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Beginning fasting

T

Type1jeap

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Hello everyone

This is the first time I've posted in a forum EVER. So I've been reading a lot of Jason Fung recently. I'm type 1 but have put on a lot of weight after having my son and am now obese. I seem to be needing more and more insulin and wonder if I'm now suffering double diabetes. There's a lot of type 2 in my family so I guess I'm predisposed.

I tried to talk about intermittent fasting with my diabetic nurse but she acted like she'd not even heard of it. I'm confident adjusting my insulin myself but it'd be nice for a bit of moral support while getting started. I'm planning to start a fasting regime on the 2nd January (have a family get together on the 1st). Was thinking 24 hour fasts where I eat dinner each day. I've got about 5 stone to lose and wanted something where I'd see progress fast. I've got lots of bone broth and green tea on standby. Apart from hypos, my main problem when I've tried bits of fasting in the last few months was heartburn.

Any advice? Is anyone else planning to lose weight in the new year?

Thanks
 
Not a T1 but I eat in a restricted window daily and have done some extended fasts in the past.

In your shoes I'd ease into it as the insulin timing, even if you are pretty sure about what you are doing, might need some tweaking.

How many meals do you usually eat per day?
Maybe try skipping one (breakfast or dinner usually the best) and eat within a restricted window for a week or so before going OMAD (one meal a day) immediately.
The last thing you want is to hypo and then need extra glucose to counteract that.
 
As a T2D I cannot comment on the health risks of a T1D fasting. I imagine great care needs to be exercised in regulating your insulin during the day. If your getting heartburn then the only suggestions I can make is that before you start a fasting program you prepare your body by going Keto and eating fats and stomach friendly foods such as yogurt or kefir. Start with 3 regular Keto meals a day to ensure you can regulate your insulin properly. You may find that going Keto and having gut friendly food will trigger weight loss on it's own. Only after your confident with a new diet regime and the insulin levels you need should you consider dispensing with one of those meals and adjusting your medication. You should view it as a long term project not a quick fix. Simply fasting for one day is unlikely going to do much, and if you are predominantly eating carbs your more likely to experience a crash and a drop in your body metabolism as your body seeks to accommodate the calorie reduction. By going gradually Keto your body will adapt to eating your body fat rather than wait for you to digest carbs. When you burn fat you will naturally lose weight. Again, because of your T1D take it slow, monitor your BSL as often as you can. Good luck.
 
You're jumping in with both feet eh? I don't know how wise that is with T1, rather than gradually going in, but I suppose it all depends on how good you are with adjusting your insulin and keeping an eye on possible hypo's.... From the sound of it though, you'll manage just fine. As for the heartburn, you might want to try drinking some water with a splash of apple cider vinegar. Takes a little getting used to, but it does work.
 
Fasting isn't recommended for type 1's as there is a risk that nutritional ketosis will turn into DKA if your ketones continue to build and can't be cleared as you don't produce any insulin. As ketone levels rise, the acidity of the blood also increases, leading to ketoacidosis, a serious condition that can prove fatal. The recommended way is good old fashioned calorie reduction (and exercise if you can). I eat 800 calories when I need to drop a couple of kgs. I suggest you ask for medical advice and support from your type 1 team.
 
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ert said:
Fasting isn't recommended for type 1's as there is a risk that nutritional ketosis will turn into DKA if your ketones continue to build and can't be cleared as you don't produce any insulin.
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As long as you keep taking your basal (pumped fast or injected slow) at the appropriate rate, it’s perfectly safe. DKA happens with a trinity of things - high blood sugar levels, dehydration and absence of insulin. Keep hydrated, keep your glucose levels steady, take your basal and nutritional ketosis won’t suddenly turn to DKA. I fast for 24h quite regularly, and suffer no ill effects whatsoever, unless increased energy and greater mental clarity is an ill effect.
 
