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 25!
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 for the sole purpose of assisting Jude and Grace if they get diagnosed in the future. I share this information with those who subscribe for informational purposes only. I don’t accept advertising or sponsorships, and I don’t use social media. In fact, I incur significant direct costs and spend countless hours creating content. What Nassim Nicolas Taleb describes as – Skin in the Game (a must-read)
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.
- 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 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%).
- 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.
- 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.
- Automated Insulin Delivery Systems: This will help explain what these device are, how to think about choosing one, and will give you the best tips and tricks for each system.
- Automated Insulin Delivery Study Day: This is for health care professionals working in type 1 diabetes and for those living with type 1 diabetes wanting a very deep understanding of AID Systems.
- 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.
- Conference Reports. My highlights from the diabetes related conferences I attend or present at.
- 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 have landed at The Glucose Never Lies due to concerns regarding CGM regulation, you need the #WeDeserveBetter and November 2023 update.
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, also 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 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 (my beautiful wife) as she is interested in doing what counts, taking action.
To clarify, when I give specific instructions in my writing, it’s meant as guidance for Dani and me, and for Grace and Jude to use in the future. It’s not intended as advice for other readers. For everyone else, this information should be considered in the context of their own unique situations and discussed with their diabetes care team before they apply any of 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 the 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 in conjunction with Dynamic Glucose Management is the ultimate.
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.
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?
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.
- Technologies.
- 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.
I am not active on social media because I believe it often operates without accountability. Individuals on these platforms can easily dispense advice without facing any negative consequences if their guidance proves harmful or incorrect. Additionally, many users are willing to profit through affiliate marketing, sponsorships, and the promotion of products despite lacking firsthand knowledge of the products’ quality. This behavioiur is reminiscent of how bankers eagerly accepted large bonuses during economic booms but were not required to return any money when the financial system collapsed in 2008—they had no personal stake or ‘skin in the game.’
However, you can drop me a message by this contact form, and I will get back to you if possible.
Next step? Start building the Foundations or read Principles of the blog.
If you want to know when a new section of blog is added, click here.
