#95 August 2021 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.

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 two chapters 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 August 2021

In August 2021, my glycemic results were comparable to those of a non-diabetic individual, but slightly short of my ultimate goal of no blood glucose values less than 70 mg/dl. My mean blood glucose was 100 mg/dl and standard deviation of blood glucose (SDBG) was 17 mg/dl, equivalent to non-diabetic individuals (see below). The graph below shows all the blood glucose measurements and daily insulin dose totals for August 2021. My daily insulin dose totals were more stable this month compared to prior months.

My blood sugar goals are shown in Table 2.3 below. I set my goal standard deviation of blood glucose (SDBG) to ≤ 18 mg/dl (1.0 mmol/l), although normal is ≤ 25.2 mg/dl (1.4 mmol/l).

The table below summarizes my glycemic results for August 2021 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. However, fortunately I did not have any hypoglycemic episodes nor did I need to take any glucose tablets or Smarties™ this month.

The table below tracks my total daily meal macronutrients.

During August 2021, I decreased my total daily caloric intake down to ≈ 1,975 kcal/day in an effort to reduce my body weight to 67 kg, the next lower weightclass in master’s olympic weightlifting, for the third time. Unfortunately, I started thinking about food and wanting to eat more, so I went back to 2,025 kcal/day. I will try again this month and see how it goes. My Humalog doses were a bit lower this month which is always a good thing. I continued with 4 meals/day to both even out all four bolus insulin doses and possibly to help preserve lean muscle mass. Below is a photo of myself from April 2021.

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 ≈ 70 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 2.2 below shows the mean and 95th percentile of the interstitial glucose (IG) and standard deviation of the interstitial glucose (SDIG) of 564 non-diabetic subjects as measured by CGM from the five studies referenced below.

The references for these five studies are shown below.

As always, my goal for September 2021 is to eliminate all BG values < 70 mg/dl as part of making managing T1D as safe as possible. I will continue applying all of the strategies detailed in my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, available in the U.S. on Amazon, to try and achieve this goal.

In summary, 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….

#94 July 2021 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.

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 two chapters 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 July 2021

In July 2021, my glycemic results were comparable to those of a non-diabetic individual, but slightly short of my ultimate goal of no blood glucose values less than 70 mg/dl. My mean blood glucose was 98 mg/dl and standard deviation of blood glucose (SDBG) was 17 mg/dl, equivalent to non-diabetic individuals (see below). The graph below shows all the blood glucose measurements and daily insulin dose totals for July 2021.

My blood sugar goals are shown in Table 2.3 below. I set my goal standard deviation of blood glucose (SDBG) to ≤ 18 mg/dl (1.0 mmol/l), although normal is ≤ 25.2 mg/dl (1.4 mmol/l).

The table below summarizes my glycemic results for July 2021 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. However, fortunately I did not have any hypoglycemic episodes nor did I need to take any glucose tablets or Smarties™ this month.

The table below tracks my total daily meal macronutrients.

I adjust my caloric intake to achieve an optimal body composition, muscle mass, and energy level with minimal insulin doses. During July 2021, I decreased my total daily caloric intake back down to ≈ 2,025 kcal/day. I am going to attempt to get to 67 kg bodyweight, the next lower weightclass in master’s olympic weightlifting, for the third time. This time I will be lowering the daily caloric intake much more slowly and in smaller steps than in the past. I continued with 4 meals/day to both even out all four bolus insulin doses and possibly to help preserve lean muscle mass. Below is a photo of myself from April 2021.

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 ≈ 70 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 2.2 below shows the mean and 95th percentile of the interstitial glucose (IG) and standard deviation of the interstitial glucose (SDIG) of 564 non-diabetic subjects as measured by CGM from the five studies referenced below.

The references for these five studies are shown below.

As always, my goal for August 2021 is to eliminate all BG values < 70 mg/dl as part of making managing T1D as safe as possible. I will continue applying all of the strategies detailed in my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, available in the U.S. on Amazon, to try and achieve this goal.

In summary, 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….

#93 June 2021 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.

My new 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 two chapters 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 June 2021

In June 2021, my glycemic results were comparable to those of a non-diabetic individual, but slightly short of my ultimate goal of no blood glucose values less than 70 mg/dl. My mean blood glucose was 101 mg/dl and standard deviation of blood glucose (SDBG) was 18 mg/dl, equivalent to non-diabetic individuals (see below). The graph below shows all the blood glucose measurements and daily insulin dose totals for June 2021.

My blood sugar goals are shown in Table 2.3 below. I set my goal standard deviation of blood glucose (SDBG) to ≤ 18 mg/dl (1.0 mmol/l), although normal is ≤ 25.2 mg/dl (1.4 mmol/l).

The table below summarizes my glycemic results for June 2021 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. However, fortunately I did not have any hypoglycemic episodes nor did I need to take any glucose tablets or Smarties™ this month.

The table below tracks my total daily meal macronutrients.

I adjust my caloric intake weekly, if needed, to achieve an optimal body composition, muscle mass, and energy level with minimal insulin doses. During June 2021 I decreased my total daily caloric intake back down to ≈ 2,200 kcal/day. I continued with 4 meals/day to both even out all four bolus insulin doses and possibly to help preserve lean muscle mass. Below is a photo of myself from April 2021.

