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 February 2020
My February 2020 glycemic results were excellent except for having more blood sugars < 74 mg/dl than my goal of < 5%. My monthly blood glucose variability, as measured by standard deviation, was a new low at 16 mg/dl, since my diagnosis of type 1 diabetes in 1998.
The graph below shows all the blood glucose measurements and daily insulin dose totals for February 2020.
My blood sugar goals are shown in Tables 2.3 and 2.4 below. I used as my measure of normality, a standard deviation of blood glucose (SDBG) of less than 18 mg/dl (1.0 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. Despite this I did have to decrease my Tresiba dose by 1 IU this month to address fasting low blood sugars. 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 (SDBG), the coefficient of variation (COV), the calculated HbA1c, and the percentage of blood glucose values < 74 mg/dl, between 74 and 126 mg/dl, and > 126 mg/dl. As mentioned, my percentage of blood glucose values < 74 mg/dl was higher than my goal of < 5%. I did not need to take any glucose tablets (or Smarties) this month.
My total daily insulin dose was lower this month and on par with previous months.
Table 2.2 below shows the mean and 95th percentile of the interstitial glucose (IG) and standard deviation of the interstitial glucose (SDIG) of 564 nondiabetic subjects as measured by CGM from the five studies referenced below.
The references for these five studies are shown below.
In February, I tinkered with a mathematical model to predict insulin doses. This month, I will test it and hope that it will be the final version. It is clear that there will always be some inherent variability in blood sugars when treating T1DM with exogenous insulin, but as long as normal blood sugars can be achieved while being safe, i.e., with minimal hypoglycemia, then I will be satisfied. I expect this mathematical approach will only be useful after one has established a consistent schedule of meals, exercise, and sleep, i.e. factors known to affect insulin sensitivity.
Till next time….