#77 March 2020 Update on My T1DM Management

This is a monthly update on my glycemic management of type 1 diabetes (T1DM) using Humalog and Tresiba insulin injections with a ketogenic whole-food diet and resistance and aerobic exercise.

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.

My books are available for purchase: The Ketogenic Diet for Type 1 Diabetes also available on Amazon in print, and my other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print.

Glycemic Results For March 2020

I was satisfied with my March 2020 glycemic results with a mean blood glucose of 100 mg/dl and a standard deviation of blood glucose of 19 mg/dl, just short of my goal of ≤ 18 mg/dl.

The graph below shows all the blood glucose measurements and daily insulin dose totals for March 2020.

My blood sugar goals are shown in Tables 2.3 below. I used as my measure of normality, a standard deviation of blood glucose (SDBG) of ≤ 18 mg/dl (1.0 mmol/l).

The table below shows my body weight at the end of the month, mean total daily insulin dose, mean basal insulin dose, mean bolus insulin 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. Diluting my Humalog 5:1 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 coefficient of variation (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 meet this goal this month. I did not need to take any glucose tablets (or Smarties™) this month.

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 nondiabetic subjects as measured by CGM from the five studies referenced below.

The references for these five studies are shown below.

I have been tinkering with a mathematical model to predict insulin doses. While the method provides an estimate, it is not perfect. There is an inherent variability when treating T1D with exogenous insulin, but as long as normal blood sugars can be achieved while being safe, i.e., with minimal hypoglycemia, then I will be satisfied. I will continue testing it this month and hopefully my current method will be the final version.

Till next time….

#76 February 2020 Update on My T1DM Management

This is a monthly update on my glycemic management of type 1 diabetes (T1DM) using Humalog and now Tresiba insulin injections with a ketogenic whole-food diet and resistance and aerobic exercise.

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.

In October I did an interview with Ross Wollen on asweetlife.org titled “Interview: Dr. Runyan is the Diabetic Ketogenic Athlete.” You can read it here.

I wrote an article for DietDoctor in July titled “What you need to know about a low-carb diet and your kidneys.“ You can read it here

My books are available for purchase: The Ketogenic Diet for Type 1 Diabetes also available on Amazon in print, and my other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print

Glycemic Results For February 2020

My February 2020 glycemic results were excellent except for having more blood sugars < 74 mg/dl than my goal of < 5%. My monthly blood glucose variability, as measured by standard deviation, was a new low at 16 mg/dl, since my diagnosis of type 1 diabetes in 1998.

The graph below shows all the blood glucose measurements and daily insulin dose totals for February 2020.

My blood sugar goals are shown in Tables 2.3 and 2.4 below. I used as my measure of normality, a standard deviation of blood glucose (SDBG) of less than 18 mg/dl (1.0 mmol/l). This value was measured in 434 metabolically healthy subjects in China as reported in this study.

The table below shows my monthly mean body weight, mean total daily insulin dose, mean basal insulin dose, mean bolus insulin dose, and the mean bolus insulin dose for each meal and the bedtime bolus insulin dose which I started using a few months ago to try to improve my fasting blood sugar while keeping the basal insulin dose constant. Despite this I did have to decrease my Tresiba dose by 1 IU this month to address fasting low blood sugars. Diluting my Humalog 5:1 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 coefficient of variation (COV), the calculated HbA1c, and the percentage of blood glucose values < 74 mg/dl, between 74 and 126 mg/dl, and > 126 mg/dl. As mentioned, my percentage of blood glucose values < 74 mg/dl was higher than my goal of < 5%. I did not need to take any glucose tablets (or Smarties) this month.

My total daily insulin dose was lower this month and on par with previous months.

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 nondiabetic subjects as measured by CGM from the five studies referenced below.

The references for these five studies are shown below.

