Tag Archive for: diabetes

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Type 1 Thursday – Why Real Food?

Real food is actual food, food that comes from nature and is not refined, made in a factory or tampered with by humans. And no matter of what way you choose to eat, be it keto, paleo, vegan or otherwise, we can all agree that real food is what is the best for our bodies, health and blood sugars.

But why is eating real food so important? And especially so if you live with diabetes? In this week’s episode, I outline a few quick points. Watch the video, or read the transcription below, and let me know your thoughts!

Ps. If you do like the concept of eating real foods, why don’t you join me and an amazing group of people at The Low Carb Universe 2019 in Mallorca, Spain in November? Incredible international health experts, amazing views, movement, joy AND 100% real food! You can book your ticket here!

Type 1 Thursday with Hanna Boëthius – Why Real Food?

Do you eat mostly real foods?

Transcription

If you prefer to read to learn, below is a text version of the video about real food above. You can also read why low carb is a great option for Type 1 Diabetics here!

Why Real Food?

Today I have quite an exciting topic, if you ask me, because my background is within nutrition. My topic for you today is the importance of eating real food.

I am so happy to hear your comments and ideas and thoughts about this topic or any other topic, actually, I’m easy that way! Jot them down in a comment below and I will be happy to chat with you there anyway, about real food.

If you ask me, that is the only topic where we can actually agree on, no matter what kind of diet we choose to follow or eat. I don’t really like the word diet, but I choose to use it anyway, as it’s normally the one used. The thing is, whether you are keto, paleo or vegan, or, well, maybe not the Standard Western Diet, actually, because the importance of real food may not be so, so big there. In any other diet that you may or may not be following, I think real food is the one thing that we can agree upon, that it is very good for us.

What I define as real foods is foods that don’t have a label. Real foods actually comes from nature, which is quite rare, if you think about the standard Western diet. It is foods like meat, poultry, eggs, fish, seafood, vegetables, and all these things that actually come from nature and from the earth and not through a factory, or from a factory or has been tampered with too much with by human beings. They’re just as clean and natural and real as possible. That’s my definition of real food, so that we’re all on the same page throughout this discussion.

The main point of this is that real food has no additives. What additives often do, is that they mess with your blood sugar. For example, maltitol is a classic example of this! It is a sugar substitute that still affects your blood sugar. Don’t be fooled and eat that, although it’s supposed to be great and “diabetic friendly”, can be labelled whatever you want to be labelled with whatever health claim. They still include things that are really not good for your blood sugar and really not good for your health. In effect, you’re not doing yourself any favours by buying these “health foods”. No additives, so that they can’t mess with your blood sugar, in this case, if you are diabetic, or live with a blood sugar problem.

If you are going to venture into that kind of a sphere with pre-made foods, I have as a rule of thumb for you. The food item can include five ingredients, and those five ingredients all have to be recognisable to me, I need to know what they are, without googling, because that’s cheating. Then, if I approve all of those ingredients, then yes, absolutely, I will buy it and consume it and enjoy it. But if that is not the case, it will most likely go back on the shelf! “I see it, I love it, I want it, I checked the carb count, put it back”, is pretty much like going to the grocery store with me. My poor husband, I mean, seriously… Anyway, 5 ingredients that are recognisable otherwise, to me, it is not worth the gamble of a possible really high blood sugar or a possible low blood sugar, because I’ve overdosed insulin. It’s just not worth the hassle for me.

What are the top my top three “watch out” ingredients for additives in food?

If you do live in the States, or a similar kind of an environment, high fructose corn syrup. Just stay away, that can really mess up so many metabolic markers within you, so much of your metabolic health can be ruined, because of the consumption of high fructose corn syrup. It’s just so highly refined and so highly tampered with that it’s not really worth it to consume in my opinion. It’s no longer food, it is just factory made.

Number two, trans fats, man made oils, trans fats, are really not good for you. They add a lot of unnecessary strain on your body and your metabolism (that you can just actually fix with eating real food). Adding real fat such as butter, avocado, olive oil, things that are actually not man made, but is made by nature, is a lot better for you than highly refined and processed fats.

Number three, and this can be a tricky one, I do admit it. So bear with me before you slam down the lid of your laptop or turn off your phone, but it’s artificial sweeteners. And with that I really mean the artificial sweeteners, the ones that have been made in a factory. Maybe stevia is fine for you, if you enjoy the the flavour of it. And monkfruit can also be fine. Erythritol to a certain extent, absolutely. But things like aspartame and things that we don’t really know what it’s doing with our bodies yet. It’s definitely not natural in any way or form, and that I would be careful with. I remember growing up, this was a huge thing, as long as there were artificial sweeteners, then, hey, this product is a go! I was raised in the 80s and 90s, when it was still a little bit more controlled what people with diabetes should be eating. I had to eat a lot of terribly sweetened things. It’s been shown in studies since that for example, fructose, which we thought back then was the holy grail for diabetics, can actually clog up your liver, so that it can’t do its job properly. Then your whole metabolism might be damaged.

There’s a lot to be said about this stuff, of course! These three things impact your gut health, they can have an impact on anxiety levels, they can, as I said, clog up your liver, so that can do its job properly. And other things like your skin and other things that are really important for us to work properly. These additives can make an impact on our health, and that’s not very good, is it?

I do want to sort of give a special warning, I did touch upon it a little bit at the beginning of this. For example, “keto foods” some of them or “vegan food” or whatever it’s labelled, heart healthy, don’t even touch this stuff is not healthy for you at all. Don’t trust the labelling on the box! Look at the ingredients, does it have five ingredients? Do you recognise them? Buy it, if you think you’re going to enjoy it, if it doesn’t, maybe you should rather leave it alone? “Foods”, such as salad sauces, sauces, spice mixes, soups, ready made things that you don’t think will have an impact can actually contain a bucket load of sugar and will impact your blood sugar. Stay with the real food is my opinion! It’s better for us, it’s healthier for us, and we’re going to feel a lot better.

If you’re just starting out from, for example, a standard Western diet, to going to more into the real food way of eating, then I really suggest you adopt the 80/20 rule, so that 80% of the time, on work days, you eat real food, and on the weekends, you can still have a bit of what you still think is fun.

I would love to hear from you. Do you eat mostly real foods? Let’s talk in the comments below and I can’t wait to see you next time.

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Type 1 Thursday – Period & Blood Sugar?

Type 1 Thursday is back!

