#109 October 2022 – Keith Runyan, MD – My T1D Management

This is a monthly update on my glycemic management of type 1 diabetes (T1D) using lispro and Basaglar insulin injections, metformin, a ketogenic whole-food diet, and resistance and aerobic exercise (olympic weightlifting and walking). I did two interviews recently with Dr. Bret Scher at Diet Doctor here and Dr. Tony Hampton here.

For those who haven’t been following this blog, I was diagnosed with type 1 diabetes in September 1998 and followed conventional advice to manage my diabetes for the next 14 years. While my HbA1c was 6.5 to 7% during those years, I suffered from frequent hypoglycemic episodes and grew to loathe them. I stumbled onto the use of a low-carb diet for diabetes in late 2011 and started my ketogenic diet on Feb. 8, 2012. The low-carb ketogenic diet greatly reduced my glycemic excursions and halved my insulin requirements from 58 to 28 IU/day and markedly reduced, but did not eliminate, my symptomatic hypoglycemic episodes. In 2019, in an effort to further reduce my hypoglycemic episodes, I added consistency of meals, exercise, and sleep to my blood glucose management strategy. As a result, I have had only 5 mildly symptomatic hypoglycemic episodes since 2019. In addition, my average blood glucose and standard deviation of blood glucose are equivalent to those without diabetes. This has kept me motivated to continue my regimented lifestyle (relative to most others). Although my lifestyle is regimented and consistent, it does not feel burdensome to me. The decision to make certain lifestyle choices is very individual and I can certainly understand if some might not to want to make all the changes that I have to obtain normal blood sugars. In addition to the avoidance of hypoglycemia, I am motivated to continue my current lifestyle as a result of having witnessed firsthand as a physician for 28 years the consequences of poorly controlled diabetes. It was not just witnessing the hospitalizations, surgeries, procedures, dialysis treatments, and infusions of medications, but most memorably, the suffering my patients with diabetes experienced until they met their death, 11 to 13 years sooner, on average, than those without diabetes. I realize that many with diabetes not do think these consequences will happen to them until they actually do. But if my mentioning these realities of poorly controlled diabetes motivates you to adjust your lifestyle habits to improve your glycemic control, then I will have served a purpose. Hippocrates (460 – 357 BC) said, “Before you heal someone, ask if he is willing to give up on the things that make him sick.” I think that applies to type 1 diabetes. Are you willing to give up refined dietary carbohydrates and sugar and haphazardly timed meals, exercise, and sleep that contribute to rollercoaster blood sugars?

My book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, explains in detail the strategies that need to be implemented to achieve normal blood sugars without hypoglycemia and is available in the U.S. on Amazon and internationally on your countries’ Amazon in Kindle, Paperback, and Hardcover versions. The book incorporates all the new strategies that I learned since my previous book that have allowed me to achieve truly normal blood sugars. It also describes why blood sugars can be so difficult to regulate with T1D without these strategies. The ‘Look Inside’ feature on Amazon will allow you to read the Table of Contents and some of the book contents. My other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print.

If you feel you might benefit from some individual attention and suggestions for achieving success with blood sugar control for type 1 or type 2 diabetes and/or losing excess body fat, I can assist you with a personal consultation via Google Meet or Skype. See the Coaching page for more info.

Glycemic Results for October 2022

This month, my glycemic results were comparable to those of non-diabetic individuals (see below), but slightly short of my ultimate goal of no blood glucose values < 70 mg/dL. My average blood glucose for the entire month was 100 mg/dL and the standard deviation of blood glucose (SDBG) was 19 mg/dL. The top graph below shows all of my blood glucose measurements and the bottom graph shows the daily dose totals for bolus and basal insulin and the total daily insulin dose. Fortunately, I did not have any hypoglycemic episodes nor did I need to take any glucose (dextrose) tablets or Smarties™ this month.

My blood sugar goals are shown in Table 2.2 below. I adjust my target blood glucose (TBG) depending on my glycemic results in the previous 2-week period. I increase my TBG by 10 mg/dL immediately if I have a blood glucose value < 70 mg/dL. I decrease my TBG by 5-10 mg/dL if I haven’t had any blood glucose values < 70 mg/dL in the previous 2 weeks. I have decided not to seek a TBG < 90 mg/dL because I have not found any compelling evidence that a lower TBG would further reduce the risk of diabetic complications or improve healthspan or lifespan, but the risk of having hypoglycemia definitely increases as the TBG is reduced.

The table below summarizes my glycemic results over the previous year. In the table, MBG = mean blood glucose, SDBG = standard deviation of blood glucose, BG COV = blood glucose coefficient of variation which equals SDBG ÷ MBG, MTDID = mean total daily insulin dose, MDBD = mean daily Basaglar dose, MDLD = mean daily lispro dose, and the remaining columns include an estimated HbA1c (%) based on the mean blood glucose, the percentage of blood glucose values < 70 mg/dL, between 70 and 130 mg/dL, and > 130 mg/dL, and body weight (kg). My goal is to have 100% of my blood glucose values in the range 70−130 mg/dL, but did not quite meet that goal this month.

The table below tracks my total daily meal macronutrients, body weight, insulin dosage, and the ketogenic ratio of my diet.

I increased my daily caloric intake to 2,400 kcal/day this month. I will continue to adjust my caloric intake +/- 25 kcal/day once weekly as needed to maintain my body weight at or just below 73 kg. The foods in my diet currently include bacon, eggs, salmon, cheddar cheese, broccoli, unsweetened tea, and a dessert made with cream cheese, heavy whipping cream, coconut oil, unsweetened baker’s chocolate, allulose, chopped macadamia nuts and sunflower seeds, and water to adjust the consistency. The choice of these foods and the amounts I eat result in obtaining close to 100% of the RDA of 40 vitamins, minerals, and other essential nutrients. I do supplement with Morton Lite Salt added to my bacon and eggs for its sodium and potassium content and take magnesium chloride (300 mg/day) added to water. I also supplement with creatine monohydrate (1 gram/day), vitamin C (180 mg/day), vitamin B12 (0.5 mg/2 weeks because I take metformin), and vitamin D (5,000 IU 3x/week). In addition to Basaglar and lispro insulins, I take metformin 500 mg with each of 4 meals daily (2,000 mg/day). My meals are eaten at 7 am, 12:15 pm, 5:30 pm, and 10:45 pm, or as close to those times as possible. Each meal contains 0.45 to 0.49 grams/kg body weight of protein to help retain my muscle mass as I age.

Below is a photo of myself from April 2022 at 72.8 kg (160.5 lb.).

My best olympic lifts this month were 125 lb. snatch and 172.5 lb. clean and jerk. These are considerably less than December 2020 (147.5 lb. snatch and 200 lb. clean and jerk) prior to injuring my shoulder later that month. My shoulder is much better but not fully healed and I suspect it won’t be 100% anytime soon. Although I would like to get back to those heavier weights, I still enjoy doing what I can. My daily exercise program is doing a good job of keeping my insulin sensitivity stable which contributes to achieving normal blood sugars.

Table 1.2 below shows the mean interstitial glucose (IG) of 732 non-diabetic subjects and standard deviation of the interstitial glucose (SDIG) of 708 non-diabetic subjects as measured by CGM from the seven studies referenced below. One of the studies, Sundberg, F, et al., 2018, was in 15 healthy, normal weight children, age 2−8. The mean CGM 24-hr IG was 95 mg/dL (5.3 mM) and SDIG was 18 mg/dL (1.0 mM). This study again confirms that children’s blood sugars are about the same as those of adults. The age of subjects in these seven studies ranges from 2−80 years. I think it is important for those with T1D to know the glucose results of metabolically healthy study subjects to be used as a reference for seeking normal blood sugars. Although achieving normal blood sugars with T1D is not an easy task, it can be made more difficult by choosing a target blood glucose that is too low and results in hypoglycemic episodes. The lower the target blood glucose, the more likely hypoglycemic episodes are to occur in those with T1D taking exogenous insulin. Having hypoglycemic episodes means that your target blood glucose is set too low. Achieving a normal mean blood glucose without hypoglycemia, requires that one’s glycemic variability as measured by the standard deviation of blood glucose is normal as well.

The references for these seven studies are shown below.

My goal moving forward is to eliminate all BG values < 70 mg/dL as part of managing T1D as safely as possible. Although I have yet to achieve this goal for an entire month, I am not discouraged and continue to strive for better results each day.

The purpose of this blog is to share my experience with a low-carb ketogenic diet and exercise to better manage my blood glucose as a person with T1D. A low-carb ketogenic diet also allows for lower daily insulin doses and normal body composition which I believe reduces the risk of developing insulin resistance and the host of chronic diseases associated with insulin resistance including atherosclerosis, cancer, and neurodegenerative diseases. I also take metformin 500 mg with each of 4 meals daily (2,000 mg/day) to suppress liver glucose production which tends to be chronically elevated in those with T1D. This occurs due to the lower concentration of insulin around the pancreatic alpha-cells increasing the concentration of glucagon reaching the liver as well as the lower concentration of insulin entering the liver both of which increase liver gluconeogenesis and glucose production relative to those without T1D. Metformin also improves glucose uptake by skeletal muscle. Metformin, exercise, and a low-carbohydrate diet also improves glycemic control for those with glucose intolerance, prediabetes, type 2 diabetes, and double diabetes [T1D with insulin resistance]. As explained in detail in my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, injecting insulin in the subcutaneous fat is just not the same as when it is secreted by the beta-cells in the pancreas according to the prevailing blood glucose concentration. I have accepted the fact that there will always be more variation in my blood glucose than I would like, but if I can continue to keep the mean and standard deviation of my blood glucose readings equivalent to that of non-diabetic individuals while avoiding hypoglycemia, I will be satisfied. I would appreciate those who want to purchase my book and derive some benefit from reading it to leave a positive review on Amazon so that others will see the book when they search for books on T1D. The search rankings in Amazon are based the number of books purchased and the reviews of the book.

Comments or general questions are welcomed.

Till next time….

