I broke my toe, I’m barely moving, I’ve lost three pounds, I’m not hungry, my blood sugar’s in range. What’s happening?


While I’m typing this my right foot is in a surgical shoe. New Year’s Day I broke a bone in my toe and badly bruised my foot. For those who want the gory details: the husband and I were sleeping at my mother’s house and I had moved a small bookcase out of the bedroom to make more space. I ran smack into the corner of it with my foot the next morning in the dark.  Stars? Yea, I saw them.

These past three weeks I’ve not moved more, or more quickly, than this slug above. I’m spending an inordinate amount of time, literally, lying around. On my back, on my side, on my bed, on the couch, watching videos, binge watching the fantastic Scott & Bailey and being my inner slug.

When I do go outside, I put my bad foot forward and drag my other foot behind. Think Tim Conway on the old Carol Burnett show. I have a six block radius I can cover to get essentials. Then it’s back to the bed, couch, wherever immobility is welcome.

I will recover. In three to five weeks. But this morning I was reflecting on how this has turned into an unexpected experiment about exercise, weight and diet. And while I’ve been a believer these past few years in the health benefits of keto (ketogenic diet) and intermittent fasting (IF), my beliefs have only been confirmed.

This is what I’ve experienced:

  1. Regular daily exercise has little to no impact on weight. I’ve lost three pounds with opening and closing my eyes being one of my most arduous activities.
  2. I’ve been doing 16 hour intermittent fasting since I broke my toe. I don’t eat after dinner, unless I need something to raise my blood sugar before bed. The next morning I have a cup of coffee with half and half and don’t eat until lunch at noon or 1 PM. I’m also eating what I call a modified version of keto: a very low refined carb, (vegetables are carbs but not refined carbs) moderate protein, moderate healthy fat diet. This is the lowest weight I’ve been as an adult since I was in my twenties one day. I think it was a Tuesday.
  3. The intermittent fasting and keto has lowered my appetite hormone, gherlin, and raised my satiety hormone, leptin. I’m watching tons of videos on YouTube about keto, IF, insulin resistance, metabolic syndrome, cardiovascular disease and diet and none have stimulated my appetite.
  4. The Dawn Phenomena. Normally I take 1 unit of rapid acting insulin when I wake to counteract the rise in my blood sugar. In the early morning hours the liver  throws glucose out into the blood stream to get you ready for activity and cortisol rises. These days my biggest activity after checking my rising blood sugar is going back to iPad (yes, now a verb) on my bed. 1 unit is too much. I’m guessing my liver, noticing there is sparse activity after I wake, is throwing less glucose into my blood stream. And, on this way of eating my blood sugar stays in range 95% of the time.
  5. My energy has not wavered. Committed one hour a day walker that I am, I feel no more or less tired being a slug.

Sure this is an N of 1. This is just me. What’s happening to me now. Still, these are interesting discoveries. The insight that exercise really does not impact weight (although I do agree it’s healthy and helps you maintain your weight) and that IF and keto really take weight off quickly and easily.

These are the keto, intermittent fasting, LCHF (low carb high fat eating which is my keto style) gurus I’ve been watching and reading:

Dr. Jason Fung – nephrologist and IF advocate

Dr. Robert Lustig – UCSF Professor, advocate in getting rid of processed foods, expert in weight, metabolism and diabetes

Michael Pollan – investigative journalist, author of several books including Food Rules

Nina Teicholz – investigative journalist, author of The Big Fat Surprise

Gary Taubes – investigative journalist author of several books including Good Calories, Bad Calories

Ivor Cummins and Dave Feldman – engineers who’ve cracked IR and the bad cholesterol myth

Dr. Eric Berg – tons of videos on YouTube about keto, IF, diabetes, metabolic syndrome. Short, simple and old fashioned teacher style, markers on a white board

Dr. Mark Hyman – Director of Functional Medicine, Cleveland Clinic. This is a great interview series.

