#68 July 2019 Update on My T1D Management

I wrote an article for DietDoctor this month titled “What you need to know about a low-carb diet and your kidneys“. You can read it here. If you feel you might benefit from some individual attention and suggestions for achieving success with blood sugar control for type 1 or type 2 diabetes and/or losing excess body fat, I can assist you with a personal consultation via Skype. See the Coaching page for more info.

My books are available for purchase: The Ketogenic Diet for Type 1 Diabetes also available on Amazon in print, and my other book, Conquer Type 2 Diabetes with a Ketogenic Diet, is also available on Amazon in print.

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.

This month I continued making adjustments even though I was hoping to keep everything constant for a change. Unfortunately, my earlier decision to drop my body weight to make the 67 kg weight class in olympic weightlifting was a mistake. I had reduced my calories to the point that I felt a lack of energy, was thinking a food too frequently, was wishing for more food at the end of each meal, and I suspect that my energy expenditure went down to compensate for the lack of calories. Not only was this not pleasant, but I could not train enough to be able to lift the weights needed to be competitive. So during July, I progressively increased my caloric intake in steps and each time having to readjust insulin doses upward (see graph below). This process of adjusting food intake, insulin doses, and exercise results in less than optimal blood glucose control.

Glycemic Results For July 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 July 2019.

The standard deviation of BG was about the same as June, but I did not reach my goal of < 25 mg/dl was considered normal in the study reviewed last month (Post #67).

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

This month’s results were about the same as in June. I reached only one of my three goals for % of blood glucose readings in the three ranges above. As mentioned in previous posts, my goals are < 10%, > 80%, and < 10%, respectively. That said, the reduction in hypoglycemia is my highest priority so I am pleased with that. In addition, I needed to take glucose tablets on only 4 occasions in the month of July.

The graphs below show all of the daily insulin dose totals and all of the BG readings for July 2019. HUM = Humalog in blue, LAN = Lantus in green, INS = total daily insulin dose in red.

Even though the range of BG excursions continues to improve (I’m not complaining), there still appears to be a significant number of BG swings.

I have decided to change from Lantus to Tresiba because of the reported lower day-to-day variability of Tresiba compared to Lantus. Note that the study that found the largest difference in day-to-day variability was conducted and paid for by the maker’s of Tresiba, so we must take the results with a grain-of-salt. Nevertheless, the best way to know if something works better – or not – is to test it for myself. I have three more months of Lantus left in the refrigerator and I can’t bear to throw it out given the fact that many people with T1DM do not have enough insulin. So I should be able to start Tresiba in November 2019.

If you have questions or topics you would like me to write about, leave them in the comments. Till next month…

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2 comments

  1. Ellenor Malik (/u/j4jackj on Reddit)

    Good afternoon Keith,

    This blog post was just used as an example by a veganoid robot stalking me on Reddit. They used this page in claiming how meat and fat is bad if insulin is bad.

    The veeg (/u/lalalalabot) neglected to mention that you had been on a cut and had starved yourself to get your lowest ever insulinemia.

    The high carb vegan (who is, like you, insulin-agenetic) was using more insulin than you, and was on a deficient diet (which all plant-based diets are).

    I will reproduce the post if you desire.

    Keep up the good fight.

    ~ Ellenor

    Like

    • Keith Runyan, MD

      Hi Ellenor. I don’t quite understand the issues you are trying to raise, but that’s OK because I am not in a fight with anyone. I think anyone who has a choice of what food to eat is privileged. Meat and fat are not “bad,” nor is it “bad” for a person with T1DM to take insulin. I think the best way to handle internet stalkers is to just ignore them i.e. do not respond to them. You do not owe anyone a justification for the way you choose to eat, nor do they to you.

      Like

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