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 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

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24 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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  7. Mary

    Dr. Runyan, Check out Dr. Richard K Bernstein’s Diabetes University on Youtube. He is an 83 year old Type I diagnosed @ age 12. He manages to get his current patients to successfully maintain blood sugar levels @ a non-diabetic level. You may be able to gain more knowledge yourself. You have already discovered a lot on your own. He manages to exercise using specific steps that HE needs. I don’t remember specifically what he does.

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    • Keith Runyan, MD

      Thanks for the comment Mary. I found Dr. Bernstein’s story and book in 2011 which I used to start my journey toward more normal blood glucose. You can find more details about Dr. Bernstein in older posts on my blog.

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  8. Pingback: 1308: LLVLC Classic – Dr. Keith Runyan Discovered Keto Works Best For His Type 1 Diabetes | The Livin La Vida Low-Carb Show
  9. Beth

    I’m so glad I ran into this blog – I am a very recently diagnosed T1D (2 weeks before my 40th birthday a month ago) and am still learning how carbs/protein/fats affect my BG and the still-adjusting insulin doses recommended by my doctor. I’m still technically hyperglycemic but slowly coming down overall.
    I love your charts and data (since I’m a data analyst/accountant) and now that I’m out of DKA/lost 35 lbs of fat and mostly muscle and was in the hospital for 4 days (which is how I got diagnosed) and recovering slowly – I want to reclaim my physical health and start really exercising again.
    I was not comfortable with how many daily carbs the docs were recommending (or what they were feeding me in the hospital) so I’ve been cutting back along with the still-mild bicycle rides and nightly walks and seeing the bg dropping. My kidneys seem happier and I’m retaining less water. Now I’m doing my research on ketones and this type of diet and how it has affected other T1Ds. It’s amazing how little the average person knows about their food and how it impacts them. I look forward to your blog updates.

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  10. Roxie Morrow

    Just bought your and Ellen’s book on Keto for T-1’s, read it front to back in 2 days!! One thing I can’t seem to find info on, and am having a hard time understanding, is how dietary Fat affects BG. I’ve been T1 since 2005 (am currently 47 yrs old), and started the Keto Diet a little over 3 months ago. My A1c went from 9.5 to 6.2, and I lost 25 lbs. I feel pretty successful, but seem to still have roller coaster numbers (between 70-200) daily. Not sure what I’m doing wrong (I am bolusing for Protein), could it be the Fat?
    Also, my last dr appt, she changed my basal from 20 to 10 and my Target BG from 100-150. I was SO confused! I had quite a few hypos, so she was super worried and was trying to stop them from happening so often.
    Thanks for any help/advice you could give!!
    Roxie

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    • Keith Runyan, MD

      Good question. We didn’t talk much in the book about the effect of fat on blood glucose (BG) because it has little effect at all. Dietary fat can favorably affect BG more significantly when eating more carbohydrates, especially simple sugars, by delaying absorption of glucose/fructose. However on a ketogenic diet, dietary effect has little effect at all. So first of all, congratulations on your remarkable improvement in BG control and body fat loss!!! BG can still be somewhat of although less of a roller coaster even after being on a ketogenic diet for a while. I still struggle with that. My variability originates primarily from exercise. Another common source of variability for many comes from variation in size and macronutrient composition of their ketogenic meals. I try very hard to keep each meal (breakfast, lunch, and dinner) constant from day to day and eat those meals at the same time each day. I use small doses of rapid-acting insulin to correct high BGs. I try my best to avoid stacking of and excessively high doses of insulin to avoid hypoglycemia. Your endocrinologist’s recommend to increase your target BG from 100 to 150 mg/dl is quite common. Not to be critical, but that is a very easy solution which does not require any thought in trying to figure out the source of your hypos. The downside of course, is higher mean BG which could translate to a higher risk of long-term complications. You should look carefully at what was going on before the hypo. Look at both basal and bolus insulin doses, food intake, exercise, and any other medications. Unfortunately, I can’t give medical advice and don’t have enough information to even attempt to do so. I hope you and your endocrinologist can figure out what is going on.

