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Quick Start: The Guide To Optimizing Type 1 Diabetes Management That We Wish We Had At Diagnosis

August 28, 2021
Photo by SpaceX

As mentioned in our Welcome Post, in July of 2020, one of Delta Data Lab’s founder’s children was diagnosed with Type 1 diabetes. At the time, it was a devastating diagnosis that left their family bewildered, disbelieving, and wondering what to do next.

A Better Way
DDL’s founders immediately began breaking this problem down into bite sized manageable chunks, and began building the first crude prototypes of the HERO analytical platform to help guide their way.

Over the course of the weeks and months that followed diagnosis, this child’s parents were diligent about tracking data related to this child’s diet, environment, and lifestyle… and over time large amounts of data started coming in. As it did, DDL’s founders eagerly dove into this data to distill whatever insights they could from it. These insights served as the guide for their future actions, ultimately helping them to achieve the goals they set out to accomplish. These goals were/are:

Type 1 Diabetes Mitigation Goals

  • Goal 1: Stop the Autoimmune Attack: If accomplished, this child would conceivably be able to, worst case scenario, retain whatever innate pancreatic insulin producing capacity that remained in their body, even if this functionality were to be permanently diminished.
  • Goal 2: Normalize Blood Glucose Levels and Minimize/Eliminate Insulin Injections: Our research indicated that when individuals attempt to control their blood glucose using insulin injections while consuming a traditional high-carb standard American (SAD) diet, unstable highs and lows in blood glucose often result. Also, insulin is quite expensive. Reuters reported that a person with type 1 diabetes incurred annual insulin costs of $5,705, on average, in 2016. Eating the BG friendly food and finding some way to minimize the need for insulin injections seemed like a good way to go.
  • Goal 3: Regain Pancreatic Function: While Goal 1 is focused on stopping the diminishment of this child’s pancreatic function, this goal is focused on rebuilding it.

Type 1 Diabetes Mitigation Results

While taking synthetic insulin injections was a critically important early part of the treatment plan for this child, by making the right diet, lifestyle, and environment choices immediately after their Type 1 Diabetes diagnosis, this child was able to minimize their need for insulin thereafter, averaging 0-3 units per day. Since diagnosis, they have also been able to maintain blood glucose levels largely in the normal range thereafter. The following chart outlines their progress from diagnosis to roughly 5 months afterwards.

(Click to zoom in)

– Advice To Ourselves –

Achieving these results hasn’t been easy, and the team has made some mistakes along the way. Additionally, recording and analyzing all of this data, distilling insights, taking action, and then measuring outcomes takes time, and they wanted to move this child as quickly as possible along the shortest path to optimum health. The faster they acted, the better chance they had of retaining whatever innate pancreatic function this child had remaining at the time of diagnosis, while they still had it. Time was of the essence!

Just like “stop, drop, and roll” is the guidance given to people who find themselves on fire, the following is the advice the DDL team would have given to this child’s parents, managing the care of a newly diagnosed type 1 diabetic child, if they knew then what they now know about how to optimally manage this condition.

Note: Again, what follows are points of recommendation we would have made to ourselves at the time when this child was diagnosed with Type 1 Diabetes; had we known then what we know now. Neither DDL’s founders nor the authors of this article are physicians, and no portion of this site is intended to provide medical advice. What follows are simply steps that have worked for us, that we wish we would have known sooner.

Self Advice #1: Manage Your Environment

Photo by Sidekix Media

Environmental Pollutants and Allergens

The DDL team has employed a variety of approaches when attempting to gauge the effect of environmental pollutants and allergens on blood glucose levels. These approaches include periodically analyzing data associated with the following: pollen levels, humidity levels, HC02 Levels, VOC levels, and airborne particulate levels. This data was sourced from both Internet connected measuring devices in the community, and measuring devices placed in this child’s home.

In addition to attempting to quantify those environmental factors that could potentially affect this child’s blood glucose levels, the team also attempted to document how this child felt in response to general environmental conditions. We did this by having a child record entries in the HERO app related to how they felt, including any stomach pain, sore throat, and more. Taking this approach helped us understand, generally, and qualitatively, whether any unseen factors, potentially coming from the environment may be having an effect on their body. These measurements proved especially insightful, once all of the food-based influences on blood glucose were controlled for.

While our ability to consistently collect and incorporate this environmental data has proven challenging, some general insights have been distilled. The team has found that whenever any of the following conditions are elevated in the environment, this child’s blood glucose levels tend to subsequently spike upwards.

