“Be the change you wish to see in the world” – Gandhi

IMG_0966 I wish to see a world that understands and values food quality.

I wish that nutritional guidelines in this country weren’t overrun by large food companies.

I wish that people with type 1 diabetes were given the option of a ketogenic diet upon diagnosis.

I wish that more of us will become self-empowered to make a positive difference in our own health.

 

This is what I’m doing about it: I’m conducting my own n=1 study on how a paleo ketogenic diet affects the blood sugar control of a person with type 1 diabetes. It’s something I’ve been able to successfully do in the past. This time I’m focusing on the process of initiating it from a higher carbohydrate diet (~150g of carbs per day), noting insulin ratio changes, and how to make it a sustainable way of life. I will eat the same thing each day for 5 days, with added low treatments when needed, and evaluate changes in my basal long acting and insulin meal dose calculation method.

Average Day of blood glucose control for me on a SAD (standard American diet):

IMG_5235 - Copy IMG_5126 - Copy

Previous success with a paleo ketogenic approach:

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This is the meal plan I will be eating each day:

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Here is the macronutrient breakdown:

EDITED Screenshot 2014-11-18 16.32.39

* Low treatment is not included in this table. I usually eat half of a miniature box of organic raisins (~6g carbs).

Insulin Macronutrient Ratio:  I came up with this term because I could not find an existing term in the literature.  It is conceptually similar to an insulin to carbohydrate ratio (I:CHO) but it accounts for all macronutrients. When eating a ketogenic diet it is necessary to take insulin to cover the carbohydrates, the protein, and the fat. When eating a diet low in carbohydrates, sixty percent of protein can be turned into glucose through a process called gluconeogenesis. One percent of fat can also be turned into glucose. Therefore, these macronutrients need to be taken into consideration when calculating an insulin does.

Grams of carbs + (grams of protein x .60) + (grams of fat x .01) = Insulin points for your meal

I chose to eat multiple small meals this week to lessen the effect an insulin dose error would have on my blood glucose control.

Day 1:

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What I learned:

  • I was pretty excited about the first days results! I am surprised how quickly my blood sugars stabilized after dropping my carbohydrate intake so drastically (150g to 30g). I also noticed a drastic difference in my energy level.
  • Things went well for the first part of the day. My fasting BG was 108, my goal is under 100 so it was pretty close. The equation I used to calculate insulin doses worked out. I will aim for less of a blood glucose change in my postprandial (after meal) readings in the future.
  • That evening low: I dropped into the mid 30’s. I felt like I was melting and like I wanted to eat everything in the kitchen all at the same time. It was horrid. The low came two hours post strength training (it was leg day). Next time I need to take the glut-4 receptor translocation effect (the natural increase of your muscles uptake of glucose post-work out) into account. I also only waited one hour between meals which means there was slight insulin stacking. Insulin stacking is the additive effect insulin has when you take an insulin dose before your previous dose has worn off.  I thought it would have less of an effect because my doses were so small (1-3 units). Next time I’ll know to decrease my insulin ratio post work out and when eating within two hours of the last meal. Lesson learned.

Day 2:

photo 3 (2)

What I learned:

  • The overnight blood sugar crash is a direct sign that my basal long acting insulin is too high. I lowered it by 1 unit of Lantus last night and I will lower it again tonight by 1-2 units, depending on how today’s blood sugar levels go. I have been expecting my basal insulin levels to decrease however my strategy was to wait until my body gave me the sign, instead of doing it preemptively.
  • I’m overcorrecting for my lows. I’ve been eating 11g of fast acting carbs (miniature box of organic raisins). It looks like I am becoming more glucose sensitive (or I just have less overall insulin in my system). I will decrease my correction carbs to 5-6g and see if that will prevent the glucose spike over 120mg/dl. This should also help me keep my total carbohydrate level lower to help me achieve ketosis.
  • I am still amazed by the amount of energy I have. The difference is like night and day. I am having to restructure my workouts because I haven’t felt much muscle fatigue at the end of my weight lifting sets. I also seem to be able to think clearer and fit much more into my day. I am loving it!

