#69 August 2019 Update on My T1DM 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.

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.

I wrote an article for DietDoctor last month titled “What you need to know about a low-carb diet and your kidneys“. You can read it here.

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 month I continued making adjustments even though I was hoping to keep everything constant for a change. I decided to go ahead and increase my weight to 73 kg, the masters olympic weightlifting class I would like to compete in. Changes in body weight are accompanied by changes in food intake, insulin doses, and blood sugar responses to those changes. Despite all these changes, I was pleased with my blood sugar results this month even though I did not reach my goals which are shown in the table below.

Glycemic Results For August 2019

The table below shows my mean blood glucose (BG), standard deviation (SD), coefficient of variation (CV), calculated HbA1c, body weight, and mean insulin dose totals for August 2019. You can see I am close to achieving both normal mean (average) blood sugar and variability of blood sugar (standard deviation). Now that I am at goal body weight, I might be able to achieve my blood sugar goals in September. If not, perhaps changing Lantus to Tresiba, which is scheduled to begin in November, will do the trick. Also note the increase in insulin dose that accompanies a larger body weight even when calculated as IU/kg/day. A higher body weight requires more daily food intake and more tissue that requires insulin. Still, this is a relatively low daily insulin requirement as most with T1DM require about 0.80 IU/kg/day which was my insulin requirement prior to starting regular exercise and a low carbohydrate diet.

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

This month’s results were about the same as in July. 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 1 occasion in the month of July which is a new record low.

The graphs below show all of the daily insulin dose totals and all of the blood sugar (BG) readings for August 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 two 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…


  1. Robin

    Looking forward to your review of Tresiba! Just made the switch from Lantus myself, so far so good – I am seeing more stable lines on my Dexcom lately. Thank you so much for sharing this blog, please keep it up!!