Low carb, type 1 diabetes and pregnancy

Author: Lic.Lucía Feito Allonca, Heath Law and Biomedicine. Patient’s Rights Specialist. Diabetes Educator (DE)

At International Low Carbohydrate Awareness Week 2023, Allison Herschede, BSN, RN, CDCES, gave a presentation on how to minimize risk in pregnancy for positive outcomes when living with diabetes.

Allison has been living with diabetes for 42 years, and was told to avoid pregnancy. However, she has had two successful pregnancies on the standard American diet - using high doses of insulin and having numerous episodes of severe hypoglycaemia - and one on the low-carbohydrate regimen, with normalised blood glucose levels and giving birth at 40 weeks. She has been leading pregnancy and diabetes groups since 2006 and is a registered nurse and diabetes educator. She has a book on this topic, available on Amazon, called "Grit pregnancies: How to have a healthy pregnancy and normal blood sugars with Type 1 Diabetes", available on Amazon.

THE RISKS OF TYPE 1 DIABETES IN PREGNANCY

In pregnancy with type 1 diabetes, the patient is at risk of miscarriage, birth defects and complications such as pre-eclampsia, progression of diabetic retinopathy, progression of chronic kidney disease, macrosomia (large for gestational age baby), too much amniotic fluid, neonatal hypoglycaemia, respiratory distress syndrome, jaundice, placental failure and, in the worst case, stillbirth.

As I anticipated at the beginning of the article, Allison has had three successful pregnancies, how to minimize these risks and their causes will be discussed below.

THE CAUSE OF THE RISKS

In terms of risk of miscarriage, pregnancy loss before 20 weeks gestation is more common in type 1 diabetes due to genetic abnormalities. Elevated fasting glucose is also closely related to the levels of maternal hormones needed to maintain pregnancy.

Birth defects occur mainly due to hyperglycemia. High blood glucose (sugar) levels during the first 10 weeks of gestation increase this risk.

For pre-eclampsia, macrosomia, placental failure, progression of diabetic retinopathy and diabetic kidney disease and other conditions, there is a common cause: again, these risks are caused by hyperglycemia

Dr. Lois Jovanovic-Peterson, an endocrinologist and pioneer in diabetes and pregnancy, states that "A fasting blood glucose level above 120 mg/dL in the first trimester increases the risk of macrosomia by 24%.

It is clear that hyperglycaemia or high blood glucose (sugar) levels are the cause, not type 1 diabetes per se, if properly and strictly managed, which is in our interest to do at such a special time in our lives.

RISK MINIMIZATION STRATEGIES

The levels "in range" during pregnancy are as follows:

As of 2023,the ADA recommends a fasting blood glucose level of 70

As we have seen before, hyperglycaemia is the cause behind all the risks, and to avoid it, normalising our blood glucose or blood sugar values is essential. Is this possible

Yes, it is. Allison is a coach for diaVerge diabetes and has been helping people for many years to optimise the management of their type 1 diabetes and improve their time in range and glucose results.

Some tips for normalizing our glucose levels are as follows:

• Therapeutic restriction of ingested carbohydrates: avoid cereals, sugar, starches and sweet fruit.

• Test basal insulin. Find our ideal dose.

• Test our insulin and glucose sensitivity.

• Implement the use of regular insulin or give extended boluses to cover protein in the diet.

• The use of continuous glucose monitoring (CGM).

Dr. Richard Bernstein, who has been living with type 1 diabetes since 1946 and still practices medicine, is convinced that people living with diabetes have the right to enjoy the same blood sugar levels as people without diabetes, and has provided us with his protocols and findings in his best-selling book "Diabetes Solution".

His method differs from the predominant recommendations on the global scene. Bernstein stresses that diabetes is a condition of carbohydrate intolerance, and that lowering insulin levels by eating fewer carbohydrates makes managing our diabetes a more predictable task.

As far as calories are concerned, in pregnancy we need to consider an extra 200-400 calories more than usual, 400 during the third trimester, taking into account that fat provides 9 calories per gram and protein 4 per gram, a packet of nuts contains 500 calories, so this increase will not be a difficult target to meet.

If done consciously, a low-carbohydrate eating plan can provide all the necessary nutrients. It is especially recommended to increase the intake of foods rich in folic acid (such as liver, peanuts, almonds or hazelnuts).

