ketoacidosis and type 2 diabetes

JennyToy

My hubby is awesome, and wants to try the keto diet. He's a t2 diabetic on two injected medications. He's done lazy atkins before including phase 1 without complication. I don't understand ketoacidosis other than to understand the normal person (moi) doesn't have to worry about it. He has high blood pressure as well as alot of fat in the waist. He's a walking example of metabolic syndrome. He needs this diet. Is he in danger of getting ketoacidosis and if so how is it avoided other than careful monitoring of meds and blood sugar?

radiii

http://highsteaks.com/forum/health-nutrition-and-science/nutritional-ketosis-vs-ketoacidosis-369.0.html

No danger of diabetic ketoacidosis.


Definite concerns about serious bouts of low blood sugar when you drop carbs if you're on medications that regulate your blood sugar on a high carb diet. That is probably worth discussing with his doctor before starting for advice (and if he finds his doctor is completely unsupportive of a low carb diet figure out what to do after that).

KetoGirl83

If the injected medications are insulin he definitely needs a doctor who understands low carb diets, they'll need to get adjusted (to lower dosage) as his blood sugar numbers improve. But it is worth the effort to find a supportive doctor, this is the only hope a diabetic has of getting a normal healthy life.

JennyToy

Thankfully his doc is on board. One of the injections is insulin the other is victoza.

SteveKroll

He's not in danger of ketoacidosis. I'm a T2 also and the ketogenic diet has shown unbelievable results for me. Within three weeks of starting the diet, my blood sugar numbers dropped to normal levels, and I don't require any medication at all. My doctor wasn't on board at first, but he is now. He's pretty much said that if it's working, keep it up.

Dragonwolf

I wouldn't say there's no danger of it, especially since he's on injected insulin, but very likely the risk is low, and the more immediate issue is severe hypoglycemia from too much injected insulin. His level of risk depends largely on how much insulin his own body is still able to produce. Is he getting injected insulin primarily because he's on a high-carb diet and his body is simply being overwhelmed? Or is he getting injected insulin, because his body has stopped producing insulin altogether? You don't need to answer those questions here, but the answers to those questions will factor into his risk. That said, it's quite rare, even among T1Ds, and can be prevented by monitoring blood sugar as usual and adjusting things if necessary (especially in the beginning).

It may help to understand how diabetic ketoacidosis (DKA) happens, to better gauge/understand his risk.

The layman's explanation:

Internal glucose and ketone production are both regulated by insulin. As insulin goes up, both glucose and ketone production are reduced. The message here is that blood sugar and ketone levels are sufficient (either through internal production or dietary sources) to fuel the body's needs.

If the body can't produce insulin at all (ie - Type 1 Diabetics, advanced stage Type 2 Diabetics), then the "off" switch is broken. With no insulin, the body thinks it's starving entirely and needs to turn on ketone and glucose production. With no insulin to not only tell the body to stop, but also to actually do something with those energy bodies, they build up in the blood. Combine that with any dietary carbs and you further increase the amount of it all in the blood, until it reaches the breaking point. (This is why T1Ds, even on keto, still need to take what's known as "basal" insulin. It's the background insulin that the body needs to regulate internal ketone and glucose production.)

If you notice, the key here is total (or very near total) lack of insulin production entirely. If the body can make even a small amount of insulin, then the risk of DKA drops off dramatically.

Dr. Peter Attia has a great description, complete with illustration, on the difference between the two and how DKA happens.

JennyToy

Ty DW. I will research the links you provided also thank you!