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 has 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 – October 2020
Glycemic Results For October 2020
In October 2020, my glycemic results were improved compared to September. My mean blood glucose was 97 mg/dl and a standard deviation of blood glucose (SDBG) was 18 mg/dl. The graph below shows all the blood glucose measurements and daily insulin dose totals for October 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, 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 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.
The graph below shows my breath acetone measurements for the month of October 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.
My current macronutrients are: 40 grams total carbs (5% of energy) of which 12 grams is fiber, 170 grams protein (28% of energy, 2.3 grams/kg BW/day), and 189 grams fat (67% of energy) or 2,497 kcal/day. The ketogenic ratio (KR) of my diet is 1.57. 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.
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.
As always, my goal for November 2020 is to eliminate all BG values < 70 mg/dl. In addition, I have just changed my metformin dosage from 1,000 mg at breakfast and dinner to 1,000 mg at breakfast, 500 mg at lunch, and 500 mg at dinner to see if the lunchtime insulin (Humalog) dosage can be reduced in exchange for a slightly higher dose at dinner. I think the lower and more consistent insulin doses can be, the better. I have accepted the fact that there will always be some variation in blood glucose, but if I can continue to keep the mean and standard deviation of blood glucose normal, I will be satisfied. 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 would appreciate anyone who wants to purchase my book and derives 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….