Low Carb, High Fat vs Low Fat, High Carb

I follow a low carbohydrate, high fat diet to manage my blood sugar levels because most carbohydrates spike it to levels I consider unacceptable. My doctor recommends that I eat low fat, high carbohydrate, where the carbs are the so-called complex carbohydrates. These are things like potatoes, rice, pasta and whole wheat breads. Unfortunately, though the peaks aren't as high, I still get blood glucose spikes from these foods and those spikes leave me at higher numbers for longer.

I'm always interested to read about the research into these competing diets. Here's an interesting paper from Diabetologia, describing a comparison of low fat and low carbohydrate diets. In this case, the low fat diet did not appear to be the better choice for type 2 diabetics. Low carbohydrate diets improved glycaemic control when compared to the standard medical diet advice.

>>In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss

New Diabetes Treatment Blocks VEGF-B Protein Signalling

From "Gizmag".

According to the World Health Organization, there are currently 347 million diabetics worldwide, with 90 percent of those people having type II diabetes specifically. It occurs when fat accumulates in places such as muscles, blood vessels and the heart, causing the cells in those areas to no longer be sufficiently responsive to insulin. This insulin resistance, in turn, causes blood glucose levels to rise to dangerous levels. Ultimately, it can result in things such as heart disease, strokes, blindness, kidney failure, and amputations. Fortunately, however, an international team of scientists has just announced a new way of treating the disease.

>> Read the original article

Two Weeks On

It's now two weeks since I returned to my "normal" low carb, medium protein, high fat diet, following two weeks of 600 calories per day. The results have not been what I would have hoped for. I have regained a little weight, which I'm happy with, and my ability to exercise for longer and with greater intensity has returned. The problem is that my blood glucose levels have also increased, which is disappointing.

Before the experiment, my average fasting blood glucose (FBG) was approximately 5.6mmol/l (101mg/dL). This lowered during the starvation diet, as one would expect, to 5.1mmol/l (92mg/dL). A good improvement. However, in the two weeks since the experiment my FBG has been not only higher than during the experiment, but also greater than before the diet began. The lowest FBG I've seen was 5.7mmol/l (103mg/dL). The highest, this morning, was 6.1mmol/l (110mg/dL). The average has been around 5.8mmol/l (104mg/dL).

This doesn't seem like a huge increase and some might say that it's not that significant. I'm not happy with it though. I am disappointed with any FBG reading over 5.6mmol/l (101mg/dL) and very unhappy to see anything beginning with a 6.

I'm now considering my next experimental diet and exercise change to see if I can bring it back down again. Any suggestions a welcome!

Guest Post - High Intensity Exercise and Low Calorie Diet to Reverse Type 2 Diabetes

I'm really please to be able to bring you a guest post from a really good friend of mine, Pete. I used to work with him up until around eleven years ago and we've stayed friends since. When I was diagnosed, Pete was really helpful and supportive. He was able to give great advice from his knowledge of type 1 diabetes, which affects a family member. Little did we know that within a couple of weeks of my diagnosis, he would also be confirmed as a type 2 diabetic. However, through a similar plan to my experiment, and with a lot more strenuous exercise, Pete was able to reverse his diabetes to the point of passing a glucose tolerance test. No longer diabetic, not even pre-diabetic, here's Pete's plan in his own words...

                                          

I have been following Richard’s experiment with the 600 calorie diet on his blog with great interest.

I should say at this point that Richard is a very good friend of mine who I have known for over twelve years. I have a very personal interest in seeing Richard succeed with his 600 calorie diet: I was diagnosed with type 2 diabetes at the end of February 2012, some 6 weeks after Richard received his own bad news on the subject.

Luckily for me (and Richard) the BBC showed “The Truth About Exercise” on their Horizon program. This demonstrated the link between high intensity exercise, regular exercise and reducing blood fat levels and, importantly, visceral fat deposits. The program demonstrated the link between visceral fat around the pancreas and liver and the development of type 2 diabetes. Visceral fat is the stubborn, hard to get rid of fat that accumulates around internal organs. It is thought that the presence of this fat around the pancreas inhibits the correct production of insulin.

There is also some evidence that fat cells are more resistant to insulin than muscle cells. If a person has more fat cells than muscle cells, then the insulin becomes less effective overall, and glucose remains circulating in the blood instead of being taken in to the cells to be used as energy.

