Hi,my 2 year old son was diagnosed with type 1 ketoacidosis diabetes when he was 19 months old. He is still in his honeymoon period,taking small units of insulin. he is eating very healthy and I just started putting him on a low carb high fat diet-almost ketodiet.for almost 8 months he did not gain any weigh. Finally with this new diet,even though it is not 100% ketodiet, he finally gain 1lbs in a week! His glucose is very good,however, there are moderate ketons in his urine.he is drinking lots of water, but I cannot flush them out.He seems perfectly fine, full of energy,no other symptons of ketoacidosis. Should I be worried about ketons, what should I do?FYI I would like to reverse his diabetes even though the doctors tell me it is impossible. Does anybody have any experience with this? Thank you
Having ketones with a normal blood sugar (i.e. 80-140 mg/dl) is perfectly normal. Ketones are generated by the body by fat burning and provide energy to your cells. In fact it is common in non-diabetics to have ketones during an overnight fast or when exercising. The primary concern with ketones is when you have an elevated blood sugar (i.e. > 250 mg/d). And if you test blood ketones you may find moderate or even high ketones when on a ketogenic diet during exercise, this simply reflects fat burning. More typically less ketones are found in the urine as only excess ketones are excreted.
Your child is T1, Sadly at this stage nothing can fix that, especially not diet… don’t get sucked in with the scammers promising a cure for $50
T1 use low carb just to have more stable bloods …so they don’t get the rollercoaster highs and lows…
adult T2 is totally different and where diet can help
I would follow the sick day rules, the term starvation ketones = ketogenic, as it applies to ketones and if you are on VERY low carb, with good bloods… quite normal
https://c.ymcdn.com/sites/www.ispad.org/resource/resmgr/Docs/CPCG_2014_CHAP_13.pdf
what is a concern is the lack of weight gain, normally with T1, this is because of high BG. In your case there may be a diet problem. you should really see a low carb dietitian to get a proper diet plan,
I would guess a LCHP …low carb higher protein with higher fats would be better
till your appointment, this group may be of a help, you need to join on FB by sending a message
Ok, so there is a lot of confusion here. Lots of people use Low Carb High Fat (LCHF) diets. People with both T1 and T2 use the LCHF diet both for glycemic control and weight. T1 and T2 are not totally different with respect to the diet.
And the introduction of sick day rules is just confusing. They don’t apply if one is not sick. Medical professionals will use these rules and suggest that regular ketones testing is a good way of avoiding DKA. It isn’t useful when you follow a LCHF diet. A ketogenic diet by definition is where your carb intake is low enough that your body starts burning fat and generating ketones. That is why you have ketones in your blood. And you go into ketosis often when on a LCHF diet even if you are not always in ketosis. Do not follow sick day rules that suggest ketones as a screening tool. Despite claims, ketones are not generally useful for diagnosing whether you are sick. Richard Bernstein in fact says to not even bother testing for ketones unless you have a high blood sugar. If you don’t have his book you really should get it (Diabetes Solution).
And now let’s get to Low Carb High Protein (LCHP). My observation is that high protein diets are not advised. You should not go over about 30% of your calories from protein. There are almost no diets that suggest LCHP. My understanding is that the “Protein Power” diet from Michael Eades is only 25% of calories from protein. Overeating protein can make you sick. And Bernsteins diet is a low carb moderate protein high fat diet. Bernstein only recommends like 50g/day for an adult which is the moderate amount of protein recommended even in the SAD diet. I would greatly encourage you to not follow a LCHP diet. And you are likely not going to find a dietician who will help you with LCHF.
It sounds like you have had progress already with weight gain. Bernsteins recommendation for weight gain (and loss) is to increase and decrease protein. And I am a member of the facebook group, it is helpful if you need encouragement but not the best if you wish to get competent advice on these sorts of diets. One good resource is the Bernstein discussion forum.
And personally, you might want to just stop testing ketones regularly. It isn’t meaningful. If your child is sick and has an elevated blood sugar, then check ketones.
They say Bernstein is LCHP on FBook group
I would say 30% is a very high protein diet, and more than I would consider
sick day rules are for when you have high BG,and may have ketones as well, These rules are used in many examples when not sick. a blocked injection site on a pump for example as one.
For a t1, sick day rules are very needed for BG and the ketone level between ok and not ok… Also the treatment methods when high BG, high ketone and when to seek medical care. the OP is asking about ketone levels, the sick day rules explain this is great and professional detail, I assume you read the link?
I have to tell you, FB is not a good source of credible information. Don’t even let Bernstein hear you say that his diet is LCHP. For a better understanding of LCHF diets I recommend “The Art and Science of Low Carb Living” by Phinney and Volek. In it they explain why LCHF is not HP, why the 30% level and why healthy and sustainable diets are moderate protein. And of course Bernstein himself is a better source of what is diet is all about.
I did read the reference you sent and the concern is that it while it does passingly understand the difference between normal ketosis and dangerous ketones associated with DKA it still fundamentally messes people up. But in fact the sick day rules only mention “starvation” ketones, they don’t say that ketones naturally occur overnight, when exercising or when following a low carb diet. And then it says:
Strive for a BG between 4 and 10 mmol/L (70 – 180 mg/dL) and blood ketones below 0.6 mmol/L when the child is ill (E).
This leads parents to constantly screening their kids for ketones as a way of detecting illness and believing that low levels of ketones need to be eliminated. Seriously? I just went through why ketones are perfectly fine with normal blood sugars. And why suggest that ketones need to be reduced? Parents and people with diabetes come here with really mixed up ideas including the OP who wanted to know how to “flush the ketones.” There is absolutely no need to flush ketones when they occur naturally as a result of fat burning.
I am well aware of LCHF, as I do that myself.
I am repeating the website T1grit
I think I explained it enough, I’m happy for you to expand if you wish to
I did say…
I’ve seen that chart and he knows better than to call Dr. Bs diet LCHP. I have commented on that FB page.
I’ve never seen Bernstein refer to his plan as LCHF, If he is higher protein, it may not be ketogenic
here is an interview where protein and some vegetables are mentioned by him.
This is a classic interview from dlife. I have to tell you, I’ve followed Dr. B for a decade and joined his forum in 2006. I’ve listened to his teleconferences for years and have virtually all the books he has ever written. Trust me, in his teachings his diet is moderate protein. It is important to not confuse his eating large amounts or the protein “food group” but those protein foods are high fat. In his book he says that adults require 1-1.2 g/kg/day. His example is a 155 lb adult which works out to 70-85 g/day of protein. In the last few years during his teleconferences he has further reduced his recommendations and now suggests more like 0.8 g/kg/day which works out to the 50 g/day I quoted. He has always had the position that you modulate protein intake to increase or decrease weight. So you fix your carbs at 6-12-12 (30g/day, i.e. 120 calories), eat your required protein (say 75g/day or 300 calories) and everything else is fat or indigestible. Which means about like 15% of calories from protein and 75% of calories come from fat. This is definitely LCHF diet and not a LCHP diet.
ps. And I really love how he just leaves Hope Warshaw speachless. She absolutely hates Dr. B to this day.
I did a google and he is about 1.2g per kg/lean body mass, for an adult and I would call that moderate
up to 2,3,4 or 5 times that per kg for a child. I think that is far too much for a child and I hope he mis-spoke and meant 1.2 to 1.5g per kg
RDA protein
