Cycle 2 of the Fasting Mimicking Diet in a person with Type 1 Diabetes

All material on this website is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on any matter relating to their health and well-being.

You may want to click over to my first post about the Fasting Mimicking Diet in a person with Type 1 Diabetes to help you better understand this post.

This cycle of the FMD was easier than the first one – and once again I felt better than normal during the fast. In the time that has elapsed since I decided to do this, I did finally track down a Google Group where a couple other Type 1s had engaged in the FMD. I’m excited to see that a couple other people have given this a try and are willing to experiment with their bodies. I’m also a little discouraged because one person reported trying 10 cycles – and during that time, the results were the opposite of what he was trying to achieve. In fact, he wrote me personally saying that after a cycle of the FMD, he went to Indian food and had to dose 200U for a meal that normally would have required 20-30U! Yikes!!

Luckily, this reduced insulin sensitivity does not seem to be permanent, and I do enjoy feeling good during the times of fasting. Non-diabetics may not understand how you could possibly “feel good” during a fast – but basically what you’re doing is removing blood sugar swings from your day. Going from low to high to low blood sugar takes a toll on your body – and when you’re “out of range,” you can feel pretty crappy. In my first two cycles, I found that fasting even enabled me to eat small amounts of carbohydrate without having to inject insulin, which is a nice treat.

As I mentioned in my previous post, I shortened this cycle up a little – down to 96 hours this time. It seems that you start to get the benefits of the FMD once you exceed 48 hours of heavy protein restriction, and 96 hours was a more comfortable duration.

Below is detail of what I ate during this cycle. You will notice that on the 4th day, I began “re-feeding” at dinner time. Calories were quite high. The foods listed were all carefully weighed, but you need to ignore the insulin dosing in these slides because I didn’t record everything (I recorded insulin elsewhere).

Here are my blood glucose reading during the FMD cycle:

FMD Cycle 2 Results

A couple observations:

• In this cycle, I didn’t have the very low blood glucose readings that I had on the first cycle. My theory on this is that I had quickly depleted my liver of glycogen on the first day of cycle 1 by doing a big bike ride. In this cycle, I exercised less.
• Insulin still worked fairly well on the day following the fast. Nevertheless, I did need to start increasing the dosage quite a bit in the subsequent days. The mouse study took 50 days and several cycles – so I’m not really expecting any big changes at this point in the experiment.
• In the week following the fast, I was somewhat displeased with my BG control. I wasn’t really making my targets. I had some readings in the 200s as well as a scary 31mg/dL hypo (my worst hypo yet). This is not entirely related to the FMD, but more related to the fact that I wanted to eat some apricots from our tree. My insulin to carb ratio varies dramatically depending on how much I’m moving around – and I was doing some house chores with the insulin for the apricots on board – and suddenly my vision started to black out. To my surprise, this severe hypo was relatively asymptomatic. The lack of suffering during the hypo was kind of a relief – but of course it is quite scary to think that you cannot perceive a hypo coming on. Since then, I’ve had symptomatic hypos when I drop below 60mg/dL – so it seems that my ability to detect them has been restored.
• My average blood glucose and standard deviation deteriorated significantly after coming off the fast. I attribute this at least in part to the fact that I was really hungry post-fast. I suppose that if I had exercised more self-control post FMD, that this wouldn’t have happened. In my head, I figured I would feed “ad libitum” like the mice – which meant eating until I wasn’t hungry any more.
• Perhaps as a consequence of my type 1 diabetes, I am always hungry at all times of the day. This has a reasonable scientific explanation: Type 1 diabetics are lacking at least 3 proteins: Insulin, C-peptide, and Amylin. Amylin is also produced by the beta cells in non-type-1 diabetics. One job of Amylin is to signal satiety.¹ since Type 1’s cannot produce this Amylin hormone, it stands to reason that this signal of satiety is also missing. **UPDATE October 30, 2018: I wrote a post about my experience using Symlin, which is synthetic Amylin!
• I am conducting these experiments during the warm summer months in the Northern Hemisphere. We have days here that often exceed 100F, and an added bonus of the FMD is that my body is cooler due to the caloric restriction. In fact, on the warmest nights, I’ve had cool hands and feet and even pulled up the covers in an attempt to stay warm. I can see quite clearly that apart from type 1 diabetes, caloric restriction could be a useful tool in staying comfortable during hot spells.
• This is highly subjective, but I feel like my skin “looked better.” In other words, blemishes and cuts seem to be healing faster. I almost don’t want to mention it because it is so subjective.
• I was in a really good mood during the fast. Also, I felt more “carefree” about things in general. This may have been simply due to having less overall energy – and being less willing to put energy into worrying about things.
• During the fast, my blood pressure drops. It drops very low (approx 90/60). I recently purchase a home blood pressure meter (this one is a good deal), and the results were repeatable during the 2nd (and 3rd) cycle of the FMD. The particularly low blood pressure isn’t very desirable, however, because when I would go to stand up quickly, I had to be careful as to not black out. Once I got moving around, however, things were fine.