In February, I tinkered with a mathematical model to predict insulin doses. This month, I will test it and hope that it will be the final version. It is clear that there will always be some inherent variability in blood sugars when treating T1DM with exogenous insulin, but as long as normal blood sugars can be achieved while being safe, i.e., with minimal hypoglycemia, then I will be satisfied. I expect this mathematical approach will only be useful after one has established a consistent schedule of meals, exercise, and sleep, i.e. factors known to affect insulin sensitivity.

Till next time….

#75 The 2020 Kick Sugar Summit Starts Soon

 My friends over at the Kick Sugar Summit headquarters have done it again!

They have lined up the who’s who in the world of sugar and sugar addiction. It is intended to help sugar lovers find the information and inspiration they need to break up with refined carbohydrates.

It is well known that refined carbs are the root cause of modern lifestyle diseases, and no amount of healthy food, medical intervention or pharmaceutical can undo the damage sugar does. There is only one way out, only one way to keep sugar from undermining your efforts to get healthy, and that is to kick it. Whether you have a bad habit or a true addiction, this summit is for you.

I am thrilled to be a part of this event and to share the stage with world experts from around the world. You can catch my interview on Day #5, Friday, March 6th, 2020.

 If you are curious to know what kicking sugar can do for you, join us!

 It is 100% free and launches live on Monday, March 2, 2020.

Register here: https://www.kicksugarsummit.com

#74 January 2020 Update on My T1DM Management

This is a monthly update on my glycemic management of type 1 diabetes (T1DM) using Humalog and now Tresiba insulin injections with a ketogenic whole-food diet and resistance and aerobic exercise.

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.

In October I did an interview with Ross Wollen on asweetlife.org titled “Interview: Dr. Runyan is the Diabetic Ketogenic Athlete.” You can read it here.

I wrote an article for DietDoctor in July titled “What you need to know about a low-carb diet and your kidneys.“ You can read it here

My books are available for purchase: The Ketogenic Diet for Type 1 Diabetes also available on Amazon in print, and my other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print

Glycemic Results For January 2020

My January 2020 glycemic results were a new record: the lowest monthly blood glucose variability, as measured by standard deviation, since my diagnosis of type 1 diabetes in 1998. I started taking Tresiba on November 22, 2019 in hopes of further reducing my blood glucose variability and I think it has contributed to my improvement.

The graph below shows all the blood glucose measurements and daily insulin dose totals for January 2020.

My blood sugar goals are shown in Tables 2.3 and 2.4 below. I used as my measure of normality, a standard deviation of blood glucose (SDBG) of less than 18 mg/dl (1.0 mmol/l). This value was measured in 434 metabolically healthy subjects in China as reported in this study.

The table below shows my monthly mean body weight, mean total daily insulin dose, mean basal insulin dose, mean bolus insulin dose, and the mean bolus insulin dose for each meal and the bedtime bolus insulin dose which I started using a few months ago to try to improve my fasting blood sugar while keeping the basal insulin dose constant. Diluting my Humalog 5:1 helps to give precise doses with meals and at bedtime.

The graphs below are new and show the individual mealtime and bedtime blood glucose, PRE and POST, values and the corresponding bolus Humalog doses for the month. I think what is remarkable about these doses is how much they vary from day to day despite keeping each meal and exercise session constant. This is currently consuming my thoughts as I search for a method to smooth-out both the blood glucose and insulin doses from day to day. I have in the past and continue to notice a lag effect of blood glucose to changes in insulin doses. When I have to increase insulin doses for higher blood glucose readings, invariably about two days later, I get one or more low blood glucose readings.

The table below shows my blood glucose variability data including the monthly mean blood glucose, the standard deviation of blood glucose (SDBG), the coefficient of variation (COV), the calculated HbA1c, and the percentage of blood glucose values < 74 mg/dl, between 74 and 126 mg/dl, and > 126 mg/dl. As mentioned, these are the lowest monthly SDBG and COV values since my diagnosis of T1DM and technically equivalent to a non-diabetics blood glucose values. I did not take any glucose tablets (or Smarties) this month either.

