Diabetes 102

https://optimisingnutrition.wordpress.com/2015/03/22/diabetes-102/

I found this data useful to calibrate target blood sugar.  

I would be interested in your thoughts.

Good to see some decent optimal BG levels. NHS & DAFNE advocate levels dangerously high in my opinion. I have been told twice that my HbA1C is too low ! Crazy ! Thanks for link Marty.

Hi Marty

I have had a very quick look at your blog and am extremely impressed. I will spend more time tomorrow reading it more fully. This may be a strange question, but what are trying to achieve? Your blog clearly has an end game, rather than being a general blog regarding diabetes or diet etc. Others may see exactly what you are trying to achieve, but at the moment I cannot see it.

As an ex Aerospace Engineer I believe in simplicity. The most simple component that will be fit for purpose. The most reliable and cost effective. Is this making sense, can you see where I am coming from. No disrespect, but if your blog is a guide for the average diabetic, to assist in the gaining of safe control, it seems to me to be very complicated. That being said, that may not be your intention at all.

Hey Loose Cannon

Glad you're impressed.

What am I trying to achieve? Interesting question.

Einstein said, "Make everything as simple as possible, but no simpler."

I'm an engineer and I tend to be a bit convoluted but my end goal is to create a concise usable tool for diabetics to achieve health, but there's a journey to get there.

The first function of the blog is to share my learnings about diabetes. With the insulin index I think I have stumbled across something novel that I think is exciting and worth sharing. However to convince people that it's worth following I need to write it down to get it straight in my head and then to workshop it with others to get their buy in. I want people to understand the system before I ask them to buy into it.

What I'm proposing is a reasonably significant paradigm shift in diabetes management from the current standard of care, so to get buy in on that I need to put together something that diabetes and LCHF experts can understand, acknowledge and accept. The manifesto is that treatise on bringing together the concepts of insulin load with nutrient density to create a dietary approach tailored for a person's situation and goals.

I have created some simple lists of optimal foods and I'm creating a list of meals that are optimal for various goals. Once this is all published on the site I think it should also be a 'go to' resource for people to work out what they could eat now that would be good for them.

I hope that in the long run it will be successful at both levels - both the how to and the why.

I would love your feedback and thoughts on how I can achieve that.

Cheers

Marty Kendall
https://optimisingnutrition.wordpress.com/

martykendall wrote:Hey Loose Cannon

Glad you're impressed.  

What am I trying to achieve?  Interesting question.  

Einstein said, "Make everything as simple as possible, but no simpler."

I'm an engineer and I tend to be a bit convoluted but my end goal is to create a concise usable tool for diabetics to achieve health, but there's a journey to get there.  

The first function of the blog is to share my learnings about diabetes.  With the insulin index I think I have stumbled across something novel that I think is exciting and worth sharing.  However to convince people that it's worth following I need to write it down to get it straight in my head and then to workshop it with others to get their buy in.  I want people to understand the system before I ask them to buy into it.  

What I'm proposing is a reasonably significant paradigm shift in diabetes management from the current standard of care, so to get buy in on that I need to put together something that diabetes and LCHF experts can understand, acknowledge and accept.  The manifesto is that treatise on bringing together the concepts of insulin load with nutrient density to create a dietary approach tailored for a person's situation and goals.

I have created some simple lists of optimal foods and I'm creating a list of meals that are optimal for various goals.  Once this is all published on the site I think it should also be a 'go to' resource for people  to work out what they could eat now that would be good for them.  

I hope that in the long run it will be successful at both levels - both the how to and the why.  

I would love your feedback and thoughts on how I can achieve that.  

