When I first started working on my own hypoglycaemia I didn’t even have access to the now prevalent glycaemic index, glycaemic load and zone diet systems. Even with the help of these diet systems it would still take at least a year for my patients to fully get to grips with the effects that different carbohydrates and meal combinations would have on their blood sugar so that they could work out the perfect blood sugar balancing diet for their own individual body.
This will enable you to quickly work out the optimum diet for you to eliminate both high and low blood sugar problems in a fraction of the time it used to take and how to make sure you are maintaining the optimal low blood sugar levels in the future to prevent degenerative disease from AGE and free radical damage.
Self-testing will then enable you to treat your blood sugar condition more accurately than you ever could by just following the generic glycaemic index glycaemic load and zone diets. Self-testing will also enable you to get around the common problem of not being able to find a GI or GL number for a specific food you eat, a specific brand of rice for example, or the variety of breakfast cereal sold in your country; from now on you will be able to determine the actual glycaemic effects for the foods you eat for yourself. Self-testing will enable you to measure exactly how your typical real meal choices actually affect your blood sugar levels and see how different combinations of protein, oil and fibre affect the carbohydrates. Self-testing will enable you to use sophisticated blood sugar control techniques, things like see how different methods of food preparation affect the way a specific carbohydrate affects your blood sugar, for example you could see for yourself how mashed potatoes produces a much quicker rise in your blood sugar compared to the same potatoes served as a chilled potato salad.
Finally taking the guess work out of the effects on your blood sugar of what you’re eating self-testing will enable you to precisely adjust the amount, type and way you eat carbohydrates to save you years of trial and error to achieve your health goals.
Please note I’m not suggesting you test yourself continuously every day for the rest of your life, the idea is just to do a few tests over the coming months until you achieve your blood sugar health goals and can put together meal combinations that you can be sure are not going to produce unhealthy effects on your blood sugar.
Let’s briefly recap how mainstream medicine tests blood sugar before moving on to how you can do a better job by testing your blood sugar levels for yourself. This is exactly what’s happening to millions of people throughout the world, besides the individual human cost the financial costs of diabetes and diabetic related illness are rapidly becoming unsustainable, numerous governments and economists in many countries around the world have been reported as saying that if current trends were to continue diabetes and diabetic related illnesses will financially bankrupt national health care services around the world. So if you don’t want to be just another statistic of the diabetic epidemic take matters into your own hands and test your own blood sugar routinely once a year or so to make sure your diet and lifestyle are not causing degenerative high blood sugar levels. First thing in the morning after fasting for at least 12 hours other than a little water prick your finger, squeeze out a drop of blood and apply it to the test strip of your blood sugar meter, keep a record of the number and the date for future comparison. Test your blood sugar just before the meal you want to test, breakfast, lunch or dinner and then again one hour after eating, two hours after eating and finally three hours after eating. You’ll want to test all the typical meals you eat, for example you want to know if the muesli or beans on toast you typically eat for breakfast overwhelms your blood sugar regulating capacity, the pasta salad or sandwiches you have for lunch and the various dinner options you eat.
I like the above method because it tells you what’s happening in the real world on a daily basis, however another useful test you may want to try is every once in a while really test your blood sugar control by giving it a tougher challenge to reveal it you (still) have some insulin resistance and a poor pancreatic function. 3 hours after eating you should be back down to the same baseline as you were before you ate i.e.
Always eat plenty healthy oils and lots of fibre to slow down digestion and the release of glucose into the blood. Consume a desert spoon or 2 of the acidic liquid such as Apple cider vinegar or lemon juice, either diluted in a little water or as addressing. If you have insulin resistance undergo the insulin resistance and Type II diabetes recovery program described elsewhere.
Remember: high GI foods are the primary cause of high blood sugar spikes after eating so avoid eating anything with a GI above 70. Whenever you eat start and carbohydrate foods, especially on those occasions when you eat more than you should take the supplement transglucosidase which converts a portion of the carbohydrates you’ve eaten into beneficial prebiotic dietary fibre instead of into glucose. There are some fancy all in one devices that take a drop of blood from your finger and measure it as well but I’ve never tried them, the well tried and tested method consists of two basic parts the blood sugar meter with disposable test strips and the finger pricking device with disposable lancets (sterile needles). You can buy a blood sugar meter at the pharmacy or online without a prescription, all today’s blood glucose meters are adequate for our purposes, which one you choose just comes down to personal preference and price.
