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Type 1 Diabetes

My Personal Results: 30+ Years of Type 1 Diabetes

Bo Frese
7 min read

How a ketogenic approach transformed my diabetes management

Table of Contents

After three decades with Type 1 diabetes, adopting a ketogenic approach has been the most significant improvement in my diabetes management. Not marginally better - fundamentally different.

What Made the Difference

Three factors work together to make diabetes management far less stressful:

None of these individually would have achieved what they do together.

Why I Stopped Carb Counting

Carb counting never worked for me. Too much effort for too little actual learning. Focusing on abstract numbers didn't help me remember what worked.

The exhausting approach I abandoned:

  1. Guess the carbs in my food
  2. Calculate insulin using ratios
  3. Take insulin and hope
  4. Try to remember for next time

What I do instead:

  1. Write down what I actually ate
  2. Note how much insulin I took
  3. See what happened to my blood sugar
  4. Search for similar situations later

The difference? When I'm about to eat chicken and vegetables after a workout, I can search my history: "What did I do last time?"

This takes less than 30 seconds per entry. Instead of calculating, I'm building actual experience I can use. Over time, intuition develops - but backed by data, not just guesswork.

I still estimate carbs roughly when facing something new. But mostly I rely on my searchable history of what actually worked.

Learn more: The Carb Counting Myth: Why 50% of Diabetics Rely on "Gut Feeling"

The Numbers

Current Results (90-day average)

My CGM doesn't report longer periods, but I've maintained these levels consistently for several years:

  • Time-in-Range (3.9-10 mmol/L): 93% (standard diabetic target)
  • Time-in-Range (3.9-8 mmol/L): 75% (non-diabetic range)
  • Average glucose: Consistently non-diabetic
  • Daily insulin needs: Reduced by more than 60%
  • Hypoglycemia: Rare and mild - not a concern

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Context for These Numbers

The official treatment goal for Type 1 is 70% time-in-range (3.9-10 mmol/L). Only about half of people with diabetes achieve thisSorry this page is not ready yet..

Even with advanced technology like hybrid closed-loop insulin pumps, only some users reach 75-80% - still below what I maintain with simpler tools: a standard insulin penSorry this page is not ready yet., CGM, and the Glysimi App.

When I use the tighter range that matches healthy blood sugar (3.9-8 mmol/L), I still maintain 75% time-in-range.

The best way to avoid diabetes complications must be maintaining blood sugar and insulin levels as close to a non-diabetic as possible.

A Typical Day

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On good days, my CGM shows an almost flat line - the stability that was impossible following conventional diabetes nutrition advice.

It's not perfect every day. Stress, illness, schedule changes still affect things. The difference is that with very low carbohydrate intake, the potential for major swings is dramatically smaller.

Exercise used to require constant vigilance. Even a walk or round of golf meant stopping to check blood sugar and eat fast carbs to prevent lows.

Now I barely think about it. I still log exercise in the Glysimi App because it has some influence, but it's not something I worry about anymore.

The Journey

Before: Following Guidelines

For over 25 years, I followed standard diabetes diet recommendations:

  • 45-60% of calories from carbohydrates
  • "Complex carbs are healthy" - whole grain bread, brown rice, oatmeal
  • Low-fat options when available
  • Constant carb guessing and insulin timing

Results: HbA1c around 55-60 mmol/mol - high but "acceptable." Daily blood sugar swings from 3-15 mmol/L. Frequent hypoglycemia. The constant mental burden of trying to stay off the blood sugar rollercoaster.

By this time I'd also developed early neuropathy in my feet - tingling, numbness, affecting my balance. This naturally increased my worry about what other complications might be coming.

I'd been using an early version of the Glysimi App for over five years before starting keto. It helped - having a searchable diary was better than pure "gut feeling" when guessing insulin doses. But it couldn't fix the fundamental problem of eating high-carb while trying to manage blood sugar precisely.

The Turning Points

It started with a conference presentation by Dr. Jason Fung about diabetes. While focused on Type 2, I was fascinated by what he explained about insulin's role in disease and how metabolism actually works.

Type 2 diabetes, pre-diabetes, and metabolic syndrome are so prevalent that everyone is affected - either personally or through someone close. And nothing prevents Type 1s from also developing Type 2. This is increasingly common with the "eat anything and bolus" approach that's become standard.

Fung discussed both low-carbSorry this page is not ready yet. and Fasting. I dove in to see if I, as a Type 1, could do this safely and benefit.