Horizon highlighted a recent study by Dr Niels Vollaard, of the University of Bath, into the application of HighIntensity Training (HIT) for the reduction of visceral fat.

Clearly the Horizon program was of great interest.  To cut to the chase, the key to HIT is as follows:
Use an exercise bike, cross trainer or similar, set it to a high resistance and perform the following exercise 3 times a week:

·         Cycle / run flat out, as hard as possible for 20 seconds (timed).

·         Rest for 40 seconds.

·         Repeat the above 2 more times, making a total of 3 high-intensity bursts of exercise over 3 minutes.

WARNING! Do not attempt this without first consulting your GP, making them fully aware of what you intend to do, and having a physical. Please also watch the Horizon program carefully before embarking on this.

Richard and I also discovered another study at the same time, at Newcastle University, showing that a very low calorie diet of 600 calories a day could reverse type 2 diabetes.

I consulted my GP with an idea. What if I applied both techniques together? What if I began using HIT and the low calorie diet in concert? My GP gave me a clean bill of health to proceed, but told me to be careful and to monitor my weight and, in particular, to watch out for adverse physical reactions (heart palpitations, dizziness and so on).

I needed to lose the weight. When I started I weighed 93 ½ kilograms (that’s 14 stones 10 pounds in old money) – I’m only 5 feet 8 tall – too heavy!

Fortunately I spent many years doing martial arts and gym work (but obviously that had lapsed!).  Nevertheless I was determined to try this. On my first HIT session I had already eaten. Bad idea. I was sick afterwards. Tip: only do HIT on an empty stomach!

The 600 calorie diet was another ball game and the first 3 weeks were very tough. I would go to bed hungry. I would wake up hungry. I was hungry all day. I cut out all lunch (something I still do).  However, I designed a very low carb, low fat, protein high diet, which incorporated plenty of green veg and salad (I have included it at the end for interested readers). I also ran it by a dietician, who OK’d it (but frowned at the lack of lunch). However, after 3 weeks the hunger subsided and I started getting the weight off.

I also steadily built up my use of the cross trainer. I do the HIT sessions on setting 5 of a maximum 8 on resistance. I have built up to doing a session in the morning of between 2.5 – 4.0 miles (time sometimes limits me to 2 miles) on the cross trainer, 100 press-ups, 100 sit-ups and 40 arm curls with 13 Kg weights. Of course, I didn’t start at that level. Initially I was doing ½ a mile and twenty press-ups. But I do them every day, unless there’s a good reason why I can’t. I soon moved into a session on the cross trainer in the evening as well. Now I average around 4 – 5 miles an evening, taking around 20 - 25 minutes on average.

The exercise, in addition to HIT sessions is essential. Remember, the heart is a muscle. If you start fasting and don’t exercise, your muscles may begin to atrophy somewhat – the heart is a muscle! So keep the all muscles fit and healthy.

All the time I tested my blood glucose levels. After a while they started to reduce, bit by bit.

So what was the outcome?  At the end of May 2012 my GP gave me a second glucose tolerance test. The results were startling. My GP was delighted to tell me that I no longer had type 2 diabetes.

I should add that I tested my blood glucose with a proprietary glucose testing meter (about 8 or 10 times a day) for the entire time. I still test my blood, but not quite as many times a day.

Is it a miracle cure? No. I know now that I will always be predisposed to develop type 2 diabetes – if I let my discipline falter. So I monitor my weight, I eat sensibly and I check my blood glucose. I will always do the exercise. Why? Because I was in a place physically that I couldn’t afford to stay in and I definitely don’t want to have to take the medication. Downsides? I had to buy a new set of clothes. I now weigh 11 stones 2 pounds. I kept one pair of my old jeans so I can remind myself now and again of where I had allowed myself to get to. My wife says I have a cute tush again (I might be exaggerating).

I cannot claim that this will work for everyone – it depends on each individual’s physiology and whether there are any other underlying factors. However, it worked for me. Just remember if you decide to try this – MAKE SURE YOU INVOLVE YOUR GP AT EVERY STEP!

And now, the diet! You’ll notice it’s not all exactly 600 calories. That’s because I slightly tailored it to that fact that I work for a living (albeit a desk job) and was doing increasing levels of exercise over time. Plus you have to have the occasional treat!

