cosmoscon

It’s been almost 6 years since I abandoned the advice of my endocrinologist (who told me that I’d have to take medicine the rest of my life to control my Type 2 Diabetes) but instead adopted the Paleo lifestyle and I’m pleased to report things are going great!

The following graphs are from blood work that I received for my annual physical and I think the results speak for themselves.

I eat close to 150 grams each of protein and saturated fat daily (while eating less than 30 grams of carbohydrates (which come solely from vegetables) and one of the arguments I hear against Paleo or Keto lifestyles is that all that fat and protein will raise my cholesterol and Triglycerides.

Well, not so much.

Cholesterol problems are not caused by eating foods high in cholesterol and fat, the problems come when you combine these foods with Carbohydrates (specifically process sugars and grains).  When you eliminate the process sugars and grains, the high fat and protein diet doesn’t cause cholesterol problems.

Another criticism of the Paleo/Keto lifestyle is that you can’t exercise because you lack the glycogen that comes from carbohydrates.  I have maintained an active lifestyle during these past 6 years and even participate in endurance activities (long runs of 10K distances) all while fueling my body with just fat and protein.

I’m an engineer by education so that makes me both comfortable with experiments and skeptical by nature. Because of who I am, I was willing to use my body as a clinical trial with an N=1 sample size to try this Paleo lifestyle out but honestly, I was not expecting to see these results 5+ years into it.  With each passing year, I am more convinced that the Medical community should lead with a Paleo or Keto lifestyle prescription as a cure for Type 2 diabetes.

The theory goes something like this – Increased exercise allows a Type 2 Diabetic to eat high glycemic index foods without seeing a spike in blood glucose levels.

I’ve written about it before but I decided to put that theory to the test this weekend.

First a little background. Although potatoes (and especially sweet potatoes) are technically ok to eat on a Paleo diet, I’ve avoided them as they have spiked my blood glucose levels since I’m a Type 2 Diabetic who has an insulin sensitivity issue that I control with only diet by following the Paleo lifestyle.  White potatoes especially spike my blood glucose levels (more than if I ate ice cream) but even sweet potatoes have a noticeable reaction.

But today I ran 7.5 miles and I decided to put this theory to the test by eating a dinner consisting of a grilled pork chop, broccoli and sweet potato fries roasted in an oven (equivalent to roughly half of a large sweet potato).

As you can see from my CGM reading, my blood glucose levels stayed in the normal range after my meal.

Notice how my blood glucose level dropped during the run, which started around 12:45.  My blood glucose after the dinner peaked at around 120 mg/dL, which is well within the normal range for even folks who do not have Type 2 Diabetes.  Also note that my blood glucose level was slightly higher after my late breakfast (around 10:30 that consisted of eggs, onions, tomatoes, bacon, avocado and mayonnaise) versus my dinner that had sweet potatoes.

It should be noted that there was an odd peak/dip/peak of my glucose levels after my dinner.  It peaked at around 120 mg/dL about 1.5 hours after the meal, dipped to below 100 mg/dL at 21:30 and then went back up at 22:30 to around 120 mg/dL.  I can’t explain this odd movement as I ingested nothing after dinner except water.

But this experiment further reinforced my previous findings that intense exercise allows me to eat foods with a high glycemic index with no adverse effects on my blood glucose levels.

Can you run long distance without carbohydrates?  That’s crazy talk, right?  Well, not so much.

In March I will reach the 20 year anniversary of being a runner and for all but the last 6 of those years, I worshiped at the altar of carbs (bread, Gatorade, energy bars, etc.) as the necessary requirement to run long distances.  But since I’ve switched to Paleo to reverse my Type 2 Diabetes almost 6 years ago, I’ve still been able to run and bike long distances with next to zero carbs prior, during and after exercise.

Let me use this post to provide evidence that you don’t need carbs to successfully participate in endurance exercise.

I’m currently training for the Ville To Ville Craft Brew Relay Race in April where a 6 person team run 75 miles from Asheville, NC to Greenville, SC and this will be the 2^ndyear I’ve done it.  This race amounts to each member of the team basically running 2 10K’s with about 5 hours in between and this is not easy!

