The Practical Diabetic

Welcome to the club no one wants to join. If you are reading this it is likely you, or someone close to you, has just been diagnosed as having Type 1 diabetes. This is the guide I would have loved when I first got diagnosed. Do not have the time to read? Go to tl;dr.

Everything Is Going To Be OK

First of all, while it may feel overwhelming, everything is going to be fine. There are Type 1 diabetics in most walks of life from elite athletes to pilots. Around 1% of people in the UK, USA, and Australia (1 in 100) have Type 1 diabetes. That is one in three or four school classrooms. Type 1 diabetes affects both genders roughly equally, people of all ages, and people from all walks of life. You are not alone.

You may not know someone with Type 1 but they are out there and dealing with it every day. For me, it was 11 months from diagnosis before I met another Type 1 diabetic in the flesh. There were plenty of resources along the way to help me though.

Quick Reads

Two excellent online documents my endocrinologist pointed me to was the Australia JDRF’s Adult Guide, and the Australian Type 1 diabetes Starter Kit. These sites also have guides for parents, and guides for family and friends.

In the USA there is the US JDRF, and in Canada there is Diabetes Canada. If you live somewhere else Google: ‘diabetes “type 1” <your country>’ for local resources.

Longer Reads

There are some really great resources for Type 1s in book form, written by Type 1 diabetics. Some of the ones I rate or which other Type 1s I know have rated are:

• Dr Bernstein’s Diabetes Solution: Even if you do not subscribe to Dr Bernstein’s very strict low carbohydrate diet, the book is full of information about diabetes and tips for managing it.
• Think Like a Pancreas: Great advice on how to manage diabetes with insulin as well as covering the essentials of what diabetes is.
• Bright Spots and Landmines: This is a more general guide for Type 1s and Type 2s. I have not read it, I hear good things.
• Sugar Surfing: While books such as Dr Bernstein focus on the more traditional basal + mealtime bolus insulin regimen, Sugar Surfing incorporates the use of a continuous glucose monitor (CGM) to do regular micro-adjustments of insulin. The people I know who do multiple daily injections (MDI), all rate this book strongly as a guide for keeping blood sugars within range

Online Communities

By far it was the online communities that helped me the most in the first 11 months. Practically every form of social media has some kind of diabetes group in it. While I do not ask a lot of questions on social media, it is great to listen to the questions and answers of others. Ones which I found (and continue to find) useful are:

• Facebook: So many diabetes communities here; some friendlier than others. Embrace the ones which work for you
• Twitter: Around the world are Twitter chats for diabetics. Basically, each week, diabetics gather to converse on a topic of the week. The format is a series of questions, thrown out to the group and people answer with the relevant hashtag. Ones I have participated in are:
  • #OzDOC: The Australian Diabetic Online Community, this group is, sadly, all but wound up.
  • #ADEAChat: A gathering of the Australian Diabetes Educators Association but diabetics are also welcome. The weekly chat is at 7:30pm AEST on Tuesdays
  • #DSMA: The US-based Diabetes Social Media Advocacy meet at 9:00pm EST on Wednesdays
  • #GBDOC: The UK-based chat which runs weekly at 9:00pm UTC on Wednesdays
• Reddit: A relatively new medium for me, Reddit has two Type 1 channels and the karma system ensures people are, mostly, on their best behavior.
• YouTube: Arguably the best diabetes resource on YouTube is Dr Bernstein’s YouTube channel. If his book is too expensive or you want to try before you buy, watch his hundred or so free videos.

A Good Health Care Team

At diagnosis it surprised me to learn it would take a team to help me manage diabetes but it is absolutely true. The best advice I can give is do not accept anyone into your health care team you are not comfortable with. You are paying good money for their expertise and service but this does not give them the right to make you feel bad about yourself. Diabetes is stressful enough without a health care professional exacerbating the problem. Get a good health care team and it will make managing diabetes so much easier. People you have on the team might include:

