Against medical advice I am trying the 5:2 diet with Type 1 diabetes. I find it easy to lose weight and I am still working on the best way to avoid hypos. Key to this is whether to alter my background (basal) insulin and this takes trial and error to work out.
My typical weight before begining the 5:2 diet was 12 stone, 3 pounds (12:3). Before starting the diet I fasted for a day to see what it was like and my starting weight was 12:1¾ or 169.75 pounds. At the same time I had a diabetes check up which measured my cholesterol, blood pressure and HbA1c.
My key aims were:
- to see if the 5:2 diet reduces my cholesterol enough to prevent the doctors badgering me about statins,
- To reduce my blood pressure so that I can avoid taking drugs for that,
- and of course a slimmer profile wouldn’t go amiss.
My cholesterol and blood pressure was measured a long time after the diet had ended but I was still at my target weight. Weight loss did not improve my cholesterol and blood pressure.
My Target weight.
Initially I wanted to be medium weight for my height and that is 12:7 but as I approached that level I could see that mid weight meant carrying quite a bit of fat. I wondered what it would be like to be less that mid weight.
I want to know what it is like to weigh 11 stone and to see what my cholesterol and blood pressure levels would be.
So I have set a target weight of 10 stone, 12 pounds (152lb) for the day after fasting. That means with the normal day to day weight variation that you can see in my daily weight graph my typical weight would be 11 stone. The red line (7 day average) should level out at 152lb and be maintained with 6:1 fasting.
I record my progress with observations that could be useful for Type 1 diabetics and for medics. You could call it a Diary of a Type 1 diabetic on the 5:2 fast diet.
On the BBC TV programme “Trust Me I’m a Doctor” Dr Michael Mosley investigated intermittent fasting as a way of producing various health benefits such as a longer life, reduced risk to heart disease, lower blood pressure and of course weight loss. There are even signs that it increases brain cell growth.
He came up with a 5:2 diet where you eat normally for 5 days and for 2 days you reduce your calories to 25% on the daily recommendation. So that’s a fasting day level of 500 calories for a woman and 600 for a man.
My aim and target
Whilst I have often wanted to be medium weight for my height which should give me a better shape around the stomach region it was the prospect of having lower blood pressure without medication that was particularly appealing. Also lower cholesterol would be good so that the medics would stop pestering me about statins.
Here are my observations, ideas and progress log of the beginning of the diet programme to show how I found the fast diet with Type 1 diabetes.
Don’t do as I do
The FAQ on the Fast Diet website says those who should not do the 5:2 diet include “Type 1 diabetics and diabetics taking medication for their diabetes (other than Metformin)”. Therefore if you have type 1 diabetes I don’t recommend that you do what I am doing.
I have seen comments on diabetes forums about “carb dodging” and they severely restrict carbohydrates so that they need less insulin and to me intermittent fasting sounds similar and feasible. Also, one time my wife went on to the Atkins diet and I joined her and although I approached it as a short term fad for “research”, I found it ok and it was refreshing to need virtually no rapid acting insulin.
On that basis I am ignoring the recommendation and I see that I am not alone since there others on the forum at the Fast Diet website.
I think I am safer than many other diabetics because I have gained experience of measurement and control and an understanding of Type 1 diabetes by doing the DAFNE course. I also have a recent HbA1c of 6.4% which shows a good level of control. I guess that if my HbA1c was above say 7.5% that would signify I was likely to have problems with this fast diet.Advice: Don't do the #52diet #fastingdiet #intermittentfasting with #type1diabetes Reality: see these results Click To Tweet
The Medical Advice
I began the fasting diet just after a routine diabetes review with my specialist doctor who’s line was that he didn’t recommend that I do the 5:2 diet. He seemed a bit in a hurry and I wonder if I had seen the other doctor he would have gone into more detail and he’d not be so strict.
The diabetes specialist nurse said she had heard of Type 1 diabetics doing the fasting diet but had nothing in the way of feedback to give to me. However she did say “Do not reduce your background bolus insulin“. If your background insulin is right then it is the level you need when you eat nothing at all so don’t mess with it.
I see comments in forums where people are adjusting their background insulin for fasting days because they are eating less. According to the nurse’s advice you should not do that.
I have come to the conclusion that in order to have the freedom to fast I must reduce my background insulin and possibly take none at all under some circumstances, such as taking exercise on a fasting day. Furthermore it is not easy to devise a set of rules and my rules are likely to be completely different to somebody else’s. To avoid hypos you need a good understanding of your diabetes.
