6 weeks of Keto as a T1D

My weight has been on a steady uptick over the last 6–9 months. I’ve not been concentrating on optimizing what I eat or drink (ie beer). My BG values have been pretty good, but I was starting to see a trend return with insulin resistance. I would particularly notice it after a big carb+protein dinner when I would literally have be pumping in insulin for 8 hours to cover it.

I decided to make a change, mostly because of my growing belly (as opposed to being type 1 diabetic). From past experience I know that fat loss is 80% diet and 20% exercise. I locked in a start date of January 9th, 2017. Here is my story.

I thought about doing the slow carb diet again as it worked well for me in the past. But, I had been hearing a lot about the ketogenic diet over the last few months. I decided to take 6 weeks off drinking and focus on weight loss via diet at the same time…..I thought — what the heck, let’s give this keto thing a go.

If you are not familiar with the diet, at it’s basic level it is very low carb, medium protein and you use fat to cover the rest of the calories your body burns (that fat can come from yummy things like bacon or fat stored in your beer gut). It’s also great for T1D’s because we’re restricting the things that cause the BG to yo-yo up and down — big bolus = big waves.

I’ve spent the last month pouring of tons of great resources on the subject. If you are new to this and want to learn more, here are some of my favorites.

I did finally take a look at Dr. Bernstein’s book — Diabetes Solution. It was an interesting read, but for the most part was just a reinforcement of what I am already doing. There are a few differences in suggested nutrition, but for the most part it was already 95% a match with what I was doing. Tick.

I also have enjoyed many of the videos on LowCarbDownUnder’s youtube channel.

I started on Monday, Jan 9. I was 189.2 lbs and set my target weight to 170. I was not planning to reach it in 6 weeks, but I figured if I got half way I’d be in great shape. Here’s how it went.

I weighed myself each day. Progress was fast the first couple of days as I lost the typical water weight and all the beer and sushi rice I had eaten on our snowboarding trip to Japan the week before.

189.2 on Jan 9–173.9 on Feb 17

I mapped my total insulin intake each day. The first drop was from bolus reduction. The second week it continued to drop a bit when I had to start hacking away at basal rates due to my new insulin sensitive body.

I went back to my numbers from Dec 24th to show the dramatic change.

I tracked my macros (carbs, protein, fat, fiber and others) both as raw values and % of total calories. I also had calories on file, although I tried to not make that much of my focus. After all my research by week 4 I had settled that < 20 net carbs and just under 1.5g of protein per lean KG of body mass to be my best bet.

Here is my resulting BG trends over that time, compared to the period before it. Note, I’ve been Looping (using an DIY automated insulin delivery system), eating no carb breakfast and other efforts to get my BG optimized prior to going keto. It was really exciting to see both the standard deviation of BG in a day’s average drop to approx. 15 mg/dl per day vs 35–40 previously. The average BG is a big win as well.

BG is tested every 5 minutes using a Dexcom G5 Continuous Glucose Monitor

Along the way I learned a bunch more about keytones, tracking them and how they have a different lens than just ketoacidosis which is really really bad for us t1d’s.

I did want to track keytones, but I also thought for sure I was in fat burning mode after the first week. Even as a T1D, I do not actively check keytones. I did not own a meter or urine strips to do this. If I needed to test for that I’d have to scramble (I am not the best planner).

I did take up one of the device manufacturer’s offer to send me a free keytone meter, but of course it never showed up in the mail.

Eventually I ended up buying a Ketonix, received in the next day and started using it in the middle of week 5.

Nutritional ketosis is expected to be >4 parts per million (ppm) from these breath keytones. Turns out the whole first month I was not really in Ketosis?!? I was pretty shocked to be honest. Between the insulin drop, BG drop, following the plan pretty closely I thought I was for sure already “fat adapted”. Confusion set it more than frustration (hey, I was losing weight and my predicted A1C looks to be epic).

On Feb 9 I got home from a concert. I only had a small dinner at 6, and I thought — I am just going to fast and see what happens.

I fasted for 26 hours and then I started measuring levels considered in nutritional ketosis. I ate 1,250 calories for dinner and evening snacks (it did not feel like much actually). Then I blew a 13ppm into my Ketonix followed by a 14ppm in the morning. It looks like fasting for a day threw me over the line!

For the next 10 days or so I tested with the Ketonix just about every time I had the chance. What I found is that even a few oz of milk kicks me out for two days. The far dip on the right below was also caused by eating too much chicken. In short, it is easy to get kicked out of ketosis, even if carb intake is under 20 net. But does it really matter if you are dropping the lbs anyway?

First reading may have been wrong. Fasting caused spike in the middle! Drops from milk in coffee & chicken

I had a lab A1C on during early week 2 of this plan. I was excited to see an all time low of 5.3% and that was before this test could have much of an impact!

I subsequently using the Dexcom Clarity app on a daily basis to monitor their expectations. I use the 2 week trend (a real A1C is 90 days). It dropped down to 4.8% late in week 2 and remained right around these averages for the duration of the 6 week.

All in all, I ended the 6 weeks with a total loss of 15.3 lbs. A huge improvement in BG values, A1C and standard deviation. My BG was easier than ever to manage and I feel great!

I’d definitely recommend trying it out to anyone who is insulin resistant (how to test that even if not T1D. If you aren’t resistant, then I think there is probably a different nutrition plan (good resource for that) that may work as well without all the restrictions. We saw this with my wife, who is insulin sensitive.

If you are interested in following my live BG values, I publish them at http://live.crushingt1d.com and if you want to dig in to any of the stats, I have them available here in Google docs. It includes BG values in mmol as well as my % bodyfat, BMI and a few other stats.

Now what? :) I am planning to break the trend a bit over the weekend. Nothing crazy, but planning to have a few of my favorite IPAs and a night of Sushi. Then, I am planning to get back on Keto, start adding in some real exercise and probably have a glass of dry red wine or some whiskey (neat) here and there. I hope to hit 170 by mid March!

Happy to answer questions in the comments below or on twitter Jim is CrushingT1D.