About

This is the personal blog of Keith Runyan, MD. The purpose is to chronicle the management of my type 1 diabetes with a ketogenic diet while pursuing exercise for enjoyment and its health benefits. As I will explain in detail, a ketogenic diet has several unique benefits in the management of type 1 diabetes as well as for type 2 diabetes, metabolic syndrome, pre-diabetes, glucose intolerance, and insulin resistance. The ketogenic diet has benefits for other medical conditions, but my main emphasis will be on diabetes with which I have personal experience and on the metabolic syndrome for which there is the most scientific evidence in the published literature to substantiate it.

You are welcome to post your comments at the bottom of a blog post to initiate a dialogue, but I do ask that you not use the opportunity to attack me or others who post comments. By attack I mean personal derogatory statement(s). Constructive criticism is acceptable as long as it is not relentless. The purpose of comments in my mind is to provide feedback on your experiences with and exchange information regarding diet and exercise in those with diabetes or related conditions.

If you prefer to contact me directly, shoot me an email

krunyanmd@gmail.com

09-01-27 Keith Runyan Photo Crop 1

12 comments

  1. Peter Defty

    HI Keith, please shoot me an email….I think I can improve the trajectory you are on….it is the right one! Congrats on your epiphany. (BTW, I was a reviewer for both Art & Science books and am mentioned in the Performance book in the case studies)

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  2. Lisa Croft

    My coworker has given me information about you and the Ketogenic diet. I am extremly interested in learning more & applying this into my life. Thank you for taking the time to share your information, it is truly appreciated & I look forward to learning much more.
    Lisa Croft. Livermore, CA

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  3. Alan Nove

    I just bought your book for type 1 diabets, thank you.

    My Grand-daughter (13 yrs old) has type 1 diabetes, and still in her honeymoon phase. Would like your thoughts on getting her into LCHF diet to reduce stress on her pancreas, and maybe making her life more normal.

    She has doctor here in Anchorage who would work with you – I believe.

    One thing, she is very very thin, as went into coma from starving before discovered that she was type 1 diabetic.

    Please respond if you can assist or you know someone who can. We are happy to take her to your practice in FL.

    Alan

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    • Keith Runyan, MD

      Hi Alan, I hope the book gives you, your granddaughter, and her doctor the information they need. The LCHF ketogenic as described in the book is appropriate for children with type 1 diabetes. It is unclear whether the diet will prolong the honeymoon period. I discussed this issue in blog post #18. It certainly won’t hurt and will likely improve her glucose control with less insulin and fewer hypoglycemic episodes which is a great help. My email is in the About section should her doctor want to contact me, I can answer questions as needed.

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  4. Brian J Gilbreath

    Hi Dr. Runyan,

    I had my first bout with hypoglycemic unawareness last night. I have been following a strict ketogenic diet for about 3 months, but have done ketogenic diets for about half of the time that I have been Type I (7 years). I know this means I need to scale back my basal dose, but it did create some anxiety as it occurred right before I was to go to sleep. My BGC dropped was at 40 when I checked it before bed, and I over-corrected up to almost 400. I am scheduled to get a continuous monitor in November – my endocrinologist is making me come in for an office visit to put the transmitter in place the first time – but if I’m keto-adapted, will I wake up if my BGC is low and my ketone levels drop? Thank you so much for your blog!

    Brian

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    • Keith Runyan, MD

      There is not enough information to answer your question specifically so I’ll try to address your question in general terms. Hypoglycemia unawareness means that one has fewer or no symptoms of hypoglycemia due to recent recurrent episodes of hypoglycemia. Avoidance of hypoglycemia for about 2-3 weeks is enough to restore awareness of hypoglycemia. On a ketogenic diet, there may be enough ketones to supply the brain such that a low blood glucose (BG) would not cause symptoms since the ketones are providing the energy the brain needs. In this later case, not having symptoms is not a problem. In the case of hypoglycemia unawareness, not having symptoms is a problem because the brain does not have ketones to use for energy. Unfortunately, there is no definite way to distinguish one from the other.
      A continuous glucose monitor (CGM) has a low alarm that should awaken you from sleep before your glucose gets so low as to be dangerous i.e. one of the potential advantages of using the device.
      You can avoid over-correcting your BG by taking one or two glucose tablets (4 grams each) and rechecking your BG in about 15 mins so you know it has been corrected before going to sleep. Hope that helps.