Download the diet (PDF)

Undesirable Results

It's now a few days since I stopped the 600 calorie diet and reverted to my more normal low carbohydrate plan.

On the day I stopped, I decided to treat myself to a takeaway meal. I had quite a large Indian meal with lots of chilli-infused curry and vegetables. As I avoid the rice and bread, I had this with a salad. The results of my blood glucose tests weren't bad but were not marvellous either. One hour after eating my BG was 6.3mmol/l (133mg/dL). After two hours it was higher, at 6.8mmol/l (122mg/dL). The first reading I was happy with, the second I wasn't. However, I had never eaten that particular meal before so wasn't sure what to expect.

The other days I've had since increasing my calorie intake were pretty normal, except that my fasting blood glucose has been a little higher than normal, averaging around 5.8mmol/l (104mg/dL). That's about 0.3mmol/l (5mg/dL) higher than I'd expect. Not the end of the world but certainly not improved by the two week starvation diet.

More worryingly, today's readings have all been higher than I like. It may be that I've an infection that I'm unaware of that's skewing the results or it may be "just one of those days", but "those days" make me nervous. My fasting BG this morning was 5.9mmol/l (106mg/dL). One hour after lunch, which was a small green salad with no dressings, I had 6.3mmol/l (113mg/dL). My evening meal gave the worst results though. It was a salad with a few Indian tidbits, some nuts and some cheese. I tested after 1.75 hours and recorded 7.9mmol/l (142mg/dL). That's the highest reading I've had since near my diagnosis and I'm very unhappy with it. I had to beat it into submission with a 2km run (not so pleasant in the dark, cold and wind we have here this evening). It had to be done though and got my BG down to a more reasonable 4.7mmol/l (85mg/dL).

I'll keep an eye on this and let you know if it's a blip, an infection or a new pattern emerging.

Week Two

That's week two complete. It really wasn't difficult to survive on 600 calories per day for me. I lost some weight (quite a lot actually at around ten pounds) but that's partly the point of the experiment so I won't worry unduly about it. My average fasting blood glucose numbers fell by about 0.5mmol/l (9mg/dL) but stabilised at that point and didn't go any lower. My body fat percentage fell by about 2% (or 10% of the starting value).

I've now got to think about what I'm going to do from now on, since I return to work on Monday. I also want to increase the amount of strength training I'm doing and I've found that I've not been able to do this on the low calorie diet. In fact, in some exercises I've been unable to even continue with the same weight, sets and repetitions that I could do before the experiment. I've decided that for the next week or two at least, I'm going to return to my "normal" diet. This isn't normal in the English sense; I won't be eating meat, as I haven't done so for twenty-five years, and I won't be eating bread, rice and pasta. It will be the normal-for-me, low carbohydrate, high protein, high fat, high fibre, vegetarian diet.

I'll keep an eye on my blood glucose over the next couple of weeks and report back on any improvement or deterioration. This might help me understand whether the low calorie diet has made any difference. I could do a glucose tolerance test - drinking nearly a full bottle of Lucozade and monitoring the blood glucose over two hours - but this isn't something I want to put my body through.

Alzheimer's = Type 3 Diabetes?

From "The Guardian".

Even if you can detach yourself from the suffering caused by diseases arising from bad diets, you will carry the cost, as a growing proportion of the health budget will be used to address them. The cost – measured in both human suffering and money – could be far greater than we imagined. A large body of evidence now suggests that Alzheimer's is primarily a metabolic disease. Some scientists have gone so far as to rename it: they call it type 3 diabetes.

>> Read the original article

Day Eleven

After yesterday's low fasting blood glucose level, today's was a return to normal for the experiment at 5.1mmol/l (92mg/dL). There's not a lot more to report really. I've decided that I won't continue posting a message every day. I'll now post weekly or if something out of the ordinary happens. I'll continue updating the progress chart, though I suspect that I'm not going to see much change. It does appear that my FBG numbers are sticking around the 5.0mmol/l (90mg/dL) mark.

Dr Jay Wortman on "Curing" Type 2 Diabetes

I found this video a while ago after switching to a low carbohydrate diet to control my type 2 diabetes. This doctor made the switch and found this helped his type 2 diabetes, lowered his blood glucose, helped him lose weight quickly and stay diabetes drug-free.