Day 3:

DAY 3 photo (2)

What I learned:

  • This day was really upsetting to me. I worked so hard to try and adjust my macronutrients and insulin to make things work and it just didn’t happen. I was tempted not to post the results at all. Not because I wanted to skew my data, but because I feel like it is a representation of my faults. I know many other people with type 1 diabetes who do not like posting or talking about their out of range blood sugar levels. I believe that it’s an area of vulnerability for those who are questioning their own health. Ironically, it doesn’t represent faults at all, it just represents an average day of struggle for a person with type 1 diabetes that is trying their best. It is crucial to remember that some things are out of our control. I decided to post this day, so it portrays an accurate depiction of what living with type 1 diabetes is like. No matter how hard you try, what you eat, how much math you do, or how many time you get your hopes up, diabetes happens.
  • My best guess on exactly what happened this day was that I lowered my basal long acting insulin too drastically (2 unit reduction from 20 units to 18 units). I was also a little stressed so increased cortisol levels could have caused slight insulin resistance which made it harder to get my blood sugar back in range with a correction bolus of fast acting insulin.
  • Additionally, I chose to skip my work out this day because my current strength training program tends to raise my blood sugar slightly.

Day 4:

day 4photo (2)

  • Today I was able to get back on track, I increased my basal long acting insulin level back up to 20 units. I chose to show this time slot on my CGM (continuous glucose monitor) screen so that it would clearly show the blood sugar drop I had from 12am to 8am. This is a clear sign that my basal long acting insulin is too high. Tonight I will take 19 units and see how that affects tomorrow.
  • At 6pm my blood sugar stayed around 125mg/dl for a few hours. I ate a different dinner than identified on the meal plan. We celebrated my father’s birthday and I had keto brownies for dessert. They were surprisingly delicious and it was nice to have a treat. In the past when I have eaten conventional treats in celebration of birthday’s my blood glucose spike to at least 250mg/dl and then crashes 3-4 hours later. So the night was a success indefinitely!
  • Cutting my correction carbs for the low to 6g of fast acting carbs seemed to help prevent the drastic glucose spike.

Day 5:

day 5 photo (2)

  • Another wonderful day! I’m still in shock to be honest. This is the first time since I was diagnosed almost 10 years ago that my blood sugar has ever been this controlled. I feel like a different person. My energy level has continued to be stable and I feel like everything takes less effort when I am in a normal blood sugar range. My productivity has increased, I haven’t wanted to take any naps, my weights have gone up in the gym, and I’m smiling a lot more. I realize that this could partially be a placebo effect because this has been a goal of mine for… almost 10 years and I could just be really excited.
  • Today was the first day I tested positive for ketones, each previous day I only had trace amounts. My measurement this evening was about 1.5mmol/l or 25mg/dl. Urine ketone strips are not very exact, however I have been dealing with the pharmacy, my endocrinologist, and insurance all week to try and get a blood ketone meter and strips. Hopefully, tomorrow I will be able to pick them up. Good thing I wasn’t actually concerned I had ketoacidosis or it would have been a frustrating situation.
  • My strength training work out at 3pm elevated my blood glucose about 40mg/dl. I’ll be interested in seeing if training different body parts has gradient effects on my blood glucose (legs vs. shoulders). Once I can predict my body’s response of glycogen release for specific work outs, I hope to be able to take insulin preemptively to prevent spikes.

What’s next?

  • I will continue a ketogenic paleo approach and try to collect more data about the amounts of carbohydrates, protein, and insulin that will keep me in or knock me out of ketosis.
  • I will continue to remind myself that this is not about blood sugar perfection, it is about increasing my quality of life. Which it has undoubtedly done so far.
  • I will continue to post updates on my blood glucose successes and challenges.
  • I will evaluate the sustainability of this lifestyle and work on continuing to incorporate it into my life.

 

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16 thoughts on ““Be the change you wish to see in the world” – Gandhi

  1. Happy to come across your blog. My two yr old daughter was just diagnosed with type one 2 months ago. Once home from the hospital she slowly came completely off insulin, honeymooning. We have been doing a keto type paleo diet with her and she has been doing great and has been off insulin 6 weeks now. We are hoping this will keep her honeymooning longer. I have no doubt she would be back on insulin with a SAD diet. Though her dr doesn’t agree with limiting her carbs. Look forward to reading more on your blog!

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    1. Lisa,

      It is so wonderful to hear your story! Congratulations on your daughters success. I can’t imagine how much careful consideration went into making that choice for her. May I ask you how you heard about that as an option? Most type 1’s I know are never introduced to this idea. You should definitely win an amazing Mom award for that. Let me know if you have any questions or insights. We’re in this together!