Last year when I was training for this event I convinced myself that on the days when I trained hard (especially on days I ran twice) I needed to add back carbs to give me enough energy to complete those long, hard runs.  I noticed that although I ate carbs and my blood sugar levels did spike following that meal, they quickly came down during the run as my body cleared the glucose.  Because of my prior running experience, I thought that I ‘needed’ these carbs to tackle the tough exercise regime but this year I’m going to try something else.

Instead of loading up on carbs before a run, I’m going to load up on fat and let that fuel be my energy source to see if I can get through this training (and the race) without the carbs.

Today I put this theory to the test as I was due to run 6 miles and instead of eating a breakfast that had carbs, I doubled up on the fat.  Today’s pre-workout meal consisted of 4 eggs, 3 pieces of bacon, 3 tablespoons of mayonnaise, ½ cup of cheddar cheese, a 1/3^rdstick of real butter (from grass-fed cows), onions and tomatoes.  That amounted to about 50 grams of protein, 5 grams of carbs (all from the onion and tomato) and 75 grams of fat.

Full disclosure, on an average day I eat 150 grams of protein, <25 grams of carbs (all from vegetables) and 150 grams of fat.  So this pre-workout meal is not too much out the norm for me but the fat content was higher than my normal breakfast.

Well, what happened?

I am happy to report that I had no issues with cramps or muscle fatigue during the entire run and I actually felt like I could’ve run longer.  I only consumed water during the entire run and recovered from the run with a quick meal of ham, mayo and a dill pickle.

You can see the workout summary from my Fitbit below.

Also, you can see from my Continuous Glucose Monitor that my blood sugars stayed within the normal range all day and there was a sharp decline during the workout.

Fat is an incredible energy source but when we default to eating carbs, our body first seeks to use glycogen but that is only a temporary energy source and that is why I used to have to continue to replenish it with Gatorade, energy bars or other high carb foods before I was Paleo.  But fat is a deep well of energy that doesn’t get depleted quickly and is perfect for low intensity, long workouts.

I will continue with my ‘no carbs’ training ritual through race day on 13-APR-19 and will report back on any findings.

As a Type 2 Diabetic who has controlled my blood glucose levels by adopting the Paleo lifestyle, I’ve written before on the benefits of exercise on my blood glucose levels and it should be common practice for docs to lead with this sort of ‘therapy’ for Type 2 Diabetics but unfortunately many medical professionals lead with medicine that have horrific side effects.

Over the past month I’ve increased my exercise activity and held to a strict Paleo diet and the results from my Continuous Glucose Meter (CGM) will provide further proof to this theory that exercise and Paleo alone (without meds) will control blood glucose levels in a Type 2 Diabetic.

Here are the data to support my claim.

As you can see, my blood glucose levels are very stable in the later graph vs the earlier graph and the nighttime levels were around 100 consistently.  The estimated A1c for the last 2 weeks is also in the normal range (And not just normal for a Type 2 Diabetic, normal for someone who DOESN’T have Type 2 Diabetes).

For those interested in specifics of my exercise routine over the past month, I’ve stepped up my running frequency (moderately, only 3 times per week) and distance (long runs of only 3-4 miles) as I prepare for a 10k race on Thanksgiving and eliminated the ‘cheat’ days where I eat high carb vegetables and questionable menu items from restaurants. This is not ‘crazy’ type, high intensity workouts, just moderate jogging and cutting back on high carb foods.

It continues to baffle me why the medical community continues to ignore this ‘cure’ for Type 2 Diabetes.

It’s been about 3 months since I’ve been using the Abbott Freestyle Librecontinuous glucose meter (CGM) and I’d like to provide an update.

There are still a few minor issues with this CGM that I’ll touch on here but for the most part, this device has far surpassed my expectations with regard to real time feedback that the CGM provides with regard to lifestyle and diet changes.

The report that I just downloaded from my reader for the last 2 weeks provided some key insights that I’d like to share in this post.

Dawn Phenomena

The Dawn Phenomena relates to seemingly mysterious rises in blood glucose a couple of hours before you wake and eat breakfast.  It is something I’ve written about before and even with stick meters it’s easy to verify but the CGM provides rock solid evidence of this.

See from the graph below how many of the days over the past 2 weeks show a spike in blood glucose around 5:00 or 6:00 even though I don’t eat breakfast until around 8:00.