On the other hand, a low-carbohydrate diet can lead to nutritional ketosis, not to be confused with diabetic ketoacidosis. Nutritional ketosis is a natural state, whereas diabetic ketoacidosis is an acute and life-threatening complication of diabetes.

Basal insulin requirements may change in pregnancy and it is important to monitor them. The use of glucose tablets or similar is recommended to dose the amount of carbohydrate with which we treat potential hypoglycemias, as food is much less predictable.

Overeating, Binge Tendencies, Insatiable Appetite?

For those of us navigating the tricky landscape of type 1 diabetes, hunger is often more than just a passing craving — it can be an everyday challenge.

The truth is, it's not your fault. You are not lacking willpower. You are not lazy. You are NOT to blame.

There are very specific physiological reasons why you may feel hungry all the time. From fluctuating blood sugar levels to the complex dance of hormones, there are numerous reasons why relentless hunger pangs often accompany life with T1D.

What are these reasons and what can we do about it?

Polyphagia is the medical term for increased appetite, and there are both medical and non-medical reasons for this:

• People with T1D do not produce amylin. Amylin is hormone that is co-secreted with insulin by the pancreatic beta-cells in response to food consumption. Since beta cells are destroyed or damaged in T1D, amylin is also not produced. Amylin’s role is a physiological control of meal-ending satiation (feeling full), and it limits the rate of gastric emptying, and reduces the secretion of pancreatic glucagon after eating. So, amylin tells you when you’re full, keeps food in the digestive tract for longer, increasing nutrient absorption, and helps to control blood sugar spikes after eating. And we don’t have this incredible helper hormone. Great (eyeroll).

• Hyperthyroid/Graves disease can increase hunger levels, causing overeating.

• Sleep deprivation/interruption - Acute sleep deprivation reduces blood concentrations of the satiety hormone leptin. Leptin sends a signal to your brain that helps you feel full and less interested in food. It also plays a role in how your body turns fat into energy. Sleep deprivation also increases the hormone ghrelin, which signals hunger. This is the perfect storm to make you feel hungrier, and less full/satisfied once you eat.

• Growth hormones in kids: this is normal, and usually causes times of increased appetite, followed by an obvious growth spurt.

• Estrogen in women: ​​Increased appetite is due to spikes in the hormones estrogen and progesterone, and decreased levels of serotonin, which is a neurotransmitter. Decreases in estrogen (perimenopause & menopause) can cause both increased hunger cues and insulin resistance.

• Low testosterone in men is associated with dysregulated eating 

• Nutrient and electrolyte deficiencies: Deficiencies in iron, Vitamin D, and B Vitamins all can cause increased hunger because your body is seeking those vitamins. Request these tests at your next lab blood draw and follow your doctor’s advice to supplement, if needed.

• Blood sugar levels:

  • Hypoglycemia/low blood sugar levels cause a very real need to eat, and it’s our body’s method of self-preservation. We need to eat to raise our blood sugar level to stay alive! Oral liquid glucose or glucose gel, or glucagon treatment is the fastest way to raise blood sugar levels quickly and stop this insatiable need to eat.

  • Hyperglycemia/high blood sugar levels can also cause an increased appetite because without insulin, the body cannot process the food consumed into energy, thus craving more.

• Processed Food Addiction: Processed foods are engineered to be addictive, keeping you craving and buying more. Dr. Joan Ifland is a leader in processed food addiction research and treatment. She advocates for a whole foods diet, and removal of all processed trigger foods from your surroundings. You can find out more about her program at foodaddictionreset.com

• Complex relationship w/ food. Of course, we need food to live, but food raises our blood sugar and requires insulin. Because of this, many of the reasons above, and common diet culture, many people with type 1 have struggled with their weight and their relationship with food. It’s a complex issue, with many interconnected factors.

But what can you do about all of this? Is there a way out?

Be kind to yourself.

Talk to your doctor.

And consider increasing your protein consumption percentage.

We know that protein will keep you full for longer than carbs or fat will, that’s purely because protein foods take longer to break down in the digestive system, and per gram of food, protein foods have more nutrient density and calories than carbs or fat.

Because of this nutrient and energy density, the Protein Leverage Hypothesis states that the body craves protein for survival, and will eat until the optimal protein threshold is reached. If not enough protein is consumed, it will continue craving, and eating whatever it can to reach that protein threshold.

