#103 April 2022 Update on My T1D Management

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….

#102 March 2022 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 (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 March 2022

In March 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 98 mg/dL with a standard deviation of blood glucose (SDBG) of 18 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 March 2022. Fortunately, I did not have any hypoglycemic episodes nor did I need to take any glucose tablets (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 March 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, 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.

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 2,300 kcal/day which I think is closer to my needs to maintain my body weight at about 72 to 73 kg.

Below is a photo of myself from April 2021 at 69.7 kg (153 lb.).

Below is a photo of myself from today, 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 April 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….

#101 February 2022 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 (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 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 chapter 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 2022

In February 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 98 mg/dL with a standard deviation of blood glucose (SDBG) of 18 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 February 2022. Fortunately, I did not have any hypoglycemic episodes nor did I need to take any glucose tablets (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 February 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, 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.

The table below tracks my total daily meal macronutrients, body weight, insulin dosage, and the ketogenic ratio of my diet.

I stopped thinking about food (my symptom of being hungry) so I decreased my daily caloric intake to 2,500 kcal/day which I think is closer to my needs to maintain my body weight at about 72 to 73 kg. I reduced the amount of cashews and peanuts in my diet to reduce my total daily carbohydrate intake. They are my favorite nuts (technically peanuts are legumes and cashews are drupes as are almonds and pistachios) but are the highest in carbs relative to all the other nuts. I suspect that is why I like them so much. Cashews are 21% carbohydrate (% of calories), 68% fat, and 10% protein. Peanuts are 11% carbohydrate, 72% fat, and 17% protein. Now I am only eating 10 g/day of cashews and 10 grams of peanuts/day (a spoonful of each). When my current supply of cashews runs out, I will stick with just peanuts to reduce my carb intake a bit further.

The food industry understands that the human palate likes the combination of carbs and fat. If you look at the macros of most processed foods, you will see roughly equal caloric amounts of carbs and fat, e.g., 45% from carbs, 45% fat, and lower protein, e.g., 10% protein (% of calories). For example, Doritos snack chips are 53% carbohydrate, 41% fat, and 6% protein (% of calories). Foods in nature are not composed this way. This macronutrient combination drives up insulin secretion (insulin requirements in those with T1D) and our desire to eat processed foods. There are many processed foods that I used to eat that I would like to eat now. But the knowledge of the illnesses that eating processed foods can create in the long run, prevents me from eating them. Perhaps eating a ketogenic diet because I developed T1D will ultimately improve my healthspan and lifespan beyond what it would have been had I never developed T1D. The above may also explain the U.S. and global obesity and diabetes pandemics: a processed food induced global pandemic! Perhaps it also accounts for the morbidity and mortality from COVID-19. The most vulnerable persons being those who ate the most processed foods for the longest period of time, i.e., those who are elderly, have obesity, diabetes, and/or hypertension (all associated with insulin resistance).

Below is a photo of myself from April 2021 at 69.7 kg (153 lb.).

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 ≈ 75 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 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 March 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….

#100 January 2022 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 (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 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 chapter 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 2022

In January 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 96 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 January 2022. Fortunately, I did not have any hypoglycemic episodes nor did I need to take any glucose tablets (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 values < 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 January 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, 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.

The table below tracks my total daily meal macronutrients, body weight, insulin dosage, and the ketogenic ratio of my diet.

I increased my caloric intake in January until I stopped thinking about food (my symptom of being hungry) to 3,100 kcal/day which was more than I had anticipated needing. I no longer think about food and I feel energetic which is important to me. The addition of cashews and peanuts into my diet explains the increase in total daily carbohydrate intake. They are my favorite nuts (technically peanuts are legumes and cashews are drupes as are almonds and pistachios) with macadamia nuts a close third. I haven’t eaten cashews or peanuts in a long time simply because they have the highest carb count per gram compared to other nuts. I suspect that is why I like them so much. The combination of carbs and fat is a culinary temptation for humans. Cashews are 21% carbohydrate (% of calories), 68% fat, and 10% protein. Peanuts are 11% carbohydrate, 72% fat, and 17% protein. This is why I am only eating 14 g/day (a spoonful) of cashews and 42 grams of peanuts/day. When my current supply of cashews runs out, I will stick with just peanuts to reduce my carb intake.

The food industry understands that the human palate likes the combination of carbs and fat. If you look at the macros of most processed foods, you will see roughly equal caloric amounts of carbs and fat, e.g., 45% from carbs, 45% fat, and lower protein, e.g., 10% protein (% of calories). For example, Doritos snack chips are 53% carbohydrate, 41% fat, and 6% protein (% of calories). Foods in nature are not composed this way. This macronutrient combination drives up insulin secretion (insulin requirements in those with T1D) and our desire to eat processed foods. There are many processed foods that I used to eat that I would like to eat now. But the knowledge of the illnesses that eating processed foods can create in the long run, prevents me from eating them. Perhaps eating a ketogenic diet because I developed T1D will ultimately improve my healthspan and lifespan beyond what it would have been had I never developed T1D. The above may also explain the U.S. and global obesity and diabetes pandemics: a processed food induced global pandemic! Perhaps it also accounts for the morbidity and mortality from COVID-19. The most vulnerable persons being those who ate the most processed foods for the longest period of time, i.e., those who are elderly, have obesity, diabetes, and/or hypertension (all with insulin resistance).

