Type 1 Keto

Half -marathon 1

A wonderful city-type half marathon. And, more importantly a big flashy medal for finishers! That should start off the year well, if I can do it. A flat course around the city centre, on into the parks and finishing along a stretch of waterfront. It was made for a full weekend and my partner and some good friends arrived the day before to take in the atmosphere of this vibrant city.

But, before you read further, please go back to the menu and read the warning if you haven’t done so already.

The training for this event was a good attempt if a little compressed. If you can take a such a thing as a power nap, then this was certainly power training. I usually allow 3 months but this was cut to 6 weeks because of the need to get started on my year’s activity.

I managed some 6 mile runs and in the last 2 weeks a couple of 9’s then an 11 mile run a week before. These were only 3 days apart and caused some calf pain that was to be bothersome. Was that the inflamation of the tendons that people talk about? There is evidence that glycation of tissue with less than optimal HBA1c can cause ‘hardening’ of tissue. Perhaps it was that. More likely poor training and running technique. Otherwise I was sure that I would complete my first half on a ketogenic diet.

What was I trying to achieve here? Well, simply to run on keto only. That would be a good start. I have a 20 year mindset based around carbohydrate loading before a run, and glucose rescue of any hypos that might happen during a run. But, now that I am on a ketogenic diet, there will be no carbs, just fat and protein. So, in theory I should inject basal insulin and then some rapid acting to cover the protein in the meal and hormones such as cortisol and adrenaline. But not too much. With keto, there is practically no carbohydrate counting and this means that the requirement for rapid-acting insulin doses are low anyway. But it is difficult psychologically not to worry. Richard Bernstein, who is my mentor for this, feels that protein of 1g/kg/day in divided into regular doses is the best management in order to be able to predict the glucose raising effect of protein. So I went with that. The Runner’s World calorie calculator estimates that I am going to use up about 1500 calories, so I will need a reasonable energy load from fat as well.


A rather late meal. And it was a late-ish night with an early start to the run . I decided to breakfast 2 hours prior to the event. 4 slices of bacon, 2 eggs and creamy coffee. About 500 calories. I would get the rest from my fat stores. 900 or so calories, mere ounces of fat.

Morning runs can be tricky. It is not my ‘time of day’. I prefer the afternoons and evenings when my control seems smoother. Ever since I can remember early morning runs have seemed heart attack territory for me. I need at least an hour before I start to function, so these morning starts are challenging. The dawn phenomenon is also an irritating nuisance. The dawn phenomenon happens because, in the early hours of the morning, cortisol hormone levels increase as part of the body rhythm which raises the glucose level in turn. If you have no diabetes the body simply secretes insulin to counter this. That is normal. If you have no insulin like me then you rely on injected insulin to cover any glucose rise. This time of morning is also at the end of the previous nights dose of long acting and is troublesome. I have found that a tiny 2 units of rapid acting insulin usually does the trick. Clearly this has the potential to lower glucose mid morning. Richard Bernstein has some data to state that in a person of my weight, 1 unit of insulin reduces the blood glucose by 2.2mmol/lit. It

can vary from person to person of course but I have found this a reasonable figure for me. But injections themselves are not always reliable and there can be a 30% variation of the insulin absorbed depending on where you inject. For example those favourite sites that are not rotated can scar up a bit and the insulin tends not to be absorbed well in these. You also really need to know your insulins and rotate injection sites in order to guess when they might have a maximum action. My rapid-acting does not even start to lower blood glucose for 3 hours, so even if I were to inject rapid-acting on waking it would take until mid morning to have an effect. So breakfast is often skipped because of this. Supposedly innocuous foods can also cause surprises. Sometimes coffee can raise the glucose but for me this is not reliable. So, I am going to need an educated guess at this. Basal insulin for me is sorted. 10 units in the morning and 10 in the evening. If I choose not to eat, basal insulin gives me a steady decline in glucose at a low rate of 1 mmol/l/hour. Nothing really, easily managed by the occasional glucose tablet. If I inject rapid-acting insulin as well, that does nothing for 3 hours then it reduces glucose at a rate of 6mmol/l/hour for 3 hours. I have done several tests on this using a continuous glucose meter. It is very reproducible, so I can rely on that figure. I might be recovering some of my insulin sensitivity (*) and am noticing over the months that the time of onset of insulin action is reducing. But today that is 3 hours.

