The Type A Diabetic believes in being in control of the situation, instead of allowing the situation to take control of you. For this reason, the Type A Diabetic focuses on what every successful organization does: management.

As someone who has worked in Corporate America for most of his career, I am experienced in effective management techniques. Managing this condition is really no different than managing any process. It’s about having a deep understanding of the mechanics of a process, including what the efforts and costs are, the desired outcome, adjusting inputs and outputs, and then, importantly, measuring the results and adjusting as-needed. 

Measurement Matters

Let’s start with the end: measurement. Measurement is fundamental to success, as we simply are unable to take full control of our glucose levels if we don’t know what they are. In order to effectively manage the mechanics that enable glucose equilibrium, the Type A Diabetic invests in a CGM (continuous glucose monitor). Without a CGM, you’re almost flying blind, and you’ll never truly understand how to take control. This applies to virtually every type of insulin disorder.

Every person with an insulin disorder should monitor their glucose for at least one month every year using a continuous glucose monitor.

Mind Over Matter: It’s Time for the Manual Override

Now that we have established that it is required to have a strong measurement system in place, it’s time to understand the process so that we can start manually managing the process ourselves (since our organs apparently aren’t going to be doing this automatically for us anymore). Yes, this is a management job. Yes, you are up for it. And, yes, just like your real job, if you’re good at your job, you will get satisfaction from it. Note that, unlike your professional job, your performance ratings for this job will be given to you by your body, not by your boss.

Put simply, glucose homeostasis used to be automatically managed by our bodily systems, and we didn’t have to worry about it. Similar to a situation at your real job where if you had a great team of people working for you who just did their job consistently and the customer was always satisfied. A lovely situation. Unfortunately, having an insulin disorder is similar to having a few bad employees that we simply cannot fire: we now need to compensate for these sub-par workers by putting in management techniques to compensate ensuring we still get the desired outcome.   

There is a ton of science that explains, in great detail, how the metabolism works. And, it’s complicated. But, like a boss, I’m going to intentionally simplify things so that we can actually manage this complex beast. 

We all know that the #1 objective to ensure long-term health with an insulin disorder is to ensure that our blood doesn’t have excess glucose swimming around in it. And (hopefully!) we all know its insulin’s job is to help remove glucose from the bloodstream and into cells for storage. However, what I’ve learned is that not nearly enough people are aware of the various mechanisms there are at our disposal to control the amount of glucose we produce, the amount of insulin we need, and the various non-pharmaceutical ways we can reduce the amount of glucose in our bloodstream. For this, I think we need a control panel. 

The Type A Diabetic Glucose Control Panel  

Carbohydrates	Glucose Production	Exercise	Alcohol	Insulin

It’s probably worth stating explicitly here that I am not a doctor, nor do I play one on TV. You can tell because no (Western) doctor would ever put alcohol on any control panel to help manage anything! Caveats now taken care of, let’s get into why this is how I define the Type A Diabetic Control Panel, and how we can put it to use.

As people with insulin disorders, our primary issue is that too much glucose gets stuck in the bloodstream, which ends up hurting or killing us if it gets stuck there for too long. The Type A Diabetic asks one simple question in response: How can I reduce the amount of glucose in my bloodstream?

(NOTE – As with any complex system, there are no simple answers to simple questions. For instance, there are some things that reduce glucose in the bloodstream that have other potential negative effects on other aspects of your health. I, for instance, have an issue with triglycerides, which works against my glucose management strategies at times. Others may have liver complications. However, since each of us have our own body chemistry and unique dynamics that I cannot control for, I will keep this solely focused on managing glucose equilibrium as an independent, isolated issue. It’s on you, the Type A Diabetic, to mitigate other factors.)

The good news is that there are many ways to answer the question of reducing blood glucose beyond “take prescription medication,” or “take insulin shots.” Both can be helpful and quite often necessary, but due to the myriad of pharmacologics available (especially for those with insulin resistance issues/type 2s), this control panel will not dive into prescription medication. Please consult your doctor to see what pros and cons look like for each pharmacologic remedy. And with regards to insulin, most — if not eventually all — with insulin production conditions will need exogenous insulin at some point in time. However, as technology progresses, so do the options for getting the insulin needed. We will explore these options. 