This one is for the ladies – managing blood sugar before and during your period, HOW?! 🥵

I was asked on Instagram about how I handle my blood sugar during my cycle, and I wanted to share my four best tips on what to do. It can certainly be tricky and requires extensive trial and error in order to find what works for you, but it’s definitely worth it.

Watch the recording of my Facebook live session here:

Type 1 Thursday with Hanna Boëthius – Period & Blood Sugar?

How do you manage? Share in a comment!

Transcription

If you prefer to read about period and blood sugars, here’s a transcribed version of the video above.

Welcome to the return of Type 1 Thursday! Type 1 Thursday has been enjoying a beautiful summer break. But we are now back and more than happy to share thoughts, concerns and everything else regarding Type 1 Diabetes, and blood sugar management, food, nutrition, all of these things that really bother us in our everyday life.

I am Hanna Boëthius, the founder of Hanna Diabetes Expert. I am also a Type 1 diabetic since 34 years, I was diagnosed in 1985. And I have a fantastic topic for you today! This one is for the ladies, so if any guys are watching, please, you’re welcome to stay. But it’s going to get a lot with female hormones and so on. If you’re interested, please tag along. If not, I completely understand if you choose to maybe not stay around for it this particular episode.

Today we are talking about how to control blood sugar, before your period during your period, as that can be really difficult especially when you do live with Type 1 Diabetes. It’s not just one hormone that is fluctuating at same time, and remember that you don’t even produce one of the key hormones. That’s why maybe don’t have as easy of a time as other ladies have.

Fluctuating hormones ahead of your period will, in most cases give you a very bumpy ride when it comes to your blood sugar. Our blood sugar is impacted by everything, not just insulin, movement and nutrition, those things that are commonly known as influencers of blood sugar. Beautiful hormones such as estrogen and progesterone definitely have a big impact on what happens to your blood sugar’s during, or ahead of that time of the month.

Estrogen and progesterone are the two biggest female hormones and are made in the ovaries, which is a really important thing for our bodies to do. It’s a natural thing that should be there and we shouldn’t suppress them, like some may suggest. They essentially prepare the uterus for the upcoming pregnancy, and if it doesn’t happen, that’s when you have your period. That is the whole point of those two hormones. So PMS or PMD, or whatever you want to call it, is all about the changes in hormone levels. That’s why you sometimes feel cranky, sometimes you want to cry about it, sometimes you are really hungry, and sometimes you crave weird foods that you didn’t have any clue that you were even eating anymore.

A lot of things can happen when your hormones are at play. This is also what causes the erratic blood sugars ahead of your period. Female hormones can also call cause insulin resistance, which is why we get fluctuating blood sugars. The body doesn’t react to the insulin like it should, because it’s impacted by the other hormones.

What can you do to make this better, to improve this for yourself? And what are the tips and tricks that maybe you can can do to to help your time of month get a little bit easier?

(I’m of course super happy to hear your experiences. Please share those with me in a comment somewhere on the internet, and I will continue the discussion with you there.)

Before I start the what’s and the how’s, remember that very often, in very many cases, insulin sensitivity returns on day one, or two of your period. Be careful and do not push too hard on the insulin dosing.

Number one of what you can do is to track. Track your cycle, when you have what symptoms and also track your blood sugar. There are beautiful apps for this! If you know of an app that combines period tracking or cycle tracking with your blood sugar, please let me know because I’m looking for one of those myself. What you do is to look at the trends from both of these trackings, and compare them and see where and when when you can expect to see the pattern of insulin resistance increasing. Then you know exactly on which day, at which point of time in your cycle, you have to start reacting. This can be done by on paper, as well. But I like to keep as much as I can digitalized, I would prefer to have an app to track both of these at the same time.

In terms of tracking, this is where a CGM really, really does pay off. You can see exactly when the blood sugar went up, and not have to wait for the finger prick to show you. CGM is the movie of your blood sugar, and the finger pricks are the photographs you take every once in a while. You simply get a more complete overall picture. I recommend every single Type 1 diabetic, who has the possibility, to get a CGM of some kind, so that you have a better overview of what’s going on in your body. We’re all individuals and all react differently.

Number 2, this goes hand in hand with the tracking – find out how insulin resistant you become so that you can change your insulin dosages in time. Or even before even the blood sugar starts going up. You can change your basal dose if that’s what’s needs tweaking and tracking during that time, or bolus, or maybe both need to be increased a little bit in the week or days before your period? Some women also experience a few days of insulin resistance when they ovulate in the middle of their cycle, but not everyone. And so that’s also a good reason for tracking, so that you can find out how much more insulin you need.

Number 3 is be ahead of the curve. Make sure that you do find the patterns through your tracking, so that you know what is happening when, to empower you to act before anything really happens at all. You have to go through how much you should increase your doses when you become insulin resistance ahead of your period with your healthcare professionals. Or if you feel comfortable doing it alone, then you know what, that’s fine. I suggest that you talk to health care professional, like your doctor, your CDE or nurse, who can help you figure this out and how to play with the dosages if you’re not comfortable doing it yourself.

Number 4, I know it’s difficult in many cases, but keep to your healthy lifestyle. Try to keep to your nutritious and nutrient dense foods that you’re eating, make sure that you move your body (that also helps the cramping), make sure that you de-stress because this is an additional stress on the body (which could also cause insulin resistance and your blood sugar’s to be wonky).Make sure that you have the supplements that you need, for example Magnesium can be really good for relieving cramps and also for de-stressing. Hydrate properly.

The reason why I chose this topic today is because I was asked on Instagram how I handle it in my own case. I have to say that I used to have huge problems with insulin resistance ahead of my cycle a couple years ago. My blood sugars would be up in the 200’s mg/dl, or 10-11 mmol/l, without me doing anything differently. I tried to handle it with these tips and tricks that I’ve just given you, I tried to work with insulin dosages, tried to work with all these tools that I have in my toolkit. Frankly, it was a hit and miss. I didn’t really know if I was going to be successful, if I increased the dose too early so that I would go low, for example. It was really difficult. But actually, and I know this sounds stupid, but the longer that I have stayed low carb and keto and not have eaten that much sugar, the more my hormones have, all together, regulated so that I don’t really have a problem today at all. Maybe it could be an age thing, as well. I’m older now, and I have a different body than I did a couple years ago. I really believe strongly that eating healthy, nutritious food can really help regulate your hormones, even the female hormones. Today I maybe notice a day ahead of my cycle that “oh something is off, I’m a little bit insulin resistant today”, followed by “oh yeah, of course”.

