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.
May 2019 was an interesting month with more changes. I now believe I have tried every possible combination of Lantus dosing. I have given it at 4 different times of the day 7 AM, 12 PM, 6 PM, and 11 PM once daily. I have given it twice daily and three times daily. I have changed the doses up and down the entire spectrum from A to Z. This month I changed my BG check times to 7 AM, 12 PM, 6 PM, and 10 PM. I also decided to change my insulin-dosing strategy and add a fourth meal daily. The reason for the fourth meal was two-fold. First, based on research in the sports science field that I mentioned last month which shows that muscle protein synthesis (MPS) is maximized by consuming 0.4 – 0.55 grams of protein/kg/meal in each meal. This stimulation of MPS is not as powerful as that produced by resistance exercise, but the benefits of exercise on MPS is also dependent on eating enough protein within the next 3-4 hours. Eating more protein than 0.55 g/kg/meal does not further increase MPS. Each meal results in net MPS over and above the muscle protein breakdown that occurs during fasting between meals and especially fasting overnight. Adding the fourth meal at bedtime potentially results in more net MPS per day. This is a hypothesis rather than a proven fact. Understand that the number of studies in humans is small and the ones that do exist are all short-term studies. Most of the studies on MPS were done in animals, primarily rats, and they too are short-term studies. However my decision to add the fourth meal was not just related to this potential, but uncertain, benefit on MPS. My second purpose was to test a different insulin-dosing strategy. The idea was to take my basal insulin (Lantus) dose with the bedtime meal, now 10 PM, such that I inject a dose of Humalog with each of the four meals daily. This means taking a total of five injections daily and no more. The Humalog dose would now have three purposes. 1) cover the meal, 2) correct for either high or low BG readings, 3) supplement my basal insulin needs for 20 of the 24 hours per day. The 20 hours represents the duration of action of Humalog of 5 hours x 4 doses daily. This last purpose is the new part. I am specifically choosing the basal insulin (Lantus) dose to cover my insulin needs between 3 AM and 7 AM, the time period where all Humalog is done. The hope is that the Lantus dose required to accomplish this will be low enough to never cause hypoglycemia at any other time of the 24-hour day. Another way of stating this is that I hope I can find a Lantus dose that is low enough that I always have to take greater than or equal to 0.4 IU of Humalog with each meal. If the Humalog dose at a meal is less than 0.4 IU, then the accuracy of drawing up my 5-fold diluted Humalog is questionable. I thing this approach makes sense because rapid-acting insulin doses can be precisely adjusted daily whereas any change in a Lantus dose takes 3-5 days to take full-effect. This method does not require eating 4 meals per day. If one chooses 3 meals per day, then Humalog could be given at 10 PM with the Lantus without eating a meal. I figured why not use the Humalog for both of the purposes stated above. I started this new regime on May 14 with 7 IU Lantus at 10 PM. I had to subsequently increase to 8, 9, 10, 11 IU, and back down to 10 IU. I hope that 10 IU at 10 PM will do the trick from this point forward. My BG values started looking pretty good on May 24th and the two lows I had subsequently is what prompted the reduction in Lantus from 11 IU to 10 IU.
This month I reached my goal weight of 67 kg at 2000 kcal/day, but today, June 1, I got hungry and fatigued again and increased my caloric intake back to 2100 kcal/day. Hopefully my weight will stay close to 67 kg so that when it comes time to compete in olympic weightlifting, I won’t need to cut much weight. An interesting observation I have had with this body weight adjustment process is that the symptoms of insufficient caloric intake is delayed. In other words, I can feel fine on the caloric intake that leads to the weight loss for several weeks before any symptoms develop. This sounds like the observation noted by overweight persons who lose weight. They find it is easier to lose the weight than to maintain the weight loss. This might be why. I think that covers all the new developments in May 2019.
Glycemic Results For May 2019
The table below shows my mean blood glucose (BG), standard deviation (SD), coefficient of variation (CV), body weight, and mean insulin dose totals for May 2019. I experienced a slight reduction in insulin doses, mean BG, SD, and CV compared to April.
The table below shows the percentage of BG values in the indicated ranges of low, goal, and high values for May 2019. Two of the three values were improved compared to April.
The graphs below show all of the daily insulin dose totals and all of the BG readings for May 2019. HUM = Humalog, LAN = Lantus, INS = total daily insulin dose. Note: I accidentally forgot to take a Lantus Dose on May 8th. I attributed that to a “senior moment” and to my frequent changes in dosing schedules. I don’t expect that to continue.
In June, I will continue with the above plan. I do not have plans for any more experiments. I think I need to give the current plan some time to settle out and see if I can get normal blood sugars in June.
I found a new study I plan to review next month regarding measuring interstitial glucose in nondiabetic subjects. It was published in 2009, so I don’t understand why it took me so long to come across it, but I guess better late than never. It is a better study than any of the others I have come across on this topic and involved 434 metabolically healthy nondiabetic subjects.
Finally, I would appreciate your comments on the idea of using inhaled insulin for the sole purpose of eating candy “as a treat.” I assume that means not very often, but I’m not sure how often that is. For me, I’m afraid that would send me down a path of having “treats” more and more often. I believe I was once addicted to chocolate and sweets in general. My low-carbohydrate diet fixed that, thank goodness. Also, not sure if this matters, but the person doing this is an endocrinologist with T1DM who states he/she follows a “not very strict low-carbohydrate diet.” To me, this means he/she understands the purpose of the low-carbohydrate diet. To me, the purpose of eating carbohydrates is to get nutrients from plant foods that are difficult to get, or are not available, in animal foods. The nutrients in my diet that come almost exclusively from plants include vitamin C, vitamin K1, manganese, lutein, and zeaxanthin. The nutrients from plants in my diet that make up at least 40% of my daily requirements include folate, vitamin E, copper, magnesium, and potassium. I would be interested in hearing your thoughts on the idea of eating candy as a “treat” with T1DM.
Well that is all I have for this month. Wishing you smooth blood sugars in June 2019.