• An Endocrinologist (endo) for specific disease-related advice
• A Diabetes Educator to give you more practical day-to-day advice for managing the disease
• A General Practitioner (GP) for general medical advice (and generally cheaper than the endo)
• A Podiatrist for regular feet checks (diabetes-related damage often reveals itself in the feet)
• An Optometrist/Ophthalmologist for regular eye checks (diabetes-related eye damage can often be prevented through an eye check and early intervention)
• A Nutritionist to assist, if required, with food and nutritional advice. Try to make it one who specializes in Type 1 diabetics otherwise you will likely be told advice which may be useful for muggles (non-diabetic folk) but of limited value to someone who cannot process carbohydrates well.
• An Audiologist for regular hearing exams (or benchmark yourself with an online test list like this one and get the specialists involved when there is a measurable change)
• A Dentist for regular teeth checks (a diabetic’s sugary nature makes their teeth more susceptible to problems).
• A Cardiologist for regular heart health checks (diabetics have a higher risk of heart problems than muggles)
• An Exercise Physiologist if you are looking to get into shape to help manage the disease

Get Educated

With the internet you have the ability to go into as much detail as you like on any topic you desire. You are the best advocate for your health and well-being so be the strongest advocate you can be.

Topics worth researching include:

• Food and nutrition. Understanding which foods have low carbohydrate levels, which foods are low GI (glycemic index), and how you can ‘hack’ the GI of foods can be very beneficial in managing blood glucose levels
• What those blood tests actually mean (and do not be afraid to suggest additional tests if you think they will help inform your management. In my experience endos and doctors are happy to add other measures to their list of blood tests if you ask)
• What do your medications do and how to avoid the side effects e.g. taking Metformin in the middle of my meal helps me to avoid embarrassing side effects
• How does diabetes work. Understanding how Type 1 works means you can effectively assess the relevancy of information you come across. It might be information useful exclusively for Type 2s or it could be complete nonsense. With a good knowledge of Type 1, you will be able to discern the difference.
• What is the latest medical research? An excellent source of information is NCBI which contains a vast repository of the latest medical research. I try to review this at least once a month for new findings to help inform my management. For example it was through NCBI that I found the growing evidence that DPP-4 inhibitors help preserve beta cell function in newly diagnosed Type 1s. With this evidence I then convinced my endo to prescribe me saxagliptin to help extend my honeymoon

Another way to get educated is through courses set up by diabetes groups in your local area. Often these are free and provide a great foundation for the newly diagnosed. Your endo or Diabetes Educator should be able to point you in the right direction.

If you are venturing onto the internet for information, you will need to be discerning about the quality of the sites you visit. As mentioned, NCBI is an excellent source of information but there are plenty of junk sites out there promoting their own snake oil products and feeding fearful diabetics a lot of nonsense.

Similarly, do not take medical advice from strangers online, me included. Some self-important bloggers and Facebook pundits take it upon themselves to insist, for example, that every newly diagnosed Type 1 should go onto insulin as soon as they are diagnosed. While this may be true for many Type 1 diabetics, it is far from a blanket rule (I am a prime example of this as I am still in insulin-free honeymoon as I write this, two and a half years after diagnosis, with well-managed blood glucose levels). If someone online is telling you to start or stop a medication, especially one as serious as insulin, walk away. This is a decision for you and your health team with careful consideration of your specific symptoms and medical history.

Get To Know Your Blood Better

What I mean by this is start keeping track of your blood glucose levels. I initially started with a glucometer (the machine with the strips). Using an app like MySugr I was able to record my blood glucose readings before, during, and after meals, and understand which foods were ‘friendlier’ than others. This allowed me to make smarter food choices and bring my HbA1c under control. These days I use a CGM which provides a wealth of information about the things that affect my sugariness.

tl;dr

While Type 1 diabetes may seem daunting and overwhelming when first diagnosed, it is manageable and the proof are the millions of Type 1 diabetics out in the wild doing it every day.

By educating yourself with quality information and getting involved with online and offline diabetes groups, you can get through this and thrive as a Type 1.

Online Resouces

PDFs and Pages:

• Australia JDRF’s Adult Guide
• Australian Type 1 diabetes Starter Kit
• A guide for parents of a Type 1 diabetic
• A guide for family and friends of a Type 1 diabetic
• The US JDRF newly diagnosed guide
• The Diabetes Canada newly diagnosed guide

Online communities:

• Facebook groups
• Twitter chats:
  • #ADEAChat: 7:30pm AEST on Tuesdays
  • #DSMA: 9:00pm EST on Wednesdays
  • #GBDOC: 9:00pm UTC on Wednesdays
• Reddit Type 1 channels
• Dr Bernstein’s YouTube channel

Medical Research:

• NCBI

Offline Resources

Books written by Type 1 diabetics:

• Dr Bernstein’s Diabetes Solution
• Think Like a Pancreas
• Bright Spots and Landmines
• Sugar Surfing

A good health care team:

• An Endocrinologist (endo)
• A Diabetes Educator
• A General Practitioner (GP)
• A Podiatrist
• An Optometrist/Ophthalmologist
• A Nutritionist
• An Audiologist (or an online test list like this one until there is a measurable change)
• A Dentist
• A Cardiologist
• An Exercise Physiologist

Online courses run by local diabetes organisations.