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#108 September 2022 Update on My T1D Management

This is a monthly update on my glycemic management of type 1 diabetes (T1D) using lispro and Basaglar insulin injections, metformin, a ketogenic whole-food diet, and resistance and aerobic exercise (olympic weightlifting and walking). For those who haven’t been following this blog, I was diagnosed with type 1 diabetes in September 1998 and followed conventional advice to manage my diabetes for the next 14 years. While my HbA1c was 6.5 to 7% during those years, I suffered from frequent hypoglycemic episodes and grew to loathe them. I stumbled onto the use of a low-carb diet for diabetes in late 2011 and started my ketogenic diet on Feb. 8, 2012. The low-carb ketogenic diet greatly reduced my glycemic excursions and halved my insulin requirements from 58 to 28 IU/day and markedly reduced, but did not eliminate, my symptomatic hypoglycemic episodes. In 2019, in an effort to further reduce my hypoglycemic episodes, I added consistency of meals, exercise, and sleep to my blood glucose management strategy. As a result, I have had only 5 mildly symptomatic hypoglycemic episodes since 2019. In addition, my average blood glucose and standard deviation of blood glucose are equivalent to those without diabetes. This has kept me motivated to continue my regimented lifestyle (relative to most others). Although my lifestyle is regimented and consistent, it does not feel burdensome to me. The decision to make certain lifestyle choices is very individual and I can certainly understand if some might not to want to make all the changes that I have to obtain normal blood sugars. In addition to the avoidance of hypoglycemia, I am motivated to continue my current lifestyle as a result of having witnessed firsthand as a physician for 28 years the consequences of poorly controlled diabetes. It was not just witnessing the hospitalizations, surgeries, procedures, dialysis treatments, and infusions of medications, but most memorably, the suffering my patients with diabetes experienced until they met their death, 11 to 13 years sooner, on average, than those without diabetes. I realize that many with diabetes not do think these consequences will happen to them until they actually do. But if my mentioning these realities of poorly controlled diabetes motivates you to adjust your lifestyle habits to improve your glycemic control, then I will have served a purpose. Hippocrates (460 – 357 BC) said, “Before you heal someone, ask if he is willing to give up on the things that make him sick.” I think that applies to type 1 diabetes. Are you willing to give up refined dietary carbohydrates and sugar and haphazardly timed meals, exercise, and sleep that contribute to rollercoaster blood sugars?

My book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, explains in detail the strategies that need to be implemented to achieve normal blood sugars without hypoglycemia and is available in the U.S. on Amazon and internationally on your countries’ Amazon in Kindle, Paperback, and Hardcover versions. The book incorporates all the new strategies that I learned since my previous book that have allowed me to achieve truly normal blood sugars. It also describes why blood sugars can be so difficult to regulate with T1D without these strategies. The ‘Look Inside’ feature on Amazon will allow you to read the Table of Contents and some of the book contents. My other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print.

If you feel you might benefit from some individual attention and suggestions for achieving success with blood sugar control for type 1 or type 2 diabetes and/or losing excess body fat, I can assist you with a personal consultation via Google Meet or Skype. See the Coaching page for more info.

Glycemic Results for September 2022

In September 2022, my glycemic results were comparable to those of a non-diabetic individuals (see below), but slightly short of my ultimate goal of no blood glucose values < 70 mg/dL. My average blood glucose for the entire month was 100 mg/dL and the standard deviation of blood glucose (SDBG) was 18 mg/dL. The top graph below shows all of my blood glucose measurements and the bottom graph shows the daily dose totals for bolus and basal insulin and the total daily insulin dose. Fortunately, I did not have any hypoglycemic episodes nor did I need to take any glucose (dextrose) tablets or Smarties™ this month.

My blood sugar goals are shown in Table 2.2 below. I adjust my target blood glucose (TBG) depending on my glycemic results in the previous 2-week period. I increase my TBG by 10 mg/dL immediately if I have a blood glucose value < 70 mg/dL. I decrease my TBG by 5-10 mg/dL if I haven’t had any blood glucose values < 70 mg/dL in the previous 2 weeks. I have decided not to seek a TBG < 90 mg/dL because I have not found any compelling evidence that a lower TBG would further reduce the risk of diabetic complications or improve healthspan or lifespan, but the risk of having hypoglycemia definitely increases as the TBG is reduced.

The table below summarizes my glycemic results over the previous year. In the table, MBG = mean blood glucose, SDBG = standard deviation of blood glucose, BG COV = blood glucose coefficient of variation which equals SDBG ÷ MBG, MTDID = mean total daily insulin dose, MDBD = mean daily Basaglar dose, MDLD = mean daily lispro dose, and the remaining columns include an estimated HbA1c (%) based on the mean blood glucose, the percentage of blood glucose values < 70 mg/dL, between 70 and 130 mg/dL, and > 130 mg/dL, and body weight (kg). My goal is to have 100% of my blood glucose values in the range 70−130 mg/dL, but did not quite meet that goal this month.

The table below tracks my total daily meal macronutrients, body weight, insulin dosage, and the ketogenic ratio of my diet.

I increased my daily caloric intake to 2,300 kcal/day this month. I will continue to adjust my caloric intake +/- 25 kcal/day once weekly as needed to maintain my body weight at or just below 73 kg. The foods in my diet currently include bacon, eggs, salmon, cheddar cheese, broccoli, unsweetened tea, and a dessert made with cream cheese, heavy whipping cream, coconut oil, unsweetened baker’s chocolate, allulose, chopped macadamia nuts and sunflower seeds, and water to adjust the consistency. The choice of these foods and the amounts I eat result in obtaining close to 100% of the RDA of 40 vitamins, minerals, and other essential nutrients. I do supplement with Morton Lite Salt added to my bacon and eggs for its sodium and potassium content and take magnesium chloride (300 mg/day) added to water. I also supplement with creatine monohydrate (1 gram/day), vitamin C (180 mg/day), and vitamin D (5,000 IU 3x/week). My meals are eaten at 7 am, 12:15 pm, 5:30 pm, and 10:45 pm, or as close to those times as possible. Each meal contains ≈0.4 grams/kg body weight of protein to help retain my muscle mass. I eat more dessert at lunch and dinner compared to breakfast and bedtime to try to even out the bolus insulin dose across all 4 meals. This is because the resistance exercise and afternoon walk done after lunch increase my insulin sensitivity for about 8 hours which reduces my insulin requirements at lunch and dinner. I consume 21% of my daily calories at breakfast, 29% at lunch, 29% at dinner, and 21% at bedtime. My bolus insulin dose this month was distributed across my meals as follows: 41% at breakfast, 20% at lunch, 12% at dinner, and 27% at bedtime. I take my basal insulin dose once daily at bedtime and adjust the dose based on the morning blood glucose results overall and try not to change the dose very often.

Below is a photo of myself from April 2022 at 72.8 kg (160.5 lb.).

Table 1.2 below shows the mean interstitial glucose (IG) of 732 non-diabetic subjects and standard deviation of the interstitial glucose (SDIG) of 708 non-diabetic subjects as measured by CGM from the seven studies referenced below. One of the studies, Sundberg, F, et al., 2018, was in 15 healthy, normal weight children, age 2−8. The mean CGM 24-hr IG was 95 mg/dL (5.3 mM) and SDIG was 18 mg/dL (1.0 mM). This study again confirms that children’s blood sugars are about the same as those of adults. The age of subjects in these seven studies ranges from 2−80 years. I think it is important for those with T1D to know the glucose results of metabolically healthy study subjects to be used as a reference for seeking normal blood sugars. Although achieving normal blood sugars with T1D is not an easy task, it can be made more difficult by choosing a target blood glucose that is too low and results in hypoglycemic episodes. The lower the target blood glucose, the more likely hypoglycemic episodes are to occur in those with T1D taking exogenous insulin. Having hypoglycemic episodes means that your target blood glucose is set too low. Achieving a normal mean blood glucose without hypoglycemia, requires that one’s glycemic variability as measured by the standard deviation of blood glucose is normal as well.

The references for these seven studies are shown below.

My goal moving forward is to eliminate all BG values < 70 mg/dL as part of managing T1D as safely as possible. Although I have yet to achieve this goal for an entire month, I am not discouraged and continue to strive for better results each day.

The purpose of this blog is to share my experience with a low-carb ketogenic diet and exercise to better manage my blood glucose as a person with T1D. A low-carb ketogenic diet also allows for lower daily insulin doses and normal body composition which I believe reduces the risk of developing insulin resistance and the host of chronic diseases associated with insulin resistance including atherosclerosis, cancer, and neurodegenerative diseases. I also take metformin 500 mg with each of 4 meals daily (2,000 mg/day) to suppress liver glucose production which tends to be chronically elevated in those with T1D. This occurs due to the lower concentration of insulin around the pancreatic alpha-cells increasing the concentration of glucagon reaching the liver as well as the lower concentration of insulin entering the liver both of which increase liver gluconeogenesis and glucose production relative to those without T1D. Metformin also improves glucose uptake by skeletal muscle. These strategies also work well for those with glucose intolerance, prediabetes, type 2 diabetes, and double diabetes [T1D with insulin resistance]. As explained in detail in my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, injecting insulin in the subcutaneous fat is just not the same as when it is secreted by the beta-cells in the pancreas according to the prevailing blood glucose concentration. I have accepted the fact that there will always be more variation in my blood glucose than I would like, but if I can continue to keep the mean and standard deviation of my blood glucose readings equivalent to that of a non-diabetic individual while avoiding hypoglycemia, I will be satisfied. I would appreciate those who want to purchase my book and derive some benefit from reading it to leave a positive review on Amazon so that others will see the book when they search for books on T1D. The search rankings in Amazon are based the number of books purchased and the reviews of the book.

Comments or general questions are welcomed.

Till next time….

#107 August 2022 Update on My T1D Management

This is a monthly update on my glycemic management of type 1 diabetes (T1D) using lispro and Basaglar insulin injections, metformin, a ketogenic whole-food diet, and resistance and aerobic exercise (olympic weightlifting and walking). For those who haven’t been following this blog, I was diagnosed with type 1 diabetes in September 1998 and followed conventional advice to manage my diabetes for the next 14 years. While my HbA1c was 6.5 to 7% during those years, I suffered from frequent hypoglycemic episodes and grew to loathe them. I stumbled onto the use of a low-carb diet for diabetes in late 2011 and started my ketogenic diet on Feb. 8, 2012. The low-carb ketogenic diet greatly reduced my glycemic excursions and halved my insulin requirements from 58 to 28 IU/day and markedly reduced, but did not eliminate, my symptomatic hypoglycemic episodes. In 2019, in an effort to further reduce my hypoglycemic episodes, I added consistency of meals, exercise, and sleep to my blood glucose management strategy. As a result, I have had only 5 mildly symptomatic hypoglycemic episodes since 2019. In addition, my average blood glucose and standard deviation of blood glucose are equivalent to those without diabetes. This has kept me motivated to continue my regimented lifestyle (relative to most others). Although my lifestyle is regimented and consistent, it does not feel burdensome to me. The decision to make certain lifestyle choices is very individual and I can certainly understand if some might not to want to make all the changes that I have to obtain normal blood sugars. In addition to the avoidance of hypoglycemia, I am motivated to continue my current lifestyle as a result of having witnessed firsthand as a physician for 28 years the consequences of poorly controlled diabetes. It was not just witnessing the hospitalizations, surgeries, procedures, dialysis treatments, and infusions of medications, but most memorably, the suffering my patients with diabetes experienced until they met their death, 11 to 13 years sooner, on average, than those without diabetes. I realize that many with diabetes not do think these consequences will happen to them until they actually do. But if my mentioning these realities of poorly controlled diabetes motivates you to adjust your lifestyle habits to improve your glycemic control, then I will have served a purpose. Hippocrates (460 – 357 BC) said, “Before you heal someone, ask if he is willing to give up on the things that make him sick.” I think that applies to type 1 diabetes. Are you willing to give up refined dietary carbohydrates and sugar and haphazardly timed meals, exercise, and sleep that contribute to rollercoaster blood sugars?