I think that reason thefastdiet.co.uk recommends that Type 1 diabetics refrain from the diet is because some who are not good at their control could get into trouble with hypoglycemia. Having done DAFNE and with an HbA1c of 6.4% I think I’ll be fine.
If I had a high HbA1c and the doctor said that I wasn’t “well controlled” I wonder if the 5:2 diet would be good or bad. It is impossible to say but a high HbA1c is synonymous with high blood glucose levels and restricting food by fasting sounds like a good idea.
However a high HbA1c could be because of a lack of understanding about how to control diabetes and if I didn’t understand then I might take insulin when fasting and that could lead to terrible hypos that could land me in hospital. I can see the justification for the blanket recommendation that people with Type 1 diabetes should not do the 5:2 Fast Diet.
I’m doing the 5:2 diet and and it’s great!
Consecutive days fasting versus split days
The common format is that the 2 days of fasting are separated and not consecutive, say Monday and Thursday. I’m not sticking to that idea. I am making my two days of fasting consecutive: Monday and Tuesday. Monday is notoriously dull that fasting couldn’t make it much worse. Tuesday’s no great shakes either.
There a number of reasons for going for consecutive fasting days.
- I enjoy wine and to split fasting days means there will be times when an open bottle has to be finished off or left standing for two days while I fast.
- It is good practice to abstain from alcohol for more than one day to give the liver a longer recovery period. Consecutive fasting days creates a pause whereas with split fasting days I am less likely to be so kind to my liver.
- The idea of fasting is that it kicks the body into a short term survival mode which produces health benefits. I think that is more likely to be successful with two days in succession than a single day which could have been preceded by stocking up on food that could linger and reduce the impact of a single day of abstinence. In Michael Mosley’s TV programme he tried a recommended 4 day fast because there was evidence that a longer period was better.
- I think I am less likely to make insulin misjudgements with two consecutive days since there is less to think about. Adjusting different levels of background insulin will easier with two consecutive days.
- Food bought for especially fasting day meals will spend less time in the fridge if I fast on consecutive days. For example there is no way that I’m going to eat lettuce on a non fasting day. It’s a minor consideration of course.
The 5:2 diet progress log
- The log contains observations with a level of detail that can bore. There are conclusions below the table.
- The level of detail should help medics get an idea of the experience of fasting with Type 1 diabetes and help them decide if my conclusions are valid.
- The most helpful details will be in the comments during the beginning of the diet where I make initial observations.
- TMW20 means I walked on my treadmill for 20 minutes (5km/hour and 8% slope). Apart from warm-up that is mostly in the fat burn zone. When I extend that to thirty minute my heart rate reaches the aerobic zone. I became fitter and increased the duration to 30 minutes and 5.3km/hour plus a high intensity training burst (HIT) of 20-30 seconds at the maximum (8%) slope and maximum speed of 14km/h. I call it TMW30+HIT.
- I later changed to TMW40+HIT because I became fitter and I switched to a more rigourous fasting regime. The HIT wasn’t limited to a number of seconds but I kept going until my body told me I was it was well exercised – muscles saying they weren’t getting any energy. I found the first 30 seconds of the worst that the treadmill was capable of to be quite easy. It’s surprising what a 57 year old can do.
Just below 600 Calories but my blood sugar was too low for going to bed with night time insulin. Took half the normal background insulin and 35 cals of sultanas to prevent a hypo. Woke and measured at 2am since I felt low but was actually 5.1mmol/l. It seems that at night the feeling of fasting can be confused with hypo recognition yet there is no harm in that.
Looks like I have lost 2½ pounds in one day but that is just normal weight variability.TMW20 before a lunch which was virtually carb free so I didn’t take insulin, despite being 7.2mmol/l, to see if that exercise lowers the blood sugar levels or prevent is rising. A hypo would spoil the fasting and limit my meals later.
At 1:14 am I had a night time hypo of 3.1mmol/l despite taking half the normal basal insulin (8U Lantus). Since that was nearly 2 hours before a typical 3am hypo I can say that the 50% basal insulin was still too much.
Maybe next week I’ll switch to taking all of it on the morning after a fasting day. To deal with the hypo I ate about 50g of carbohydrate (5 CP in DAFNE) which at breakfast gave my a commendable 6.3mmol/l. That completely blew my 600 cal allowance adding 335 carbohydrates.
