Q. Diabetes, Low-Carb & Ketones
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pseudandry
Posts: 41 Member
You can find anything on the Internet to support anything you want to support. I'm having trouble finding scientifically-supported information specifically on under-control type 2 diabetes and the effects of ketones. Going into ketosis for type 1 diabetics is not good; going into ketosis for diabetics whose BG is 250-300 or higher is not good; but what about if your daily BG ranges from 80-130 using a low-carb (45g/day or under) food plan?
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Two excellent resources I recommend are: a book by a neurologist/nutritionist, Dr. David Perlmutter, "The Grain Brain."
The second is a website: dietdoctor.com.
I hope you find the answers you are looking for.0 -
It depends on your ability to produce insulin. If your beta cells are burnt out, then you may have trouble down-regulating ketone production.
Otherwise, reducing carb intake and insulin levels should help. I don't think ketones would help, but they shouldn't lead to ketoacidosis.
Discuss with your doc perhaps?0 -
Dr. Richard Bernstein has spear headed the low carb movement for diabetics. His book, Dr Bernstein's Diabetes Solution makes so much sense. He is a T1D so has more insight and empathy than many doctors would have. It might be a good place to start... He argues diabetics should have normal blood sugars on a low carb diet. Not "normal for diabetics" but normal period.0
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It depends on your ability to produce insulin. If your beta cells are burnt out, then you may have trouble down-regulating ketone production.
Otherwise, reducing carb intake and insulin levels should help. I don't think ketones would help, but they shouldn't lead to ketoacidosis.
Discuss with your doc perhaps?
OP--you may want to find a registered diabetic specialist to understand a range of high and low as long as the average is say 100 and being at 100 really isn't going to negatively impact your day. More then a few T2 diabetics rely on both their doc and a register diabetic specialist to understand their fluctuations post meal or workout.
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Before injectable insulin was available, a low carb ketogenic diet is how doctors treated diabetics.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1325029/
The study I linked to above was performed on 28 diabetics and also references data from a number of prior studies, all indicating positive success. The only adverse effect they were concerned with was hypoglycemia and no participants had adverse reactions that required them to leave the study, though only 21 completed it, but that was not because of problems with the diet.
There are a number of links from that study to other research papers on using a LCKD to treat diabetes.0 -
Google Dr. Jason Fung on YouTube. He has a six part series that goes into a lot of detail and sites numerous studies. I don't know if it will have everything you need but he seems to have a good handle on diabetes0
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pseudandry wrote: »You can find anything on the Internet to support anything you want to support. I'm having trouble finding scientifically-supported information specifically on under-control type 2 diabetes and the effects of ketones. Going into ketosis for type 1 diabetics is not good; going into ketosis for diabetics whose BG is 250-300 or higher is not good; but what about if your daily BG ranges from 80-130 using a low-carb (45g/day or under) food plan?
You're confusing ketosis with ketoacidosis. The former is safe even for insulin-dependent diabetics. The latter is a dysfunctional state in which both continue to increase in an uncontrolled rate, because the body is not producing insulin (like, at all), and that ends up telling the body that a) there's no glucose (so make it) and b) it's starving (so make ketones).
http://eatingacademy.com/nutrition/is-ketosis-dangerous0 -
Ketosis is not only perfectly safe for T1D's it can, not surprisingly, provide them with the best control.
Even children can manage their T1D better in ketosis and it's widely accepted that children's blood glucose is going to be all over the map on a daily basis. This is just one story of a T1D, who happens to be only 10 years old, with an A1C of 4.5. He's got even T2D's beat and is certainly not suffering from DKA. Lol
http://livinlavidalowcarb.com/blog/the-llvlc-show-episode-831-dave-dikeman-is-a-10-year-old-type-1-diabetic-on-fire-for-low-carb-living/229230 -
Ditto what @Dragonwolf & @Sunny_Bunny_ said. There are whole websites that promote ketosis for type one & two diabetic sugar control.
Google it.
I hope this helps,
Dan the Man from Michigan
Keto / The Recipe Water Fasting / E.A.S.Y. Exercise Program0 -
Thank you for all of your resources. It's my endo that has me confused; she was listening and discussing, but I was having confusion between ketones, ketosis, and ketoacidosis, esp. because I'm on Ivokana, and it purposefully excretes glucose through urine. So I am curious/confused, too, between the glucose-ketone connections. I have some places to look, now thanks to you...0
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Have you talked to your endo about going low-carb instead of taking invokana?
Ketosis is a result of extreme carb restriction, and it will cause a reduction in your blood glucose.
