Nutritional Ketosis & Type 1 Diabetes


My first ketogenic diet experiment. Way back in 2015 my pre-med self took on a project in search of more energy and better blood sugars. Turns out, it totally changed my life for the better.  

I conducted a ketogenic diet experiment many years ago when first introducing the ketogenic diet. I loved the metabolic results and increased quality of life it gave me so much that I have since incorporated it as a part of my lifestyle. I now choose to eat a cyclic ketogenic diet. Since the post below, I have learned the importance of incorporating higher protein and more electrolytes into my daily intake when in nutritional ketosis. None the less, the results below are pretty exciting and powerful. Moral of the story = Food matters.

KETOGENIC DIET EXPERIMENT WITH TYPE 1 DIABETES: 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. 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):

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Previous success with a paleo ketogenic approach:

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


Here is the macronutrient breakdown:

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* 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:

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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:

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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:

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  • 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:

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  • 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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