#7: The Ketogenic LCHF Diet for T1D, 2014

In the previous post, I reviewed the results of using the ketogenic low carbohydrate high fat (KLCHF) diet for the control of my type 1 diabetes (T1D) in the year 2013, the second year since starting the KLCHF diet on Feb. 8, 2012.

In this blog post, I’ll review my results from 2014. I won’t repeat the results of measuring blood ketones that I did through August 2014 since that was covered in the last post. My goal for 2014 was to normalize my BG as long as I was not having symptoms of hypoglycemia. I was not then nor can I ever be sure that my lack of symptoms is due to brain utilization of ketones or due to hypoglycemia unawareness which can be dangerous. In 2014 with no plans to enter any triathlon events, I focused on trying to exercise daily in such a manor that my insulin sensitivity would remain constant. I learned during years 2012 – 2013 that variations in the type, intensity, or volume of exercise had a significant effect on my BG results and the amount of insulin I needed to take. Taking only one rest day would result in needing to take extra insulin by dinnertime of the rest day or the following morning. And if I had an injury including various overuse injuries or back pain, I had to take several days off from exercise to recover. This resulted in significant increases in insulin doses (up to 25% increase) and further variability in BG results while insulin dose adjustments were being made. In other words, the improved insulin sensitivity due to exercise lasted at most 24 hrs. So by trial and error I tried to find the types of sports, intensities, and volume of exercise that I could do on a daily basis such that I would not need to rest the next day, and would result in near-normal BG results with the same insulin doses. Unfortunately, this was not easy to do because of overuse injuries and back injuries and it was compounded by trying to achieve a normal BG (83 mg/dl). It was close to the end of the year 2014 (after retiring from my medical practice Sept. 26, 2014) that I had both figured out how to use a spreadsheet and had the time to enter thousands of BG and insulin dose data points into the spreadsheet. However, doing so was revealing and I noticed that my BG readings and insulin doses were seesawing up and down through the year.

Below are tables and graphs of my BG and insulin dose data for the year 2014.

Keith Runyan, MD Results 2007-2014

From the Table above one can see that in 2014 compared to 2013, my HbA1c improved from 5.6% (11 measurements) to 5.1% (9 measurements) and my mean BG from 95 to 85 mg/dl which was my goal. My body weight increased from 161 to 166 lb. related to taking coconut oil as mentioned in the previous post. The total daily insulin dose increased from 28.3 to 31.6 IU/day. The basal insulin dose increased from 21.7 to 23.6 IU/day, while the mealtime insulin dose increased from 6.6 to 7.9 IU/day. I had a total of three symptomatic hypoglycemic episodes in 2014, an increase from none in 2013. Also, increased was the frequency of BG values <51 mg/dl from 12% in 2013 to 14% in 2014. These were asymptomatic, but increasing in frequency all the same. The frequency of “adequate” BG values increased from 64% to 70%, and the frequency of high values decreased from 22% to 15% (BG 121-200) and from 2% to 1% (BG > 200 mg/dl).

Below is the one week moving average BG for the year 2014.

2014 Blood Glucose One Week Moving Average

Although the mean BG was at my goal, there seemed to be a lot of variability. I will be writing a future blog post on BG variability, but for now, I’ll just say, the less BG variability the better.

In the graphs below, the top graph shows the one week moving average total daily insulin dose for the year 2014 and the bottom graph shows the actual total daily insulin doses for the year 2014, so that you can see that the moving average is good representation of the actual data. Of course, a moving average does reduce the extremes somewhat.

2014 Total Daily Insulin Dose

My impression of the results above was that although I virtually met my mean BG goal of 83 mg/dl, the increase in frequency of BG values < 51 mg/dl, having three symptomatic episodes in the year, plus being unable to be sure that some or all of the asymptomatic low BG values were due to brain ketone utilization versus hypoglycemia unawareness, I decided that I needed to continue to make improvements. The factors that I wanted to improve were: 1) reduce the variability in both my BG meter reading results and insulin doses, 2) continue to refine my exercise regimen to reduce the variability in insulin sensitivity which I felt would require that I put more emphasis on the effect of the exercise on diabetes management and less emphasis on improving my sports performance goals (e.g. speed, endurance). I did not want to have to make that choice, but felt in the long term it was the better choice. It did not appear that I was going to be able to achieve both improving sports performance, at least in the sport of triathlon, and near-normal BG management with the currently available insulin analogs even with a KLCHF diet.

Due to recurrent back pain from improper lifting technique (of heavy objects), poor sitting posture, the aero position on my triathlon bike, and with the suggestion of my son, I decided to take up the sport of olympic weightlifting (OWL) on Dec. 8, 2014. I’ll do a future post on my experiences so far with OWL, but if you aren’t familiar with the sport and are curious, the World Weightlifting Championships are going on in Houston, Texas and you can watch them here through November 28, 2015.

In the next post, I’ll review my T1D management results so far in 2015 and give you a preview of the topics I plan to write about next.