Healthy Actions Breed Healthy Habits

The more I fast, the more I get used to it and discover what works for me, which makes perfect sense. 

Diabetes, on the other hand, doesn't make perfect sense. 

I'd been having my usual basal insulin on fast days, now that my body is more used to it. I might go a little low by mid-afternoon if I've been more active than usual, but generally have few problems. Today, though, I'm hypo at 10:45am... Not feeling at all hungry and, being slightly under the weather, not really wanting to eat anyway, it was very annoying having to have food. I chose to have a cup of tea with sugar, and half a cereal bar (at 42 cals). I keep in mind the calories I've consumed to treat hypos, and might have a few cals less for tea, but generally don't count them into my fasting allowance because it just makes things far too hard as a diabetic.

Generally speaking, though, I've been enjoying fasting. It opens your eyes to the extra snacking and picking you may do, too. As a mum, I'm always having to go into the kitchen for things, which means that it's frightfully easy to pick - a piece of chocolate here, some blueberries there, even a sliver of butter... fasting reminds me that today I can't do this (and shouldn't too frequently on other days either), and means that even on non-fasting days I'm much more aware of this. 

Fasting also enables me to make positive changes, so for example I will more often evaluate whether I really am hungry - and if not, I don't eat (at least, try not to). I'm also finding it much easier to choose fruit or other healthy snacks for when I am hungry. The more healthy food I eat, the more healthy food I want to eat, which is great. Cakes and other sweet treats are far less appealing nowadays. I still have a weakness for chocolate, though!

Another tip for anyone trying fasting is that, while drinking a lot is essential, I would discourage, for example, drinking loads of coffee to fill you up. If you're hungry, wait for it to pass. Yes, have some water. Yes enjoy hot drinks throughout the day. But I was drinking far too much, and my stomach wasn't getting used to being empty because I was constantly putting liquid into it. It's good to drink, but don't go over the top like I did! Your stomach will get used to being emptier, and this will help you with your portion control on non-fasting days too.

Eat Well

It's interesting to see how my body responds to new regimes or diet changes. It always takes a little while, but sooner or later, it seems to get used to it. This is really good news for me, because I have often been quite despondent about feeling as though I am fighting diabetes. The truth, it seems, is that I can 'train' my body to get along with the changes I make, as long as I do it regularly enough. Two or three times a week is a good schedule for exercising - just often enough that it recognises something and remembers how to cope with it (for want of a better description).

I have also felt very good about eating my normal amount of food today. Sometimes, a day or two after fasting, I have felt like I'm eternally hungry, or just want to eat loads even when I'm not. But today is probably the first time I really did just want my usual salad lunch with yoghurt afterwards. (Not forgetting the vital one piece of dark chocolate with my cup of tea.) I'd been eating extra healthily for quite a while, though, and so it didn't surprise me that after first starting the 5:2 I wanted to eat more calorific foods, simply because my calorie intake was already fairly good - according to NHS guidelines, anyway, which stated that I should be consuming between 1492 and 1918 calories per day. My usual intake is somewhere between 1600-1900. Nice.

Eugh, it's raining very heavily outside. I need to go collect my son from nursery soon. Usually I look forward to the exercise - not today!!

24 versus 34

Yesterday (well, technically, this morning) I finished my first 'proper' fast. By that, I mean one that fit almost exactly with the primary examples in the book. I felt my body had adjusted fairly well to the version I was doing (very few hypos) and might be able to cope with a more hard core version, i.e. getting through the night without an extra snack or meal before bed.

Interestingly, the book says that it's fine to start and end your fast at any time of day, but it seemed to me that unless you fasted from breakfast to breakfast, it was never quite right. Thinking of the hours involved, though, that actually makes sense, because a fast from, say, 8pm to 8pm is 24 hours, and a fast from 8am to 8am is also 24 hours, except the latter, if you think about it carefully, actually includes two nights. (Unless you get up at 7 and have a massive breakfast before your fast begins - who does that?) So really, fasting from 8am is a fast from the last snack eaten the night before - in my case, usually between 8:30 and 10pm, making the total fast time at least 34 hours.

This extra fast length, and the lack of evening snack, was reflected in my sugar levels this morning - a nice 4.2. I felt a little bit wobbly but nothing too bad, so I'm not worried about this because, I'm assuming, my body will continue improve as it gets used to these changes.

Interestingly, this morning has been the first one since the beginning where I felt lighter. All of a sudden, you understand, not some gradual change from the last week or two. I've been weighing myself quite a lot lately (I tend to do this out of scientific interest when starting a new regime of any kind), and I had actually put a little weight on since starting the 5:2. But this morning, I weighed in at about 6lbs less than I had been weighing the previous few days (and 1/2 a pound less than before I began). I wondered at the change a few more hours made to the fasting process, and whether sleeping off a fast was part of the sudden change.

As I should have guessed, doing the longer fast affected my blood sugars the following day. As is quite typical for me, I half-forgot about this, and should have reduced my bolus insulin slightly but forgot! As a result, I had a few hypos and felt pretty hungry for much of the day. 