  • Environmental mold levels (airborne mold after it rains)
  • Environmental pollution (smog, smoke, ozone)
  • Environmental allergens (Cedar, Oak, other pollens)
  • Dusty conditions within the home

While the physical mechanism in this child’s body responsible for spiking blood glucose levels in the presence of the above factors is unclear, we hypothesize that it is related to general inflammation. As general inflammation goes up, blood glucose levels also go up.

For all of the above reasons, we have found that keeping portable air filters in each room of the house has led to significant improvements, especially on days where any of the above conditions are high.

Related Links:

  • Google Search: AccuWeather AQI

Heat and Humidity

Numerous research studies have shown that people with diabetes are more sensitive to heat. There can be several reasons for this. Higher temperatures can actually change how your body uses insulin. Moreover, people with diabetes also tend to dehydrate more quickly than others. Other factors could be at play as well.

Additionally, when high humidity levels are brought into the picture, one’s body can have a more difficult time cooling off, which can make an already dangerous situation worse.

Staying cool is a key component of maintaining normal blood glucose levels.

Related Links

Check For Toxins

Checking for environmental toxins, such as mold at home is important. Inflammation caused by these pollutants can cause blood glucose levels to rise.

  • How To Test For Environmental Mold (coming soon)
  • Other Environment Testing information (coming soon)
  • Analysis: Environment & Blood Glucose (coming soon)
  • Research Page

Self Advice #2: Optimize Your Diet

Photo by Yuhan Du

Volumes could be written on this topic, and we will be diving into it in more detail in future Blog Posts. In this brief overview however, it suffices to say that eating the right diet plays a foundational role in both normalizing blood glucose levels in the hectic days/weeks immediately post-diagnosis, (for Type 1 and Type 2 diabetes) and in the successful ongoing management/mitigation of this condition.

Eating Low Carb

Our research indicates that eating a diet very low in carbohydrates (no more than 8-11 carbs per meal) is significantly associated with maintaining healthy blood glucose levels in this child. These kinds of diets are called Ketogenic or “Keto” diets. While on a Keto diet, your body enters into a state called ketosis. In this state, your body primarily uses ketones to fuel your cells, as opposed to glucose.

When carbohydrates are consumed, they are broken down by the intestines into simple sugars. The level of carbohydrates found in the Standard American Diet (SAD), often consisting of more than the Mayo Clinic recommended 75g – 108g of carbs per meal (see link below), causes blood sugar levels to spike up after each meal. To help keep these now elevated blood sugar (glucose) levels in check, the pancreas steps up its production of insulin. This is at least true for people that have the ability to produce insulin. Not everyone has this ability, however. Some people, Type 1 Diabetics in particular, have diminished or no ability to produce this insulin. This can be a real problem when carbs are consumed. To keep their blood glucose numbers in check, they typically have to introduce insulin into their bodies from external sources (injections or pumps). However, determining the right amount to inject, at the right time, can be a challenging endeavor.

As an alternate approach, if one simply does not consume substantial amounts of carbohydrates in the first place, by sticking to a Keto diet, then there’s no subsequent spike up in blood glucose levels. There is, therefore, no subsequent need for the body to produce, or a person to inject, the increased levels of insulin necessary to keep this non-existent elevated blood glucose level in check.

The data that DDL’s founders have collected to date strongly shows that sticking to a Keto-based diet, as a general approach, is foundational to maintaining healthy blood glucose levels when someone has diminished insulin producing capacity. Having said this, it is important to note that not all Keto dishes are created equal, and there are some that we’ve come to know to avoid. This will be discussed in more detail in upcoming blog posts.

Related links:

Eating Low Lectin Foods

We believe that adhering to a low lectin diet has been a key part of managing this child’s type 1 diabetes diagnosis.

Given that one of our goals was to stop this child’s autoimmune attack on their pancreas, we began looking for information post diagnosis that could help us accomplish this goal. Fortunately for us, just prior to diagnosis, we happened to be reading a book called The Plant Paradox by Dr. Steven Gundry.

This book proposes that lectins found in certain plant based foods can spur on autoimmune attacks very much like the one this child was experiencing at the time of diagnosis. The various books published by Dr. Gundry and others provide numerous anecdotal, and the occasional data-driven pieces of evidence supporting this relationship.

Since the presence and severity of an autoimmune attack are measured using laboratory tests that are typically conducted on a long-term periodic basis (i.e. not daily/weekly), we were unable to establish a data-driven relationship between following a low lectin-based diet and a diminishment in the level of the autoimmune attack in this child’s body.