In January, I gained 2.4 kilograms of body weight which is fine. My experimentation with different caloric and protein intakes and their effects on appetite and insulin doses has been enlightening.

Below is a photo of myself from April 2021 at 69.7 kg (153 lb.).

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 ≈ 75 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 1.2 shows the mean interstitial glucose (IG) and standard deviation of the interstitial glucose (SDIG) of 732 non-diabetic subjects as measured by CGM from the seven studies referenced below. In September 2021, I found two additional studies in the medical literature and added them to Table 1.2 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 February 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….

#99 December 2021 Update on My T1D Management

Happy New Year !!!

I have never made serious New Year resolutions, but have always thought about one thing I would like to improve about myself. This year, 2022, I would like to reduce my glycemic variability to < 16 mg/dL, have no symptomatic hypoglycemia episodes, and eliminate all blood sugars < 70 mg/dL. Of those three goals, the third will be the most challenging, but if I can achieve it some, but not necessarily every month, I will be satisfied. Having only 1-2 symptomatic hypoglycemic episodes per year has been a great relief, but in fact, I don’t think I had any in 2021. This is my primary motivation for continuing to manage my T1D as carefully as I do.

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 (olympic weightlifting) and aerobic (walking) 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 December 2021

In December 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 < 70 mg/dL. My mean blood glucose for the entire month was 95 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 December 2021. Fortunately, I did not have any hypoglycemic episodes nor did I need to take any glucose tablets (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 values < 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 December 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.

The table below tracks my total daily meal macronutrients, body weight, insulin dosage, and the ketogenic ratio of my diet.

I increased my caloric intake in November until I stopped thinking about food (my symptom of being hungry) and then in December I decreased it to 2,500 kcal/day which I think is just right. I no longer think about food and I feel energetic which is important to me. I also added back cashews and peanuts, 16 g/day of each, into my diet which explains the increase in total daily carbohydrate intake. They are my favorite nuts (technically peanuts are legumes and cashews are drupes as are almonds and pistachios) with macadamia nuts a close third. I haven’t eaten cashews or peanuts in a long time simply because they have the highest carb count per gram compared to other nuts. I suspect that is why I like them so much. The combination of carbs and fat is a culinary temptation for humans. Cashews are 21% carbohydrate (% of calories), 68% fat, and 10% protein. Peanuts are 11% carbohydrate, 72% fat, and 17% protein. This is why I am only eating 16 g/day (a spoonful) of each. The food industry understands this and if you look at the macros of most processed foods, you will see roughly equal caloric amounts of carbs and fat, e.g., 45% from carbs, 45% fat, and lower protein, e.g., 10% protein (% of calories). For example, Doritos snack chips are 53% carbohydrate, 41% fat, and 6% protein (% of calories). Foods in nature are not composed this way. This macronutrient combination drives up insulin secretion (insulin requirements in those with T1D) and our desire to eat processed foods. There are many processed foods that I would like to eat if I didn’t have T1D and the knowledge of the illnesses they can create in the long run. Perhaps developing T1D, my desire to avoid hypoglycemia by following a ketogenic diet, and the knowledge I acquired in the process will ultimately improve my healthspan and lifespan beyond what it would have been had I never developed T1D. The above may also explain the U.S. and global obesity and diabetes pandemics: a processed food induced global pandemic! Perhaps it also accounts for the morbidity and mortality from COVID-19. The most vulnerable persons being those who ate the most processed foods for the longest period of time, i.e., those who are elderly, have obesity, diabetes, and/or hypertension (all with insulin resistance).

In December, gained about a kilogram of body weight which is fine. My experimentation with different caloric and protein intakes and their effects on appetite and insulin doses has been enlightening.

Below is a photo of myself from April 2021 at 69.7 kg (153 lb.).

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 ≈ 75 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 1.2 shows the mean interstitial glucose (IG) and standard deviation of the interstitial glucose (SDIG) of 732 non-diabetic subjects as measured by CGM from the seven studies referenced below. In September 2021, I found two additional studies in the medical literature and added them to Table 1.2 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 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 January 2022 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….

#98 November 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 November 2021

In November 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. I decided to experiment with decreasing my target blood glucose to 90 mg/dL beginning on September 8, 2021. My mean blood glucose for the entire month was 95 mg/dL with a standard deviation of blood glucose (SDBG) of 16 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 November 2021. Fortunately, I did not have any hypoglycemic episodes nor did I need to take any glucose tablets (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 ≤ 18 mg/dL (1.0 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 values < 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 November 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.

The table below tracks my total daily meal macronutrients, body weight, insulin dosage, and the ketogenic ratio of my diet.