By using this management control panel, you may be able to reduce or no longer require prescription medication (or insulin if you still produce it).

 

Now, let’s go through each knob:

The Carbohydrate Knob

Dial it down to reduce glucose in your bloodstream

Carbohydrates: The Fasted Path to Glucose in your Bloodstream

[Note: This section of the control panel covers a lot of ground. Other sections aren’t as long.]

There is no shortage of debate around diets that are low carb vs. high carb vs. anything in-between. The Atkins diet first popularized low-carb a few decades ago (albeit in a less health-conscious way), and now it’s been re-invented through the keto movement. Then there’s a new high-carb, low-fat, plant-based diet, and even a diet that lets you eat anything you want (as long as you have full control of your insulin). 

I am not here to evangelize one approach over another. Each person needs to find the diet that works well for them. However, it is an indisputable fact that our bodies convert the digestible carbohydrates we ingest into glucose [source]. Ergo, the more carbs you eat, the more glucose you will create. 

Therefore, one surefire way of reducing the amount of glucose in your blood is to reduce carbohydrate consumption. The Type A Diabetic credo is to take this low-carb/keto approach to the next level by making some novel assertions for type 2 and type 1 diabetics.

 

Have an Insulin Resistance Disorder (i.e., Type 2 Diabetes)? Reframe Your Condition as a Carbohydrate Allergy

Let me just get this out of the way from the get-go: the American Diabetes Association’s Diabetes Plate Method is akin to prescribing poison to someone with an insulin resistance disorder (i.e., type 2) and even someone with a stage one insulin disorder (i.e., prediabetic). The ADA’s recommendation is to fill up ¼ of your plate with carbohydrates. To make things worse, in their example of what a diabetes plate would look like, they recommend sticking to “just 1 or 2 slices [of pizza] and serve with a side salad so that half your meal is nonstarchy vegetables.” 

One foundational lesson I’ve learned that applies to every person with an insulin disorder, but especially for those with insulin resistance (type 2s), is that insulin resistance is akin, in terms of management, to having a carbohydrate allergy. 

When someone has a food allergy (for example, with strawberries), they tend to have an obvious physiological response that is clearly dangerous. Hives. Rash. Throat closes up. Violent gastronomical response. There are a number of ways a food allergy expresses itself. With most food allergies, the cause-and-effect is pretty straightforward. People figure it out. And when they do…they stop consuming that food type. Because, y’know, most people want to continue living. 

The Type A Diabetic Manifesto states that people with insulin resistance disorders (type 2 diabetics) should rethink their condition as being allergic to carbohydrates. 

 

As soon as I was diagnosed, I went on the American Diabetes Association diet, and (very un)happily pricking my finger in the mornings and evenings. Everything seemed fine. But then I got my first continuous glucose monitor. And it changed everything.

Suddenly, that “healthy” apple (or mango or whole-wheat slice of bread or ancient grain salad, etc.) that caused no rash, no pain, no swelling of the throat – no typical allergic reactions that would scare me out of eating them again – would send my glucose skyrocketing, live and in real-time on my monitor. Here’s what my CGM alerted me to when I tried to eat a cup of “healthy” oatmeal for breakfast:

A fingerstick at 8AM and 10PM, which is what so many type 2 diabetics practice, would have told me I had a great glucose day! Even a finger prick 2 hours after my breakfast would have resulted in a relatively tame 155 mg/dl. 

There are varying opinions around what constitutes a glucose level that starts creating damage to your vascular system and beta cells, but most suggest somewhere between 140-180mg/dl. This is why you see the green band graciously set to 180mg/dl, even though 140mg/dl is probably a more frugal and realistic upper limit. 

When I saw just how my body was screaming bloody murder (inside, quietly) surging into the 200s when I ate moderately carb-heavy “healthy” food, it became quite obvious, super quickly, just how dangerous these types of foods were for me. 