I added the quotes around the word "cure", as to my mind this is a way of controlling and reversing type 2 diabetes but not necessarily a way of curing it outright.

Enjoy.

 

Day Ten

Ah, a return to normal. Or is it? Actually this morning's fasting blood glucose level was much lower than it has been; it's actually the lowest FBG I've ever had, at 4.3mmol/l (77mg/dL). That's the kind of number I'd be over the moon to see every day. However, I suspect that this is unlikely.

Still no hunger but I have noticed a large change in my sleeping. Over the period of the experiment I've been sleeping less each night. Last night was a particularly extreme example though, as I found I was unable to sleep until late into the morning and, so far today, I have been operating normally on just one hour of sleep. It will be interesting to see how this develops.

Day Nine

I wonder if I'm being punished for my slight indiscretion yesterday or if today's fasting blood glucose is just a weird result. This morning's reading was the highest of the experiment and one that I would have been disappointed with even if I was not trying this diet. I scored 5.8mmol/l, which is 104mg/dL. I'm guessing that this isn't bad for some type 2 diabetics (some may even think it's a good value) but I'm not happy with it at all.

I hope it's a one-off and that this lowered calorie intake is not affecting my glucose tolerance in the wrong direction. I would normally eat double the calories that I did yesterday and not expect to see a poor result in the morning. However, I can't see it as too significant as there are lots of reasons why I could get one high reading other than a problem. It may be because I am not taking the readings at the exact same time every day, I'm not eating or waking at the same times either. It could also have been due to the error allowance of the meter. My meter gives an accuracy of +/- 10% at this range, so my actual blood glucose was between about 5.3mmol/l (95mg/dL) and 6.3mmol/l (113mg/dL). It's a shame they can't be more accurate.

So I'm not going to dismiss this high reading but I am not going to worry unduly yet. Only if I see more high numbers will I become concerned.

Day Eight

I have to confess that today I ate more than 600 calories. After two miles of running and a three sets each of eight weight-training exercises I needed some protein so had some nuts and an extra whey protein shake, bringing my total calorie intake to around 900. Not too bad but not the target I was really aiming for. I'll be doubling my efforts for the rest of the week.

Today's overeat (if that's a sensible thing to say about 900 calories) made me think about the way that I want to approach this experiment over the coming weeks. I've been losing weight too quickly, and some of that has been muscle. I've also been finding it more difficult to concentrate occasionally, which is not a good thing in my job. I've therefore decided that the remainder of my two week break from work will continue as planned, eating 600 calories per day. I had previously considered continuing this for a further four to six weeks. I've decided instead that I will increase my calorie intake after the second week.

I'm not sure what target I'll aim for but I expect that it will be around the 1,000 calorie mark, perhaps 1,200. This will still leave me with a large calorie deficit so I should continue to lose fat but hopefully I'll be able to maintain muscle. The aim of this experiment is to try to lose visceral fat, which the original study suggested allowed the liver to have improve insulin sensitivity, hence "fixing" the type 2 diabetes. Hopefully a slightly increased calorie count will allow me to lose any remaining visceral fat and reap the benefits.

Today's numbers: fasting blood glucose was 5.2mmol/l (94mg/dL). The highest yet since the starting Saturday but still lower than my previous average.

Week One

Week one is now over. I probably should have monitored more information than just my fasting blood glucose and weight. However, that's the only data I have so it seems worth reporting on.

During the first week my average fasting blood glucose, including the Saturday where no change had been made before the FBG reading, was 5.1mmol/l (92mg/dL). I've gone back through the readings from the week before the experiment and found that my average FBG was 5.6mmol/l (101mg/dL). So that's an improvement of 0.5mmol/l (9mg/dL). Not a huge jump but my starting numbers were pretty good.

My weight has plummeted from the lack of food (hardly surprising!) At the start of the experiment I weighed 11 stones, which is 154 pounds or 69.9kg. After just one week I have lost 6 pounds to reach 10 stones and 8 pounds, which is 148 pounds or 67.1kg. My BMI has fallen from 23.4 to 22.5, both of which are in the "healthy" range. My body fat percentage, measured using electronic scales and some form of magic, dropped from 20.1% to 18.6%.