Having said this, we did observe a diminishment in this autoimmune attack over the period of many months while following this low lectin approach. Whether this diminishment is being driven by this child’s adherence to a low lectin diet, or one or more other factors is unclear. We hypothesize that there is a connection, however.

Related Links:

Eating Enough Calories

Our analysis has shown that the correlation between calories and weight is generally greater than +0.7. See the Understanding Correlation Coefficients link below to better understand what this number means. Bottom line, there is a very strong positive association between number of calories consumed, and weight. It is important to note that our research has not defined a causal relationship between these two factors. Despite this, it generally appears that the more calories one consumes, the more weight one typically gains, and vise versa.

Weight Gain From T1D Diagnosis to + 1 Year (Using no insulin after late Aug 2020)

When looking for sources of calories, there are three general categories one can turn to. These sources are Carbohydrates, Fats, and Proteins. These are called macronutrients, or “Macros” for short. If one follows a low-carb ketogenic diet, then carbohydrates are effectively eliminated as a potential major source of calories. This means that one would need to then look to Fat or Protein as the primary source of calories. Since it is difficult to be calorie sufficient using protein alone, this means that one needs to increase fat intake to maintain a healthy weight.

You may be asking yourself, “But, isn’t fat bad for you?”. We wondered the same thing. Over the course of several years post-diagnosis, outlining this child’s overall health markers, there was marked improvement in their over numbers when compared to those at diagnosis. Overall, everything returned to the normal range, including cholesterol levels, despite consuming large amounts of fat. Having said this, the types and amounts of fats consumed are important. More on this in upcoming blog posts. The following blog posts provide additional information on this topic:

Related Links:

Minimizing Dairy Consumption

While dairy is delicious, convenient, a relatively dense source of calories, and a primary component of many ketogenic recipes found online, we have found that it is best to avoid dairy in general.

Analyses we have performed have shown reasonably strong positive correlations between various dairy products and blood glucose levels in following meals. We have found this to be true even if the dairy product being consumed indicates that it contains no carbs. See our related blog posts for more information.

Related Links:

  • Analysis: Dairy and Blood Glucose (coming soon)

Time Your Carbs With Your Daily BG Cycle

While adopting a Ketogenic diet means that one attempts to obtain no more than 5-10% of one’s calories from carbohydrates, carbs are a natural and frequently unavoidable part of most foods. When consuming keto-friendly meals that contain higher quantities of these carbs (i.e. in the range of 10-11 total carbs consumed in one meal), it is important to time this consumption with the natural highs and lows in one’s body’s daily blood glucose levels.

We have found that this child’s blood glucose levels are naturally higher first thing in the morning, and last thing in the evening. While there could be several explanations for these highs and lows, the important point to note is that they do occur. Knowing this, when thinking about eating higher levels of carbs, it’s important to time the eating of these carbs so that the resulting elevated blood glucose levels will compliment the body’s natural BG highs and lows.

When this child consumes these higher carb meals, they typically do so at breakfast and lunch. Blood glucose levels are typically relatively low at lunch, and at dinner, so the overlap is perfect. Carbs consumed at breakfast show up in the bloodstream at lunch, complimenting the natural low at that time. Similarly, carbs consumed at lunch naturally compliment the relatively lower blood glucose levels typically seen at dinner.

While this timing seems to work well for this child, everybody and every body, is different. Whatever your natural cycle, be sure to time your consumption of carbs accordingly. The following post explores this topic futher.

Related Links:

  • Perfect Timing: How to Optimize Glucose Response By Adjusting When You Eat Carbs (coming soon)

Eating Fat To Lower Blood Glucose

We have performed a variety of statistical analyses on hundreds of foods, and even build data driven statistical and machine learning models that attempt to forecast future blood glucose levels based on this child’s diet, environment, and lifestyle.

Interestingly, one variable that keeps coming up again and again, with a consistently strong association to lower subsequent blood glucose numbers, is fat. Not only is it a relatively dense source of calories, but this additional apparent capability has made it an essential tool in this child’s arsenal for controlling blood glucose levels.

From an analytical standpoint, we have calculated the amount of fat this child needs to consume in a given evening to ensure that their blood glucose number in the next subsequent period is in the desired range. Fat, as a single (univariate) predictor of subsequent blood glucose levels has proven useful as a benchmark to understand whether other factors may be driving this child’s blood glucose levels higher. As part of a multivariate model, total fat consumed has proven to be not only a statistically significant predictor of subsequent blood glucose levels, but one of the most influential variables in statistical and machine learning models we’ve developed to forecast blood glucose levels and later periods. For all of these reasons, on any given day, 70% to 80% of this child’s calories are derived from fat.

