#72 November 2019 Update on My T1DM Management

This is a monthly update on my glycemic management of type 1 diabetes (T1DM) using Humalog and now Tresiba 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.

Last 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.

Glycemic Results For November 2019

My November 2019 glycemic results were a new record: the best blood sugar results since my diagnosis of type 1 diabetes in 1998. I also started taking Tresiba on November 22, 2019 in hopes of further reducing my blood glucose variability. It is too early to know if it will, but by next month, I should have an answer. My back injury healed and I resumed olympic weightlifting on November 6, 2019.

The graph below shows all the blood glucose measurements and daily insulin dose totals for November 2019.

My blood sugar goals are shown in Table 3. below. 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.

The table below shows my monthly mean body weight, mean total daily insulin dose, mean basal insulin dose, mean bolus insulin dose, and the mean bolus insulin dose for each meal and the bedtime bolus insulin dose which I started using a few months ago to try to improve my fasting blood sugar while keeping the basal insulin dose constant. Diluting my Humalog 5:1 helps to give precise doses with meals and at bedtime.

The table below shows my blood glucose variability data including the monthly mean blood glucose, the standard deviation of blood glucose, the coefficient of variation, the calculated HbA1c, and the percentage of blood glucose values < 70 mg/dl, between 70 and 130 mg/dl, and > 130 mg/dl.

As you can see, for November 2019 I have reached all my goals. Additionally, my total daily insulin dose is satisfactorily low and stable. I have never been confident that I could actually accomplish these goals. I think my attention to details that I previously thought would not make much difference has paid off. These details include consistency of my very low-carbohydrate diet from day to day and consistency of daily exercise, both aerobic (walking 2.5 miles twice daily) and weightlifting 2 hours daily, and the use of diluted Humalog to more precisely dose bolus insulin. I will be interested in seeing if changing from Lantus to Tresiba will further improve my standard deviation of blood glucose and coefficient of variation results. I would also like to eliminate all blood glucose values below 70 mg/dl. BTW, I took a total of 2 Smarties candies (12 grams of glucose) for the month of November which I think is also a new record.

My current daily macronutrients are 44 grams of carbohydrates (10 grams of fiber) (5% of energy), 185 grams of protein or 2.5 grams/kg/day (26% of energy), and 230 grams of fat (69% of energy).

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

5 comments

  1. Eva

    Thank you for sharing your excellent results. What kind of glucose monitoring device do you use and how often do you test? I maintained a no or low carb diet for a week and felt great I couldn’t believe how eating protein foods and vegetables like cucumbers actually made me less hungry and I could exercise – I felt alive with bs average between 72-118. I then ate high glycemic carbs such as yams and pumpkin pie for the holiday and even though I delivered insulin correctly got low the next day and then blew into 449 without a bolus injection! I use my glucometer that I’ve had for several years and am considering a new one with more features. I’m thinking wine could have done this. Thank you again Dr. Runyan!

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  2. Joel Brandt

    I purchased and read and support your book, amazing insight.
    Your oly lifts are impressive, the weight you moved is higher than I would have guessed! Well done.

    On that, while lifting, our BS spikes. Are e shouting ourselves in the foot by elevating our sugars? Do you Pre-bolus for lifting?

    What about for long distance running… I’m in keto, and fat adapted but don’t want to drop dangerously low while on a 6 mile run. Do you suggest eating fat carbs prior to the run? Or just consume them during the run as needed? Both of which knocks you out of keto correct? Is it worth it?

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    • Keith Runyan, MD

      Thanks Joel, these are good questions, but hard to answer for a specific person via a blog comment. If you look back to my old posts, you will see a time when my BG spiked frequently after weightlifting, but the amount of increase was quite variable so I did not feel comfortable with dosing insulin before a workout to prevent a BG spike for fear I would become hypo. I don’t think short-term BG spikes are particularly harmful. However, if you want to do weightlifting long-term, you should find a solution to the BG spikes. That’s what I embarked on about a year ago and finally figured it out. Consistency was the key for me, both in meals and all types of exercise. It kind of makes sense after seeing it work out. Regarding endurance exercise, you should always carry glucose tabs with you and take them as needed while you are figuring out how to keep your BG stable during runs. Taking enough glucose to raise a low BG will not interfere with nutritional ketosis, in fact, the exercise increases ketosis. This is called POST-EXERCISE KETOSIS. See this paper from 1980. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1279383/pdf/jphysiol00778-0089.pdf

      My coaching service is designed to help people find solutions to these types of BG problems.

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      • Joel Brandt

        Thank you for the reply and the link to the study done in South Africa, very interesting.
        I’m glad to have found a Keto-type1-Oly-Dr to follow along with! Incredible insight, and impressive a1c & time in range. Please keep the insight coming!

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