Q. Diabetes, Low-Carb & Ketones
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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.
You would think that because medical people need to maintain a certain level of post-school education credits, they'd know more about the things they're supposed to be knowledgeable about, like a diabetes specialist knowing the difference between NK and DKA.
Unfortunately, most doctors don't know as much as you'd think.
Here's a fun fact for you -- as recent as 40 years ago, doctors didn't believe glucose even could be controlled in humans.
Dr. Bernstein shares his first-hand experience with the backwardness of the medical field (emphasis mine):What I did find was that such complications had repeatedly been prevented, and even reversed, in animals.Not through exercise, but by normalizing blood sugars! To me, this was a total surprise. All of diabetes treatment was heavily focused in other directions, such as lowfat diets, preventing severe hypoglycemia, and preventing a potentially fatal extreme high blood sugar condition called ketoacidosis. Thus it had not occurred to me that keeping blood sugar levels as close to normal as possible for as much of the time as possible would make a difference.
Excited by my discovery, I showed these reports to my physician, who was not impressed. “Animals aren’t humans,” he said, “and besides, it’s impossible to normalize human blood sugars.” Since I had been trained as an engineer, not as a physician, I knew nothing of such impossibilities, and since I was desperate, I had no choice but to pretend I was an animal.
[...]
I had the new sensation of being the boss of my own metabolic state, and began to feel the same sense of accomplishment and reward I had in engineering when I solved a difficult problem. I had taught myself how to make my blood sugars whatever I wanted them to be and was no longer on the roller coaster. Things were finally under my control.
Back in 1973, I felt quite exhilarated with my success, and I felt that I was on to something big. Since getting the results of my computer search, I had been a subscriber to all of the English-language diabetes journals, and none of them had mentioned the need for normalizing blood sugars in humans.
In fact, every few months I’d read another article saying that blood sugar normalization wasn’t even remotely possible. How was it that I, an engineer, had figured out how to do what was impossible for medical professionals? I was deeply grateful for the fortuitous combination of events that had turned my life, my health, and my family around and put me on the right path. At the very least, I felt, I was obliged to share my new found knowledge with others. Millions of “ordinary” diabetics were no doubt suffering needlessly, as I had. I was sure that all physicians treating diabetes would be thrilled to learn how to prevent and possibly reverse the grave complications of this disease.
[...]
I submitted it and its revisions to many medical journals over a period of years—a period during which I was continually improving in health, and continually proving to myself and my family, if to no one else, that my methods were correct. The rejection letters I received are testimony that people tend to ignore the obvious if it conflicts with the orthodoxy of their early training. Typical rejection letters read in part: “Studies are not unanimous in demonstrating a need for ‘fine control’” (the New England Journal of Medicine), or “How many patients would use the electric device for measurement of glucose, insulin, urine, etc.?” (Journal of the American Medical Association). As a matter of fact, since 1980, when these “electric devices” finally were made available to patients, the worldwide market for blood glucose self monitoring supplies has come to exceed $4 billion annually. Look at the array of blood glucose meters in any pharmacy and you can get an idea of just how many patients use, and will use, the “electric device.”
Trying to cover several routes simultaneously, I joined the major lay diabetes organizations, in the hope of moving up through the ranks, where I could get to know physicians and researchers specializing in the disease. This met with mediocre success. I attended conventions, worked on committees, and became acquainted with many prominent diabetologists. In this country, I met only three physicians who were willing to offer their patients the opportunity to put these new methods to the test.
Meanwhile, Charlie Suther was traveling around the country to university research centers with copies of my unpublished article, which by now had been typeset and privately printed at my expense.
The rejection by physicians specializing in diabetes of the concept of blood sugar self-monitoring, even though essential to blood sugar control, was so intense, however, that the management of his company had to turn down the idea of making meters available to patients until many years later. His company and others could clearly have profited from the sale of blood glucose meters and test strips. However, the backlash from the medical establishment prevented it on a number of counts. It was unthinkable that patients be allowed to “doctor” themselves.
They knew nothing of medicine—and if they could, how would doctors earn a living? In those days, patients visited their doctors once a month to “get a blood sugar.” If they could do it at home for 25 cents (in those days), why pay a physician? But almost no one believed there was any value to normal blood sugars anyway. In some respects, blood glucose self-monitoring still remains a serious threat to the incomes of many physicians who specialize in the treatment of the symptoms of diabetes and not the disease. Drop into your neighborhood ophthalmologist’s office and you will find the waiting room three-quarters filled with diabetics, many of whom are waiting for expensive fluorescein angiography or laser treatment.