As you can see for January 2020, I just missed my goal of < 5% of blood glucose values < 74 mg/dl. My total daily insulin dose was higher this month for reasons that are not exactly clear other than I needed more for mildly, but still in range, blood sugars. I am optimist that I can continue to improve my results. I continue daily exercise and a very low-carbohydrate diet. My exercise program is easy 2.5 mile walks with a 20 kg weight-vest twice daily and olympic weightlifting 2 hours daily, for a total of about 4 hours/day. As mentioned in the past, about 1 hour of the weightlifting time is resting between lifts.

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 nondiabetic subjects as measured by CGM from the five studies referenced below.

The references for these five studies are shown below.

This month, I plan on working on a mathematical method to predict insulin doses in the hopes of smoothing-out the blood glucose readings and insulin doses. I expect this approach will only be effective after one has established a consistent schedule of meals, exercise, and sleep, i.e. factors known to affect insulin sensitivity.

Till next time….

#73 December 2019 Update on My T1DM Management

Happy New Year to All !!!

This is a monthly update on my glycemic management of type 1 diabetes (T1DM) using Humalog and now Tresiba insulin injections with a ketogenic whole-food diet and resistance and aerobic exercise.

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.

In October I did an interview with Ross Wollen on asweetlife.org titled “Interview: Dr. Runyan is the Diabetic Ketogenic Athlete.” You can read it here.

I wrote an article for DietDoctor in July titled “What you need to know about a low-carb diet and your kidneys.“ You can read it here

My books are available for purchase: The Ketogenic Diet for Type 1 Diabetes also available on Amazon in print, and my other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print

Glycemic Results For December 2019

My December 2019 glycemic results were a new record: the lowest monthly blood glucose variability, as measured by standard deviation, since my diagnosis of type 1 diabetes in 1998. I started taking Tresiba on November 22, 2019 in hopes of further reducing my blood glucose variability and although the improvement was minimal, it is safe to say that Tresiba is at least as good as Lantus, if not slightly better. I think some additional time will help sort this out.

The graph below shows all the blood glucose measurements and daily insulin dose totals for December 2019.

My blood sugar goals are shown in Table 3. below. I used as my measure of normality, a standard deviation of blood sugar of less than 25.2 mg/dl (1.4 mmol/l). This value was measured in 434 metabolically healthy subjects in China as reported in this study.

The table below shows my monthly mean body weight, mean total daily insulin dose, mean basal insulin dose, mean bolus insulin dose, and the mean bolus insulin dose for each meal and the bedtime bolus insulin dose which I started using a few months ago to try to improve my fasting blood sugar while keeping the basal insulin dose constant. Diluting my Humalog 5:1 helps to give precise doses with meals and at bedtime.

The graphs below show the individual mealtime and bedtime bolus Humalog doses for the month. I think what is remarkable about these doses is how much they vary from day to day despite keeping each meal and exercise session rather constant. The variability is greatest for dinnertime Humalog dose which follows the 2.5 hours of afternoon exercise.

The table below shows my blood glucose variability data including the monthly mean blood glucose, the standard deviation of blood glucose, the coefficient of variation, the calculated HbA1c, and the percentage of blood glucose values < 70 mg/dl, between 70 and 130 mg/dl, and > 130 mg/dl.

As you can see for December 2019, I have reached all of the blood sugar goals I had set. My total daily insulin dose is satisfactorily low and stable. I continue to be cautiously optimist that I can continue to meet these goals henceforth by maintaining the consistency of my very low-carbohydrate diet and daily exercise (aerobic (walking 1.5 miles twice daily with a weighted vest) and weightlifting 2 hours daily).

The table below shows the mean and 95th percentile of the interstitial glucose and standard deviation of the interstitial glucose of 564 nondiabetic subjects as measured by CGM from the five studies referenced below.

The references for these five studies are shown below.

Since January 1 is the day for setting yearly goals, my goal for 2020 is to eliminate all blood glucose values below 70 mg/dl and I am setting a new goal of a standard deviation of blood glucose ≤ 18 mg/dl which will be within the range of mean values for non-diabetics from the five studies referenced above as shown in the Table below.

Wishing you a happy and healthy new year!