This protein threshold is helpful, because by prioritizing your overall protein percentage, you effectively leave little room for carbs in the diet, and consume fewer calories overall to get to that protein threshold.

Other things you can do:

Synthetic amylin replacement (called pramlintide, brand name Symlin) is available, but it has challenges to use and is rarely prescribed.

Sugar-free electrolyte supplementation is helpful, and adequate sleep (7+ hours) is a must when it comes to helping regulate the complex interplay of hormones.

If constant hunger, overeating or binge tendencies are an issue for you, please know that you’re not alone. This is a complex issue that many of us experience daily. Let’s normalize this as a part of life with type 1.

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What is diabetes? Types of diabetes

Written by Lucía Feito Allonca, Heath Law and Biomedicine. Patient’s Rights Specialist. Diabetes Educator.

There is a lot of talk about diabetes, but what is it really?

Is it a single health condition, or several?

Are there different causes for developing diabetes, or are there common elements?

With the aim of disseminating reliable information and education on diabetes, I attach this article that I wrote within the framework of the “This IS diabetes” campaign in Beyond Type 1, with the aim of eradicating myths and erroneous beliefs, harmful to our health.

The Latin phrase diabetes  “to pass through” comes from the Greek loan word  Dia “through” and Betes “to pass.” It is, according to the dictionary of the Royal Spanish Academy, a metabolic disease characterized by excessive urine output, weight loss, intense thirst and other general disorders.

TYPE 1 DIABETES

Type 1 diabetes was previously also known as juvenile diabetes due to the high number of diagnoses in children and young people. Today it is known that type 1 diabetes because it can appear at any time of life, not just childhood or adolescence.

It is a chronic condition of autoimmune origin that causes the body to be unable to produce the hormone insulin, responsible for regulating blood glucose (sugar) levels. Its symptoms are polyuria, which means frequent urination, polyphagia, which implies excessive hunger, weight loss that occurs without apparent explanation, and tiredness/fatigue.

It is important that we understand that type 1 diabetes has an autoimmune origin and that the person will depend on the external supply of the hormone insulin to live and stay healthy.

It is essential to put an end to myths and erroneous beliefs that still circulate in society, such as that “diabetes is a thing for older people” or that “insulin is for serious cases.” In type 1 diabetes, insulin is the only treatment option.

Managing type 1 diabetes involves making interventions in people's lifestyles, such as diet, exercise, and taking insulin. To carry out an adequate dosage of this hormone we must know our blood glucose (sugar) levels, a task which will require a continuous glucose meter or blood glucose measurements made with a blood sugar meter. The success of treatment will be affected by the level of commitment of the family and the environment, personal/family circumstances, as well as other socio-economic factors.

TYPE 2 DIABETES 

Diabetes 2 manifests itself when the body cannot use insulin adequately, presenting the so-called “insulin resistance.” The pancreas releases extra insulin, but over time it can't keep up with production to keep blood glucose (sugar) levels in a healthy range.

The factors that influence the appearance of type 2 diabetes are obesity, smoking, genetic factors and factors related to lifestyle, making it a multifactorial condition.

The myths that single out and stigmatize people who live with type 2 diabetes often do so because they do not understand the cause of the disease.

Also, the use of insulin seems to be associated in popular culture with negative connotations, something that we have to tackle at its roots, since allowing these erroneous beliefs has a serious associated cost: posing a psychological obstacle for many people who need it to be able to take insulin, enjoy better health and quality of life.

GESTATIONAL DIABETES

It is a type of diabetes that causes high blood glucose levels during pregnancy. It usually starts between the 13th and 28th week of the pregnancy and will disappear after the baby is born.

Gestational diabetes causes a high level of blood glucose, dangerous for your baby's health, and subsequently produces a greater risk of type 2 diabetes in the future.

LADA DIABETES 

Like type 1 diabetes, Latent Autoimmune Diabetes in Adults (LADA) is the result of an autoimmune process. This type of diabetes usually occurs in people over 30 years of age, which is why it is often misdiagnosed as type 2 diabetes.

Unfortunately, even today, many health care providers continue to think that type 1 diabetes/LADA only occurs in the child and adolescent population, and many adults are misdiagnosed with type 2 diabetes. It is crucial to breaking myths and share accurate information. Type 1 diabetes (called LADA in adults) can be diagnosed at any age!