If anything the more important choice than the blood glucose meter is the bloodletting lancet device you buy, you want to get one that reviewers say is painless and comfortable to use. If money is an issue what you should pay particular attention to is not just the initial cost of the meter itself but the ongoing costs of the test strips, the price of which can vary considerably from say 30p to 1 pound ($.50 to over a dollar).
To monitor the progress in your fasting blood sugar in the morning you only need to do say 2 tests a month, but each time you test your after meal blood sugar response you do a total of 4 tests. Oral Glucose Tolerance Test: unrealistic, stressful to the body and unnecessary, do real-world, real meal testing instead. Instead of selling the information as an e-book I’m giving you the information first and then asking you to make a donation if you feel that you would have been happy to buy it as an e-book.
If you notice spelling and grammatical errors in the text please email me pointing out the page and paragraph of the error, I really appreciate it. I practice at the Hale Clinic (central London) as a holistic medical practitioner and have been in practice since 1988. As we learned from Attia’s presentation, insulin controls adiposity, and high insulin will block fat burning.
For that period, follow a strict Paleo reset diet, like the the one described in Chris Kresser’s new book or the Whole30 program. This step resolves a myriad of common health complaints, in addition to optimal body composition and fat adaptation.
Sugar is easy to market because our brains are hardwired to appreciate it and seek out more. Like me, you’re probably a creature of habit, and once the Superstarch starts working, you will not want to change anything. When exercising in this glycogen-depleted state, there’s a chance your body might panic and start catabolizing lean muscle tissue for glucose production. If you haven’t already, accept that CGM has accuracy issues and is not going to eliminate your need for fingersticks. Calibrate only when glucose levels are relatively stable to avoid discrepancies related to lag time.
Ensure that the fingerstick readings used for calibration are accurate: test on the finger (rather than an alternate site), clean the finger before testing (dirt, lotion and food residue will affect the readings), apply a sufficient drop of blood to the test strip (don’t underdose), and make sure the meter is coded properly (on meters that require coding). CGM systems can produce enough beeps and buzzes to drive almost anyone (and their partner) up a wall. To minimize the frequency of alarms, set the high and low glucose alerts at levels that are well above and below actual target glucose ranges, particularly during the first several weeks of using a CGM. Although the sensors are composed of a flexible material, the introducer needle used to insert them can cause momentary pain. The out-of-pocket cost for a CGM system and sensors continues to be beyond the reach of many people.
Every CGM company has a team of specialists dedicated to helping customers obtain maximum coverage. Gary Scheiner is Owner and Clinical Director of Integrated Diabetes Services, a private consulting practice located near Philadelphia for people with diabetes who utilize intensive insulin therapy worldwide. In the field of diabetes, continuous glucose monitoring (CGM) has seen a similar evolution.
Each manufacturer of CGM equipment (Medtronic, DexCom, and Abbott) has installed a department dedicated to working with clients to help secure insurance coverage. The engineers at each of the CGM companies have been hard at work making improvements to their respective systems. The original DexCom was often criticized because of the number of substances (including several common medications) that could interfere with the sensor’s accuracy. Perhaps the most important changes in the DexCom system involve the transmitter and calibration algorithm. First, despite the fact that Navigator already offers excellent on-screen data analysis in both graphic and statistical form, downloading software was made available last year. Insurance coverage for CGM systems and sensors has been one of the major roadblocks for those looking to use this innovative technology. Through a better understanding of the sensor’s functionality, Medtronic has implemented a number of changes to their training processes.
Editor’s note: Gary Scheiner MS, CDE is Owner and Clinical Director of Integrated Diabetes Services, a private consulting practice based near Philadelphia offering intensive diabetes management consultations via phone and the internet. A couple of years ago, when real-time continuous glucose monitors were first introduced, my opinion was less than enthusiastic.
In our experience at Integrated Diabetes Services, Freestyle Navigator from Abbott has delivered the best overall accuracy, but other groups have their own opinions.
For those of us looking for ways to improve our blood glucose control and make living with diabetes just a bit easier, CGMs do a lot more than just post numbers. Perhaps the most valuable aspect of CGM systems is their ability to alert the user when blood sugar levels may be approaching high or low levels.