12-Hour Delay With New Sensor

In the manual of the sensor and reader it clearly states that there is a 12-hour period from when you install a new sensor where data is not logged.  I don’t know why this is but I suspect that it takes time to have the sensor sampling tube and electronics conditioned to the new location and it’s a minor inconvenience knowing that I’ll get 10 full days of continuous glucose monitoring.

You can see the gap in the graph below.  The sensor 10 day limit ended on 16-SEP-18 so I removed the old sensor, installed a new one and data started to be logged about 12 hours later.

Exercise Effects

I’ve seen the effects of exercise on my blood glucose the day after and the CGM really highlights this.

On 15-SEP-18 (a Saturday) I walked 22,277 steps (9.77 miles) and you can see my blood glucose on Saturday night and Sunday morning was very low even though I ate a hotdog (with a bun!) Saturday afternoon.

Gaps In Measurements

For some odd reason, there are hours where data is not logged with this CGM.  For the most part, these gaps always occur when I’m sleeping and this could be due to me rolling over on my side and the pressure on the sensor causes it to not log the data.

OK, that is all I have to report now but more will be coming later.

As a reminder to those that are new here, I am a type 2 diabetic that manages my disease by following the Paleo lifestyle and continuous feedback is a must when deciding what lifestyle and diet changes affect my blood glucose.  If you are a type 1 or 2 diabetic, please see your physician and get a prescription for a CGM so that you can manager your disease in the best possible manner to prevent a certain, slow, painful death (which is inevitable if you continue to ignore the data).

It’s been a couple weeks since I’ve tried my new continuous glucose monitor (CGM) and finally something happened the other night that validated my desire, since I was diagnosed with Type 2 Diabetes, to have a CGM.

It is extremely problematic to wake myself up in the middle of the night to use my stick meter to see what my blood glucose levels are so a CGM (that takes measurements once every minute) is exactly the right tool for this job.

I’ve often wondered what my blood glucose levels are when I’m sleeping and for the most part they’ve remained stable but the other night something caused my blood glucose levels to drop close to 50 mg/dL.

I have no explanation as to why this happened.  I don’t take medicine or insulin injections to control my Type 2 Diabetes so I can’t attribute a poor application of medication for this.  I didn’t do anything odd (that I know of) with regard to straying from my Paleo lifestyle.

And this drop occurred around 3:00 am so it’s not like I jumped up and ran a 5K in the middle of the night on an empty stomach!

Although I haven’t found a causal explanation for this, I’ll be watching this closely now that I know this happens.

I’ve been using the Abbott Freestyle Libre Continuous Glucose Monitor (CGM) for about 9 days now and I’ve had the opportunity to compare its blood glucose measurements with the Livongo stick meter that I’ve used for a couple of years now.

The following graphs show the comparison of blood glucose measurements between the Freestyle Libre and Livongo meters.

Line represents zero delta between measurements of the two meters

I have several brands of stick meters that I routinely compare and there is always a delta of at least 10-20 mg/dL so I’m not surprised that these two meters don’t measure the exact same blood glucose levels.  Blood glucose meter accuracy is about 20% so even multiple measurements with the same meter won’t line up exactly and can vary by 20%.

A blood glucose meter is no different than other meters that measure things like temperature, pressure, flow rates, etc.  There is an accuracy stated for the meter but that accuracy may not hold true for the entire range that the meter can measure.  Usually the meter manufacturer will have a tighter accuracy in a range where the measurement is more important (for example, with temperature it would be in the middle of the range where the temperature control system would expect to control).  While I can’t find this information in the literature for blood glucose meters, I’d expect the accuracy of these meters to be tighter at measurements <75 mg/dL because low blood glucose level can kill you quickly.

So while I’m not surprised that the Freestyle Libre and Livongo meters have deltas in their measurements, I am surprised that the delta between the Freestyle Libre and Livongo is always positive.  I would expect some to be positive and some to be negative (as the natural variation in measurement accuracies play out) but the fact that 12 of the 13 comparisons were positive (1 comparison had a delta of 0) leads me to assume that one of these meters has a consistent offset.

Now it should be stated that I have no idea which meter is closest to my actual blood glucose levels but that really doesn’t matter as long as the deltas continue to be consistent. With frequent blood glucose monitoring, the absolute value of these measurements isn’t what’s important; what you should be looking for is trends in the measurements that can be correlated with a diet or lifestyle change.