My third attempt to lower and maintain my body weight in the 67 kg weight class for Masters Olympic Weightlifting was unsuccessful. I continued thinking about food a lot without being overtly hungry, but my athletic performance deteriorated to the point that there would be no advantage to being in the lower weight class. I have decided to eat enough food to feel and perform well and let my body weight be what it will be. My guess is 70 kg (154 lb.) and 2,800 kcal/day will be just about right. My experimentation with different caloric and protein intakes and their effects on appetite and insulin doses has been enlightening.

Below is a photo of myself from April 2021 at 69.7 kg (153 lb.).

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 ≈ 75 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 1.2 shows the mean interstitial glucose (IG) and standard deviation of the interstitial glucose (SDIG) of 732 non-diabetic subjects as measured by CGM from the seven studies referenced below. In September 2021, I found two additional studies in the medical literature and added them to Table 1.2 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 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 November 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….

#97 October 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 October 2021

In October 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. I decided to experiment with decreasing my target blood glucose to 90 mg/dL beginning on September 8, 2021. I might need to increase my target blood glucose in order to hit my goal of no blood glucose values less than 70 mg/dL. My mean blood glucose for the entire month was 94 mg/dL with a standard deviation of blood glucose (SDBG) of 19 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 October 2021. Fortunately, I did not have any hypoglycemic episodes nor did I need to take any glucose tablets (Smarties™) this month.

My blood sugar goals are shown in Table 2.2 below. My goal for the standard deviation of blood glucose (SDBG) to ≤ 18 mg/dL (1.0 mmol/l). I will continue with my target blood glucose set at 90 mg/dL for now, but will adjust it upwards if I experience any hypoglycemic episodes or if the number of blood glucose values < 70 mg/dL increases.

The table below summarizes my glycemic results for October 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.

The table below tracks my total daily meal macronutrients.

Near the end of October 2021, I started thinking about food again and decided to increase my protein and total daily caloric intake. Time will tell what happens with my body weight. Reducing dietary protein for most of the month did not appear to lower my insulin doses significantly, but I had reduced the protein intake for only 3 weeks. I think dietary protein reduces hunger, or thoughts of food in my case, but again that is difficult to determine because the total caloric intake increased when the protein intake increased. Below is a photo of myself from April 2021. I will eventually take another photo, but honestly, I don’t look any different at 67.3 kg than I did in the photo from April 2021 when I was weighting 69.7 kg.

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 ≈ 75 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 1.2 shows the mean interstitial glucose (IG) and standard deviation of the interstitial glucose (SDIG) of 732 non-diabetic subjects as measured by CGM from the seven studies referenced below. In September 2021, I found two additional studies in the medical literature and added them to Table 1.2 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 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 November 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….

#96 September 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 September 2021

In September 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. I decided to experiment with decreasing my target blood glucose to 90 mg/dL beginning on September 8, 2021. My mean blood glucose for the entire month was 93 mg/dL and standard deviation of blood glucose (SDBG) was 16 mg/dL, equivalent to non-diabetic individuals (see below). The graph below shows all the blood glucose measurements and daily insulin dose totals for September 2021. Fortunately, I did not have any hypoglycemic episodes nor did I need to take any glucose tablets (Smarties™) this month.

My blood sugar goals are shown in Table 2.2 below. My goal for the standard deviation of blood glucose (SDBG) to ≤ 18 mg/dL (1.0 mmol/l). I will continue with my target blood glucose set at 90 mg/dL for now, but will adjust it upwards if I experience any hypoglycemic episodes or if the number of blood glucose values < 70 mg/dL increases.

The table below summarizes my glycemic results for September 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.

The table below tracks my total daily meal macronutrients.

During September 2021, I kept my total daily caloric intake constant because I felt I was on the verge of becoming hungry. I even thought about increasing my caloric intake, but held on, hoping to reduce my body weight to 67 kg, the next lower weight class in master’s olympic weightlifting. I finally got to 67.3 kg body weight at the end of the month without feeling hungry or thinking about food constantly as I have during previous attempts to reach 67 kg. I think the difference this time was recognizing that there is a lag from the time one reduces caloric intake to when the body decides it is safe to give up body fat, so to speak. In late September and for the month of October 2021, I am experimenting with reducing my dietary protein intake to see if it will reduce my insulin requirements while keeping my caloric intake the same. I will be monitoring my muscle mass, but honestly, I have consumed quite a range of dietary protein intakes over the years since starting resistance exercise and have not noticed any significant changes in muscle mass. I think the primary stimulus for muscle growth is resistance exercise and taking more dietary protein doesn’t add much to that stimulus. Below is a photo of myself from April 2021. I will eventually take another photo, but honestly, I don’t look any different at 67.3 kg than I did in the photo from April 2021 when I was weighting 69.7 kg.

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 ≈ 75 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 1.2 shows the mean interstitial glucose (IG) and standard deviation of the interstitial glucose (SDIG) of 732 non-diabetic subjects as measured by CGM from the seven studies referenced below. In September 2021, I found two additional studies in the medical literature and added them to Table 1.2 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 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 October 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….

#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….