What are your experiences wit hormonal fluctuations and blood sugar? Leave a comment below and I’ll be happy to chat with you there.

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Type 1 Thursday – Injections vs Insulin Pump?

Today’s topic is MDI (multiple daily injections) vs insulin pump – which is better?

This comes after a question I got on an Instagram post, where I was asked if it’s necessary to use a pump as a Type 1 Diabetic?

My short answer is DEFINITELY NO! If you achieve great results and reach your goals, it doesn’t matter what kind of insulin delivery system you use. The main point is that you have normal, healthy, happy blood sugars.

Watch the video (or read the transcription below, if that’s more your thing) to find out my pros and cons of MDI and insulin pumps.

I want this to be a conversation starter, so why don’t you let me know YOUR pros and cons in a comment below? And, what do you use to deliver insulin? Let me know!

Transcription

The age old question for most people living with insulin dependent diabetes, is the question I recently got on my Instagram post.

The question was about whether it is necessary to use an insulin pump, or if multiple daily injections, either though a pen or syringe is better for diabetic?

This is very difficult to answer straight off the bat, because this is a highly individual topic. In my opinion, the short answer is that it doesn’t really matter what you use to deliver the insulin, that you do need as a Type 1 Diabetic, as long as you do. If your diabetes is well managed with maybe a completely crazy version of either MDI or insulin pump or whatever, then hey, that’s fantastic. You found what works for you, and that is great.

Today, I wanted to have a conversation starter with you, which we can happily continue in the comments below. I wanted to outline my pros and cons for both MDI, which is multiple daily injections, you deliver your insulin by injecting yourself every so often with both basal and bolus insolence. And also pros and cons for the insulin pump that I’ve noticed for the past couple of years. Maybe this can help you make up your mind, maybe there you find out something that you want to try, and if you do, please let me know in a comment.

My own story in regards to my insulin delivery method has been a little bit jumpy. Well, I was actually flat out refusing to have an insulin pump for so many years. I had had diabetes for 27 years before I finally agreed with my diabetes nurse that now I was ready to try. And this despite health care professionals suggesting an insulin pump to me, for the majority of my upbringing, (well, maybe not in the 80s. They weren’t super common back then.) since they have become more common, they have been suggest to me every once in a while, and I’ve always refused. Because, and this was the biggest con for me the insulin pump back then, was that there’s something always attached to me. I was afraid that I would feel sicker than I have to be. And I was afraid that I’d be constantly reminded of that I am maybe not as chronically healthy as I would like myself to be or as other people may be. (I am, however, chronically awesome!)

So I was very, very hesitant and very afraid of getting myself my first insulin pump. I opted for a tubeless patch pump, which then changed into a tubed pump, about one and a half years ago, I took the step towards a tubed pump for a variety of reasons, which we can happily discuss, and maybe a little bit later. I’ve done multiple daily injections for a lot longer than I have lived with an insulin pump constantly attached to my body.

I wanted to outline few pros and cons of them each.

So let’s start with MDI, as that’s where I actually have most of my personal experience. I want to start with the pros. This is a biggie for me, and for very many other people who live with diabetes, the freedom factor you have with multiple daily injections. You don’t have anything attached to your body, unless you’re wearing a CGM, but they are a lot smaller and maybe you don’t want two things connected to your body at all times.

Hand with this goes also that it makes the illness more invisible. Because you don’t have a pager looking thing stuck to your hip or your clothes somewhere. It becomes a very much more visible illness to live with, with an insulin pump.

If you do multiple daily injections, you can also take a lot more different types of insulin, because different insulins act in differently during different times. For example, as Dr. Bernstein always recommends, is that you take regular insulin, or R insulin, to cover protein, and the protein spike that comes a few hours after you eat a lot of protein. This is easier to do if you are on MDI then having to remember to also have another shot when you’re on an insulin pump. You can also then take fast acting insulin, to which you have to correct high blood sugar or for covering for carbs. Finally, you can choose which long acting insulin that you combine this with in a way more flexible way. When it comes to types of insulin that you take, you can find a routine and a regime that works for you. And for your diabetes, to manage it properly.

MDI can also be seen as being a bit simpler, you take an injection and you’re done. Instead of having to care about every time you remove a piece of clothing or something that the tubing gets stuck or you snag the the infusion set… If you get the benefits and reach your goals with MDI, then why not stay with that?

I think it can also be argued that MDI is cheaper than being on the pump. With the pump comes very many things that you have to pay for, such as rent of the pump, for example. I have to pay rent every month for having my pump. All the supplies for it also cost a lot. It’s not just the insulin that costs! With MDI, either you use syringes that are reasonably cheap, or you have insulin pens that most people with diabetes actually get for free.

Also, from a very, from very superficial point of view, because sometimes you need to be that, too. On MDI, you can wear anything, and you won’t see any devices poking or sticking out, or being in the way, or there’s a seam or there’s something that is just obstructing either the pump or the tubing. With MDI, you are freer in that way too.

I would conclude that with the main point of the pros of MDI is freedom.

The cons of MDI! I find it in hindsight, it is quite inconvenient to be on MDI for myself. I can only speak for myself here! But every time I had to correct, every time it’s time for the the basal shot, I had to pull up my shirt, or pull down my pants… For me, it became quite inconvenient, because I had to inject myself about 10 times a day, before I swapped to the pump. That was a big sales argument for me, to be honest, not having to pierce myself with a needle 10 times a day, only do it once every three days, that sounded like heaven! That’s why I went for it, actually. You also have to remember to take your basal insulin at the right time. It became a huge effort for me to try to remember when and how and how much, which dose at this time of day…

What else I see as a con for MDI, in my opinion, is that you have a lot more to carry along with you when you leave the house. An insulin pump is always on you. So that’s it for the insulin thing. Then you need a blood sugar meter, maybe some glucose tabs and that’s fine. That’s a lot easier to carry then two types of pens and the pen needles and blah, blah, blah, for me it becomes a lot more carrying along. That being said, for most people is not a problem.