A glucometer and an app like MySugr, or a CGM to help you understand how your body reacts to different foods.

There is some debate over the appropriate amount of carbohydrate in the diet of diabetics (and muggles for that matter). If you want the summary, here is link to tl;dr, otherwise keep reading.

On one side of the argument we have Dr Bernstein and the Type One Grit advocates. They promote very low levels of daily carbohydrate (around 30g) and see excellent control because of this. The risks of hyperglycemia are small because of the lack of carbohydrates and Dr. Bernstein argues the risk of hypoglycemia is small because of the correspondingly smaller amounts of insulin used and the strict control of the carbohydrate count at each meal (typically 6g/12g/12g for breakfast/lunch/dinner).

On the other side we have high carbohydrate advocates, such as Forks Over Knives and the unfortunately named ‘FOK Diet’. FOK promotes a plant-based diet high in carbohydrates and low in animal fats. The thinking here is to reduce insulin resistance in the body and, through this, provide better control. Clearly, the focus is on Type 2 diabetics but the FOK folk also promote this diet for Type 1s. The argument is that while control can be achieved through a low carbohydrate approach, the health cost of high levels of animal fats is too high; you are replacing one problem with another. Hypoglycemia is avoided by eating lots of carbohydrates. Hyperglycemia is avoided by making sure you eat low GI (glycemic index) foods, preferably plant-based. It should be noted that FOK do not say high levels of dietary carbohydrates are necessarily good or essential, they simply say high levels of animal fat are bad.

I am not intending to resolve this debate with this blog article but I do consider where the body gets its energy from and answer just how essential carbohydrates are. From there, it is up to you. In full disclosure, I do not eat a lot of carbohydrate. As a Type 1 LADA in honeymoon, I believe the best thing I can do for my pancreas is to give it as little work to do as possible and a low carbohydrate regimen achieves that.

What Foods Give Us Energy?

There are four main components of food which give us energy. These are:

• Fat (yielding 37 kJ/g or 9 kcal/g)
• Ethanol (aka alcohol) (yielding 29 kJ/g or 7kcal/g)
• Protein (yielding 17 kJ/g or 4 kcal/g)
• Carbohydrate (yielding 17kJ/g or 4 kcal/g)

There are a few other sources of energy, such as organic acids and alcoholized sugars, but we will keep things simple with the main ones.

What Food Gives Us Glucose?

Of these foods, the only ones which get converted to glucose are carbohydrates (whenever you eat them) and proteins (significantly when you are fasting via gluconeogenesis). For a recap of what gluconeogenesis is, refer to “What is Ketosis and Diabetic Ketoacidosis?” where I wrote in detail about how the body finds alternative sources of energy when fasting. In short, when there is insufficient dietary carbohydrate, the liver engages the following processes:

• Glycogenolysis: The release of glucose into the blood from the glycogen energy stores of the liver and muscles
• Gluconeogenesis: The conversion of amino acids from proteins into glucose
• Ketosis: The conversion of fatty acids from fat into ketones (an alternative fuel for some parts of the body)

So even if we are not eating carbohydrate, the liver can release glucose into the blood to fuel the body and, when this runs out, it can convert the body’s protein supplies.

What Food Elements Are ‘Essential’?

So we know, from an energy perspective we can possibly make do but perhaps carbohydrates are needed for something else. In fact, while proteins and fats are necessary to build the structures of the body, this is not the case for carbohydrates. Here are some of the uses of fats, proteins, and carbohydrates:

• Fats: Break down into fatty acids in the body and used for:
  • Regulation of vitamin intake
  • Hormone regulation
  • Insulation and protection of organs
• Proteins: Break down into amino acids in the body and used for:
  • Build structures in the body like muscles
  • Facilitate communication between cells
  • Act as transporters for other molecules
• Carbohydrates: Break down into glucose in the body and used for:
  • Energy

That is it. Carbohydrates are used for energy or stored for use as energy later on. There is nothing essential about carbohydrates.