Cheers

Marty Kendall
https://optimisingnutrition.wordpress.com/

Marty I love what you are trying to achieve, and I hate to be sounding negative, but you said "I hope that in the long run it will be successful at both levels - both the how to and the why." My question at this stage is why? It's almost as if you are trying to re-invent the wheel. Dr.Richard Bernstein (another engineer) had diabetes control fully worked out decades ago. Over the years others have looked at some sort of holy grail to beat the betus, it cannot be done. You must know about the GI index method of rating food, it was trumpeted as the way forward. It does not work and will never work as the video below shows. It was said on this forum recently carb counting is old hat, I believe carb counting will always be the way to sound control.

As I said keep it simple. How simple is this. Imagine explaining why a diabetic should low carb to a bright 5 year old, and I have tried this out on one of my grandchildren. To the questions would you eat food I gave you if it made you ill? obviously no. What about eating this food and taking drugs that could also make you ill, obviously no again. That's the bottom line. Type one diabetics and other diabetics have zero choice when it comes to having to use insulin. Bernstein again has the answers, he calls this the power of small numbers. The less the carbs, the less the insulin, the less the insulin, the great the control and predictability.

Come back to me any time, I am no expert on anything, but take advice from experts and have studied them closely for seven years. I am only to pleased to help you in any way I can. One last point for now, have you checked out Rods master class for type two diabetes control called how to reverse type two diabetes, well worth your time.

Regards Eddie

I think Marty still advocates low carbing ( hence small margin for error ) and is still counting certain foods to enable working out of insulin units. It's not that too far apart from carb counting, just a better way of doing it. Carb counting is a good guess but can get confusing when accompanied by differing amounts of fats and proteins.

mo1905 wrote:I think Marty still advocates low carbing ( hence small margin for error ) and is still counting certain foods to enable working out of insulin units. It's not that too far apart from carb counting, just a better way of doing it. Carb counting is a good guess but can get confusing when accompanied by differing amounts of fats and proteins.

Why is it a better way? this really interests me.

Because for me, simply counting carbs is not accurate enough. If I have for example 20g of carbs, depending what I eat them with will have a bearing on the insulin I will need. This is a separate issue to GI value which only aids me in the timing of the shot. There will never be a system that will be accurate for all but I feel this one takes the simple idea of counting carbs but takes it one step further.

"There will never be a system that will be accurate for all" There will never be a 100% accurate system for anyone, because we are human beings not machines. You know there are so many variables in the control of blood glucose for diabetics. That being said most on here have just about as good as control as most diabetics will ever get. I know people with optimum control 24/7 they are called non diabetics. Because of the myriad of situations that can effect a diabetic, such as a minor infection, stress, lack of sleep, the list goes on. At this moment in time, I fail to see how any index, will achieve better results than what a well controlled diabetic can achieve now.

Seriously Mo, can you give me a full explanation why you think an insulin index will give better control.

I thought I just did ? I fully understand the variables and I'm not saying this is the Holy Grail for diabetics but just counting carbs isn't enough. If I have an omelette for example, Carbs n Cals and DAFNE says 0g carbs so no need to inject. For me this is wrong. I still need some insulin for eggs. This is just another tool to help manage diabetes, albeit still a "work in progress" one.
To turn the argument around then, can you tell me why carb counting alone is better ?

I'm enjoying this discussion. Thanks guys!

Eddie, I'm a big fan of Bernstein's work. A lot of my thinking has been inspired / influenced by being part of the TYPEONEGRIT Facebook group who are a group of Bernstein disciples getting spectacular HbA1cs and flat line CGM traces. You're probably aware that they told Bernstein at the time that there was no value in a diabetic obtaining normal blood sugars.

Bernstein acknowledges that you need to dose insulin for protein (about half as much as carbohydrate) however this hasn't made it into carb counting as generally applied. One of the challenges that I see for a lot of people who have adopted a low carb lifestyle is that their blood sugars are still thrown out of wack by the effect of protein that is not accounted for by simple carbohydrate counting as it currently stands.

Another issue is how to deal with fibre. Some people advocate for a net carbs approach to carb counting while some people believe it's more 'intellectually honest' to not consider the fibre.