#72 November 2019 Update on My T1DM Management

This is a monthly update on my glycemic management of type 1 diabetes (T1DM) using Humalog and now Tresiba insulin injections with a ketogenic whole-food diet and resistance and aerobic exercise.

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.

Last month I did an interview with Ross Wollen on asweetlife.org titled “Interview: Dr. Runyan is the Diabetic Ketogenic Athlete.” You can read it here.

I wrote an article for DietDoctor in July titled “What you need to know about a low-carb diet and your kidneys.“ You can read it here

My books are available for purchase: The Ketogenic Diet for Type 1 Diabetes also available on Amazon in print, and my other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print.

Glycemic Results For November 2019

My November 2019 glycemic results were a new record: the best blood sugar results since my diagnosis of type 1 diabetes in 1998. I also started taking Tresiba on November 22, 2019 in hopes of further reducing my blood glucose variability. It is too early to know if it will, but by next month, I should have an answer. My back injury healed and I resumed olympic weightlifting on November 6, 2019.

The graph below shows all the blood glucose measurements and daily insulin dose totals for November 2019.

My blood sugar goals are shown in Table 3. below. I used as my measure of normality, a standard deviation of blood sugar of less than 25.2 mg/dl (1.4 mmol/l). This value was measured in 434 metabolically healthy subjects in China as reported in this study.

The table below shows my monthly mean body weight, mean total daily insulin dose, mean basal insulin dose, mean bolus insulin dose, and the mean bolus insulin dose for each meal and the bedtime bolus insulin dose which I started using a few months ago to try to improve my fasting blood sugar while keeping the basal insulin dose constant. Diluting my Humalog 5:1 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, the coefficient of variation, the calculated HbA1c, and the percentage of blood glucose values < 70 mg/dl, between 70 and 130 mg/dl, and > 130 mg/dl.

As you can see, for November 2019 I have reached all my goals. Additionally, my total daily insulin dose is satisfactorily low and stable. I have never been confident that I could actually accomplish these goals. I think my attention to details that I previously thought would not make much difference has paid off. These details include consistency of my very low-carbohydrate diet from day to day and consistency of daily exercise, both aerobic (walking 2.5 miles twice daily) and weightlifting 2 hours daily, and the use of diluted Humalog to more precisely dose bolus insulin. I will be interested in seeing if changing from Lantus to Tresiba will further improve my standard deviation of blood glucose and coefficient of variation results. I would also like to eliminate all blood glucose values below 70 mg/dl. BTW, I took a total of 2 Smarties candies (12 grams of glucose) for the month of November which I think is also a new record.

My current daily macronutrients are 44 grams of carbohydrates (10 grams of fiber) (5% of energy), 185 grams of protein or 2.5 grams/kg/day (26% of energy), and 230 grams of fat (69% of energy).

If you have questions or topics you would like me to write about, leave them in the comments. Till next month…

#71 October 2019 Update on My T1DM Management

This is a monthly update on my glycemic management of type 1 diabetes (T1DM) using Humalog and Lantus insulin injections with a ketogenic whole-food diet and resistance and aerobic exercise.

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.

This month I did an interview with Ross Wollen on asweetlife.org titled “Interview: Dr. Runyan is the Diabetic Ketogenic Athlete.” You can read it here.

I wrote an article for DietDoctor in July titled “What you need to know about a low-carb diet and your kidneys.“ You can read it here

My books are available for purchase: The Ketogenic Diet for Type 1 Diabetes also available on Amazon in print, and my other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print.

Last month, after 13 months of specifically trying to achieve normal blood sugars, I was able to accomplish that goal. This month, in addition to achieving a normal average and standard deviation of blood sugar, I was able to reach an additional blood sugar goal: the percentage of blood sugar values in the range 70 to 130 mg/dl of > 80%. This was despite having a back strain on 10/19/19 during olympic weightlifting that required changing my exercise regimen and insulin doses significantly. As mentioned in previous posts, I have had a normal mean blood sugar since I started my ketogenic low-carb diet in 2012. But last year I decided I also wanted normal blood sugar variability. I used as my measure of normality, a standard deviation of blood sugar of less than 25.2 mg/dl (1.4 mmol/l). This value was measured in 434 metabolically healthy subjects in China as reported in this study. My blood sugar goals are summarized in Table 3 below.

