The Glucose Never Lies®

Why create this resource?

My son, Jude, tested positive for type 1 diabetes auto-antibodies on a preliminary screening blood test. Needing to act fast, I created a comprehensive type 1 diabetes management resource. I combined relentless personal (type 1 diabetes since 2008) experimentation with in-depth clinical experience (career as a specialist diabetes dietitian) to create;

The Glucose Never Lies®

Two months after the preliminary positive result, Jude tested negative for type 1 diabetes auto-antibodies on the blood draw.

Relief?

Yes, but Jude and/or Grace could develop type 1 diabetes at any point. After all, I was diagnosed with type 1 diabetes at 27! Furthermore, children from dads with type 1 diabetes are 100 times more likely to develop type 1 diabetes. So, I shall keep my skin and soul in the game and update this resource regularly.

Skin and Soul in the Game?

I create information about managing type 1 diabetes to assist Jude and Grace if they are diagnosed in the future. I share this information with those who subscribe to or listen to the Glucose Never Lies® Podcast for informational and educational purposes only. I incur significant direct costs and spend countless hours creating content. What Nassim Nicolas Taleb describes as – Skin in the Game (a must-read).

In return, I get to learn and refine my ability to translate complex science into actionable insights to make type 1 diabetes more manageable and, dare I say, even enjoyable through trial and error!

For example, on using activity to keep glucose levels in check!, 99 Problems But Highs Aint One (click if you want to download it, use it, share it!)

Where should I start? 

Finish this page first. Ensure you understand the advice is for Jude and Grace ONLY, and those looking after them. For everyone else, it’s ONLY information. This is very important. I do not have skin in your game. I do not know you or your circumstances. Once this is clear;

Here is the master plan. Work through these in order.

1. Foundations: Your diabetes team will have done a good job at teaching the basics. However, the foundations I have put down are more than just solid.
2. Dynamic Glucose Management: It will not take long to understand how it works, but the real learning and fun come with the application. It has taken me from 85% time in range to 99%, and my HbA1c from 48mmol/mol (6.5%) to 34mmol/mol (5.3%).
3. Mealtime Insulin Guide: This goes beyond carb counting. You will learn how to get a steady CGM line regardless of eating high or low carbs- oh, and how to master pizza.
4. Exercise Guide: This will teach you how to make starting plans for all types of exercise (aerobic, mixed, and anaerobic). There’s no exercise you cannot do, you just need to plan.
5. Continuous Glucose Monitoring Systems Guide: This will help explain what CGM is, how to define accuracy, and will help you select the best CGM system for you!
6. Automated Insulin Delivery Systems Guide: This will help explain what these devices are, how to think about choosing one, and will give you the best tips and tricks for each system.
7. Automated Insulin Delivery Study Day: This is for diabetes educators working in type 1 diabetes and for those living with type 1 diabetes wanting a very deep understanding of AID Systems.
8. Overcoming Insulin Resistance with T1D Guide: This is explains why losing weight with T1D is so hard. It also offers insights into combatting insulin resistance to start making real progress.
9. Articles and Experiments: This is where I update the blog with interesting topics regarding type 1 diabetes. For example, what type of type 1 diabetes (how much c-peptide) do you have? My 120-day carb experiment (from keto to high carb) and the power of short bursts of activity to improve glucose control.
10. Conference Reports. My highlights from the diabetes related conferences I attend or present at.
11. Resources and Guides. All the best infographics, calculators, and videos in one place. This will allow you to quickly access what you need when you need it!
12. The Glucose Never Lies® Podcast: Try it and share it with those you think will benefit.

How is this blog written? 

Each section is made up of two parts.

The main part is for Dani (my amazing wife) and my family, as well as Grace and Jude when they are old enough to understand. This part explains precisely what to do with a clear explanation of why. There are no scientific references, just straight-up quality education.

The last part of most sections is for the John Pemberton of 2008. This part goes deep into the why and is littered with scientific references and detailed diagrams. The underpinning mechanisms of why strategies work are debated. It is fuelled by an obsession to know why glucose behaves in unpredictable ways.

This part will be enjoyed by those obsessed like me and have some background in physiology, nutrition or psychology. This part should be skipped by Dani (my beautiful wife) as she is interested in doing what counts, taking action.

To be crystal clear, when I give specific instructions in my writing, it’s meant as guidance for Dani and me, those who may support Grace and Jude, and for Grace and Jude to use in the future.

For any other reader, this information should be considered in the context of their unique situations and discussed with their diabetes care team before they apply any of it. I do not have skin in your game!

If you prefer to watch the above sections in videos, check out the YouTube channel.

If you want to stay up to date, listen to the Glucose Never Lies® Podcast.

If you want to know more about why I put The Glucose Never Lies together – the two beauties in the picture are the inspiration – for more detail, read on.

How would I teach Dani, Grace, and Jude how to manage type 1 diabetes?

