from 4-12 hours – it all depends on which strategy suits you best (I cover all the different IF strategies inside the members’ site)
• The fasting periods increase counter regulatory hormones that liberate fuel for body stores for energy and also suppress appetite (win-win for fat loss)

…But, what about people with diabetes?

Q. Does it work for us?

Q. Is it dangerous?

Q. How do you manage insulin and blood glucose levels when you fast for hours?

I discuss all of these questions and more in a personal video blog I recorded in Barcelona City earlier this year.

Enjoy.

PS. For those of you who are control freaks about saturated fat and carbs in the diets of people with diabetes, please do your homework and consider my context is different to yours.

Quick Summary 

• The more emotionally attached you are to your health and fitness goals, the clearer they’ll be and the greater you’ll value them.
• Lifting weights to look better is a sound reason to get started, as the health benefits always come as a byproduct.
• Increased muscle mass can help reduce diabetes medication needs and improve blood glucose control.
• You should never go into a set completely shattered. Each set needs to be quality.
• It doesn’t matter how good your training program is: if you don’t control your blood glucose levels, you’ll never build the body you desire.
• Each session should provide the body with a different training stimulus.
• Rest is equally as important as the training itself.
• A professional coach is worth their weight in gold.

What you’re in for?

4,000 Words

Reading Time ~ 26 minutes

HOW TO SET UP A WEIGHT LIFTING PLAN FOR DIABETES

We get all sorts of visitors on DiabeticMuscleandFitness.com: both men and women, ranging from the everyday gym goer to professional bodybuilders with diabetes, sports athletes right through to newly diagnosed teens who haven’t an ounce of muscle to their name.

If the idea of building muscle, getting stronger and improving whole body definition sounds good to you, then you’re in the right place.

The training information I am about to share with you is grounded on the latest exercise science, thousands of gym sessions and countless hours coaching people with diabetes of all shapes and sizes.

Let’s get started.

Weight Training and Diabetes 101

Weight training, also known as resistance, body weight or strength training is one of the most beneficial forms of exercise you can perform, especially if you live with diabetes.

When performed properly, weight training delivers a host of health benefits including,

1. Increased physical strength.
2. Denser, stronger bones.
3. Increased metabolic rate at rest (allows you to eat more calories, whilst staying lean)
4. It burns body fat and helps prevent obesity.
5. Releases key endorphins that make you feel great.
6. Improves balance and coordination.
7. It can protect against sarcopenia (age-related muscle loss)
8. Increased glucose uptake (it can help manage diabetes)
9. Improved blood lipids.
10. Plus, looking jacked and toned in your favourite clothes feels great!

In this article, I want to discuss the most important principles for building a highly effective weight training program for people living with diabetes, whose goal is to build muscle and simply look better naked.

If you are a typical reader of fitness magazines like Muscle and Fitness, Men’s Health, Women’s Health and Oxygen, this article is for you.

What this article is not.

This article does not focus on the goal of building maximum strength for sports like powerlifting and Olympic lifting. I will cover these specific training goals in another article.

Let’s get started…

The Diabetic Muscle and Fitness Training Pyramid.

The Diabetic Muscle and Fitness Training Pyramid outlines all the most important variables that make up a successful weight training program in order of importance. Similar to nutrition, many people prioritize the wrong stuff like what is the best exercise for arms over more important stuff like sets, reps, weight used on the bar and personal values for health and fitness (the driving force).

Let’s run through each aspect of the pyramid and highlight everything you need to know when it comes to getting the most out of strength training with diabetes.

Feel free to download the pyramids and upload them onto your social media if you wish. It’s important other people living with diabetes see these. If you’re using a PC right click and ‘Save As’. If you are using a mobile, hold your index finger down and saving the image.

Also, (if you haven’t already) get signed up to my insiders’ mailing list. You don’t want to miss an update. Strength training science is constantly evolving. I’ll keep you in the loop with anything worth knowing. So sign up and don’t miss a thing.

THE MOST IMPORTANT ELEMENTS OF SETTING UP A WEIGHT TRAINING PLAN IF YOU LIVE WITH DIABETES ARE…

1. PERSONAL VALUES FOR HEALTH AND FITNESS.

Change your mindset, before you change your behaviour.

Why are you thinking of getting more muscular and healthy?