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 ≈ 70 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 2.2 below shows the mean and 95th percentile of the interstitial glucose (IG) and standard deviation of the interstitial glucose (SDIG) of 564 non-diabetic subjects as measured by CGM from the five studies referenced below.

The references for these five studies are shown below.

As always, my goal for June 2021 is to eliminate all BG values < 70 mg/dl as part of making managing T1D as safe as possible. I will continue applying all of the strategies detailed in my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, available in the U.S. on Amazon, to try and achieve this goal.

In summary, 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 amount 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 new 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 variability 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….

#92 May 2021 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.

My new 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 two chapters 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 May 2021

In May 2021, my glycemic results were comparable to those of a non-diabetic individual, but slightly short of my ultimate goal of no blood glucose values less than 70 mg/dl. My mean blood glucose was 98 mg/dl and standard deviation of blood glucose (SDBG) was 17 mg/dl, equivalent to non-diabetic individuals (see below). The graph below shows all the blood glucose measurements and daily insulin dose totals for May 2021.

My blood sugar goals are shown in Table 2.3 below. I set my goal standard deviation of blood glucose (SDBG) to ≤ 18 mg/dl (1.0 mmol/l), although normal is ≤ 25.2 mg/dl (1.4 mmol/l).

The table below shows my bodyweight at the end of the month, mean total daily insulin dose in IU/day and in IU/kg BW/day, coefficient of variation of the total daily insulin dose, mean basal insulin (Tresiba) dose, mean bolus insulin (Humalog) dose, and the mean bolus insulin dose for each meal and the bedtime bolus insulin dose which I take to supplement my Tresiba dose to adjust for the variations in my bedtime blood glucose reading. Diluting my Humalog five-fold helps to give precise doses with meals and at bedtime.

The table below shows my blood glucose variability data including the monthly mean blood glucose, the standard deviation of blood glucose (SDBG), the COV%, the calculated HbA1c, and the percentage of blood glucose values < 70 mg/dl, between 70 and 130 mg/dl, and > 130 mg/dl. My goal is to have 100% of my blood glucose values in the range 70−130 mg/dl. I did not have any hypoglycemic episodes nor did I need to take any glucose tablets or Smarties™ this month.

I am measuring breath ketones every other month now. The graph below shows my breath ketone (acetone) measurements for the month of April 2021. I use the Ketonix® breath acetone meter which was gifted to me by Michel Lundell, the inventor of Ketonix® in 2015. It has been working for the past 6 years and is an economical way to monitor ketosis. Ketonix® readings between 25% and 50% are consistent with nutritional ketosis. The wide variability in the Ketonix readings is in part due to the technique of blowing into the device. I have found that holding my breath before blowing into the meter results in higher readings. This makes sense because breath-holding allows more equilibration of the gases (acetone in this case) in the blood and the air in the alveoli in the lung prior to exhalation.

The table below tracks my total daily meal macronutrients.

I adjust my caloric intake weekly, if needed, to achieve an optimal body composition, muscle mass, and energy level with minimal insulin doses. During May 2021 I increased my total daily caloric intake weekly to ≈ 2,350 kcal/day. I also went back to consuming 4 meals/day to both even out all four bolus insulin doses and to preserve lean muscle mass. Below is a photo of myself from April 2021.

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 ≈ 70 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 2.2 below shows the mean and 95th percentile of the interstitial glucose (IG) and standard deviation of the interstitial glucose (SDIG) of 564 non-diabetic subjects as measured by CGM from the five studies referenced below.

The references for these five studies are shown below.

As always, my goal for June 2021 is to eliminate all BG values < 70 mg/dl as part of making managing T1D as safe as possible. I will continue applying all of the strategies detailed in my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, available in the U.S. on Amazon, to try and achieve this goal.

In summary, 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. 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 new 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 variability 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….

#91 April 2021 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.

My new 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 two chapters 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 April 2021

In April 2021, my glycemic results were comparable to those of a non-diabetic individual, but slightly short of my ultimate goal of no blood glucose values less than 70 mg/dl. My mean blood glucose was 99 mg/dl and standard deviation of blood glucose (SDBG) was 17 mg/dl, equivalent to non-diabetic individuals (see below). The graph below shows all the blood glucose measurements and daily insulin dose totals for April 2021.

My blood sugar goals are shown in Table 2.3 below. I set my goal standard deviation of blood glucose (SDBG) to ≤ 18 mg/dl (1.0 mmol/l), although normal is ≤ 25.2 mg/dl (1.4 mmol/l).

The table below shows my bodyweight at the end of the month, mean total daily insulin dose in IU/day and in IU/kg BW/day, coefficient of variation of the total daily insulin dose, mean basal insulin (Tresiba) dose, mean bolus insulin (Humalog) dose, and the mean bolus insulin dose for each meal and the bedtime bolus insulin dose which I take to supplement my Tresiba dose to adjust for the variations in my bedtime blood glucose reading. Diluting my Humalog five-fold helps to give precise doses with meals and at bedtime.

