This is a monthly update on my glycemic management of type 1 diabetes (T1DM) using Humalog and Lantus insulin injections with a ketogenic whole-food diet and resistance and aerobic exercise.
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 in July 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.
After 13 months of specifically trying to achieve normal blood sugars, I was able to accomplish that goal this month. As mentioned in previous posts, I have had a normal mean blood sugar since I started my ketogenic low-carb diet in 2012. But last year I decided I also wanted normal blood sugar variability. I used as my measure of normality, a standard deviation of blood sugar of less than 25.2 mg/dl (1.4 mmol/l). This value was measured in 434 metabolically healthy subjects in China as reported in this study. My blood sugar goals are summarized in Table 3. below.
Glycemic Results For September 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 September 2019. You can see I am achieved both normal mean (average) blood sugar and variability of blood sugar (standard deviation). Also note the decrease in average daily insulin dose compared to August. I attribute this to the fact that my body weight was stable throughout September as apposed to increasing in August. My current insulin dose is less than half (0.36 IU/kg/day) what it was (0.80 IU/kg/day) prior to starting regular exercise (in 2007) and a low-carbohydrate diet (in 2012).
The table below shows the percentage of blood glucose values in the indicated ranges of low, goal, and high values for September 2019. I just barely missed my stated goals for these parameters, but the low frequency of hypoglycemia is the most important one to me.
This month’s results were improved compared to August. I reached only one of my three goals for % of blood glucose readings in the three ranges above. As shown in the Table 3. above, my goals are < 10% lows, > 80% normals, and < 10% highs. I am pleased with the relatively low frequency of hypoglycemia. My true goal is 0% of blood glucose values < 70 mg/dl, but I am trying to be realistic and thus have set the goal to less than 10%.
The graphs below show all of the daily insulin dose totals and all of the blood sugar (BG) readings for September 2019. HUM = Humalog in blue, LAN = Lantus in green, INS = total daily insulin dose in red.
In olympic weightlifting, the goal is to lift as much weight as possible and to increase the weight over time. This means you are always looking to improve and you never arrive at a final destination. There is always more weight that can be added to the bar. I actually like this aspect of the sport. I like having a daily challenge. I think glycemic control in T1DM is similar to this concept. You can always seek a lower blood sugar variability. I have decided to change from Lantus to Tresiba because of the reported lower day-to-day variability of Tresiba compared to Lantus. I have one more month of Lantus left in the refrigerator and I can’t bear to throw it out given the fact that insulin is very expensive and many people with T1DM do not have access to enough insulin. I plan 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…