In the end it's not about carbs, it's not really about what raises blood sugar and what causes the body to secrete / require insulin. With the ACCORD study we're learning that it's not just high blood sugars that are dangerous, loading up with heaps of extra insulin and diabetes drugs to manage blood sugars is also highly dangerous.

The food insulin index data helps us understand how carbs, protein and fibre affect insulin. The recent studies from the University of Sydney show that, all things being equal, people did actually get better control from using the insulin index calculations compared to standard carb counting.

What I've done is worked out that you can calculate the insulin index and insulin load for every food (without testing it in real people) based on the carbs plus about half the protein minus the fibre. You can then use this to prioritise your food choices based on this or even count the insulin load as you would count carbohydrates if you wanted to go to that effort.

I also some from a Paleo / nutrient density headspace. There has been some good work looking at quantifying nutrient density. One thing I see in the LCHF community is people sometimes sacrificing nutrients for low carb. I think you can have both, or at least prioritise based on your goals. What I've tried to do is bring together the insulin index and nutrient density into a system that highlights optimal foods and meals depending on whether you're after thereaputic ketosis for cancer, blood sugar control, weight loss or you're lucky enough to be a healthy metabolically healthy athlete.

I've created this series of articles for the end user - https://optimisingnutrition.wordpress.com/2015/03/22/articles-2/

The manifesto - https://optimisingnutrition.wordpress.com/manifesto/ - and the blog posts - https://optimisingnutrition.wordpress.com/the-insulin-index/ - go into the theory a little more for those who need more convincing.

There's a simple list of foods here - https://optimisingnutrition.wordpress.com/2015/03/22/cheat-sheets/

And I'm building a list of meals here - https://optimisingnutrition.wordpress.com/2015/03/22/recipes/ - that will contain the carb count, insulin load, fat, protein and fibre counts.

I hope it will be a useful resource. I know this approach has been a real step change for my family.

Cheers

Marty Kendall
https://optimisingnutrition.wordpress.com/

Eddie

I just watched the GI video you posted.

I agree with most of what he's saying. GI and GL is interesting to minimise blood glucose excursions. But you can still have a moderate GI or GL food that still generates a lot of insulin just because it takes a long time to digest.

At the end, the video says that what matters is the total carbohydrate. I would argue that what's more important than the blood sugars or the carbohydrate is the total amount of insulin that the food you eat requires.

I think it's a subtle but important difference.

I believe that by factoring in the effect of protein and fibre on top of carbohydrate counting we can more accurately predict the insulin required by our food and achieve even better health. It may not be for everyone, but I think it might be useful for people who want that extra step change in their health and diabetes control.

Cheers

Marty

"Eddie, I'm a big fan of Bernstein's work. A lot of my thinking has been inspired / influenced by being part of the TYPEONEGRIT Facebook group who are a group of Bernstein disciples getting spectacular HbA1cs and flat line CGM traces. You're probably aware that they told Bernstein at the time that there was no value in a diabetic obtaining normal blood sugars."

"You're probably aware that they told Bernstein at the time that there was no value in a diabetic obtaining normal blood sugars."

That is the most ludicrous statement I have heard in a long time. That being said it's how you achieve non diabetic numbers that is all important . The ACCORD study proved ramming down BG numbers with meds and insulin killed so many the study was abandoned early.

"Bernstein acknowledges that you need to dose insulin for protein (about half as much as carbohydrate) however this hasn't made it into carb counting as generally applied. One of the challenges that I see for a lot of people who have adopted a low carb lifestyle is that their blood sugars are still thrown out of wack by the effect of protein that is not accounted for by simple carbohydrate counting as it currently stands.

All clued up diabetics know protein has to be accounted for in working out insulin regimes.

"Another issue is how to deal with fibre. Some people advocate for a net carbs approach to carb counting while some people believe it's more 'intellectually honest' to not consider the fibre."

