Physiological Insulin Resistance?
Options
nvmomketo
Posts: 12,019 Member
I came to a LCHF diet, and then ketosis, to treat my emerging prediabetic blood glucose. I appeared to be early in insulin resistance and wanted to nip it in the bud. My fasting blood glucose was often between a 5.6 and 6.1 while eating a reasonable diet which consisted of me unreasonably including a soda or a bag of candies on most days.
I also had an oral glucose tolerance test at one point. My FBG was 6. At 30 minutes after drinking the glucose drink my BG was up to a 9 something. At 1 hour it was 7.8. At 1.5 hours it was 6, and by 2 hours it was into the 4s (reactive hypoglycemia). The 9 and FBG was prediabetic although my FBG plummetted which is not prediabetic normal.
During that time my fasting insulin rose from 23 pmol/L (normal) when FBG was 5.3, to 46 pmol/L when FBG was 6 - getting into slightly high.
Pretty minimal elevated insulin and BG but I wanted normal to healthy levels.
When I started keto my FBG fell. It was usually in the 4s to low 5s. Yeah! It would go up to the mid 5s following a "high" carb ketogenic day (30g carbs). Fair enough.
So far so good.
That lasted about 4 months, or the amount of time I was losing weight. I am now at 150lbs, at 5'8", and feel good but not noticeably losing weight; maybe 0.5 lbs per month. Maybe. I would like to hit 140lbs but if I never hit it, I'm happy. It would just be the difference between snug and loose size 8 pants.
I still eat ketogenic, 9 months later, but my FBG is climbing. Unless I include some sort of fasting (IF, 24-50 hour) or eat less than 10g carbs, my FBG is usually above a 5.5. If I snack at night it is often a 6. If it is a big snack that includes carbs, like macadamia nuts, coconut and cacao nibs, it will get to a higher. After adding some cheese to that, I hit a 6.8 the other day. Geez!
My FBG is almost ALWAYS my highest reading of the day. I go to bed with a 5 and wake up with 5.8 or 6. My foods are not spiking my insulin by much.
Could this just be physiological insulin resistance? My hope is yes, that my muscles are becoming more insulin resistant because it is making it smpler for my brain to use what glucose I have in my blood. Okay. Seems reasonable. Supposedly it is benign, but why is elevated FBG due to physiological insulin resistance caused by a ketogenic diet any better than pathological insulin resistance?
The first is temporary, and lasts only as long as one is very LCHF, but since I plan to be a lifer, this temporary state may last the next 40 years.... so, meh.
Is it okay because my insulin is conceivably not elevated all the tme from diet causes? I am very low carb and moderate to low protein.
Is it okay because my BG is not high a few times per day, just "sort of" high in the mornings and then falling throughout the day. I was of the mind that elevated BG is elevated BG though; i don't want it to continue to creep up.
I am usually in mild ketosis as long as my FBG is not much above a 6. To get beyond trace ketones I NEED to use IF now a days. To hit moderate ketones I need to fast more than 24 hours.
There isn't a lot on this right now:
http://optimisingnutrition.com/tag/physiological-insulin-resistance/
http://high-fat-nutrition.blogspot.ca/2007/10/physiological-insulin-resistance.html
http://caloriesproper.com/ketoadaptation-and-physiological-insulin-resistance/
Mark's daily apple suggests increasing carbs up to 150g if this happens but I don't want to lose the benefts of ketosis. http://www.marksdailyapple.com/does-eating-low-carb-cause-insulin-resistance/#axzz43MdoxJ4C
I am in for a carnivorous April to see if I can shake this physiological IR a bit, and maybe move the scale a bit. I don't see a lot of options on how to change this.... I mean, I don't see a lot of desirable options on how to fix this.
I will try carnivore. Beyond that there is just... exercise (grumble grumble). I haven't explored that yet alhough I am dabbling. I'm having some autoimmune issues with my joints lately so much beyond walking is tricky, with walking being uncomfortable some days.
... This could also be part of the cause of my FBGs going above 6. Perhaps my inflamed autoimmune system has bumped FBG from a 5-6, up to a 5.5-6.5?
Any thoughts or experiences you can share? I know my numbers are not bad, and I am probably overthinking this, but my FBG is trending upwards and is now worse than it was before I started keto... I don't like the upward trend.