MONOGENIC DIABETES (MODY)

Monogenic diabetes (MODY) is a type of diabetes that has characteristics of type 2 diabetes and occurs at a young age, usually before the age of 25. It is due to mutations in certain genes (there are 7 known gene mutations at this time that cause MODY) and in a single gene subtype that affects the maturation of pancreatic beta cells (insulin-producing cells) and therefore, insulin secretion. It is a type of diabetes that is frequently misdiagnosed as type 1 or type 2 diabetes.

TYPE 3C DIABETES

It is related to pancreatic diseases such as pancreatitis (of which the most common causes are gallstones or alcohol abuse), pancreatic cancer, cystic fibrosis, pancreatic surgery and hemochromatosis. Chronic pancreatitis is the most common cause and is often misdiagnosed as Type 2 diabetes.

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Even with these various types of diabetes, and a variety of medications/technologies available for management of the condition, we are more alike than we are different. We ALL have issues controlling blood sugar level. As noted above, the lines between the types are often blurry and easily confused by medical professionals, patients, and the general public.

Let’s spread awareness, understanding, and compassion for all people who are impacted by diabetes, of all types.

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Did you know of all the different types of diabetes? Leave a comment below to share!

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Low Carb Diets, Children, Adolescents, and Technology

by Lucía Feito Allonca 

In this post I will discuss two recent studies on the treatment of diabetes with a low carbohydrate diet.

Firstly, a study by the Spanish Diabetes Society where the conclusion was clear: that low-carbohydrate eating coupled with the use of technology is beneficial for diabetes management, and secondly, a recent study on low-carbohydrate diets in children and adolescents living with or at risk of developing diabetes.

Low carb diet + Closed Loop Systems: Better glucose management

In a recent study conducted by the Spanish Society of Diabetes (SED), it was found that even though up to 66% of patients with type 1 diabetes (T1D) were following a diet considered balanced, only a third of them were able to maintain an HbA1c level below 7%. Additionally, around 40% of T1D patients were overweight or obese. This raises the question of whether the conventional diet recommended for these patients is the most suitable and whether there are alternatives to achieve better therapeutic outcomes.

In the 2020 update of the American Diabetes Association (ADA) guidelines, low-carbohydrate diets were included as one of the healthy dietary options.

In T1D patients using closed-loop insulin infusion systems (hybrid closed-loop systems), it has been observed in a retrospective observational study at the Vall d’Hebron Hospital in Barcelona that combining a low-carb diet with this technology can lead to more stable blood sugar control, especially during the night when there are fewer external stimuli. 

Low Carb Diets in Children and Adolescents with or at risk of diabetes

The present study is very recent and dates from 18 September 2023. It examines the use of a low-carbohydrate diet as a tool for weight loss and management of type 1 and type 2 diabetes.

It highlights the fact that the pediatric population in the United States faces a serious problem: obesity, and that its prevalence is increasing. It is noted that low-carbohydrate diets have been used for decades in adults to improve metabolic health and treat diabetes.

Current dietary recommendations for children and adolescents with type 1 diabetes reflect those of the general population. It is common to dose insulin at mealtimes according to the amount of carbohydrate to be eaten. People with type 1 diabetes may use low-carbohydrate diets to facilitate the reduction of exogenous insulin requirements and reduce mealtime blood glucose excursions. 

However, although we are aware of success stories, there are very few data on the use of very low-carbohydrate or ketogenic diets in children and adolescents with type 1 diabetes. A study in adults with type 1 diabetes showed a decrease in insulin requirements.

A survey was conducted with an international social network-based group of adults with type 1 diabetes and parents of young people with type 1 diabetes who choose to use low or very low carbohydrate diets as an adjunctive treatment. Respondents reported excellent glycaemic control, but a poor relationship with diabetes professionals associated with mistrust and a feeling of being judged for their diabetes management decisions.

The study notes that there is clinical consensus to support lower carbohydrate intake and higher quality protein and fat intake in young people under medical supervision, if this is their choice and they have family and medical support, open dialogue about diabetes management decisions, dietary habits and choices, and regular medical follow-up with a supportive multidisciplinary team, including a pediatric dietitian.

