The case for low carbohydrate diets in diabetes management


A low fat, high carbohydrate diet in combination with regular exercise is the traditional recommendation for treating diabetes. Compliance with these lifestyle modifications is less than satisfactory, however, and a high carbohydrate diet raises postprandial plasma glucose and insulin secretion, thereby increasing risk of CVD, hypertension, dyslipidemia, obesity and diabetes. Moreover, the current epidemic of diabetes and obesity has been, over the past three decades, accompanied by a significant decrease in fat consumption and an increase in carbohydrate consumption. This apparent failure of the traditional diet, from a public health point of view, indicates that alternative dietary approaches are needed. Because carbohydrate is the major secretagogue of insulin, some form of carbohydrate restriction is a prima facie candidate for dietary control of diabetes. Evidence from various randomized controlled trials in recent years has convinced us that such diets are safe and effective, at least in short-term. These data show low carbohydrate diets to be comparable or better than traditional low fat high carbohydrate diets for weight reduction, improvement in the dyslipidemia of diabetes and metabolic syndrome as well as control of blood pressure, postprandial glycemia and insulin secretion. Furthermore, the ability of low carbohydrate diets to reduce triglycerides and to increase HDL is of particular importance. Resistance to such strategies has been due, in part, to equating it with the popular Atkins diet. However, there are many variations and room for individual physician planning. Some form of low carbohydrate diet, in combination with exercise, is a viable option for patients with diabetes. However, the extreme reduction of carbohydrate of popular diets (<30 g/day) cannot be recommended for a diabetic population at this time without further study. On the other hand, the dire objections continually raised in the literature appear to have very little scientific basis. Whereas it is traditional to say that more work needs to be done, the same is true of the assumed standard low fat diets which have an ambiguous record at best. We see current trends in the national dietary recommendations as a positive sign and an appropriate move in the right direction.

DOWNLOAD: The case for low carbohydrate diets in diabetes management

How To: Look after yourself with Type 2 diabetes

This section is for all type twos and any type ones who think they are developing insulin resistance. This is often recognisable by an increasing waist line, blood pressure and need for high doses of insulin relative to your thinner years.

Slim type ones may proceed to the How To: “Eat to Meter” section.

When you eat carbohydrate it gets broken down by the digestive system and appears in the blood stream as glucose.  Insulin is immediately released by the pancreatic beta cells.  Insulin is the hormone that tells certain types of cell in the body to take up glucose in the bloodstream.  In this way the glucose level in the blood stays within a narrow range.

In insulin resistant states such as metabolic syndrome and type 2 diabetes the cell wall insulin receptors are less sensitive to insulin and in an effort to keep blood sugar levels normal the pancreas releases more insulin.

High insulin levels causes inflammation and stiffening of the lining of your blood vessels. This lining is called the endothelium. This stiffening causes high blood pressure.

The pancreatic cells can initially make plenty of extra insulin to compensate for the weakened effect of the insulin but eventually become exhausted and start to die off. This causes higher blood sugars.  Unfortunately blood sugars higher than 6.1 are toxic to beta cells and they start to die off with higher and higher blood sugars. The whole thing is a vicious circle.

Type two diabetes is often thought of as being less serious in some ways than type one diabetes. It is certainly true that a type two will not die as rapidly if they don’t get insulin as in type ones. On the long term however type two diabetes causes all the same complications as type one and can be just as fatal. Instead of it being obvious that something is drastically wrong with your health as in type one, those with type two can have it creep up on them over many years, slowly causing damage to the blood vessels, eyes, kidneys and nerves and not even know about it.

In type two diabetes there is initially more insulin produced to try to overcome the effect of insulin resistance. In early type two diabetes there can even be episodes of low blood sugars when the pancreas releases too much insulin at the wrong time. As time goes on the beta cells become exhausted and produce less and less insulin and  die off. In many people insulin injections are eventually needed to give anything like normal blood sugar control.

Type two diabetics store less immediately available insulin than normal people. In addition they also need to produce more than normal because their cells are less sensitive to insulin. As their ability to produce insulin on demand declines they get higher blood sugars after eating and this persists for much longer than in non diabetic people.

High blood sugars after eating can be minimised by eating fats, protein and carbohydrates that release sugar gradually so that their pancreatic insulin factory (phase two insulin response) can keep up. This effectively means eating non starchy vegetables as the main source of carbohydrates.