This is what I describe as a painless-yet-insidious allergic reaction to carbohydrates that is literally hurting my internals every time this happens. And only with continuous glucose monitoring did I become aware of just how much damage the recommended ADA diet was likely doing to millions of clueless diabetics everywhere. 

The real-time measurement via a continuous glucose monitor (CGM) is a game-changer. When you have a CGM, the quarterly A1c feels like an executive summary whereas the CGM is a meter that measures how your body is reacting to ingredients you’re ingesting. 

Once you see, in real-time, data that represents pain-free damage you’re doing to your system, you start to see this for what it practically appears to be – a carbohydrate allergy (to be clear, neither allergists nor endocrinologists would agree with me in referring to this as an actual food allergy, as an insulin disorder cannot be medically considered an allergy.) However, when I look at my CGM results, it’s the closest actionable mental model to what is actually happening. For those with insulin resistance disorders, the CGM basically becomes an allergy translator.

By reframing insulin resistance (i.e.,type 2 diabetes) as a carbohydrate allergy, we’ve reduced victimization while providing millions of patients with a more relatable mental model that helps them stay in healthy compliance more readily.

 

This is an important recharacterization of metabolic insulin resistance disorders. As you’ll read in more detail later, thinking about insulin resistance in this novel way does two things:

1. It shifts the mental model from having a disease to having an “allergy,” which may reduce stress and pain for many, 
2. More importantly, it can help to align behaviors with what the condition requires. After all, it’s far easier to understand how to not die of an allergic reaction (i.e., stop consuming what causes the reaction) than it is to understand the complex dynamics surrounding glucose management. 

I recommend that studies be designed to test this hypothesis.

Have an Insulin Production Disorder (i.e., Type 1 Diabetes)? Eat As If You Have a Carbohydrate Allergy

As I talk to people with insulin production disorders (i.e. type 1 diabetics), I pick up (anecdotally) that they are only taught about carbohydrates as something to compensate for with insulin. As a result, they continue to eat a semi-normal diet, and simply add insulin to mitigate the carbs being ingested. This would seem to be the right move – instead of the pancreas creating insulin, someone with an insulin production disorder simply calculates how much insulin a pancreas would release and injects that amount manually. 

But, it turns out, needle-injected insulin is not the same as a pancreas releasing insulin. In fact, injected insulin is quite inefficient compared to how well-integrated the pancreas beta cells are with the bloodstream. We’ve learned from several studies that inhaled insulin is far more responsive than injected insulin. It makes sense – your lungs, being organs and all, are passing the insulin to your system far more broad-based than a single injection site can. 

Why am I deep-diving into the efficiency of injected insulin? Because that inefficiency means you can’t simply give yourself a shot to compensate for carbs being ingested. Due to delays between injection and impact, a person with an insulin production disorder (IPD) needs to inject well before ingesting said carbohydrates if they are to avoid harmful glucose spikes and optimize their time-in-range. Because of this, they need to guess how many carbs, and when, they will be eating. This is a messy guessing game, rife with calculation and timing errors. The result? People with an IPD typically have glucose spikes that are now thought to be more dangerous to long-term health than a higher A1c glucose average (as articulated in the A1c vs. Time-in-range debate in the diabetic community today). Time-in-range focuses on glucose levels staying within a healthy range (approx 70-140mg/dl) whereas an average is not the mode is easily skewed by very low and/or very high glucose levels. The result? A “great” A1c of 5.5% could actually be due to a patient going hypoglycemic every evening (which is unhealthy), and having an elevated glucose during the day, which is also unhealthy.  Yet, the average would seem fine. 

If you’ve got an insulin production disorder, and you’re eating a normal high-carb meal like pizza or pasta, you are likely spiking to 250-350mg/dl until the insulin kicks in and brings it back down to a healthy range. This “spikey” glucose management leads directly to glucose toxicity complications over time. Yet this is what so many (the vast majority of?) people with an insulin production disorder do all the time. 

