#73 December 2019 Update on My T1DM Management

Happy New Year to All !!!

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.

In October 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 December 2019

My December 2019 glycemic results were a new record: the lowest monthly blood glucose variability, as measured by standard deviation, since my diagnosis of type 1 diabetes in 1998. I started taking Tresiba on November 22, 2019 in hopes of further reducing my blood glucose variability and although the improvement was minimal, it is safe to say that Tresiba is at least as good as Lantus, if not slightly better. I think some additional time will help sort this out.

The graph below shows all the blood glucose measurements and daily insulin dose totals for December 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 graphs below show the individual mealtime and bedtime bolus Humalog doses for the month. I think what is remarkable about these doses is how much they vary from day to day despite keeping each meal and exercise session rather constant. The variability is greatest for dinnertime Humalog dose which follows the 2.5 hours of afternoon exercise.

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 December 2019, I have reached all of the blood sugar goals I had set. My total daily insulin dose is satisfactorily low and stable. I continue to be cautiously optimist that I can continue to meet these goals henceforth by maintaining the consistency of my very low-carbohydrate diet and daily exercise (aerobic (walking 1.5 miles twice daily with a weighted vest) and weightlifting 2 hours daily).

The table below shows the mean and 95th percentile of the interstitial glucose and standard deviation of the interstitial glucose of 564 nondiabetic subjects as measured by CGM from the five studies referenced below.

The references for these five studies are shown below.

Since January 1 is the day for setting yearly goals, my goal for 2020 is to eliminate all blood glucose values below 70 mg/dl and I am setting a new goal of a standard deviation of blood glucose ≤ 18 mg/dl which will be within the range of mean values for non-diabetics from the five studies referenced above as shown in the Table below.

Wishing you a happy and healthy new year!

9 comments

  1. Joel Brandt

    Wow am I ever impressed.
    Your Time In Target, YOUR target range specifically is impressive. Keep up the meticulous work, it will pay off.
    Curious – switching from Lantus to Tresiba, What triggered the decision to make that shift? If Lantus was previously working, and costs half as much as Tresiba? Why specifically Tresiba? Have you tried detemir (Levemir) ?

    Also – I recently read from a reliable source (unsure if you would want me to post the reference to another book or not, so i’ll leave it unless you reply indicating otherwise), that Lantus may contribute to cancer cell growth? Have you heard this, What’s your take on this?

    Always appreciate your feedback! Joel

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    • Keith Runyan, MD

      Thanks Joel. As stated, several published studies have shown a lower glycemic variability with Tresiba compared to Lantus. I wanted to see if it panned out for me. The cost difference is not that much. I tried Levemir, definitely not as good as Lantus. Lantus has not been shown to cause cancer in persons with diabetes. The book you are referring to quotes an old epidemiologic study in persons with type 2 diabetes whose results have never been replicated. Epidemiologic studies cannot prove causation.

      Liked by 1 person

      • Joel Brandt

        Thanks, I may explore Tresiba (vs Lantus) based on that reply paired with even further digging. 🙂

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  2. Svet Pavlovsky

    Happy New Year, Keith! That is very nice that you achieved your target blood sugars. With the move to Tresiba, do you inject it once in two days? Is the Humalog before bed is a correction dose?

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    • Keith Runyan, MD

      Thanks, same to you too. I inject Tresiba once daily at bedtime. Yes, the bedtime Humalog is designed to correct for varying bedtime blood sugar readings so that the Tresiba dose can be kept constant. I did give one dose of 16 units only because the Tresiba pen only had 16 units left in it.

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  3. Nancy Dougherty

    I’ve recently watched Netflix, “What the Health”. They advocate T1 being caused by milk. The advice from their doctors also propose a plant based diet.

    Do you have an opinion?

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