Hopefully my body (and I) will get used to the slight change to my fasting nice and quickly. I think it's going pretty well so far. 

Some Days Work, Some Days Don't

Some days just 'work' as fast days. Others, it would seem, don't. In the fasting book it does advise you to give in gracefully if it is one of those days.

My body seemed to be getting used to fasting, in that the increased insulin sensitivity had levelled out. Yesterday though, being an extra fast day technically, was obviously just a bit too full on for my body (at least for now). I breakfasted as normal, but only an hour or so afterwards I started to feel unusually hungry; by 11:30am I felt starving and my sugar level was quite low (5.1), and by half 12 I decided that to skip lunch would just cause more problems that it might solve, since I was starting to pick at food to try and feel better. In the end I had a slightly smaller lunch than usual and that was okay, but then by 2:30pm I felt desperate for food again (my levels were hovering around the 5 mark most of the day, dwelling on the verge of dipping). I decided to forget fasting altogether. I had a snack at 3pm and then still felt the need (diabetically) for more food at 4:30pm. I ended with a good tea at 6pm with my sugar levels finally feeling stable.

Of course, nothing is that easy with diabetes, and despite being a perfect 7.3 before bed, I had a sky-high reading of 20.9 at 5:30am. Thankfully I am a slightly more acceptable 12.9 this morning. It is also the first sunny day in AGES, so I shall end this here, get up and enjoy the sunshine!

Some Positive Effects

I took great delight in my extra fast yesterday. I feel like I have more energy - or, perhaps a more accurate description - I am less tired, and much less worn out by the children than usual. I feel a lot more alert, and I also slept better last night than I have done in ages. I'm hoping these aren't coincidences, because I could really use the extra energy!

I'm not convinced that my now 8:30pm to 8:30pm fast is working terribly well. My struggle yesterday was being fed some fish and broccoli at my Mum's house around 6pm (fitting in with my calorie count) and having insulin with this small meal. By 8:15pm I was only 6.7 but feeling extremely wobbly and like my body was desperate for sugar. I decided to be sensible and break the fast early to prevent the incoming hypo. However, because I came out of 'fast mode,' I ate a proper meal, quite large really for a breaking fast meal (fruit cake for the hypo, then some left-over stir fry, then scrambled eggs with toast), and ended up needing more insulin with this. I finished feeling extremely full and bloated, despite having felt exceptionally hungry - this was probably due to the hypo), and it was about 9:30pm that I had the insulin, which never really works for me (night times are still much of a mystery when it comes to my insulin requirements, and having novorapid shortly before bed never helps this!). I think this would have been a lot better had I had less or no insulin with the small tea, and then later treated the hypo only (i.e. take some dextrose tablets and have a cereal bar). So I will try this. Doing this may also mean I can switch to an AM to PM fast, which is easier to work out in my head, and will help me to eat less erratically, because I will be able to skip the late-evening meals and instead break my fast in the truly appropriate way - with breakfast.

What I have found interesting today is my lack of desire to eat loads of 'bad' things, a greater awareness of when I'm feeling full, and if I do have something 'unhealthy' I only want a little bit. I think that, overall, I have had lower sugar levels too. Just tallying up from my monitoring diary, over the past week I have had 22 tests where my levels were below 8 mmol/l, compared to the week before where there were 17, only 13 the week before that, and only 6 the week before that! That has to be a good thing. There have still been some very high readings, but overall much better control.

Another fast day tomorrow. I hope that I will start to see some weight change after a few weeks - so far I have stayed almost exactly the same!

An Extra Fast Day

Okay, so maybe I'm impatient, but three days of no fasting (between Monday and Friday) seems like an age. Having not seen any results yet (either visibly or on the scale - not that I would expect this after only two days of fasting but apparently it's quite common) I decided to fast today as well as Monday and Friday. I may only do this intermittently or I may do it every week; I will see how it goes. Alternate day fasting is another type of fasting talked about in Dr Michael Mosley & Mimi Spencer's book, The Fast Diet, where, as the name suggests, people fast every other day. It isn't hugely popular due to being quite full-on, plus it is extremely difficult to plan more than a week or two ahead of time. However, a 4:3 diet is fairly similar, an in between if you like, but with much more structure (always fasting on the same weekdays) and so I know it should be just as safe me to try this.

Yesterday, my third post-fast day, was very up and down in terms of blood sugars. In fact, it felt like one of my usual 'bad control' days usually do. These days just seem to happen, regardless of what I eat, inject, or do with my day - and one of my biggest struggles with diabetes. I ended the day with some yoga and weights exercise in an attempt to level the day out, since I usually find that exercise has nothing but a positive effect on my sugar levels as long as I am sensible with regard to hypos. This obviously had the desired effect because it helped bring my sugars down from a 15.

This morning started well with my first breakfast reading under 7 mmol/l in weeks, a 5.9. The day has continued well so far, with a 7.7 reading at 12:30pm. I am also managing fine on 'lighter drinks' - my usual is a milky tea with half a spoon of sugar (to take away the bitterness which I've never enjoyed in tea), but today I have had a cup of marginally-whitened red bush tea, a coffee (again with little milk), and just now a small cup of tea with much less milk than my usual and without sugar. I was surprised at how great this tasted! Fasting today has apparently enabled me to really taste the milk and enjoy the drink much more, and without finding it bitter. Great! This also works with food - everything just tastes so much more.

