A fascinating talk! Of course fasting also applies to having surgical procedures under general anaesthesia (and for safety's sake for procedures under local anaesthesia in case general anaesthesia needs to be substituted partway through). Last year for elective lower back surgery at the 'tender;' age of 69 with T1D for 56 years, the anaesthetist 'required' for my upcoming operation that I maintain a BGL at 10 mmol/l (180 mg/dl) "or a bit higher" according to protocol. I can understand that any anaesthetist does not wish to find their patient has suffered from the effects of hypoglycaemia which might to be missed or not recognised during surgery. Being on a ketogenic diet for the past 5 years I knew that on the rare occasions that I obtained a high bsl (dental troubles, post vaccination etc) that at 10 mmol/l I would feel absolutely terrible - not something most proponents of keto-diets in T1D talk about - and how difficult it can be to reduce such a bsl back to the range most use of say - 3.8. to 6.7 mmol/l. So - I ran a CGM-monitored trial run of fasting from 12mn til 2 pm the next day - to cover the likely fasting time for my planned 8 am start operation and recovery - and by luck, serendipidity or whatever, my basal Levemir ([plus one unit of Novorapid/Novolog - see below)) produced a steady bsl of 6 to 7 mmol/l through the specified time period) I even simulated the perceived stress of the day of operation by watching a thriller movie at 6 am, and only needed the 1 unit of novorapid (? novolog) to deal with that. For completeness sake I did also perform another CGM trial which revealed a steadyish level of 9 to 10 mmol/l level for the same time period - but swore I would never try to emulate that ever again !! Fortunately I rarely have nutritional ketosis in the mornings so that I did need to discuss any ketone level with the anaesthetist whose protocol might have led to me being refused general anaesthesia. The operation, recovery and ;post op course went brilliantly and I was able to enjoy fruitful discussion about ketogenic diet with the physician who provided care for my diabetes post-op. However, despite relaying my experiences of this to the State-Wide committee for Surgical and Perioperative Care on the Aussie State I live in, said committee has not acknowledged or otherwise responded to my missive about the need to adapt protocols for those diabetics who are keto-adapted.
I’m T1D, I am zero carb (or near as can be) and I regularly do alternate day fasting…. I find it quite easy… and I do higher intensity exercise when fasted. HbA1C is 5.2% and all other blood markers are good… apart from LDL which is high because I pretty much live in nutritional ketosis…. Issue I have is how out of step the so called diabetes professionals are with the way I live. To me it’s dead easy and the risk of hypos is basically zero…. But alll they do is lose their minds that I’m not eating carbs six times a day…. I’ve ‘got’ this…. Why is it so hard for them to ‘get’ it???
