#8: The Ketogenic LCHF Diet for T1D, to Nov. 2015

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 2014, the third year since starting the KLCHF diet on Feb. 8, 2012.

In this 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. Year 2015 was notable for the new sport of olympic weightlifting (OWL). With this being the first new sport since I started training in the sport of triathlon in 2007, I can now say I have noticed a pattern as far as how my BG management responds to a new exercise. That is after starting a new activity my BG, more times than not, will decrease during and after the exercise. OWL started with that pattern, but as the weights I could lift increased, I noticed some increases in BG in part related to taking glucose at the start of the activity but also presumably as a result of stress hormones, including glucagon, cortisol, epinephrine, and growth hormone. I presumed hormones were the cause because my BG increased even when taking no glucose. Later in the year as I acclimated to the activity, I stopped taking the glucose and noticed much smaller changes, some up, some down, again a repeating pattern as with other types of exercise in the past. I’ll be writing a future blog post on the effect of exercise on BG management in persons with T1D.

In June 2015 after noticing the same seesawing of BG values and insulin doses that I noticed in 2014 despite my attempts to even out my exercise regimen, I decided to make two more changes: 1) take rapid-acting insulin correction doses only if the BG result exceeded 125 mg/dl (mainly to decrease asymptomatic hypoglycemia), and 2) minimize changes in my basal insulin dose and only make changes if the morning fasting BG was <70 mg/dl or > 120 mg/dl for several consecutive days and to make a 10% or less change in dose. I knew this would result in a higher mean BG value at the end of the year, but I thought the tradeoff would be worth it. Besides, I have been unable to find any evidence that persons with T1D have any more complications with near-normal BG compared to normal BG. The data just does not exist since there are so few persons with T1D who come even close to normal or near-normal mean BG values. Also, recall from a previous post that my diabetic complications (except one) resolved with an average HbA1c of 6.2% (most of those values were prior to the national standardization of HbA1c, so it may not be comparable to results obtained currently).

Results through November 21, 2015

Shown below are the table and graphs showing my BG and insulin dose results through Nov. 21, 2015.

Keith Runyan, MD Results 2007-2015

My exercise time increased significantly from about 5 hours/week in 2014 to about 9 hours/week in 2015. My HbA1c increased from 5.1% to 5.4%, as did the mean BG from 85 to 93 mg/dl. My weight remained stable compared with 2014. Total daily insulin dose was almost unchanged with a slight decrease in basal insulin dose (23.6 to 22.1 IU/day) and a slight increase in mealtime insulin dose (7.9 to 9.9 IU/day). I have experienced two symptomatic hypoglycemic episodes so far in 2015. The frequency of BG values <51 mg/dl has improved slightly from 14% in 2014 to 12% in 2015. Whereas the frequency of BG values that I consider “adequate” decreased from 70% to 66%, the frequency of BG values in the range 121-200 mg/dl increased from 15% to 21%.

The graphs below show the one week moving average BG and total daily insulin doses for 2015. Note the seesawing of both BG and total daily insulin doses continued until July when both started to moderate in a narrower range. Also note the overall trend throughout the year was a slight increase in BG values and a decrease in total daily insulin doses (least squares regression line is shown in green) .

2015 BG and Insulin One Week Moving Averages

As always, my BG management goals are to achieve near-normal BG values to avoid diabetic complications and to minimize hypoglycemia to avoid death in the event that my asymptomatic hypoglycemia is due to hypoglycemia unawareness. As part of these goals I will continue to follow a KLCHF diet which I find is quite enjoyable and I also consider it to be health promoting and the nutritional ketosis that results may provide some protection from hypoglycemia due to brain utilization of ketones. Finally, I will continue my exercise aiming for daily exercise that results in a consistent level of insulin sensitivity that will minimize both fluctuations in BG and insulin doses and keep insulin doses to a minimum.

In future posts, I’ll start writing about topics related to T1D. Here is a list of topics I have planned. At the end of each post, I’ll update my BG and insulin dose results since the previous post.

  1. My Ketogenic Low Carbohydrate High Fat Paleo Diet
  2. Measures of Blood Glucose Variability in T1D & My Results
  3. Ketone Metabolism – Basic Biochemistry
  4. Ketones – Brain Fuel During Hypoglycemia
  5. Nutritional Ketosis versus Diabetic Ketoacidosis
  6. Why Insulin Preparations Do Not Mimic Normal Insulin Secretion in T1D
  7. Hypoglycemia – The Major Limiter in Achieving Normal Blood Glucose
  8. Pharmacokinetics of Different Insulin Preparations
  9. Diabetic Complications – Why You Want To Avoid Them
  10. How Exercise Affects Blood Glucose Management
  11. Home Blood Glucose Meters
  12. The Hemoglobin A1C Test
  13. The Fructosamine Test
  14. Continuous Glucose Monitors
  15. Insulin Pumps
  16. The Artificial Pancreas
  17. Pancreas Transplantation
  18. Islet Cell Transplantation

If you have any topics not listed above that you would like me to address, just leave a comment and I’ll add it to my To Do list. Have a Happy Thanksgiving!

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2 comments

  1. Svet Pavlovsky

    Hi, I know you have not experienced the honeymoon phase in T1D but would like if possible a topic on honeymoon and how to prolong it for newly diagnosed. I know the most important is not overload the pancreas with sugars. Thanks, Svet

    Like

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