Although they may not detect every high and low, CGMs will provide an early warning for the vast majority – and much earlier than most of us would detect them on our own.
Another valuable bit of information to go along with the immediate blood glucose value is the direction it is headed. The Medtronic and Navigator CGM systems display up or down arrows to denote both the direction and magnitude of blood sugar changes over the past 20 minutes.
Another way to use the trend information is to adjust your meal and correction boluses based on where the blood sugar is headed. For example, checking the 2, 3 or 4-hour trend graph a couple of hours after meals can reveal the postprandial (after-meal) effect of various types of foods.
The 2-to-6-hour trend graphs can also reveal blood glucose patterns related to stress or exercise. The nine-hour graph on the DexCom system and 12-to-24 hour trend graphs on the Medtronic and Navigator can play a key role in the regulation of basal insulin, particularly overnight. In the next example, taken from a person using Lantus as their basal insulin, the blood sugar level is rising through the night from 2am until 8am.
In addition to helping fine-tune basal insulin doses, long-term trend graphs can be used to determine the action curve of your rapid-acting insulin.


It is best to verify that your basal insulin levels are set correctly before attempting to measure the insulin action curve. Whether you use your CGM data for dosing purposes or verifying the data with fingerstick readings, the simple act of looking at and using your monitor has its rewards.
With so much to learn and so many ways to use CGMs, it makes sense for more people to use them. Editor’s note: Gary Scheiner MS, CDE is Owner and Clinical Director of Integrated Diabetes Services, a private consulting practice located near Philadelphia for people with diabetes who utilize intensive insulin therapy. Last year, the FDA approved Medtronic’s Guardian REAL-Time System, which reads glucose levels in the interstitial fluid every five minutes. Steve Sabicer, a Medtronic spokesperson, says that CGM therapy combined with an insulin pump is the most aggressive and effective diabetes therapy available. We bristle a little at the two points, since that wasn’t the average reduction, although some patients at very high A1c’s did see a reduction like this. Of course, young patients will still face some of the same hurdles as their older counterparts.
Another hurdle for Medtronic had been the large size of the transmitter, but this also has seen vast improvement. CGM remains far from perfect, as we wrote in Test Drive in an earlier issue, but of course both pumps and blood glucose monitors took a long time to develop a big following; so as long as reimbursement emerges, we think CGM could still ultimately help many patients. Our mission is to help individuals better understand their diabetes and to make our readers happier & healthier.
Our mission is to help individuals better understand their diabetes and to make our readers happier and healthier. The glycemic index (GI) is a standard that determines how fast a food raises blood sugar, which stimulates insulin production and weight gain. Once you understand why eating this way is so important, you will be empowered to make necessary healthy changes. After adopting the eat every three hours, small portioned controlled, low glycemic meals from the time you get up in the morning until you go to bed strategy. The GI, GL and zone diets are incredibly useful systems to help us balance our blood sugar and some of the greatest developments in nutritional medicine I’ve seen in the past 20 years. Even if you don’t have diabetes or pre-diabetic high blood sugar but just want to prevent bouts of low blood sugar causing tiredness, carbohydrate cravings and possibly more seriously contributing to your mental health problems using a blood sugar meter will help you quickly and effectively achieve your goals. For accuracy do this on two separate days, consecutive days if you want and average the two numbers. Keep a record of the numbers, the date and details of what you wait, particularly the type and amount of carbohydrates and how you cook them.
Eat about 170 g (6oz) of a high GI carbohydrate like baked potato or high GI rice without any oil or fat that would sow down your digestion. To prevent this problem you must reduced the glycaemic load of your meals and reverse insulin resistance.
To perform a test you put a new test strip in the meter and a new lancet in the finger pricking device, prick your finger squeeze a drop of blood onto the test strip and a few seconds later the meter reads your blood sugar level. Different units are sold in different countries so I can’t recommend a specific unit for you, to choose a device look at the online reviews on the national diabetic websites for your own country or ask your local pharmacists for their recommendation for a simple blood glucose tester and lancet device. Initially you might test your after-meal blood sugar 10 times (2 to 3 breakfasts, 3 lunches and 3 to 4 dinners), thereafter you will monitor your treatment progress over several months by testing your after meal blood sugar response once a week initially and then every few weeks as you make progress and your fasting blood sugar a couple of times a month for several months. Determinants of glucose toxicity and its reversibility in the pancreatic islet beta cell line, HIT-T15. Increased prevalence of impaired glucose tolerance in patients with painful sensory neuropathy.