On the body fat percentage, a starting point of 154 pound in weight and 20.1% body fat suggests that total fat used to have about 31 pounds of fat and 123 pounds of other "stuff". With the new weight and body fat percentage I now have 27.5 pounds of fat and 120.5 pounds of stuff. That means that I've lost 2.5 pounds of something that isn't fat. Assuming that my brain and bones haven't shrunk, some, if not all, of that must be muscle, which is concerning.

Day Seven

Seven days of the experiment now complete. A full week of "starvation" and I still don't feel hungry. It's starting to feel like I'm cheating as this is far too easy so far. I do feel like I want to eat something nice but it's more from boredom with my current diet, rather than actually feeling any hunger pangs.

One thing I have noticed is that my ability to concentrate for long periods is suffering slightly, but not much. I'm getting restless when I do one thing for more than an hour or two, wanting to do something else instead. Having said that, that is pretty usual for me when I'm not at work.

Fasting blood glucose was 5.0mmol/l (90mg/dL) this morning so about average for this experiment. I didn't do any specific exercise as I spent the day doing DIY (tiling) and also went for a four mile walk.

Week two starts tomorrow. I'm not sure whether this will be the final week of my experiment or not. If my concentration remains affected I'll have to start eating normally again before I return to work. If my concentration is OK, I may continue further.

Day Six

Day six and still no hunger. I'm starting to come around to the idea that the hunger won't arrive.

I had a blood test today and it happened that the person taking the blood was the surgery's nutritionist. I had a little chat with her about a friend who managed to reverse his type 2 diabetes following a similar process to my experiment (I've asked him to write a guest post about this). I didn't mention my experiment as I wanted to avoid a lecture.

I expected the nutritionist to tell me that eating so little was a bad idea and to give me the usual information about eating low fat foods and lots of complex carbohydrates, and that curing type 2 diabetes was not possible. It was a pleasant surprise when she nodded enthusiastically and said that the best diet for type 2 was the Cambridge diet. I don't know much about this diet so I won't recommend it (or link to it). She said it was a very low calorie plan based around milk shakes. She even went as far to say that people who followed this plan and lost weight through it had been cured. Unfortunately, she said it wouldn't be suitable for me as I'm too thin.

Today's food was a change. No salad today (though maybe later for a snack as I've got 53 calories spare). Instead a plain two-egg omelette and a couple of slices of vegetarian "bacon". This food caused a peak blood glucose of 5.0mmol/l (90mg/dL), which was actually lower than my fasting blood glucose today, which was 5.1mmol/l (92mg/dL).

Day Five

Five days in and still no hunger. Surely it will come eventually! The only effect I noticed today was that I felt tired this afternoon during a walk. However, I had been for a run before the walk so it could just be that. It was nothing serious, I just found that after the first couple of miles I became fed up and wanted the walking to be over.

Fasting blood glucose was a little lower again this morning at 4.8mmol/l (86mg/dL), which is the lowest I've ever recorded. I've created a chart now that there are a few results so you can see the progression. My fasting levels are definitely lower than they usually are, by an average of about 0.5mmol/l (9mg/dL). I'm not sure how significant this is in terms of improved health but every decrease is a bonus.

My highest blood glucose readings today were both 6.1mmol/l (110mg/dL). The first time I got this reading was immediately following my morning run. This is the first time that running has increased by results; normally a run lowers my BG significantly. The second was ninety minutes after my evening salad. I won't bore you with the details of my food; they are pretty much the same as the previous four days: whey protein shake, vitamin supplements, salad and some nuts.

My concern at the moment is my weight loss. In four days I've lost four pounds. I'm still at a good weight for my height but if this continues for too long I won't remain that way. I'm hoping my weight stabilises somewhat, though on such a calorie-restricted diet this is unlikely. If the weight loss slows a little I'm be happier.

Day Four

Four days into the experiment and I've now consumed a total of 2,400 calories. That's 100 calories fewer than the recommended intake for a single day. And yet, I still do not feel hungry.

My fasting blood glucose was a little higher than yesterday at 5.0mmol/l (90mg/dL). That's about as low as I would normally see before the experiment but slightly disappointing after yesterday's lower number. I guess there's a range that my body likes to be in and it's doing its best to stay within that range with the limited fuel I'm giving it. Certainly I'm not at risk of hypoglycaemia at present.