I also had an oral glucose tolerance test at one point. My FBG was 6. At 30 minutes after drinking the glucose drink my BG was up to a 9 something. At 1 hour it was 7.8. At 1.5 hours it was 6, and by 2 hours it was into the 4s (reactive hypoglycemia). The 9 and FBG was prediabetic although my FBG plummetted which is not prediabetic normal.
During that time my fasting insulin rose from 23 pmol/L (normal) when FBG was 5.3, to 46 pmol/L when FBG was 6 - getting into slightly high.
Pretty minimal elevated insulin and BG but I wanted normal to healthy levels.
When I started keto my FBG fell. It was usually in the 4s to low 5s. Yeah! It would go up to the mid 5s following a "high" carb ketogenic day (30g carbs). Fair enough.
So far so good.
That lasted about 4 months, or the amount of time I was losing weight. I am now at 150lbs, at 5'8", and feel good but not noticeably losing weight; maybe 0.5 lbs per month. Maybe. I would like to hit 140lbs but if I never hit it, I'm happy. It would just be the difference between snug and loose size 8 pants.
I still eat ketogenic, 9 months later, but my FBG is climbing. Unless I include some sort of fasting (IF, 24-50 hour) or eat less than 10g carbs, my FBG is usually above a 5.5. If I snack at night it is often a 6. If it is a big snack that includes carbs, like macadamia nuts, coconut and cacao nibs, it will get to a higher. After adding some cheese to that, I hit a 6.8 the other day. Geez!
My FBG is almost ALWAYS my highest reading of the day. I go to bed with a 5 and wake up with 5.8 or 6. My foods are not spiking my insulin by much.
Could this just be physiological insulin resistance? My hope is yes, that my muscles are becoming more insulin resistant because it is making it smpler for my brain to use what glucose I have in my blood. Okay. Seems reasonable. Supposedly it is benign, but why is elevated FBG due to physiological insulin resistance caused by a ketogenic diet any better than pathological insulin resistance?
The first is temporary, and lasts only as long as one is very LCHF, but since I plan to be a lifer, this temporary state may last the next 40 years.... so, meh.
Is it okay because my insulin is conceivably not elevated all the tme from diet causes? I am very low carb and moderate to low protein.
Is it okay because my BG is not high a few times per day, just "sort of" high in the mornings and then falling throughout the day. I was of the mind that elevated BG is elevated BG though; i don't want it to continue to creep up.
I am usually in mild ketosis as long as my FBG is not much above a 6. To get beyond trace ketones I NEED to use IF now a days. To hit moderate ketones I need to fast more than 24 hours.
There isn't a lot on this right now:
http://optimisingnutrition.com/tag/physiological-insulin-resistance/
http://high-fat-nutrition.blogspot.ca/2007/10/physiological-insulin-resistance.html
http://caloriesproper.com/ketoadaptation-and-physiological-insulin-resistance/
Mark's daily apple suggests increasing carbs up to 150g if this happens but I don't want to lose the benefts of ketosis. http://www.marksdailyapple.com/does-eating-low-carb-cause-insulin-resistance/#axzz43MdoxJ4C
I am in for a carnivorous April to see if I can shake this physiological IR a bit, and maybe move the scale a bit. I don't see a lot of options on how to change this.... I mean, I don't see a lot of desirable options on how to fix this.
I will try carnivore. Beyond that there is just... exercise (grumble grumble). I haven't explored that yet alhough I am dabbling. I'm having some autoimmune issues with my joints lately so much beyond walking is tricky, with walking being uncomfortable some days.... This could also be part of the cause of my FBGs going above 6. Perhaps my inflamed autoimmune system has bumped FBG from a 5-6, up to a 5.5-6.5?
Any thoughts or experiences you can share? I know my numbers are not bad, and I am probably overthinking this, but my FBG is trending upwards and is now worse than it was before I started keto... I don't like the upward trend.
0
Replies
-
I would definitely recommend an HBA1C test so you can get a big picture view of how this change is affecting you, if it's been happening for the last 3 months.
I can say with certainty that the less I eat carbs, the more they affect me when I do eat them, so I believe there is something to be said for the argument that low carb can increase carb resistance, not that I'm going to start eating carbs because of that.
And I know you're averse to exercise and have pain to deal with, (I totally understand, I'm at that point myself with my BG and am fighting it too) but it doesn't take much activity to cause a really positive affect on your blood glucose. A slow walk could very well get you to where you want to be, there's no need to go to the gym or do anything strenuous.