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  11. Roxie Morrow

    I can’t thank you enough for taking time to respond. I actually see a NP and not an Endo, so I always question nutritional knowledge on her part and wonder if she truly knows how to even begin to adjust my insulin requirements for Keto.
    That makes sense about fat and carbs together making the absorption of glucose slower. You opened my eyes to the fact that I may be varying my macros too much for each meal, not staying too consistent. I feel that I am, but I am going to look at that closer.
    Also, at the moment, I’m practicing OMAD. I only eat at 5 pm and my macros are on point. Seems as though my BG constantly stays in the higher range all day, I’m constantly checking and taking rapid acting insulin to cover the highs. Hate doing that.
    Could this be my basal dose not being the right amount, therefore not working to cover my fasted state? It’s the only thing I can think of.
    Thanks again, your help is the only REAL advice I’ve gotten from an actual type 1 Keto Diabetic….ever!
    Roxie

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    • Keith Runyan, MD

      Eating only one meal per day at 5 pm may require an extra morning dose of rapid-acting insulin because the morning dawn phenomenon is not covered by the breakfast rapid-acting insulin dose. An elevated BG all day could be from that. Also, too low a basal dose could have the same result. The basal dose, as stated in the book, is determined by your fasting BG. Once your fasting BG is normalized, your basal dose is set. If your BG increases during the day while fasting, that could due to an untreated dawn phenomenon or that your basal insulin does not work evenly the entire day which could be helped by splitting it into two doses, every 12 hrs, and adjusting both doses to seek your target fasting and daytime BG values. Remember, basal insulin doses need to be adjust slowly due to the long half-life. Generally, no more than a 10-15% increase in dose/day once or twice per week. If your taking 20 units/day basal insulin, increase by no more than 2 units every 4 days, for example. You’ll need to experiment with these ideas along with a doctor you trust.

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      • Roxie Morrow

        Thank you SO much! You’ve given me a lot to go on. I asked my NP if I could split my basal into two doses, she said no. (??) Gave me no reason other than said it wasn’t necessary.
        I know the Keto diet works best with IF, but when I fast, my BG is fairly high throughout the day, so I just may need to figure out what my basal should be set at. The fact that she lowered it from 20 to 10 has me confused,10 seems to low. Probably because, again, she was worried about how many hypos I was having.
        I’m gonna work on getting my basal rate set and go from there.
        Thanks again! I appreciate the feedback more than you’ll ever know!
        Roxie

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    • Kristin

      I’ve been Type 1 for just over 4 years. Diagnosed at 50.
      Interestingly I see some comments that I MIGHT be able to help with, or at least something to experiment with.
      For me, if I increase my basal to last through the morning I have hypos. So I use basal to get me to the fasting number and then I use humalog ( bolus) for my food.

      That being said, I CANNOT fast or I continue to rise all day long. I only need something very small when I get up. Lately it’s just a small lettuce salad with a drizzle of EVOO. I take tiny doses of humalog 4-5 times a day and eat small meals, more like snacks. If I don’t eat I need 3x the insulin through the day. So I eat

      Another huge thing that helps me manage great control is the timing of my insulin and when I eat. If I’m on target I wait 20 min before my first bite. If I’m a little high I wait 30ish and if I’m a little low I wait 10 or eat right away. Eating very slowly helps as well. It marries th etiming that insulin and food get there.

      Protein can be a problem for me. I can’t eat more than 2-3 oz without splitting my bolus. If I take it all at once I’ll hypo and then spike. If I take half before the meal and half an hour later I stay much steadier. I also don’t eat protein in the morning or I’m injecting every hour or so to stop the morning cortisol, adrenaline and the glucagon actions. I save protein for lunch and dinner.

      Hope this helps someone.

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