For type two diabetics who do not need insulin they may get better results from eating  4 or 5 small meals a day rather than sticking to three bigger meals a day.

Many people have inherited their tendency to insulin resistance.  If your parents or grandparents had heart disease, high blood pressure, fat round the middle, high cholesterol, high triglycerides, type two diabetes or swollen ankles you are more at risk.

The diabetes tendency becomes noticed at times such as pregnancy, ageing and if the person tends to eat a high sugar or starch diet.  Lack of exercise also affects how rapidly the tendency will appear.

Insulin primarily affects blood sugar but also affects blood pressure, cholesterol and triglycerides and the storage of fat. No medications can reduce excess insulin production: only a low carb diet. A low carb diet works by reducing the oversecretion of insulin and helps restore balance.

Beta blockers and diuretics which are often used to control blood pressure also increase insulin resistance and are best avoided in some people.

Although there are cut off points in blood sugar tests to say who is normal, who has metabolic syndrome and who has diabetes, the condition is really a continuum.  Someone who has metabolic syndrome can get retinopathy, kidney disease and cardiovascular disease just the same as a diabetic.

The worse your sugar control is the worse your cardiovascular and complication risk.  A popular test to do is the hbaic. This is the percentage of sugar attached to your red cells in the blood. Although a normal range of 4-6 is often given for instance it has been found that your risk goes up progressively from levels of just 4.6.  It therefore makes sense to have as good blood sugar control as you can, particularly if you have a moderate to long life expectancy.

Tests that you can have done to find out your risk or severity of metabolic syndrome and type two diabetes include measuring your waist/hip ratio, hbaic, glucose tolerance test, fasting lipids and blood pressure.

There is a progression in how type two diabetes is treated:

Low carbohydrate diet
Appropriate weight loss
Drugs that enhance insulin sensitivity or insulin action
Insulin injections with or without oral drugs.

People who have lived with high blood glucose levels for years can feel shakey or ill at normal blood sugar levels.  They also can have blurred vision. A gradual adjustment of the target blood range and progressive reduction in carbohydrates can help these symptoms settle down.

Quick Quiz:
1. One of these is true for type two diabetics…
a They get less serious complications than type ones.
b They can have slowly developing damage to tissues without realising it.
c They need the same level of daily monitoring as insulin using type ones.
d Those not on insulin get on best with three meals a day.

Have you got it?
1. B is correct. Unfortunately the myth that type twos get less serious complications than type ones persists. Diabetes is certainly not as dramatic in onset as in type ones. It’s insidious nature makes it harder to detect and so damage goes unchecked. It is the case that monitoring of blood sugars needs to be done a lot less often than in insulin dependants but dietary habits must be just as good. If reasonable amounts of a person’s own insulin are being made type two diabetics may have better sugar results with smaller and more frequent meals than the 3 or 4 a day advocated for type one diabetics.

Reference Info:
Most of the information in this section is from Dr. Bernstein’s Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars.
Where to Next?
You are now ready to proceed to the How To: “Eat to Meter” section.

Endings and New Beginnings

Now. I do recollect that I said I would read you a story. But until this site gets a bit more sophisticated technically, you will either need to read it to yourself or perhaps ask your helpers to read it to you.

This is a very special story. It is one of my favourite fairy stories that my mum used to tell me when I was little . And just like then, I’d like you to settle back and take a well deserved rest. Now we will begin.

Once upon a time. In a distant land, in a far away kingdom, a King and Queen, a bit past their youth, reigned.

The Queen was very happy.

A few months before she had given birth to a much longed for and awaited child. Her first born. Aurora.

But the Queen had her worries. It was soon to be her daughter’s naming ceremony. And just like many of us today, she only had so many gold plates and goblets.  She couldn’t possibly invite everyone she ought to.

Her happiness at being able to get into her lovely gowns again was somewhat dimmed. Decisions. Decisions.

The day of the great event dawned.

Among the most favoured guests were several of the Queen’s old school chums. They were to be Godmothers to the new Princess.  Their gifts would be in the form of blessings. You see, Aurora was destined to be the most spoiled and pampered Princess ever.  No siblings.  Middle aged doting parents. Unlimited wealth. No Marks and Spencers vouchers.  No  hand knitted cardigans. No babygrows from Bloomingdales. It was THAT sort of family.

One by one the Godmothers approached Aurora’s crib to give their blessings on the babe.