***Update 08/15/2018***
My doctor agreed to run a c-peptide test as well as antibody tests (usually these are only run at diagnosis). This was after re-feeding after 2.5 cycles. For the c-peptide, I ate some fruit – and did not dose insulin. The goal was to see just how much insulin my body can produce while stimulated. The result was a mere 0.14 ng/mL. I’ve seen papers where 10 year type 1’s have a higher fasting c-peptide than this… so clearly my diabetes progressed very rapidly. This is probably due to the extremely high GAD antibodies I had. I did note that the IA-2 antibodies decreased by 50%. Since I did not see a benefit from the FMD in my blood sugar management, my insulin dosing, or my test results, I don’t currently have any plans to try again.

***Update 07/24/2018***
I did start a 3rd cycle of the Fasting Mimicking Diet on the evening of July 16, 2018. By noon on July 18, 2018, I had found a post from Hoping4Cure (another person who has gone through over 10 cycles of the FMD) that read like this:

This post kind of scared me. A few other people had also posted their results in the forum, and many of their experiences mirrored mine – although insulin needs plummeted during the fast, they seemed to be higher during the re-feeding period. Only a few people seem to have done this and reported back – but no one has seen a major reduction in insulin needs – even after completing quite a few more cycles than I have completed. If anything, I get the feeling that blood sugar control is worse afterwards. This was definitely the case with me – as you’re re-feeding, you are basically guessing what your insulin sensitivity is going to be on that hour of that day. If you’re doing the same thing every day, your insulin sensitivity is more stable. If you’re making dramatic switches between fasting and feeding, your insulin sensitivity is all over the map. I hate to be a quitter, but for the time being, I’m pulling the plug on the FMD until I see better results from other people who have tried. When I first began, I believed that I was the first person to have tried this. Now that I see the results from others, I’m going back to what was working best.

What was working best?

If you have Type 1 diabetes, you probably already know that every day is different. I collect a ton of data about my exercise and blood sugars, and then I plot it out in graph form and try to look for patterns. Here is what seems to be keeping me closest to my targets (i.e avoiding uncomfortable swings) AND minimizing my insulin needs:

• Skipping Breakfast. Skipping just breakfast (but not lunch and dinner) is pretty awesome. It is not hard because you still have lunch to look forward to, and you get to skip the morning mealtime dose. This makes morning exercise MUCH EASIER because you don’t get the large variations in blood sugar. Also, your body is primed to burn fat for fuel in the morning, which (as long as you avoid high intensity exercise) seems to result in stable, perfect blood sugars.
• Eating a low and slow carb diet. I do find that with longer exercise, I can “get away” with eating more carbs. I have already started working on a post about this topic, but I think that the reason I can eat more carbs during extended exercise is simply because I have not adjusted my basal insulin appropriately downwards. What I mean to say is that I have to eat more carbs in these instances – which isn’t necessarily a good thing, but I guess you could consider it to be a nice treat. Unfortunately, in these situations, the carb “treat” comes at a time when I’m least likely to be able to get any enjoyment out of the sugar because I’m out of my mind with hypoglycemia.
• Exercise. The best exercise for me seems to NOT be cycling, but instead just puttering around the house. This consists of gardening, and doing household chores. Cycling is second best if I can keep the effort low, long, and consistent. What does NOT work is sitting in front of the computer (i.e. writing these blog posts!)
• Staying Hydrated. I think that the mechanism of action for this might partly have to do with insulin absorption. My theory is that when you’re dehydrated, interstitial fluid is pulled from the subcutaneous area. The problem with that is your insulin is injected into the subcutaneous space (unless you’re doing IM’s² or using Afrezza³). So, when I’m dehydrated, my blood sugars will creep upwards. It could be that the Lantus isn’t being absorbed as quickly due to the aforementioned reason – or it could be due to my blood becoming more concentrated due to the lack of fluids – or both.

It is not fair of me to say anything about the ACTUAL FMD. The actual FMD is an expensive, clinically tested product (that so far has not been clinically tested on type 1 diabetics). It would be incorrect for anyone to directly associate what I did with their product; they specifically state that their product should not be used by type 1 diabetics. The purpose of this post is to share what happened, and I think the data is pretty interesting: in particular the relatively low glucose readings and reduced insulin dose during the “fast.”

References & Footnotes

1. Pancreatic amylin as a centrally acting satiating hormone, Lutz TA, 2005, https://www.ncbi.nlm.nih.gov/pubmed/15777188
2. Intramuscular injections – https://en.wikipedia.org/wiki/Intramuscular_injection
3. Afrezza is a type of inhaled insulin that works faster than injected insulin. I like it, but it gives me a cough, and may be implicated in higher rates of lung cancer. Furthermore, it is a little more difficult to get a precise (i.e. repeatable) dosage due to the delivery mechanism.