Reporting on my food intake is going to be quite repetitive. Vanilla protein shake, coffee and salad. Today Lisa prepared me some delicious garlic mushrooms using 8 calories-worth of mushrooms and 15ml of olive oil infused with garlic. There's little to tell on the food side because there's not a lot of food to talk about.

I spent four hours cleaning, polishing and waxing my car today so not much time left for exercising. I did some weight training afterwards, fitting in five exercises with three sets for each. One of the exercises seemed more difficult than normal and I couldn't finish the third set. I'm not sure if this is due to lack of energy from the diet, if I was fatigued from all of the car polishing or if I'm getting a little bit weaker; I hope my body isn't starting to use my muscles for food instead of that nasty visceral fat. I've read that you should be able to fast for a long period without losing muscle mass as long as you keep exercising. I hope that's true - only time will tell.

Paracetamol Overdose Drugs and Type 2 Diabetes

From "The Scotsman".

A MEDICAL breakthrough has given Scotland’s 200,000 sufferers of type-2 diabetes fresh hope of avoiding heart disease – the major cause of reduced life expectancy in sufferers. Scientists at the University of the Highlands and Islands (UHI) have discovered that a drug used in reversing the effects of paracetamol overdose has the potential to reduce the risk of heart disease in patients.

>> Read the original article

What Constitutes Success?

I've been thinking about the goals of this experiment and how I measure those goals. Firstly, the goal. Clearly the ideal would be to cure my type 2 diabetes. However, cure is a loaded word. Lots of people have claimed to have cured type 2. Every other day my Google Alerts box gets another so-called cure. Some  are studies by professional scientists that have been blown out of proportion by the media. Scientist says, eating dust seems to show, in a tiny uncontrolled study, that insulin resistance was lowered by an almost statistically insignificant amount. The newspapers turn this into, "Dust Miracle Cure for Diabetes!" (not a typo - they would drop the type 2 part as well).

Another bunch of alerts are snake oil salespeople. Perhaps I'm a cynic but I'm unconvinced by a magical diabetes cure that couldn't describe on page one of an overly colourful dedicated web site, but could be explained for just $19.95. If I had discovered that cure, I might not try to get a few pounds or dollars for it. Instead I might subject it to scientific scrutiny via the peer review process. I might not get my $20 a sale for a year but I may well get a Nobel prize, a patent and become a hero for millions of people with this terrible disease.

Anyway, the goals...

I'll see this experiment as an amazing success if my blood sugars normalise and I can eat "normally" again. That means that I can eat carbohydrates without spiking my blood sugar over 7.0mmol/l (126mg/dL). Will I go back to eating high carbohydrate food? Probably not. I wouldn't mind being able to go out for a meal once a month and not have to hunt around the menu for the one (if there is one) low-carb, vegetarian meal. An occasional relaxation of the low-carb diet, rather than giving up on it.

Would that be a cure? Maybe, maybe not. Talking about a cure is controversial to many. Some would say that normalising my blood sugar and insulin response would not be a cure, but would be remission or reversal of diabetes. The expectation is that going back to my old style of eating would reverse the reversal and I would become diabetic again. This is probably true and is the reason that I will never become a high carbohydrate eater again.

I suppose what I'm hoping for (and I'm not that hopeful to be honest) is something better than being in a position of managing my diabetes, along with the daily, nay hourly, work that this entails.

Day Three

This is getting confusing now. Three days into the experiment and I'm feeling no adverse effects. Despite only five hours of sleep last night, and just 1,800 calories eaten in three days, I feel fine. I've been slightly tired but I'm pretty sure that that's the lack of sleep, rather than the deficit of food. I haven't felt hungry today at all.

I started the day with a blood glucose reading that was within the "normal range", at 4.9mmol/l (88mg/dL), which matches my lowest ever fasting blood glucose reading. No headache this morning and no hungriness. I have lost two pounds of weight in just two days, which is a bit of a worry. Hopefully that's fat from my liver and around my pancreas, which the original study suggests may be one of the problems that causes type 2 diabetes.

My food intake was essentially the same as yesterday. A vanilla shake for breakfast, some coffees (I needed those today) and a large salad for an evening meal. With today's salad I had a couple of soya sausages, which meant slightly less olive oil. I've had another few peanuts to take my total up to the magic 600 calories.