First, I would teach, Dynamic Glucose Management, which has beaten every Automated Insulin Delivery (AID) system. No algorithm has come close to 99% time in range!

This is despite eating at least 200 grams of carbs per day, exercising ten hours a week, and running around after two energetic children.

Who was my teacher?

Something that updates every five minutes, twenty-four hours a day, 365 days a year. It has no emotion, no biases, it’s not held back by outdated theories learnt at university. It provides crystal clear guidance on what works and what doesn’t. My Continuous Glucose Monitor (CGM).

Most importantly, CGM provides objective, individualised feedback.

You only need one mantra when being taught by CGM:

The Glucose Never Lies

The main purpose of this blog is to enable my wife, Dani, to master Dynamic Glucose Management. When the time is right, the blog should be simple enough for Grace and Jude to follow and start taking the reins.

Second, in the spirit of science, I need to provide the John Pemberton of 2008 (when, upon diagnosis, I was desperately looking for help), a source that goes beyond the basics. A source getting deep into the physiological, biochemical, and psychological weeds to explain why things work.

Both Grace and Jude will likely want this deep insight if they get my curious and nerdy mind.

I know both Jude and Grace will have high standards. They will be thinking;

“Ok, 99% between 3.5-10.0 mmol/L (70-180mg/dL), that’s pretty good. What about the time in the optimal glucose range where the healthiest people without diabetes stay most of the time, 3.3-6.7mmol/L (60-120mg/dL)?”

Here you go.

Almost 80% with only 0.5% low. AID systems only hit 50% in this range.

Dynamic Glucose Management works equally well with injections. You do not need to be hooked up to a pump.

However, to ensure luxurious sleep for the whole family and less daily hassle, I think using an AID System is best for 90-95% of people living with type 1 diabetes. But, they can maximise time in range of 3.9-10.0 mmol/L (70-180mg/dL) by using Dynamic Glucose Management during the day, as required.

Are you an expert? 

No, but I am pretty close to expert status in two things.

Firstly, John Pemberton’s type 1 diabetes management.

Everyone’s type 1 diabetes is unique due to genetics, physiology, lifestyle, psychology, and environment. To think that anyone knows more about a person’s diabetes than the person does is laughable.

Since 2008, I have checked my glucose level on average fifteen times a day. Over 70,000 data points provide immediate feedback on what works and what doesn’t, FOR ME!

In truth, acquiring a good underpinning knowledge of crucial disciplines helped me learn fast. I put the time in at university and have a raft of clinical practice under my belt:

• Personal experimentation with type 1 diabetes since 2008, amassing over 70,000 data points and hitting 99% time in range.
• Lead author on multiple research papers putting Dynamic Glucose Management into action at Birmingham Children’s Hospital
• I am the author of important CGM papers, and I sit on the IFCC Working Group for CGM
• Working as a Diabetes Specialist Dietitian in the NHS since 2011.
• A 1st class degree in Sport, Health, Exercise & Nutrition.
• A distinction in Post-grad Diploma in Dietetics.
• Ongoing learning – My favourite source is “The Drive,” Peter Attia’s Podcast. You will know how much he has influenced me if you listen to The Glucose Never Lies Podcast.

Secondly, the parenting of Grace and Jude Pemberton.

Nobody, except Dani, knows Grace and Jude like me. I have watched them grow, know all their quirks, and have been by their side for all the ups and downs. My love for them is so great, I cannot express it with words.

This makes me uniquely qualified to suggest what will and will not work for them in this blog. 

Expert?

I dislike the term expert! 

It implies the person believes they know everything, and they stop learning.

“Every fact has a half-life; some are just longer than others.” – Peter Attia.

This means some of what I write will be incorrect and possibly unhelpful. I make no apologies for this. At the time of the writing, it will be the best I can do and will be created with love to help Dani, Grace, and Jude.  

Should I follow the type 1 diabetes management strategies discussed in the blog? 

If you feel Dynamic Glucose Management or any other strategies will help, it’s your responsibility to do three things:

1. Check with your health care team before trying anything – I don’t have skin in your game.
2. Don’t expect things to work the first time.
3. Apply trial and error with continual tinkering – keep what works and discard the rest.

The blog will expand over time to include:

• Partying with type 1 diabetes.
• My diabetes experiments.
• Technologies.
• Other stuff I think will help.

Grace and Jude, I hope you never have to read this blog, but if you do, I hope you will be proud. Enjoy.

How can I get in touch?

The three most important things to me, in rank order, are:

1. Husband and father with soul in the game.
2. A key member of my tribes – family, friends and the local community.
3. Diabetes educator who empowers people with type 1 diabetes.

I work full-time as a Diabetes Dietitian, volunteer for many Diabetes events, and write this blog. Any more time invested will remove my soul from the most important game, being a great husband and father.

Subscribing to the blog will provide updates and a direct email to message me, if required. Also, subscribing to the Podcast via your favorite player will keep you in the loop.

Next step? Start building the Foundations or read the Principles of the blog.