      Do you also integrate a paleo based meal plan?

      Thanks for your comment, Hannah

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    2. Doctors don’t know! I’m a health coach, and I have a client who has diabetes. Her doc sent her to a nutritionist who told her NOT to do low carb. Fortunately, she did it anyway. In 12 weeks on low carb, she lost 30 pounds and is off of both diabetes meds!

      Also, my son recovered from autism on a low carb diet! There are children all over the world recovering, but media doesn’t touch the story!

      IMO, you’re doing the best thing for your daughter! She’s so lucky you found keto!

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  2. I am glad I found this blog. My boyfriends daughter is a Type 1 Diabetic and his ex wife keeps saying she is not going to change her diet. I can’t wait to read more.

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    1. Thanks Julie, It’s always difficult when working with more than one person. If I were the daughter I would probably like to learn both ways so that when I was old enough to make my own decision I would know how to do either one successfully. Good luck!

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  3. Thank you for another informative blog. Where else could I get that
    type of information written in such a perfect way?
    I’ve a project that I’m just now working on, and I’ve been on the look out for
    such information.

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  4. This is pretty impressive, and its clear you’ve got a pretty good handle on how to manage your DM. Its pretty crazy that many of the current guidelines for diabetic nutrition are so outta whack with new evidence for a lower carb, mod protein and higher fat diets. I think people who are diabetic, and less cluey that you just need to be aware that there is a lot to know and that switching suddenly to keto can be tricky and dangerous. You risk dangerous hypos if you don’t know what you are doing, so need to be well advised. If there are diabetics reading this you should always get the advice of a dietician/doctor who is knowledgeable and on board with keto diets. Im an emergency doc, and even knowing the basics of diabetes, I would find this hard to institute without hiccoughs.
    Well done, this is truly impressive

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    1. Thank you for your comment! I completely agree, if someone is unsure about manipulating insulin and carb levels they should seek a physician who is on board. Unfortunately, there are very few in this country that are willing to help. I have done some pretty extensive searching for endocrinologists and dietitians who have Certified Diabetes Educator credentials that also support a low carb approach to treatment. Hopefully, it’s a direction that medicine can move towards in the future that will give patients another option.

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  5. First of all great info, great blog. I’m 24 diagnosed when i was 14. First i just wanted to make a point also in regarding what you mentioned about how diabetes is diabetes on that particular day it was sitting slightly higher day 3. I literally felt your emotional sigh on that note, worst thing i find about being a diabetic is that constant breathing down your back to get those perfect levels from people who don’t even have diabetes, im not saying that in a bad way i know they care but it isn’t like eat this take that you should be perfect, then when your not achieving that its depressing you tend 2nd his your self and you wanna give up, diabetes is 50% emotional 50% physical. My dad got me into the whole lchf diet and i was heavily skeptical at first but after some lengthy convincing i was hooked first time i went at it, it was awesome levels were lower and stable consistently had a few bumps here and there but mostly good, one thing i could honestly say i had honestly 1 sometimes none, lo bg levels weekly, i do martial arts im a carpenter im constantly active. In saying what the person in the other comments said about it being dangerous, for the less info savvy diabetic yes it can be but if you’ve had diabetes for at least 2 years you should know your body the foods you eat and the logical amount of insulin always better to start small and bring down hi bgls then to bring up lo bgls. Sorry for rambling on i have plenty of questions possibly ask via email.

    Hayden from Australia.

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    1. Hayden,
      Thank you so much for your comment. I really appreciate your relation to the emotional side of Type 1. It is nice to hear from someone that completely understands what it’s like! I struggle with that too, I often find that I’m too hard on myself when my blood glucose is high. It is all a delicate balance of health and happiness. I’m so glad that you found a low carb high fat way of eating and that is working for you well. I also have less low blood sugars, I am studying to be a group fitness instructor and I never thought I would be able to do it before I made the dietary switch because I constantly had lows during work outs. I feel much safer this way and my energy is great. I’m still in shock of how amazing I feel. Don’t be sorry for rambling, that’s pretty much what this blog is about. Haha. Feel free to email me of message me on the facebook page. It’s always nice to keep the blog comments going too so that others who might be interested can read them too. I would be more than happy to talk about life with type 1.
      – Hannah

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  6. I am not diabetic but plan to follow your plan. Please keep posting menus as I’m not very creative. Blessings

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