Shifting Gears
A new way to understand type 1 diabetes — built on insulin optimisation, not glucose chasing.
A 1,000-mile ride from England to the Alps became a real-world experiment in living well with type 1 diabetes.
Quote: ‘I can forget about glucose control altogether, knowing that good insulin management means glucose will follow.’
It started with an omelette one morning, a change in routine.
I just wanted to get through a morning without another glucose rollercoaster.
But that simple meal did something unexpected. No spike. No crash. No correction.
For the first time in years, things were just… steady.
And when the chainsaw of constant diabetes noise stopped, I could hear the birds sing.
Educational content only. Type 1 diabetes management is individual and should be discussed with your clinical team.
Why does type 1 still feel so hard?
We are taught to focus on glucose. Count carbs. Match insulin. Correct the numbers.
But despite doing everything “right”, many people still experience hypos, spikes, fatigue and burnout.
Because glucose is not the root problem.
Glucose is the symptom.
Insulin is the driver.
Optimised insulin — not just normalised glucose
Insulin is not just a glucose-lowering drug. It is a master hormone that regulates energy use, fat storage, inflammation and metabolic stability.
The goal is not more insulin.
It is:
As much as needed. As little as possible.
With optimal insulin we can achieve the metabolic flexibility enjoyed by healthy people without type 1 diabetes.
We create an environment where tissues can access fat and ketones as fuel.
We can work to understand how insulin acts on the Five Foundations of Health:
Nutrition, activity, mindset, environment and circadian rhythm.
A real-world test: 1,000 miles across Europe
To test this approach, I cycled from the UK to Switzerland.
Not as an athlete. Not as a stunt. But as an experiment.
Across 21 days I tracked glucose, insulin, ketones, distance and food.
- 89% time in range
- Lower insulin use
- No performance drop
- No fear of hypos
“Shifting Gears offers a rare and valuable perspective — a physician living the reality of type 1 diabetes. Dr Lake reframes insulin as a central metabolic hormone and shows how lifestyle, nutrition and activity shape real-world outcomes. This book challenges assumptions and gives both patients and clinicians a clearer, more practical way to understand diabetes.”
— Eric C. Westman, MD, Duke University
“Dr Ian Lake combines clinical expertise with lived experience to show how insulin can be used more precisely, with less chaos and better results. His 1,000-mile journey demonstrates that stable glucose and lower insulin are not only possible, but practical. This is a clear, insightful and empowering book for anyone seeking a better way to manage type 1 diabetes.”
— Roshani Sanghani, MD, Endocrinologist
“Ian Lake brings rare clarity and courage to the management of Type 1 diabetes. Combining lived experience with medical precision, he transforms daily guesswork into thoughtful, strategic care — showing what is truly possible.”
— Jane Hall-McLean. Artist and author living with Type 1 diabetes
This is two books in one
The journey
A daily cycling diary across Europe, recording the diabetes challenges and the adventure. Real decisions. Real challenges. Real outcomes.
The science
Text: Clear explanations of insulin, metabolism, nutrition and the five foundations of health.
Each chapter includes route maps and QR codes linking to real images from the journey.
Who this book is for
- People living with type 1 diabetes
- Parents and carers
- Clinicians seeking deeper understanding
- Anyone tired of constant firefighting of their type 1 diabetes
Why listen to me?
I am an NHS doctor with over 40 years’ experience, and I have lived with type 1 diabetes for more than 30 years.
This book is not theory alone. It is lived experience, clinical insight and a real-world experiment.
I was both the prescriber and the patient.
This is not about perfection. It’s about peace.
This book won’t cure type 1 diabetes.
But it may change how you understand it.
And that changes everything.