An interview between Ivor Cummins and Eric Berg on insulin resistance, diet, diabetes and how we’ve all been nutritionally duped:

And a fascinating video on how IR, the elephant in the room, and metabolic syndrome drive cardiovascular disease and what to do about it:


It’s Insulin Resistance, not cholesterol, that causes most degenerative diseases


If you doubt this watch a few of Dr. Eric Berg’s videos on YouTube. He’s an expert on the ketogenic diet and intermittent fasting. He explains, simply, why it’s Insulin Resistance that creates diabetes, obesity, fatty liver and heart disease, most degenerative diseases.

Having just stumbled across him, it was a coincidence that a friend this morning sent me an email to say his wife was researching foods low in cholesterol to create a healthier diet for them. I wrote this response immediately and figured this is information I should share:

The great majority of our cholesterol is made by the body, not consumed from food. Dietary cholesterol has little impact on us. And, it is a common myth that cholesterol is the culprit of heart disease. Rather than cause obstructions in our arteries, cholesterol shows up like an ambulance, when irritation occurs, to fix it. It’s been shown through scientific studies over decades that just as many people get heart attacks as have low cholesterol as high.

Cholesterol is only threatening when it’s oxidized. Oxidized cholesterol is called Remnant cholesterol. You calculate your remnant cholesterol by adding up your LDL and HDL and subtracting the number from your total cholesterol. If the number is less than 17 that’s optimal. Increasingly higher numbers are less so.

But cholesterol is only a minor player. The real offender is a diet of too much sugar and starch causing too much insulin in the bloodstream. Every time you eat carbs (and there are carbs in almost everything including vegetables, but not in fat), insulin is released to ferry the breakdown of that food or beverage, which is now glucose, from the bloodstream into the cells. Due to our highly refined carb diet, and frequent snacking, extra insulin is being called forth multiple times a day. We begin to develop a state of insulin resistance (IR): either 1) You can’t produce enough insulin for your constant carb consumption and/ or 2) You’re gaining weight (the two go hand in hand) and belly fat blocks the action of insulin. This inefficient use of insulin is what causes obesity, type 2 diabetes, heart disease and brain diseases like dementia and Alzheimer’s – also known as Type 3 diabetes.

Let’s unpack that a little more. Insulin is a fat storage hormone. When it drives sugar (glucose) into the cells from the blood, the glucose gets stored as fat for future energy use.  With the constant consumption of carbs, our bodies run on these for energy and never get to use our stored fat. Insulin being a fat storage hormone, we start gaining weight. As we gain weight, this fat accumulation around our middle further impedes  insulin’s action. Now the body has to push out more insulin to keep blood sugar levels from rising above normal. This typically goes on for years before the body can no longer push out enough insulin and blood sugars noticeably rise. Wham, type 2 diabetes!

The common theory is people get type 2 diabetes because they’re fat. The alternate, and widely growing, theory is people don’t get diabetes because they’re fat. They get fat from years of insulin resistance (IR) due to our heavy carb diet.

Another way to say this: With our highly processed, carb heavy American diet, our body pushes out greater and greater amounts of insulin to drive the sugar into cells where it gets stored (as fat) for later energy use and keep blood sugar in normal range. As the cells reach capacity to hold the fat, insulin drives the sugar into and around vital organs. This happens for years until the maximum amount of insulin the body can produce no longer is enough. Then, after years of insulin resistance you see on your blood test a higher than normal blood sugar level and you’re told you have type 2 diabetes. Most people will also have signs of a fatty liver and the beginning of heart disease.

Most people with type 2 diabetes are started on pills to lower their blood sugar. But the IR has not been resolved. When the pills no longer work  they are put on insulin to keep their blood sugar down. Now they have extremely excessive amounts of insulin circulating in their bloodstream. This drives their blood sugar down, but makes the IR worse, makes the fat accumulation worse, creates more weight gain and fat in and around the organs until the person dies of a heart attack or gets dementia.

So why is IR going unaddressed? Your treating practitioners have been taught diabetes is a condition of high blood sugar, not a condition of insulin resistance. Their focus is to lower the blood sugar, and so the cause, the IR, remains.