Another, slightly inconvenient part of MDI, is that you have to expose body parts. Usually this is not a problem at all, whether you’re female, male, whatever. But – imagine what is it really, really cold, and you have to like take up your shirt, and you feel that icy wind against your skin. Then you also have to inject yourself. I don’t miss that at all. I really do enjoy the fact that for example, if I am out and about around town or something, I can just take up my insulin pump, I can look like I’m texting (or whatever ignorant people choose to believe). That’s how easily I’ve saved my life with more insulin if that’s what I need, or turned down the basal if that’s what I need. But it becomes a little bit inconvenient for me to expose body parts here and there, especially when I’m out and about.

The importance of rotating sites becomes very, very big on MDI, because we all have those favorite spots that we like to inject ourselves in. And that’s fine. But you do have to rotate your sites! I noticed for myself, that it is a lot easier for me to rotate pump sites than it was to rotate injection sites. It even got so bad that no one could touch my upper thighs for a while because I had just injected so much long acting insulin into them.

For the MDI cons, in conclusion, inconvenient to me.

Let’s move over to the pros of the insulin pump. So the absolute highlight for being on an insulin pump for me is that it is very, very flexible. I can be very flexible with my basal rate, for example. If I notice that I’m trending upwards, I can change it, I can add on a bit of temporary basal to see if that’s the problem. And also with the bolus, you have the different bolus profiles. Instead of, as I was talking about in MDI, you can use different insulins for this, you use the same insulin the whole time, just in different profiles, so to speak. For me, it’s a lot easier to just remember that I have one tool to work with and I can do different things with this same one thing.

My second favorite pump benefit, it is micro-bolusing. I can take bolus’ in the size of 0.1 unit, for example. If I really want to, I can do a 0.05 bolus on some pumps, making it much more precise. This is not possible on MDI, because there you have the minimum is half a unit. So it depends a little bit on how tight you want to steer your diabetes ship. I really like the fact that I can really micro manage my blood sugars, to a certain extent, not overly so of course, because that becomes ridiculous on all other levels. But it is very nice that I can do a micro bolus every now and then. When I see the CGM trending up, I’m like, oh, let’s try with 0.X units and see if it comes a little bit down. If not, then I have to redo and recalculate. But it is a good check for me to see what’s wrong.

As I mentioned before, it is very easy to handle when you are on the go. You can even take care of your health and blood sugar during a business meeting (I have done that many times before), and when you’re out with friends, if you are in a busy street. Or imagine, for example, it’s rush hour at the farmers market and you feel or you get a notification for your CGM that your blood sugar is a little bit high, you would like to correct but you can’t really find a quiet corner. With an insulin pump, it’s a lot easier because you just click a few buttons and you’re done. You’ve taken care of the situation and you can move on with your day.

To a certain extent, I also find that it’s more efficient for me to treat and manage my diabetes with an insulin pump. I don’t use nearly half of the insulin as I do before. I also don’t spend as much time managing my diabetes as I did with MDI. Also, of course, if you are a data nerd, you have a lot of data to take care of and see and have insights and analyze and see trends. And the ever so important tech integration, more and more pumps now do integrate with a CGM, so that you can get both things at in the same device. And also, the looping possibilities that are coming up now that are very, very exciting to everyone who lives with diabetes.

The cons of insulin pumps (yes, yes, they are. There are cons with these ones too, it’s not all just roses and happy flower dances.)

I already mentioned one of them, which is that this is something that you always have attached to your body. And that can be very draining, both emotionally and physically and mentally, for some. It’s not always easy to always be connected in that way.

The tubing does, if you have a tubed pump, get caught on stuff like door handles, and other things, clothing, everything. It’s not really the most maybe smooth thing in the world to live with, you do have to watch out and make sure that your tubing is inside of your clothing, preferably, so that you don’t snag it somewhere.

I find that using an insulin pump produces a lot more trash than MDI. I’m not really happy about that, but as it is a lot easier for me to manage my diabetes with the help of an insulin pump, I keep with it, and I hope that the insulin pump provider companies will at some point really reconsider their recycling policies, so that you can maybe even send that stuff back so that they can take care of it. And not to mention Dexcom, please get your act together! But that’s another video. 😉

One problem with insulin pumps is that if it for some reason, malfunctions, and that can be the site malfunctions, the battery runs out, or the insulin goes bad or the machine get some sort of hiccup. If it somehow malfunctions, you don’t get any insulin at all and that can become dangerous quite quickly. That is one of the bigger cons for an insulin pump.

For me, airport security, or generally when you travel, insulin pumps can sometimes get a little bit interesting. They will want to swipe them for explosives. For certain airports, I do have to take more time into consideration when I travel through there because they just don’t know really what it is yet. It is unfortunately becoming more and more common, meaning it is less of a problem. But sometimes I could happily maybe be on MDI for a trip!

What do you have to add in terms of pros and cons for MDI and pros and cons for insulin pump? What do you use it to deliver insulin?

Please let me know in a comment below. I will be happy to chat with you there.

Type 1 Thursday – My HbA1c Formula

Lowering your HbA1c as a Type 1 Diabetic is HARD!

How did I turn my double digit HbA1c nightmare into a healthy 5.0% habit? Find out all about my 12 step formula in this week’s Type 1 Thursday!

My HbA1c Formula

What is your goal A1c? Or healthy goal in general? Let me know in a comment below!

Transcription

If you prefer to read about my HbA1c Formula, here you go:

Getting your HbA1c down as a Type 1 Diabetic is hard! It’s really, really hard and requires a lot of work and effort. So how did I turn my HbA1c from a double digit nightmare to a 5.0% healthy habit?

In this week’s Type 1 Thursday, with me Hanna Boëthius, one of the cofounders of The Low Carb Universe, as well as a Type 1 Diabetic since 34 years. I don’t know if you know, but I reached something magnificent. I have had a long, long standing dream of reaching a HbA1c of 5.0% (31 mmol/mol) in the “other scale”. This week, I finally got confirmed that this was the case and I couldn’t be happier! But what you may not know about me, yet, at least is that not that many years ago, I was a total diabetic mess. I failed to take care of myself. I had terrible blood sugars and very little knowledge of how to actually manage diabetes. So my A1c not too long ago was in the double digits, which is not good for anyone who knows anything about blood sugar. At the same time, I was so hopeless because I was clearly not given a the proper tools of taking care of my diabetes.

I actually shared my full story a couple of weeks ago, but so that no one else has to go through all the trials and tribulations that I did, I have formulated my getting a better HbA1c formula!