When I go for a run and inject long-acting insulin only, I find that my glucose levels often go up and remain there for at least an hour. That is probably the result of stress hormones and the body making it’s own glucose for essential functions. So, if glucose levels were high enough,, above about 8, 2 units of rapid acting would only cause a 4.4mmol/lit reduction at most. So, that would fall into the safe zone. I had never really tried running on short acting insulin without a carbohydrate cover before. But today was the day, I decided. Glucose of 7 on waking and an inevitable rise due to protein in the breakfast, cortisol effects and possibly adrenaline in the run. I had not a clue if this was the correct strategy but in theory it was sound. I am not going to make progress by following conventional advice. I am an expert at following that advice and am at the brink of a personal health disaster. I have absolutely nothing to lose. Damned if I do follow advice. Definitely. But not necessarily if I don’t. Instinctively I know this is right for me personally. I know exactly how my insulin’s work for me. I know my body and it’s unique quirkiness. After 20 years of fouling things up I am a goner anyway. My partner once bought me a mug with the sentiment, ‘Press on Regardless’. So that is what I will do today. See what happens. Succeed or die trying. I like that sentiment today.

So, an hour and a half before the run, 10 units of long acting, which is a normal amount and fairly stable, then 2 units as cover. A bit risky but it worked well. Glucose did rise to 10-11 but was flat, and returned to normal at 2 hours, just before the end of the run. I needed no glucose supplementation and felt good . But cramp was a major issue on this run. It began at 4 miles as a right-sided calf niggle, by 6 miles it was affecting both legs, and on crossing the 7 mile marker it became intense and disabling. Running was impossible for a minute or so and the action for the next mile was a fast limp. I did consider if I was salt depleted but felt it unlikely as I was well keto-adapted. There are people who regularly supplement with salt for runs but for me this is unnecessary. I reckon fluid balance plays a part. A lot of runners just take too much fluid. Tim Noakes spent the best part of 2 decades trying to reform hydration in sport. He came up with the value of 400-800ml of water per hour. So on a 15 degree, light-wind day I will be at the lower end. Coffee 250ml, perhaps another 250 pre-run then top up twice en route. That would be more than the 800 ml I planned on taking. But I am certain this cramp today is not overhydration, it is simply poor quality over-training and possibly a result of the inflammation in my body after years of eating the wrong type of diet for me personally. Pain management saved the day, by just putting the pain to the back of the mind and thinking of

those people unable to run who would readily swap places with me. I owed it to them not to wimp out. Calf pain was also distracted by a fall at 11 miles on a prominent kerb on the waterfront. I was carrying a glucose meter and some smart shades in my hands, so in an attempt to save them, I went down first onto my knees. Then somehow I managed to get my elbow under my hip and this acted as a perfect pivot point to cause me to smack my head into the pavement. It must have looked comical and some people must have thought I was in rigor mortis. I certainly felt like I was in rigor mortis by that stage. The inevitable sickening crunch, followed by the obligatory nosebleed. Some very helpful co-runners gave up their personal -best times and picked me off the ground. There is a cooperative camaraderie amongst runners, I find. So, thank you. When I realised everything was roughly straight I felt the best way to stop the bleeding was to continue running and keep the adrenaline levels up. At the finish I looked like an extra from a zombie movie, but I had done my first run. A respectable time for a first run in a while . I was pleased with that. A fully keto-adapted run, with sensible calculations based on physiology and also personal experience of how insulins work. A good start to the year and potential for later when I am hoping to beat my best carb -loaded time done about 10 years earlier.

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