Just for the record, beginning my first non fasting day I don’t feel particularly hungry but the small cereal breakfast was surpisingly tasty. I was conservative with the amount of insulin I took at breakfast since I assumed the two days of fasting has increased my insulin sensitivity. But I was wrong. The breakfast insulin wasn’t enough and blood sugars were in excess of 12mmol/l before lunch.
Then I over compensated and had a hypo. One of those see-saw days that happens sometimes. The lesson is to treat the day after fasting like a normal day in terms of insulin dosage.
Monday fasting. Technique for the day: I drank water but ate nothing until 3pm then I ate one boiled egg which is mostly protein and won’t increase blood sugars much, so no fast acting insulin.
I took an early evening 45 minute walk and felt pretty dizzy towards the end. I suspect my blood pressure was too low so I stopped taking the low 4mg dose of Candesartan blood pressure tablets. Getting off blood pressure medication is a prime objective. That’s one reason I’m on the 5:2 diet. When I was on 8mg I used to get dizzy spells so we reduced it to 4mg.
At 8:30pm I ate the rest of my calorie allowance using what was in the fridge. A marinated chicken omlette with peas and onion so still no fast acting insulin. Bedtime blood sugar level was 9mmol/l which is what I had hoped for since the recommended target for going to bed is at least 8mmol/l. That’s high enough to insure against a night time hypo. (later on in this log I contradict that. The start of the diet is different to later on). Next morning the level was 5.3mmol/l. It’s quite a novelty to have such benign blood sugar readings.
I ate no calories until about 5pm when I had a virtually carb free boiled egg. This was followed by 9pm by a low carb meal and a top up of cream crackers to ensure my bedtime blood sugar levels are high enough to get through the night without a hypo.
TMW30 30 minutes of vigorous walking on the treadmill took away the hunger and gave a feeling of well being. Whereas yesterday my fasting blood sugar levels were all joyfully between 6.3 and 6.9mmol/l today it fell to 4.6mmol/l after the exercise so I needed 1 CP of carb mid afternoon. It fell again to 4.5mmol/l in the evening before the supper meal. In conclusion too much exercise on a fasting day makes it difficult to manage my blood sugar levels.
With the treadmill exercise I wore a heart rate strap connected wirelessly to my iPod which was programmed with my weight and other stats. It told me that I had burnt 350 calories and since because of the strict fast I definitely had no residual glucose in my blood and liver those calories burnt will come from muscle and fat. The muscle will rebuild, helped by further exercise.
I checked ketones before bed with Ketostix and it read mid scale 4mmol/l. No dizziness today unlike yesterday.
The two day fast has ended and my weight this morning is half a pound less than the same time last week. The rate of weight loss seems to have slowed and I don’t think I indulged too much last week. It doesn’t seem that way.
At 5:00am my blood sugar reading was 3.5% which is borderline hypoglycemia. This goes to show that it is difficult to manage the 5:2 diet when you have Type 1 diabetes and you are taking Lantus at night. I quite like the Lantus night time regimen but I wonder if it is easier to do the 5:2 diet with a different background insulin.
Despite having cream crackers last night to prevent a hypo I actually only had about 520 calories in total yesterday. I should have had more carb in that supper meal or consumed that spare 80 calories.
Today I have a bad back so I am sedentary. I tried a treadmill walk but it was too painful.My fasting technique is to consume only water until supper. Supper at 9pm consisted of simply 600 calories of oats and oatbran soaked in water with stevia sweetener. That sounds incredibly boring but my attitude today is that fasting is about ignoring food so why make it a pre-occupation by focusing on delicious options? On the assumption that even black tea during the day would raise my interest in food I stuck to copius amounts of water. I think for me that approach works.The idea of saving the one and only meal until late was that fasting should work better since during the day there is no carb at all available to sustain me during the day so there should be more fat burnt. That’s the theory.The idea of making the supper meal high in carbohydrate was to prevent a night time hypo after taking my background insulin Lantus. However I had too much carb. My blood glucose was 4.5 mmol/l before eating but there was about 80g of carb (8CP in DAFNE) which raised my level to 14.6 mmol/l before bed even though I didn’t actually finish the meal.Under normal circumtances with such a high bedtime blood glucose reading I would take a little fast-acting insulin to bring that down and I was sorely tempted to do that. I resisted and the following morning my waking level was a very good 5.7mmol/l. It seems that fasting improves my body’s ability to sort itself out. Without fasting I would have expected my morning blood sugar level to be too high still.