Glycemic Results For October 2019

The table below shows my mean blood glucose (BG), standard deviation (SD), coefficient of variation (CV), calculated HbA1c, body weight, and mean insulin dose totals for October 2019. You can see I have achieved both normal mean (average) blood sugar and variability of blood sugar (standard deviation). Note the increase in average daily insulin dose compared to September. As mentioned, I attribute this to the change in exercise due to the back strain. My current insulin dose (0.39 IU/kg/day) is still less than half what it was (0.80 IU/kg/day) prior to starting regular exercise in 2007 and a ketogenic low-carbohydrate diet in 2012.

The table below shows the percentage of blood glucose values in the indicated ranges of low, goal, and high values for October 2019. I met two out of three of my stated goals for these parameters, but the low frequency of hypoglycemia is the most important one to me.

This month’s results were improved compared to last month. As shown in the Table 3 above, my goals are < 10% lows, > 80% normals, and < 10% highs. I am pleased with the relatively low frequency of hypoglycemia. My true goal is 0% of blood glucose values < 70 mg/dl, but I am trying to be realistic and thus have set the goal to less than 10%.

The graphs below show all of the daily insulin dose totals and all of the blood sugar (BG) readings for October 2019. HUM = Humalog in blue, LAN = Lantus in green, INS = total daily insulin dose in red. You can see the increase in insulin doses beginning after the back strain on 10/19/19. In contrast to times past, the increase in insulin doses was modest and stabilized much sooner. I think this why I was able to keep the blood sugars normal this month. You can also see the increase in blood sugars after 10/19/19 that prompted the increase in insulin doses. It took 3 days of insulin dose increases to resolve the high blood sugars. Had I known exactly how long it would take for my back to recover, I would have increased the basal insulin (Lantus) dose sooner. As of today, I still have not returned to olympic weightlifting, but my back is improving and I hope to start back on Monday, Nov. 4th. Note that the day after the back strain on 10/20/19, I increased my walk distance from 1.5 to 2.5 miles twice daily to try stay as insulin sensitive as I was while lifting weights. Clearly, walking is not as insulin sensitizing as lifting weights. On 10/27/19, I started doing bodybuilding type machine weight training and you can see the blood sugars and Humalog doses started decreasing.

This is a pattern I have observed over and over again. Each type, duration, and intensity of exercise results in different blood sugar, insulin sensitivity, and insulin dose requirements. I have found that keeping exercise constant from day to day has helped me achieve normal blood sugars, but when changes are required, as in the case of injury, at least devising a new exercise regimen and keeping that constant will allow blood sugars and insulin doses to again stabilize.

As I have mentioned in previous posts, I decided to change from Lantus to Tresiba because of the reported lower day-to-day variability of Tresiba compared to Lantus. I have received my order of Tresiba and it is in my refrigerator ready to go as soon as my last vial of Lantus is used up. I expect to start Tresiba in November 2019.

If you have questions or topics you would like me to write about, leave them in the comments. Till next month…

#70 September 2019 Update on My T1DM Management

This is a monthly update on my glycemic management of type 1 diabetes (T1DM) using Humalog and Lantus insulin injections with a ketogenic whole-food diet and resistance and aerobic exercise.

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.

I wrote an article for DietDoctor in July titled “What you need to know about a low-carb diet and your kidneys“. You can read it here

My books are available for purchase: The Ketogenic Diet for Type 1 Diabetes also available on Amazon in print, and my other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print.

After 13 months of specifically trying to achieve normal blood sugars, I was able to accomplish that goal this month. As mentioned in previous posts, I have had a normal mean blood sugar since I started my ketogenic low-carb diet in 2012. But last year I decided I also wanted normal blood sugar variability. I used as my measure of normality, a standard deviation of blood sugar of less than 25.2 mg/dl (1.4 mmol/l). This value was measured in 434 metabolically healthy subjects in China as reported in this study. My blood sugar goals are summarized in Table 3. below.