In addition, with a high-carb diet, people with insulin production disorders can easily overcompensate for their carb intake (timing glucose spikes with insulin is an art and a science, given all the multivariat dynamics of carbohydrates, fat, and protein).  The result? Many who rely on insulin shots will accidentally miscalculate and then “go low” into a hypoglycemic state. Hypoglycemia is an acutely dangerous state that could lead to immediate death if they go hypoglycemic in the wrong situation (like driving a car or operating heavy machinery). It just is common sense that if your glucose levels don’t rise that high, you won’t need as much insulin to adjust, significantly reducing the chances of over-compensation that would lead to a dangerous hypoglycemic state.  

I know many people with decades-old insulin production disorders (i.e., type 1 diabetes), and all of them suffer from glucose toxicity complications. I also know that their endocrinologists guided them down the path toward these complications by being satisfied with A1c’s under 8%. This is unacceptable. While there’s no telling how compliant each patient will be, the patients I know would have followed doctor’s orders if they were geared toward an A1c under 6%, even if that meant a slightly more regimented lifestyle. I’m not trying to be pollyanna here: I acknowledge that many (or perhaps most) patients may not be compliant with the regimen required to maintain healthy glucose balances, but it is a disservice to not give patients the option to live a life free of glucose toxicity complications. Every diabetic patient deserves the opportunity to understand what’s happening, why it’s happening, and be provided with the tools required to successfully monitor and manage the condition. 

Specifically, the Type A Diabetic credo suggests that someone with an insulin production disorder (type 1’s) should be given the same diet and lifestyle training as many with an insulin resistance disorder (type 2’s) – training that demonstrates the implications carbohydrates have on managing glucose levels, and reducing the possibility of complications.

Another Type A Strategy: Plant-exclusive High-Carb/Low-Fat

Sometimes referred to as the “Mastering Diabetes” program, this is another approach to keeping glucose toxicity at bay. With this approach (full disclosure, I have never attempted this diet, so I cannot personally vouch for it), the entire strategy is reducing/removing insulin resistance by severely limiting fat intake and exclusively eating plant-based foods. While its adherents claim much success with this approach, it works differently than the other approaches. So differently, in fact, that this approach essentially debunks my earlier claim that Type 2 diabetics have something akin to a carbohydrate allergy. While the allergy allusion works if you eat a “normal” diet, if you limit your diet to exclusively plant-based foods and virtually no additional fat, you can have as many carbohydrates as you like!  Sounds good, right? Well, it is, as long as you’re comfortable with ending your relationship with meat, dairy, and essentially any processed food product. If you live and love fruits, berries, vegetables, grains and the like, then you can eat as much as you like. No need to count carbs anymore — just count fat. In this diet, fat is the equivalent of carbs in the low-carb approach: you need to limit them to 30 grams per days. 

Comparing the carbohydrate allergy/low carb diet with the plant-based high carb diet may make your head spin a bit. They seem almost opposite, yet both work. This actually makes sense because each approach is addressing different dynamics that create glucose toxicity:

The Low-carb “carbohydrate allergy” approach addresses glucose production by not giving your body the ingredients required to convert food to glucose. Plant-based high-carb diets address insulin sensitivity, ensuring that any insulin you have or take is used optimally to pull the glucose out of your bloodstream and into the cells where it belongs.  

Yet Another Type A Strategy (only for those with insulin production disorder who are insulin-dependent): Sugar Surfing

There is another “Type A” tribe that has emerged for people with insulin production disorders – the “sugar surfers.” The emergence of the CGM allows for continual glucose level feedback, which, in turn, empowers people who require insulin to predict imminent glucose levels and match it with manually adding insulin. The result? A kind of closed-loop system that enables people with IPDs/Type 1s who love to control life (vs. being controlled/victimized) to dynamically adjust insulin supplementation against any kind of carbohydrate ingestion. 