Again, please keep in mind, however, that not all fats are created equal. Some fats like bacon, beef, various sausages (saturated fats) are associated with increased risk of heart disease later in life. Other fats like Avocados, Pecans, and Olive Oil (unsaturated fats) are not. Choose your fats wisely. Remember, moderation is almost always the right path forward.

Staying Hydrated

While we have found it difficult to consistently and accurately keep track of data related to water consumption over time, we have noticed (qualitatively) an association between the amount of water consumed and blood glucose levels. The more water one consumes, the lower blood glucose tends to be.

Other diabetes researchers have perform studies that highlight the importance of water consumption for diabetics, especially type 1 diabetics.

Related Links:

Low Water Intake and Risk for New-Onset Hyperglycemia (ADA)

Self Advice #3: Optimize Your Lifestyle

Photo by Priscilla du Preez

Maintaining a lifestyle that supports your body is important. This is especially true when one is diabetic or pre-diabetic. This is even more true when one follows a Ketogenic diet, and is also diabetic or pre-diabetic. The two primary components of a healthy lifestyle that we have found to be most relevant to controlling blood glucose are Exercise and Sleep.

Exercise

Exercise is an important part of maintaining healthy blood glucose levels, and overall health, for diabetics and non-diabetics alike.

While our analysis hasn’t shown a significant difference in the effects of different types of exercise (walking, swimming, etc) on subsequent blood glucose levels, differences do likely exist. Regardless, our data does indicate that while exercise does appear to temporarily increase blood glucose levels during the duration of the exercise itself, blood glucose levels post-activity do appear to drop by noticeable amounts.

Our analysis of data collected between the latter part of 2020 and the first half of 2021 indicates that (average number of times exercised over a roughly two day period) and (subsequent blood glucose levels) have a correlation of -0.14. This negative correlation indicates that the more one exercises, the lower ones subsequent blood glucose tends to be. While the magnitude of this correlation is not as high as other variables we’ve studied (see Eating Enough Calories above), it is still significant enough for this child to use it as another blood glucose control measure.

Diving deeper, additional analyses we have performed on this data indicates that (average number of times exercised over a roughly two day period) is associated with a 23.6 point drop in subsequent average blood glucose levels in the next time period. That is to say that a one unit increase in the number of times exercised over a period of two days is associated with a 23.6 point drop in later blood glucose levels. This relationship is not linear, however, so exercising two times in a two day time period will not deliver a 47.2 point drop in subsequent blood glucose levels. The bottom line, however, is that more aerobic exercise = generally lower subsequent blood glucose levels.

Bottom Line: More exercise = generally lower subsequent blood glucose levels

DDL Research

As mentioned in the above Heat and Humidity section, it is important for diabetics to stay cool while exercising and that they drink plenty of water. Exercises that help facilitate this include swimming, and indoor or morning walking/running.

Related Links:

Sleep

Sleep is an essential component of both diabetes management and prevention.

Numerous research studies have shown that insufficient sleep can lead to insulin resistance, prediabetes, and diabetes. Sleep can have a significant influence on blood glucose tolerance.

Our own analysis of data associated with DDLs founder’s child has found that each incremental hour of sleep lowers blood glucose by 0.8 points. That means getting 8 hours of sleep will lower the average subsequent blood glucose level by 6.4 points. In contrast, getting 10 hours of sleep will lower the subsequent blood glucose levels by 8 points.

Related Links:

Self Advice #4: Growth and Body Changes

When a child is growing and, in particular, when a child is going through puberty, unexpectedly high blood glucose levels can and do often occur. When these unexpected highs happen, it’s important to treat them in the moment, especially with a rapid acting type of insulin. When doing this, it can be a tricky task to not overshooting one’s target blood glucose level and subsequently experience hypoglycemia. Getting the dosage of insulin right can often be exceptionally difficult, given that the same conditions that caused an individual’s elevated blood glucose levels can often make one’s body insulin resistant. This means that each unit of insulin given can sometimes have little to no lowering effect on blood glucose levels. This problem is further compounded by the fact that it is often difficult to know exactly when, and to what extent a person is experiencing an acute insulin resistance. These are all problems that the HERO app attempts to solve for.