Fibre another misnomer dragged out of thin air. No one I know worries about how much fibre they are consuming.

"In the end it's not about carbs, it's not really about what raises blood sugar and what causes the body to secrete / require insulin. With the ACCORD study we're learning that it's not just high blood sugars that are dangerous, loading up with heaps of extra insulin and diabetes drugs to manage blood sugars is also highly dangerous."

Not about carbs, tell me you are pulling my chain. ACCORD already addressed.

"The food insulin index data helps us understand how carbs, protein and fibre affect insulin. The recent studies from the University of Sydney show that, all things being equal, people did actually get better control from using the insulin index calculations compared to standard carb counting."

Can you give us a link to this information please.

"What I've done is worked out that you can calculate the insulin index and insulin load for every food (without testing it in real people) based on the carbs plus about half the protein minus the fibre. You can then use this to prioritise your food choices based on this or even count the insulin load as you would count carbohydrates if you wanted to go to that effort."

"What I've done is worked out that you can calculate the insulin index and insulin load for every food"

Every food? or food groups.

I also some from a Paleo / nutrient density headspace. There has been some good work looking at quantifying nutrient density. One thing I see in the LCHF community is people sometimes sacrificing nutrients for low carb. I think you can have both, or at least prioritise based on your goals. What I've tried to do is bring together the insulin index and nutrient density into a system that highlights optimal foods and meals depending on whether you're after thereaputic ketosis for cancer, blood sugar control, weight loss or you're lucky enough to be a healthy metabolically healthy athlete.

"One thing I see in the LCHF community is people sometimes sacrificing nutrients for low carb."

Not with the foods I promote. I can honestly say I and other who work with me, are on the most highly dense nutrient foods of our lives.

Eddie

> Can you give us a link to this information please.

This is an excellent read. Exciting work. It's by the same group of people that developed the GI. I wonder if they realised the GI doesn't work and are now trying to get to the core of the issue with the insulin index.

See Clinical Application of the Food Insulin Index to Diabetes Mellitus - http://ses.library.usyd.edu.au/handle/2123/11945

Here's the link to Bernstein talking about the ADA's reaction to carb counting at the time her devised it - https://youtu.be/WFNGdKSXx64?t=766. Sounds rediculous now!

> All clued up diabetics know protein has to be accounted for in working out insulin regimes.

But how?

> Fibre another misnomer dragged out of thin air. No one I know worries about how much fibre they are consuming.

The food insulin index data indicates that indigestible fibre does not affect insulin or blood sugar. Sort of makes sense if it is ingestible.

See https://optimisingnutrition.wordpress.com/2015/03/30/what-about-fibre-net-carbs-or-total-carbs/

> Not about carbs, tell me you are pulling my chain. ACCORD already addressed.

I'm saying it's more important to think in terms of insulin than carbs.

ACCORD showed that dosing with heaps of insulin to manage blood sugars is not as good as they thought. Every diabetic who puts on weight because of their insulin regime knows something is not quite right.

> Every food? or food groups.

Every food. See https://optimisingnutrition.wordpress.com/2015/03/23/most-ketogenic-diet-foods/

Thanks for the discussion. I'm enjoying it.

Cheers

Marty Kendall
https://optimisingnutrition.wordpress.com/

Marty I am also enjoying our debate. I will come back to you on your last post soon. Saturday night and all that, and I do love my wine. Would not want to blot my copybook, as others have said I am no diplomat, especially after a bottle of good Rioja.

Have a great night mate, talk again soon.

Bring it! It's good to actually engage with someone meaningfully on the topic. I'm eager for a critical review. The full manifesto at https://optimisingnutrition.wordpress.com/manifesto/ contains all of my thinking if you've got the time to have a look.

Don't know if you've heard of Lisa Scherger who's son is a Type 1 Marty, if not this video is worth a watch.

