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.
This month I did an interview with Ross Wollen on asweetlife.org titled “Interview: Dr. Runyan is the Diabetic Ketogenic Athlete.” You can read it here.
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.
Last month, after 13 months of specifically trying to achieve normal blood sugars, I was able to accomplish that goal. This month, in addition to achieving a normal average and standard deviation of blood sugar, I was able to reach an additional blood sugar goal: the percentage of blood sugar values in the range 70 to 130 mg/dl of > 80%. This was despite having a back strain on 10/19/19 during olympic weightlifting that required changing my exercise regimen and insulin doses significantly. 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 October 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 October 2019. You can see I have achieved both normal mean (average) blood sugar and variability of blood sugar (standard deviation). Note the increase in average daily insulin dose compared to September. As mentioned, I attribute this to the change in exercise due to the back strain. My current insulin dose (0.39 IU/kg/day) is still less than half what it was (0.80 IU/kg/day) prior to starting regular exercise in 2007 and a ketogenic 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 October 2019. I met two out of three of 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 last month. 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 October 2019. HUM = Humalog in blue, LAN = Lantus in green, INS = total daily insulin dose in red. You can see the increase in insulin doses beginning after the back strain on 10/19/19. In contrast to times past, the increase in insulin doses was modest and stabilized much sooner. I think this why I was able to keep the blood sugars normal this month. You can also see the increase in blood sugars after 10/19/19 that prompted the increase in insulin doses. It took 3 days of insulin dose increases to resolve the high blood sugars. Had I known exactly how long it would take for my back to recover, I would have increased the basal insulin (Lantus) dose sooner. As of today, I still have not returned to olympic weightlifting, but my back is improving and I hope to start back on Monday, Nov. 4th. Note that the day after the back strain on 10/20/19, I increased my walk distance from 1.5 to 2.5 miles twice daily to try stay as insulin sensitive as I was while lifting weights. Clearly, walking is not as insulin sensitizing as lifting weights. On 10/27/19, I started doing bodybuilding type machine weight training and you can see the blood sugars and Humalog doses started decreasing.
This is a pattern I have observed over and over again. Each type, duration, and intensity of exercise results in different blood sugar, insulin sensitivity, and insulin dose requirements. I have found that keeping exercise constant from day to day has helped me achieve normal blood sugars, but when changes are required, as in the case of injury, at least devising a new exercise regimen and keeping that constant will allow blood sugars and insulin doses to again stabilize.
As I have mentioned in previous posts, I decided to change from Lantus to Tresiba because of the reported lower day-to-day variability of Tresiba compared to Lantus. I have received my order of Tresiba and it is in my refrigerator ready to go as soon as my last vial of Lantus is used up. I expect 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…