Introduction
Silencing the Chainsaw and Hearing the Birds Sing
The morning I cracked three eggs into a pan of melted butter, I didn’t know I was beginning a revolution. I wasn’t planning one. I wasn’t trying to break rules or challenge a system. I just wanted a peaceful morning. I wanted to avoid another hypo by 10 a.m. I wanted, if I’m honest, a break from the constant firefighting of my glucose levels.
That omelette turned out to be the first moment of clarity I’d had in over two decades of living with type 1 diabetes. For the first time, I ate a meal without needing to react. I didn’t crash or spike. I just… stayed steady. The chainsaw of diabetes—the relentless mental noise, corrections, recalculations, corrections of corrections—finally fell quiet. And when I silenced the chainsaw, I could hear the birds sing. I began to tune into my body.
And so began the shift. Not just a change in diet or insulin strategy, but a complete rethinking of what it means to live with type 1 diabetes. A paradigm shift. A rebellion, gentle but grounded in science and lived experience. I was a doctor. I was also a patient. I had followed the guidelines for years. And I had been getting sicker.
This book is the story of how I found another way. One that is simpler, saner, and more sustainable. One that replaces chaos with calm. One that does more than manage blood sugar—it transforms lives.
I was diagnosed in 1995. Like most of us, I followed the medical advice of the time: eat complex carbs, keep fat low, match insulin accordingly, and exercise as much as you can. I did all of it. I cycled to work, counted carbs, carried glucose tablets, and chased my numbers with good intentions and a growing sense of frustration.
The blood test for long-term glucose control, HbA1c, is less than 42 mmol/mol (6%) for those without the condition. The guideline-accepted target for good type 1 control is 48 mmol/mol (6.5%). Back then, the number was 58 mmol/mol (7.5%) when I was diagnosed. HbA1c is a predictor of the likelihood of diabetes complications. The higher it is, the higher the risk of complications.
My numbers hovered in the high 50s mmol/mol (7.5%) for years. Sometimes they were close to that. Sometimes much worse. I was told, and believed, that this was acceptable. That I was doing okay. At the time, it was the guideline target, after all. But it was way off normal. I can get to normal nowadays, but back then, it seemed impossible. No one went for normal.
Every Monday was a reset as I tried to do better. Porridge for breakfast. Then a cycle ride to work. I was aiming for stability. But by 10:30 a.m., I was treating a hypo. By lunch, I was spiking. Then crashing again. Repeated until burnout. But I didn’t question it. Because I was part of the system delivering it. I was always told that type 1 diabetes was a tough condition, and so I thought this was as good as it got.
The turning point came when I stumbled upon Dr Richard Bernstein. His story mirrored mine: someone living with type 1 diabetes who became fed up with the chaos of trying to manage his type1 diabetes. He found stability through a low-carb diet and minimal insulin.
His logic was sound. His results were compelling. But it ran counter to everything I had been taught, and everything I was teaching others. At first, I dismissed it. It didn’t fit my paradigm. I wasn’t ready.
But when early complications began to appear, when brain fog became my default state, when my HbA1c drifted into the 80’s (9%), I gave Bernstein’s method a try. The result was immediate and dramatic. My glucose stabilised. My insulin use dropped. The fog lifted. Aches vanished. My mood improved. My sleep deepened.
I hadn’t realised how unwell I’d been until I started feeling well.
The breakthrough wasn’t just cutting carbs. It was understanding insulin itself.
In medical school, we’re taught that insulin is just a glucose-lowering drug. But it’s more than that. It’s a master hormone of energy balance, inflammation, fat storage, and ageing. Excess insulin, even in the presence of normal glucose, can harm the body. The goal isn’t just to lower glucose. It’s to use insulin wisely as well.
What I needed wasn’t more insulin. It was less. Better timed. More in sync with how my body would naturally release it. This was the beginning of what I call Optimised Insulin.
As I refined my insulin strategy, I began noticing how other aspects of life affected my control. I grouped them into what I now call the Five Foundations of health:
- Nutrition – A diet based on real food, prioritising protein and fat whilst restricting carbohydrate. It transformed my need for insulin and my glucose control.
- Activity – Exercise became a tool to support insulin sensitivity, not to compensate for poor control or be feared.
- Mindset – The psychological burden lifted. With fewer hypos and less chaos, I felt human again.
- Environment – Light exposure, temperature, and stress altered my glucose. I learned to work with these forces.
- Circadian Rhythms – Understanding how my body clock regulates hormones helped me align insulin dosing more precisely.
This became my new model of care. Optimised insulin, rooted in biology, but personalised by lived experience.
To test this model in real life, I set off on a three-week cycle ride from my home in the southwest of England to a medical conference in St Moritz, Switzerland, 1000 miles distant (1600km). I was not aiming for superhuman activity levels but rather to explore how accessible this lifestyle is to everyone. I was going to take my time and enjoy the view. This was not a “man-of-a-certain-age” challenge, or a Lycra-fest. My goal was to cover a modest, achievable daily distance and arrive on time in St Moritz. My bike was my office chair, and my office was the cycle route across South England, along the River Rhine and over the Swiss Alps.
Along the way, I tracked glucose, ketones, insulin, heart rate, food, and distance. It wasn’t a race. It was an experiment. Could optimised insulin carry me over the Alps? Could the five foundations of health keep me steady, fuelled, and well?