Glycemic Results For September 2019

The table below shows my mean blood glucose (BG), standard deviation (SD), coefficient of variation (CV), calculated HbA1c, body weight, and mean insulin dose totals for September 2019. You can see I am achieved both normal mean (average) blood sugar and variability of blood sugar (standard deviation). Also note the decrease in average daily insulin dose compared to August. I attribute this to the fact that my body weight was stable throughout September as apposed to increasing in August. My current insulin dose is less than half (0.36 IU/kg/day) what it was (0.80 IU/kg/day) prior to starting regular exercise (in 2007) and a low-carbohydrate diet (in 2012).

The table below shows the percentage of blood glucose values in the indicated ranges of low, goal, and high values for September 2019. I just barely missed my stated goals for these parameters, but the low frequency of hypoglycemia is the most important one to me.

This month’s results were improved compared to August. I reached only one of my three goals for % of blood glucose readings in the three ranges above. As shown in the Table 3. above, my goals are < 10% lows, > 80% normals, and < 10% highs. I am pleased with the relatively low frequency of hypoglycemia. My true goal is 0% of blood glucose values < 70 mg/dl, but I am trying to be realistic and thus have set the goal to less than 10%.

The graphs below show all of the daily insulin dose totals and all of the blood sugar (BG) readings for September 2019. HUM = Humalog in blue, LAN = Lantus in green, INS = total daily insulin dose in red.

In olympic weightlifting, the goal is to lift as much weight as possible and to increase the weight over time. This means you are always looking to improve and you never arrive at a final destination. There is always more weight that can be added to the bar. I actually like this aspect of the sport. I like having a daily challenge. I think glycemic control in T1DM is similar to this concept. You can always seek a lower blood sugar variability. I have decided to change from Lantus to Tresiba because of the reported lower day-to-day variability of Tresiba compared to Lantus. I have one more month of Lantus left in the refrigerator and I can’t bear to throw it out given the fact that insulin is very expensive and many people with T1DM do not have access to enough insulin. I plan to start Tresiba in November 2019.

If you have questions or topics you would like me to write about, leave them in the comments. Till next month…

#69 August 2019 Update on My T1DM Management

This is a monthly update on my glycemic management of type 1 diabetes (T1DM) using Humalog and Lantus insulin injections with resistance exercise and a ketogenic whole-food diet.

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.

I wrote an article for DietDoctor last month titled “What you need to know about a low-carb diet and your kidneys“. You can read it here.

My books are available for purchase: The Ketogenic Diet for Type 1 Diabetes also available on Amazon in print, and my other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print.

This month I continued making adjustments even though I was hoping to keep everything constant for a change. I decided to go ahead and increase my weight to 73 kg, the masters olympic weightlifting class I would like to compete in. Changes in body weight are accompanied by changes in food intake, insulin doses, and blood sugar responses to those changes. Despite all these changes, I was pleased with my blood sugar results this month even though I did not reach my goals which are shown in the table below.

Glycemic Results For August 2019

The table below shows my mean blood glucose (BG), standard deviation (SD), coefficient of variation (CV), calculated HbA1c, body weight, and mean insulin dose totals for August 2019. You can see I am close to achieving both normal mean (average) blood sugar and variability of blood sugar (standard deviation). Now that I am at goal body weight, I might be able to achieve my blood sugar goals in September. If not, perhaps changing Lantus to Tresiba, which is scheduled to begin in November, will do the trick. Also note the increase in insulin dose that accompanies a larger body weight even when calculated as IU/kg/day. A higher body weight requires more daily food intake and more tissue that requires insulin. Still, this is a relatively low daily insulin requirement as most with T1DM require about 0.80 IU/kg/day which was my insulin requirement prior to starting regular exercise and a low carbohydrate diet.