It's down-regulated by insulin, metabolites of glycolysis, and even ketones themselves.
http://www.fda.gov/Drugs/DrugSafety/ucm475463.htm
Patients should stop taking their SGLT2 inhibitor and seek medical attention immediately if they have any symptoms of ketoacidosis, a serious condition in which the body produces high levels of blood acids called ketones. Symptoms of ketoacidosis include nausea, vomiting, abdominal pain, tiredness, and trouble breathing. Patients should also be alert for signs and symptoms of a urinary tract infection, such as a feeling of burning when urinating or the need to urinate often or right away; pain in the lower part of the stomach area or pelvis; fever; or blood in the urine. Contact a health care professional if you experience any of these symptoms.0 -
Ketoacidosis does not just sneak up on you. Prior to becoming acidotic you would feel like you are dying. I am not kidding. There is pain, all over your body. You feel nauseated and will be vomitting as it progresses. You feel so thirsty that it consumes your thoughts. You cannot get enough to drink and you are urinating just as much.
Ketoacidosis cannot happen if insulin is present in the body. Weather or not you're making ketones, if you're producing insulin, you won't become acidotic. I should say, the only exception I am aware of is non-diabetic Ketoacidosis caused by severe hypothyroidism. That is incredibly rare and only actually occurs due to extreme dehydration resulting from the underlying illness that went untreated for weeks.
Anyway, even in T1D the acid build up that occurs due to dehydration is what the problem is. In the event that your body has no insulin, your blood glucose would climb very high and your body would need to keep itself alive so it starts making ketones. This is a life saving action that the body is supposed to do. The presence of ketones is not actually a problem at all. The problem is the lack of insulin and high glucose. In an effort to reduce the glucose, since there is no insulin, your body will begin flushing it out in your urine. Because you're running on ketones, your body will also be flushing out the acetoacetate in an effort to keep your bodys PH in good range. You get very thirsty because your body has a lot of flushing to do... If you cannot fix the lack of insulin problem quickly enough, your body simply cannot keep up with the rate of acid production and flush the excess acid and glucose out. You just can't drink enough water, fast enough to keep the balance. Especially once your electrolytes are depleted and your body wants to start reserving water as much as possible in an effort to hang on to the small amount of remaining electrolytes, and you become severely dehydrated and critically low on potassium because your body has already dumped all the sodium and magnesium it could and then begins dumping potassium too. When that water goes electrolytes go with it too. Sodium is first to go until it gets to a certain point.
I have quite a lot of experience with DKA. Researching it to understand it as much as possible, to keep my T1D daughter healthy, is how I discovered that anyone can produce ketones and how they are actually good for us.
I hate to say it, but even diabetes specialists don't know anything about ketosis outside of the way it relates to DKA. They are completely unaware of the actual science and the details. My daughter mentioned to her diabetes nurse that she plans to eat low carb (150g or less) once she goes back on her insulin pump and the nurse told her that she couldn't do that because she would get DKA. I corrected her that having ketones is not the same as being acidotic and that no one said she was planning to stop taking insulin so it's perfectly safe. Nurse lady just gave me one of those looks that people give when they see someone doing something completely idiotic. And I gave her the look right back.
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Sunny_Bunny_ wrote: »Ketoacidosis does not just sneak up on you. Prior to becoming acidotic you would feel like you are dying. I am not kidding. There is pain, all over your body. You feel nauseated and will be vomitting as it progresses. You feel so thirsty that it consumes your thoughts. You cannot get enough to drink and you are urinating just as much.
Ketoacidosis cannot happen if insulin is present in the body. Weather or not you're making ketones, if you're producing insulin, you won't become acidotic. I should say, the only exception I am aware of is non-diabetic Ketoacidosis caused by severe hypothyroidism. That is incredibly rare and only actually occurs due to extreme dehydration resulting from the underlying illness that went untreated for weeks.
Anyway, even in T1D the acid build up that occurs due to dehydration is what the problem is. In the event that your body has no insulin, your blood glucose would climb very high and your body would need to keep itself alive so it starts making ketones. This is a life saving action that the body is supposed to do. The presence of ketones is not actually a problem at all. The problem is the lack of insulin and high glucose. In an effort to reduce the glucose, since there is no insulin, your body will begin flushing it out in your urine. Because you're running on ketones, your body will also be flushing out the acetoacetate in an effort to keep your bodys PH in good range. You get very thirsty because your body has a lot of flushing to do... If you cannot fix the lack of insulin problem quickly enough, your body simply cannot keep up with the rate of acid production and flush the excess acid and glucose out. You just can't drink enough water, fast enough to keep the balance. Especially once your electrolytes are depleted and your body wants to start reserving water as much as possible in an effort to hang on to the small amount of remaining electrolytes, and you become severely dehydrated and critically low on potassium because your body has already dumped all the sodium and magnesium it could and then begins dumping potassium too. When that water goes electrolytes go with it too. Sodium is first to go until it gets to a certain point.