My book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, explains in detail the strategies that need to be implemented to achieve normal blood sugars without hypoglycemia and is available in the U.S. on Amazon and internationally on your countries’ Amazon in Kindle, Paperback, and Hardcover versions. The book incorporates all the new strategies that I learned since my previous book that have allowed me to achieve truly normal blood sugars. It also describes why blood sugars can be so difficult to regulate with T1D without these strategies. The ‘Look Inside’ feature on Amazon will allow you to read the Table of Contents and some of the book contents. My other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print.

If you feel you might benefit from some individual attention and suggestions for achieving success with blood sugar control for type 1 or type 2 diabetes and/or losing excess body fat, I can assist you with a personal consultation via Google Meet or Skype. See the Coaching page for more info.

Glycemic Results for August 2022

In August 2022, my glycemic results were comparable to those of a non-diabetic individuals (see below), but slightly short of my ultimate goal of no blood glucose values < 70 mg/dL. My average blood glucose for the entire month was 100 mg/dL and the standard deviation of blood glucose (SDBG) was 18 mg/dL. The top graph below shows all of my blood glucose measurements and the bottom graph shows the daily dose totals for bolus and basal insulin and the total daily insulin dose. Fortunately, I did not have any hypoglycemic episodes nor did I need to take any glucose (dextrose) tablets or Smarties™ this month.

My blood sugar goals are shown in Table 2.2 below. I adjust my target blood glucose (TBG) depending on my glycemic results in the previous 2-week period. I increase my TBG by 10 mg/dL immediately if I have a blood glucose value < 70 mg/dL. I decrease my TBG by 5-10 mg/dL if I haven’t had any blood glucose values < 70 mg/dL in the previous 2 weeks. I have decided not to seek a TBG < 90 mg/dL because I have not found any compelling evidence that a lower TBG would further reduce the risk of diabetic complications or improve healthspan or lifespan, but the risk of having hypoglycemia definitely increases as the TBG is reduced.

The table below summarizes my glycemic results over the previous year. In the table, MBG = mean blood glucose, SDBG = standard deviation of blood glucose, BG COV = blood glucose coefficient of variation which equals SDBG ÷ MBG, MTDID = mean total daily insulin dose, MDBD = mean daily Basaglar dose, MDLD = mean daily lispro dose, and the remaining columns include an estimated HbA1c (%) based on the mean blood glucose, the percentage of blood glucose values < 70 mg/dL, between 70 and 130 mg/dL, and > 130 mg/dL, and body weight (kg). My goal is to have 100% of my blood glucose values in the range 70−130 mg/dL, but did not quite meet that goal this month.

The table below tracks my total daily meal macronutrients, body weight, insulin dosage, and the ketogenic ratio of my diet.

I increased my daily caloric intake to 2,195 kcal/day this month. I will continue to adjust my caloric intake +/- 25 kcal/day once weekly as needed to maintain my body weight at or just below 73 kg. The foods in my diet currently include bacon, eggs, salmon, cheddar cheese, broccoli, unsweetened tea, and a dessert made with cream cheese, coconut oil, cocoa powder, allulose, chopped macadamia nuts and sunflower seeds, and water to adjust the consistency. The choice of these foods and the amounts I eat result in obtaining close to 100% of the RDA of all the vitamins and minerals. I do supplement with Morton Lite Salt added to my bacon and eggs for its potassium content and take magnesium chloride (300 mg/day) added to water. My meals are eaten at 7 am, 12:15 pm, 5:30 pm, and 10:45 pm, or as close to those times as possible. Each meal contains 0.4 grams/kg body weight of protein to help retain my muscle mass. I eat more dessert at lunch and dinner compared to breakfast and bedtime to try to even out the bolus insulin dose across all 4 meals. This is because the resistance exercise and afternoon walk done after lunch increase my insulin sensitivity for about 8 hours which reduces my insulin requirements at lunch and dinner. I consume 22% of my daily calories at breakfast, 28% at lunch, 28% at dinner, and 22% at bedtime. My bolus insulin dose this month was distributed across my meals as follows: 42% at breakfast, 17% at lunch, 14% at dinner, and 27% at bedtime. In September, I will further adjust the amounts of dessert at each meal to improve the bolus insulin distribution and report those changes next month. I take my basal insulin dose once daily at bedtime.

Below is a photo of myself from April 2022 at 72.8 kg (160.5 lb.).

Table 1.2 below shows the mean interstitial glucose (IG) of 732 non-diabetic subjects and standard deviation of the interstitial glucose (SDIG) of 708 non-diabetic subjects as measured by CGM from the seven studies referenced below. One of the studies, Sundberg, F, et al., 2018, was in 15 healthy, normal weight children, age 2−8. The mean CGM 24-hr IG was 95 mg/dL (5.3 mM) and SDIG was 18 mg/dL (1.0 mM). This study again confirms that children’s blood sugars are about the same as those of adults. The age of subjects in these seven studies ranges from 2−80 years. I think it is important for those with T1D to know the glucose results of metabolically healthy study subjects to be used as a reference for seeking normal blood sugars. Although achieving normal blood sugars with T1D is not an easy task, it can be made more difficult by choosing a target blood glucose that is too low and results in hypoglycemic episodes. The lower the target blood glucose, the more likely hypoglycemic episodes are to occur in those with T1D taking exogenous insulin. Having hypoglycemic episodes means that your target blood glucose is set too low. Achieving a normal mean blood glucose without hypoglycemia, requires that one’s glycemic variability as measured by the standard deviation of blood glucose is normal as well.

The references for these seven studies are shown below.

My goal moving forward is to eliminate all BG values < 70 mg/dL as part of managing T1D as safely as possible. Although I have yet to achieve this goal for an entire month, I am not discouraged and continue to strive for better results each day.

The purpose of this blog is to share my experience with a low-carb ketogenic diet and exercise to better manage my blood glucose as a person with T1D. A low-carb ketogenic diet also allows for lower daily insulin doses and normal body composition which I believe reduces the risk of developing insulin resistance and the host of chronic diseases associated with insulin resistance including atherosclerosis, cancer, and neurodegenerative diseases. I also take metformin 500 mg with each of 4 meals daily (2,000 mg/day) to suppress liver glucose production which tends to be chronically elevated in those with T1D. This occurs due to the lower concentration of insulin around the pancreatic alpha-cells increasing the concentration of glucagon reaching the liver as well as the lower concentration of insulin entering the liver both of which increase liver gluconeogenesis and glucose production relative to those without T1D. Metformin also improves glucose uptake by skeletal muscle. These strategies also work well for those with glucose intolerance, prediabetes, type 2 diabetes, and double diabetes [T1D with insulin resistance]. As explained in detail in my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, injecting insulin in the subcutaneous fat is just not the same as when it is secreted by the beta-cells in the pancreas according to the prevailing blood glucose concentration. I have accepted the fact that there will always be more variation in my blood glucose than I would like, but if I can continue to keep the mean and standard deviation of my blood glucose readings equivalent to that of a non-diabetic individual while avoiding hypoglycemia, I will be satisfied. I would appreciate those who want to purchase my book and derive some benefit from reading it to leave a positive review on Amazon so that others will see the book when they search for books on T1D. The search rankings in Amazon are based the number of books purchased and the reviews of the book.

Comments or general questions are welcomed.

Till next time….

#106 July 2022 Update on My T1D Management

This is a monthly update on my glycemic management of type 1 diabetes (T1D) using lispro and Basaglar insulin injections with metformin and a ketogenic whole-food diet and resistance and aerobic exercise (olympic weightlifting and walking). For those who haven’t been following this blog, I was diagnosed with type 1 diabetes in September 1998 and followed conventional advice to manage my diabetes for the next 14 years. I suffered from frequent hypoglycemic episodes and grew to loathe them. I stumbled onto the use of a low-carb diet for diabetes in late 2011 and started my ketogenic diet on Feb. 8, 2012. The low-carb ketogenic diet greatly reduced my glycemic excursions and halved my insulin requirements from 58 to 28 IU/day and markedly reduced, but did not eliminate, my symptomatic hypoglycemic episodes. In 2019, I added consistency of meals, exercise, and sleep to my blood glucose management strategy in hopes of further reducing the frequency of hypoglycemia. As a result, I have had only 5 mildly symptomatic hypoglycemic episodes since 2019. In addition, my average blood glucose and standard deviation of blood glucose are equivalent to those without diabetes. This has kept me motivated to continue my somewhat regimented lifestyle. The decision to make certain lifestyle choices is very individual and I can certainly understand if some might not to want to make all the changes that I have to obtain normal blood sugars. In addition to the avoidance of hypoglycemia, I am motivated to continue my current lifestyle as a result of having witnessed firsthand as a physician for 28 years the consequences of poorly controlled diabetes. It was not just witnessing the hospitalizations, surgeries, procedures, dialysis treatments, and medication infusions, but most memorably, the suffering my patients with diabetes experienced until they met an early death. I realize that many with diabetes not do think these consequences will happen to them until they actually do. But if you are motivated to adjust your lifestyle habits to improve your glycemic control, then mentioning these realities of poorly controlled diabetes will have served a purpose. Hippocrates (460 – 357 BC) said, “Before you heal someone, ask if he is willing to give up on the things that make him sick.” I think that applies to type 1 diabetes. Are you willing to give up refined dietary carbohydrates and sugar and haphazardly timed meals, exercise, and sleep that contribute to rollercoaster blood sugars?

