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.
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Comments or general questions are welcomed.
Till next time….