As I stated in an earlier post, I intentionally went off my typical Paleo diet for the first week of using the CGM so I could see what my blood glucose levels were after non-Paleo meals but next week I’ll return to my normal Paleo diet and I will be interested in seeing if the delta between these two meters decreases as more of my measurements are <100 mg/dL. If my theory about blood glucose meter accuracies being tighter at the lower range is true, this should play out in the data as my blood glucose levels drop to those lower ranges.

As I’ve written about recently, I’m coming up on my 5 year anniversary of abandoning prescription medicine treatment of my Type 2 Diabetes by using the Paleo lifestyle and followers of this blog should have noticed that I’ve done that by using data to drive my decision making process.

And while I’ve tried on occasion to take frequent measurements per day to assess what impacts diet and exercise have on my blood glucose levels, there hasn’t been a way to monitor my blood glucose continually (i.e. every few minutes) and it’s just too much of a hassle to prick your finger dozens of times a day (and expensive!).

There have been continuous glucose monitors (CGM) out on the market for many years now but they have mainly been used to pair with insulin pumps and that really doesn’t help type 2 diabetics out who don’t need insulin injections.

But recently two new CGM devices have been approved by the FDA that don’t need to be paired with insulin pumps – Dexcom G5 and Abbott Freestyle Libre.

I recently got the Freestyle Libre and started using it yesterday and I’d like to share some of my initial findings.

What’s In The Box

First off the Freestyle Libre system involves two devices – a reader and a sensor.  The meter is a handheld device that looks very similar to a normal strip reader and while you can use Abbott strips to perform instant readings of blood glucose levels, the beauty of the CGM lies with the sensor.  The sensor is a disk that has a needle that inserts below the skin and this is how it takes glucose measurements every minute.

Inserting The Sensor

Each sensor can be used for up to 10 days and they come packaged individually with a special application device and alcohol wipes.  The sensor can only be installed on the back of the upper arm (where your triceps are) and I didn’t need help with this, as it was easy to do.  You pick up the sensor with the applicator and then push the applicator against the skin to ensure the needle and sensor properly attach to your arm (there is some sort of adhesive that makes sure the sensor is securely attached (more on the quality of this attachment later).

Full disclosure, I’m not a guy who likes needles and I’m quite the pansy in that regard and I’m not particularly proud of that.  With that being said, I will say that there was a brief amount of pain that lasted a few seconds when the sensor was applied and there was a dull ache/pain for about an hour but after that I forgot the sensor was there.

Obtaining Blood Glucose Data

After you insert the sensor you then activate it through the reader but for some reason, you have to wait 12 hours before you can take your first reading.  I don’t know if this 12-hour delay is only for the first sensor you apply or for each new one and I’ll find that out in about 10 days.

But after the 12-hour delay, you can download data from the sensor by turning on the reader and placing it about 1-2 inches from the sensor.  The reader beeps and then you see a graph of blood glucose levels for the past 8 hours.   You can add notes such as info on the meal you just ate and insulin injection by tapping the pencil icon, which takes you to other menus.

Glucose Readings Compared To Stick Meter

I use the Livongo meter to take instantaneous glucose meters via the traditional finger prick/stick method and I compared blood glucose measurements (ug/dL) between the Livongo meter and the Freestyle CGM 4 times over the past 24 hours.

As you can see, the Freestyle Libre CGM was mostly higher than the Livongo meter with an average of +11.5 mg/dL.  Now it should be noted that the Livongo meter (like all glucose meters) have a larger margin of error than I’d like to see and I’m sure the Freestyle Libre CGM and Livongo are no different.  That is why I’ve always said to pay attention more to trends than the absolute values of individual measurements.  But this is something I’ll continue to watch to see if this delta continues or if the average goes to zero as the sample size gets larger.

I will say that I have good confidence in my Livongo meter because I’ve seen good correlation with my A1C measurements I get from my doctor’s office. During my visit last month I had an A1C reading of 6.0%, which corresponds, to a blood glucose level of 126 ug/dL and from my Livongo data, I’ve averaged 127 ug/dL for the last 90 days.