The table below shows the percentage of BG values in the indicated ranges of low, goal, and high values for August 2019.

This month’s results were about the same as in July. I reached only one of my three goals for % of blood glucose readings in the three ranges above. As mentioned in previous posts, my goals are < 10%, > 80%, and < 10%, respectively. That said, the reduction in hypoglycemia is my highest priority so I am pleased with that. In addition, I needed to take glucose tablets on only 1 occasion in the month of July which is a new record low.

The graphs below show all of the daily insulin dose totals and all of the blood sugar (BG) readings for August 2019. HUM = Humalog in blue, LAN = Lantus in green, INS = total daily insulin dose in red.

Even though the range of BG excursions continues to improve (I’m not complaining), there still appears to be a significant number of BG swings.

I have decided to change from Lantus to Tresiba because of the reported lower day-to-day variability of Tresiba compared to Lantus. Note that the study that found the largest difference in day-to-day variability was conducted and paid for by the maker’s of Tresiba, so we must take the results with a grain-of-salt. Nevertheless, the best way to know if something works better – or not – is to test it for myself. I have two more months of Lantus left in the refrigerator and I can’t bear to throw it out given the fact that many people with T1DM do not have enough insulin. So I should be able to start Tresiba in November 2019.

If you have questions or topics you would like me to write about, leave them in the comments. Till next month…

#68 July 2019 Update on My T1D Management

I wrote an article for DietDoctor this month titled “What you need to know about a low-carb diet and your kidneys“. You can read it here. 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.

My books are available for purchase: The Ketogenic Diet for Type 1 Diabetes also available on Amazon in print, and my other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print.

This is a monthly update on my glycemic management of type 1 diabetes (T1DM) using Humalog and Lantus insulin injections with resistance exercise and a ketogenic whole-food diet.

This month I continued making adjustments even though I was hoping to keep everything constant for a change. Unfortunately, my earlier decision to drop my body weight to make the 67 kg weight class in olympic weightlifting was a mistake. I had reduced my calories to the point that I felt a lack of energy, was thinking a food too frequently, was wishing for more food at the end of each meal, and I suspect that my energy expenditure went down to compensate for the lack of calories. Not only was this not pleasant, but I could not train enough to be able to lift the weights needed to be competitive. So during July, I progressively increased my caloric intake in steps and each time having to readjust insulin doses upward (see graph below). This process of adjusting food intake, insulin doses, and exercise results in less than optimal blood glucose control.

Glycemic Results For July 2019

The table below shows my mean blood glucose (BG), standard deviation (SD), coefficient of variation (CV), body weight, and mean insulin dose totals for July 2019.

The standard deviation of BG was about the same as June, but I did not reach my goal of < 25 mg/dl was considered normal in the study reviewed last month (Post #67).

The table below shows the percentage of BG values in the indicated ranges of low, goal, and high values for July 2019.

This month’s results were about the same as in June. I reached only one of my three goals for % of blood glucose readings in the three ranges above. As mentioned in previous posts, my goals are < 10%, > 80%, and < 10%, respectively. That said, the reduction in hypoglycemia is my highest priority so I am pleased with that. In addition, I needed to take glucose tablets on only 4 occasions in the month of July.

The graphs below show all of the daily insulin dose totals and all of the BG readings for July 2019. HUM = Humalog in blue, LAN = Lantus in green, INS = total daily insulin dose in red.

Even though the range of BG excursions continues to improve (I’m not complaining), there still appears to be a significant number of BG swings.

I have decided to change from Lantus to Tresiba because of the reported lower day-to-day variability of Tresiba compared to Lantus. Note that the study that found the largest difference in day-to-day variability was conducted and paid for by the maker’s of Tresiba, so we must take the results with a grain-of-salt. Nevertheless, the best way to know if something works better – or not – is to test it for myself. I have three more months of Lantus left in the refrigerator and I can’t bear to throw it out given the fact that many people with T1DM do not have enough insulin. So I should be able to start Tresiba in November 2019.

If you have questions or topics you would like me to write about, leave them in the comments. Till next month…