Living with Type 1 Diabetes: A Personal Journey of Blood Sugar Management
Receiving a Type 1 diabetes diagnosis at just nine years old marked the beginning of a lifelong journey for one individual, who has spent two decades navigating the complexities of this chronic autoimmune condition. Unlike the more common Type 2 diabetes, Type 1 is not linked to body weight or lifestyle factors and cannot be prevented. The pancreas ceases to produce insulin, necessitating manual administration to regulate blood glucose levels.
Currently, this involves multiple daily insulin injections, though insulin pumps are becoming more accessible through the NHS. Without insulin, the body cannot manage blood glucose, leading to potentially dangerous highs and lows. The condition, once known as 'juvenile diabetes', typically manifests in childhood or young adulthood.
The Discovery of Fasting as a Stabilising Tool
Over the years, managing the condition has presented significant challenges, including periods of elevated blood sugar and occasional hypoglycaemic episodes. However, one consistent habit has emerged as particularly effective for maintaining stable glucose levels: intermittent fasting.
Utilising a sensor-based glucose monitoring system that provides real-time data via a smartphone, the individual can track how specific foods, drinks, and activities impact blood sugar. This technology has been instrumental in identifying patterns and optimising management strategies.
The preferred fasting window is in the morning, creating an 18-hour period from a 7pm dinner until a 1pm meal the following day. During this time, hydration is maintained with water, sugar-free squash, and occasionally decaffeinated black coffee.
Expert Perspectives on Fasting and Diabetes
Sandra Cohen, a consultant nutritionist featured on healthcare platform Doctify, explains that fasting can improve insulin sensitivity by reducing glucose spikes and allowing the body to switch from using glucose to burning stored fat for energy. "This metabolic switch can support more stable blood sugar levels in some individuals," she notes, emphasising that any approach must be personalised and structured.
However, Cohen warns that fasting isn't suitable for everyone, particularly those using insulin or glucose-lowering medications, as it can increase the risk of hypoglycaemia. "Even when blood sugars feel more stable subjectively, there can be hidden risks if fasting isn't medically supervised," she cautions.
Hypoglycaemia, defined as blood glucose falling below 4 mmol/L, can cause symptoms like trembling, sweating, hunger, anxiety, light-headedness, and irritability. Fast-acting carbohydrates are typically required to address such episodes.
Balancing Benefits with Potential Risks
Ann Jarris, a board-certified emergency physician, suggests that fasting can smooth out post-meal glucose swings and simplify insulin dosing for some people. "A modest, earlier time-restricted eating window often reduces late-night hyperglycaemia and steadies overnight numbers," she observes, highlighting the importance of consistency and clinical review.
Nutritionist Erin Viljoen points to research indicating fasting can improve insulin sensitivity, lower fasting glucose, and modestly reduce HbA1c, a key marker of long-term glucose control. "Simply limiting eating to an eight-hour window has been shown to improve blood sugar regulation," she explains, noting that benefits can occur even without calorie reduction.
Nevertheless, Katie Murray, a nutritionist at gut supplement brand AltruVita, cautions that fasting is not safe for everyone, especially those on certain diabetes medications, people prone to blood sugar drops, or individuals under significant stress. "Potential dangers include dramatic spikes or drops in blood sugar levels, dehydration, and raised cortisol levels," she warns.
Alternative Views and Essential Precautions
Not all experts are convinced of fasting's universal benefits for Type 1 diabetes. Tobias Mapulanga, co-founder of Repose Healthcare, argues that fasting creates a narrower margin for error. "Basal that is even slightly too high can drive hypoglycaemia without the cushioning of snacks," he explains, suggesting that regular eating patterns with adequate protein, fibre, and properly matched insulin may be simpler and more stable for some.
For those considering fasting with Type 1 diabetes, Mapulanga advises consulting a diabetes team first and avoiding fasting if recently experiencing hypoglycaemia or diabetic ketoacidosis, during pregnancy, with an eating disorder, or when ill. Essential precautions include never stopping basal insulin, using continuous glucose monitoring with alerts, staying hydrated, and carrying rapid-acting carbohydrates.
While fasting has proven beneficial for this individual, it is not a one-size-fits-all solution. Anyone with diabetes should seek professional guidance before making dietary or lifestyle changes, ensuring any approach is safe and tailored to their unique circumstances.