It’s what I have done to bring my HbA1c from double digits to a healthy, happy 5.0 habit. I’ve actually been under 5.5% for more than three years now, something I’m very happy about! That means that it’s stable, that means that I have found out a few things that work for me. That doesn’t necessarily means that they work for every single Type 1 out there, but they work for me. And maybe just maybe you or someone you know will be able to draw a little bit of inspiration from what I’ve done, so that you can get healthier and to your health or A1c goal as well.

This is a 12 point plan, so buckle up and get ready, we have a lot to go through!

Number one is definitely eat low carb. I know, it’s a very heated topic in all of this. But if you have problems with blood sugar, there is really nothing else that will work as well as to lower your intake of dietary carbohydrates. This also means my favorite topic in the world, which is the law of small numbers. Instead of with a lot of carbs, you add a lot of sugar, and then you have to chase it with a lot of insulin and then the margin of error is just equally as big. Instead, you can eat a little sugar, you add a little insulin and the margin of error is smaller. This is the number one reason why low carb for diabetics is such a great idea, because it leaves out so much of the guessing work. I also incorporated intermittent fasting into my routine a good couple of years ago. This means that I skip breakfast every day, just because I’m just not hungry, and I don’t see the point of stressing my body with trying to, to digest more. Intermittent fasting that has helped me a lot, and maybe it’ll help someone out there too.

You have to find out if you are intolerant towards any sort of foods. A very common intolerance is dairy, for example, which is a big thing within low carb. If you have any issues or allergies, then maybe it’s not going to help you reach those blood sugar goals that you are so dearly after. Make sure that you find out other things, for example eggs, night shades… People have intolerances towards many foods, but you might not find out.

What is your personal carb threshold? I know this is also very widely discussed within the diabetic community. I personally eat maybe 20 grams of carbs a day, most days not even. For example, the great Dr. Richard Bernstein says that you should eat 30 grams a day with six grams of carbs for breakfast, 12 for lunch, and 12 for dinner. It’s all up to you finding out what kind of level that you should be at for the best results. This is definitely not carbs from cookies, and pasta, rice, potatoes, all this stuff. This is green leafy vegetables, vegetables that have grown above ground, as these vegetables don’t impact your blood sugar as much.

Treating the few hypoglycemia as that you still will experience, but not as many, with precision so that you don’t go up and down and down and up and up and down as we were used to on the high carb lifestyle that I was on before, but treat lows with precision. Use the exact number of grams of glucose that you need to get into back into a healthy, safe level of blood sugars. If you overshoot too often, then your average blood glucose is going to go up. If you want to bring your A1c down, then make sure that you stay in range as much as possible.

Second point is medication, whatever kind of medication you’re on. Yes, insulin, but I don’t want to discount any other sort of medications you may be on, they may have an impact on your blood sugar, please check this with your doctor. When it comes to insulin, there are two really important things that you have to do: number one, basal rate or your basal dose of insulin, the long acting insulin that should keep you stable throughout the day and night. Please test that this is correctly dosed. If it’s not, then it’s going to cause you to either slowly but surely go up in blood sugar or go down and blood sugar if you’re take too much basal. You can test this by fasting and checking your blood sugar every hour of that fasting window, you can either divide it up or do 24 hours in one go. The second part is of course, bolus insulin, the mealtime insulin. Make sure you know your ratios, and that they are properly calculated, or found out through trial and error, as they are in my case. The common ratio calculations that exists with high carb eating, don’t quite apply to all diabetics eating low carbs. So for very many of us it has to become a trial and error. With a law of small numbers, the error margin is not that big. So you’re not going to be in for a wild ride. It takes some time to figure it out.

Also pre bolus for your meals, even if they don’t contain that many carbs, just so that the insulin has a bit of time to start working before the food comes and does the same. What really helps when you’re trying to find out your medication and ratios and pre bolusing for meals, and everything else, is of course to have a continuous glucose monitor. This is either Dexcom, for example, or Freestyle Libre, or any of the other ones that are out there, whatever one fits you the best. I know they’re very expensive, and they’re very hotly debated as well. But they are a huge, huge help when it comes to really lowering your A1c, because when you see a trend you can start acting before the catastrophe is a fact, hyper or hypo.

The next point, is blood sugar levels. As a perfect diabetic, or whatever that means, you should try to aim for an average of 4.6 mmol/l or 83 mg/dl. This is what people who are healthy and have a functioning pancreas’ are on average. If you are at a much higher average right now, don’t try to get down to 4.6 or 83 in one go, do it step by step. All of the modern blood sugar meters have an average measurement of blood sugar. Depending on how often you prick your finger, it might may be representative of what it actually looks like. As soon as you see where that average is, just try to aim for values slightly below that. You will slowly but surely take it down to normal healthy levels and therefore achieve a normal healthy A1c. You HbA1c, in short, it’s the average blood sugar for the past sort of six to eight to 12 weeks.

How you correct blood sugar also matters! Don’t be aggressive about it, whether you have to correct a hypo or a hyper. That causes the large margin of error. Be careful about it, and have a little bit of patience. I’m the worst person to talk about this, as I have zero patience! Be sure that you have a little bit of patience when you do treat, as things can turn quite suddenly. Find out if you are affected by the dawn phenomenon, for example, which is when the liver kicks in and starts shooting out sugar so that you wake up in the morning. Or if you have something that is called boots on the ground syndrome, which is when you are have woken up and you put your feet on the ground and the stress of your day gets your liver going and your blood sugar consequently goes up. Those can also be fine tuned with basal insulin, which needs to be handled by a doctor.

Then number next is stress. Stress is a really a blood sugar killer! It really aggravates your whole system, and it causes your blood sugars to go up. Make sure that you can prevent and avoid as much stress as you can in your every day life. How can you reduce it? Well, you have to find what works for you. Could it be yoga? Could it be meditation? Could it be a long walk in the nature? Could it be a hobby, could it be having a pet? Stress is really something that we have to work all of us, but especially people with glucose problems need to work hard at trying to eliminate it.

Next point, movement. I don’t like the word exercise, so I’m going to use movement. Our bodies are made to be moving and our bodies feel good if they get to move often and in different ways. Find out what makes you happy. What is fun for you, what way of moving is so fantastic that you just forget about time? It could be dancing, it could be the ones that I mentioned before, yoga, walking. It could be weight training, it could be dancing on the beach (which we do happen to do in Mallorca! If for nothing else, join us to find out how much fun that is in November.)

