Congrats, @Allison1 on your recent success with glucose management and also losing weight. Have you been reading Jason Fung on intermittent fasting?
Thanks! No, I browsed his site quickly but haven’t dug into it. I do a lot of reading on Reddit and find the before & after pics there very motivational 
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I find it interesting that fasting is so beneficial to our health. I think it’s evolutionarily hard-wired into our DNA. The cognitive clarity is another benefit I love. Keep up the good work!
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Allison - Like @Terry4, I’ve found intermittent fasting has enormous benefits. I’ve pretty much been a one meal a day (OMAD) person for as long as I can remember, but started implementing 36 hour, then 48 & 72 hour fasts about a year ago.
Allow me to say this is not for everyone. I have several other autoimmune comorbidities, and the state of autophagy reached during 72 hour fasts is unparalleled.
I would caution anyone, especially T1D’s, to carefully plan your fasts, and 2 things are essential: Be prepared to cut your basal dose by 25-40%, and maintain your electrolytes (often salt in just not enough, some people lose a lot of potassium). I was dropping up to 6 pounds over 72 hours, and while you might put 3-4 lbs back on, it’s a great way to lose another 4-5 pounds a month when your weight loss plateaus.
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On twitter - Validating Time in Range
From ISPAD2019 - each 5% increase in TiR (70-180 mg/dl) decreases the risk of retinopathy by 28%.
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Thanks Jim! Having CGM has made it so much easier since I can see the immediate benefits of not eating.
How do you do electrolytes? Do you do that even if it’s only OMAD? And do you use any supplements? I’m not trying to bulk up or get super fit, just maintain a relatively healthy body 
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Allison - I’ll send you a pm so we don’t completely hijack the thread 
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As the original poster, I don’t mind divergence from the original topic. Please include us, if you don’t mind. I often learn important stuff when the topic migrates.
Wow. And they’re using the wider 70-180 range. Those numbers are powerful. I think TIR is a better statistical measure from a patient’s perspective. TIR indirectly includes the goals of time hypo and hyper as well as standard deviation and average BG. It’s a concise statistic that is easily understood.
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Except for my endocrinologist. He doesn’t have a clue nor does he show any inclination to learn.
I shared with @Allison1 that Keto / LCHF / IF can result in significant loss of electrolytes, primarily sodium, potassium and magnesium. Given the loss of water during extended 48 hour+ fasts, many people require additional electrolytes. For some, sea salt isn’t enough.
I’ve found supplementing my electrolytes with SaltStick capsules, which closely resemble the body’s natural electrolyte profile, are what I’d been missing early on in my fasting days.
If you find yourself experiencing aching muscles, dizziness, tachycardia or arrhythmia’s, there’s a good chance your electrolytes are seriously out of balance.
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For me, it’s soooo much easier to grasp and manage than this nebulous and virtually meaningless A1c concept.
BTW, the presenters @ ISPAD2019 agree that A1c has seen its day.
Time to move on from A1c Four good slides here.
@Terry4 - I think they are trying to set some standards here (but NOT in stone)
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Thanks for adding the electrolyte info, Jim. I’ve been trying to add magnesium starting a year ago to help treat my coronary artery disease. My problem is that I’m particularly susceptible to its laxative effect. My latest experiment is with making magnesium bicarbonate from seltzer water and magnesium hydroxate powder. It’s till triggering the unintended side effect.
I use lots of Celtic salt on the meat I cook but I don’t supplement potassium. I still get some muscle cramping but not as much I used to.
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The more enlightened practitioners see the benefit of using TIR instead of A1c. I for one am tired of managing some doctors’ reflexive hyperphobic reaction to a low (normal, actually) A1c. Good to read some things are changing.
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Hi @rcarli,
Very interesting thread.
Can I ask if 70-180 is still not a good range if I’m only using Dexcom and MDI, and our daughter is 9 years old and very sporty? We feel really good with ourselves for a 94% TIR over the last 6 months and an A1C of 5.9%. Our ‘Endo’ (Consultant UK), says she’s never seen such good control from an athlete and dancer. I suppose my question is, is it really that ‘good’ based on what I’ve read from you and Terry et al on this thread regarding a tighter, healthier TIR?
Thanks in advance
Eddie
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Hi Eddie1, an A1C of 5.9% is excellent for anyone but especially for an active 9 year old.
Do you know what her average blood sugar and standard deviation are that contribute to this excellent AIC and TIR? Whatever your daughter is doing I wouldn’t try to change anything unless you have specific concerns. Diabetics generally should be concerned about hypos in the short-term and complications in the long-term. If your daughter is having few hypos that’s tremendous and I’m sure you know how to treat an unexpected low. If her average blood sugar is also low then there should be very little concern about developing long-term complications. Do you have any specific concerns? This looks like tremendous management.
Thank you for such a speedy and positive response @rcarli.
I don’t know if this image will open for you but her BG for the last 90 days is 6.8mmol and standard deviation is 1.6.
I read your messages with real envy, I must confess. We’ve applied for the Omnipod
(being sporty and dainty it seems the right fit) as we think we can massively improve SD with smaller doses and possibly using closed algorithms. It’s slightly holding us back with stacking. One complication we have is that Niamh is totally and completely asymptomatic so that does take a lot of work. Any advice or thoughts?? Much appreciated. Eddie.
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You and your daughter appear to be well educated in managing you diabetes. My only diabetes training is from personal research, experimentation and always seeking to improve even with 50+ years as T1D. I always preach to “experiment on yourself but do it safely”. That’s where the most improvement will come. I am in a much different position being retired and not being active. I hesitate to make specific recommendations for a young, active person. I can’t imagine why you are seeking improvements to your current management. It’s great!
@Eddie1, I agree with @rcarli, I think you are doing a great job with your young daughter’s glucose management. Statistics regarding glucose management in one segment of the US population (are you in the UK?) shows discouraging results with plenty of room for improvement.
Check out this diaTribe article entitled, Few Type 1s Meet A1C Goals Despite Treatment Innovations, published earlier this year.
From that article:
A1C Goals
The majority of both youth and adults surveyed aren’t meeting A1C goals defined by the American Diabetes Association, and average A1C in the network has actually risen.
- 17% of youth have an A1C below 7.5%;
- 21% of adults have an A1C below 7%;
- Average A1C overall has risen from 7.8% in 2010-2012 to 8.4% in 2016-2018.
The A1C stats for adults hasn’t actually changed much from 2010-2012, but outcomes in young people have actually worsened. Higher A1Cs are linked to diabetes complications.
Keep in mind that people enrolled in the T1D Exchange are receiving care from endocrinology clinics, which likely means above-average care; these results are not generalizable to the entire US type 1 population. Unfortunately, general population outcomes are likely to be worse than those presented in this paper.
I don’t know the statistics from the UK but wouldn’t be surprised if they are similar. You are setting a good foundation for your daughter before she enters the more turbulent teen age years. Getting through those years safely with reasonable glucose control is a challenge for most families. Or so I’ve read as I wasn’t diagnosed until the age of 30!
Congrats on your excellent glucose management performance! And, of course, your daughter deserves a lot of credit. Diabetes is not easy at any age!
Niamh definitely hits the ball out of the park. @Eddie1, what do you expect from OmniPod? I am an OmniPod user for 10 years and looper since July. I am happy to answer any question you might have.
Thank you @Terry4, we are in the UK, and I agree that patterns in the UK will be extremely similar to those in the US. I had read the article relating to the amount not achieving their goals and found it both shocking and against perceived logic with such huge advancements in technology and community empowerment to exploit technologies. But understand that there are other social and cultural factors that have a greater pull for some people than technological advancements.