I’ve seen the same process work well for others, including another mountain biker frequently winning at the highest level of amatuer competition.
Therefore, if you are accustomed to eating a high carb diet, the first step is to remove the blocking factors. Most of the advantages of fat adaptation come before ketosis, but it still might be worth your taking the experiment further into the extremes of high fat, low carb. This is particularly true for the Medtronic system; never calibrate when up or down arrows are present on-screen. This may seem petty to those who have been checking for years, but even experienced testers can get sloppy. There are high and low glucose alerts, predictive high and low alerts, rate of change alerts, and general system alarms (low battery, sensor change reminders, calibration reminders, etc.). These levels can gradually be brought toward desired target ranges with improvements in control and experience using the system. I have never been a fan of this practice, as the cream may interact with the sensor and will definitely hinder tape adhesion. They can help you to obtain a letter, form or prescription from your physician (preferably an endocrinologist) and collect all the necessary documentation. The “Glucowatch” debacle notwithstanding, most real-time CGM systems were introduced just three years ago. And thanks to their persistence and the appearance of original research in peer-reviewed scientific journals, insurance coverage for CGM is spreading across the US.
What we have today is far from perfect, but it is definitely more serviceable than what we had a few years ago. A special “extension” program can be added to Abbott’s PC-based Copilot software, allowing it to incorporate data from the Navigator system via Bluetooth technology. When Navigator sensors were first introduced, concern was raised about the possibility of silicon residue being left under the skin after the sensor was removed. No company has been more aggressive or dedicated more resources in this area than Medtronic. These changes, including altering the angle of insertion and allowing for a “wetting” period after insertion, have resulted in improved sensor performance. New iterations of their original web-based Carelink Personal software have already been launched, along with a CareLink USB device for easing and speeding the data upload procedure without going through a blood glucose meter. A few years from now, we’ll probably look back at today’s CGM systems and think, “How primitive was that?” But at some point, the good stuff clearly outweighs the bad stuff, and it makes sense to make the move. Published data show an average discrepancy of 14% between the numbers generated by Navigator and concurrent fingerstick readings. To me, they act sort of like “highway rumble strips” that keep us from veering off the road and into a ditch. Some systems even have predictive alerts: they let you know if your blood sugar is expected to cross your high or low threshold soon based on the current level and rate of change. Although looking back at the past several hours of data will not help you fix a current problem, it can provide you with information for preventing a recurrence. Checking the graph during and after stressful events and physical activity will show when and how much your blood sugar rose or fell.
By looking at the CGM’s trend graphs starting approximately 4 hours after the last bolus was given, you can evaluate the effectiveness of your basal insulin. Basal rates that are too high will produce an artificially long action curve; basal rates that are too low will make it appear that the insulin runs out earlier than it actually does.
The downloading programs that can be used with CGM systems (Medtronic’s Carelink website; DexCom DM2 software, and Abbott’s Copilot program) can be used to examine long-term trend graphs over multiple days. Research has shown that checking the monitor at least 12 times per day (hourly during waking hours) and wearing the system most of the time (rather than intermittently) tends to produce significant improvements in A1c and reductions in hypoglycemia. As is the case with insulin pumps, success with a CGM usually hinges on having appropriate training and guidance. He is the author of several books, including Think Like A Pancreas: A Practical Guide to Managing Diabetes With Insulin.
On March 12, the FDA approved new REAL-Time (CGM) devices for children and adolescents ages seven to 17. We actually think it’s not all about A1c, as we have learned at meetings over the years and as Dr. We just discovered at Diabetes UK in Glasgow, Scotland, that the new mini-LINK transmitter has started shipping already! You could just stop eating carbohydrates altogether but for many people being able to include at least some carbohydrates with meals is important to help them feel satisfied from the meal and therefore preventing feelings of hunger causing cravings and overeating. Even after such a meal a healthy body will still be able to bring blood sugar back down to less than 120 (6.66) after 2 hours and back to the same level as before the meal after 3 hours. The end of season rest period is a particularly good time to give this a try because your results in competition will be unaffected.