Movement has a very individual reaction on blood sugar. In the long run it definitely smooths things out. But when you’re doing exercise, or you’re moving vigorously, chances are that your blood sugar is going to go up. You need to find out what strategy works best for you. There is a rule of thumb – strength training makes your blood sugar up and cardio makes your blood sugar go down. But that’s not true for everyone, that’s just a rule of thumb! You have to find out what works for you and what happens to your body in different movement situations.

Next point is planning. Make sure that you are prepared for basically anything when it comes to diabetes. If you’re traveling, carry a glucagon kit, always have glucose tabs with you, no matter where you go. And even if you’re only doing a quick run, make sure that you are prepared for anything that can happen.

No matter how great of control you have of diabetes, things still do happen. Please be prepared for all eventualities at all times. For example, also bring enough test strips for your blood sugar meter, make sure that your insulin pump or your vials have enough insulin in them for the day or the time you’re going to be away. It is all about planning. It really is about treating and treating blood sugar – if you fail to plan, you really plan to fail. Don’t get caught in that trap. That can save you a lot of “interesting” moments with diabetes.

Next point is mindset. What is your goal? Set a clear, actionable, timely goal. Also make a plan of how you’re going to get there. Without motivation and a proper mindset, you aren’t going to reach your goals.

Next one, acceptance. Accept that diabetes is what it is, life still happens with it. And you can only do the best you can, and you can only do the best that works for you. You can’t do much more than that. And please don’t hate diabetes! The more you make it your enemy, the more it’s going to lash right back at you and you’re not going to be able to work with it, which is what you have to do. You have to be kind to yourself, you have to show yourself some love, even when things go wrong. That way you’re going to get to a better relationship with your diabetes, which is also a huge point.

Find your support network, whether that is that our coaches, CDE’s and nurses, doctors, spouses, personal trainers, and other happy people around you, like your friends, family, pets – all of these people that that create the network around you. Make sure they are supportive. This is who you turn to when you have a bad day, or when you want to celebrate a fantastic achievement. You don’t have to sit there by yourself, you can turn to other people and let them help you both in good times and in bad. When it comes to the medical side of your support network, please make sure that you have a Medical Dream Team. This is a key to getting the care that you know that you need, and to try to find out what works best for you. This is where you can really get support for your lifestyle choices, and also help you with your diabetes management.

Hydration, you have to hydrate! Make sure that you hydrate properly, because this helps the body to keep all that, perhaps, unnecessary sugar at bay. The body really does well when it is well hydrated. I personally try to aim for about two liters of clean water a day. It doesn’t have to be that for you.

Finding a routine that works for you . A daily routine, as in you get up sort of the same time in the morning, you go to bed sort of the same time at night, and everything in between. Of course you should be spontaneous and have fun, too! But the main parts that could have a little bit of a structure will help you manage your blood sugars better. Perhaps this could include when you take your basal injection, if you’re on pens or syringes, or when you change your pump site. Also work into your routine when you take your supplements, when and how much you hydrate, when you eat, what you eat, when you move… Building it into a routine is great, because blood sugars, as far as I’m concerned, aren’t too happy about uneven routines, they tend to do better when there is a routine, so that you know what you’re doing.

My final point are supplements. Some potentially blood sugar lowering supplements may be of use. The ones that I take, for example, are omega 3, vitamin D (helps autoimmunity) magnesium (high blood sugars do require a lot of magnesium), also zinc for the immune system. Chromium also can help keeping your blood sugar levels a little bit more stable, as it helps with insulin sensitivity way down in the cells. Also, I’ve heard a lot of good things, but I haven’t tried it myself yet, about alpha linoic acid, ALA.

These are my 12 steps of what I did, and my HbA1c formula to lower mine from a double digit nightmare to a healthy and happy 5.0% (which actually in fact, if I get to brag for a second, is better than even some healthy people have!). I’m very very proud of myself, especially after 34 years of living with this disease and it not having been very easy at for very long periods of time.

What is your A1c goal (or if you are not focusing on A1c – what is your health goal)?

Let me know in a comment and I’ll be happy to chat with you there.

Type 1 Thursday – Why the Dietary Wars?

In today’s Type 1 Thursday, it’s time for a more personal comment… 

Why do people disagree so strongly about what people with diabetes should eat, when we all should have a common goal (notmal, healthy blood sugars)? 

Type 1 Thursday with Hanna Boëthius – Why the Dietary Wars?

What’s your opinion about this? What tools and tricks have you tried to try to manage your diabetes and what worked for you? I would love to hear in a comment somewhere and I will be happy to chat with you there. Comments and questions are welcome!

Transcription

If you prefer to read, here’s the transcription of the episode above:

Hello, and welcome to another episode of Type 1 Thursday with me Hanna, one of the cofounders of The Low Carb Universe. Also, as I’m sure you’ve heard me say many, many times now, I’ve had Type 1 Diabetes since I was two years old. So for 34 years, I’ve been juggling this wonderful roller coaster that is Type 1 diabetes. And I am happy to share some of my knowledge with you that I figured out and some of the aces up my sleeve that I have gathered in these 34 years! I wasn’t always in control, as I am today. I was very uneven moment, even majority of my diabetes career…

But today, I want to talk about a topic on more of a personal comment. And this is actually something that I’ve gotten comments about before and also during this series, namely the nutrition debate for people with diabetes.

Why is it so inflamed regarding what you should eat as a person with diabetes? How can there be such divided opinions? Everyone who has an opinion seems to be going head to head with each other about this?

I’m actually sad about this, because we all should have that one common goal, which is that all people with diabetes are worthy of normal, healthy, happy healing blood sugars. How the person in question, who is living with diabetes, gets there should be less of a question – as long as they do. If someone comes to me and says, “Hey Hanna, I went vegan and since then my blood sugars are really great!” I’m like, “amazing, great! I’m so happy you found what works for you!” Or if someone says, “you know what, I’m following the Western diet to a tee, and I have amazing blood sugar’s” My response? “Great, fantastic!!

No one could be happier for you than I am in that moment, when you tell me that you have fantastic blood sugars regardless of how or what you’re eating, I, and I know very many people with me, who do advocate for a lower carb, real food, sugar free way of eating don’t want to be militant about it. It’s not that I want to convert every single person with diabetes, that’s not my point. It will never be my point.

But the point is to educate, to inform, and to make people with diabetes aware that they do have a choice.

There is a choice when you’ve tried everything else. When you’ve tried every single diet, every single insulin, every single supplement, way of eating, timing of insulin, there are still options. There’s always, always, always something that you can do in order to improve your health.

