[valenceelectron]

> (insulin sensitivity is your ability to clear blood sugars, exercise does not improve insulin sensitivity directly but helps clear the sugar making it as if insulin was more effective).

Can you elaborate? As far as I'm aware exercise (even moderate) does indeed increase insulin sensitivity. I was told so by my doctor and as type 1 diabetic with 24/7 glucose monitoring sensor I can "see" this. A day long hike (not intense, just long) does incredibly things to my required insulin dosage. It can go down to mere 10% the amount of insulin per carbs that I usually use. Now of course some of this is due to the exercise itself and the muscles taking in some of that energy. But some should be due to a reduced insulin sensitivity.

[twawaaay]

Regardless of the type of diabetes you have, your body needs to clear sugar from bloodstream. It really does not matter how this happens, exactly. Insulin performs other functions in your body... but ability to clear sugar is the absolutely most vital concern.

If you can do things that either prevent or clear blood sugar levels from your bloodstream you can technically live without the need for insulin at all.

With a proper diet and discipline you can theoretically even dispense with continuous monitor. What this would require is observing yourself with a monitor while you test your lifestyle choices to validate you are not making mistakes and then stop using it when you trust what you are doing is effective.

Please, do not misconstrue this as an actual medical advice (I am a software developer and definitely no medical education). But if I was type 1 diabetic I would probably try to ensure correct levels of sugar without external insulin. The problem with external insulin is that the dosage is always delayed, it is a point in time and is never perfect. This is not perfect for your health, it is just the best we can.

Now, I would never recommend this to a person I don't know they can be responsible and disciplined enough not to endanger themselves this way. I think this is critical and I also think that unfortunately most people who have diabetes are not fit mentally to do this.

But lowering your blood sugar without insulin would lead to much better results because you would avoid the spikes altogether and you would not risk getting sensitive to insulin from overdosing it.

FYI when I am on keto diet my blood sugar levels are staying consistently low regardless of how much I eat. I have lower blood sugar levels right after a large meal than most people have before the meal(~85mg/dL or 4.7mmol/L after a meal with ~75mg/dL or around 3.9mmol/L before the meal).

I do not plan to stay on keto all the time, I am using it as a tool to build metabolic flexibility. But if I was diabetic I would probably consider keto very seriously to improve my prospects and break dependency on external insulin, constant blood sugar monitoring and every day decisions on what and how much to eat.

[valenceelectron]

I'm afraid but this is a very simplistic view and not how it actually works. You cannot keep your blood sugar stable by eliminating intake of carbohydrate. Something every diabetic who goes into weight lifting learns really quickly (and is well established in literature and known by doctors): protein will increase your blood sugar. It is a very delayed response (3-5h+) and its amplitude is low but it will happen. The process is called gluconeogenesis. Your body has multiple metabolic pathways to create glucose out of nearly any kind of protein found in your body (figuratively speaking) and will do so even in the presence of enough calories (i.e., this is not a response to malnutrition or under-eating).

And then there are all the hormone-based reactions. The classic obvious culprit for raising blood sugar out of nowhere is of course adrenaline but even many others can do so. Stress reactions and others will do this. The glucose in this case comes from your liver which stores it as glucagon. Note that your liver will store glucagon even when you have no carbohydrate intake. As mentioned above, your body will metabolize it eventually.

Your advice about keto is downright harmful. Type 1 diabetics should not go on a keto diet. This is actively advised against and will lead to coma and death. The reason keto works for healthy people is that they actually do not go 0 on carbohydrate and, therefore, still have some amount of insulin in their blood (also for other reasons). Even vegetables contain small amounts of digestible carbohydrates that will trigger trace amounts of insulin and protein, through the pathway illustrated above, will do so as well. Please understand that diabetes is an old and very well researched condition. Modern medicine has a trove of long-term detailed data and statistics telling us what works well and will lead to a side-condition-free life in old age and what will lead to long term damage. This is well understood. Contrary to what you suggested, modern diabetes management does not advise to reduce insulin need as much as possible through dietary means for type 1 diabetics.

Edit: Please note that blood sugar is not a "lower means better" metric. A low blood sugar has risks associated just as high blood sugar has. The "band" of good values is well understood and the headroom "upwards" (i.e., higher than normal values that still won't cause damage) is a lot larger than the headroom "downwards". In fact, standard therapy for diabetics keeps them a little higher than the normal person just for safety reasons. Personally, I stay in a "normal person" range but I also have the luxury of fewer trouble managing my values than others.

[twawaaay]

> Something every diabetic who goes into weight lifting learns really quickly (and is well established in literature and known by doctors): protein will increase your blood sugar.

It is true that EXCESS protein will be converted to sugars. As long as you limit your protein intake it will be used exclusively for housekeeping. That's why keto diet is not only carb elimination, it is carb elimination WHILE restricting protein to about 30% of your calorie intake.

It is exactly this reason why keto diet is so hard to maintain -- because you have to fill the rest with fat and this is a hard thing to do.

> Please understand that diabetes is an old and very well researched condition.

It is funny that you mention it, because do you know what was the actual first treatment for diabetes? Before they were able to produce insulin?

It was actually eliminating carbs from the diet. Yes, in the past, keto diet was the main (and the only) way to treat diabetes.

[valenceelectron]

>It was actually eliminating carbs from the diet. Yes, in the past, keto diet was the main (and the only) way to treat diabetes.

Except it didn't work. People died. Meanwhile, today, we have a very good understanding about the secondary diseases, long-term damages, and how to prevent those with therapy. And a keto diet is no part of that.

Edit:

>It is true that EXCESS protein will be converted to sugars. As long as you limit your protein intake it will be used exclusively for housekeeping. That's why keto diet is not only carb elimination, it is carb elimination WHILE restricting protein to about 30% of your calorie intake.

While excess protein is indeed converted that way, it will also happen to small amounts of "non-excess" protein. Protein in your body is in a constant flux. Your muscles are not static but undergo constant breakdown and build-up. While gluconeogenesis can be strongly reduced with dietary restrictions, it cannot be completely stopped. In fact, an important inhibitor to gluconeogenesis is insulin and thus, for a healthy person, consumption of carbohydrates.