Type 2 diabetes results from resistance to the physiological action of insulin in muscle and liver and progressive failure of pancreatic β-cells leading to relative insulin deficiency. Treatment requires addressing insulin resistance and insulin deficiency. Reducing carbohydrate can be an important and effective part of the overall management of type 2 diabetes, as it reduces insulin resistance and the demand for increasing amounts of insulin by the pancreas. As with people with type 1 diabetes, people with type 2 diabetes who use exogenous insulin for treatment can follow low-carbohydrate diets to lower blood glucose values and reduce exogenous insulin requirements.

Moderate or low-carbohydrate diets in adults with type 2 diabetes are beneficial for blood glucose and cardiovascular disease risk.

The final conclusions are as follows:

• Low-carbohydrate (<26% energy) and very low-carbohydrate (20-50g) diets are not recommended for children and adolescents with type 1 diabetes, except under close supervision of a diabetes care team.

• For the prevention and treatment of pre-diabetes and type 2 diabetes, it is recommended to reduce intake of nutrient-poor carbohydrates by minimising consumption of processed foods with large amounts of refined grains and added sugars and eliminating sugar-sweetened beverages.

• Eliminating sugary drinks and juices significantly improves blood glucose and weight control in children and adolescents.

Although the recent news headline "Low-carbohydrate diets are not recommended for children" is often published, it does not tell the whole story.

It is still possible for us as a family to decide that a diet that reduces carbohydrate intake is the approach we want to take to avoid dangerous glycaemic excursions in our children and adolescents.

With the supervision of our health care team, and regular check-ups, we can arrive at the diabetes management outcomes we want, for ourselves and our loved ones.

What Knitting a Sweater Teaches About Habits - and Diabetes Management

by Lisa La Nasa, founder of diaVerge Diabetes

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It’s time for New Year's goals and resolutions.

Today, I'm pulling back the curtain and showing you more about my life outside of diabetes management and social media.

Here's something you may not know about me:

I love textiles and fiber arts.
Sewing is my first love, and comes more naturally to me.

Knitting, though, has been an enigma (a mysterious, difficult, frustration) that I really want to change.

After 15 years of years trying to knit, with small projects here and there, sometimes finishing, sometimes not, I've decided that 2023 is my year to really get good at knitting.

I'm committed to honing my skills and I’m dedicating the necessary time to do so.

Lisa with a ball of yarn and new knitting set - and an unedited, unusually elongated head 🤣

In fact, I have a brand new set of knitting needles that I received for Christmas (thanks, Mom!), and I'm finally using up some wild multicolor yarn that I've had in my office/craft closet for the last 2 years.

Since I've knitted small projects previously but haven't been consistent with it, I have to start over each time and re-learn what I’ve forgotten.

I'm going for the gusto this time. No more taking years off and then expecting to pick it back up again. I'm going for something that I have to devote the time and effort to complete, that is a challenge and will build my skills.

I’m knitting a sweater.

This will take many weeks, and I need to devote the time every single day to get it done. To ensure this happens, I've scheduled it in my calendar. There’s a block of time every day for knitting.

• This is not just a hobby. It's personal development.

• It's learning and mastering a new skill.

• It’s being comfortable with the discomfort of being a beginner.

• It's practicing and learning from missteps.

• It's building consistency and doing it every day whether I feel like it or not.

And that's exactly what we need to do to build new habits and skills.

The bottom ribbing of my new sweater.

Plus, it’s setting an example of commitment and follow-through for my 10-year-old daughter who also wants to knit.

AND, it’s quality time as we chat while we knit together.

Diabetes management is also a skill — but it’s one that we don’t often think of in the same way.

As a result, this is not something that most people devote the time to mastering.

Even though we might have been practicing diabetes management for years, most of us only learn bits and pieces, then wonder why we’re not achieving the same results as people on the internet who make it look so easy. But that’s not fair for anyone because we’re comparing our starting point to others mastery.

The truth is, it’s rare that people with type 1 will ever dedicate the time needed to improved diabetes management.

If you’re one of those few, and improved health (and diabetes management) is on your goal list for 2023, start here:

1. Commit to making improved diabetes management a daily practice

2. Read Dr. Bernstein’s Diabetes Solution book. If you’ve already read it, read it again. ;)

3. Schedule time in your calendar DAILY for learning and putting information into action.

4. Review your data OFTEN (using Dexcom Clarity, Libreview or other program of your choice)

5. Adjust your inputs when needed (quantity and/or timing food, insulin & exercise)

6. Seek out help such as an accountability partner who can give you a friendly nudge and help along the way when you don’t feel like doing the work

We all have the power to see what parts of our lives may need attention, and focus our efforts on learning and growth.