It is important to lower high blood sugar, but what’s needed is to work on reducing insulin resistance: address the cause. This can only be done by eating less carbs so less insulin is needed. When insulin levels fall, weight comes off and the body begins to normalize its blood sugar. Sugar, not fat, insulin, not cholesterol, are responsible for 2 out of 3 people having diseases grouped under diabesity – diabetes, high blood pressure, heart disease, dementia and Alzheimer’s, among others.

This brings us back to the ketogenic diet that is gaining so much popularity. Keto is a very low carb (and so will reduce insulin), moderate protein and high healthy fat diet. People lose weight and  many people are able to reverse their diabetes. I do a modified version of keto.

Intermittent fasting (IF), is often linked with keto as a form of switching the body from burning carbs to burning fat. Like its name, IF means you go longer periods of time without eating. You might fast between finishing dinner around 8 PM and eating lunch the next day. You could not eat for 24 hours or do a fast of several days. IF also significantly drops insulin levels and people lose weight and many reverse their type 2 diabetes. Dr. Jason Fung, is a leading expert in the field.

Just as we’ve heard,  genetics load the gun, but it’s the environment, largely diet, that pulls the trigger. If this speaks to you, do your own research. There’s lots of information online regarding all these topics above.

“Diabetic” foods for being stranded on a desert island should you ever be


First I hate the word “diabetic” proceeding anything, but hey, I use it here to be able to say that. Second, there’s nothing special about food for people with diabetes. I never eat low sugar or low fat anything. I eat healthy real food that has little to no sugar and healthy fat.

When I used to answer that childhood question – “If you were stranded on a desert island and could only have a few things to eat what would they be?” I would have told you Greek plain yogurt and peanut butter. I could never understand why of all the things they put in yogurt today, peanut butter is still glaringly not one of them.

These days, however, I would slightly amend that request. I’d want what I typically eat for breakfast when I’m not intermittent fasting. I’d want Brown Cow plain yogurt with its incredible creamy top (like the cream that floats to the top of fresh milk) and almond butter (inexpensively purchased from Costco) and tahini (pulverized sesame seeds) which I get from the middle eastern store 1.5 miles away from my home. But I think it can be found in most supermarkets.

I do add some nuts but I’ll skip the nuts since I don’t want to tax whoever is being kind enough to give me some food on this desolate desert island I have somehow found myself on.


These days if I could ask for one more edible it would be chia seed pudding. Of course it’s one food, but does have several ingredients as you can see above: a can of full fat coconut milk, chia seeds, liquid stevia, unsweetened cocoa powder and cinnamon. I mistakenly left the vanilla out of the picture. I mix it all in that yellow pint-sized container and voila in about an hour in the fridge it’s pudding.

My chia recipe – It really doesn’t get much easier. Fill the container with as much coconut milk as it will hold, most, but not all of this 13.5 oz can, add 4 or 5 tbs of chia seeds. I like 4 so the pudding is not so thick, a few drops of stevia depending how sweet you like it, a teaspoon of vanilla and a handful of blueberries. Today they came out of my freezer. The cocoa powder and cinnamon are optional.

Of course you can really play around with what you add after the coconut milk and chia seeds. Add nuts, different fruits, sometimes I cut a dried prune into the mix. Some people replace the coconut milk with almond or soy milk but I feel the coconut milk has particularly healthy benefits as a short chain fatty acid whatever, whatever… The chia seeds are high in omega 3 antioxidants and fiber, you get anti inflammatory benefits from the cocoa powder and cinnamon seems be a wonder drug with many benefits ascribed to it including lowering blood sugar (which I can’t say I’ve ever noticed) and reduced risk of heart disease.