Thanks Graham. I met Lisa after she gave this talk in Brisbane. She's very inspirational. Very passionate. We've been keeping in contact about my blog (she recently posted it on hers). We've also been talking about dosing for protein during her recent refinements using her new Dexcom toy. See http://diabeticalien.blogspot.com.au/2015/04/preventing-protein-spike.html

Another amazing talk from the day day is from Troy Stapleton. https://www.youtube.com/watch?v=SI5l6NqVYw0

martykendall wrote:Thanks Graham.  I met Lisa after she gave this talk in Brisbane.  She's very inspirational.  Very passionate.  We've been keeping in contact about my blog (she recently posted it on hers).  We've also been talking about dosing for protein during her recent refinements using her new Dexcom toy.  See http://diabeticalien.blogspot.com.au/2015/04/preventing-protein-spike.html

Another amazing talk from the day day is from Troy Stapleton.  https://www.youtube.com/watch?v=SI5l6NqVYw0  

We have featured Troy Stapleton on our blog Marty it's one of the most viewed posts with thousands of hits, our website even gets a mention in his excellent video.

http://thelowcarbdiabetic.blogspot.co.uk/2013/12/drtroy-stapleton-i-manage-my-type-1.html

Troy is my hero. He lives on the Sunshine Coast about an 45min north of me and Lisa live son the Gold Coast about 30 minutes south of Brisbane. Troy was my sister in law's boss as a radiologist at Nabour Hospital. He's lovely and very encouraging. I really like the way he shows photos of real healthy food that is really hard to object too.

Back from the Pub and still semi compos mentis. Do you know what strikes me Marty, how Troy, and Lisa's son and so many other type ones hold non diabetic BG numbers on the old low carb high fat lifestyle. Hard to imagine how they could do better than they do, seems optimal to me.

I was taken aback when you said the Insulin index people, are the same Australian outfit who pushed the low GI index nonsense. I see they turned the GI index malarkey into a commercial enterprise.

"The glycemic index (GI) is not just bad science, it has a dangerous loophole big enough to drive an ice-cream truck through. Its time it went to the place where old (and wrong) public health messages go to die.

Wendy’s Chocollo (with waffle cone), Bulla Light vanilla ice-cream, Nestle Milo, Uncle Toby’s Choc Chip Crunchy Muesli Bar and CSR LoGiCane Sugar all have something in common. Yes, they’d all look pretty good on the dessert menu, but they also share something else. The owners of each of these products (and almost 100 others like them) have paid for the right to display a GI symbol."

Looks to me this outfit will endorse junk for money.

Link to info here http://www.crikey.com.au/2011/07/18/the-glycemic-index-has-passed-its-use-by-date/

A tip for you Marty, always follow the money. BTW, do you have commercial aspirations for your work, just asking. Our Low carb Team work for love, we have turned down advertising revenue for our sites on numerous occasions. We get nothing for the ads displayed on this forum which are seen if you are not running an ad blocker.What do think of our humble website and blogs.

Regards Eddie

To comply with the copyright rules for this abstract of the paper this is for study purposes. From the paper you quoted Marty re. the insulin index.

"The Food Insulin Index (FII) is a novel system of ranking foods based on the insulin response in healthy subjects relative to an isoenergetic reference food. The goal of this thesis was to explore the clinical application of the FII to mealtime insulin dosing in type 1 diabetes.
Carbohydrate counting is the current gold standard method for determining prandial insulin dose in type 1 diabetes, however only 7 studies assessing the efficacy of carbohydrate counting for glycaemic control in people with type 1 diabetes could be identified. Meta-analysis revealed there was no significant improvement in HbA1c with carbohydrate counting over general dietary advice and/or usual care (-0.35%, p = 0.096). This study highlighted the need for research into alternative strategies to improve the accuracy of the mealtime insulin dose.