So, assuming you could eliminate carbohydrates, fats, or proteins completely from your diet, could you survive?

For carbohydrates, as we can make glucose from protein via gluconeogenesis, we know they are not essential.

For fats, there are two essential fatty acids: omega-6 and omega-3. Essential meaning the body cannot synthesize enough of them on its own to maintain function. Without omega-6 and omega-3 the body simply cannot function.

For proteins, there are nine essential amino acids. Of these, you may have heard of Phenylalanine, which is one on the substances the sweetener aspartame breaks down into. Another is Tryptophan, made popular by the myth that it causes the drowsiness of excess turkey eating.

Do Our Bodies Need Glucose?

There is a common myth that the brain requires carbohydrate to function. This is not true; the brain runs primarily on glucose, from any source but, more importantly it can also utilize ketones to run as an alternative fuel source in times when glucose is in short supply. In fact there are four main fuel sources the organs of the body can use to fuel themselves.

• Glucose (fuels the kidneys, brain, liver, fatty tissues, and muscles)
• Fatty Acids (fuel the muscles)
• Ketones (fuel the brain and muscles)
• Amino Acids (fuel the liver)

Source: https://www.ncbi.nlm.nih.gov/books/NBK22436/

Clearly glucose is the most versatile fuel source, covering all the bases but the only parts of the body solely dependent on glucose are the kidneys and fatty tissues. Everything else can supplement with alternatives.

I tried to find the maximum rates of glucose production possible through glycogenolysis and gluconeogenesis but came up short. Of particular interest is the rate of glucose production for gluconeogenesis because the liver only keeps enough glycogen stored for a couple of days. After that the only way for the body to generate glucose is through gluconeogenesis.

The story all students are told before going on school camp is the rule of three: you can survive three days without water and three weeks without food. If this is true, as we know glycogen stores are only good for a couple of days, this means the body can get by on gluconeogenesis alone until, presumably, the available protein stores run out. Of course, with enough protein in the diet, we can keep the glucose production going indefinitely.

tl;dr

Unlike fats and proteins, carbohydrates are not essential because the body has ways of generating glucose outside of the digestion of carbohydrates. This is not true for essential amino acids and essential fatty acids which are needed to maintain the health of the body and which can only be obtained by the dietary intake of proteins and fats, respectively.

Moreover, while the kidneys and fatty tissues rely exclusively on glucose for energy, the rest of the body can access alternative fuel sources, such as amino acids, fatty acids, and ketones.

Finally, we know the body can generate enough glucose for its needs outside of carbohydrate ingestion because a person can survive with no food for up to three weeks. Given the liver and muscle’s glycogen stores are only good for a couple of days this means the process of gluconeogenesis (the body’s conversion of amino acids to glucose) is all that is required to maintain blood glucose levels, and as long as a regular supply of protein is provided, this means the process can continue indefinitely.

You do not need to eat carbohydrates!

There is a lot of confusion around ketosis and diabetic ketoacidosis. Some people think they are the same thing; others think ketosis leads to ketoacidosis. Neither of these notions are true.

To better understand the differences, let us understand precisely what the terms mean. As a disclaimer, the metabolic processes of the body are extremely complicated. There is much more to it all than just the liver and insulin but using these gives us a practical working model. As usual, if time is short you can go to tl;dr.

I have used a lot of internet searches and Wikipedia pages on the human metabolism to put this blog together. A couple of key sources of information were:

https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0008/220679/nepean_guide_DKA_2007.pdf

https://www.ruled.me/what-is-gluconeogenesis/

The Role of Insulin

To understand ketosis and ketoacidosis, we need to understand the role of insulin in the body. It is generally understood by many diabetics that insulin is needed to move glucose from the blood into cells. What is less well know is that insulin is also a control switch for the liver.

While the pancreas releases insulin based on the levels of glucose in the blood, the liver releases glucose into the blood based on the amount of insulin. Other hormones also influence this process but ignoring these external factors for simplicity, the liver and pancreas work together to keep the glucose in the blood stable, both producing small amounts of glucose and insulin respectively to keep the other in check. The doctors call such an equilibrium ‘homeostasis’.