My book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, explains in detail the strategies that need to be implemented to achieve normal blood sugars without hypoglycemia and is available in the U.S. on Amazon and internationally on your countries’ Amazon in Kindle, Paperback, and Hardcover versions. The book incorporates all the new strategies that I learned since my previous book that have allowed me to achieve truly normal blood sugars. It also describes why blood sugars can be so difficult to regulate with T1D without these strategies. The ‘Look Inside’ feature on Amazon will allow you to read the Table of Contents and some of the book contents. My other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print.

If you feel you might benefit from some individual attention and suggestions for achieving success with blood sugar control for type 1 or type 2 diabetes and/or losing excess body fat, I can assist you with a personal consultation via Google Meet or Skype. See the Coaching page for more info.

Glycemic Results for July 2022

In July 2022, my glycemic results were comparable to those of a non-diabetic individuals (see below), but slightly short of my ultimate goal of no blood glucose values < 70 mg/dL. My average blood glucose for the entire month was 99 mg/dL and the standard deviation of blood glucose (SDBG) was 18 mg/dL. The top graph below shows all of my blood glucose measurements and the bottom graph shows the daily dose totals for bolus and basal insulin and the total daily insulin dose. Fortunately, I did not have any hypoglycemic episodes nor did I need to take any glucose (dextrose) tablets or Smarties™ this month.

My blood sugar goals are shown in Table 2.2 below. I adjust my target blood glucose (TBG) depending on my glycemic results in the previous 2-week period. I increase my TBG by 10 mg/dL immediately if I have a blood glucose value < 70 mg/dL. I decrease my TBG by 5-10 mg/dL if I haven’t had any blood glucose values < 70 mg/dL in the previous 2 weeks. I have decided not to seek a TBG < 90 mg/dL because I have not found any compelling evidence that a lower TBG would further reduce the risk of diabetic complications or improve healthspan or lifespan, but the risk of having hypoglycemia definitely increases as the TBG is reduced.

The table below summarizes my glycemic results over the previous year. In the table, MBG = mean blood glucose, SDBG = standard deviation of blood glucose, BG COV = blood glucose coefficient of variation which equals SDBG ÷ MBG, MTDID = mean total daily insulin dose, MDBD = mean daily Basaglar dose, MDLD = mean daily lispro dose, and the remaining columns include an estimated HbA1c (%) based on the mean blood glucose, the percentage of blood glucose values < 70 mg/dL, between 70 and 130 mg/dL, and > 130 mg/dL, and body weight (kg). My goal is to have 100% of my blood glucose values in the range 70−130 mg/dL, but did not quite meet that goal this month.

The table below tracks my total daily meal macronutrients, body weight, insulin dosage, and the ketogenic ratio of my diet.

I decreased my daily caloric intake to 2,150 kcal/day this month. I will continue to adjust my caloric intake +/- 25 kcal/day once weekly as needed to maintain my body weight at or just below 73 kg.

Below is a photo of myself from April 2022 at 72.8 kg (160.5 lb.).

Table 1.2 below shows the mean interstitial glucose (IG) of 732 non-diabetic subjects and standard deviation of the interstitial glucose (SDIG) of 708 non-diabetic subjects as measured by CGM from the seven studies referenced below. One of the studies, Sundberg, F, et al., 2018, was in 15 healthy, normal weight children, age 2−8. The mean CGM 24-hr IG was 95 mg/dL (5.3 mM) and SDIG was 18 mg/dL (1.0 mM). This study again confirms that children’s blood sugars are about the same as those of adults. The age of subjects in these seven studies ranges from 2−80 years. I think it is important for those with T1D to know the glucose results of metabolically healthy study subjects to be used as a reference for seeking normal blood sugars. Although achieving normal blood sugars with T1D is not an easy task, it can be made more difficult by choosing a target blood glucose that is too low and results in hypoglycemic episodes. The lower the target blood glucose, the more likely hypoglycemic episodes are to occur in those with T1D taking exogenous insulin or having hypoglycemic episodes means that your target blood glucose is set too low.

The references for these seven studies are shown below.

My goal moving forward is to eliminate all BG values < 70 mg/dL as part of managing T1D as safely as possible. Although I have yet to achieve this goal for an entire month, I am not discouraged and continue to strive for better results each day.

The purpose of this blog is to share my experience with a low-carb, ketogenic, diet and exercise to better manage my blood glucose as a person with T1D. A low-carb, ketogenic, diet also allows for lower daily insulin doses and normal body composition which I believe reduces the risk of developing insulin resistance and the host of chronic diseases associated with insulin resistance including atherosclerosis, cancer, and neurodegenerative diseases. I also take metformin 500 mg with each of 4 meals daily (2,000 mg/day) to suppress liver glucose production which tends to be chronically elevated in those with T1D. This occurs due to the lower concentration of insulin around the pancreatic alpha-cells increasing the concentration of glucagon reaching the liver as well as the lower concentration of insulin entering the liver both of which increase liver gluconeogenesis and glucose production relative to those without T1D. Metformin also improves glucose uptake by skeletal muscle. These strategies also work well for those with glucose intolerance, prediabetes, type 2 diabetes, and double diabetes [T1D with insulin resistance]. As explained in detail in my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, injecting insulin in the subcutaneous fat is just not the same as when it is secreted by the beta-cells in the pancreas according to the prevailing blood glucose concentration. I have accepted the fact that there will always be more variation in blood glucose than I would like, but if I can continue to keep the mean and standard deviation of my blood glucose readings equivalent to that of a non-diabetic individual while avoiding hypoglycemia, I will be satisfied. I would appreciate those who want to purchase my book and derive some benefit from reading it to leave a positive review on Amazon so that others will see the book when they search for books on T1D. The search rankings in Amazon are based the number of books purchased and the reviews of the book.

Comments or general questions are welcomed.

Till next time….

#105 June 2022 Update on My T1D Management

This is a monthly update on my glycemic management of type 1 diabetes (T1D) using lispro and Basaglar insulin injections (a change from Humalog and Tresiba due to insurance issues) with a ketogenic whole-food diet and resistance and aerobic exercise (olympic weightlifting and walking). For those who haven’t been following this blog, I was diagnosed with type 1 diabetes in September 1998 and followed conventional advice to manage my diabetes for the next 14 years. I suffered from frequent hypoglycemic episodes and grew to loathe them. I stumbled onto the use of a low-carb diet for diabetes in late 2011 and started my ketogenic diet on Feb. 8, 2012. The low-carb ketogenic diet greatly reduced my glycemic excursions and halved my insulin requirements from 58 to 28 IU/day and markedly reduced, but did not eliminate, my symptomatic hypoglycemic episodes. In 2019, I added consistency of meals, exercise, and sleep to my blood glucose management strategy in hopes of further reducing the frequency of hypoglycemia. As a result, I have had only 5 mildly symptomatic hypoglycemic episodes since 2019. In addition, my average blood glucose and standard deviation of blood glucose are equivalent to those without diabetes. This has kept me motivated to continue my somewhat monotonous lifestyle. The decision to make certain lifestyle choices is very individual and I can certainly understand if some might not to want to make the changes that I have to obtain normal blood sugars. In addition to the avoidance of hypoglycemia, I am motivated to continue my current lifestyle as a result of having witnessed firsthand as a physician for 28 years the consequences of poorly controlled diabetes. It was not just witnessing the hospitalizations, surgeries, procedures, dialysis treatments, and medication infusions, but most memorably, the suffering my patients with diabetes experienced until they met an early death. I realize that many with diabetes not do think these consequences will happen to them until they actually do. But if readings about it here will give you some needed motivation, then mentioning it will have served a purpose. I recently read a quote from Hippocrates (460 – 357 BC) — “Before you heal someone, ask if he is willing to give up on the things that make him sick.” I think that applies to type 1 diabetes. Are you willing to give up on the dietary carbohydrates and haphazard meals, exercise, and sleep that cause rollercoaster blood sugars?

My book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, explains in detail the strategies that need to be implemented to achieve normal blood sugars without hypoglycemia and is available in the U.S. on Amazon and internationally on your countries’ Amazon in Kindle, Paperback, and Hardcover versions. The book incorporates all the new strategies that I learned since my previous book that have allowed me to achieve truly normal blood sugars. It also describes why blood sugars can be so difficult to regulate with T1D without these strategies. The ‘Look Inside’ feature on Amazon will allow you to read the Table of Contents and some of the book contents. My other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print.

If you feel you might benefit from some individual attention and suggestions for achieving success with blood sugar control for type 1 or type 2 diabetes and/or losing excess body fat, I can assist you with a personal consultation via Google Meet or Skype. See the Coaching page for more info.

Glycemic Results for June 2022

In June 2022, my glycemic results were comparable to those of a non-diabetic individuals (see below), but slightly short of my ultimate goal of no blood glucose values < 70 mg/dL. My average blood glucose for the entire month was 100 mg/dL and the standard deviation of blood glucose (SDBG) was 18 mg/dL. The top graph below shows all of my blood glucose measurements and the bottom graph shows the daily dose totals for bolus and basal insulin and the total daily insulin dose. Fortunately, I did not have any hypoglycemic episodes nor did I need to take any glucose (dextrose) tablets or Smarties™ this month.

My blood sugar goals are shown in Table 2.2 below. My goal for the standard deviation of blood glucose (SDBG) is < 16 mg/dL (0.89 mmol/l). I am now adjusting my target blood glucose (TBG) depending on my glycemic results in the previous 2-week period. I increase my TBG by 10 mg/dL immediately if I have a blood glucose value < 70 mg/dL. I decrease my TBG by 5-10 mg/dL if I haven’t had any blood glucose values < 70 mg/dL in the previous 2 weeks. I have decided not to seek a TBG < 90 mg/dL because I have not found any compelling evidence that a lower TBG would further reduce the risk of diabetic complications or improve healthspan or lifespan, but the risk of having hypoglycemia definitely increases as the TBG is reduced.

The table below summarizes my glycemic results over the previous year. In the table, MBG = mean blood glucose, SDBG = standard deviation of blood glucose, BG COV = blood glucose coefficient of variation which equals SDBG ÷ MBG, MTDID = mean total daily insulin dose, MDBD = mean daily Basaglar dose, MDLD = mean daily lispro dose, and the remaining columns include an estimated HbA1c (%) based on the mean blood glucose, the percentage of blood glucose values < 70 mg/dL, between 70 and 130 mg/dL, and > 130 mg/dL, and body weight (kg). My goal is to have 100% of my blood glucose values in the range 70−130 mg/dL, but did not quite meet that goal this month.

The table below tracks my total daily meal macronutrients, body weight, insulin dosage, and the ketogenic ratio of my diet.

I decreased my daily caloric intake to 2,200 kcal/day this month. I will continue to adjust my caloric intake +/- 25 kcal/day once weekly as needed to maintain my body weight at or just below 73 kg.

