Why write this blog?
I am a male with type 1 diabetes which means my children’s chance of getting type 1 jumps from 0.3% to 3.0%. This means Grace and Jude’s risk is ten times higher because of my genes.
The odds are stacked in their favour; however, I feel compelled to distil what I have learnt since 2008. Just in case the bookies are wrong!
Where should I start?
Here is the master plan. Work through these in order.
- Foundations: Your diabetes team will have done a good job at teaching the basics. However, the foundations I have put down are fit to build a mansion upon.
- Dynamic Glucose Management: It will not take long to understand how it works, but the real learning and fun comes 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%).
- Mealtime Insulin Guide: This goes beyond carb counting. You will learn how to get flat a CGM line regardless if eating high or low carbs, oh, and how to master pizza.
- Exercise Guide: This will teach you how to make starting plans for all types of exercise (aerobic, mixed, anaerobic). There’s no exercise you cannot do, you just need to plan ahead.
- 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!
If you prefer to watch the above sections in videos check out the YouTube channel
If you want to know more about why I put The Glucose Never Lies together – the two beauties in picture are the inspiration – for more detail, read on.
How to teach Dani, Grace and Jude how to manage type 1 diabetes?
First, I must codify my type 1 diabetes management system, Dynamic Glucose Management, that has beaten every automated pancreas system to date. No algorithm has come close to 99% time in range!
This is despite eating at least 200 grams 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 It has no emotion, no biases, it’s not held back by outdated theories learnt at university.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 feedback that is highly specific to each person. You only need one mantra when being taught by CGM:
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 with credible information. A source that goes beyond what to do. 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 4.0-10.0mmol/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. The automated pancreas systems (April 2021) only hit 50% in this range to put this into context.
Also, 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, I think using an automated pancreas system overnight, then changing to Dynamic Glucose Management during the day is favourable.
Grace and Jude, the current best options are the T-Slim x 2 with Control-IQ and DIY looping, because they run off manually set basal rates. This means jumping between closed-loop and open-loop will not mess up the algorithm. It would mess up the 670G, 780G and CAMS APS FX algorithms – more on this on a technology blog.
How is this blog written?
Each section is made up of two parts.
The main part is for Dani, Grace and Jude. 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 each section 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 as she is interested in doing what counts, taking action.
Are you an expert?
No, but I am pretty close 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 themselves is laughable.
Since 2008 I have checked my glucose level on average fifteen times a day. Over 70,000 data points providing 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 a research paper putting Dynamic Glucose Management to the test in fifty children and young people.
- Lead Dietitian for Children with Diabetes UK – Friends for Life.
- 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.
Secondly, the parenting of Grace and Jude Pemberton.
Nobody, except Dani, know 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 talk about what will and will not work for them in this blog.
Please understand when I write prescriptively in this blog, it’s not medical advice for the reader. It’s prescriptive advice for Dani and me to follow and for Grace and Jude in the future.
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?
This blog is written for Dani, Grace, Jude and the John Pemberton of 2008.
Do not mistake the information in the blog for medical advice.
It’s for informational purposes only.
Note, no therapeutic relationship is formed.
However, If you feel Dynamic Glucose Management or any other strategies will help, it’s your responsibility to do three things:
- Check with your health care team.
- Don’t expect things to work the first time.
- 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.
- Other interesting 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:
- Husband and father with soul in the game.
- A key member of my tribes – family, friends and the local community.
- Diabetes educator who empowers people with type 1 diabetes.
I work full-time as a Diabetes Dietitian, volunteer as lead diabetes dietitian for Children with Diabetes, and write this blog. Any more time invested will remove my soul from the most important game, being a great husband and father.
Therefore I have social media but am not very prolific.
However, you can drop me a message by this contact form, and I will get back to you if possible.
If you want to know when a new section of blog is added, click here.