No specific exercise today. Instead I went to the seaside with my wife, Lisa. A day at Scarborough in North Yorkshire gave us the opportunity to walk down the coast and back for a total of around five miles. Half way through this walk I checked my blood glucose. The level was 4.4mmol/l (79mg/dL). This would be an excellent reading for me normally but I think signifies nothing except that I'm not eating a lot.

I got to see a very tall, metal chap who I may have mistaken for Santa on his day off. (I asked for a new bike for Christmas but I don't think I'll be lucky - he looked grumpy). Still, I got to sit on his knee for a minute half way through our walk whilst Lisa took a snap (inset).

The image to the left shows the first mile and a half of our route. It was the perfect day for walking. Quite warm and dry and the tide was out so we didn't get splashed.

The cliff in the distance isn't the end of the journey. The road continues round for another half mile or so before reaching the town centre, the amusement arcades and the many tempting food outlets. These sell chips (the British kind that you eat with fish), donuts, ice cream and some of the biggest, sweetest sweets you can imagine.

Lisa had a tray of chips (photo to the right). I used to eat chips quite often but I had a meal with just six chips soon after I had got my blood glucose levels under control and found they spiked my BG badly. At first I missed them but nowadays I don't really care any more as my tastes have changed drastically. I did like the smell of the vinegar though.

I had a black coffee and no food. Ha ha!

Day Two

I thought day two would be a problem but actually it was another pretty easy day. I started the day with a minor headache; nothing too bad, more of a niggle than a real pain. Not sure if it's because of the dietary changes or because of a late night last night. My fasting blood glucose was 5.2mmol/l (94mg/dL), which is on the low side of average for me.

Breakfast was another chocolate flavoured protein shake made with soy milk. I think I'll have to restock on almond milk for a bit of a change another day. I've also got some vanilla flavoured whey protein to mix it up a little.

Because of the late night I had my breakfast shake pretty late too so didn't bother with one at lunch time. Instead I went for a walk for an hour, after which my blood glucose had lowered to 4.5mmol/l (81mg/dL). I'm quite pleased with that, though not surprised as my calorie intake at that point was 730kcal in 36 hours.

Evening meal was salad again. As I had over 450 calories to play with I had a huge salad of lettuce, cabbage, peppers, tomato, onion and jalapenos, with 75 calories worth of quorn thrown in. Adding 15ml of olive oil brought the calorie count to 327. Subtracting the calories from a couple of cups of coffee left me with approximately 125 calories for the small bowl of nuts I'm currently munching as my last snack of the day.

During the day I've taken my BG reading several times. The highest value I've had was the fasting level this morning of 5.2mmol/l (94mg/dL). One hour after my main meal I had the same value again. Two hours after eating this was just 5.1mmol/l (92mg/dL).

Surprisingly I haven't felt hungry or tired today at all. I suspect this may change tomorrow.

What are Normal Blood Glucose Levels?

One of the biggest problems I found when I was diagnosed was that it was hard to find out what the "normal" blood glucose (BG) levels are. Actually, at first I didn't even measure my BG as I received the standard advice for a type 2 diabetic who has not yet been prescribed any drugs: eat lots of complex carbohydrates, little fat and don't get a BG meter. For a couple of weeks I followed that advice but I also did my own investigation, starting with Gretchen Becker's excellent book, "Type 2 Diabetes: The First Year". This changed my mind about the dietary advice I had been given and made me decide to buy a meter. I'm glad I did as my fasting blood glucose (FBG) was not improved since diagnosis, still being 8.0mmol/l (144mg/dL) or more.

So what are normal levels? To be honest, I still wonder because there are so many different answers to a seemingly simple question.

Diabetes UK say that before meals normal BG is between 3.5 and 5.5mmol/l (63 to 99mg/dL) and below 8.0mmol/l (144mg/dL) two hours after eating. On the same page they give more relaxed numbers for diabetics to aim for. I prefer to aim for the normal range at all times as I believe from my own research that this will lower the risk of diabetic complications to near normal levels. However, for diabetics that use insulin or oral BG-lowering medications there is logic in aiming higher to avoid hypoglycemia.