I have quite a lot of experience with DKA. Researching it to understand it as much as possible, to keep my T1D daughter healthy, is how I discovered that anyone can produce ketones and how they are actually good for us.
I hate to say it, but even diabetes specialists don't know anything about ketosis outside of the way it relates to DKA. They are completely unaware of the actual science and the details. My daughter mentioned to her diabetes nurse that she plans to eat low carb (150g or less) once she goes back on her insulin pump and the nurse told her that she couldn't do that because she would get DKA. I corrected her that having ketones is not the same as being acidotic and that no one said she was planning to stop taking insulin so it's perfectly safe. Nurse lady just gave me one of those looks that people give when they see someone doing something completely idiotic. And I gave her the look right back.
Since I referenced registered diabetic specialists I cannot answer for all of them about being completely unaware of the actual science and the details. I find it unsettling how you have one interaction with a nurse and paint a whole group of people lacking knowledge. A RDS has to maintain so many credit hours per year through continuing education credits. States require a certain amount for them to maintain their professional status. I can't speak to what they are required to read and learn but it would seem a stretch to presume one interaction with a nurse equates to a whole group of people dedicated to working with diabetics on a daily basis not understanding the science behind the illness or disease. Many people on the forums have and continue to with RDS and have been successful at improving their diabetic conditions.
If, by your education, you can teach other people then I'm sure you'd be able to apply and find a teaching position in a nursing school or other accredited group. Heck, if you are really good, you could eventually move the LC/keto diet to the forefront of effectiveness. Until then, maybe not all professionals in a field are worthless and lack knowledge.
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_Terrapin_ wrote: »Sunny_Bunny_ wrote: »Ketoacidosis does not just sneak up on you. Prior to becoming acidotic you would feel like you are dying. I am not kidding. There is pain, all over your body. You feel nauseated and will be vomitting as it progresses. You feel so thirsty that it consumes your thoughts. You cannot get enough to drink and you are urinating just as much.
Ketoacidosis cannot happen if insulin is present in the body. Weather or not you're making ketones, if you're producing insulin, you won't become acidotic. I should say, the only exception I am aware of is non-diabetic Ketoacidosis caused by severe hypothyroidism. That is incredibly rare and only actually occurs due to extreme dehydration resulting from the underlying illness that went untreated for weeks.
Anyway, even in T1D the acid build up that occurs due to dehydration is what the problem is. In the event that your body has no insulin, your blood glucose would climb very high and your body would need to keep itself alive so it starts making ketones. This is a life saving action that the body is supposed to do. The presence of ketones is not actually a problem at all. The problem is the lack of insulin and high glucose. In an effort to reduce the glucose, since there is no insulin, your body will begin flushing it out in your urine. Because you're running on ketones, your body will also be flushing out the acetoacetate in an effort to keep your bodys PH in good range. You get very thirsty because your body has a lot of flushing to do... If you cannot fix the lack of insulin problem quickly enough, your body simply cannot keep up with the rate of acid production and flush the excess acid and glucose out. You just can't drink enough water, fast enough to keep the balance. Especially once your electrolytes are depleted and your body wants to start reserving water as much as possible in an effort to hang on to the small amount of remaining electrolytes, and you become severely dehydrated and critically low on potassium because your body has already dumped all the sodium and magnesium it could and then begins dumping potassium too. When that water goes electrolytes go with it too. Sodium is first to go until it gets to a certain point.
I have quite a lot of experience with DKA. Researching it to understand it as much as possible, to keep my T1D daughter healthy, is how I discovered that anyone can produce ketones and how they are actually good for us.
I hate to say it, but even diabetes specialists don't know anything about ketosis outside of the way it relates to DKA. They are completely unaware of the actual science and the details. My daughter mentioned to her diabetes nurse that she plans to eat low carb (150g or less) once she goes back on her insulin pump and the nurse told her that she couldn't do that because she would get DKA. I corrected her that having ketones is not the same as being acidotic and that no one said she was planning to stop taking insulin so it's perfectly safe. Nurse lady just gave me one of those looks that people give when they see someone doing something completely idiotic. And I gave her the look right back.
Since I referenced registered diabetic specialists I cannot answer for all of them about being completely unaware of the actual science and the details. I find it unsettling how you have one interaction with a nurse and paint a whole group of people lacking knowledge. A RDS has to maintain so many credit hours per year through continuing education credits. States require a certain amount for them to maintain their professional status. I can't speak to what they are required to read and learn but it would seem a stretch to presume one interaction with a nurse equates to a whole group of people dedicated to working with diabetics on a daily basis not understanding the science behind the illness or disease. Many people on the forums have and continue to with RDS and have been successful at improving their diabetic conditions.
