Compared to May 2016, my glycemic control was a bit worse with a higher mean blood glucose (BG), more hypoglycemia, and more hyperglycemia. However in light of the fact that I was traveling and thus eating different food and doing different exercise for 20 of 30 days in June, I’m not too disappointed.
Traveling presents a significant challenge to a type 1 diabetic who is trying to closely follow a ketogenic low carbohydrate real food diet. At restaurants I had to ask for multiple substitutions of carb containing foods in exchange for meat and vegetables. Sometimes they accommodate, other times they don’t do such a good job. At some meals, I may not get enough food and have to order something extra. Sometimes I just get along with less food rather than eat foods not on my ketogenic diet. Its benefits are too valuable to me to deviate from it. The change in exercise is also a significant challenge. This month backpacking and hiking (to which I was not accustomed to) seemed to significantly lower my BG and I supplemented with trail mix (containing nuts and raisins) and glucose tablets to prevent or treat hypoglycemia. Despite these measures the change from weightlifting to aerobic exercise (swimming and hiking) resulted in more hypoglycemia. There were several days of travel with no exercise which results in hyperglycemia the following day and a need for rapid-acting insulin correction doses. This combination increases BG variability.
The summary table of current and previous mean BG and insulin doses is shown below. Compared to May 2016, my exercise time decreased from 12 to 9 hrs/week due to the change in type of exercise and travel days with no exercise. The mean BG increased from 95 to 97 mg/dl, but my mean total daily insulin dose decreased from 35.3 IU/day to 28.5 IU/day due to a decrease in both rapid-acting insulin (from 8.9 to 5.5 IU/day Humalog) and basal insulin (from 26.5 to 23.o IU/day Lantus). I had 14 of 129 (11%) BG readings < 51 mg/dl, but all were without symptoms due to either nutritional ketosis or hypoglycemia unawareness (see blog post #12 for more details). I had 81 of 129 (63%) BG readings between 51 and 120 mg/dl, 32 of 129 (25%) between 121 and 200 mg/dl, and 2 of 129 (1%) > 200 mg/dl.
Below are my BG readings along with exercise type and time so you can see how the type, time, cessation, and resumption of exercise affects my glycemic control.
The table below shows the summary of current and previous BG variability results. Most of the results were not as good as last month with an increase in the following variability measures: standard deviation = 42, coefficient of variation = 44%, mean BG Δ per hour = 11, mean daily BG range = 90, mean time of hyperglycemia = 5.2 hr/day, mean time of hypoglycemia = 1.4 hr/day, interquartile range BG = 61. The measures of BG variability were defined and explained in blog post #10.
The actual daily insulin doses and daily insulin dose totals are shown in the graphs below. You can see the need to decrease insulin doses with the change in exercise type from resistance (weightlifting) to aerobic (swimming and hiking). I have also experienced increases and decreases in insulin requirements in the past that I did not understand.
I did not take my Ketonix breath ketone (acetone) monitor with me during travel so I have omitted that graph this month.
I required quite a few doses of rapid-acting insulin (Humalog) to correct hyperglycemia this month. The resulting change in BG is shown in the graph below. Negative values represent a decrease in BG. Again larger doses result in larger reductions in BG, but there is much variability in what in theory should be a linear result.
I have written two ebooks with Ellen Davis of ketogenic-diet-resource.com that explain how to use a real food low carbohydrate ketogenic diet to manage type 1 and type 2 diabetes. They also explain how insulin, oral, and other injectable diabetes medications need to be adjusted or discontinued at your physician’s direction after changing to the diet. In addition, they explain how the ketogenic diet can be used to support exercise while improving body composition by decreasing fat mass and increasing muscle mass. Links to relevant scientific literature are included as well.
Till next time ….