Below is a photo of myself from April 2021 at 69.7 kg (153 lb.).

Below is a photo of myself from April 2022 at 72.8 kg (160.5 lb.). The extra body fat does make a difference in muscle definition.

Table 1.2 below shows the mean interstitial glucose (IG) of 732 non-diabetic subjects and standard deviation of the interstitial glucose (SDIG) of 708 non-diabetic subjects as measured by CGM from the seven studies referenced below. One of the studies, Sundberg, F, et al., 2018, was in 15 healthy, normal weight children, age 2−8. The mean CGM 24-hr IG was 95 mg/dL (5.3 mM) and SDIG was 18 mg/dL (1.0 mM). This study again confirms that children’s blood sugars are about the same as those of adults. The age of subjects in these seven studies ranges from 2−80 years. I think it is important for those with T1D to know the glucose results of metabolically healthy study subjects to be used as a reference for seeking normal blood sugars. Although achieving normal blood sugars with T1D is not an easy task, it can be made more difficult by choosing a target blood glucose that is too low and results in hypoglycemic episodes. The lower the target blood glucose, the more likely hypoglycemic episodes are to occur in those with T1D taking exogenous insulin or having hypoglycemic episodes means that your target blood glucose is set too low.

The references for these seven studies are shown below.

My goal moving forward is to eliminate all BG values < 70 mg/dL as part of managing T1D as safely as possible.

The purpose of this blog is to share my experience with a low-carb, ketogenic, diet and exercise to better manage my blood glucose as a person with T1D. A low-carb, ketogenic, diet also allows for lower daily insulin doses and normal body composition which I believe reduces the risk of developing insulin resistance and the host of chronic diseases associated with insulin resistance including atherosclerosis, cancer, and neurodegenerative diseases. I also take metformin 500 mg with each of 4 meals daily (2,000 mg/day) to suppress liver glucose production which tends to be chronically elevated in those with T1D. This occurs due to the lower concentration of insulin around the pancreatic alpha-cells increasing the concentration of glucagon reaching the liver as well as the lower concentration of insulin entering the liver both of which increase liver gluconeogenesis and glucose production relative to those without T1D. Metformin also improves glucose uptake by skeletal muscle. These strategies also work well for those with glucose intolerance, prediabetes, type 2 diabetes, and double diabetes [T1D with insulin resistance]. As explained in detail in my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, injecting insulin in the subcutaneous fat is just not the same as when it is secreted by the beta-cells in the pancreas according to the prevailing blood glucose concentration. I have accepted the fact that there will always be more variation in blood glucose than I would like, but if I can continue to keep the mean and standard deviation of my blood glucose readings equivalent to that of a non-diabetic individual while avoiding hypoglycemia, I will be satisfied. I would appreciate those who want to purchase my book and derive some benefit from reading it to leave a positive review on Amazon so that others will see the book when they search for books on T1D. The search rankings in Amazon are based the number of books purchased and the reviews of the book.

Comments or general questions are welcomed.

Till next time….

#104 May 2022 Update on My T1D Management

This is a monthly update on my glycemic management of type 1 diabetes (T1D) using lispro and Basaglar insulin injections (a change from Humalog and Tresiba due to insurance issues) with a ketogenic whole-food diet and resistance and aerobic exercise (olympic weightlifting and walking). For those who haven’t been following this blog, I was diagnosed with type 1 diabetes in September 1998 and followed conventional advice to manage my diabetes for the next 14 years. I suffered from frequent hypoglycemic episodes and grew to loathe them. I stumbled onto the use of a low-carb diet for diabetes in late 2011 and started my ketogenic diet on Feb. 8, 2012. The low-carb ketogenic diet greatly reduced my glycemic excursions and halved my insulin requirements from 58 to 28 IU/day and markedly reduced, but did not eliminate, my symptomatic hypoglycemic episodes. In 2019, I added consistency of meals, exercise, and sleep to my blood glucose management strategy. I have had a total of 5 mildly symptomatic hypoglycemic episodes during the past three years. This has kept me motivated to continue my somewhat monotonous lifestyle. The decision to make certain lifestyle choices is very individual and I can certainly understand if some might not to want to make the changes that I have to obtain normal blood sugars. In addition to the avoidance of hypoglycemia, I am motivated to continue my current lifestyle as a result of witnessing firsthand in my job as a physician for 28 years the consequences of poorly controlled diabetes. It was not just witnessing the hospitalizations, surgeries, procedures, dialysis treatments, and medication infusions, but most memorably, the suffering my patients with diabetes experienced until they met an early death. I realize that many with diabetes not do think these consequences will happen to them until they actually do. But if readings about it here will give you some needed motivation, then mentioning it will have served a purpose. I recently read a quote from Hippocrates (460 – 357 BC) — “Before you heal someone, ask if he is willing to give up on the things that make him sick.” I think that applies to type 1 diabetes. Are you willing to give up on the dietary carbohydrates and haphazard meals, exercise, and sleep that cause rollercoaster blood sugars?

My book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, is available in the U.S. on Amazon and internationally on your countries’ Amazon in Kindle, Paperback, and Hardcover versions. The book incorporates all the new strategies that I learned since my previous book that have allowed me to achieve truly normal blood sugars. It also describes why blood sugars can be so difficult to regulate with T1D without these strategies. The ‘Look Inside’ feature on Amazon will allow you to read the Table of Contents and some of the book contents. My other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print.

If you feel you might benefit from some individual attention and suggestions for achieving success with blood sugar control for type 1 or type 2 diabetes and/or losing excess body fat, I can assist you with a personal consultation via Zoom or Skype. See the Coaching page for more info.

Glycemic Results for May 2022

In May 2022, my glycemic results were comparable to those of a non-diabetic individual, but slightly short of my ultimate goal of no blood glucose values < 70 mg/dL. My mean blood glucose for the entire month was 102 mg/dL with a standard deviation of blood glucose (SDBG) of 17 mg/dL, equivalent to non-diabetic individuals (see below). The graph below shows all the blood glucose measurements in the top graph and the daily dose totals for bolus and basal insulin and the total daily insulin dose in the bottom graph for May 2022. Fortunately, I did not have any hypoglycemic episodes nor did I need to take any glucose (dextrose) tablets or Smarties™ this month.

My blood sugar goals are shown in Table 2.2 below. My goal for the standard deviation of blood glucose (SDBG) is < 16 mg/dL (0.89 mmol/l). I am now adjusting my target blood glucose (TBG) depending on my glycemic results in the previous 2-week period. I increase my TBG by 10 mg/dL immediately if I have a blood glucose value < 70 mg/dL. I decrease my TBG by 5-10 mg/dL if I haven’t had any blood glucose values < 70 mg/dL in the previous 2 weeks. I have decided not to seek a TBG < 90 mg/dL because I have not found any compelling evidence that a lower TBG would further reduce the risk of diabetic complications or improve healthspan or lifespan, but the risk of having hypoglycemia definitely increases as the TBG is reduced.

The table below summarizes my glycemic results for May 2022 and the previous 11 months. In the table, MBG = mean blood glucose, SDBG = standard deviation of blood glucose, BG COV = blood glucose coefficient of variation which equals SDBG ÷ MBG, MTDID = mean total daily insulin dose, MDBD = mean daily Basaglar dose, MDLD = mean daily lispro dose, and the remaining columns include an estimated HbA1c (%) based on the mean blood glucose, the percentage of blood glucose values < 70 mg/dL, between 70 and 130 mg/dL, and > 130 mg/dL, and body weight (kg). My goal is to have 100% of my blood glucose values in the range 70−130 mg/dL, but did not quite meet that goal this month.

The table below tracks my total daily meal macronutrients, body weight, insulin dosage, and the ketogenic ratio of my diet.

I increased my daily caloric intake to 2,250 kcal/day this month. I plan to adjust it +/- 25 kcal/day once weekly as needed to maintain my body weight just below 73 kg.

Below is a photo of myself from April 2021 at 69.7 kg (153 lb.).

Below is a photo of myself from April 2022 at 72.8 kg (160.5 lb.). The extra body fat does make a difference in muscle definition.

Table 1.2 below shows the mean interstitial glucose (IG) of 732 non-diabetic subjects and standard deviation of the interstitial glucose (SDIG) of 708 non-diabetic subjects as measured by CGM from the seven studies referenced below. One of the studies, Sundberg, F, et al., 2018, was in 15 healthy, normal weight children, age 2−8. The mean CGM 24-hr IG was 95 mg/dL (5.3 mM) and SDIG was 18 mg/dL (1.0 mM). This study again confirms that children’s blood sugars are about the same as those of adults. The age of subjects in these seven studies ranges from 2−80 years. I think it is important for those with T1D to know the glucose results of metabolically healthy study subjects to be used as a reference for seeking normal blood sugars. Achieving normal blood sugars with T1D is not an easy task, but it can be made more difficult by choosing a target blood glucose that is too low, which means it results in hypoglycemic episodes. The lower the target blood glucose, the more likely hypoglycemic episodes are to occur in those with T1D taking exogenous insulin. Another way to state this is that one’s glycemic variability must be lower to achieve a lower target blood glucose without incurring hypoglycemic episodes. Or, put yet another way, having hypoglycemic episodes means that your target blood glucose is set too high.

The references for these seven studies are shown below.

As always, my goal for June 2022 is to eliminate all BG values < 70 mg/dL as part of making managing T1D as safe as possible.

The purpose of this blog is to share my experience with a low-carb, ketogenic, diet and exercise to better manage my blood glucose as a person with T1D. A low-carb, ketogenic, diet also allows for lower daily insulin doses and normal body composition which I believe reduces the risk of developing insulin resistance and the host of chronic diseases associated with insulin resistance including atherosclerosis, cancer, and neurodegenerative diseases. I also take metformin 500 mg with each of 4 meals daily (2,000 mg/day) to suppress liver glucose production which tends to be chronically elevated in those with T1D. This occurs due to the lower concentration of insulin around the pancreatic alpha-cells increasing the concentration of glucagon reaching the liver as well as the lower concentration of insulin entering the liver both of which increase liver gluconeogenesis and glucose production relative to those without T1D. Metformin also improves glucose uptake by skeletal muscle. These strategies also work well for those with glucose intolerance, prediabetes, type 2 diabetes, and double diabetes (T1D with insulin resistance). As explained in detail in my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, injecting insulin in the subcutaneous fat is just not the same as when it is secreted by the beta-cells in the pancreas according to the prevailing blood glucose concentration. I have accepted the fact that there will always be more variation in blood glucose than I would like, but if I can continue to keep the mean and standard deviation of my blood glucose readings equivalent to that of a non-diabetic individual while avoiding hypoglycemia, I will be satisfied. I would appreciate those who want to purchase my book and derive some benefit from reading it to leave a positive review on Amazon so that others will see the book when they search for books on T1D. The search rankings in Amazon are based the number of books purchased and the reviews of the book.