The Beauty Of CGM Data

OK, so that is the extent of my experience for the first 24 hours using this meter and expect many posts in the future as I dive into this new treasure trove of data but I couldn’t wait to analyze this data.

Since this was my first experience with a CGM I wanted to really put my body to the test by deviating from my Paleo diet and eating a couple meals of high carbs and follow that up with exercise to see how my body reacted.

For the past two days, prior to exercise, I have eaten a breakfast that consisted of 4 eggs and three pieces of ciabatta toast with butter and blackberry jelly.  Grains and jelly are basically verboten for me under Paleo but I have previously discovered that I can eat those prior to intense physical activity with no detrimental effects to my blood glucose levels. But that was when I measured my blood glucose levels after exercise and I had no idea what happened between the 2 hours after the meal and the end of my exercise.  Now with the CGM I can see what happens!

The two physical activities I planned were golf on 06-JUL-18 and riding my bike for 20 miles on 07-JUL-18. Golf is not nearly as strenuous as riding a bike for 20 miles so I mainly want to focus on 07-JUL-18 for right now.

As you can see from the screen cap from my Fitbit app, it took me about an hour and a half to ride 20 miles.  The manual for the Freestyle Libre states that the sensor is water proof up to 3 meters but swimming should be limited to 30 minutes.  During the bike ride, I was subjected to rain for the entire hour and a half of the ride and the sensor not only maintained its electrical functionality but stayed firmly attached even after the shower after the ride so the robustness of the sensor to water was validated.

I finished my breakfast on 07-JUL-18 around 10:30 and left on my bike ride at 11:05.  As you can see from the graph below, my blood glucose level peaked around 250 ug/dL at 11:20 but then came down to 97 when I finished my ride at 12:35.

It should also be noted that I had a dinner of pork, zucchini and mashed potatoes that caused my blood glucose levels to peak at 173 approximately an hour after the meal (potatoes are bad for me as they cause my blood sugar to spike more than if I ate something with a high content of sugar).

I should also add that the Freestyle Libre has an app/program that you can download to your computer to export the data to reports and the options available are shown in the pic below.

So much more to come regarding my new CGM later but after the first 24 hours I’m extremely happy to have this new technology to help me control my type 2 diabetes!

It’s been almost 5 years since I abandoned the treatment for my Type 2 Diabetes prescribed by my endocrinologist (Janumet) and adopted the Paleo lifestyle and I’m happy to report things couldn’t be better.

I went in for my annual physical recently and my A1c is still in the high range of a normal person without diabetes (< or = to 6.0%) and this is much better than the insane guidance from the American Diabetes Association that says folks with Type 2 Diabetes should have an A1c less than 7% which they push can only be obtained through medication.

Red Line signifies when I went off mediation and adopted the Paleo lifestyle

Everything in my comprehensive blood work was normal but I’d like to make a point that my triglycerides came down from a high reading the previous year (These readings should be below 150 mg/dL).

I attribute this to both the lack of exercise I had in early 2017 as opposed to the increased exercise regime I adopted toward the end of 2017 and continue today.

I signed up for a group relay race that amounted to me running two 10k legs with only a 5 hour break in between and I’m convinced that the training that led up to that race helped drop my triglycerides back to normal levels. That is the only explanation as my diet didn’t change in the past 2 years and the only variable was the amount and intensity of my exercise.

I should also note that when I was starting to train my body to be accustomed to running twice in a single day (I’ve been a runner for the past 19 years of my life and I can attest that running twice in the same day is no easy task….) I noticed that I had to deviate from my Paleo diet and eat grains and a higher level of carbs during the days I pushed myself to run twice.

At first I stuck to Paleo on the days I ran the doubles but when it came time for my 2^ndrun of the day my legs were dead and I had no energy.  So allowing myself to ‘cheat’ on those days gave me more energy for that 2^ndrun and my blood glucose levels on those days never strayed from levels associated with someone without diabetes – They were routinely around 100 mg/dL.  It was amazing that I could eat pancakes, muffins and pasta on those days and it was like I got a free pass!

Even with my body’s DNA, which predisposes me to be insulin resistant, increasing my exercise drastically compensated for that and my body found a way to clear the glucose in my blood stream and metabolize it in my cells.

I guess this is why you never hear of professional athletes who contract Type 2 Diabetes because their exercise regime prevents buildup of glucose in the blood stream.