Wednesday, September 28, 2011

Dawn Phenomenon and Intermittent Fasting

I always have tricky blood sugars in the AM and I usually think of it as the time when my numbers are off, and insulin doesn't work well.

The Dawn Phenomenon is created by your liver doing some cleanup work over night and releasing glucagon in the wee hours of the morning before you wake up. When you wake the glucagon makes you more insulin resistant and you have a harder time with bolusing for food as well as correcting AM highs.

A surprising solution to my DP effect has been to skip breakfast. I never thought I could be a breakfast skipper, even though for years my breakfast has been only eggs. Even having protein in my system seems to be complicated by DP.

I became interested in the possible benefits of intermittent fasting this summer and started to go from dinner (7pm) to lunch (1pm) as a short fast. I had read that it might help me to reset my metabolism and help me to lose some weight. In the end, I found that increased energy levels and better blood sugar control have been the real payoff.

First of all, it was hard for me to imagine that I'd feel comfortable going that long without eating anything. I was pretty sure that I'd feel fuzzy in the head and not be able to function. Well, for a day or two I did feel strange (jittery and wired, not tired) and then my body switched over and was able to do the extended overnight fast. I even exercised in the morning and it didn't make me uncomfortably ravenous.

I was doing these experiments on myself in the summer, but I wondered if it would work when I went back to work teaching high school art, thinking on my feet all morning. It still works for me. I am still functioning in a mostly fasted state for my whole work day, and having good energy and attention. Mid-morning I have tea, some nuts, and a piece of chocolate. Those are my only calories before I have lunch at 1:30 or 2:00pm. 

I think part of the reason this is working for me is because I'm eating a ketogenic diet, getting most of my energy from fat. My body is burning my body fat and it is used to burning fat for energy as well. My brain responds well to this, and I've found that I am more attentive, decisive, and mentally nimble since I've been eating this way. Our brains need fat to function.

My body also likes having glucose in a normal range, and once I got my basal insulin nailed down with my pump, I have cruised through my fasting period keeping my sugars at 90-120 the whole day. When I break my fast I take a square bolus that is spread over an hour and works slowly with the fat, protein and carbs that I eat for lunch. Right now my basal is doing most of the work because I don't have much of a spike from meals. My diabetes educator doesn't really know what to do with my numbers because they usually insist that your basal:bolus ratio should be 50:50 or something like that. I'm at about 80:20. My total insulin for the day is averaging 38 units of Novolog.

Needless to say, I'm planning to keep things this way. I feel great and am very slowly losing some of the extra weight that I have gained over the past couple years of higher insulin doses.

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