Beauty. Grace. Kindness. A lovely voice. Then. Suddenly. The door was thrown open and a hush descended on the room.

“Hells Bells!” cried the King, “ It’s my big sister, Carabos. Here to ruin it all!”

“You bet!  You little runt. If they had changed the succession laws in time it would have been me, Me, ME who would have been Queen” glared the tall, angry, dark clad figure that was Carabos.

The Queen quivered with fear. She had never got on with “Big Sis.” She trembled with apprehension.

She could see Carabos glide nearer and nearer her precious child and her heart was gripped with fear. She lunged to save her baby …only to fall flat on her face as her Manolo Blaniks buckled beneath  her.

From floor level her sister in law’s angular, pitiless face  looked even more terrifying than ever.

“ I have a gift for the child. “ Carabos said slyly, picking up the little pink bundle. “ Yes, my SWEET….You will indeed grow up to be beautiful, graceful and kind. Yes. You will have a pleasing voice. BUT. When you are seventeen years of age you will prick your finger on a poisoned needle on a spinning wheel and you will die!”

As the sounds of “You will DIE, you will Die, you will die…” faded into the walls of the corridors a feeling of terrible foreboding clutched the heart of every living soul.

“Our daughter is doomed!” yelled the King. “That bitch of a sister of mine will never lift that curse !”

He slouched on his throne. And buried his wet face in his hands.

A woman quietly approached him and gently placed her hand on his arm.

“King. Do not despair. I have not yet given my blessing.”

“What difference can you possibly make?” sobbed the Queen, still prostrate.

“The forces of evil are strong. I’ll admit. “ The woman started hesitantly. “ Aurora will indeed grow up. She will indeed prick her finger. This I cannot change.  But she will NOT die. Instead she will fall asleep, as will you all, until the curse is lifted by someone who is not yet born.”

Now you would think that Mum and Dad would have been happy with the poor Godmother’s efforts. But they weren’t. They became very, very depressed. All the could think of was the harm that was to befall their only child.

They banned all the spinning wheels in the kingdom. Aurora’s immunisation schedule was everything.  It started Dip Tet Polio and ended Hepatitis A to Z.

The years passed.

Despite her paranoid and over protective parents Aurora grew into the lovely young woman that her birthright demanded.  Yet.  Even though she couldn’t stand the sight of needles due to all those vaccinations, the day came when  Aurora pricked her finger on a spinning wheel just as her evil aunt had planned.

As the blood spurted from her finger, Aurora had a few last gasps. “ The curse has come true! I’m going to die! I’m never going to university !  I might as well as watched “Neighbours” with my pals instead of all that studying….I should have just eaten all the donut…”

Well, regrets. We’ve all had a few. But then again too few to mention compared to the fate of this poor wee lassie and her family.

A hundred years passed.


One         h..u…..n…….d………r……e………………..d………..y……e………a………….r……………………s.

Meanwhile….Aurora tossed. She turned. She snored. She squirmed. She was not entirely continent.

Then one day.  A handsome Prince – who looked a bit like David Beckham- was playing football outside some old overgrown walls when he kicked the ball so high that it went right OVER the wall.

He climbed right over the wall using his muscular yet agile build to help him.

To his amazement he saw the outline of what looked like a huge palace in the jungle that had become of the once immaculate gardens.

“Too posh to do the garden!”  He chuckled with his faintly Mancunian/Spanish/Los Angeles accent. “I’ll fix that in a jiffy.”

With a bit of help from the rest of the football playing lads they assembled all their “in case of road rage”  car boot tools.

Chain saws. Grappling devices. And midgie repellant.  And they got to work.

To some of them it was a bit strange seeing old people, oddly dressed, all around, wearing wigs, fast asleep. To others they had seen it all before at their local Sheriff Court.

As if love was guiding our handsome hero, the Prince at last found the chamber in which our lovely Aurora reclined.

At once he took in the hairy legs, the wet mattress and the matted locks of our still youthful but not quite pristine Princess.

At first he was a bit put off by the you know, nursing home type smell. But she had such a lovely, sweet smile. And before he realised he had kissed her and she woke up.

Did they live happily ever after?

Did they get a new mattress?

Did she ever get to university?

Well. We don’t know.

But if you are waiting for a cure for diabetes you can do more than lie about in bed dreaming about it.  If you want it to take less than a hundred years, please look at our links below.