The FII reveals a notable insulin demand for foods high in protein and fat, nutrients that would normally be disregarded for mealtime insulin dosing with traditional carbohydrate counting. Compared with carbohydrate counting, the FII algorithm was able to reduce mean blood glucose level for six foods high in protein (5.7 +/- 0.2 mmol/L vs 6.5 +/- 0.2 mmol/L, p = 0.003), without significantly increasing the risk of hypoglycaemia (p = 0.155).
In the first randomised, controlled trial of the real-world application of the FII, the FII was at least as good as carbohydrate counting for glycaemic control in 26 adults with type 1 diabetes (HbA1c FII: -0.1 ± 0.1% vs CC: -0.3 ± 0.2%, p = 0.855), with a trend towards reduced risk of hypoglycaemia in the FID counters after 12 weeks.

Collectively, these studies offer exciting insights into the potential of the FII for optimising glycaemic control in type 1 diabetes. Until a cure can be found, the potential for clinically significant enhancements in glycaemic control offer people with diabetes greater wellbeing through a reduced burden of disease and decreased risk of long-term diabetes complications."

First thoughts, oh dear. I can rip it to bits.

Hey Eddie.  Welcome back from the pub.  

> Do you know what strikes me Marty, how Troy, and Lisa's son and so many other type ones hold non diabetic BG numbers on the old low carb high fat lifestyle. Hard to imagine how they could do better than they do, seems optimal to me.

Troy and Lisa have both read my doc and have provided positive feedback.   See https://optimisingnutrition.wordpress.com/feedback/

The other thing to remember about Troy and Lisa's son Daniel is that they are both newly minted type 1s who to some extent are still in the honeymoon period (I've talked to Troy about this).  As time goes on and you punish your pancreas with carbage the luxury of any background insulin from your own pancreas goes away.  For my wife who has had diabetes for nearly three decades it seems that any pancreatic function is long gone and it takes a bit more effort.  

> Looks to me this outfit will endorse junk for money.

I'm not endorsing Sydney University's work, but I do think the insulin index is some interesting data.  I would be interested in your views on the thesis that I sent you the link to and my manifesto document which sets out the system.  See https://optimisingnutrition.wordpress.com/manifesto/

> BTW, do you have commercial aspirations for your work, just asking.

I've been puddling around in the nutrition headspace for a while with moderate success.  Applying this approach has been a breakthrough for my and my family.  I prepared the manifesto document to work it through in my head and get some real feedback on my thoughts.  And then once you've put some time into preparing something you hope that someone will read it and perhaps others will benefit from it.  

My blog is hosted on WordPress for nothing and I get a good income from my day job as an engineer.  Plus, how do you monetise telling people to eat healthy food without a bar code?  I'm getting 250 visitors per day and if you converted that to 1c per person it wouldn't buy me a coffee a day from advertising revenue!  

I look forward to hearing from you once you've read some more of the detail on the blog or the manifesto.  I would honesty appreciate feedback on the content that I'm putting out there.  

Cheers

Marty Kendall
https://optimisingnutrition.wordpress.com/

Marty I'm turning in for the night. I reckon we can learn from each other, and there is nothing I enjoy more than a good debate. But before I go, I will leave you with this thought.

You have stated on your blog your Wife struggled for years with her diabetes. Thankfully she now has it under control and turned her life around. People would love to know how this was achieved. I will stick my neck our here and say, I bet she followed medical professionals advice and run a carb up and shoot up regime. I'll go further, I bet her good control was achieved with a drastic reduction in carbs and replaced the lost calories with high quality natural fats.

Talk again soon. The best of luck and health to you and yours.

Eddie

Hi Marty and welcome from another Aussie. Your work seems to fit in quite well with Dr Jason Fung's approach - he talks about the insulin index but doesn't seem to have pushed the theory quite as far along as you have.

I've posted the link for your ketogenic foods list at another diabetes forum after Jan first posted it.

Seems like you've found yourself one very intriguing hobby and I admire your passion for the subject.

Keep up the good work - hope I get the time for more reading (and a lot of brain athletics) at your blog soon