If we consider the role of food, when carbohydrates are consumed, blood glucose goes up and insulin production is increased to move the glucose out of the blood. Similarly, the liver’s production of glucose goes down. When blood sugars return to a base level, the liver and pancreas also return to their homeostatic rate of production.

When someone chooses not to eat, the opposite occurs. With glucose in the blood not being replenished by food, glucose levels drop and the pancreas produces less insulin. This, in turn, encourages the liver to produce glucose to give the cells of the body the energy it needs.

Prolonged Fasting

In a world before widespread food transportation and refrigeration, winter meant a time of limited carbohydrates. Fortunately, the human body has some backup measures when times get tough.

The glucose stores of the liver are good for a day or two. As these run low, and insulin levels continue to drop, a new process ramps up. The protein sources of the body are broken down into amino acids and converted by the liver into glucose in a process called gluconeogenesis (other substances in the body are also used, such as lactate and glycerol but let us keep things simple).

This can keep the body going for a few days to a few weeks, depending on things like diet (protein sources can be found in the winter, after all). After this, and the insulin levels drop a little further, the fat stores of the body are broken down into fatty acids. Different parts of the body can use fatty acids and amino acids as alternative fuel sources to glucose so, even with a low carbohydrate diet, the body can maintain the necessary energy levels.

If carbohydrate fasting continues, insulin levels keep dropping and there are sufficient fatty acid levels in the blood, another process kicks in to convert fatty acids into ketones, yet another fuel source which can be used by the brain and muscles (a commonly held misconception is that the brain can only use glucose as a fuel source; it is simply not true). This final process of converting fatty acids into ketones is called ketosis.

Ketoacidosis

In a body with a low but sufficient level of insulin, ketosis is regulated and poses no threat. In the muggle (non-diabetic person) body, it is very difficult to go below the threshold where ketosis becomes a problem. To do so requires literal starvation or large amounts of alcohol over an extended period of time. Starvation can be understood as an extension of the explanation above. Alcohol causes a problem by blocking the liver’s ability to generate glucose from the energy stores and amino acids, forcing the overproduction of ketones.

For the diabetic, where insulin production is impaired, it is much easier to go below the threshold. This is why insulin-dependent diabetics, whose pancreas cannot maintain a basal level of insulin, do so through a pump or via the injection of long-acting insulin. For non-insulin-dependent diabetics, one path to ketoacidosis is feeding the body fast-acting carbohydrates which flood the blood with glucose and overwhelm the pancreas. The insulin in the blood becomes depleted and the liver goes unchecked.

With no insulin to regulate it, the liver goes into energy production overdrive, running all of the energy production processes as quickly as possible. The body is flooded with glucose and ketones and, while the excess can be removed from the body through urination, even this has its limits. The ketones begin to accumulate, changing the pH (acidity) of the blood. This has knock-on effects throughout the body leading to sickness and often vomiting. If not dealt with, ketoacidosis can lead to coma and death.

The Key Differences

While ketosis is a state of low dietary carbohydrate, ketoacidosis is a state of low insulin in the blood, which is almost impossible to generate through a lack of eating, except in extreme cases of starvation. A diabetic who maintains a basal level of insulin in their blood will not go into diabetic ketoacidosis (DKA) from a low carbohydrate diet. It is simply not possible.

The manifestation of the two in the body is also different. While someone in ketosis will have a low/normal blood glucose and generally feel fine, someone in ketoacidosis will have elevated blood sugar levels, be urinating frequently e.g. a full bladder every 30 minutes, may feel thirsty and be dehydrated, and feel ill. Unfortunately, there is no over-the-counter test for serum insulin levels (the amount of insulin in the blood) or blood acidity levels, which would provide a definitive answer to a concerned diabetic.

EDKA

A rare form of DKA is Euglycemic DKA (EDKA). In this case, the body is flooded with ketones but blood glucose levels are normal. This usually occurs when there is extremely low insulin levels in the blood and the liver also has low glucose stores. This is something to watch out for if, for example, you are fasting. It is also the reason why it is vital to ensure you always have a sufficient basal level of insulin.

As EDKA does not present with high blood sugars, it is often missed by doctors. If you suspect you could have EDKA tell your health care team of your suspicion and insist they measure your blood pH which is the definitive test for DKA and EDKA (reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592704/).