Spoiler: yes, they could! I felt strong. I slept soundly. My glucose stayed in range. My mind was clear. My body—flexible and pain-free—kept going without fuss. I didn’t chase perfection. I couldn’t in reality. I had no pump to finesse the numbers. And I’m not painstakingly diligent by nature. But I did chase consistency based on knowledge of how to optimise insulin.
Modern tools like continuous glucose meters (CGMs) and pumps are remarkable advances and can be very helpful. But they easily dazzle us with their technological prowess, and we can forget the fundamental question: how much insulin are we using, and why?
We’re told that a flat glucose line is the gold standard. But if that flatline is driven by excess insulin with no regard for volume, it may be doing more harm than good. Optimised insulin uses smaller doses, less often, with more impact. It will augment technology, not replace it.
It respects Dr. Bernstein’s “Law of Small Numbers”:
Smaller mealtime carbohydrates + smaller insulin doses = smaller margins of error.
The very-low-carbohydrate, or ketogenic, approach is backed by strong evidence: lower HbA1c, reduced hypoglycaemia, improved lipid profiles, mental clarity, and better mood.
And yet, it remains marginalised. Why?
Partly because medical education still teaches outdated dietary advice. There is, in fact, not a single piece of research that shows the superiority of the current high-carbohydrate guideline diet recommended for type 1 diabetes. We were bolted onto guidelines designed to prevent second heart attacks in non-diabetics, because it was felt that, well, we have a higher risk of heart disease anyway, so let’s recommend a “heart-healthy” diet. No one, it seems, thought about the effect a high-carbohydrate diet would have on the insulin demands of the body.
Partly because change is hard. New paradigms require giving up past habits.
And partly because, as clinicians, we are slow to question what we ourselves were taught. New knowledge is hard to teach when almost all textbooks preach old ideas, repeated until they start to look like fact.
But science moves forward still. Paradigms shift. And I believe we’re on the brink of such a shift.
My journey to Switzerland was also an identity reckoning. I had been both prescriber and recipient of the same failed advice. Changing my mind meant confronting my professional pride.
It meant standing apart. It meant admitting that I had been wrong. But it also meant finding freedom. And once I experienced the power of optimised insulin, I couldn’t go back. Not ethically. Not personally.
I began teaching this method to others. And I watched them thrive.
If you’re living with type 1 diabetes, or treating someone who is, this book is an invitation. Not to abandon science, but to deepen it. Not to reject tools, but to use them more wisely. Not to strive for perfection, but for peace. This is not rebellion for the sake of it. It’s a quiet revolution grounded in science, experience, and a desire to do no harm. I’m not promoting a fringe theory. I’m living the results. And I’ve seen what happens when others do the same. Better control. Less insulin.
This approach won’t cure your diabetes. But it can silence the chainsaw. It can replace firefighting with foresight. Panic with pattern. Guesswork with understanding.
It can help you—or those you care for—hear the birdsong again.
What This Book Offers
This is not a diet book. It’s not a how-to-manage-diabetes manual. I know what it’s like to be on both sides of type 1 diabetes, and so I have written this primarily for my fellow T1s. I have put all of my learning about type1 diabetes into this book.
It contains a wealth of information that should be useful to clinicians—they are very welcome to read it, and I think it will provide some valuable insights into the optimised insulin approach.
By the end of this book, you should have a deep understanding of how optimised insulin can work with your unique type 1 diabetes and feel confident in its management. You should be knowledgeable enough to feel empowered to collaborate with your clinician about your care. This is a condition that has to be managed 24 hours a day, and often the only person in charge is the person with the condition. You will be lucky indeed to find a diabetologist available at three in the morning.
It is not a textbook on type 1 diabetes. It’s a story of paradigm shift—a lived experiment in healing and hope. It weaves personal experience with clinical insight. It’s grounded in data but told with heart.
And above all, it’s optimistic. Because I’ve seen what’s possible. I’ve lived it.
This is two books in one. Firstly, it is an account of my cycling journey to Switzerland. It is a daily diary of the three-week adventure, with details of how I managed my type 1 diabetes with optimised insulin.
Alternating with this travel adventure are chapters that will take you through how the body metabolises insulin, what insulin is, and how insulin impacts many aspects of our daily life. It explores the foundations of health: nutrition, activity, mindset, our environment, sleep, and circadian rhythms. The diary chapters begin with a cycle symbol, and the detail chapters begin with the target symbol. The book can be read solely as a travel diary, which will give a lot of information about the daily management of type 1 diabetes. At the end of each chapter is a map of the day’s route and a QR code linking you to a series of images taken on that day. It can equally be read as a textbook. I hope that by alternating chapters, you will build up your knowledge and enjoy learning along the journey.
You do not need a medical background to understand the medical details, though some sections may require a second read. There are references at the end of the book that you can explore to dive deeper into the concepts that interest you. I hope it will become clear that type 1 diabetes need not be complex to manage if you adopt the principles of optimised insulin. I hope also that, by the end of the book, you are an expert and feel confident through knowledge that your chosen path is the result of an informed choice, whatever path you choose.
I think you’ll be surprised how straightforward it really is.
As doctors, we give ourselves an impossible task by prescribing the wrong diet. The metabolic mayhem that follows adds unnecessary complexity.
This book follows an approach based on the latest findings in the science of nutrition, metabolism, and biochemistry. Hopefully, by the end, you will feel more in control. When the realisation dawns as you go through the book, I challenge you not to say,
“Why wasn’t I told this years ago?”
It is the most common reaction I get.