The more value you see in your health and fitness goals, the more attention you’ll give them. This is why personal values for health and fitness are the most important aspect of the Diabetic Muscle and Fitness Training Pyramid.

If you want to get the most out of strength training you need to identify how it will benefit your life. For most people, the idea of looking better is more important than health.

Girls, you’ll probably see more value in building a great shaped butt, tight core and strong defined legs over improving your bone density.

Guys, you’ll value a well-cut 6-pack, jacked arms and 300lbs bench with more than improved glucose uptake.

Lifting weights to look better is a sound reason to get started, as the health benefits always come as a byproduct.

The more you value something in life, the more energy and focus you’ll put into it. This is your WHY.

Check out these examples of WHY people value strength training.

• I’ll look better naked.
• Have better sex.
• Have more confidence.
• Be able to wear nicer clothes.
• Physical Strength and Fitness.
• Both physical fitness and a great looking body are signs of self-respect and care.
• Working out feels amazing and lets me clear my head.
• Being strong will help me protect myself.
• Lifting weights allows me to eat more food, (if you follow my insta stories you’ll know I love food. 🙂
• Increased muscle mass lowers my insulin needs – it literally resembles a vacuum for glucose.

Setting Realistic Goals Is Important.

Goal setting is a powerful process for mind and body. Clear goals provide you with direction and motivation to turn your vision into a reality.

However, there is a big difference between positive and realistic goal setting.

What is your goal, is it realistic?

Positive goal setting is like flicking ‘Beast Mode ON’ and thinking you’re going to be Arnold Schwarzenegger in 6 months or Monica Brant after you finish your newest tub of pre-workout.

So many of us fall prey to this mode of thinking. They spend so much time scrolling through Instagram and Facebook comparing incredibly jacked and ripped guys and girls on Instagram, thinking to themselves,

‘I’m going to look like that!’

The problem is, not many people come to terms with the backstory to their favourite fitness photos on Instagram.

• Genetics (different parents, ethnicities).
• Years of training experience.
• Expert coaching and mentorship.
• Use of anabolic steroids.
• More free time (giving them the ability to train multiple times a day).
• No kids to keep them up at night.
• The list is endless…

Be realistic when setting your training goals.

Be original, define YOUR own personal success criteria, do not borrow those belonging to an individual whose life bears no resemblance to yours.

Stay focused and make the best of your own unique circumstances, rather than comparing yourself to everyone else, especially the pro fitness models and bodybuilders who have been at it a lot longer than you.  The acronym S.M.A.R.T is a great framework to base your goals off.

Every time you set a goal, ask yourself, is it…

S –  Specific, Significant, Stretching

M – Measurable, Meaningful, Motivational

A – Attainable, achievable

R – Realistic

T– Time-Based

The best way to set a training goal is to acknowledge;

• How you don’t want to look and feel.
• How you want to look and feel in your new body.

You need to get very specific.

Ask the right questions and you’ll come up with great answers.

• How lean do I want to be?
• How muscular do I want to be?
• How strong do I want to be?
• How do I want feel?

Goals will differ from person to person. Some people will want to look better for the beach, while others will want to look like a hardcore bodybuilding monster.

Once you visualise how you want to look, hold that image in your head and think about it constantly.

So, how do you look? It’s not that far away.

Now we have goal setting and motivation out of the way, let’s look at the fundamental building blocks that make up a highly effective diabetes weight training program.

The Diabetic Muscle and Fitness Training Pyramid outlines all the key elements of strength training program design in order of importance. Too many people prioritise the wrong stuff, like the best exercise to do, or the best weightlifting belt to buy over the much more important stuff like managing blood glucose levels around exercise, adequate training volume and sufficient rest.

We’ve already covered the most important element of the pyramid ‘Personal Values for Health and Fitness’. Now, let’s discuss the other factors and their role in building a successful strength training plan for diabetes.

2. DIABETES MANAGEMENT.

It doesn’t matter how good your training program is, if you don’t control your blood glucose levels, you’ll never build the body you desire. One of the most important take-homes people have when reading my best-selling book, The Diabetic Muscle and Fitness Guide is this:

‘OBSESS OVER PERFECT BLOOD GLUCOSE CONTROL 24/7 – 365 DAYS A YEAR.’