It’s also possible that a micronutrient deficiency is a blocking factor, as was the case for me.
Put a piece of duct tape over the glucose value field on the display if you must, and pay attention to the other stuff.
This is similar to trying to predict the weather tomorrow (short time interval), in three days (medium time interval), or in seven days (long time interval). When alarms go off too frequently, not only are they annoying, but we might start to ignore them completely.
It may also be best to leave the other alarms (predictive alarms, rate of change alarms) in the off mode until you have become comfortable with the system’s basic features. Inserting at the appropriate angle (not too sharp or close to the skin surface) also reduces pain over the life of the sensor.
If you feel the need to numb your skin, rub an ice cube over the site for a couple of minutes, then dry the area completely before inserting.


Gary and his team offer consultations via phone and internet, in addition to sensor trials (for those new to CGM) and data analysis (for those currently using CGM). Few cell phones had Internet access, and televisions could pick up local broadcasts without the aid of a cable. For the most part, these first-generation systems had their share of quirks and glitches, including accuracy problems, complex programming, and annoying alarms. In the past year, there has been a 30-fold increase in CGM coverage, with more than 200 million Americans now having some form of coverage for CGM in their commercial health plans. To me, the true test of technology is whether what you get out of it exceeds the work you put into it. Their latest model, the Seven Plus, sports a number of features that were not available in earlier models.
Unlike earlier versions of the DexCom, the system now gears its current readings and trend graphs immediately toward calibration entries. Although this was an extremely rare occurrence, Abbott changed the sensor’s backing material from silicon to ordinary carbon in order to eliminate the risk entirely. Led by the emergence of research data such as the STAR 1 Study (published in Diabetes Technology and Therapeutics) supporting CGM’s safety and benefits, Medtronic’s work with payers has paved the way toward vastly improved insurance coverage.Early adopters of the Medtronic CGM may recall recurring issues with sensor availability. The latest version of Carelink supports more than thirty different blood glucose meters and this software wins very high ratings from doctors and educators, who can access it via the web. My practice continues to offer CGM “trials” for those looking to try out the latest systems and receive some insight regarding the results. If blood glucose meters are within 15% of lab values, and CGMs are within about 15% of the meters, how useful could they possibly be? Our Integrated Diabetes Service team’s experience has been even better than that, with less than a 10% variance almost any time we’ve compared the Navigator against a meter. The low alerts make it considerably safer to work, drive, exercise, and aim for tighter glycemic control.
The next time a similar situation arises, insulin and snack adjustments can be made based on the patterns seen on-screen.
If the blood sugar level is rising or falling after the food and mealtime insulin have worn off, the basal insulin probably needs adjustment. Action curves can vary from person to person, with times typically ranging from two to five hours. Checking the data during and after holidays, illnesses, menses, medication changes, and periods of very high physical activity can reveal patterns of higher- or lower-than-usual blood sugar levels.
He and his team of Certified Diabetes Educators work with people throughout the world via phone and the internet.
Great news for any diabetic who can vote, but bad news for everyone else (and their parents). Medtronic’s REAL-Time CGM will soon be available in specifically designed pediatric models of the MiniMed Paradigm REAL-Time System and Guardian REAL-Time System. According to the company, Medtronic REAL-Time CGM therapy can reduce the duration of hypoglycemic events and can lower A1c levels by as much as two percentage points. What’s more, it remains to be seen how many grade-schoolers will want to wear a complicated sensor, which – like any new technology – requires time, patience, and trouble shooting.
You eat every three hours, small portioned controlled, low glycemic meals from the time you get up in the morning until you go to bed. To better understand the advantages, take an hour to watch Peter Attia’s fantastic presentation, which explains everything from first principles. Spiking insulin 15 minutes before activity will shut down fat burning and lead to glucose dependency for the duration of the exercise. I personally use (and sell) a product called Master Amino Acid Pattern, which prevents fatigue during endurance exercise and delayed onset soreness after endurance exercise.
Organic acids testing is reasonably inexpensive and an excellent gateway test for assessing your physiology and showing the way forward.
There is an inherent lag time in the data, and signal transmission can be affected every time you move. Dexcom has reported that calibrations may be performed when glucose is rising or falling, but I think still may be best to wait until things are stable. Eventually, after years of quality service, there comes a time when senility or burnout kicks in, and the situation falls apart.
