#79 May 2020 Update on My T1DM Management

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

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.

Lift of the Month – May 2020

Glycemic Results For May 2020

In May 2020, I turned 60 years of age and celebrated with gratitude that I’m in good health despite having T1D. My glycemic results were close to my stated goals with a mean blood glucose of 98 mg/dl and a standard deviation of blood glucose of 18 mg/dl.

The graph below shows all the blood glucose measurements and daily insulin dose totals for May 2020.

My blood sugar goals are shown in Table 2.3 below. I used as my measure of normality, a standard deviation of blood glucose (SDBG) of ≤ 18 mg/dl (1.0 mmol/l).

The table below shows my body weight at the end of the month, 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 take to supplement my Tresiba dose to adjust for the variations in my bedtime blood glucose. 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 < 70 mg/dl, between 70 and 130 mg/dl, and > 130 mg/dl. My goal is to have 100% my of blood glucose values fall in the range 70−130 mg/dl. I did not meet this goal this month, although I came pretty close. I did not have any hypoglycemic episodes or need to take any glucose tablets (or Smarties™) this month.

The graph below shows my breath acetone measurements for the month of May 2020. I use the Ketonix® acetone meter which was gifted to me in 2015 by Michel Lundell, the inventor of Ketonix® while I was on Jimmy Moore’s Low-Carb Cruise. It has been working for the past 5 years.

Ketonix reading between 25 and 50% are consistent with nutritional ketosis. For May 2020, 34% of the reading were in the range 25−50% and 66% were above that range. My current macronutrients are: 34 grams total carbs (4% of energy), 159 grams protein (23% of energy, 2.2 grams/kg BW/day), and 230 grams fat (73% of energy). The ketogenic ratio (KR) of my diet is 1.88. I will discuss the KR in a later post and its value in predicting whether or not a particular diet is likely to result in nutritional ketosis. The reference is here.

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.

My goal for June 2020 is to eliminate all BG values < 70 mg/dl. I will increase my target BG to 105 mg/dl and see if that is all that is required and hope my mean BG stays ≈ 100 mg/dl and the number of BG values > 130 mg/dl does not increase too much.

Till next time….

6 comments

  1. Leigh Rollins

    Hi, I’m ready to read “The Ketogenic Diet for Type 1 Diabetes” a second time. I’ve been T1d for 38 years; I switched to a LC Diet about 7 years ago and VLCHF lat year, then finally keto this past Jan. I’m getting a great deal of push-back from my endo and cardiologist on my cholesterol numbers but refuse to take a statin more than twice a week.

    How do you handle push-back on keto and cholesterol from your peers? Thank you.

    Like

    • Keith Runyan, MD

      Hi Leigh, It wasn’t an issue when I was practicing. The bottomline is each individual is ultimately responsible for their own health and lifestyle decisions. Doctors serve as advisors, not dictators. You should do whatever feels right for you. Keep in mind that the #1 cause of cardiovascular disease in T1D is poor-glycemic control. If your diet improves your glycemic control, you would likely reduce your risk of CVD. If you want to push-back on your endo or cardiologist, politely ask them to provide evidence from the medical literature that statins will improve your risk of developing CVD or better yet, improve all-cause mortality. Depending on what they find, one or both of you might learn something new. Cheers.

      Like

      • Leigh Rollins

        Thank you for your quick response! For the past 3 years, my A1c’s have been between 5.6-5.8. Then before that in the 6’s on LC. Of course, it was in the 7’s on the SAD. Since I’ve been on the Tandem CIQ, my hypos have decreased plus I’m in range a greater part of the time. Thanks again!

        Like

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