It requires commitment, time, and focused action to make improvements. Just don’t leave your future up to chance.

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If you want to skip past many of the learning steps (and potential missteps) or you know you need accountability, structure and professional guidance along the path to improved health and habit formation, we can help.

diaVerge offers customized 1:1 coaching options and our flagship Diabetes Redesigned Membership (where you’ll get lifetime support and a Success Guarantee).

If you’re ready to build the habits of improved diabetes management, schedule a no-pressure call with me so I can learn more about you, your experiences with diabetes, and what might best help you reach your goals.

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We're DCB Open Innovation Semifinalists!

diaVerge is working to develop the future of diabetes education through the intersection of personal connection, compassionate support, and technology.

This past August, the diaVerge team, lead by Lisa La Nasa and Pat Rowe, applied to the Diabetes Center Berne (DCB) International Open Innovation Challenge for our proprietary type 1 tech solution and we were thrilled to be announced as Top 20 Semifinalist in September.

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About the DCB Challenge, from the Diabetes Center Berne website (Berne, Switzerland)

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A sneak peek at our proposal -

As semifinalists, we received mentorship from global leaders specializing in diabetes, tech, funding, and legal/regulatory considerations, many with T1D themselves.

The process of application, refining our proposal, and meeting with this group of mentors was an incredible experience that pushed us as a team to explore the 'why' and 'how' of optimal diabetes management, and what can be done to bring compassionate diabetes support & education to those with type 1 worldwide. 

Although diaVerge didn’t make the final 3, we’re incredibly happy for the teams who did. There were many well-developed, deserving proposals, but the final 3 really stood out as exceptional.

It was an honor to be among the top 20 semifinalists, and we're grateful to DCB and all of our advisors and mentors who have helped us along the way. 

This is not over, though! We're applying to other think tanks, innovation challenges, and tech accelerator opportunities. The past three months have pushed us to see what is possible - and sorely needed within the T1D community - and we're just getting started!

Stay tuned for more.  

New Year's Resolutions

With the start of the new year, it may feel like the perfect chance to start some new healthy habits.

After all, we have 365 chances to make a big change in our lives this year. Let’s be honest, though: most resolutions don't get us very far. 

In fact, the majority of people give up on their New Year's resolutions by January 17, now dubbed National Quitters Day.

According to happiness expert and New York Times bestselling author Gretchen Rubin, certain techniques can help you along the process of creating change in you life without it feeling like a chore. On the mindbodygreen podcast, she discusses her top goal-setting methods, which we've outlined for you here:

1. Look to your past

While resolutions are inherently future-focused, reflecting on the past can help you identify what works for you and, more importantly, what doesn't. "The key is this idea of self-knowledge," says Rubin. "You could ask yourself questions like Well, is there a time when I've succeeded in the past?" So let's say your goal this year is to exercise more consistently: Ask yourself, have you ever exercised consistently? "Maybe the past has a clue," she notes. "Maybe there's something that was true in the past that [you] could bring into the future."

For example, maybe in the past you’ve enjoyed working out with a friend, but you find waking up to go on a solo run more challenging. That past experience could be a clue that you thrive with accountability—so signing up for more exercise classes or grabbing a workout buddy might help you better reach that exercise goal.

Or maybe in the past you felt more energized after an evening workout than an early morning one —that experience can help you identify the time of day that might help the habit stick.

The takeaway: Reflect on your past, and you'll have a better grasp of how you'll act in the future. As Rubin notes: "You're much better thinking, What's true for me?"

2. Make your resolution a habit

After you consider what may have worked for you in the past, the key is figuring out how to make the new goal stick. According to Rubin, it's helpful to treat this goal as a habit: "The thing about habits is they are so helpful to us," she says. "They put a behavior on autopilot." And once those actions start to feel like second nature, it's easier to make them a permanent part of your routine. "Habits are absolutely crucial," Rubin explains. "Research suggests that about 40% of what we do every day is governed by habits, so if you have habits that work for you, it's going to be a lot easier to be happier, healthier, more productive, and more creative."