Thank you.

If you have enjoyed this course please pass the address for D-solve, , onto someone who needs this gift.  Also, as stated in the introduction please send me any feedback or comments by clicking on my name below.

Dr Katharine Morrison


Where to Next?
…the beginning of course.



How To: Use Insulin to the Best Effect

This section is for everyone.

In this section I am aiming to give you information on  what you need to know to use insulin not just to keep you alive, but to keep you as well as you would want to be if you didn’t have diabetes.

I will be discussing different sorts of insulins and different sorts of delivery devices.  Most basic techniques are covered in your diabetic clinic but here I want to help you take things further. I want to try to help you get the best match possible to cover your daily rhythms and food intake.

As in most of this course self experimentation is the key. Various techniques are described and you have to decide if you would like to use this technique to control your blood sugars or not.  You then need to change what you do in a gradual and controlled way.  Whenever you are experimenting with new food, exercise and insulin patterns you need to test more frequently and be prepared to adjust things according to the results you are getting.

I hope that you will have started to count up how much carbohydrate you are eating each day. You may still be seeking some more information before you begin to reduce it and this is okay.  Arm yourself with lots of test strips for this section!  And lets begin.

What is insulin?

Insulin is a big protein made by the beta cells of the pancreas. It controls several functions in the body.  The most important ones for diabetics are:

Insulin tells certain cells to take in sugar from the blood stream and so drops blood sugar levels.

Insulin tells your liver to reduce the amount of sugar it is making from protein.

Insulin is a growth hormone.

Insulin is a fat storage hormone.

High insulin levels tend to stiffen and age your blood vessels.

In 1922 researchers in Toronto, Banting and Best discovered how to extract insulin from animals to give to humans.

Fine tuning did not really exist until blood monitoring was popularised in the 1980s for all type one diabetics. Since then genetically engineered insulin has been produced from yeast and the e coli bacteria which is structurally identical to human insulin.

Different action times of insulin have been developed by altering the chemical structure of the insulins or by the addition of stabilising substances.

Syringes and vials have been supplemented by pen injectors, pumps, and now inhaled and oral insulins.

There are different potencies of insulin with different onsets and durations of action. Eg rapid acting, regular insulin, intermediate acting and slow acting.

Modern analogue insulins tend to have a more predictable pattern of action than some older insulins. Unfortunately their popularity and higher price has resulted in some older insulins becoming less profitable and there has been a decrease in the range of insulins available as a result. One of the most noticable is the lack of human  regular insulin available in pen form. You can use Novonordisk actrapid in vial and syringe but need to use a pork or beef derived actrapid to have this duration of insulin in pen form. This is available from Wockhardt in the UK and the Owen Mumford Autopen Classic is the delivery system but is only available in one and two unit increments.

In general the total carbohydrate content of a food is a more important consideration than the amount of sugar in it. Whether it is a starch or a sugar that is present the same amount of insulin is needed to deal with it and both types raise your blood sugar pretty fast. Your major challenge is to carefully match your insulin intake to your carbohydrate intake. There are also factors like exercise, stress and illness to be considered.

Where do I inject?

One of the best sites to inject insulin is in your bottom or on the fat pad above your trouser line. These areas usually are quite fatty and tend to hurt the least. You are also most unlikely to mistakenly inject into a muscle.

Other sites that you may use in public are your abdomen or your thighs. You can adjust your clothing or inject through it.

Some people prefer to inject in a washroom and others will be happy to inject at the table in a restaurant or plane.

How do I inject insulin?

If using a vial and syringe the best technique is to draw up the insulin smoothly and quickly and inject it smoothly and quickly.  Dr Bernstein has a video of this in his CD series.

If you use a pen you need to count to ten slowly, “one thousand, two thousand…” etc.  Otherwise the insulin tends to leak a bit more than you would like.

For pump users they need to change the site anything from daily to every three days. The abdomen and  rear trouser line are the most popular. Special hygeine routines are helpful in preventing infection.

If you are using plain needles you don’t need to clean the area with an alcohol swab. You just inject.

The needle depth and fineness can vary.  6, 8 and 12 mm needles are available in the UK.  If you are pretty thin or using your thighs a smaller needle is often used. If you are fatter or prefer your backside the longer needles are better.

In some circumstances you may want to put the needle into muscle. This could be for the purpose of achieving a more rapid effect which you may want to use if correcting for high blood sugars.