The table below shows my blood glucose variability data including the monthly mean blood glucose, the standard deviation of blood glucose (SDBG), the COV%, the calculated HbA1c, and the percentage of blood glucose values < 70 mg/dl, between 70 and 130 mg/dl, and > 130 mg/dl. My goal is to have 100% my of blood glucose values fall in the range 70−130 mg/dl. I did not have any hypoglycemic episodes nor did I need to take any glucose tablets or Smarties™ this month.

I am measuring breath ketones every other month now. The graph below shows my breath ketone (acetone) measurements for the month of April 2021. I use the Ketonix® breath acetone meter which was gifted to me by Michel Lundell, the inventor of Ketonix® in 2015. It has been working for the past 6 years and is an economical way to monitor ketosis. Ketonix® readings between 25% and 50% are consistent with nutritional ketosis. The wide variability in the Ketonix readings is in part due to the technique of blowing into the device. I have found that holding my breath before blowing into the meter results in higher readings. This makes sense because breath-holding allows more equilibration of the gases (acetone in this case) in the blood and the air in the alveoli in the lung prior to exhalation.

The table below tracks my total daily meal macronutrients.

I adjust my caloric intake weekly, if needed, to achieve an optimal body composition, muscle mass, and energy level with minimal insulin doses. Below is a photo of myself from April 2021. Next month, I will increase my total daily caloric intake to ≈ 2,150 kcal/day since I do not want to become any leaner and I am always hoping for more muscle mass. I do realize that my age, 61 this month, and my genetics will limit the amount of muscle mass I can achieve, but these factors will not stop me from trying.

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 ≈ 70 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 2.2 below shows the mean and 95th percentile of the interstitial glucose (IG) and standard deviation of the interstitial glucose (SDIG) of 564 non-diabetic subjects as measured by CGM from the five studies referenced below.

The references for these five studies are shown below.

As always, my goal for May 2021 is to eliminate all BG values < 70 mg/dl as part of making managing T1D as safe as possible. I will continue applying all of the strategies detailed in my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, available in the U.S. on Amazon, to try and achieve this goal.

In summary, 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. This strategy also works well for those with glucose intolerance, prediabetes, type 2 diabetes, and double diabetes (T1D with insulin resistance). As explained in detail in my new 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 variability 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….

#90 March 2021 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.

My new 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 two chapters 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 March 2021

In March 2021, my glycemic results were comparable to those of a non-diabetic individual, but slightly short of my ultimate goal of no blood glucose values less than 70 mg/dl. My mean blood glucose was 102 mg/dl and standard deviation of blood glucose (SDBG) was 19 mg/dl, equivalent to non-diabetic individuals (see below). The graph below shows all the blood glucose measurements and daily insulin dose totals for March 2021.

My blood sugar goals are shown in Table 2.3 below. I set my goal standard deviation of blood glucose (SDBG) to ≤ 18 mg/dl (1.0 mmol/l), although normal is ≤ 25.2 mg/dl (1.4 mmol/l).

The table below shows my bodyweight at the end of the month, mean total daily insulin dose in IU/day and in IU/kg BW/day, coefficient of variation of the total daily insulin dose, mean basal insulin (Tresiba) dose, mean bolus insulin (Humalog) dose, and the mean bolus insulin dose for each meal and the bedtime bolus insulin dose which I take to supplement my Tresiba dose to adjust for the variations in my bedtime blood glucose reading. Diluting my Humalog five-fold helps to give precise doses with meals and at bedtime.

The table below shows my blood glucose variability data including the monthly mean blood glucose, the standard deviation of blood glucose (SDBG), the COV%, the calculated HbA1c, and the percentage of blood glucose values < 70 mg/dl, between 70 and 130 mg/dl, and > 130 mg/dl. My goal is to have 100% my of blood glucose values fall in the range 70−130 mg/dl. I did not have any hypoglycemic episodes or need to take any glucose tablets or Smarties™ this month.

I am measuring breath ketones every other month now. The graph below shows my breath acetone measurements for the month of February 2021. I use the Ketonix® breath acetone meter which was gifted to me by Michel Lundell, the inventor of Ketonix® in 2015. It has been working for the past 6 years and is an economical way to monitor ketosis. Ketonix® readings between 25% and 50% are consistent with nutritional ketosis. The wide variability in the Ketonix readings is in part due to the technique of blowing into the device. I have found that holding my breath before blowing into the meter results in higher readings. This makes sense because breath-holding allows more equilibration of the gases (acetone in this case) in the blood and the air in the alveoli in the lung prior to exhalation.

Below is a new table that tracks my daily meal macronutrients. Recall that earlier in the year I was increasing my daily caloric intake to maximize the amount I could eat and still maintain my weight at about 73 kg. There was more of a lag phase that I expected before my bodyweight increased. When my bodyweight exceeded 73 kg, I started decreasing daily caloric intake and again there was quite a lag phase before my bodyweight began to decrease. This anecdotal information might be helpful to others seeking to adjust their bodyweight. During the month of January 2021, I decided to further reduce my food intake to lower my daily insulin requirement and be a bit leaner while still getting adequate micronutrients and having enough energy to support my exercise goals. On February 18th, 2021, I experienced some fatigue and a vague sense of wanting to eat more, but not technically feeling hungry. However, the fatigue was enough impetus to increase my caloric intake which I enacted immediately. Since then, I have continued to adjust my caloric intake weekly to achieve an optimal bodyweight and energy level with minimal insulin doses.