As for how to create a habit that lasts, she shares that it really depends on the person: "There's no magic, one-size-fits-all solution for how you want to set up a habit, whether you do it in the morning, afternoon, or night. People are going to differ on when they feel most productive, creative, and energetic." The key is learning what works for you (that's where the past reflection point comes in handy!) and testing different methods to see what sticks.

3. Track your progress.

Your brain loves rewards—so celebrate your small wins! In fact, tracking your progress can help kick-start change: "If you monitor a behavior, you tend to start to do a better job with that behavior, even if you're not consciously trying to change," she says.

She explains that tracking these behaviors in a journal or app can be rather reinforcing—she even offers a Don't Break the Chain habit tracker on her website to help people master their habits. "When people do something every day, it goes onto autopilot that much more easily," she says. "Many people find this 'don't break the chain' approach to be really helpful because once they get that streak going, they don't want to break it. They want the satisfaction of keeping it going." Even the act of monitoring is a helpful reminder that you set this goal for a reason—it helps you remember the why behind your resolutions, which many people tend to forget after the first few days of January.

4. Give yourself grace

If you try a technique that ultimately doesn't work for you? Give yourself grace and compassion; you might just need to try a different approach. Rubin states, "Sometimes, people get discouraged when something that works really well for someone else doesn't work for them, and they think, What's wrong with me? I should just try harder and try it again." Rather, she suggests saying to yourself: "There's nothing wrong with me. I've learned something about myself. This tool doesn't work. Now, I'm going to try a different tool."

The takeaway.

As we head into 2022, try these techniques to create a plan that works for you. It can be easy to compare yourself to others, but your journey is your own. Celebrate small wins and treat yourself with kindness at the end of the day.

20 Mainstream Beliefs That Keep People with T1D Sick

Imagine you were in a class where only 24% of the students achieve a passing grade.

That would feel pretty impossible, right? You might feel depressed, working as hard as you could, knowing that the overwhelming majority of your class would not succeed. Like a mouse on a wheel, doing everything you can, while getting absolutely nowhere.

A 24% pass rate might tell us that the students weren’t prepared. It even might call into question the teaching methods and resources used.

The American Diabetes Association (ADA) has published that only 24% of adults with T1D ages 18+ are achieving the A1c target of <7% (53 mmol/mol). That percentage is even lower for children.

That’s heartbreaking. What’s happening and why?

With all of today’s tools and technology, why aren’t more people meeting the ADA’s target A1c level?

What we’ve uncovered is a series of common beliefs that people with type 1 diabetes are being taught. These beliefs/misconceptions/myths/lies (whatever you want to call them), are NOT promoting health, in many cases, keeping people with T1D far from achieving a 7% A1c, and often in declining health due to chronically high blood sugar levels.

1. “People need to eat 30-45 grams of carbohydrates at each meal to live.”

   Actually, there’s no such thing as an essential carbohydrate. Our bodies produce all the glucose that our brains need through gluconeogenesis and glycolysis.

2. “Kids need carbs to grow.”

   Kids do not need carbs to grow, they need protein (and lots of it), and all the essential amino acids and fatty acids that come along with protein. High blood sugar levels caused by a high-carb diet can cause cognitive issues in kids.

3. “Even non-diabetics have large blood sugar spikes.”

   Metabolically healthy individuals eating whole foods do not have large blood sugar spikes. If you’re prediabetic, T2, and/or eating a lot of heavily processed carbs, yes, you will experience large blood sugar spikes. This isn’t healthy for anyone.

4. “Highs and lows are inevitable.”

   High blood sugar levels are due to excess dietary carbs and a mismatch with injected insulin. Lows are due to too much insulin being used to treat the carbs being eaten. It’s a vicious cycle. When you cut back on the carbs, you reduce insulin needs, greatly reducing the dangers of hypoglycemia.

5. “An A1c of 7.0% (which is the ADA target for adults) is normal.”

   Non-diabetic A1c levels are 5.6 % and below. 7.0% is hyperglycemia.

6. “Diabetes is a progressive disease”

   See #4 and #5. Hyperglycemia (high blood sugar level) is proven to cause cellular damage throughout the body, causing diabetic complications. If you control blood sugar levels, you greatly reduce the risk of diabetic complications.

7. Diabetic complications only start after many years with diabetes

   Complications can start within 10 years after diagnosis.

8. “Whole grains are good for you.”

