#64 March 2019 Update on My T1D Management

This is a monthly update on my glycemic management of type 1 diabetes (T1DM) using Humalog and Lantus insulin injections with resistance exercise and a ketogenic whole-food diet as described in my book, The Ketogenic Diet for Type 1 Diabetes also available on Amazon in print. My other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print. I would appreciate anyone who has read and benefited from either of these books to leave a review on Amazon. The number and ratings of the reviews are used by Amazon to order the search results when people are looking for books on diabetes.

I now also offer online coaching for those who need some individual attention in optimizing their glycemic control for either type 1 or type 2 diabetes and/or weight management. See the Coaching page for more info.

March 2019 was an interesting month. Having reduced my body weight from 75 kg to 65 kg over the past six months, this past month I suddenly developed symptoms of excessive calorie restriction and/or excessively lean body composition. These symptoms included feeling cold, generalized fatigue, lack of desire to exercise, hunger, and frequent thoughts of food. Fortunately, it did not take long to recognize the cause of the symptoms and take corrective action. I progressively increased my daily caloric intake from 1900 kcal/day to 2700 kcal/day over about a 7 day period. The cold feeling resolved first, followed by my energy level and desire to exercise, and finally the feeling of hunger and thoughts about food ceased. My weight increased pretty quickly as well and went beyond my goal of 67 kg which is the olympic weightlifting weight class I would like to compete in at some point in the future. My weight has peaked and stabilized at 69.9 kg. I am now slowly reducing my caloric intake and adjusting my insulin doses to try and get back to 67 kg more slowly without the return of any symptoms. My current daily calorie intake is 2300 kcal/day.

Glycemic Results For March 2019

The table below shows my mean blood glucose (BG), standard deviation (SD), and coefficient of variation (CV), and mean insulin dose totals and body weight for March 2019.

The table below shows the percentage of BG values in the indicated ranges of low, goal, and high values for March 2019.

The graphs below show all of the daily insulin dose totals and all of the BG readings for March 2019.

You can see I have not met my BG goals. I am aiming for a lower BG SD, fewer BG values < 71 mg/dl, and fewer BG values > 120 mg/dl. I think the fluctuating caloric intake, body weight, and travel made my BG management more challenging. I hope that this will improve in April. Seems my goals are just out of reach each month for one reason or another. However, I will not be deterred. I will keep trying until I get it right. You can probably guess the dates of my travel from the BG graph above. If you want to guess the dates, you can leave a comment. Hint: it was a 5-day trip. Travel has always been challenging for my BG management, but this too I want to conquer.

My goal for April 2019 is to find the correct caloric intake to bring my body weight down to 67 kg, and this will likely require some slight reduction in insulin doses. Because I am eating the same breakfast and dinner everyday, I am not really “counting calories” in the usual sense of the term. I am simply using calories as a measure of food quantity. Keeping each meal constant allows me to identify a bolus insulin dose that will hopefully result in a post-meal BG in my desired target range. In April, I hope to improve my BG variability i.e. BG standard deviation and % of BG values in my target range of 71 – 120 mg/dl. Till next time ….

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8 comments

  1. theresa unter

    Just wondering if you stopped using the Metaformin/Glucophage? Perhaps you posted that in an email I missed?

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    • Keith Runyan, MD

      Hi Theresa, I was trying not to be repetitive. I am continuing the metformin, 1,500 mg with breakfast and 1,000 mg with dinner. I really think it helps reduce my insulin dosage, although the effect is small, maybe 2 IU/day. But as previously mentioned, metformin is being investigated for other potential beneficial effects like cancer prevention and because I have no side effects, I plan to continue it.

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  2. drhannahhamlin

    Amazing results! Thank you for sharing. What is your average carbohydrates intake? How often do you have to use some sort of fast acting glucose to treat a low? Thanks.

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    • Keith Runyan, MD

      Hi Dr. Hamlin, it is nice to see a young physician interested in a the ketogenic diet for diabetes. I checked out your blog. I use red cabbage to make my sauerkraut which I have 60 grams of every morning. My exact carb intake every day is 41 grams, 25 net carbs, and 17 grams fiber. The frequency that I need to take glucose tablets varies, but for the month of March, I took glucose tablets on 10 occasions. It is more than I would like, but I am working on that also. I typically take 2,3, or 4 tablets depending on what I am planning to do next. Each tablet is 4 grams of glucose. Best wishes for your fellowship. If I were able to do it over again, I would either skip doing a fellowship entirely and just learn on my own after residency, or I would try and find a preventive medicine program that emphasizes nutrition and lifestyle as medicine. I know you did not ask for my advice, but it’s too late, you just got it!!! LOL.

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      • drhannahhamlin

        Dr. Runyan, thank you for your kind a very thoughtful reply. I am so grateful. I have been eating a Whole Foods cyclic ketogenic diet for about 5 years now and it’s drastically improved my life. I find that cycling in higher carb days helps my hormonal balance. Anyway, I am so impressed that someone wrote a book about this. I’m sure your familiar with Dr. Bernstein’s Diabetes Solution book. It is informative but disregards the importance of food quality. I also treat my lows with dextrose. I use the 6g smarty packs because I find they are cheaper and more convenient to carry. I find myself increasing my total daily carb count by treating lows to a higher level than ideal. That’s what prompted my question. I’ll have to work on not over bolusing. Currently I use MDI and the freestyle libre to maintain an A1C of 5.5%. I will admit my standard deviation is far higher than ideal though. I think the stress of med school has contributed to this. As I begin family med residency this summer, I hope to create better routine. I am also considering looping. I’m unsure if you are familiar with this technique of autonomous basal adjustments, it’s a self done change to the omnipod allowing the user to set their own goal bg level (as opposed to the Medtronic 670g that has a set goal of 120mg/dL). I am VERY interested in preventative medicine and have been playing with the idea of becoming integrative or functional medicine certified. The full board certification are expensive and may not increase my salary so I’m unsure if the additional knowledge would be something I can learn on my own. The current lifestyle board certification promotes a vegan diet, which I am very much against as it relates to optimizing health, so I have ruled that off my list. I’d love to hear any recommendations you have about learning more about lifestyle and preventative medicine outside of a formal fellowship. Thanks again for your kind message, Hannah

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      • Keith Runyan, MD

        I am board certified in internal medicine, nephrology, and obesity medicine. In 30 years of practice I had a grand total of two patients ask me whether or not I was board certified. Board certification is expensive and I believe is somewhat of a “racket.” The latest issue of Internal Medicine News has an article about the American Board of Internal Medicine being sued for have a monopoly and overcharging doctors for board certification. My advice, get only enough certification to have a job or hospital privileges as needed, like in family medicine only. You can call yourself preventative, integrative, complimentary, alternative, or any other adjective you would like to let patients know you are different in your approach, but being certified in any of those areas is definitely not required in my opinion. I explored getting certified in functional medicine. On further study, it seemed like a gimmick to me. My board certification in obesity medicine was definitely not necessary, although it did give me the opportunity to meet many of the doctors in the low carb community.
        That’s my opinion, but that doesn’t mean I am right. In other words, another doctor could give completely different advice. Good luck with your studies. I still think medicine is a great profession.

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