This strategy is almost diametrically opposed to the above call for those with IPDs/Type 1s to manage carbs like an allergy (and presumes affordable access to insulin!). This strategy essentially uses data and trends to overcome the virtual allergy. The Type A Diabetic credo supports this strategy as it fits the manifesto criteria. However, just be aware that there are raging debates over the overall health benefits/problems with a high-carb/high-sugar diet. The great part about sugar surfing is that it’s simply an empowering technique; not a mandatory lifestyle choice. If you control your own insulin intake, you have the opportunity to completely control your glucose balance by understanding your diet instead of managing your diet. 

While most say that people who can’t create insulin due to an auto-immune disorder have the “worse” version of diabetes because it requires far more management and maintenance, the Type A credo prefers to have control over things: having complete control of your glucose thanks to manual/automated infusion allows for more sophisticated and highly-managed approaches to maintaining glucose equilibrium.

 

The Glucose Production Knob

Dial it down by reducing carbohydrates, and by putting your liver to sleep

You Always Produce Glucose. Managing Output is Key.

[Managing glucose output is key except for people on a plant-exclusive high-carb diet. For details, see the Carbohydrates section of the control panel]

Our bodies convert and create glucose all the time, and for good reason: they’re designed to rely on it as our primary form of energy. By default, our bodies convert carbohydrates and, to some extent, protein, to glucose. Our bodies are pretty smart – we store extra stores of glucose in the liver for when we might need a jolt of energy when we cannot eat. 

For those who enjoy normal insulin function, having a steady stream of glucose and glucose storage for on-demand energy needs is quite ideal. However, for those of us with an insulin disorder, having more than enough glucose is actually a serious health problem.

Another interesting aspect of glucose production is the store-and-release function of the liver. As mentioned above, your liver (and muscles) store glucose for on-demand usage when food isn’t being actively converted. That stored glucose (technically glycogen) can end up being a royal pain for those of us with an insulin disorder.  Specifically, there’s a common dynamic amongst diabetics called the dawn phenomenon. Like diabetes itself, the dawn phenomenon is poorly named: it’s not a phenomenon. We know why it happens – hormones are released overnight and into the morning that encourage the liver to release glucose into the bloodstream. Y’know, to help get your sleepy butt out of bed and on with your day! It’s a pretty good reason all things considered. 

Insulin disorders make the dawn phenomenon dangerous because the lack of automatic insulin regulation can lead to someone waking up with too much glucose in their bloodstream. And this, over time, can lead to glucose toxicity complications. 

There are some medications (like metformin) that appear to help reduce the liver’s desire to “dump glucose” into the bloodstream, but scientists don’t actually know how it works. There are other prescription therapies that claim to have some impact here as well. But, alas, there really is no prescription therapy that can simply tell the liver to cool its jets in response to the morning cocktail of hormones being released. Especially without unwanted side effects. 

But I am here to share with you some potentially exciting news: I have stumbled upon a supplement that has actually, fairly consistently, ended my dawn phenomenon: It’s a supplement called Enzymatic Therapy Fatigued to Fantastic! Revitalizing Sleep Formula (yeah, it’s not a great name for something that appears to work so well). I have not yet broken down which ingredient(s) within this supplement keep my liver sleeping all night long, but this combination does keep my glucose levels level throughout most nights, which is a tremendous improvement over my levels when I do not take this supplement. 

If you try this over-the-counter therapy and it works for you, I invite you to share your results in this survey that tracks how effective this therapy is for others. 

 

The Exercise Knob

Dial it up to burn off the glucose in your bloodstream

Exercise: The Healthy Way to Remove Glucose from your Bloodstream

Virtually every diabetes guide recommends “healthy diet and exercise.” To me, this phrase might as well be “blah blah blah and bleh bleh” because everyone seems to say “diet and exercise” as a solution to just about everything, and virtually nobody hears  these words, has an epiphany, and changes their behaviors.

This “virtually nobody reads these words and changes their behaviors” included me, even when I was diagnosed as prediabetic. It felt far more like I was a child being told what to do rather than an adult who had agency (control) over what I could do to optimize my longevity and minimize future pain and agony.  

However, when I got my continuous glucose monitor, I was able to see exactly how  this “diet and exercise” mantra really made an impact, quantitatively. And, it made all the difference in the world.