Now, you do deserve a prettier picture of the pudding than I’ve supplied above along with recipe variations —


Doubly upset with insulin manufacturers for look-alike insulin pens


On the top Tresiba long-acting basal insulin. On the bottom FIASP ultra-rapid insulin

Please Novo Nordisk, what are you thinking? Both your Tresiba and FIASP insulin pens are nearly identical. I know already I will at least once, if not more, grab the wrong pen and take seven times my mealtime dose accidentally.

For the first time ever, after 46 years with type 1 diabetes, I’m using Novo Nordisk’s insulins for both my basal and bolus: Tresiba and FIASP.

This is the picture I took this morning of my pens just after looking down at the Tresiba pen in my thigh as I had my finger on the plunger having just pressed it, thinking, “Oh, my god, is that my Tresiba in my leg or the FIASP? SH*T!!!” All I saw was a navy blue pen.


The caps look different because the Tresiba pen (on the bottom) has a Timesulin cap on it.

I switched to Tresiba and I’m experimenting with FIASP after being a long time user of Sanofi’s Lantus and Lilly’s Humalog. I’m very happy with both insulins. Tresiba covers me a full 24 hours plus, while Lantus only stretched to about 19 hours. And FIASP, which I’ve just started to see if it actually is faster than Humalog, appears to be. No complaints about the insulins. In fact, I’d recommend them easily.

But how could those at pharma companies, whose hands these pens flow through upon creation and sale – device designers, engineers, research and development, business development, marketing and strategy professionals – not consider the risk to patients of confusing these two pens? Untold numbers of people with diabetes will use both these products – just as the company would like them to.

How could one not notice that the identical color of the pens, design and shape will cause many customers to mix them up and result in potentially life-threatening consequences?

I’ve already done it, mixed up my short acting and long acting pens once with two pens from two different companies that were not identical.

Novo Nordisk is not alone, although I find the choice of navy blue for both pens egregious. Here are Sanofi’s Lantus (basal insulin) and Apidra (bolus insulin) pens. Also, far too similar. In “real life” the color difference is not as pronounced; they both share a blue/grey hue.


Luckily, this morning the correct pen was in my leg. But trust me, in the middle of making breakfast and picking up a pen to take one of my six or so shots a day, the day will come when I take seven units of FIASP (my Tresiba dose) when I meant to take one. Am I to blame? Sure. But make it easier for us to avoid potentially life-threatening mistakes. Make insulin pens mistake-proof.

Why can we not have pens that are dramatically different colors, especially from the same company, different shapes, different texture or make a sound when you take off the cap. Users of insulin pens already take it upon themselves to distinguish their pens by putting duct tape or rubber bands around one pen, or keeping their pens in different rooms. It should not be so hard.

I’d like to see the company that embraces the hippocratic oath, “first do not harm” and reflects it in the pens they put in our hands.

You can do more, you can do better to help people with diabetes have one less thing to worry about – taking an insulin overdose – when they take their medication multiple times a day.


Grace for the new year

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Reflecting on this past year I realize how truly rich I am. How many experiences and adventures have colored my days. How many friends and colleagues have enriched my journey. And how grateful I am for family who always give me, and the husband, a safe space to land.

I hope 2019, amid the noisy, chaotic world, is a year we all find our inner stillness; that quiet, vast and unflappable place within us. And that you be touched by the grace of those who come along your path just as you have graced other’s paths.

Wishing you peace, happiness and health in the new year.

The language of diabetes and diabetes-speak

Of all that’s happened in diabetes this year, it was also the year of bringing people’s attention to the judgmental language embedded in our diabetes culture. I offer congratulations to the American Diabetes Association and the American Association of Diabetes Educators who jointly created a white paper on the topic. Among the paper’s recommendations is replacing “diabetic” with “people with diabetes.” Replacing  “test” blood sugar with “check” blood sugar. To never, ever label people with diabetes as “non-adherent” or “non-compliant” and, in general, to use language that is factually correct and judgment free.

That said, there is another language in diabetes. It’s the talk that goes on between those of us who tread water every day with this condition.

My friend just emailed me with this photo of her pump. The photo came with this message, “Just when I’m feeling like I’ve eaten too much and not been exercising…my pump responds with this.”