It’s not about being militant, it’s not about standing my ground and holding it tight. No,. My goal is for every person with diabetes, to know that there are different ways of managing blood sugar and diabetes, and it but it doesn’t have to be according to the standard Western diet, it doesn’t have to be a vegan approach. It doesn’t have to be low carb, it can be something completely different, as long as it works for YOU. The main point to find what works for you, you can’t look at anyone else. You can draw inspiration from other people who are doing something that is working for them, and then take the good parts. And leave what doesn’t work for you, it’s all about information.

I have had a struggling past with diabetes, it’s been very, very difficult for me to control my diabetes with the standard Western diet that I was told to eat for 26 years. Which, requires, well, recommends, 35 to 60 grams of carbs per meal, five times a day. For me that became unreasonable. It didn’t work. I couldn’t maintain good, healthy, normal blood sugars, without mountain tops and valley bottoms, in terms of blood sugars, which of course doesn’t make you feel great at all. It makes you feel terrible.

My whole point about advocating for low carb for diabetes, and I know very many with me, it is that as long as you get stable, healthy, happy blood sugars, we are all game for it. It wasn’t until I actually did start cutting down my carbs, coincidentally, perhaps, that I started to get better control of my diabetes. So I went from a double digit HbA1c, to a level of 5.1% last time. This is well within the healthy range!

I swear that I could not have done that without the help of dietary change, a change in my lifestyle, and a change in the way that I was eating. For me, I know that it’s not sustainable to do that on a standard Western diet with up to 240 grams of carbohydrate a day, I can’t chase that with insulin. We come back to the law, small numbers, this works a lot better for many, many diabetics.

I really wish I would have had the choice myself earlier to know about that there is a low carb way of eating so that I could have made the decision and try it out earlier, seeing the benefits. I would have saved myself a lot of pain, a lot of suffering a lot of worry, a lot of anxiety because that always comes hand in hand with wobbly blood sugars

This is this is why it’s become such a passion for me, and for the rest of us talking about low carb for diabetes, that every single person with diabetes knows that there is that option to try out as well. When every other option has been explored and transpired, that’s run out of time. It is so important to me that you know that there is another option. And that there are very many options beyond this, too. The main point is that this isn’t disregarded as an option.

So it’s so sad to me that the nutrition debate, especially within diabetes, but also generally, for the general population, has become so inflamed. And I really wish that we could see that we all have a common goal, all of us trying to educate people with diabetes, whether it is with different ways of eating, with exercise, with all of these lifestyle measures… I just would be so happy if we could just realize that we have a common goal, and that is that people with diabetes have normal, healthy, happy blood sugars.

If you have any questions or comments, or what’s your opinion about this? What tools and tricks have you tried to try to manage your diabetes and what worked for you? I would love to hear in a comment somewhere and I will be happy to chat with you there.

,

Type 1 Thursday – Type 1 vs Type 2 Diabetes

It’s Thursday – time for another Type 1 Thursday! 

Today’s topic is Type 1 vs Type 2 Diabetes. What are the differences? What are the similarities (if any)? And what about management and treatment, what are differences and similarities there?

Type 1 Thursday – Type 1 vs Type 2 Diabetes

What are your take aways from this video? Share in a comment!

Transcription

If you prefer to read, here it is:

For today’s topic, I wanted to explain and go through the differences between the two main types of diabetes. So that is, Type 1 Diabetes, as I have, and also Type 2 Diabetes that is the more common version. There are also many other versions of diabetes together with it.

I wanted to draw the outline of the sort of differences between these two, and perhaps if there are any similarities. And what about management? How does that work between the two different types?

So basically, Type 1 Diabetes, as you may or may not know, is an autoimmune disease. That means that my beautiful immune system decided that those insulin producing cells looked a little bit dodgy when I was two years old, and kick them out of commission, which is not great because that means that I am all other type 1’s will have to inject insulin for the rest of our lives no matter what we do, no matter whether we go low carb and no matter if we go carnivore – we will always have to inject some insulin. Perhaps not as much as when on the standard American or Western diet, but still a bit so that we keep our engines running, as insulin is the master hormone. And it’s very much needed. So if you don’t produce any, you have to add some.

It is, as I already said, it’s the pancreas that get or a part of the pancreas that gets kicked out. That means that I produce no insulin, but other Type 1’s may produce some, but it is nearly not enough insulin. This can be hereditary, but Type 1 doesn’t have to be hereditary. I, myself, am an example of that. I have no history of Type 1 Diabetes in my family, I am the lucky chosen one. How great is that?

Type 1’s are about 5% only of all diabetes cases. Considering there are over 420 million diabetics in the world, that means that we are very small minority. And I’m not sad about this, because I don’t wish this on anyone. It does explain that we have to do a little bit more advocacy for our type of diabetes because we are not represented as much as Type 2’s.

The onset of Type 1 Diabetes can be very sudden, and it’s usually discovered within weeks. If it’s if it’s not LADA or other side types of Type 1, you will be very, very sick very suddenly. Symptoms include frequent urination and thirst, incredible unquenchable thirst, falling asleep everywhere, because your blood sugar is skyrocketed high. There are few warnings to look out for, that can also be mistaken for the common flu. Don’t wait in case you have this suspicion, go and check it out, if it happens to a family member, for example.

There’s no cure for Type 1 Diabetes. We do have better management possibilities than we’ve had in the past 34 years that I’ve been living with the condition, but there is to date, no cure, and I’m not positive about one happening anytime soon. I secretly, or not so secret, I do wish for it every single day of my life, even if it is easier to manage with lifestyle choices, it’s not as easy as maybe it would have been without having to act as your own pancreas.

Type 2 Diabetes, what is that? That is basically a severe insulin resistance. So your body is still producing insulin. In fact, it’s actually producing tons and tons and oodles and oodles of insulin. But the problem is that your cells don’t recognize the insulin that you’re producing, making you insulin resistant, making you not be able to take up the sugar from the blood stream, making it hang around in the blood stream. That is why you have higher blood sugar in Type 2 as well. Basically, the body does not recognize its own insulin. And this can be very tricky, but there are a lot of things that you can do to improve insulin resistance even as a Type 1, but definitely as a Type 2.

Type 2 can be lifestyle related, or it can also be hereditary. But the lifestyle part is a majority of the cases.

