Transform Your Diabetes Podcast with Paul Coker, MSc

Many people think that following a low carbohydrate diet means that they increase insulin sensitivity because they are using less insulin. In this episode we debunk that myth and explore the science behind why this matters for people with Type 1 Diabetes?   In recent decades researchers have become increasingly concerned about insulin resistance in those of us living with Type 1 Diabetes.   Most of us with Type 1 Diabetes have at some point been encouraged to reduce our carbohydrate intake, this means that as we reduce the amount of energy we get from carbohydrates we are forced to increase the amount of fat that we eat, sadly even high protein diets are high in fat.   You could be forgiven for thinking that if you are following a low carbohydrate or ketogenic diet that you are insulin sensitive because you are using small doses of insulin; but this is a bit like saying I did not drive my car during the COVID lockdown so it was really fuel efficient. Yet, all you really achieved was not using your car very much.   The same is true if you limit your of carbohydrates, you may use less insulin but that is not a sign of increased insulin sensitivity, instead it is simply a sign that you have eaten less carbohydrates.   Now research is demonstrating that “Higher fat, but not carbohydrate, intake is associated with increased Insulin Resistance and an adverse vascular profile in patients with T1D”   This brings us to a really important question, why does your insulin sensitivity matter?   The traditional model of Diabetes management that dates back to 1993 describes HbA1c, your blood pressure and your lipid levels (cholesterol) as the most important markers to indicate your risk of developing complications of Diabetes   Sadly the evidence and clinical experience show us that many individuals that achieve great results in all of these still go on to develop complications of Diabetes.   In 2017 a team of researchers recruited 17.050 people living with Type 1 Diabetes in Sweden set out to determine if insulin resistance was the ‘missing link’ that might explain these complications and they found that “a strong association between eGDR (insulin resistance) and all-cause mortality, as well as cardiovascular mortality, in individuals with T1D”. In other words, as insulin resistance increased so did the risk of heart attack, stroke and death by any cause.   OK, but if your HbA1c is great then does your insulin sensitivity matter?   In 2021 a team of researchers in the UK put this question to the test and they found that “diabetes complications are not only related to glucose control. Insulin Resistance, assessed as estimated Glucose Disposal Rate (eGDR), is strongly associated with both microvascular (retinopathy) and macrovascular complications regardless of HbA1c levels.”   But, we have all heard all of the fear messages for far too long haven’t we? Let’s be honest, that is not going to motivate me or you, is it?   Hi, it’s Paul Coker I have been living with Type 1 Diabetes since 1977 and I am fascinated by insulin sensitivity, that I went to medical school and earned a Masters degree in Diabetes Practice in researching the topic.   In my personal experience and based upon my research when we become more sensitive to insulin then our insulin becomes more reliable, more predictable, more of the time and that reduces Diabetes distress and improves quality of life.   Conclusion:   Reducing your carbohydrate intake means that you will eat more dietary fat and that will increase your insulin resistance,   This makes it harder for people with Type 1 Diabetes to process the carbohydrates they eat and that means that they are tempted to reduce carbohydrates. Increasing insulin resistance further and fueling the risk of Diabetes complications.   In the next videos I will look at how does dietary fat increases insulin resistance and why not all carbohydrates are equal in terms of your insulin needs and your blood glucose levels.   For more information visit www.transformyourdiabetes.com  

What is the ELSA study? The ELSA Study is the largest type 1 diabetes screening programme for children aged 3-13 years in the UK. Children can have a simple finger stick blood test to find out their risk of developing type 1 diabetes in the future. Why Screen?"The ELSA Study is finding children at high risk of developing type 1 diabetes because the sooner we screen, the sooner we can intervene."Can We Stop These Children from Developing Type 1 Diabetes? No, not yet. But, we may be able to delay the onset of Type 1 Diabetes.Is it Ethical? This is a complex ethical issue & Dr Lauren Quinn explains the benefits of screening and potential interventions that can slow down the progression to Type 1 Diabetes, whilst also exploring the potential downside of knowing that your child is very likely to go on to develop Type 1 Diabetes.

Julie Kiefer, the founder of the Diabetic Travel Network, shares her top tips for traveling with traveling with Type 1 Diabetes.For more information and top tips about how to travel, live and work overseas with Type 1 Diabetes check out https://www.diabetictravelersnetwork.com/This is the ultimate in getting more freedom from yur diabetes!

Charlotte Hurst is living with Type 1 DIabetes and is going to run the Marathon De Sable 250km across the Sahara Desert (unsupported) to prove that ordinary people living with Type 1 Diabetes can do extra ordinary things.Follow Charlie & her progress at:Facebook: https://www.facebook.com/charliedoesthemds Instagram: @charliedoesthemds An epic event in support of: https://www.t1international.com/      

3 strategies that you can use to improve your insulin sensitivity, without restricting carbohydrates.  Improving your sensitivity to insulin will geive you more freedom from your Diabetes, it might mean fewer drugs, less insulin, less expense.   Perhaps more importantly it means that your blood glucose levels become more predictable, your insulin works better and you are likely to feel better.

New evidence is showing us that your insulin sensitivity may be at least as important as your HbA1c. In this episode we look at the evidence and how you can measure your sensitivity to insulin.In the next episode we will look at strategies that you can use to improve your insulin sensitivity.If you prefer the written word the transcript of this podcast can be found at: https://www.transformyourdiabetes.com/blog/is-your-insulin-sensitivity-more-important-than-your-hba1cVisit the TransformYourDiabetes.com homepage for more resources to help put you in the driving seat of your diabetes.

In this episode Paul Coker talks to Dr Becky Thomas, a senior research officer at Swansea University School of Medicine about what retinopathy is and how and why it is different from maculopathy. There is also some disuccsuion on other forms of eye disease that can affect people with diabetes. This epsode covers: What is retinopathy? What is maculopathy? What do the codes like R1 & R2 mean, if I get a letter saying I have retinopathy How can I reduce my risk of developing retinopathy? If I have retinopathy, or maculaopathy, can I reduce the risk of it progressing? Will managing my blood glucose levels more tightly remove the risk of retinopathy? For more information visit https://www.transormyourdiabetes.com

In this first episode Paul Coker interviews Dr Emma Wilmot, Professor Pratik Choudhary and Professor Partha Kar OBE about how using Freestyle Libre and Continuous Glucose Meters can improve your quality of life. We discuss: Improving your quality of life with diabetes The benefits of time in range Comparing HbA1c and Time in Range Setting a realistic traget for your time in range Dealing with alarm fatigue When to take action based upon your cgm results and when to 'relax' For more information visit https://www.transormyourdiabetes.com