   Read Grain Brain by David Perlmutter MD, or Wheat Belly by William David MD

9. “Protein is bad for your kidneys.”

   Protein will not damage healthy kidneys.

10. “You only need to test your blood sugar level 3-4x per day.”

    A GGM (continuous glucose monitor) is best, but if you don’t have a CGM, finger-prick testing multiple times per day (as many as you can, up 10 10-12x per day) will give you a decent picture of what’s happening with your blood sugar levels.

11. “Only correct when your blood sugar level is over 250 mg/dL.”

    To avoid hyperglycemia, we need to correct our blood sugar long before it reaches 250 mg/dL. By learning how to correct your blood sugar to your target range, you can do so precisely and safely, maintaining much lower, healthier range overall.

12. “Once you have complications, it's too late to improve your health.”

    It’s never too late to gain control of your blood sugar levels and halt (or potentially reverse) diabetic complications. Retinopathy and neuropathy require very slow and steady blood sugar improvement so as to not worsen those conditions, but it can be done safely.

13. “You can't lose weight because of diabetes.”

    High doses of insulin can cause weight gain, which causes insulin resistance, requiring more insulin. Another vicious cycle.

14. “You can't exercise because of diabetes.”

    Many people experience hypoglycemia (lows) while exercising because they have too much active insulin onboard. By reducing our insulin needs, we can exercise more safely and consistently, without having our best intentions derailed by lows.

15. “All sugary foods are equal when treating low blood sugar levels.”

    Not so. We want a fast-acting, measurable, portable supply of glucose to treat a low. Liquid glucose is ideal because it does not have to be digested before starting to raise blood sugar, like food does.

16. “Eating food that is different than what others eat is alienating, will cause emotional distress and/or an eating disorder.”

    If we normalize our experience, others will as well. Many people will never even notice what you eat. Others won’t care.

17. “An insulin pump is the only way to have better blood sugar levels.”

    An Insulin pump can be a great tool, but pumps are not the only way. Injections are also great, but they’re also not the only way. You can achieve great blood sugar levels with pumping or injections. There are best-practices and testing involved with both options.

18. “You can eat whatever you want and cover it with insulin.”

    Rapid-acting insulin has a very sharp peak of action that is difficult if not impossible to match precisely with the sharp peak of high carbohydrate foods. it’s not your fault; it’s the diet PLUS the modern insulins that have been created to ‘handle' the standard carb-heavy diet.

19. “A low carb diet is unsustainable long-term.”

    A properly formulated and personalized eating plan that helps you achieve more steady blood sugar levels is sustainable, and is easier now than ever before.

20. “Normalized blood sugar levels (as a T1D) are dangerous, or impractical or impossible.”

    People with type 1 diabetes DESERVE to have the tools to normalize their blood sugar levels, but we’re not given the options by our medical professionals. With the proper training, normal, steady NON-diabetic blood sugar ranges are achievable, sustainable and healthy for those of us with type 1 diabetes.

It hurts me to my core because often, people with T1D are shamed by our medical professionals because we're not achieving the ADA's A1c guidelines.

But the game is rigged.

We can't win by following the standard rules. 

After 13 years of type 1 diabetes, I was suffering from IBS, severe clinical depression, and worsening kidney function. I felt hopeless. I was doing everything right according to my doctors, but it never felt right to me and I still wasn’t achieving that mythical 7% A1c.

Now, after 7 years of eating low carb and easily maintaining an A1c level of < 5.5 %, it’s obvious that standard methods of diabetes management are leading to all the terrible, degenerative outcomes of diabetes.  

I’ll always require insulin and nothing is going to change that. But I no longer suffer from my previous list of complications. My blood sugar levels are predictable, and on the rare occasion my numbers are off, I know exactly what to do to correct them to target quickly and safely so I can get on with my life.

That’s what we all deserve.

*The list above was based on a diaVerge Facebook post from 2017.

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Resource list:

https://diabetesjournals.org/care/article/38/6/971/37394/Current-State-of-Type-1-Diabetes-Treatment-in-the

https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

https://beyondtype1.org/type-1-diabetes-statistics/

https://www.endocrineweb.com/guides/diabetic-neuropathy/diabetic-neuropathy-overview

https://diabetesjournals.org/care/article/44/2/301/35481/The-Evolution-of-Hemoglobin-A1c-Targets-for-Youth

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