Comments or general questions are welcomed.

Till next time….

#103 April 2022 Update on My T1D Management

This is a monthly update on my glycemic management of type 1 diabetes (T1D) using lispro and Basaglar insulin injections (a change from Humalog and Tresiba) with a ketogenic whole-food diet and resistance and aerobic exercise (olympic weightlifting and walking).

My book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, is available in the U.S. on Amazon and internationally on your countries’ Amazon in Kindle, Paperback, and Hardcover versions. The book incorporates all the new strategies that I learned since my previous book that have allowed me to achieve truly normal blood sugars. It also describes why blood sugars can be so difficult to regulate with T1D without these strategies. The ‘Look Inside’ feature on Amazon will allow you to read the Table of Contents and some of the book contents. My other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print.

If you feel you might benefit from some individual attention and suggestions for achieving success with blood sugar control for type 1 or type 2 diabetes and/or losing excess body fat, I can assist you with a personal consultation via Skype. See the Coaching page for more info.

Glycemic Results for April 2022

In April 2022, my glycemic results were comparable to those of a non-diabetic individual, but slightly short of my ultimate goal of no blood glucose values < 70 mg/dL. My mean blood glucose for the entire month was 103 mg/dL with a standard deviation of blood glucose (SDBG) of 17 mg/dL, equivalent to non-diabetic individuals (see below). The graph below shows all the blood glucose measurements in the top graph and the daily dose totals for bolus and basal insulin and the total daily insulin dose in the bottom graph for April 2022. Fortunately, I did not have any hypoglycemic episodes nor did I need to take any glucose (dextrose) tablets or Smarties™ this month.

My blood sugar goals are shown in Table 2.2 below. My goal for the standard deviation of blood glucose (SDBG) is < 16 mg/dL (0.89 mmol/l). I am now adjusting my target blood glucose (TBG) depending on my glycemic results in the previous 2-week period. I increase my TBG by 10 mg/dL immediately if I have a blood glucose value < 70 mg/dL. I decrease my TBG by 5-10 mg/dL if I haven’t had any blood glucose values < 70 mg/dL in the previous 2 weeks. I have decided not to seek a TBG < 90 mg/dL because I have not found any compelling evidence that a lower TBG would further reduce the risk of diabetic complications or improve healthspan or lifespan, but the risk of having hypoglycemia definitely increases as the TBG is reduced.

The table below summarizes my glycemic results for April 2022 and the previous 11 months. In the table, MBG = mean blood glucose, SDBG = standard deviation of blood glucose, BG COV = blood glucose coefficient of variation which equals SDBG ÷ MBG, MTDID = mean total daily insulin dose, MDBD = mean daily Basaglar dose, MDLD = mean daily lispro dose, and the remaining columns include an estimated HbA1c (%) based on the mean blood glucose, the percentage of blood glucose values < 70 mg/dL, between 70 and 130 mg/dL, and > 130 mg/dL, and body weight (kg). My goal is to have 100% of my blood glucose values in the range 70−130 mg/dL, but did not quite meet that goal this month.

The table below tracks my total daily meal macronutrients, body weight, insulin dosage, and the ketogenic ratio of my diet.

I decreased my daily caloric intake to ≈2,200 kcal/day to maintain my body weight at about 72.5 kg.

Below is a photo of myself from April 2021 at 69.7 kg (153 lb.).

Below is a photo of myself from April 1, 2022 at 72.8 kg (160.5 lb.). The extra body fat does make a difference in muscle definition.

Table 1.2 below shows the mean interstitial glucose (IG) of 732 non-diabetic subjects and standard deviation of the interstitial glucose (SDIG) of 708 non-diabetic subjects as measured by CGM from the seven studies referenced below. One of the studies, Sundberg, F, et al., 2018, was in 15 healthy, normal weight children, age 2−8. The mean CGM 24-hr IG was 95 mg/dL (5.3 mM) and SDIG was 18 mg/dL (1.0 mM). This study again confirms that children’s blood sugars are about the same as those of adults. The age of subjects in these seven studies ranges from 2−80 years. I think it is important for those with T1D to know the glucose results of metabolically healthy study subjects to be used as a reference for seeking normal blood sugars. Achieving normal blood sugars with T1D is not an easy task, but it can be made more difficult by choosing a target blood glucose that is too low, which means it results in hypoglycemic episodes. The lower the target blood glucose, the more likely hypoglycemic episodes are to occur in those with T1D taking exogenous insulin. Another way to state this is that one’s glycemic variability must be lower to achieve a lower target blood glucose without incurring hypoglycemic episodes. Or, put yet another way, having hypoglycemic episodes means that your target blood glucose is set too high.

The references for these seven studies are shown below.

As always, my goal for May 2022 is to eliminate all BG values < 70 mg/dL as part of making managing T1D as safe as possible.

The purpose of this blog is to share my experience with a low-carb, ketogenic, diet and exercise to better manage my blood glucose as a person with T1D. A low-carb, ketogenic, diet also allows for lower daily insulin doses and normal body composition which I believe reduces the risk of developing insulin resistance and the host of chronic diseases associated with insulin resistance including atherosclerosis, cancer, and neurodegenerative diseases. I also take metformin 500 mg with each of 4 meals daily (2,000 mg/day) to suppress liver glucose production which tends to be chronically elevated in those with T1D. This occurs due to the lower concentration of insulin around the pancreatic alpha-cells increasing the concentration of glucagon reaching the liver as well as the lower concentration of insulin entering the liver both of which increase liver gluconeogenesis and glucose production relative to those without T1D. Metformin also improves glucose uptake by skeletal muscle. These strategies also work well for those with glucose intolerance, prediabetes, type 2 diabetes, and double diabetes (T1D with insulin resistance). As explained in detail in my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, injecting insulin in the subcutaneous fat is just not the same as when it is secreted by the beta-cells in the pancreas according to the prevailing blood glucose concentration. I have accepted the fact that there will always be more variation in blood glucose than I would like, but if I can continue to keep the mean and standard deviation of my blood glucose readings equivalent to that of a non-diabetic individual while avoiding hypoglycemia, I will be satisfied. I would appreciate those who want to purchase my book and derive some benefit from reading it to leave a positive review on Amazon so that others will see the book when they search for books on T1D. The search rankings in Amazon are based the number of books purchased and the reviews of the book.

Comments or general questions are welcomed.

Till next time….

#102 March 2022 Update on My T1D Management

This is a monthly update on my glycemic management of type 1 diabetes (T1D) using Humalog and Tresiba insulin injections with a ketogenic whole-food diet and resistance and aerobic exercise (olympic weightlifting and walking).

My book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, is available in the U.S. on Amazon and internationally on your countries’ Amazon in Kindle, Paperback, and Hardcover versions. The book incorporates all the new strategies that I learned since my previous book that have allowed me to achieve truly normal blood sugars. It also describes why blood sugars can be so difficult to regulate with T1D without these strategies. The ‘Look Inside’ feature on Amazon will allow you to read the Table of Contents and some of the book contents. My other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print.

If you feel you might benefit from some individual attention and suggestions for achieving success with blood sugar control for type 1 or type 2 diabetes and/or losing excess body fat, I can assist you with a personal consultation via Skype. See the Coaching page for more info.

Glycemic Results for March 2022

In March 2022, my glycemic results were comparable to those of a non-diabetic individual, but slightly short of my ultimate goal of no blood glucose values < 70 mg/dL. My mean blood glucose for the entire month was 98 mg/dL with a standard deviation of blood glucose (SDBG) of 18 mg/dL, equivalent to non-diabetic individuals (see below). The graph below shows all the blood glucose measurements in the top graph and the daily dose totals for bolus and basal insulin and the total daily insulin dose in the bottom graph for March 2022. Fortunately, I did not have any hypoglycemic episodes nor did I need to take any glucose tablets (Smarties™) this month.

My blood sugar goals are shown in Table 2.2 below. My goal for the standard deviation of blood glucose (SDBG) is < 16 mg/dL (0.89 mmol/l). I am now adjusting my target blood glucose (TBG) depending on my glycemic results in the previous 2-week period. I increase my TBG by 10 mg/dL immediately if I have a blood glucose value < 70 mg/dL. I decrease my TBG by 5-10 mg/dL if I haven’t had any blood glucose values < 70 mg/dL in the previous 2 weeks. I have decided not to seek a TBG < 90 mg/dL because I have not found any compelling evidence that a lower TBG would further reduce the risk of diabetic complications or improve healthspan or lifespan, but the risk of having hypoglycemia definitely increases as the TBG is reduced.

The table below summarizes my glycemic results for March 2022 and the previous 11 months. In the table, MBG = mean blood glucose, SDBG = standard deviation of blood glucose, BG COV = blood glucose coefficient of variation which equals SDBG ÷ MBG, MTDID = mean total daily insulin dose, MDTD = mean daily Tresiba dose, MDHD = mean daily Humalog dose, and the remaining columns include an estimated HbA1c (%) based on the mean blood glucose, the percentage of blood glucose values < 70 mg/dL, between 70 and 130 mg/dL, and > 130 mg/dL, and body weight (kg). My goal is to have 100% of my blood glucose values in the range 70−130 mg/dL, but did not quite meet that goal this month.

The table below tracks my total daily meal macronutrients, body weight, insulin dosage, and the ketogenic ratio of my diet.

I decreased my daily caloric intake to 2,300 kcal/day which I think is closer to my needs to maintain my body weight at about 72 to 73 kg.

Below is a photo of myself from April 2021 at 69.7 kg (153 lb.).

Below is a photo of myself from today, April 1, 2022 at 72.8 kg (160.5 lb.). The extra body fat does make a difference in muscle definition.