I still have a bad back so I am pretty sedentary apart from a short and gentle walk of 20 minutes.
Using the same approach as yesterday and consuming only water until supper I did well and felt fine. Supper had less carb than yesterday and my bedtime blood sugar was 10.0 mmol/l however my waking level was 3.6 mmol/l which too low.
I can see how critical (with Lantus) it is to time one’s carbohydrate consumption on a fasting day to prevent a night time hypo and I can see why it is recommended Type 1 diabetics don’t do the 5:2 diet. It’s ok for me because I am pretty vigilant and my HbA1c is 6.4mmol/l. Also my insulin consumption is less than many Type 1’s so maybe my pancreas is impaired but not kaput.
After two days of fasting I have lost only 0.5 pounds since last Wednesday. That’s a bit dissapointing since the diet is reputed to help you lose about a pound per week.
Rather than stuff myself today I felt naturally inclined to eat less. Despite that I got the impression that my insulin sensitivity had improved. My preprandial blood glucose readings throughout the day were lower than expected: 3.6, 4.9, 5.2, 4.7, 4.0 mmol/l.
Last Wednesday I had assumed that I would be more sensitive to insulin but I was wrong then. But this week it seems to be true so maybe it takes a couple of weeks on the 5:2 diet for physiological changes to begin.
Last night my bedtime blood sugar was 4.0mmol/l so I ate 40g of carbohydrate. I expected that to not only prevent a hypo but raise my waking level to a normal amount. However I woke early and at 6:30am my BG level was 4.1 mmol/l which is lower than expected. Not only do I think my insulin sensitivity has improved but maybe my hypo awareness has improved as well. It’s too early to tell for sure.
Yesterday I was dissapointed that I had lost only 0.5 pounds over the week. Today I weigh marginally less despite eating “normally” yesterday.
Stuck to water only until the evening. Then oatcakes, channa dal, porridge with sultanas supper giving 13 mmol/l at bedtime which I thought a bit too high. Need fewer carbs than that. But the next morning I was back down to a very good 6.1 mmol/l.
Two hypos in 24 hours. That shows why the medics say the 5:2 diet is not recommended for Type 1 diabetics.The first was three hours after a treadmill walk which was 5km/h and 8 degree slope so not a walk in the park. The idea of exercise burning off fat was too much to resist and too much for a fasting day.The second hypo was at 5am the following morning despite the night time blood glucose reading of 10.1mmol/l which I thought would be pretty safe. Next week I shall split my night time Lantus background insulin into 8u at night and 8u in the morning to prevent a night time hypo.
Target Reached. I want to weigh 11 stone (154 pounds) so my target for the morning after fasting is 10:12. That means on a normal non-fasting day I am likely to be 11 stone. Now I shall move to 6:1 fasting to see if that maintains my weight. In the chart that would mean the red 7-day moving average line should be about 154 pounds.
I am not due to have a blood pressure reading until my next check up in February 2016. My next cholesterol measurement is due 6 months later though I might be able to get that brought forward.
My Technique for the 5:2 Diet with Type 1 Diabetes
Here are my rules at the moment. I will continually change these until I have found out what works best.
- I fast for two consecutive days: Monday and Tuesday.
- I continue taking the normal background basal insulin, Lantus. Lantus is long acting and varying it has such a slow effect that it does not allow that level of control. If I was on a different background insulin with a shorter acting period there could be scope for reducing the night time dose to prevent a night time hypo. With Lantus that makes no sense.
- On a fasting day I need to be careful not to use up my 600 calorie allowance too soon. Lantus, taken before bed, has a slight peak in effect about 4 hours after taking it and the body clock tends to lower blood sugar levels at about 3am. To prevent a night time hypo it is best to eat a substantial part of the 600 calories before bed.
- On a fasting day I take very little fast acting insulin. Virtually none.
- On the day after fasting I take the normal amount of rapid insulin. After my first ever fast I wrongly guessed that my insulin sensitivity had increased. It hadn’t.
- PLEASE NOTE. Since writing this I have come up with a different approach to background insulin since my fasting became more rigorous than the recommendation. I will write about that another time.