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. In March 2021, the KR increased due to an increase in dietary fat despite a small increase in dietary protein and carbohydrate. 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 ≈70 grams/day.

Table 2.2 below shows the mean and 95th percentile of the interstitial glucose (IG) and standard deviation of the interstitial glucose (SDIG) of 564 non-diabetic subjects as measured by CGM from the five studies referenced below.

The references for these five studies are shown below.

As always, my goal for April 2021 is to eliminate all BG values < 70 mg/dl as part of making managing T1D as safe as possible. I will continue applying all of the strategies detailed in my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, available in the U.S. on Amazon, to try and achieve this goal.

In summary, the purpose of this blog is to share my experience with a low-carb, ketogenic, diet and exercise to better manage blood glucose in those 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. This strategy also works well for those with glucose intolerance, prediabetes, type 2 diabetes, and double diabetes (T1D with insulin resistance). As explained in detail in my new 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 variability 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….

#89 February 2021 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.

My new 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 two chapters 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 2021

In February 2021, my glycemic results were comparable to those of a non-diabetic individual, but slightly short of my ultimate goal of no blood glucose values less than 70 mg/dl. My mean blood glucose was 98 mg/dl and standard deviation of blood glucose (SDBG) was 19 mg/dl, equivalent to non-diabetic individuals (see below). The graph below shows all the blood glucose measurements and daily insulin dose totals for February 2021.

My blood sugar goals are shown in Table 2.3 below. I set my goal standard deviation of blood glucose (SDBG) to ≤ 18 mg/dl (1.0 mmol/l), although normal is ≤ 25.2 mg/dl (1.4 mmol/l).

The table below shows my bodyweight at the end of the month, mean total daily insulin dose in IU/day and in IU/kg BW/day, coefficient of variation of the total daily insulin dose, mean basal insulin (Tresiba) dose, mean bolus insulin (Humalog) dose, and the mean bolus insulin dose for each meal and the bedtime bolus insulin dose which I take to supplement my Tresiba dose to adjust for the variations in my bedtime blood glucose reading. Diluting my Humalog five-fold helps to give precise doses with meals and at bedtime.

The table below shows my blood glucose variability data including the monthly mean blood glucose, the standard deviation of blood glucose (SDBG), the COV%, the calculated HbA1c, and the percentage of blood glucose values < 70 mg/dl, between 70 and 130 mg/dl, and > 130 mg/dl. My goal is to have 100% my of blood glucose values fall in the range 70−130 mg/dl. I did not have any hypoglycemic episodes or need to take any glucose tablets or Smarties™ this month.

I am measuring breath ketones every other month now. The graph below shows my breath acetone measurements for the month of February 2021. I use the Ketonix® acetone meter which was gifted to me by Michel Lundell, the inventor of Ketonix® in 2015. It has been working for the past 5 years and is an economical way to monitor ketosis. Ketonix® readings between 25% and 50% are consistent with nutritional ketosis. The wide variability in the Ketonix readings is in part due to the technique of blowing into the device. I have found that holding my breath before blowing into the meter results in higher readings. This makes sense because breath-holding allows more equilibration of the gases (acetone in this case) in the blood and the air in the alveoli in the lung prior to exhalation.

Below is a new table that tracks my daily meal macronutrients. Recall that earlier in the year I was increasing my daily caloric intake to maximize the amount I could eat and still maintain my weight at about 73 kg. There was more of a lag phase that I expected before my bodyweight increased. When my bodyweight exceeded 73 kg, I started decreasing daily caloric intake and again there was quite a lag phase before my bodyweight began to decrease. This anecdotal information might be helpful to others seeking to adjust their bodyweight. During the month of January 2021, I decided to further reduce my food intake to lower my daily insulin requirement and be a bit leaner while still getting adequate micronutrients and having enough energy to support my exercise goals. On February 18th, 2021, I experienced some fatigue and a vague sense of wanting to eat more, but not technically feeling hungry. However, the fatigue was enough impetus to increase my caloric intake which I enacted immediately. You can see from the insulin dose graph above, the rapid increase in insulin doses needed to accommodate this increase in caloric intake. It will be interesting to see where my bodyweight ends up after this increase in caloric intake. It is clear to me that caloric intake and bodyweight are not perfectly correlated due to variation in caloric expenditure from exercise and NEAT (non-exercise activity thermogenesis).

In 1980, Withrow published the equation for the ketogenic ratio (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. In February 2021, the KR increased due to an increase in dietary fat along with a small decrease in dietary carbohydrate. Remember, the KR is just an estimate of a diet’s potential to produce nutritional ketosis. I have remained in nutritional ketosis continuously for 9 years regardless of the KR of my diet including a time when my daily carbohydrate intake was ≈70 grams/day.

Table 2.2 below shows the mean and 95th percentile of the interstitial glucose (IG) and standard deviation of the interstitial glucose (SDIG) of 564 non-diabetic subjects as measured by CGM from the five studies referenced below.

