What can 21 days of continuous glucose and ketone data, recorded during a 1,000-mile cycling journey, reveal about managing type 1 diabetes on a ketogenic diet?

Dr. Ian Lake is a UK-based primary care physician who has lived with type 1 diabetes for more than 30 years. After two decades of conventional high-carbohydrate management, he adopted a very low-carbohydrate, ketogenic approach and began examining insulin not simply as a glucose-lowering medication, but as a metabolic hormone whose requirements are influenced by nutrition, exercise, sleep, circadian rhythm, hydration, and stress. His new book, Shifting Gears, documents the ride and the lessons he took from it.

Dr. Lake treated the journey as a 21-day personal experiment, wearing continuous glucose and ketone monitors while consuming roughly 20 grams of carbohydrate per day. In this conversation with Dr. Dominic D’Agostino, he shares what his data showed: an average ketone level near 1.2 mmol/L, daily insulin requirements declining from the mid-20s of units to around 16, and an episode in which glucose and ketones rose together after he had taken too little insulin.

Dr. Lake describes how, in his case, one unit of insulin brought his ketones from approximately 3.0 to 0.9 mmol/L within about 20 minutes. He and Dr. D’Agostino use the experience to explore the distinction between nutritional ketosis and diabetic ketoacidosis, the essential role of adequate insulin, and why ketone readings must always be interpreted alongside glucose levels and clinical context.

They also discuss insulin sensitivity during prolonged exercise, the practical challenges of adjusting insulin during endurance activity, and research suggesting that fat-adapted athletes may sustain high rates of fat oxidation at relatively high exercise intensities.

Questions Answered in This Episode

• What did 21 days of continuous glucose and ketone monitoring reveal during a ketogenic, 1,000-mile cycling journey?
• How did prolonged endurance exercise affect Dr. Lake’s daily insulin requirements?
• How is nutritional ketosis different from diabetic ketoacidosis, and what role does insufficient insulin play in DKA risk?
• What did Dr. Lake observe when his glucose and ketones began rising at the same time?
• How might fat adaptation influence fuel use and endurance performance?
• What are the practical limitations of continuous glucose and ketone monitoring for real-time insulin decisions?

This conversation offers a rare look at 21 consecutive days of glucose, ketone, insulin, nutrition, and exercise data, while also emphasizing that Dr. Lake’s experience is an individual case, not a substitute for personalized medical supervision.

More Links:

• Shifting Gears, Dr. Lake’s book, on Amazon
• Type1Keto, Dr. Lake’s site featuring the book and the Zero Five 100 project

Special thanks to the sponsors of this episode:

✅ Zocdoc: Find and instantly book a top-rated doctor here.
✅ fatty15: Get an additional 50% off a 90-day subscription starter kit with code METABOLICLINK.
✅ Toups and Co: Get 25% off your first order with code METABOLIC.

In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in!

You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel!

Find us on social:

• Instagram
• Facebook
• YouTube
• LinkedIn

Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

Attend a Live Q&A with Dr. Glandt. Reigster here.

What if the way we treat type 2 diabetes is fundamentally backwards?

Dr. Mariela Glandt is an endocrinologist and obesity medicine specialist who spent 15 years practicing conventional medicine before concluding, in her words, that how we treat diabetes “is actually upside down.” As co-founder of OwnaHealth, she focuses on addressing the insulin resistance underlying type 2 diabetes, not only the elevated blood sugar it eventually causes.

In this episode, she walks through the science of that shift: why fasting insulin may reveal metabolic dysfunction before A1C becomes abnormal, why a laboratory “normal” range running up to 20 can be misleading, and why she believes repeatedly escalating insulin can contribute to weight gain, reduced insulin responsiveness, and worsening metabolic health.

She also shares what she has learned bringing low-carbohydrate and ketogenic therapy to underserved communities in the South Bronx, where patients may be navigating severe diabetes alongside financial pressure, cultural food traditions, psychiatric illness, chronic stress, and conflicting medical advice. Her work shows that these therapies can succeed even in communities facing significant barriers to care.

Dr. Glandt also breaks down what GLP-1 medications actually do, where they can help, and what they may leave unresolved—including the risks of muscle loss, inadequate protein intake, and relying on medication without addressing the patient’s broader metabolic health.

Questions Answered in This Episode:

• What key mindset shifts do conventionally trained physicians need to make when transitioning to a more integrated approach to medicine?
• How does reframing diabetes as insulin resistance change the way a doctor practices?
• What are the earliest signs of metabolic dysfunction that many clinicians miss?
• Can ketogenic metabolic therapy succeed in underserved communities?
• What do GLP-1 medications actually solve, and what do they leave untouched?
• Where can ketogenic therapy and GLP-1 medications work together?
• What has Dr. Glandt observed in patients living with both metabolic and psychiatric illness?
• Where does endocrinology most need to change course?

Viewers will come away with a different lens on metabolic disease, one that looks beyond glucose and weight to the biological, social, and practical factors shaping a patient’s health.

More links:

• For Richer, for Poorer: Low-Carb Diets Work for All Incomes
• OwnaHealth: Reverse the course of chronic disease — for everyone.

Special thanks to the sponsors of this episode:

✅ Toups and Co – Get 15% off your first order with code METABOLIC here.
✅ iRestore – Get a huge discount on the Elite and the Illumina bundle with the code LINK here.

In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in!

You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel!

Find us on social:

• Instagram
• Facebook
• YouTube
• LinkedIn

Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

Fewer than 40% of people with PTSD respond to standard care. For the intrusive symptoms at the core of the disorder, response rates may be lower than 15%. So what options remain for patients who have not responded to existing treatments?

Dr. Keren Doenyas-Barak, director of the PTSD program at the Sagol Center for Hyperbaric Medicine and Research and a faculty member at Tel Aviv University, has treated close to 1,000 civilian and military patients and led sham-controlled trials that are helping reshape how hyperbaric medicine is studied.

She walks host Dr. Dominic D'Agostino through the protocol her clinic uses—60 sessions over 12 weeks, with oxygen cycled at two atmospheres—the 35% CAPS-score improvement associated with continued progress after treatment ends, and the reported two-year outcomes, including improved occupational function, roughly double the proportion of patients living with a partner, and sharp drops in benzodiazepine and cannabis use. She also details the convincing sham control her team engineered after concluding that earlier placebo arms may have delivered a physiologically active dose.

Questions Answered in This Episode:

• What hyperbaric protocol is best supported for treatment-resistant PTSD?
• What does a 35% reduction in CAPS score predict about long-term recovery?
• Which outcomes beyond symptom scores changed most for patients?
• How did the team build a hyperbaric sham that patients genuinely could not detect?
• Which safety measures are non-negotiable in a hyperbaric PTSD clinic?
• Does a patient's baseline metabolic fitness predict their response to HBOT, and can the treatment affect cardiometabolic risk?

A rigorous, frontline examination of what responsible hyperbaric medicine actually requires, led by a clinician helping to build its evidence base.

Special thanks to the sponsors of this episode:

✅ Toups and Co – Get 15% off your first order with code METABOLIC here.
✅ iRestore – Get a huge discount on the Elite and the Illumina bundle with the code LINK here.
✅ MudWtr – Get up to 43% off + free shipping and a free rechargeable frother with code METABOLICLINK here.

In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in!

You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel!

Find us on social:

• Instagram
• Facebook
• YouTube
• LinkedIn

Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.