If, by your education, you can teach other people then I'm sure you'd be able to apply and find a teaching position in a nursing school or other accredited group. Heck, if you are really good, you could eventually move the LC/keto diet to the forefront of effectiveness. Until then, maybe not all professionals in a field are worthless and lack knowledge.
Seems I've struck a nerve.
I have definitely had more than one interaction than just with this one nurse. Seriously, you simply can't have a T1D kid and not get tons of dietary information. We've received education from multiple hospitals and doctors offices over the years. Even before I knew about Keto I asked questions about why it wouldn't just be better to eat less carbs. There has never been anything but advice to suggest that would be dangerous. I've also attended an annual conference held by JDRF since its first year where there are opportunities to speak with different people representing Endocrinologists and hospitals in the area as well as discuss nutritional recommendations. There are also the numerous comments from other low carbers that shared the same experience. What I haven't yet experienced is anyone in the medical field who's job it is to teach nutrition or diabetes education say anything other than "she (my daughter) has to have carbs or she will get DKA and need to be hospitalized".
So you can find it as unsettling as you want, but since I have yet to ever encounter a dietitian or diabetes educator that has a clue, I'm going to assume the norm is the uninformed information they have always shared on the subject.
I personally find it unsettling that the professionals I've encountered don't know as much about it as I do.0 -
Sunny_Bunny_ wrote: »Ketoacidosis does not just sneak up on you. Prior to becoming acidotic you would feel like you are dying. I am not kidding. There is pain, all over your body. You feel nauseated and will be vomitting as it progresses. You feel so thirsty that it consumes your thoughts. You cannot get enough to drink and you are urinating just as much.
Ketoacidosis cannot happen if insulin is present in the body. Weather or not you're making ketones, if you're producing insulin, you won't become acidotic. I should say, the only exception I am aware of is non-diabetic Ketoacidosis caused by severe hypothyroidism. That is incredibly rare and only actually occurs due to extreme dehydration resulting from the underlying illness that went untreated for weeks.
<snip> They are completely unaware of the actual science and the details. My daughter mentioned to her diabetes nurse that she plans to eat low carb (150g or less) once she goes back on her insulin pump and the nurse told her that she couldn't do that because she would get DKA. I corrected her that having ketones is not the same as being acidotic and that no one said she was planning to stop taking insulin so it's perfectly safe. Nurse lady just gave me one of those looks that people give when they see someone doing something completely idiotic. And I gave her the look right back.
You are so right Sunny. In my uncontrolled years as a diabetic, I was ketoacidosis. I was so thirsty, all I could do was drink water and peed all the time. I actually lost weight too. I thought I was doing good! My A1c was over 15. I didn't get sick/nauseated though.
I am so glad and thank God I found the keto diet. Using insulin is the absolute worst way to control BG's. Here is an actual graph from a few years ago when I was taking all the diabetic meds (see here for listing: How I got Off of Diabetic Prescriptions Drugs Since I Started Keto Updated)
The Green area was where I was supposed to be.....below the red line is "going low", which for me was way worst than too high. Going low is scary. One of those readings is 21. That's so low, I could of passed out and never woke up again. I'm single, so there would of been no one to help me. But God had my back...
I hope this helps,
Dan the Man from Michigan
Keto / The Recipe Water Fasting / E.A.S.Y. Exercise Program
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Again, thank you for all of this discussion and information. My BG has been between 80-137 while eating low carb, so I was confused why my endo was saying I was at risk for ketoacidosis. I don't think I've even been near 250-300 maybe ever, so I appreciate your perspectives.0
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@DittoDan were you hospitalized for DKA?0
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In case it wasn't clear from the FDA blurb above, DKA is a known (rare) side-effect of invokana. I assume that's why the doc was concerned.0
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Sunny_Bunny_ wrote: »@DittoDan were you hospitalized for DKA?
No. It must not of been severe enough.0 -
Sunny_Bunny_ wrote: »@DittoDan were you hospitalized for DKA?
No. It must not of been severe enough.
Well, that's what I was going to say. Actual DKA isn't something you cant just get over on your own.
But, I'm sure you were advancing in that direction from your description. No doubt had some elevation of acidity. As unbelievably bad as you felt, can you imagine it progressing to severe abdominal pain and vomitting and having your whole body just feel like... I don't know how to describe it because my daughter couldn't even describe it. She just said that she literally feels like she's dying. So, this is one of the reasons that I think it's so dumb when a medical professional just sees ketones in urine and thinks DKA. They have obviously never seen anyone experiencing actual DKA. It's so much more than severe pain and illness. It's clinging to consciousness and barely being coherent. At its worst, the person is unable to even communicate.0