This led me to Dr. Richard Bernstein - a physician with Type 1 who maintained near-normal blood sugars for over 70 years using very low-carb eating. I read his book and The Ketogenic Diet for Type 1 Diabetes by Ellen Davis and Keith Runyan.

The logic was simple: If carbohydrates raise blood sugar, and diabetes is blood sugar dysregulation, why not dramatically reduce carbohydrates?

Making the Switch

I dove in immediately - switching to keto meals from one day to the next. This isn't the recommended approach. The insulin reduction is dramatic, and a gradual transition while learning to adjust doses is safer.

But I was already monitoring closely and comfortable adjusting insulin. I logged everything in the Glysimi App and adapted quickly.

The results: I got off the blood sugar rollercoaster. Managing blood sugar during exercise became vastly easier. The numbness in my feet improved significantly. The tingling and pricking sensation disappeared. My balance returned. My worry about future diabetes complications disappeared.

Would I give up all that to eat pizza? No. I still eat carbs on rare occasions, but the vast majority of the time I don't. It's simply not worth it.

Common Questions

Don't you miss bread, pasta, fruit?

Honestly, not really. Most of the time, anyway. The freedom from blood sugar swings and the mental peace of predictable management far outweigh any food I might miss.

But I'm human. Danish bakeries make fantastic bread. On rare occasions I do indulge - when there are no good alternatives, or something is particularly special. The result is usually predictable: a spike that's difficult to manage without later crashing low. Which is why it stays rare. The low-carb alternatives are satisfying enough that I don't feel deprived.

Is it socially difficult?

Initially, yes. But most restaurants accommodate requests for meat and vegetables without issue. I've learned to focus on the social aspects rather than the food. After five years, it's second nature.

What about long-term safety?

I'm five years in with excellent lab results, stable weight, and no complication progression. Dr. Bernstein maintained this approach for over 70 years with excellent health outcomes. Many thousands worldwide have similar track records. That gives me confidence in long-term safety.

Don't you get tired of eating the same things?

I'm happy with fairly basic food. Cooking keto doesn't have to be complicated: good meat, butter, heavy cream, cheese. Eggs and bacon. Fatty fish like salmon. You discover you don't actually need the pasta, potatoes, or most condiments.

And keto meals keep you full for hours. I usually skip breakfast and eat once or twice daily - not from restriction, but because I'm not hungry. The natural appetite suppression is one of the bigger practical advantages. Most cravings simply disappear.

The Bigger Picture

Diabetes doesn't have to define your life or limit your health outcomes. With the right approach, blood sugar control that rivals people without diabetes is achievable.

The goal isn't perfection. It's achieving the best possible health while living a full, enjoyable life. For me, a ketogenic approach made that possible in ways I never imagined at diagnosis.

Keto and improved metabolic health offer benefits beyond diabetes management. More about that here: Beyond Blood Sugar: How Keto Transformed My Life

Your results may vary, but the potential exists.

Read More

References

  1. Dr. Richard Bernstein. (2014). Dr. Bernstein's Diabetes Solution: A Complete Guide to Achieving Normal Blood Sugars. Little Brown. ISBN: 0316191752 9780316191753.
  2. Ellen Davis, Keith Runyan. (2016). The Ketogenic Diet for Type 1 Diabetes: Reduce Your HbA1c and Avoid Diabetic Complications. Ellen Davis. ISBN: 194372105X 9781943721054.
  3. Belinda S Lennerz, Anna Barton, Richard K Bernstein, R David Dikeman, Carrie Diulus, Sarah Hallberg, Erinn T Rhodes, Cara B Ebbeling, Eric C Westman, Jr William S Yancy, David S Ludwig. (2018). "Management of Type 1 Diabetes With a Very Low–Carbohydrate Diet". Pediatrics, 141(6). https://doi.org/10.1542/peds.2017-3349.
  4. Jessica L Turton, Grant D Brinkworth, Helen M Parker, David Lim, Kevin Lee, Amy Rush, Rebecca Johnson, Kieron B Rooney. (2023). "Effects of a low-carbohydrate diet in adults with type 1 diabetes management: A single arm non-randomised clinical trial". PLOS ONE, 18(7). https://doi.org/10.1371/journal.pone.0288440.
  5. Turton, J.L., et al. (2018). Low-carbohydrate diets for type 1 diabetes mellitus: A systematic review. PLoS One, 13(3), e0194987.
  6. Nielsen, J.V., et al. (2005). Low-carbohydrate diet in type 1 diabetes, long-term improvement and adherence. Nutrition & Metabolism, 2(1), 23.
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