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      • Brian J Gilbreath

        In my case, I’m pretty positive that I didn’t have symptoms because I had sufficient blood ketones. I don’t have a blood ketone monitor however, so I don’t know what those levels were. My concern is that if my blood ketone levels didn’t stay elevated as a replacement for blood glucose, that the mechanism for making me aware of low blood glucose wouldn’t activate as my ketones dropped. Personally, I don’t want to be the N=1 experiment to see what happens if my BGC is 15 and my ketone levels drop, but the idea that being ketogenic could cause me to not experience hypoglycemic symptoms had never occurred to me before yesterday, and I’m a little bit freaked out, to be honest. I adjusted my morning basal dose in half today so that I can start readjusting my calculations from there. Thank you so much for your response! You wouldn’t believe (or maybe you would) the response my endocrinologist or primary care physician would give me if I asked them this question!

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      • Keith Runyan, MD

        I think you are not understanding my explanations of nutritional ketosis versus hypoglycemia unawareness in the setting of asymptomatic hypoglycemia. If you understood the difference, there would be no reason to “freak out.” Anyway, you are doing the right thing by adjusting your insulin to avoid hypoglycemia. You should be able to discuss any of your medical concerns with your doctors. In addition, I recommend that you involve your doctors, especially your endocrinologist, in helping you to manage your diabetes with a ketogenic diet. Before you assume they won’t approve, you should discuss it with them. You might be surprised.

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  5. Will Catterson

    I ate a well formulated low carb, high fat diet for a couple years and achieved fantastic blood sugar control. I’ve had type 1 diabetes for 14 years and I’m now 44. Although I achieved an A1C of 5.0 without frequent lows, the diet did not suit me well in terms of mood, sex drive, and sleep quality. By increasing carbs to roughly 25% – 40% of total calories, my mood, sex drive, and sleep quality increased significantly. Unfortunately, eating more carbs has made blood sugar control a little harder. My overall control is still good, but I have to be more careful with protein and calorie intake overall. Do you have any ideas why some people feel amazing on a very low carb high fat diet while others do not?

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    • Keith Runyan, MD

      Not really, everyone is different. I do think how quickly the carbohydrate intake is reduced may have something to do with it. A slower rate of dietary carbohydrate reduction allows one to adapt better and make the necessary changes in insulin doses as well. Eating 25-40% of calories from carbohydrate will necessitate higher insulin does, greater blood glucose excursions, and a tendency to increase body fat, which may be your need to watch calories. You might want to give the ketogenic diet another try at a slower rate of carbohydrate reduction.

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  6. Sharon

    Hi Dr R,
    I’d like to share my experiences as a T1D for 15 years. I’m 44 year old F and have been following the ketogenic diet for the past 2 years now. Lately I have tried to reduce my carbs even lower to under 20g/day to improve my BG control further. I have been using the Ketonix Breath Analyser and it regularly shows that i have a high level of ketones. I woke this morning and felt great. I usually test my blood on waking and was surprised to have a level of 48 mg and yet i had no symptoms. So this led me to your website and all the fantastic info you have shared on ketones and hypoglycemia. I have reduced my basal rate for overnight and will continue to monitor this.
    One other thing I’ve noticed since starting on low carb 2 years ago is that every morning I wake up with numb hands and forearms. This happens to both arms regardless of sleeping position and I have a move a little and it goes away, but always returns about 5 minutes later after laying still again. When it first started it seemed to be only my hands but over the past year it has progressed up my forearms. So not sure if this is happening all night long and I’m just noticing it in the morning. However I have woken at times during the night and had no numbness. Do you have any ideas why this could be happening. I read somewhere that people require addition Potassium on low carb but my blood potassium levels are in the normal range.

    I have had nerve testing and it all showed up normal. Have you heard of anyone else having a similar experience or any suggestions?
    Thanks,
    Sharon

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    • Keith Runyan, MD

      I’m glad you have experienced benefit from the ketogenic diet for T1DM. Reducing the basal rate is appropriate for morning hypoglycemia. As far as your numbness, I have not heard of that as a side effect of a ketogenic diet. My natural reaction is to suggest some diagnoses, but that would be playing doctor through the internet and is not fair to you. Hopefully, your doctors can help you sort it out. Best wishes for good health.

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