Keep us posted on your progress. I'm really interested to hear how this works out for you. Looking ahead for myself, if I'm able to get off the last bit of insulin, I'm resigned to the fact that exercise will be the only way I'll be able to add a hearty serving of veggies back into my life.0 -
I haven't sat down and tried to think about the science in this Michael Eades post very thoroughly yet, but your post made me think of it. (Maybe similar info is in the posts that you linked to).
"Since saturated fat generates a higher FADH2:NAHD ratio, saturated fat increases insulin resistance, which keeps more carbs in the blood.
Why would this be a good thing?
Well, in the event of starvation, the body ‘eats’ more fat in the sense that it extracts fat from the fat cells for energy. As the body metabolizes this fat, the FADH2:NAHD ratio increases, which increases insulin resistance and keeps the carbs available for brain function instead of being shunted into, say, muscle cells, which can function beautifully on fat.
After several days of starvation or a ketogenic diet, a similar situation prevails. Although the ketones reduce the FADH2:NAHD ratio, they also affect the proton-motive force in such a way as to both increase insulin resistance and increase the efficiency of ATP formation. So, glucose is made available for the brain while ketones become the fuel of choice for most everything else. And the ketones also power some of the brain as well, sparing glucose for those brain functions that run on glucose only. The blood sugar rises a bit, and this is what we call physiological insulin resistance. Also, understanding how this all works almost militates that there be a metabolic advantage while in ketosis, but that’s a subject for another post."
https://proteinpower.com/drmike/2016/02/03/will-the-new-dietary-guidelines-fatten-us-even-more/0 -
Have you researched Dawn Phenomenon? This could be the simple explanation of why your FBG is higher. As a type 1 Diabetic for 27years I can alway see this influx of hormones in the early morning hours in my CGM numbers.
0 -
I think some people do experience increased insulin resistance with keto, but it might be fixed by exercise.
You'll find plenty of N=1 experiments on the net supporting both increased resistance and increased sensitivity. My favorite is from Peter Attia. He's obviously in good shape, so his muscles are like glucose sponges.
He went to a lab (Stanford, I think) to have his insulin response tested. They basically give you an injection of glucose and then follow it up with various doses of insulin and then measure remaining glucose levels to determine insulin sensitivity.
Since he was keto at the time, he was already in a low insulin and low glucose state. The small incremental insulin dose they gave him brought him to an extreme hypoglycemic state and he almost lost consciousness. His muscles had already soaked up all the injected glucose, and the follow-up dose of insulin forced his glucose into the way-too-low danger zone. He was VERY insulin sensitive, even while keto.
High blood glucose can be due to poor muscle uptake, poor insulin secretion, excess cortisol, or excess liver generation. Unless you know which factors affect you, it's hard to fix with random changes.0 -
PaleoInScotland wrote: »I would definitely recommend an HBA1C test so you can get a big picture view of how this change is affecting you, if it's been happening for the last 3 months.
I can say with certainty that the less I eat carbs, the more they affect me when I do eat them, so I believe there is something to be said for the argument that low carb can increase carb resistance, not that I'm going to start eating carbs because of that.
And I know you're averse to exercise and have pain to deal with, (I totally understand, I'm at that point myself with my BG and am fighting it too) but it doesn't take much activity to cause a really positive affect on your blood glucose. A slow walk could very well get you to where you want to be, there's no need to go to the gym or do anything strenuous.
Keep us posted on your progress. I'm really interested to hear how this works out for you. Looking ahead for myself, if I'm able to get off the last bit of insulin, I'm resigned to the fact that exercise will be the only way I'll be able to add a hearty serving of veggies back into my life.
Good point. An HBA1C would tell me more. If it is physiological IR, I imagine my HBA1C would be fairly low since I am not at an elevated BG most of the time.
My last FBG (in a lab - not my glucometre) was 6.0. At that time my HBA1C was a 5.8 (I believe). I have a lab requisition for one now which I need to fill. I will know in a few weeks what it is. Hopefully it is a 5 or something thereabouts.
My exercise excuses are lame and weak. I know I need to get regular with it. To make the time to do it. I wouldn't do it for veggies but I would for a healthier life. LOL 0 -
I haven't sat down and tried to think about the science in this Michael Eades post very thoroughly yet, but your post made me think of it. (Maybe similar info is in the posts that you linked to).