Table 1.2 below shows the mean interstitial glucose (IG) of 732 non-diabetic subjects and standard deviation of the interstitial glucose (SDIG) of 708 non-diabetic subjects as measured by CGM from the seven studies referenced below. One of the studies, Sundberg, F, et al., 2018, was in 15 healthy, normal weight children, age 2−8. The mean CGM 24-hr IG was 95 mg/dL (5.3 mM) and SDIG was 18 mg/dL (1.0 mM). This study again confirms that children’s blood sugars are about the same as those of adults. The age of subjects in these seven studies ranges from 2−80 years. I think it is important for those with T1D to know the glucose results of metabolically healthy study subjects to be used as a reference for seeking normal blood sugars. Achieving normal blood sugars with T1D is not an easy task, but it can be made more difficult by choosing a target blood glucose that is too low, which means it results in hypoglycemic episodes. The lower the target blood glucose, the more likely hypoglycemic episodes are to occur in those with T1D taking exogenous insulin. Another way to state this is that one’s glycemic variability must be lower to achieve a lower target blood glucose without incurring hypoglycemic episodes. Or, put yet another way, having hypoglycemic episodes means that your target blood glucose is set too high.

The references for these seven studies are shown below.

As always, my goal for April 2022 is to eliminate all BG values < 70 mg/dL as part of making managing T1D as safe as possible.

The purpose of this blog is to share my experience with a low-carb, ketogenic, diet and exercise to better manage my blood glucose as a person with T1D. A low-carb, ketogenic, diet also allows for lower daily insulin doses and normal body composition which I believe reduces the risk of developing insulin resistance and the host of chronic diseases associated with insulin resistance including atherosclerosis, cancer, and neurodegenerative diseases. I also take metformin 500 mg with each of 4 meals daily (2,000 mg/day) to suppress liver glucose production which tends to be chronically elevated in those with T1D. This occurs due to the lower concentration of insulin around the pancreatic alpha-cells increasing the concentration of glucagon reaching the liver as well as the lower concentration of insulin entering the liver both of which increase liver gluconeogenesis and glucose production relative to those without T1D. Metformin also improves glucose uptake by skeletal muscle. These strategies also work well for those with glucose intolerance, prediabetes, type 2 diabetes, and double diabetes (T1D with insulin resistance). As explained in detail in my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, injecting insulin in the subcutaneous fat is just not the same as when it is secreted by the beta-cells in the pancreas according to the prevailing blood glucose concentration. I have accepted the fact that there will always be more variation in blood glucose than I would like, but if I can continue to keep the mean and standard deviation of my blood glucose readings equivalent to that of a non-diabetic individual while avoiding hypoglycemia, I will be satisfied. I would appreciate those who want to purchase my book and derive some benefit from reading it to leave a positive review on Amazon so that others will see the book when they search for books on T1D. The search rankings in Amazon are based the number of books purchased and the reviews of the book.

Comments or general questions are welcomed.

Till next time….

#101 February 2022 Update on My T1D Management

This is a monthly update on my glycemic management of type 1 diabetes (T1D) using Humalog and Tresiba insulin injections with a ketogenic whole-food diet and resistance and aerobic exercise (olympic weightlifting and walking).

My book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, is available in the U.S. on Amazon and internationally on your countries’ Amazon in both Kindle and Print versions. The book incorporates all the new strategies that I learned since my previous book that have allowed me to achieve truly normal blood sugars. It also describes why blood sugars can be so difficult to regulate with T1D without these strategies. The ‘Look Inside’ feature on Amazon will allow you to read the Table of Contents and the first chapter of the book which gives a complete overview of the book contents. My other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print.

If you feel you might benefit from some individual attention and suggestions for achieving success with blood sugar control for type 1 or type 2 diabetes and/or losing excess body fat, I can assist you with a personal consultation via Skype. See the Coaching page for more info.

Glycemic Results for February 2022

In February 2022, my glycemic results were comparable to those of a non-diabetic individual, but slightly short of my ultimate goal of no blood glucose values < 70 mg/dL. My mean blood glucose for the entire month was 98 mg/dL with a standard deviation of blood glucose (SDBG) of 18 mg/dL, equivalent to non-diabetic individuals (see below). The graph below shows all the blood glucose measurements in the top graph and the daily dose totals for bolus and basal insulin and the total daily insulin dose in the bottom graph for February 2022. Fortunately, I did not have any hypoglycemic episodes nor did I need to take any glucose tablets (Smarties™) this month.

My blood sugar goals are shown in Table 2.2 below. My goal for the standard deviation of blood glucose (SDBG) is < 16 mg/dL (0.89 mmol/l). I am now adjusting my target blood glucose (TBG) depending on my glycemic results in the previous 2-week period. I increase my TBG by 10 mg/dL immediately if I have a blood glucose value < 70 mg/dL. I decrease my TBG by 5-10 mg/dL if I haven’t had any blood glucose values < 70 mg/dL in the previous 2 weeks. I have decided not to seek a TBG < 90 mg/dL because I have not found any compelling evidence that a lower TBG would further reduce the risk of diabetic complications or improve healthspan or lifespan, but the risk of having hypoglycemia definitely increases as the TBG is reduced.

The table below summarizes my glycemic results for February 2022 and the previous 11 months. In the table, MBG = mean blood glucose, SDBG = standard deviation of blood glucose, BG COV = blood glucose coefficient of variation which equals SDBG ÷ MBG, MTDID = mean total daily insulin dose, MDTD = mean daily Tresiba dose, MDHD = mean daily Humalog dose, and the remaining columns include an estimated HbA1c (%) based on the mean blood glucose, the percentage of blood glucose values < 70 mg/dL, between 70 and 130 mg/dL, and > 130 mg/dL, and body weight (kg). My goal is to have 100% of my blood glucose values in the range 70−130 mg/dL, but did not quite meet that goal this month.

The table below tracks my total daily meal macronutrients, body weight, insulin dosage, and the ketogenic ratio of my diet.

I stopped thinking about food (my symptom of being hungry) so I decreased my daily caloric intake to 2,500 kcal/day which I think is closer to my needs to maintain my body weight at about 72 to 73 kg. I reduced the amount of cashews and peanuts in my diet to reduce my total daily carbohydrate intake. They are my favorite nuts (technically peanuts are legumes and cashews are drupes as are almonds and pistachios) but are the highest in carbs relative to all the other nuts. I suspect that is why I like them so much. Cashews are 21% carbohydrate (% of calories), 68% fat, and 10% protein. Peanuts are 11% carbohydrate, 72% fat, and 17% protein. Now I am only eating 10 g/day of cashews and 10 grams of peanuts/day (a spoonful of each). When my current supply of cashews runs out, I will stick with just peanuts to reduce my carb intake a bit further.

The food industry understands that the human palate likes the combination of carbs and fat. If you look at the macros of most processed foods, you will see roughly equal caloric amounts of carbs and fat, e.g., 45% from carbs, 45% fat, and lower protein, e.g., 10% protein (% of calories). For example, Doritos snack chips are 53% carbohydrate, 41% fat, and 6% protein (% of calories). Foods in nature are not composed this way. This macronutrient combination drives up insulin secretion (insulin requirements in those with T1D) and our desire to eat processed foods. There are many processed foods that I used to eat that I would like to eat now. But the knowledge of the illnesses that eating processed foods can create in the long run, prevents me from eating them. Perhaps eating a ketogenic diet because I developed T1D will ultimately improve my healthspan and lifespan beyond what it would have been had I never developed T1D. The above may also explain the U.S. and global obesity and diabetes pandemics: a processed food induced global pandemic! Perhaps it also accounts for the morbidity and mortality from COVID-19. The most vulnerable persons being those who ate the most processed foods for the longest period of time, i.e., those who are elderly, have obesity, diabetes, and/or hypertension (all associated with insulin resistance).

Below is a photo of myself from April 2021 at 69.7 kg (153 lb.).

In the table above, the rightmost column shows the ketogenic ratio (KR). In 1980, Withrow published the equation for the KR as follows: KR = (0.9 F + 0.46 P) ÷ (C + 0.58 P + 0.1 F), where F is grams of dietary fat, P is grams of dietary protein, and C is grams of dietary carbohydrate. From the equation, we can see that carbohydrate is 100% antiketogenic, fat is 90% ketogenic and 10% antiketogenic, and protein is 46% ketogenic and 58% antiketogenic. Therefore, the major determinants of a diet’s ability to produce ketosis are its carbohydrate and fat content, whereas its protein content has only a minor effect on ketosis. The KR can range from 0 (glucose) to 9 (pure fat). Using Withrow’s equation, this study, here, found that a diet with a KR ≥ 1.7 likely results in nutritional ketosis in humans. Therefore, anyone can formulate a low-carbohydrate diet to be ketogenic or non-ketogenic according to their own preference. As you can see, the KR ratio of my diet has been declining as the dietary fat and protein intake has decreased while dietary carbohydrate remaining relatively constant. Remember, the KR is just an estimate of a diet’s potential to produce nutritional ketosis. I have remained in nutritional ketosis continuously since 2012 regardless of the KR of my diet including a time when my daily carbohydrate intake was ≈ 75 grams/day. Although the KR is useful, if you need to know whether or not you are in nutritional ketosis, you should measure breath, blood, or urine ketones.

Table 1.2 below shows the mean interstitial glucose (IG) of 732 non-diabetic subjects and standard deviation of the interstitial glucose (SDIG) of 708 non-diabetic subjects as measured by CGM from the seven studies referenced below. One of the studies, Sundberg, F, et al., 2018, was in 15 healthy, normal weight children, age 2−8. The mean CGM 24-hr IG was 95 mg/dL (5.3 mM) and SDIG was 18 mg/dL (1.0 mM). This study again confirms that children’s blood sugars are about the same as those of adults. The age of subjects in these seven studies ranges from 2−80 years. I think it is important for those with T1D to know the glucose results of metabolically healthy study subjects to be used as a reference for seeking normal blood sugars. Achieving normal blood sugars with T1D is not an easy task, but it can be made more difficult by choosing a target blood glucose that is too low, which means it results in hypoglycemic episodes. The lower the target blood glucose, the more likely hypoglycemic episodes are to occur in those with T1D taking exogenous insulin. Another way to state this is that one’s glycemic variability must be lower to achieve a lower target blood glucose without incurring hypoglycemic episodes. Or, put yet another way, having hypoglycemic episodes means that your target blood glucose is set too high.

The references for these seven studies are shown below.

As always, my goal for March 2022 is to eliminate all BG values < 70 mg/dL as part of making managing T1D as safe as possible.