Basal Insulin

The basal insulin level should be matched to the liver’s normal secretion of sugar.  Because the liver tends to produce different amounts of glucose at different times of the day and night the insulin requirement will also vary. The right basal rate is one that keeps your blood sugar at a fairly constant level when you have not eaten or bolused for several hours and are not exercising.

An insulin pump gives the most flexibility over basal insulin dosages at different times of the day.

For people on a multiple daily injection regime the main analogue basal insulins are Lantus and Detemir known in Europe as Levemir.   Lantus should not be mixed with other insulins because it depends on its action for its acidic pH.  Detemir has 75% of the potency of Lantus. It is not acidic and does not sting like Lantus can when it is injected.

Lantus lasts about 22 hours in most people and Detemir lasts about 16. Either insulin can sometimes be given once a day successfully for some individuals but most people get on better with twice daily injections for both of them.  The best time to give them is right before bed and when you get up in the morning. If you have a marked dawn phenomenon no more than a 9 hour gap between the night and morning injection is recommended by Dr Bernstein.

It can take about three days for your blood sugars to stabilise after altering your twice daily basal so it is best to keep changes to three days apart or more so you can get a true reflection of the results of your insulin adjustments.

Older insulins have been stabilised so they last a long time such as  the Lente and Ultralente insulins. They are sometimes combined with shorter acting regular insulins so you can reduce the number of daily injections.  If you have a  cloudy insulin such as this it needs to be mixed thoroughly before injection. Rolling the vial or pen gently up to 20 times is advised.

Protecting Insulin

Your insulin stores can be kept stable for years in  a correctly maintained domestic refrigerator but once out and about insulin needs to be kept at room temperature or a bit cooler to retain its potency.

It can go off rapidly if overheated eg from being left in a car on a hot day.  Lantus is particularly fragile and light can affect it too. Lantus lasts in good condition for about 3 weeks and most others last about 4 to six weeks.

When you are going to be in a hot environment you can store your insulin in a frio wallet. These are available in the UK from Boots online. They are more widely available in the US. These come in different sizes and can hold insulin pens or vials.

When you travel on a plane you must keep your insulin in your hand luggage. If it goes in the hold it could freeze without you being aware of it and this too will seriously impair its effectiveness.

When you go skiing or out on a very cold day keep your insulin next to your body to prevent freezing too.

Missed a dose?

If you miss your basal by only a few hours you may simply give it as usual. If you are more than 4 hours late however the action you take may vary.  Let us assume you are awake during the day and sleep at night.

You miss your night basal which you normally give at 10 pm and remember when you get back from the party at 3am.

Check your blood sugar. You are a bit high. Give a proportion of your basal let say half of the usual dose and go to  sleep. You  probably need to sleep before work tomorrow more than worry about whether any correction dose you are thinking about is going to drop you too low through the night, especially if you have had more than one alcoholic drink.

You are likely to have to give a correction dose along with your morning basal but monitoring your sugars is easier during the day when you are awake. Put it down to experience.

You can even write essential tasks or times on ball point pen on the back your hand. Usual handwashing takes about a day to clear it and if you want to wipe off your “to do” list   little alcohol swabs come in handy.

You miss your morning basal You took your basal insulin with you to a friend’s last night and remember in the morning that it is still in your bag which is in her car. She lives across the city, and the pharmacy does not open till 2pm, and you have no spare because you have not been paying attention to the advice you were given in the organising your supplies section.

Give yourself a series of correction doses during  the day before your meals. You can use novorapid or humalog and these last about 3 and a half hours.  If you have regular insulin this is  even better as it lasts 5 hours.  Start your basal again with the night injection.

Missing a day dose is usually easier to deal with because you are awake and you can correct any lows easier.  Keeping a notebook or having one of the new pens that records your doses can be helpful. Because looking after your diabetes becomes so automatic you can easily get muddled up about whether you took the dose or not. When you are one of two parents or carers and not the diabetic person it is even more important to record what you do.  Without this it can be  even easier to make mistakes and give an infirm person or a child two doses of insulin or none !

It is human nature to muddle up from time to time. When you do, the most important things are  forgive yourself,  calm yourself down, and  THINK !


Quick Quiz:

Have you got it?

1. In a restaurant three of these places are suitable for insulin injections…

a In the washroom.
b In the abdomen at the table.
c Through your clothing.
d Hiding underneath the table.