"Since saturated fat generates a higher FADH2:NAHD ratio, saturated fat increases insulin resistance, which keeps more carbs in the blood.
Why would this be a good thing?
Well, in the event of starvation, the body ‘eats’ more fat in the sense that it extracts fat from the fat cells for energy. As the body metabolizes this fat, the FADH2:NAHD ratio increases, which increases insulin resistance and keeps the carbs available for brain function instead of being shunted into, say, muscle cells, which can function beautifully on fat.
After several days of starvation or a ketogenic diet, a similar situation prevails. Although the ketones reduce the FADH2:NAHD ratio, they also affect the proton-motive force in such a way as to both increase insulin resistance and increase the efficiency of ATP formation. So, glucose is made available for the brain while ketones become the fuel of choice for most everything else. And the ketones also power some of the brain as well, sparing glucose for those brain functions that run on glucose only. The blood sugar rises a bit, and this is what we call physiological insulin resistance. Also, understanding how this all works almost militates that there be a metabolic advantage while in ketosis, but that’s a subject for another post."
https://proteinpower.com/drmike/2016/02/03/will-the-new-dietary-guidelines-fatten-us-even-more/
Very Interesting. Thank you. I need to cogitate n that one for a while... Sat fats can cause physiological IR which is good for the brain, but if you follow the homornal theory on obesity, it would be bad for the waist. On the other hand veggie oil increases insulin sensitivity but increases fat storage? I can't get my head around that... because high insulin supposedly leads to increased fat storage but if you are insulin sensitive there should be less insulin and less fat stored.
I gotta go figure this one out. I'm tired with a post kiddie birthday party headache. My brain isn't sharp at the moment. LOL0 -
Have you researched Dawn Phenomenon? This could be the simple explanation of why your FBG is higher. As a type 1 Diabetic for 27years I can alway see this influx of hormones in the early morning hours in my CGM numbers.
I have looked into it. That could be it. My FBG isn't always up, but it is higher than the evening most of the time. How does one get the liver to calm down? Apple cider vinegar does very little to help. Exercise helps some but I have three boys in evening activities (which I often coach) so time is tight in the evenings. Evening snacks make FBG worse, even if it is just a fat snack. A large eveing meal with carbs is the worst for my FBG.
0 -
I think some people do experience increased insulin resistance with keto, but it might be fixed by exercise.
You'll find plenty of N=1 experiments on the net supporting both increased resistance and increased sensitivity. My favorite is from Peter Attia. He's obviously in good shape, so his muscles are like glucose sponges.
He went to a lab (Stanford, I think) to have his insulin response tested. They basically give you an injection of glucose and then follow it up with various doses of insulin and then measure remaining glucose levels to determine insulin sensitivity.
Since he was keto at the time, he was already in a low insulin and low glucose state. The small incremental insulin dose they gave him brought him to an extreme hypoglycemic state and he almost lost consciousness. His muscles had already soaked up all the injected glucose, and the follow-up dose of insulin forced his glucose into the way-too-low danger zone. He was VERY insulin sensitive, even while keto.
High blood glucose can be due to poor muscle uptake, poor insulin secretion, excess cortisol, or excess liver generation. Unless you know which factors affect you, it's hard to fix with random changes.
Darn exercise again. LOL Oh to have the sponge muscles of Attia!
High blood glucose can be due to :
poor muscle uptake, - could be. I am not in good shape; not horrible but 30 minutes of basketball leaves me winded. Poor uptake could be due to physiological IR too. I can't see how to fi that beyond increasing carbs or cutting them further during weight loss.
poor insulin secretion, - I doubt this is me. LADA doesn't seem to fit my situation.
excess cortisol, - My FBG and insulin went up after a year of steroids. That was 2 years ago though. I am guessing it is pretty normal now, although my dabbling in fasting could bump it up a bit.
or excess liver generation. Dawn phenomenom... no idea what to do with that.
Thanks Wab. You always seem to be able to cut to the chase of an issue.0 -
If I were you, I'd focus on exercise. Specifically on exercise that will deplete muscle glycogen -- like HIIT or weight lifting.
If nothing else, it'll improve your basketball game.