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You’re wondering what this means. She and I have been talking about noticing the number “111” on her pump and my CGM over the past weeks. Why? Because 111 is called an angel number, a symbol of spiritual awakening, pointing you to your purpose in life. We think it kinda fits us and we think noticing how frequently it shows up is a hoot.

So I of course wrote her back in diabetes-speak —

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Shall we just say I had to laugh when this came up for me this morning —

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Salt, Sugar, Fat: the book about creating the irresistable trifecta

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My last post was about the non-nutritious food served on airlines. If you want to learn how, as a nation, we have ended up with an overabundant supply of not food, but food-like substances, as journalist Michael Pollan, calls them, you should read, Salt, Sugar, Fat: How the Food Giants Hooked Us, by New York Times journalist Michael Moss.

The book is an eye-opening account of the food industry from when it began to employ scientists and marketers, and collude with the government and certain health organizations, to create cheaper food with few real ingredients and many chemicals. How and why the government began paying farmers to overgrow corn, wheat and soy, and how they all promote these fake foods as healthy with false nutrition claims.

There are so many devious, just-this-side-of-lying, and outright lying strategies about the nutritional value of these concoctions of chemicals, you will find the book jaw-dropping; unfortunately, in the worst way.

For example, America’s beloved Velveeta cheese, is a processed cheese-like product invented in 1918. Today, as over the years, its formula has changed, it is labeled as a “pasteurized prepared cheese product,” no longer technically cheese. Certainly it bears no resemblance to cheeses either made by artisanal makers here or in Europe, where the process is slow and personal and the prime ingredient, milk, comes from grass-fed cows.

Oscar Mayer Lunchables, which became a runaway lunch best-seller amongst kids, had not a speck of nutrition in it. It was the company’s way to reel in more money. Tang, which captured America’s heart when astronauts took it into space, has more sugar in it than soda. Cheap hamburger meat, that goes through bleaching and worse, that got termed “pink slime” finally got pulled off supermarket shelves when enough people complained. Trust me, I was raised on Carnation Instant Breakfast Drink and Pop Tarts and daily tuna fish sandwiches on Wonder bread. And an all time favorite, Chef Boy Ar Dee canned ravioli!

The history of how quick, cheap, processed foods arose is fascinating and all here. It started with a Kellogg brother, John Harvey, a doctor, nutritionist and health activist who created a sanitarium for people to regain their health in Battle Creek, Michigan. One of this main staples on the menu was whole grain cereal, no added sugar. When his brother, Will Keith Kellogg, in John’s absence on a trip to Europe, added sugar to the cereal and saw how people loved it, he split away from his brother and created the first sugar-laden breakfast cereal – Kellogg’s Frosted Flakes. Frosted with what? Sugar. American breakfast was born.

Coca Cola is given a lot of attention as a genius company for strategizing and turning the entire world onto Coke. During WWII they got Coke out to soldiers on battlefields, adding a patriotic feel to the product, and into gas station vending machines across the country.  Sad to say today as Americans recently began to drink less Coke, understanding the health risks, Coca Cola began exporting Coke overseas to hook poor people in underdeveloped nations.

You cannot read this book and not understand why we’re facing our current healthcare crisis and epidemic of chronic illness. And why what you eat is at the root of health, and disease.

Best and worst airline food

Each time I’m on an airplane I marvel again at how unhealthy the food is. Yes, if I can, I bring my own food on board, but that’s not always possible. I don’t eat the white bread roll and chemical-heavy salad dressing. I don’t eat whatever processed snack item they may serve like fake pizza. If I actually get a meal, I usually eat the protein and veg of the entree, skip the dessert, and save the cheese for a few hours later.

How interesting that someone actually rated the best and worst foods among most airlines. Turns out Alaska Airlines came in first place. Darn, not much chance I’m going to Alaska anytime soon.

Still, it’s interesting to see how our major and smaller airlines stack up – A ‘diet detective’ rates the best and worst US airline foods or health.