That's right, this man, who was an engineer long before being a doctor, had uncovered the secret that literally saved his life, and went against all conventional wisdom of the time -- blood sugar control -- long before the medical community caught on, and even worse, they actively rejected it until they were forced to catch on.
While there are certainly exceptions to the generalization, the generalization that Diabetes medical people still don't understand the difference between NK and DKA holds water, for the exact same reasons Dr. Bernstein describes the same specialists didn't think people could control their blood sugar.
It largely boils down to the fact that medicine, even in a specialty, is a huge field. So huge that it's daunting to learn even a small fraction of it. As a result, most of them cling to what they learned in the beginning of their career, and confirmation bias largely does the rest when they're doing their continuing education credits (which are usually self-directed theses), and they don't think to question this, because they're busy getting back to their jobs, so they can pay the bills. In other words, doctors are humans, not gods (and while it's good to hold the collective to a higher standard, it's also important to recognize that the individuals are human and don't know everything).
In my opinion, this understanding is actually good for the patient-doctor relationship, in the long run, because both can learn from one another, and the things the doctor learns from a collaborative relationship with the patient can then be used to help other patients, moreso than if the doctor attempts to stay on a pedestal and give direction from "on high."0 -
@Dragonwolf reading about the unwillingness to support self-monitoring decades ago makes me very sad as it appears we've come full circle, at least in the UK. I'm a member of the Diabetes.co.uk forum and so many Type 2 diabetics on pills are saying that their doctors will no longer prescribe test strips. Apparently it's the new NHS suggestion that self-monitoring provides no benefits, of course it's really about saving money. It truly breaks my heart. I don't know what I would do if I couldn't monitor my own blood sugar. Albeit I'm on insulin, so I don't fall into that category, but I want to cry and scream every time I read about someone being denied test strips.
https://www.diabetes.org.uk/About_us/News_Landing_Page/People-with-diabetes-denied-vital-test-strips/0 -
Limitations in Canada too. Not in prescription but with the government payment help for those without private medical coverage for prescriptions. So those that can afford to pay for them can get more. Those on more limited budgets get a limited number. Current limit set at 200 strips a year for those not on insulin. Manageable but still limited. I believe these limits are set on seniors as well but I am not sure.0
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PaleoInScotland wrote: »@Dragonwolf reading about the unwillingness to support self-monitoring decades ago makes me very sad as it appears we've come full circle, at least in the UK. I'm a member of the Diabetes.co.uk forum and so many Type 2 diabetics on pills are saying that their doctors will no longer prescribe test strips. Apparently it's the new NHS suggestion that self-monitoring provides no benefits, of course it's really about saving money. It truly breaks my heart. I don't know what I would do if I couldn't monitor my own blood sugar. Albeit I'm on insulin, so I don't fall into that category, but I want to cry and scream every time I read about someone being denied test strips.
https://www.diabetes.org.uk/About_us/News_Landing_Page/People-with-diabetes-denied-vital-test-strips/
I'm currently waiting for approval by insurance to pay for my T1D daughters test strips... It's because of the brand. They only cover the cheapo ones but not the ones that work in the meter that sends glucose readings wirelessly directly to her insulin pump. She starts back on the pump on Tuesday. Luckily she still has a box of strips, because it will likely take a month to finally get it approved. Which they had already done before. I guess it expires...
In other news...
Yesterday, I finally met a medical professional that highly supports Keto. Anyone wanna guess their field of specialty?0 -
dasher602014 wrote: »Limitations in Canada too. Not in prescription but with the government payment help for those without private medical coverage for prescriptions. So those that can afford to pay for them can get more. Those on more limited budgets get a limited number. Current limit set at 200 strips a year for those not on insulin. Manageable but still limited. I believe these limits are set on seniors as well but I am not sure.
Wow, that's less than one a day for someone who can't pay for them out of pocket.