In terms of treatment, DKA and EDKA are treated the same way: hydration and insulin to bring ketosis back under control.

tl;dr

Ketosis and diabetic ketoacidosis (DKA) are not the same thing. While ketosis is triggered through an extended lack of dietary carbohydrate, DKA is triggered by the exhaustion of insulin in the blood; the consequence of which is the liver over-producing fuel for the body, including ketones which, when they accumulate, can turn the blood acidic and lead to death.

Treatment for DKA is re-hydration and the re-introduction of insulin back into the blood.

My name is Leon Tribe. I was educated as a physicist but now work as the National Director for a large multinational organization and occasionally speak at conferences on technology and diabetes.

I live in Sydney, Australia and I am a Type 1 Diabetic. As I write this it has been two years since my diagnosis and I am still insulin free with normal blood sugars. More of that in another post.

If you are interested in my diabetes story keep reading. If you would prefer to cut to the chase and see what this blog is about, jump to here.

Where It All Began

My diabetic journey started near the beginning of 2017. I had been feeling exhausted for months, which I attributed to poor sleeping habits. My hair was falling out in small round patches (alopecia areata) but it ran in the family so I just accepted it. My ankles ached, making it hard to go up and down stairs, which I had no explanation for, other than being middle aged and not particularly health conscious. I had a rash in places one should not have a rash and this also had no valid explanation. Finally, my eyesight was acting up. I had worn contact lenses for shortsightedness since adolescence but it seemed my prescription was on the move again.

Then things started to get a bit more specific to something I could self-diagnose. I was at a conference away from home and found myself permanently thirsty. This was strange because I rarely got thirsty. I was also needing the bathroom every half hour or so and emptied a full bladder each time. This was a problem because I was supposed to be doing an hour presentation at the conference and one does not normally hop off stage for a quick bio-break.

I got through the presentation and flew home. Pretty much the only thing I knew about diabetes was it made you permanently thirsty and pee a lot so I headed to the doctor.

(Mis)Diagnosis

Sure enough my fasting blood sugar was three times what it should have been and I had ketones. For the uninitiated this meant I had the early stages of Diabetic Ketoacidosis (DKA). In short, my body had a shortage of insulin and was out of control because of it. My blood was slowly going acidic which is a very bad thing. It also confirmed to the doctor that I had some form of diabetes. The doctor recommended I immediately go to hospital, now, right now, like immediately.

Sure enough I headed directly to hospital where they put me on a drip to re-hydrate me and start a bunch of blood tests. The re-hydration stabilised me and given I was a guy with a few extra pounds in his early 40s with diabetes they came to the (wrong) conclusion I was a Type 2 diabetic.

Misdiagnosis of diabetes happens a LOT with many people being thrown into the Type 2 bucket incorrectly. It was my doctor (a generalist with an interest in diabetes but no formal specialization) who had the sense to test my blood for the tell-tale auto-antibodies which confirmed a Type 1 diagnosis; something the ‘experts’ in the hospital had failed to do. I was a middle-aged man with ‘Juvenile Diabetes’.

Since Diagnosis

Type 1 is a relatively rare disease; roughly one in 200 people have it or, 0.5% of the population. For the first 11 months I met no one with Type 1. This was quite isolating so I started up a monthly meetup to meet others and to learn from them. If you live in Sydney, feel free to come along to our monthly gathering.

While I did not need insulin to keep myself healthy, I was taking pills (Metformin at first, and now also Saxagliptin). However, the pill boxes in the market were dull so I created my own out of a pocket watch. Thinking others may also feel the same way, I now sell them on Etsy.

All this time I have also been learning as much as I possibly can about this disease. My training as a physicist means I can absorb quite a large amount of information quickly, which has proved very useful. This blog is a vehicle to share some of the things I have discovered on the way and, hopefully, help others manage this chronic disease (‘chronic’ just means long term).

Why Read This Blog?

There is a lot of complex information and a lot of nonsense out there. My aim is to reduce the noise and provide simple explanations and practical advice (non-medical, of course) for diabetics of all Types. If you have questions about how diabetes works and how to manage it effectively, my sincere hope is that my blog helps you in some way.

What Is In It For Me?

Perhaps one day I will convert this blog to a book (publishers feel free to contact me :P) but until then this is simply a vehicle for me to clarify my ideas and get them in a format I can refer back to. That is it. There are no paid endorsements and I am not yet in the pocket of Big Pharma.

If you have made it this far, well done and welcome aboard. Thank you for taking the first step with me on a journey of 1,000 miles.