No sugar in tea is something I'd like to keep up even on non-fasting days, because it's always annoyed me that I just honestly don't like tea without that bit of sugar. Even a quarter-spoon makes a huge difference to the taste as long as it isn't made too strong, but I've never quite got to the point of having none at all. I simply end up throwing two thirds of the cup away.

I am hoping that the rest of the day will pass without any particular problems. I am anticipating needing a small snack at 3pm when I collect my son from nursery because we will then be walking up to my parents' house - a very large, steep hill to push a double buggy up with a 3 year old hanging on! Other than that I think I will find it fairly easy to stick to hot drinks (nice and filling) until we get back home, where I will break my fast before bed with a small (and hopefully nutritious!) meal. Because I didn't plan this day in advance as such, I had my usual basal injection dose of 28 yesterday. It will be interesting to see how my body manages this. Technically my blood sugar should remain stable, since the lantus dose is supposed to be how much your body needs without food, but seeing as I'm not certain about being on the correct dose (I seem to have a little too much in the day; not enough at night), it's hard to know. At least, for this week, I don't have two takeaways to deal with, but instead am having my usual food for which the doses are easy to calculate!

Fasting already gives me a feeling of energy and space; I have more time to do other things or just take a break from thinking about kids or food preparation. It's really nice.

Altogether Unrevealing

Fast day number 2: altogether unrevealing. At least, for now...

After my early-morning correction dose (from a 'Hi' reading) I managed to get a more reasonable 14.6 mmol/L before breakfast. I took my usual correction dose for the reading, 4 units (1 unit for every 2 numbers above 6, my target), and 1 unit less than my normal breakfast injection (usual is 4 units for 35g of cereal). These were guess numbers, of course. I was still fairly concerned about insulin sensitivity, despite having very little basal insulin by this time, hence not going the full hog with the breakfast dose. It seemed to be a good guess, though, because by 10:30am I was 7.9. By 11:30am, though, I felt as though I might be heading for a hypo. I checked my blood sugar, which was 5.1, and ate a cereal bar (85 cals). By 2:30pm, with no further food, my level was 7.8, a reasonable level, though revealing of how little insulin I had in my body. That was the end of the 'reasonable' sugar levels, though - by 5:30pm it was obvious that I needed more basal insulin, as I was an unexpected 16.3. Unfortunately I can't remember whether I had a tiny snack at this point or not, but I did have a correction dose of 5 units. I also took my usual lantus dose of 28 shortly after this (i.e. slightly earlier than usual) in the hope of holding out until the end of my fast without needing any more correction doses!

The one thing I am not struggling with at all is the actual fasting. I don't know whether this is due to my annoyance with often having to eat (a common thing amongst diabetics, so I am told), or from the delight in the focus it seems to give me. The hunger pangs are fairly few and far between, and are very short - easily overcome by having a nice hot drink and occupying oneself with some small task or other. My next step is to move from having tea with milk to having either green tea of some kind, or red bush (which I can happily drink black). I think this might make a difference to how easy I find it, but I am going to try that on my next fast day. If I don't count the calories in the tea, I've found myself easily under the suggested 500 calories, and with them, only around 560. I reduced my breakfast size to a small bowl of cereal about 9 months ago now (I used to have a HUGE bowlful every morning!), so that is now about 200 cals - easily incorporated into a fast day - and then I don't really eat anything else for the whole day, until I break fast between 8-9pm. I wonder if this matters?

At the end of my fast today (8pm) I was 10.4, and had a medium-sized meal of bread, cheese, oatcakes and grapes, with approximately half of the novorapid I would normally take (still not sure what was going on with insulin sensitivity and now back on my normal lantus dose I didn't want to take any chances!). Two hours later I was 11.8, and as I was offered a chocolate at the time, took the opportunity for another minor correction dose with it in the hope that I could get through the night without any extreme highs or lows.

All the struggle with my basal insulin today led me to wonder whether, in the future, I should ask my consultant about trying detemir (marketed as levemir) again which, I believe, lasts between 12-16 hours in the body. I used it while I was pregnant with twins, for two reasons: I needed so much basal insulin from about 6 months on that I had to do it in two lots, and as a plus it had been tested to have no detrimental effects on babies in-utero. (Insulin requirements can more than double during pregnancy so you can imagine the effect having twins has on the body!) I don't remember many differences between it and lantus, but the advantage would be that I would be doing an injection morning and night - lantus is a 24hr insulin - and could therefore reduce my basal insulin purely for the fast day, and nor have to worry about the night before. I could also take less for the night following the fast, if it turns out to be a necessary change, without having to worry about having less come the following day. This would be much easier with a pump...

Anyway, it is now 11:30pm and my level is 10.9. Let's hope it stays fairly sensible throughout the night, and bring on tomorrow!