2.The Glycaemic Load of a food is …

a Its relative effect on your blood sugar.
b A measure of the percentage of carbohydrate it contains.
c A measure of how much insulin is needed to cover the food.
d A measure of how much the food fills you up.

3. The Glycaemic Index…

a Has been extensively tested on diabetics.
b Tells how fast your blood sugar will go up with certain foods.
c Should be the basis for a sensible eating plan in every diabetic.
d Needs to be verified by personal experimentation.

4. For insulin users you need to monitor you blood sugars in three of these situations…

a Before and after exercising.
b Before you drive and at hourly intervals when driving.
c Before you go into a public place like a cinema.
d Whenever you feel hungry or suspect you could be running higher or lower than normal.

5. Three helpful tips for type one youngsters include…

a Have your bracelet, insulin, tester and food when you are on an outing.
b Carry a charge mobile phone.
c Carry money in case you need to buy food.
d Avoid telling your mates you are diabetic so you will fit in better.

6. Three of these statements about insulin are correct. Which one is not correct…

a Lantus must never be mixed with other insulins because it depends on its acidic pH for it’s action.
b Cloudy insulins must be mixed thoroughly before injecting.
c Detemir has twice the potency of Lantus insulin.
d Humalog and Novolog have 150% of the potency or regular insulins.

7. Three statements about basal insulin are true…

a It is used to cover meals.
b It should be matched to the liver’s normal secretion of sugar.
c It is needed to keep the blood sugar level steady between meals and during sleep.
d Can be most accurately obtained by using an insulin pump.

8. At college don’t bother with one of these…

a Testing your sugar before exams.
b Eating food when you drink alcohol.
c Getting your flu shot every year.
d Going to parties.

9. When you go on holidays it is silly to do one of these…

a Go to a theme park and forget a rendezvous point.
b Carry extra food and drinks on planes.
c Test draught drinks with diastix.
d Work out how you will deal with time zones before you go.

10. Advantages of being a type one diabetic can include three of these…

a Getting a fridge in your room at college.
b Getting a room nearer the kitchen at college.
c Sleeping in on the mornings on days off.
d Getting a pass to skip long queues at some theme parks.

Have you got it?
1. D is taking secrecy too far! Although many people still prefer the privacy of a washroom it is entirely acceptable to inject at the table. With the rise in the number of people with diabetes you can expect to see this happening more frequently.

2. A is correct. The GL is and indication on what effect you can expect that food to have on your blood sugars. The carbohydrate index is the percentage of carb a food contains. This can be a helpful technique in carb counting.

3. D is correct. Its all about self experimentation. The GI was tested on healthy non diabetics. It is a rough indication of how fast sugars are released and diabetics are wise to steer clear of very fast acting carbs. The precise rate of release however depends on so many factors such as quantity, chunk size, temperature and what sorts of foods are eaten along with them that personal experimentation is the only way to find out how a food that you eat regularly will affect you.

4. ABD are musts. Use your own discretion in other situations.

5. ABC are sensible. Not telling your mates isn’t!

6. ABD are all correct. Detemir is weaker in effect than Lantus unit for unit. Detemir has around 75% of the potency of Lantus. As these are both basal insulins it is unlikely that you need to remember this unless you swap one for the other for a particular reason.

7. BCD are correct. Pumps can be adjusted for the dawn phenomenon and exercise patterns with much more versatility than basal injections. This is one of their major advantages. There are trade offs in other respects of course. Bolus injections are used to cover meals.

8. D. Parties can be quite a challenge for young diabetics away from home. Always drink moderately and avoid drugs. Let your mates know about how to detect and treat hypos. If you have passed out they must get you to hospital.

9. A is correct. It is also sensible to write down exactly where you have parked the car! Diastix were originally used to detect sugar in urine but they can be very handy for testing whether your cola is the diet version or not.

10.ABD are correct. And you didn’t think there were ANY advantages to being insulin dependent did you? Unfortunately having a lie in is not on. You must get up at the usual time to test and give yourself your basal insulin at the very least.

Reference Info:
Acknowledgements to Dr. Bernstein’s Diabetes Solution and Dr Schiener’s Think Like a Pancreas.

Where to Next?
You could be a bit tired out by that long quiz. Take a break and lets all meet back at the How To: Know How Different Insulin Regimes Compare section.