While there is no way of knowing when, or by how much, blood glucose levels will fluctuate given growth or puberty related changes, it’s important for diabetics to measure their blood glucose levels on a regular basis to watch for climbing numbers, when and as they happen. When a person is going through a puberty related growth spurt, this could mean continuously monitoring their blood glucose levels, or at the very least checking them with a finger prick every 2 to 3 hours. Using this approach, high blood glucose levels can be detected early, before they go to high, and be subsequently addressed.

Self Advice #5: Consult With Physicians

Advice we would give ourselves relative to physicians would be multi-faceted. It is critically important that one consult with numerous physicians when newly diagnosed with diabetes. These physicians can 1) treat the acute condition of elevated blood glucose levels that are often present at the time of diagnosis; and 2) physicians can also be useful in helping to diagnose what may have caused the onset of diabetes in the first place. For type 1 diabetics, this means attempting to understand why the body suddenly began attacking the pancreas’ insulin producing beta cells. For type 2 diabetics, this means better understanding what diet, environment, and lifestyle factors may have tipped the body towards insulin resistance.

In either case, the advice we would give ourselves would be to consult with a number of different physicians/specialists, in order to maximize the benefit that each brings to the healing process. Here are a couple to start off with:

Endocrinologists

Endocrinologists are specialists in the endocrine system. In the diabetes space, they can not only help diagnose the disease, but also assist with insulin prescription, insulin administration, and provide ongoing advice on proper insulin dosing. They can also run tests to see whether other parts of one’s endocrine system, or one’s body overall, might be struggling because of the effects of diabetes. When it comes to standard by-the-book diabetes management know-how, these are the doctors to go to.

Functional Medicine Physicians

While many physicians, like the endocrinologist mentioned above, are specialists in one field or another, other physicians are generalists. While there is the class of doctor called family medicine physicians, many of these people today have effectively become pill prescribers. They often look at one’s acute symptoms in the moment, and often don’t take the whole perspective of either a person’s entire physical health, or the root causes of disease, into consideration. Enter functional medicine doctors.

Functional medicine physicians are those that attempt to move beyond just addressing the acute symptoms one is facing in the moment, and move into a quantification and remediation of the root causes of disease.

When seeking out a functional medicine physician, it’s often (but not always) better to find one who not only has their functional medicine certification, but also has an MD/DO degree as well. Having said that, not all those that have functional medicine certifications and MD/DO degrees have a passion for finding solutions for their patients, and are truly engaged. Some are just attempting to collect a check. On the other hand, the same thing could be said for functional medicine practitioners that don’t have MD/DO degrees.

Bottom line, when choosing a functional medicine doctor, make sure that your doctor is engaged and is consistently delivering insights and results. If they’re not, find a new one. Our provider directory (coming soon) is a good starting point to facilitate your search.

Consulting with a functional medicine doctor was a foundational piece of the extraordinary results we’ve been able to achieve after this child’s diagnosis.

When you speak with your functional medicine doctor, be sure to ask them about, and inform them of, your specific details related to the three major categories of considerations we’ve mentioned above. These are your diet, lifestyle, and environment. Even if you don’t have all of these details understood or fully documented, tell them what you do know. This will help them fill in the gaps and lead you in the right direction. Based on the information that they gather, these physicians will likely prescribe medications to help resolve the issues you’re facing.

Final Comments

All of the above points encompass the advice we would give this child and their parents at the time of their Type 1 Diabetes diagnosis. Underlying all of these recommendations, however, especially in those very scary first few hours, days, and weeks post-T1D diagnosis, we would ask them to take heart, steady their nerves, and calm their fears. We would reassure them that there is indeed an alternate, and better path forward… if they act quickly to retain whatever pancreatic function their child has remaining. Making immediate changes to their environment, diet, and lifestyle; and seeking out the professional advice of a competent and engaged endocrinologist and functional medicine physician are essential and time is of the essence. By taking swift action, and “letting data be their guide”, however, the door opens to the possibility of mitigating of this terrible disease.

Let your data be your guide to better health

DDL Head of Data Science

This last point, of “letting your data be your guide” is critically important. Doctors may tell you one thing, and things that you read on this site, or on other sites may lead you to other conclusions as well. At the end of the day you have to find something that works for you, your body, and your specific circumstances. If something is not working, it makes sense to stop doing that, and do something different. Ideally one repeats this process until one finds something or some set of things that does work. If one follows this path diligently, and consistently, a better future invariably awaits!

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Last updated on August 24, 2024