It's still not recommended by the health care professionals. Basal insulin doesn't necessarily last the time span published. Insulin can be destroyed by your immune system, or simply used up. If you're injecting to cover meals then you have extra insulin on board to clear ketones.
 
ert said:
Basal insulin doesn't necessarily last the time span published. Insulin can be destroyed by your immune system, or simply used up.
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But it doesn’t last the time span published whether you’re eating or not. That’s why the shorter acting basals like Lantus/Levemir tend to be be split, so there isn’t the hole in cover. And you’d soon notice that hole if you weren’t eating and taking bolus insulin, because your levels would rise, thats the basis of basal testing, after all. Presumably the OP would be watching their BG levels closely when beginning to fast, so that would be quickly noticed, and dealt with by either correcting with a bolus dose, or tweaking basal doses and timings. To start with they’d be much more likely to have too much insulin in their body that too little, and need to use glucose tablets as they titrations down to the appropriate dose.

You don’t have to eat if you don’t want to, provided yourself glucose levels are where you want them. One of the worst things about diabetes was forcing myself to eat when I’m simply not hungry - I don’t do that now. One of the things they taught us on the DAFNE course was that you can eat as little or as often as you want to - just take insulin appropriately. So if you only want to eat once a day, that’s just fine.

Fasting doesn’t mean not taking insulin. If I’m not eating, my basal is running, and I still give small corrections if my levels go out of range. Can’t see an issue with that. Neither do my diabetes team.
 
Don't know if this changes your advice or not but I'm on an insulin pump so am continually receiving insulin. I'm tempted to agree with Looper that a 24h fast should be safe enough if I can contend with hypos. As I'm planning to eat dinner every day I will also be having bolus insulin for that meal. But I'll be aware of the possibility of DKA. Thanks for the feedback!
 
I'm working up to some 24h fasts with some keto days and I regularly skip breakfast now so I'm not being as daring as my first post might have sounded! Thanks for the apple cider vinegar tip - I'll definitely give it a whirl!
 
Sorry @ert I regularly fast and find it easy as long as my basal is correct. Some days I just don’t feel hungry, so eat little. I believe health care professionals are still stuck in a mindset for how Type 1 used to be managed.
@Type1jeap I would say the easiest way to lose weight as a type 1 is reduce the carbs. Look at how much fast acting you are usually injecting and reduce it gradually over a couple of weeks. If you are injecting less, then you are eating less. I haven’t counted carbs since diagnosis 6 years ago and am still the same weight I was then. I gauge my daily food intake by insulin injected. I would say 6 years in, I am healthier than on the 10 years prior.
 
I still recommend you work with your health professionals and follow their advice.
This is a good article:
https://diabetesstrong.com/how-to-lose-weight-when-you-live-with-diabetes/
 
I do appreciate your concern @ert. I have seen this article before and others like it. What I'm finding is that the NHS is often slow in moving forward with knowledge of diabetes, particularly when it comes to nutrition. As good as my health team are, they have a script they're not going to deviate from. I've decided I want to try fasting. I've had diabetes for 24 years and monitoring my blood sugars and adjusting insulin are things I am competent at doing for myself. I'm willing to take the risk of trying something out not recommended by the NHS because from the research I've been looking at and my experiments in recent weeks I think it's something I will really benefit from. Please don't be concerned. I've made my mind up to do it but will also be careful. I was more looking for tips/ people that were planning something similar for a bit of moral support.
 
Couldn’t agree more - if I’d just done as I was told and “played it safe” I’d be struggling with high levels, numb feet, encroaching retinopathy, hideous trigeminal neuralgia and a number of other things. I went off piste (low carb, keto, diy artificial pancreas) and now have a whole new lease of life. Read, research and get up to speed with what you want to try, watch levels closely, and good luck! And as for telling your team, I take the approach that’s it’s easier to seek forgiveness than permission, and let the results do the arguing for me.
 
Let me know how you go. Good luck.
 
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Out of interest, what is your time in target percentage below 3.9 mmol/l?
 
ert said:
Out of interest, what is your time in target percentage below 3.9 mmol/l?
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According to my Nightscout stats for the last 90 days, which corresponds pretty much to my HbA1c this week of 37, I’m below 3.9mmol 1.3% of the time. However the real figure is less than that, because the first 18-24 hours of a Dexcom sensor throw up spurious “low” results.
 
That's an important result.
 
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