While looking after your diabetes may seem obvious, not many people do it (well).

How dedicated are you to perfecting your control?

What does good diabetes control look like to you?

1. Do you check your blood glucose levels regularly?
2. Do you correct high blood glucose ASAP?
3. Do you question ‘WHY’ your blood glucose levels go outside range, and get to the root of the problem?

Call it obsessed, but some of us want to get more out of training and live longer.

Poor blood sugar control (both short and long term) is the enemy to building a better looking and feeling body.

We live in an age with breakthrough diabetes management tools. There has been no better time to have diabetes. Recognise this reality and make the most of what is on offer.

Dedicate your life to chasing perfect control. Get as close to normal (nondiabetic) A1C levels as you can. Your dedication will pay off.

I’ve also covered a tonne of information on the effects different types of exercise have on blood sugar levels and diabetes in my book The Diabetic Muscle and Fitness Guide.

3. TRAINING ADHERENCE.

The term fitness is defined as, ‘the ability to do a task.’

You may be fit enough for one training program, but not another.

Before you consider exercises, sets, reps and how much weight to use, you must ascertain the following key factors:

• What is the maximum number of days you can train per week?
• How much time can you spend training per session?
• What is your training experience? Do you know your exercises?
• What is your current fitness level?

These factors determine how much training you can handle.

Have you ever jumped into a hardcore program without considering what’s best for you? How did that end up?

If you’re new to training, you’ll lack the basic strength and physical fitness to handle high levels of work. You will get a lot out of a little. Less is more. The great thing is, you will progress quickly and will be hungry for more.

If you are thinking of following the training plans of professional athletes, fitness superstars or pro bodybuilders – be warned! These people are fitter than you, and most likely have more resources in their corner including genetics, supplements, more free time and a coach.

If you have a decent level of experience and strength base, you’ll be able to handle more training. However, it still needs to be manageable from a time and recovery perspective.

This is especially true if you’ve taken time out from training, because of injury or needing a mental break. You’ll not be fit enough to jump back into your old ways of training. You’ll need adequate time to get back in and adapt yourself.

YOU SHOULD NEVER LEAVE THE GYM SICK, IN PAIN, ABSOLUTELY SMASHED or asking yourself, ‘Why am I doing this?’.

Focus on leaving the gym tired, stimulated and challenged.

LEAVE SOME FUEL IN THE TANK FOR THE REST OF YOUR DAY.

So many people hold the misconceived notion that a workout must leave absolutely f***ked. If it doesn’t they automatically assume they haven’t worked hard enough.

This way of thinking isn’t smart.

What good is a workout program that burns you out physically and mentally?

There is a fine line between too much, too little and just enough. Your workouts need to be challenging and enjoyable at the same time. This is much more sustainable and you’ll reap far better results.

Follow a training program that stimulates, not annihilates.

Have an intro week, test how certain exercises feel and how well you recover from set number of training sessions.

Your strength training program should keep you healthy and yield long-term progress rather than burn you out, cause injuries and drive you to resent training.

How Long Do I Need to Train For?

Would you say you are a beginner, intermediate or pro?

This is highly dependent on your personal agenda and lifestyle. If you perform other forms of exercise like football, yoga etc. or work a very heavy laboursome job you will need to be mindful of doing too much and cap training sessions at 2-3 times per week.

As an example, let’s assume you were dedicating all your exercise time to weight training. You training frequency would look like this:

Beginners: 30 mins of strength training x3-4 times per week for the first 3-6 months.

Intermediate: 30-60 mins of strength training x5-8 times per week.

Pro: Sports Specific -30-60 mins of strength training x5-10 times per week.

You also need to consider fitting training around your family. One of the most valuable things you can do is introduce them to exercise, especially loaded movement.

There’s nothing stopping you taking time out to show your partner or kids a few simple exercises like body weight squats or weighted carries. If you have really young kids, just get them moving and playing – embracing the full range of human movement.

Why not make it a family ritual to train together one day every week? You can get a tonne of training done with just bodyweight alone.

4. TRAINING VOLUME AND FREQUENCY.

Training volume is defined as the amount of sets x reps you perform over time for a given body part or movement, in other words, the total amount of work you do.

As a general rule of thumb, your training volume should increase over time.

However, this doesn’t mean you should continually add sets and reps in an endless fashion.