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….