Shifting Gears
Cycling 1,000 Miles Across Europe with Type 1 Diabetes — and Rethinking How We Use Insulin.
In Shifting Gears, clinician and cyclist Dr. Ian Lake takes readers on a three-week cycling journey across Europe while living with Type 1 diabetes. Through a meticulous travel journal, he captures the real-time decisions, challenges, and insights involved in managing glucose during sustained physical effort.
But this is more than a story about glucose control. It reframes Type 1 diabetes as a condition of insulin optimisation. By using as much insulin as necessary, but as little as possible, the book explores how more precise insulin use can stabilise glucose, reduce variability, and bring management closer to the physiology seen in those without diabetes.
The book brings together two themes: a three-week cycling journey across Europe, told day by day, and clear, clinically grounded chapters explaining how insulin shapes metabolism and everyday health—from nutrition and activity to sleep, mindset and circadian rhythms.
Blending lived experience with clinical insight, the journey shows how careful observation and small adjustments can transform day-to-day control into something more predictable, practical, and sustainable.
Shifting Gears is ultimately an optimistic book—designed to inform and empower people living with Type 1 diabetes.
Published May 2026 — be among the first to get your copy.
Watch the Journey
In this short reel, Ian Lake captures the essence of his journey as part of an online photo extension offered with the book to follow the ride in pictures daily for 21 days. Included are meals, glucose, ketone tracing and a photo-diary, to enrich the experience whilst better understanding the relationship between insulin and the five foundations of health; diet, activity, environment, mindset and circadian rhythms. A truly holistic approach to type 1 diabetes.
What Others Are Saying
After years of following the rules, Dr Ian Lake began asking a different question: not just how to manage glucose, but how to optimise insulin. This book shares the journey, the science, and the mindset shift that followed.
“Dr. Lake writes not only as a physician but also as someone who has lived with the daily reality of Type 1 diabetes for decades. That dual perspective gives this book a rare authenticity.
His willingness to question assumptions — while remaining grounded in science — carries forward the spirit of pioneers such as Richard K. Bernstein and Keith Runyan.
What Dr Lake offers in these pages is not a rejection of established care but an expansion of it, encouraging deeper metabolic thinking while remaining practical and grounded in lived experience.”
“Dr. Lake is a cyclist and experienced clinician who takes us through his meticulous travel journal in Shifting Gears. With disarming wit and humor, he teaches you exactly how to optimise insulin therapy. Dr Lake demonstrates with brutal honesty, innovation and self-awareness how his 5 foundations process allows for the lowest and safest insulin doses. This book is a must read for anyone interested in understanding insulin, because Dr Lake's experiments bring us a wealth of knowledge and scientific data that inform us of a better way of delivering healthcare.”
“Ian Lake brings rare clarity and courage to the management of Type 1 diabetes. Weaving his cycling journey across Europe with the equally demanding terrain of blood glucose management, he combines lived experience with medical precision to transform daily guesswork into thoughtful, strategic care — showing what is truly possible.”