0 -
From my research, your gut microbiota has a lot to do with insulin resistance. Keto/low carb "manages" and regulates the gut microbiome. Is there a solution yet? I don't think so. Since the microbiomes are so diverse for each individual, scientists haven't figured out what is lacking or the correct ratios of "good" and "bad" microbiota. But they certainly are working on it.
Some day, they may come up with a test, then give you a tailored probiotic regimen to correct the microbiota and end diabetes, obesity and many other chronic diseases. Your gut microbiome IS your immune system. So, to get the gut microbiome right, is to cure you.
The closest thing the medical researchers have to correct the gut microbiome, is a transplanted microbiota from a healthy person to a chronic person, with a pretty good success rate. It is too experimental now, so don't look expect to sign up and get it. Right now, only people with c'dif can get it, they have a 90%+ curing c'dif. But, others are using a similar technique ~ for other maladies ~ all related to the gut microbiome. This is the "hottest" science right now. Expect it to come online to the mainstream more and more... as scientist discover new things...
Dan1 -
Have you researched Dawn Phenomenon? This could be the simple explanation of why your FBG is higher. As a type 1 Diabetic for 27years I can alway see this influx of hormones in the early morning hours in my CGM numbers.
I have looked into it. That could be it. My FBG isn't always up, but it is higher than the evening most of the time. How does one get the liver to calm down? Apple cider vinegar does very little to help. Exercise helps some but I have three boys in evening activities (which I often coach) so time is tight in the evenings. Evening snacks make FBG worse, even if it is just a fat snack. A large eveing meal with carbs is the worst for my FBG.
Exercise & LCHF eating seems to be the only things I've found that help those fasting numbers. And it takes continuous effort in order to see minor results. Very frustrating I know. Especially with a busy lifestyle. Hang in there!0 -
Have you researched Dawn Phenomenon? This could be the simple explanation of why your FBG is higher. As a type 1 Diabetic for 27years I can alway see this influx of hormones in the early morning hours in my CGM numbers.
I have looked into it. That could be it. My FBG isn't always up, but it is higher than the evening most of the time. How does one get the liver to calm down? Apple cider vinegar does very little to help. Exercise helps some but I have three boys in evening activities (which I often coach) so time is tight in the evenings. Evening snacks make FBG worse, even if it is just a fat snack. A large eveing meal with carbs is the worst for my FBG.
Exercise & LCHF eating seems to be the only things I've found that help those fasting numbers. And it takes continuous effort in order to see minor results. Very frustrating I know. Especially with a busy lifestyle. Hang in there!
Thanks. I am fighting change. Again. I know what to do, it is just a matter of sticking to it more than a few days. LOL
Insanity is doing the same things over and over and expecting different results, right? 0 -
I hear that!!!0
-
Have you researched Dawn Phenomenon? This could be the simple explanation of why your FBG is higher. As a type 1 Diabetic for 27years I can alway see this influx of hormones in the early morning hours in my CGM numbers.
After I started pulling my FBG and ketone levels I realized my BG level 1 hour after breakfast could be 5-10 points lower than my FBG for example if FBG was 106 then an hour after breakfast it might be at 96.
Eating LCHF seems to give different results in different people and even more so in the first 6 months of eating this way in my case.0 -
GaleHawkins wrote: »After I started pulling my FBG and ketone levels I realized my BG level 1 hour after breakfast could be 5-10 points lower than my FBG for example if FBG was 106 then an hour after breakfast it might be at 96.
Eating LCHF seems to give different results in different people and even more so in the first 6 months of eating this way in my case.
Do you suppose your FBG would go down anyhow in that time frame once you've burned off the extra glucose your liver gave you as a sunrise treat?
0 -
Yeah, my BG an hour or so after eating is usually lower. My FBG is usually my highest, or tied for highest, reading of the day.... Darn liver needs to control itself better.0
-
I seem to have mid-morning phenomenon, it drives me crazy. My BG will be just fine when I wake up, but about 3 hours later, whether I eat, don't eat, or just have coffee, it spikes. This has happened consistently ever since I dropped the carbs way down from 100 g to under 20 g and ditched most of my insulin. Hard to judge how much of this was going on before because I'd inject fast acting insulin before I ate, which I generally don't do anymore, unless those morning spikes get too high.0
-
http://docmuscles.com/2016/03/20/does-long-term-ketosis-cause-insulin-resistance/ may be worth a read.0