As mentioned in the carbohydrate control section, a CGM can help us monitor the effect food and drink have on glucose levels. The CGM can also help us monitor how much glucose we burn off when we exercise.  

Let’s first start with the fundamentals: Why does exercise burn glucose? 

Per the Cleveland Clinic: “First, your muscles need energy to work. To feed them, your body burns sugar as an energy source, lowering the glucose levels in your blood. Second, when you exercise regularly, it helps your body use insulin more efficiently. This can lower your blood sugar levels for up to 12 hours after you exercise.” [source]

Theoretically, this makes sense. But theory has rarely pushed anyone (except dedicated scientists!) into action. What converted me into a human data scientist, if you will, was seeing with my own eyes how exercise not just theoretically was good for my glucose levels, but practically (and virtually instantly) had a significant impact:

This kind of result converted me into a believer in the “exercise” part of “healthy diet and exercise” mantra. The right kind and right amount of exercise appears, at least for me, to have an impact similar to the to prescription drugs I was prescribed (glinides) designed to reduce glucose levels and even exogenous insulin! 

Thanks to my CGM, I have found a mechanism that not only keeps my body in better health (walking briskly for 1 to 2 miles/day is better for you than an apple a day!), but appears to replace the need for pharmaceuticals or, at times, insulin to get my glucose levels back in the healthy zone.

Note: Over time, the amount of glucose reduction a typical treadmill regimen affords me has evolved and become less predictable. This may be due to my body adapting too well to my regular regimen, and now expecting more, or it could be the addition of inhalable insulin to my daily routine. I still do my treadmill routine twice a day, and it still has some impact, but it’s no longer as consistently dramatic as it was for 2+ years as the chart above exemplifies. 

 

The Alcohol Knob

Dial it up to bring glucose down

The most controversial knob is also surprisingly effective.

This knob on the control panel is, in part, why what you’re reading is called a manifesto and not an FAQ or a guide. Modern medicine (at least Western medicine as far as I can tell) would never, ever include alcohol as part of a management technique for any condition. 

Is this because there’s an institutional bias against toxins? Perhaps. But it’s far more likely that far too many people would take an inch and readily turn it into a mile if given permission by their doctor to drink to remain healthy.

And, full disclosure, I think this is right. There’s no doubt that once I discovered the magical powers of alcohol when it comes to glucose equilibrium optimization, I’ve consumed far more of it than I had prior to being diagnosed. 

Now that the responsible caveats are out of the way, let’s get into the meat of this: how does alcohol reduce glucose levels? 

The way I like to tell the story is that while the liver is pretty key to keeping us alive, it’s also a pretty “dumb” organ: it can apparently only do one primary function at a time! Normally, your liver is dutifully converting glycogen into glucose and releasing it into your bloodstream, completely oblivious that you have an insulin disorder and doing such things can do irreparable harm to your system. But when you consume alcohol, your liver goes into detox mode, shifting from producing glucose to breaking down the alcohol so that it doesn’t poison your system. Alcohol also has this effect of jacking up the amount of insulin your pancreas creates (to the extent that it can!), doubling the glucose-reduction dynamic in your system. 

Alcohol is a drug, a toxin. And it can be a lot of fun when used in moderation. But neither of these are why it’s on the control panel. It’s on the control panel because it has, based on countless experiments and using my CGM to test results, a similar impact on glucose as exercise.

CONTROVERSIAL BUT DEMONSTRABLY TRUE:
Alcohol (specifically distilled spirits) is one of the four knobs to manage glucose equilibrium because it is virtually as effective in reducing blood glucose levels as exercise. 

To be clear, alcohol is in no way as healthy for you as exercise, so given the choice, always choose exercise to lower your glucose. The Type A Diabetic always chooses the strategy that optimizes long-term health and reduces long-term pain. Too much alcohol may keep your glucose under control but may end up destroying your liver (and other organs, like your brain?) in the process. 