Diabetes cases that are Type 2 in comparison to Type 1 are basically the remaining 95% (and 5% are Type 1.) This can take years to develop, although the symptoms are just the same as in Type 1, just maybe not as severe from the beginning. You might notice a need for more water over a while or you might notice that you’re more tired than usual. But that can also be attributed to stress and all these kind of things that are lifestyle related, as well. The lucky thing with Type 2 is that many cases actually can be reversed with the help of lifestyle measures, like changing your diet, movement, taking supplements, all these things that you can do with your lifestyle is to alleviate and also perhaps reverse Type 2. Even if your Type 2 has so called been turned into Type 1, which it can’t, Type 2 can only become insulin dependent, but it can never be Type 1, because it’s not an autoimmune attack on your insulin producing cells.

What are the commonalities of these two types of diabetes?

Both of them lead to the same complications. These includes retinopathy, potentially blindness, that leads to nerve damage, potentially neuropathy, and/or amputations. And it also can lead to kidney problems and nephropathy. It can lead to cardiovascular disease, it can lead to stroke… All of these things that aren’t so nice with diabetes can actually be attributed to the high blood sugars or the constant constant fluctuations in blood sugar and not the diabetes itself. If you manage to keep your diabetes at bay and keep your blood sugars at a normal, healthy level, then the risk of complications, DKA and all these things, it’s very much smaller than if you don’t and you go between minimum and maximum at all times.

A second similarity is that you have the same goals of achieving normal, healthy, stable blood sugars. Make those continuous blood glucose monitor things look like lines, not roller coasters, but lines. That goes for any diabetic, independent of type.

Thirdly, the want to reduce insulin. Before before people get angry with me here, let me explain why.

In Type 1, if you keep adding lots and lots of insulin the whole time, the risk is that you’re going to be a double diabetic. That means that you, in addition to your Type 1 Diabetes, develop severe insulin resistance so that you have both types of diabetes. For me personally, and I know very many with me, this is something that we definitely want to avoid. You can’t think of insulin as a free for all thing that can make you eat anything that you want. For those of you who works for, great! For those of us who maybe it doesn’t work for, and we need more insulin than necessary, it’s not maybe the best idea. The risk is there, and I was there myself a couple years ago, I am very sure that I had double diabetes, because I was on so much more insulin than I am on now. But it wasn’t confirmed. So I can’t say with security.

Why you want to reduce insulin as a Type 2? If there isn’t that much insulin to not react to for the cells, then maybe they start listening a little bit. It’s like a small toddler, when you scream at them, and try to reinforce your power and try to make them understand… Do they ever listen? No. If you, on the other hand, just keep calm and really give it instructions with a point and and with direction, there is at least a chance that they might listen. It’s similar with Type 2 and insulin, in my opinion.

How can you reduce the amount of insulin needed or used? How can you get stable normal blood sugars? And how can you, as a Type 1 diabetic, not get double diabetes? Lifestyle measurements. As a Type 1, as I said, you will always have to take some insulin, but it will it can be reduced. The power of nutrition in diabetes is just so immense. You can eat a sugar free, low carb, real food kind of diet (and I hate the word diet but there’s no other way of explaining it). If you eat real food, if you if you eat sugar free and if you low carb, chances are that you will be able to improve your health a lot.

This doesn’t just go for people with diabetes – this goes for everyone. Whether you have diabetes or not, if you’re healthy, if you have no health issues at all, you are always going to be better of health wise, if you eat a sugar free, low carb, nutrient dense, real food diet. That’s just it. That and of course, movement, exercise, make sure that you feel joy in your life, make sure that you take supplements if you need them. Make sure to hydrate, make sure that you have a routine that works for you. Make sure that you alleviate your stress. All of these lifestyle measurements are good for both diabetics and non diabetics.

If you have any takeaways or any ideas or any comments, let me know below and I will be happy to chat with you there.

,

Type 1 Thursday – Traveling with Diabetes

Today we’re talking about traveling with diabetes on Type 1 Thursday!

What are some tips and tricks you should bear in mind when traveling? And what shouldn’t you do?

You can find my travel check list for diabetes here!

What are your best tips for traveling with diabetes? Let me know in a comment!

Type 1 Thursday – DKA vs Ketosis: are they the same?

This is one hot potato (ha!) in the diabetes world: ketosis and DKA.

How do you get DKA, diabetic ketoacidosis? what is it, what’s dangerous? And ketosis, what is that? How do you get there, and is it dangerous, even for a Type 1 Diabetic? Check out the latest episode of Type 1 Thursday to find out:

  • Please note: This information is based on my personal experience and should not be understood as medical advice.

Andrew Koutnik is a fantastic researcher and T1D, who has summarized the difference between DKA and ketosis in a handy chart:

Physiological Differences Between Ketoacidosis and Very-Low Carbohydrate Diet.
Source: https://www.andrewkoutnik.com/blog/2018/9/8/part-3-optimal-blood-glucose-control

Andrew writes:

Ketoacidosis involves dangerously low or absent insulin which causes glucose and ketone levels to rise. A VLCKD has low to moderate insulin which is sufficient to control blood glucose in the homeostatic range while allow low to moderate elevations in ketone bodies. This pathological (ketoacidosis) versus nonpathological (VLCKD) physiological states are vastly different.

Andrew Koutnik, “Part 3: Can you Achieve Optimal Blood Glucose Control as a Type-1 Diabetic?”

I highly suggest you read the rest of Andrew’s blog post here, there is a magnitude of great information in there!

Jon us for more discussions like this at diabetes. by The Low Carb Universe in Sweden in June 2019!

What are your experiences with ketosis or DKA? Leave a comment!

Type 1 Thursday – Hanna’s Story

Join me for this week’s Type 1 Thursday!

Today, we’re talking about diabetes stories, and I will of course also share my own, full of struggles, trials and tribulations and how I’ve finally realized what is best for my own diabetes management.

If you are interested in diabetes management and hearing the stories of it, do join me at diabetes. by The Low Carb Universe in Sweden in June!

What is your story with diabetes? Leave a comment!

Type 1 Thursday – Blood Sugar Ranges

Welcome to this week’s Type 1 Thursday with me! I’m doing this series ahead of the world’s first event solely focusing on diabetes from a low carb perspective, diabetes. by The Low Carb Universe!

We’re talking blood sugar ranges today, what is normal, what can be expected on low carb and how to get there. 

Did you learn something new in this episode? Let me know in a comment below!