Diabetes.co.uk have slightly different "normal" levels. They suggest that before meals a normal person's BG is between 4.0 and 5.9mmol/l (72 to 106mg/dL), a little higher than Diabetes UK. Post-meal they are a little more stringent, suggesting 7.8mmol/l (140mg/dL). This lower two-hour post-meal number is interesting as some studies have shown that damage to the body starts, or increases greatly, when 7.8mmol/l is reached. However, reading down the linked page you see that for diabetics they still say to aim for values that are higher than these numbers.

If you take a look at the Wikipedia article, the normal blood ranges are shown as quite different from those of the above two diabetes organisations. The normal value is given as 4.0mmol/l (72mg/dL), though this fluctuates throughout the day. The article goes on to say that the normal test result before meals would be 3.9 to 7.2mmol/l (70 to 130 mg/dL). This is a substantially larger range than already mentioned. Wikipedia specifies that a post-meal reading of below 10mmol/l (180mg/dL) is normal. This is a large different indeed - I need to increase my carbohydrate intake by a substantial percentage to see the difference between 7.8 and 10mmol/l (and a 10 on my meter would make me very nervous indeed!)

Netdoctor says similar things to Wikipedia, as does the ADA (American Diabetes Association). These numbers seem to be the established answer given by medical practitioners.

Lower numbers are provided as targets for diabetics by the great web site, Blood Sugar 101. Here the suggestion is that 5.6mmol/l (100mg/dL) should be the maximum for fasting levels and the two-hour test should give a result of no more than 6.7mmol/l (120mg/dL). There's quite a bit of research to support these values and I heartily recommend that you look around the Blood Sugar 101 web site and read it.

All of this left me pretty confused about what targets I should aim for. If I follow my doctor's advice I will be happy with BG levels that would put me into the "damaging" range indicated by others. I decided to play safe. My fasting levels are what they are. Sometimes they are a little higher than 5.5mmol/l (99mg/dL), other times they are below. Post-meal is easier to control. I always aim to be below 7.0mmol/l (136mg/dL) one hour after eating and below 6.0mmol/l (108mg/dL) two hours after eating. Very occasionally I'll stray above those numbers by 0.1 or 0.2mmol/l. If I do, I find a ten-minute run or 30 minute walk usually lowers my BG considerably.

Day One

Well, that was quite easy actually. I didn't expect it to be otherwise (I've done some intermittent fasting a little in the past and that included 24 hour periods with no food). Today I spread my 600 calories throughout the day to stave off hunger and it seemed to work. It's now 10:15pm and I've just finished a snack. Throughout the day I've had only one bout of hunger and it went away after twenty minutes. I suspect that tomorrow and the following few days will be harder.

For breakfast today I had a bunch of supplements with a whey protein shake (chocolate flavour). Mixed with light Alpro soya milk it gave a total of 130 calories. I've had these shakes for breakfast quite often as they stop me from being hungry and don't seem to affect my blood glucose levels too badly. That's important because I seem to be the most insulin resistant in the morning. Today, one hour after breakfast my BG level was 5.9mmol/l (106mg/dL). Before breakfast it was 5.5mmol/l, which is 99mg/dL. That fasting level is about average for me.

Lunch was another protein shake and a decaffeinated coffee for a total of 138 calories. Before lunch I'd also popped in to a local coffee shop and had an Americano. Handily, Starbucks shows the calorie content of its drinks so that was measurable: 11 calories (though on the web site it says 10 calories). That's a total of 279 calories at the day's midpoint.

For my evening meal I had my first solid food. A salad of lettuce, peppers and tomato with pickled jalapenos, onions and red cabbage. To treble the calorie count I added 10ml of extra virgin olive oil. For something more substantial, and hot, I also had a small Indian selection. This was a vegetable pakora, a vegetable samosa and an onion bhaji. The total for all of this food was 242 calories, giving me 71 to play with. I finished that off with a 12g portion of chilli-flavoured peanuts.

My liver has been doing its job today though, so my blood glucose isn't low. Before my last meal I went for a run, which turned into a half run, half walk of two miles. Before the exercise my BG was 5.1mmol/l (92 mg/dL). Afterwards it had only gone down a tiny amount to 5.0mmol/l, or 90mg/dL.

That's it for today. I've got two exercises to do from my weekly round-up before the day ends. Some tricep extensions and Pec Deck Flies. So I'll be off now.