Importantly, alcohol here implies alcohol in its more pure, distilled state. Alcohol in the form of beer, cordials, most cocktails, and mixed drinks do not qualify. Why? Because the vast majority of these types of alcoholic drinks add in loads of carbohydrates, which counteract the natural impact that alcohol has on the metabolism. [Soon, you’ll be able to visit LowCarbLifeHacker.com to learn more about which types of alcoholic drinks qualify to be a part of this control panel]  

Importantly, I have found (for me) that a moderate amount of alcohol is all that’s needed to have its desired effect and impact.

 

 

The Insulin Knob

 

 

It’s a hormone, not a drug. And no needles required. 

One of the most terrifying prospects of being diagnosed with an insulin production disorder (i.e., type 1) was the specter of having to give myself shots several times a day for the rest of my life.  But even up to 30% of those with insulin resistance can exhaust their beta cells and also require insulin to remain glucose non-toxic. 

The good news is that the days of multiple daily shots (sometimes up to 7 per day!) are slowly and steadily coming to an end thanks to advanced technology. But let’s start at the basics: what if you can’t afford any advanced technology and the only way to get your needed insulin is through a needle? There are still ways to reduce how many injections you require per day by how well you manage the other dials on the Type A Diabetic Glucose Control Panel!  With a normal “western industrial diet” that consists of literally hundreds of grams of carbs per day, you will need all of those shots, all the time, with the hope of not going too low while compensation. A lot of stress trying to figure out exactly how much to compensate while also trying to mitigate dangerous spikes. All day, every day. 

By being a Type A Diabetic, you may be able to significantly reduce how many injections you need to keep yourself in a healthy glucose range. Wouldn’t that be nice? Well, it would be! Which is why I spent so much time developing this manifesto. 

But let’s go beyond insulin injections. Let’s move onto the increasingly-popular insulin pumps. Pumps are a true breakthrough technology because they are slowly and steadily becoming — when combined with CGMs — functionally robotic pancreases. As pumps get more on-board intelligence, they can start predicting where your glucose levels are heading and automatically provide the precise amount of insulin required…just like a pancreas!  Now, this new “pancreas replacement” technology within insulin pumps is still quite novel and is still only available on select devices, but the future is clear: tech-driven insulin automation is coming, and it will make glucose management far less stressful than ever before. 

But what if you find the pump apparatus and multiple-times-a-week installations annoying and crimping your style? Well, there’s yet another option (if you live in the U.S. and either have good insurance or have some extra money to spend on supplies): Afrezza inhalable insulin.  I have started taking Afrezza as another tool in my Type A Diabetic Glucose Control Panel toolbox because it’s painless, effective, and doesn’t crimp my style in any way, shape or form. As someone who suffers from needle phobia, it’s a godsend. 

There may be a time in my progression where inhalable insulin won’t suffice, and I am preparing to adapt to a soon-to-be-approved (update: FDA did not approve it, but the EU did) weekly basal insulin (Insulin Icodec) to supplement inhalable insulin if and when that is required. But, at least at this point in my progression, I am able to maintain a 5.4 HbA1c using all the tools in the Type A Diabetic Glucose Control Panel! 

Glucose Control Panel Implications

There is something really empowering and transformative knowing that every person with an insulin disorder actually has five control knobs at their disposal to help keep their glucose levels in a healthy range (or 4 if they can’t/should not partake in alcohol). And this is before you investigate or invest in prescription medication. 

In fact, when I hear the stories of people (mostly in the U.S.) who are either permanently injuring their systems, or even dying, due to a lack of insulin (due to its lack of affordability for those who do not have health insurance), it makes me want to get this glucose equilibrium control panel in front of them immediately. Imagine how much less insulin so many people would need if they understood just how much control they had over their glucose levels without requiring expensive prescription medication? 

This, in a nutshell, is why we need a manifesto. People are literally dying because they are led to believe that the only thing that can help them stay alive as a diabetic is insulin. This control panel clearly outlines that there are many levers of control that each one of us can apply. This fact cannot be understated or under-communicated, and I’m beside myself that so many patients are not being educated by their physicians about ideas like this control panel, which could potentially mitigate so many unnecessary hospitalizations, permanent disabilities, and even death.