The references for these five studies are shown below.

As always, my goal for March 2021 is to eliminate all BG values < 70 mg/dl as part of making managing T1D as safe as possible. I will continue applying all of the strategies detailed in my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, available in the U.S. on Amazon, to try and achieve this goal.

In summary, the purpose of this blog is to share my experience with a low-carb, ketogenic, diet and exercise to better manage blood glucose in those 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. This strategy also works well for those with glucose intolerance, prediabetes, type 2 diabetes, and double diabetes (T1D with insulin resistance). As explained in detail in my new 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 variability 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, 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….

#88 Methods to Minimize Insulin Requirements in those with Type 1 Diabetes

Today, I’m celebrating the 9^th anniversary of changing my diet to a whole-food nutrient-dense ketogenic diet which I started on February 8^th, 2012. Some may think that sustaining this dietary approach for such a long time represents a major sacrifice or that the numerous foods no longer eaten are sorely missed. But to the contrary, eating a ketogenic diet is very satisfying and I look forward to eating my meals. I have not “fallen off the wagon,” so to speak, not once. In addition, the positive results, including normal blood sugars, lack of hypoglycemia, and the potential to live a long and healthy life, motivates me to continue my ketogenic diet. Yes, I have tweaked it from time to time and varied the total daily carb intake from a low of 20 g/day to as high as 75 g/day, but I have always remained in nutritional ketosis by testing (β-hydroxybutyrate ≥ 0.5 mM or equivalent breath acetone measurement) which is the true definition of a ketogenic diet. This does not mean ketones need to be measured, followed frequently, or that a certain level of ketosis needs to be achieved, but since I am advocating a ketogenic diet, it makes sense to at least demonstrate to you that I am actually following one myself.

Some with T1D when first hearing about using a low carb or ketogenic diet are turned off when contemplating all the foods that are excluded from the diet. This is because the processed foods they are accustomed to eating are addictive. It is not the food that they enjoy, it is the rewarding brain signals that the food causes that they are attracted to. Processed foods contain various combinations of refined carbohydrates, sugars, and vegetable oils, which do not exist in nature. Because our metabolism did not evolve in the environment of processed foods, it is not adapted to tolerate them. Natural foods consist of plants and animals, neither of which are refined or contain significant amounts of both carbohydrate and fat. This combination makes processed foods addictive and is the reason those accustomed to eating them do not want to stop eating them. Again, it is not the food per se that they are attracted to, rather it is the stimulation of the reward center in their brains that make them think the food is so good to eat. Processed foods stimulate dopamine in the reward center of our brains giving us the perception that we enjoy them and that we want to continue consuming them time and time again. However, once one is able to stop eating them for 3-4 weeks, the desire to have them largely disappears. The thoughts of eating processed foods may pop into my head from time to time, but as time passes, it occurs less often and with less interest. In fact, if you think about eating most refined starches like bread, crackers, pasta, popcorn, or baked potato, they actually don’t taste good unless you add either fat, sugar, or both to them. Thus, bread only tastes good as part of a sandwich or toasted with butter, jam, or both. Same with crackers, peanut butter and jelly or maybe cheese on top. Pasta needs pasta sauce, right? Popcorn needs butter or perhaps caramel mixed in to taste interesting. Even some whole foods like baked potato aren’t tasty to eat when plain. We often add butter or sour cream with some salt to our baked potato. Cookies? Well they have refined carbohydrate (flour), sugar, and butter as ingredients. I think you get the point. Because our metabolism is not equipped to deal processed foods, a high percentage of those in Western civilizations develop chronic disease(s). The whole, nutritious foods in my ketogenic diet are not only compatible with normal metabolism, but also work quite well with T1D physiology. In addition, I feel satisfied eating the foods in a ketogenic diet and I look forward to my meals. I am literally never hungry, nor do I desire for more or different foods. With this in mind, maybe you can better understand why I have found it rather easy to follow a whole-food nutrient-dense ketogenic diet for the past 9 years and I am sure I will be able to continue doing so for the rest of my life. Now for the main topic of this blog post.

Methods to Minimize Insulin Requirements in those with Type 1 Diabetes

Why would those with T1D want to minimize insulin requirements? There are several reasons:

1. Insulin is an anabolic/anti-catabolic hormone that promotes the storage of nutrients and growth of tissues. Excess insulin promotes the expansion of body fat and the growth of cancer, both not good for us.
2. Large doses of insulin can cause hypoglycemia, also not good.
3. Chronically high insulin doses predisposes us to other chronic illnesses including atherosclerosis (leading to heart attacks, stroke, and peripheral vascular disease), Alzheimer’s dementia, metabolic syndrome, type 2 diabetes, and double diabetes in those with T1D, to name a few.
4. Large doses of insulin cost more money than small doses of insulin.

So how can we minimize insulin requirements while still achieving and maintaining normal blood sugars?

