Once again, this was right on point for me, to me this reads that you COULD still be DKA with normal sugar because the body is using the extra for fuel…This should apply to those in starvation due to surgery or illness, they should be monitoring the ketones as well as the BS
So, incidentally, this is one of the reasons why I think that exercise is far more effective for managing BG in Type 1 than most doctors, diabetics, and even exercise physiologists realize. Glycogen-depleted muscles are absolute sponges for blood glucose, and the effect can persist for hours (or even days) after intense exercise.
As for the “sudden DKA,” I haven’t had to worry about that (yet?) because my body still produces a decent amount of endogenous insulin. I’m convinced from reading that keto diets are safe for most Type 1s, as long as certain precautions are taken. Having read this article and others, one of the things that seems obvious is that Type 1s with a history of DKA should actively monitor ketones while eating very low carb and while exercising. I also think that staying hydrated and well-fed (so that your body doesn’t go into autophagy) with protein and fats is critical. I’m fairly certain that I would not feel as confident in a high caloric deficit, low-carb diet for a Type 1 who exercises a lot.
The key message I get out of this entire thread is that if you have Type 1 and produce very little to no insulin, there is always a risk of DKA and it may or may not be accompanied by high blood sugar depending on a variety of factors. I think it’s a good idea to have a ketone meter and strips always available and to follow guidelines regarding ketone testing and ketone levels to be concerned about put out by diabetes associations.
Exercise is definitely great at lowering blood sugars. But because of that, it’s very, very tricky to manage to get blood sugar exactly right before, during, and after exercise. Not that I’m an expert, but I have yet to be able to exercise without going out of range (high or low, or both) in nearly 26 years of diabetes, and I think it’s a pretty common challenge. So, I don’t necessarily think of it as an automatic pass to better control (like eating lower-carb often is). I think this is likely why it’s “overlooked” by the professionals you listed. In trying to avoid going low (by reducing pre-meal insulin doses, using temporary basal rates, eating carbohydrates, or whatever), it’s very easy to accidentally overshoot and end up high instead. I also find that I have to exercise every day or not at all, otherwise blood sugar control becomes really unstable (at least for me).
I think this would cover most Type 1s, would it not? I mean, aside from some people diagnosed very early (like you), a majority already have a history of DKA when they are diagnosed, or are at least at risk for DKA.
I don’t think any of this thread makes a low-carb diet unsafe, but I do think anyone with minimal to no insulin production should probably be testing ketones regularly while on one, especially when other risk factors (pump, illness, exercise) are added in. I have a ketone meter and am on a low-carb diet (I’m no longer taking an SGLT2 inhibitor due to side effects), and I test ketones whenever I feel unwell, regardless of blood sugar level.
Quite so. Before I had access to insulin, 20 minutes on the stationery bike was the only technique I had for correcting a high. And it worked.
I think this is why my LADA/T1 likely went for years without being diagnosed. I’ve been a regular cardio exerciser my entire adult life and I think that kept things somewhat in check for a long time. Sometimes, it would even give me symptoms of hypoglycemia which I know believe were likely not true hypos, but a BG lower than my poor body was used to during the day.
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I think the point is, there can be DKA with normal sugars as the sugars are being used up via exercise or LCHF diets and it needs to be recognized. I’ve been high ketones normal sugar for a while after my surgery. I can’t eat so I’m assuming from the article that once I can I could see quite high sugars and would need to watch for treatable DKA. I’ve already shared the article with my ENDO and she is complete agreement that once I’m able to eat we need to watch both the Ketones and the sugar and see if yet another ER visit is in my future.
I absolutely agree. This is a challenge I have confronted for 45 years, and I still haven’t mastered it. The easy solution, of course, is to stop exercising. (joke)
Yeah, I also agree that exercise isn’t necessarily overlooked re: T1 so much as it’s really not at all that simple for those of us on insulin. I think if you’re able to be very consistent in your exercise it may be one thing, but I find inconsistent exercise can cause more problems than not re: blood sugars (which is not to say it’s not important in other respects). Same thing with intense exercise, which at least for me can easily cause spikes. If I were to exercise in a way that would be maximally beneficial for my blood sugars, I’d basically just walk around all day long, every day, but that’s not really doable for me or for many folks.
Low level exercise (like walking) is what I’ve had the most success with, diabetes-wise. Anything more intense is difficult to manage. This may be very different for people with significant insulin production remaining. I believe @Terry4 has mentioned walking is his preferred form of exercise for diabetes management as well. (Swimming is actually my preferred form of exercise, but not in terms of diabetes control. See my above comment about being unable to stay in range. Staying in range even with just walking is tricky at times!)
I agree with you all: intense, exercise can be very difficult to deal with. It might very well not be worth it to many. Even when I start insulin next month, I think it very unlikely that I’ll change my exercise routine: I’ve been working out for the last 30 or so years, and I don’t plan on stopping til I’m dead. Although I’ve learned a lot in the last year, I’m sure I’ll have a lot more to learn starting next month.
And I’m not trying to minimize peoples’ troubles with balancing BG and exercise, or prescribe a course of action. However, I still believe intense exercise is one of the most powerful tools in the toolkit. Like a circular saw, it can do things that other tools can’t. However, it can also cut a few fingers off if you aren’t careful…