The purpose of this blog is to share my experience with a low-carb, ketogenic, diet and exercise to better manage my blood glucose as a person with T1D. A low-carb, ketogenic, diet also allows for lower daily insulin doses and normal body composition which I believe reduces the risk of developing insulin resistance and the host of chronic diseases associated with insulin resistance including atherosclerosis, cancer, and neurodegenerative diseases. I also take metformin 500 mg with each of 4 meals daily (2,000 mg/day) to suppress liver glucose production which tends to be chronically elevated in those with T1D. This occurs due to the lower concentration of insulin around the pancreatic alpha-cells increasing the concentration of glucagon reaching the liver as well as the lower concentration of insulin entering the liver both of which increase liver gluconeogenesis and glucose production relative to those without T1D. Metformin also improves glucose uptake by skeletal muscle. These strategies also work well for those with glucose intolerance, prediabetes, type 2 diabetes, and double diabetes (T1D with insulin resistance). As explained in detail in my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, injecting insulin in the subcutaneous fat is just not the same as when it is secreted by the beta-cells in the pancreas according to the prevailing blood glucose concentration. I have accepted the fact that there will always be more variation in blood glucose than I would like, but if I can continue to keep the mean and standard deviation of my blood glucose readings equivalent to that of a non-diabetic individual while avoiding hypoglycemia, I will be satisfied. I would appreciate those who want to purchase my book and derive some benefit from reading it to leave a positive review on Amazon so that others will see the book when they search for books on T1D. The search rankings in Amazon are based the number of books purchased and the reviews of the book.

Comments or general questions are welcomed.

Till next time….

#100 January 2022 Update on My T1D Management

This is a monthly update on my glycemic management of type 1 diabetes (T1D) using Humalog and Tresiba insulin injections with a ketogenic whole-food diet and resistance and aerobic exercise (olympic weightlifting and walking).

My book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, is available in the U.S. on Amazon and internationally on your countries’ Amazon in both Kindle and Print versions. The book incorporates all the new strategies that I learned since my previous book that have allowed me to achieve truly normal blood sugars. It also describes why blood sugars can be so difficult to regulate with T1D without these strategies. The ‘Look Inside’ feature on Amazon will allow you to read the Table of Contents and the first chapter of the book which gives a complete overview of the book contents. My other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print.

If you feel you might benefit from some individual attention and suggestions for achieving success with blood sugar control for type 1 or type 2 diabetes and/or losing excess body fat, I can assist you with a personal consultation via Skype. See the Coaching page for more info.

Glycemic Results for January 2022

In January 2022, my glycemic results were comparable to those of a non-diabetic individual, but slightly short of my ultimate goal of no blood glucose values < 70 mg/dL. My mean blood glucose for the entire month was 96 mg/dL with a standard deviation of blood glucose (SDBG) of 17 mg/dL, equivalent to non-diabetic individuals (see below). The graph below shows all the blood glucose measurements in the top graph and the daily dose totals for bolus and basal insulin and the total daily insulin dose in the bottom graph for January 2022. Fortunately, I did not have any hypoglycemic episodes nor did I need to take any glucose tablets (Smarties™) this month.

My blood sugar goals are shown in Table 2.2 below. My goal for the standard deviation of blood glucose (SDBG) is < 16 mg/dL (0.89 mmol/l). I am now adjusting my target blood glucose (TBG) depending on my glycemic results in the previous 2-week period. I increase my TBG by 10 mg/dL immediately if I have a blood glucose values < 70 mg/dL. I decrease my TBG by 5-10 mg/dL if I haven’t had any blood glucose values < 70 mg/dL in the previous 2 weeks. I have decided not to seek a TBG < 90 mg/dL because I have not found any compelling evidence that a lower TBG would further reduce the risk of diabetic complications or improve healthspan or lifespan, but the risk of having hypoglycemia definitely increases as the TBG is reduced.

The table below summarizes my glycemic results for January 2022 and the previous 11 months. In the table, MBG = mean blood glucose, SDBG = standard deviation of blood glucose, BG COV = blood glucose coefficient of variation which equals SDBG ÷ MBG, MTDID = mean total daily insulin dose, MDTD = mean daily Tresiba dose, MDHD = mean daily Humalog dose, and the remaining columns include an estimated HbA1c (%) based on the mean blood glucose, the percentage of blood glucose values < 70 mg/dL, between 70 and 130 mg/dL, and > 130 mg/dL, and body weight (kg). My goal is to have 100% of my blood glucose values in the range 70−130 mg/dL, but did not quite meet that goal this month.

The table below tracks my total daily meal macronutrients, body weight, insulin dosage, and the ketogenic ratio of my diet.

I increased my caloric intake in January until I stopped thinking about food (my symptom of being hungry) to 3,100 kcal/day which was more than I had anticipated needing. I no longer think about food and I feel energetic which is important to me. The addition of cashews and peanuts into my diet explains the increase in total daily carbohydrate intake. They are my favorite nuts (technically peanuts are legumes and cashews are drupes as are almonds and pistachios) with macadamia nuts a close third. I haven’t eaten cashews or peanuts in a long time simply because they have the highest carb count per gram compared to other nuts. I suspect that is why I like them so much. The combination of carbs and fat is a culinary temptation for humans. Cashews are 21% carbohydrate (% of calories), 68% fat, and 10% protein. Peanuts are 11% carbohydrate, 72% fat, and 17% protein. This is why I am only eating 14 g/day (a spoonful) of cashews and 42 grams of peanuts/day. When my current supply of cashews runs out, I will stick with just peanuts to reduce my carb intake.

The food industry understands that the human palate likes the combination of carbs and fat. If you look at the macros of most processed foods, you will see roughly equal caloric amounts of carbs and fat, e.g., 45% from carbs, 45% fat, and lower protein, e.g., 10% protein (% of calories). For example, Doritos snack chips are 53% carbohydrate, 41% fat, and 6% protein (% of calories). Foods in nature are not composed this way. This macronutrient combination drives up insulin secretion (insulin requirements in those with T1D) and our desire to eat processed foods. There are many processed foods that I used to eat that I would like to eat now. But the knowledge of the illnesses that eating processed foods can create in the long run, prevents me from eating them. Perhaps eating a ketogenic diet because I developed T1D will ultimately improve my healthspan and lifespan beyond what it would have been had I never developed T1D. The above may also explain the U.S. and global obesity and diabetes pandemics: a processed food induced global pandemic! Perhaps it also accounts for the morbidity and mortality from COVID-19. The most vulnerable persons being those who ate the most processed foods for the longest period of time, i.e., those who are elderly, have obesity, diabetes, and/or hypertension (all with insulin resistance).

In January, I gained 2.4 kilograms of body weight which is fine. My experimentation with different caloric and protein intakes and their effects on appetite and insulin doses has been enlightening.

Below is a photo of myself from April 2021 at 69.7 kg (153 lb.).

In the table above, the rightmost column shows the ketogenic ratio (KR). In 1980, Withrow published the equation for the KR as follows: KR = (0.9 F + 0.46 P) ÷ (C + 0.58 P + 0.1 F), where F is grams of dietary fat, P is grams of dietary protein, and C is grams of dietary carbohydrate. From the equation, we can see that carbohydrate is 100% antiketogenic, fat is 90% ketogenic and 10% antiketogenic, and protein is 46% ketogenic and 58% antiketogenic. Therefore, the major determinants of a diet’s ability to produce ketosis are its carbohydrate and fat content, whereas its protein content has only a minor effect on ketosis. The KR can range from 0 (glucose) to 9 (pure fat). Using Withrow’s equation, this study, here, found that a diet with a KR ≥ 1.7 likely results in nutritional ketosis in humans. Therefore, anyone can formulate a low-carbohydrate diet to be ketogenic or non-ketogenic according to their own preference. As you can see, the KR ratio of my diet has been declining as the dietary fat and protein intake has decreased while dietary carbohydrate remaining relatively constant. Remember, the KR is just an estimate of a diet’s potential to produce nutritional ketosis. I have remained in nutritional ketosis continuously since 2012 regardless of the KR of my diet including a time when my daily carbohydrate intake was ≈ 75 grams/day. Although the KR is useful, if you need to know whether or not you are in nutritional ketosis, you should measure breath, blood, or urine ketones.

Table 1.2 shows the mean interstitial glucose (IG) and standard deviation of the interstitial glucose (SDIG) of 732 non-diabetic subjects as measured by CGM from the seven studies referenced below. In September 2021, I found two additional studies in the medical literature and added them to Table 1.2 below. One of the studies, Sundberg, F, et al., 2018, was in 15 healthy, normal weight children, age 2−8. The mean CGM 24-hr IG was 95 mg/dL (5.3 mM) and SDIG was 18 mg/dL (1.0 mM). This study again confirms that children’s blood sugars are about the same as those of adults. The age of subjects in these seven studies ranges from 2−80 years. I think it is important for those with T1D to know the glucose results of metabolically healthy study subjects to be used as a reference for seeking normal blood sugars. Achieving normal blood sugars with T1D is not an easy task, but it can be made more difficult by choosing a target blood glucose that is too low, which means it results in hypoglycemic episodes. The lower the target blood glucose, the more likely hypoglycemic episodes are to occur in those with T1D taking exogenous insulin. Another way to state this is that one’s glycemic variability must be lower to achieve a lower target blood glucose without incurring hypoglycemic episodes. Or, put yet another way, having hypoglycemic episodes means that your target blood glucose is set too high.

The references for these seven studies are shown below.

As always, my goal for February 2022 is to eliminate all BG values < 70 mg/dL as part of making managing T1D as safe as possible.

The purpose of this blog is to share my experience with a low-carb, ketogenic, diet and exercise to better manage my blood glucose as a person with T1D. A low-carb, ketogenic, diet also allows for lower daily insulin doses and normal body composition which I believe reduces the risk of developing insulin resistance and the host of chronic diseases associated with insulin resistance including atherosclerosis, cancer, and neurodegenerative diseases. I also take metformin 500 mg with each of 4 meals daily (2,000 mg/day) to suppress liver glucose production which tends to be chronically elevated in those with T1D. This occurs due to the lower concentration of insulin around the pancreatic alpha-cells increasing the concentration of glucagon reaching the liver as well as the lower concentration of insulin entering the liver both of which increase liver gluconeogenesis and glucose production relative to those without T1D. Metformin also improves glucose uptake by skeletal muscle. These strategies also work well for those with glucose intolerance, prediabetes, type 2 diabetes, and double diabetes (T1D with insulin resistance). As explained in detail in my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, injecting insulin in the subcutaneous fat is just not the same as when it is secreted by the beta-cells in the pancreas according to the prevailing blood glucose concentration. I have accepted the fact that there will always be more variation in blood glucose than I would like, but if I can continue to keep the mean and standard deviation of my blood glucose readings equivalent to that of a non-diabetic individual while avoiding hypoglycemia, I will be satisfied.I would appreciate those who want to purchase my book and derive some benefit from reading it to leave a positive review on Amazon so that others will see the book when they search for books on T1D. The search rankings in Amazon are based the number of books purchased and the reviews of the book.

Comments or general questions are welcomed.

Till next time….

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