1. Follow a Low-Carb or Ketogenic Diet. Dietary carbohydrate, gram for gram, requires significantly more insulin to achieve transport and storage in our muscle and fat cells relative to either dietary protein or fat. Minimizing dietary carbohydrate while getting adequate protein to support growth in children and adolescents and maintaining muscle mass as we age and getting most of our energy needs from dietary fat, will minimize our insulin requirements. In persons with T1D, consuming a ketogenic diet reduces insulin requirements, best expressed as total daily insulin dosages divided by body weight (IU/kg body weight). The lower the insulin requirement (in IU/kg), the lower the above-mentioned risks of high insulin levels in the long term. For example, prior to starting my ketogenic diet in 2012, my insulin dosage was 0.80 IU/kg with an average blood sugar of 152 mg/dl. Currently on my ketogenic diet, it is 0.32 IU/kg with an average blood sugar of 100 mg/dl. Much of the improvement is due to the ketogenic diet, but part of it is due to having normal blood sugars (see 4., below).
2. Minimize body fat. The amount of fat stored on one’s body significantly affects one’s daily insulin requirements, i.e. less body fat = less total daily insulin. In addition, the lower food intake required to attain and maintain a lower body fat also lowers one’s daily insulin requirements. Remember that moderation is in order here. Having too little body fat is a problem too. Too little body fat is neither healthy nor sustainable and combined with the low food intake required to reach that body fat level can result in multiple symptoms like hunger, fatigue, feeling cold, difficulty sleeping, possible micronutrient deficiency, and should be avoided.
3. Maximize muscle mass and exercise regularly. The more muscle one has, the more glucose can be burned (oxidized) both at rest and during exercise and the more glycogen (the storage form of glucose) can be stored in muscle after meals and with a lower dose of insulin. Of course, regular aerobic and resistance exercise and adequate dietary protein are needed to build that muscle, but remember resistance exercise is the greater stimulus to muscle building relative to dietary protein. Exercise improves muscle insulin sensitivity acutely due to muscle contractions and also chronically by improving sensitivity to insulin. If exercise is performed regularly, this will result in a reduction in daily insulin requirements as a result of the improved insulin sensitivity. If the regular exercise is stopped, then the improved insulin sensitivity wanes over the next several days and insulin doses will need to be increased to compensate for the lack of exercise. While exercise is very beneficial, too much of a good thing can occur as well. Too much exercise leads to overuse injuries, muscle and tendon soreness or injuries, fatigue, and in the long term, excessive aerobic exercise can cause cardiac abnormalities like atrial fibrillation, ventricular arrhythmias, and dilated cardiomyopathy leading to stroke, sudden death, or heart failure, respectively. I am guilty of overtraining and have experienced several of these symptoms (no heart problems fortunately), but I have corrected my approach to exercise now.
4. Achieve normal blood sugars. One might think that more insulin is needed to achieve and maintain normal blood sugars compared to maintaining higher blood sugars. But in my experience, the opposite is true. Maintaining high blood sugars actually requires more exogenous insulin administration than simply maintaining normal blood sugars. Even though I have not had persistently high blood sugars ever, I have noticed many times over my 22-years of treating T1D on both a high-carb and a low-carb diet that it requires more insulin to lower my blood sugar from say, 160 mg/dl to 130 mg/dl, than it does to lower my blood sugar from 130 mg/dl to 100 mg/dl, even though both represent a 30 mg/dl reduction. This observation can be understood from investigations into the insulin sensitivity of various tissues exposed to hyperglycemia. Hyperglycemia causes insulin resistance in muscle, adipose tissue (fat cells), as well as other tissues and is referred to as “glucose toxicity.” https://pubmed.ncbi.nlm.nih.gov/12079834/ Thus insulin resistance secondary to hyperglycemia results in a larger insulin requirement and normalizing blood sugars is a method to reduce one’s daily insulin requirements. Although my highest priority is avoiding hypoglycemia, my second highest priority is avoiding hyperglycemia not only to minimize the risk of diabetic complications, but also to minimize the risk of multiple chronic diseases associated with hyperinsulinemia. I encourage those interested in achieving normal blood sugars to read my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, is available in the U.S. available on Amazon and internationally on your countries’ Amazon in both Kindle and Print versions, with particular attention to the end of Chapter 5 and use the equations to estimate mealtime bolus insulin doses. These equations have helped me to minimize the variability of my blood sugar excursions and thus minimize both hypoglycemia and hyperglycemia.
5. Metformin. Metformin is an oral hypoglycemic medication typically used for patients with type 2 diabetes. Metformin partially inhibits gluconeogenesis (the process that synthesizes glucose from lactate, glycerol, and some amino acids, especially alanine) by “inhibiting gluconeogenesis from both oxidized (dihydroxyacetone) and reduced (xylitol) substrates by preferential partitioning of substrate toward glycolysis by a redox-independent mechanism that is best explained by allosteric regulation at phosphofructokinase-1 (PFK1) and/or fructose 1,6-bisphosphatase (FBP1) in association with a decrease in cell glycerol 3-phosphate, an inhibitor of PFK1, rather than by inhibition of transfer of reducing equivalents.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393620/pdf/zbc2839.pdf Honestly, I read, but did not completely understand the details of the paper, but my take-away is that metformin causes the substrates (lactate, glycerol, and some amino acids, especially alanine) of gluconeogenesis to be oxidized (burned during glycolysis) rather than made into glucose. This is what mitigates the rise in blood glucose after meals. In those with T1D, the lower concentration of exogenous insulin around the alpha-cells in the pancreas results in a reduction in the inhibition of glucagon release which in turn stimulates gluconeogenesis in the liver. Similarly, the lower concentration of exogenous insulin that reaches the liver also results in less effective inhibition of gluconeogenesis. This is important particularly when a person with T1D eats a meal. Blood glucose rises with meals in part due to the stimulation of glucagon in the alpha-cells by amino acids (breakdown products of dietary protein) from the meal which, as mentioned, is less inhibited by exogenous insulin. One method to help out this situation is to take metformin with meals which partially inhibits gluconeogenesis and helps mitigate the rise in blood glucose after meals. Therefore, in 2017, I started taking metformin (currently I take 1,000 mg with breakfast, 500 mg with lunch, and 500 mg with dinner) and found it to be effective in allowing me to reduce my mealtime bolus insulin doses, albeit modestly, by about 3 IU per day. However, I have not experienced any adverse side-effects of metformin, it is much less expensive than the cost of 3 IU/day of insulin, and I appreciate being able to take less insulin every day for the reasons mentioned above. This is discussed in more detail in Chapter 11 of my book.
6. Consistency of Meals and Exercise. As discussed in detail in my book in Chapters 4 and 7, formulating consistent meals such that the quantity of protein, carbohydrate, and fat remains constant from day to day improves one’s ability to predict mealtime bolus insulin doses and thus achieve normal post-meal blood sugars. Similarly, designing an exercise program such that the type of exercise, intensity, and duration are either constant or equivalent in terms of one’s resulting insulin sensitivity also facilitates normal blood sugars.