If you choose to use predictive alerts and want more accurate predictions, stick with a short time interval.
Likewise, choosing an insertion site that has adequate subcutaneous fat (not near bone, scar tissue or muscle) can improve comfort considerably.
Gary has had type 1 diabetes for 25 years and has worn and trained on every make and model of continuous glucose monitor.
Combined with the lack of insurance coverage, it was enough to deter many people from giving this innovative technology a try.
Today’s systems provide more valuable information and are much less of a pain-in-the-you-know-what than they used to be. A simple, easy-to-access menu on the receiver allows for quick manual input of calibration readings (no need to plug in to a meter).
The good news is that the company has improved its production techniques to help ensure ample long-term availability.
While we all consider blood glucose very accurate, a day does not go by without a call or e-mail from a concerned client doubting the usefulness of their CGM system. There are also plenty of times in our experience when the DexCom SEVEN and Medtronic’s Guardian REAL Time systems match well with meter-generated blood glucose values.
Likewise, the high alerts allow us to be more aggressive at managing after-meal blood sugar spikes, preventing ketoacidosis, and tightening the A1c since we can reduce the amount of time spent in a high range. The ability to forecast where your blood sugar will be over the next couple of hours can help to keep you from straying too far out of your desired blood sugar range. To determine your action curve, simply check to see how long it takes for your blood sugar to stop dropping after giving insulin for a meal or to correct a high blood sugar level. Gary has had type 1 diabetes for 24 years and has worn and trained on every make and model of continuous glucose monitor.
Your daily calories should be approximately 50% low-glycemic carbohydrates, 25% healthy, lean protein, and 25% healthy fats.
Our body can only utilize so many calories at one time. When we eat that big meal, the body uses what it needs for energy and the rest is stored as……………you guessed it, FAT!
You will need to do your own experimentation to find the minimum effective dose, which for me is 2 tablets for each hour of activity.
Buy yourself a copy of Jimmy Moore’s new book Keto Clarity, and also The Art and Science of Low Carbohydrate Performance by Stephen Phinney and Jeff Volek. Despite the fact that sensor accuracy improves with each new system generation, CGM-generated glucose values still vary from simultaneous fingersticks by an average of 10-20%. Likewise, sensors are most inaccurate and troublesome at the beginning and end of their life cycle. Alarms can be customized so that loud beeps can be avoided, and a “snooze” feature keeps alarms from recurring too often.
In fact, DexCom no longer requires calibrations to be performed in a “steady state.” Calibration readings can be entered whether the current blood sugar is rising, falling or steady… a definite convenience for users of the system. Eating a large meal causes our blood sugars to spike, so our body produces more insulin. The role of insulin is to help move the glucose from the foods we consume into our cells.
Titrate down slowly, and eventually you will be able to do 2, 3, 4, 5 and even 6 hours of endurance-paced activity on plain water alone. Upward and downward trend arrows and graphs are almost always accurate since the sensor is measuring glucose concentration changes from one point in time to the next. New on-screen trend arrows indicate the direction and rate of blood sugar change, and optional alarms can occur with rapid changes in blood sugar. These times are of particular interest, but in general you’re looking to maintain stability in the 80 - 90 range. And retrospective data analysis allows for intelligent adjustments based on recurring patterns as opposed to any single event. Trend graphs display the most recent 1, 3, 6, 12, and 24 hours of data, and the download software (which can now be used with a Mac as well as a PC) provides a unique “progress report” to show how overall control is changing over time.
If there is a current upward or downward trend, the amount of the bolus will need to be adjusted accordingly. Overtime this is what leads to Metabolic Syndrome (high blood sugar levels, high blood pressure, elevated cholesterol, excess abdominal fat). Like me, you’ll probably need lots at first, perhaps one scoop 30 minutes before and then one for each additional 90 minutes thereafter.
If you are consistently seeing spikes up and over 100, then you are eating too much carbohydrate in one sitting.
You can find out more in the interview I recorded with Seth Bronheim, UCAN’s director of nutrition.
Reduce the number of carbs and add more fat, like an extra avocado, or gobs of coconut oil, grass fed butter, tallow, bacon grease, MCT oil.



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