Shifting Gears: The 1000-mile Ride That Changed My Mindset On Type 1 Diabetes

What if the problem in type 1 diabetes isn’t glucose—but how we think about insulin?For more than twenty years, Dr Ian Lake lived the reality familiar to so many: careful carbohydrate counting, precise insulin dosing, and results that still felt unpredictable. The same inputs rarely produced the same outcomes. Glucose fluctuated. Insulin requirements crept upward. And the standard model offered no satisfying explanation.Shifting Gears begins with a simple question: what if we’re looking in the wrong place?Through a 1,000-mile cycling journey from southwest England to St Moritz, Switzerland, Dr Lake tests a different way of thinking—one grounded not just in glucose control, but in insulin itself.Along the way, he introduces a framework built on five interacting forces:NutritionPhysical activityMindsetEnvironmentCircadian rhythmTogether, these shape how insulin actually works in the body—moment to moment, day to day.This is not a rulebook or a prescriptive diet plan. Instead, it offers something more useful:A way to understand type 1 diabetes that brings coherence to variability, and stability to real life.Blending lived experience with clear, clinically grounded explanation, Shifting Gears is both a travel narrative and a practical framework for anyone seeking a more precise, more flexible approach to managing type 1 diabetes.Dr Ian Lake is a UK-based medical doctor (BSc, BM, MRCGP) and has lived with type 1 diabetes since 1995. His work focuses on insulin optimisation—using as much as necessary, but as little as possible—within the wider context of lifestyle and metabolic health. Read more