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.

Well, that’s all I have for today.

Comments and general questions are welcomed.

Till next time …

#87 January 2021 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.

My new 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 two chapters 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 2021

In January 2021, my glycemic results were comparable to those of a non-diabetic individual, but slightly short of my ultimate goal of no blood glucose values less than 70 mg/dl. My mean blood glucose was 99 mg/dl and standard deviation of blood glucose (SDBG) was 18 mg/dl, equivalent to non-diabetic individuals (see below). The graph below shows all the blood glucose measurements and daily insulin dose totals for January 2021.

My blood sugar goals are shown in Table 2.3 below. I set my goal standard deviation of blood glucose (SDBG) to ≤ 18 mg/dl (1.0 mmol/l), although normal is ≤ 25.2 mg/dl (1.4 mmol/l).

The table below shows my bodyweight at the end of the month, mean total daily insulin dose in IU/day and in IU/kg BW/day, coefficient of variation of the total daily insulin dose, mean basal insulin (Tresiba) dose, mean bolus insulin (Humalog) dose, and the mean bolus insulin dose for each meal and the bedtime bolus insulin dose which I take to supplement my Tresiba dose to adjust for the variations in my bedtime blood glucose reading. Diluting my Humalog five-fold helps to give precise doses with meals and at bedtime.

The table below shows my blood glucose variability data including the monthly mean blood glucose, the standard deviation of blood glucose (SDBG), the COV%, the calculated HbA1c, and the percentage of blood glucose values < 70 mg/dl, between 70 and 130 mg/dl, and > 130 mg/dl. My goal is to have 100% my of blood glucose values fall in the range 70−130 mg/dl. I did not have any hypoglycemic episodes or need to take any glucose tablets or Smarties™ this month.

I am measuring breath ketones every other month now. The graph below shows my breath acetone measurements for the month of December 2020. I use the Ketonix® acetone meter which was gifted to me by Michel Lundell, the inventor of Ketonix® in 2015. It has been working for the past 5 years and is an economical way to monitor ketosis. Ketonix® readings between 25% and 50% are consistent with nutritional ketosis. The wide variability in the Ketonix readings is in part due to the technique of blowing into the device. I have found that holding my breath before blowing into the meter results in higher readings. This makes sense because breath-holding allows more equilibration of the gases (acetone in this case) in the blood and the air in alveoli prior to exhalation.

Below is a new table that tracks my daily meal macronutrients. Recall that earlier in the year I was increasing my daily caloric intake to maximize the amount I could eat and still maintain my weight at about 73 kg. There was more of a lag phase that I expected before my bodyweight increased. When my bodyweight exceeded 73 kg, I started decreasing daily caloric intake and again there was quite a lag phase before my bodyweight began to decrease. This anecdotal information might be helpful to others seeking to adjust their bodyweight. During the month of January, I decided to further reduce my food intake to lower my daily insulin requirement and be a bit leaner while still getting adequate micronutrients and having enough energy to support my exercise goals. Currently, I feel well at 69.6 kg and have no hunger at 1,701 kcal/day. I experienced the lowest insulin requirements when my bodyweight was 67 kg. However, I had multiple symptoms including feeling unsatisfied after eating my meals and feeling cold and fatigued at that bodyweight and increased it to 73 kg. My plan for February is to make no further changes to my food intake unless something unforeseen occurs.

In 1980, Withrow published the equation for the ketogenic ratio (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. My carbohydrate intake has remained relatively stable.