Sunny_Bunny_ wrote: »PaleoInScotland wrote: »@Dragonwolf reading about the unwillingness to support self-monitoring decades ago makes me very sad as it appears we've come full circle, at least in the UK. I'm a member of the Diabetes.co.uk forum and so many Type 2 diabetics on pills are saying that their doctors will no longer prescribe test strips. Apparently it's the new NHS suggestion that self-monitoring provides no benefits, of course it's really about saving money. It truly breaks my heart. I don't know what I would do if I couldn't monitor my own blood sugar. Albeit I'm on insulin, so I don't fall into that category, but I want to cry and scream every time I read about someone being denied test strips.
https://www.diabetes.org.uk/About_us/News_Landing_Page/People-with-diabetes-denied-vital-test-strips/
I'm currently waiting for approval by insurance to pay for my T1D daughters test strips... It's because of the brand. They only cover the cheapo ones but not the ones that work in the meter that sends glucose readings wirelessly directly to her insulin pump. She starts back on the pump on Tuesday. Luckily she still has a box of strips, because it will likely take a month to finally get it approved. Which they had already done before. I guess it expires...
In other news...
Yesterday, I finally met a medical professional that highly supports Keto. Anyone wanna guess their field of specialty?
Probably an Endo, maybe a nephrologist. Those seem to be the two most common, though Chiros sometimes nail it, too.0 -
@Sunny_Bunny_ I hope your daughter gets approval soon! That's no good at all for a Type 1 on a pump. Don't these insurance companies understand the cost savings of preventing problems with self monitoring?0
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I'll tell you the conversation I had with the doctor I am talking about that I finally met that supports Keto. Then I'll reveal their specialty.
So, she asked me how I had been losing weight. I said, well, not sure of your opinion on the method because in my experience so far when it comes up with medical professionals, isn't generally supportive. I'm eating very low carb.
She says, I actually fully support that.
I reluctantly gave more info and said, it's very very low carb. Are you familiar with nutritional ketosis?
Her- Yes! I recommend it to patients all the time. I think it's the best way anyone can eat, especially women around 40+.
I was in such shock that not only did she support it but went on to suggest that it would be great for everyone, that I didn't even discuss it any further or ask if she herself eats that way. But I imagine she must be right?
This was my gynecologist! Makes sense though. I'm sure she has many patients with PCOS which seems most commonly the doctor supported low carb audience. I wonder if she advises reducing carbs to gestational diabetic patients?
Anyway, I like her extra well now!0 -
I was chatting with some friends who also have T1D kids today. Apparently only some medications are covered and only 6 test strips per day are paid for... In fast growing tween and teen kids! Pretty sad.
Pumps aren't covered at all.0 -
Sunny_Bunny_ wrote: »I'll tell you the conversation I had with the doctor I am talking about that I finally met that supports Keto. Then I'll reveal their specialty.
So, she asked me how I had been losing weight. I said, well, not sure of your opinion on the method because in my experience so far when it comes up with medical professionals, isn't generally supportive. I'm eating very low carb.
She says, I actually fully support that.
I reluctantly gave more info and said, it's very very low carb. Are you familiar with nutritional ketosis?
Her- Yes! I recommend it to patients all the time. I think it's the best way anyone can eat, especially women around 40+.
I was in such shock that not only did she support it but went on to suggest that it would be great for everyone, that I didn't even discuss it any further or ask if she herself eats that way. But I imagine she must be right?
This was my gynecologist! Makes sense though. I'm sure she has many patients with PCOS which seems most commonly the doctor supported low carb audience. I wonder if she advises reducing carbs to gestational diabetic patients?
Anyway, I like her extra well now!
\o/ That's awesome to hear! It's especially great to see it in one of the more "front-line" divisions, too!0 -
Wow, @Sunny_Bunny_, that is great to hear!
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I'm NOT surprised. It was my gynecologist who first identified that I had diabetes in the first place. Go Gynos!Sunny_Bunny_ wrote: »I'll tell you the conversation I had with the doctor I am talking about that I finally met that supports Keto. Then I'll reveal their specialty.
So, she asked me how I had been losing weight. I said, well, not sure of your opinion on the method because in my experience so far when it comes up with medical professionals, isn't generally supportive. I'm eating very low carb.
She says, I actually fully support that.
I reluctantly gave more info and said, it's very very low carb. Are you familiar with nutritional ketosis?
Her- Yes! I recommend it to patients all the time. I think it's the best way anyone can eat, especially women around 40+.
I was in such shock that not only did she support it but went on to suggest that it would be great for everyone, that I didn't even discuss it any further or ask if she herself eats that way. But I imagine she must be right?
This was my gynecologist! Makes sense though. I'm sure she has many patients with PCOS which seems most commonly the doctor supported low carb audience. I wonder if she advises reducing carbs to gestational diabetic patients?
Anyway, I like her extra well now!
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