Keith Runyan advocates personalised approach to managing type 1 diabetes with ketogenic diet

Dr Keith Runyan, an experienced physician living with autoimmune diabetes, shares his detailed monthly account of maintaining blood glucose stability through a personalised low-carbohydrate, ketogenic approach, sparking renewed debate on its role in type 1 diabetes care.

Keith Runyan, a physician who has lived with autoimmune diabetes for decades, has published another monthly account of his effort to keep type 1 diabetes in a tight range through a ketogenic diet, metformin, exercise and carefully adjusted insulin. In the September update on his blog, Runyan says the goal is not simply to lower average glucose, but to keep blood sugar steady enough to avoid the swings and hypoglycaemia that have long shaped his treatment decisions. His account sits within a wider debate over whether carbohydrate restriction can play a useful role in type 1 diabetes care, even as mainstream guidance remains cautious.

Runyan traces his approach back to his diagnosis in 1998, after several years of unexplained weight loss, diarrhoea and eventual classic diabetic symptoms. He says he began insulin treatment immediately and later switched to more modern preparations, but still struggled with frequent low blood sugar episodes despite HbA1c results that were in the conventional target range. His blog says a low-carbohydrate ketogenic diet, introduced in 2012, cut his insulin needs sharply and reduced those episodes, while later changes to the timing of meals, exercise and sleep further improved stability. He presents that evolution as a personal experiment in which consistency is as important as the food plan itself.

That perspective echoes some of the recent literature on very-low-carbohydrate diets in type 1 diabetes. A review in PubMed Central says such diets have been associated with better HbA1c results and, in some reports, fewer diabetes-related hospital admissions, although the evidence base remains limited and the topic remains contested. Cleveland Clinic has described ketogenic diets in type 1 diabetes as both promising and a possible safety concern, stressing the need for close monitoring. Mayo Clinic, meanwhile, continues to emphasise carbohydrate awareness, regular exercise and individualised management rather than endorsing a ketogenic regimen as standard care.

In his latest update, Runyan says he is using lispro and Basaglar insulin, metformin, a whole-food ketogenic diet and both resistance and aerobic exercise. He describes a dosing method based on weighted averages of recent meal insulin use, intended to lower the risk of lows, and says his body weight is about 67 kg. He also reports no symptomatic hypoglycaemia during the month, although he says he still needed small corrections and used glucose candy when required. His target is a mean glucose around 100 mg/dL, while acknowledging that lower targets can raise the danger of hypoglycaemia.

The blog also places considerable emphasis on exercise and time-restricted eating. Runyan says he now eats twice a day and walks daily, alongside a rotating strength programme that includes lifts such as the snatch, clean and jerk, front squat and deadlift. That approach aligns with standard diabetes guidance from the National Library of Medicine, which notes that exercise can improve insulin sensitivity but also complicate glucose control during and after activity. Runyan argues that a predictable routine helps him manage those fluctuations, though his comments about fasting, mitochondrial recovery and cancer prevention go beyond what the cited clinical evidence can firmly support.

Runyan also returns to a broader argument that many people with type 1 diabetes may do better with lower carbohydrate intake, more frequent glucose monitoring and less reliance on large insulin doses. He cites research on ketones, saturated and polyunsaturated fats, and the physiological role of metformin in suppressing liver glucose production, while also pointing readers to his book and videos. The result is part personal diary, part advocacy piece and part self-experiment, framed by his view that diabetes management should aim not just for lower HbA1c, but for blood glucose patterns that resemble those of people without diabetes as closely as possible.