Table 2.2 below shows the mean and 95th percentile of the interstitial glucose (IG) and standard deviation of the interstitial glucose (SDIG) of 564 non-diabetic subjects as measured by CGM from the five studies referenced below.

The references for these five studies are shown below.

As always, my goal for February 2021 is to eliminate all BG values < 70 mg/dl as part of making managing T1D as safe as possible. I will continue applying all of the strategies detailed in my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, available in the U.S. on Amazon, to try and achieve this goal.

In summary, the purpose of this blog is to share my experience with a low-carb, ketogenic, diet and exercise to better manage blood glucose in those 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. This strategy also works well for those with glucose intolerance, prediabetes, type 2 diabetes, and double diabetes (T1D with insulin resistance). As explained in detail in my new 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 variability in blood glucose than I would like, but if I can continue to keep the mean and standard deviation of my blood glucose readings that of a non-diabetic individual, 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….

#86 December 2020 Update on My T1D Management

HAPPY NEW YEAR !!!

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.

My new 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 two chapters 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.

Lift of the Month – December 2020

Glycemic Results For December 2020

In December 2020, my glycemic results were comparable to those of a non-diabetic individual, but slightly short of my ultimate goal of no blood glucose values less than 70 mg/dl. My mean blood glucose was 95 mg/dl and standard deviation of blood glucose (SDBG) was 19 mg/dl, equivalent to non-diabetic individuals (see below). The graph below shows all the blood glucose measurements and daily insulin dose totals for December 2020.

My blood sugar goals are shown in Table 2.3 below. I set my goal standard deviation of blood glucose (SDBG) to ≤ 18 mg/dl (1.0 mmol/l), although normal is ≤ 25.2 mg/dl (1.4 mmol/l).

The table below shows my bodyweight at the end of the month, mean total daily insulin dose in IU/day and in IU/kg BW/day, coefficient of variation of the total daily insulin dose, mean basal insulin (Tresiba) dose, mean bolus insulin (Humalog) dose, and the mean bolus insulin dose for each meal and the bedtime bolus insulin dose which I take to supplement my Tresiba dose to adjust for the variations in my bedtime blood glucose reading. Diluting my Humalog five-fold helps to give precise doses with meals and at bedtime.

The table below shows my blood glucose variability data including the monthly mean blood glucose, the standard deviation of blood glucose (SDBG), the COV%, the calculated HbA1c, and the percentage of blood glucose values < 70 mg/dl, between 70 and 130 mg/dl, and > 130 mg/dl. My goal is to have 100% my of blood glucose values fall in the range 70−130 mg/dl. I did not have any hypoglycemic episodes or need to take any glucose tablets (or Smarties™) this month.

I am measuring breath ketones every other month now. The graph below shows my breath acetone measurements for the month of December 2020. I use the Ketonix® acetone meter which was gifted to me by Michel Lundell, the inventor of Ketonix® in 2015. It has been working for the past 5 years and is an economical way to monitor ketosis. Ketonix® readings between 25% and 50% are consistent with nutritional ketosis. The wide variability in the Ketonix readings is in part due to the technique of blowing into the device. I have found that holding my breath before blowing into the meter results in higher readings. This makes sense because breath-holding allows more equilibration of the gases (acetone in this case) in the blood and the air in alveoli prior to exhalation.

Below is a new table that tracks my daily meal macronutrients. Recall that earlier in the year I was increasing my daily caloric intake to maximize the amount I could eat and still maintain my weight at about 73 kg. There was more of a lag phase that I expected before my bodyweight increased. When my bodyweight exceeded 73 kg, I started decreasing daily caloric intake and again there was quite a lag phase before my bodyweight began to decrease. This anecdotal information might be helpful to others seeking to adjust their bodyweight. For December, I changed my meal plan on December 13th and noted a greater than expected decrease in my insulin requirements. I suspect this was related to either some inaccuracy of the USDA database macronutrient values for the new foods in my diet or it could the lag effect of the reduced food intake and body fat that finally resulted in a reduced insulin requirement. I experienced the lowest insulin requirements when my bodyweight was 67 kg. However, I did not feel well at that bodyweight and increased it to 73 kg.

In 1980, Withrow published the equation for the ketogenic ratio (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. The carb intake has remained relatively stable.

Table 2.2 below shows the mean and 95th percentile of the interstitial glucose (IG) and standard deviation of the interstitial glucose (SDIG) of 564 non-diabetic subjects as measured by CGM from the five studies referenced below.

The references for these five studies are shown below.

As always, my goal for January 2021 is to eliminate all BG values < 70 mg/dl as part of making managing type 1 diabetes as safe as possible. I am not confident I will be able to achieve this goal, but I will continue applying all of the strategies detailed in my book, Master Type 1 Diabetes: The Simple, Low-Cost Method to Normalize Blood Sugars, available in the U.S. on Amazon, to try and achieve this goal.

In summary, the purpose of this blog is to share my experience with a low-carb, ketogenic, diet and exercise to better manage blood glucose in those with type 1 diabetes. 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. As explained in detail in my new 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 variability in blood glucose than I would like, but if I can continue to keep the mean and standard deviation of my blood glucose readings that of a non-diabetic individual, 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.

Till next time….