Ketogenic and Paleo diets?

So maybe because I've just been schooled to fear and loath ketones for the last 16 years, I don't get this.
But all these people around me doing crossfit and boot camp exercise and eating Atkins/Paleo/Ketogenic.... the latter especially scary... are "trying to encourage ketosis?"
Doesn't that make them sick? Or do non-diabetics face less risk from spilling ketones?
AM I AT RISK for more ketones now that I'm eating lower carb? Eek!!!

The short answer is that Diabetic Ketoacidosis (DKA) is a dangerous build-up of ketones resulting in a life threatening drop in pH of the blood.

Ketosis is just higher levels of ketones, not necessarily to dangerous levels, as a result of burning primarily fat for energy. Ketones are a by-product of fat catabolism.

The reason why ketones are produced in both cases is because of more use of fat for energy. The difference, as far as I can tell, is that in DKA is that you have an overwhelming amount of ketones being produced over time.

Ok. That seems to make sense. Thanks!

Np, best of luck on the Low-carbing!!

I too have a fear of ketones. It is my understanding that when ketones approach a dangerous level in insulin producing people, the pancreas produces enough insulin to metabolize enough glycogen produced glucose to halt excess ketone production. With no detectable C-Peptide this protection is not available, and I find when the urine ketones are moderate or greater the blood sugar begins to rise and it takes larger correction boluses or temporary basals to bring things in line.

This means taking more insulin than anticipated for the carb actually eaten. Some days I end up taking more insulin for a day with less carb than a day with slightly more carb. Currently I am trying to keep daily carbs in the neighborhood of 100 grams which is not what most low carbers would call true low carb.

A dangerous condition called ketoacidosis can develop in those with type 1 diabetes, and it is sometimes confused with normal ketosis. The body usually avoids this state by producing insulin, but people with type 1 diabetes are unable to produce insulin. Even most people with type 2 diabetes who inject insulin usually produce enough insulin of their own to prevent ketoacidosis.

Yeah, as long as you burn fat for energy, you will produce ketones. You will always burn glucose as long as you can produce (or inject) the insulin necessary to allow the glucose into cells.

In order to go into ketosis in the presence of insulin (endogenous or exogenous) you have to limit your carb intake to the point where your glycogen reserves are extremely limited. This allows your cells to convert over to using fat for energy, increasing ketone production.

As long as you have insulin present, and can maintain normal BG levels with gluconeogenesis from protein and whatever amount of carb intake you require, you should keep yourself from going into acidosis from too much ketone production.

There are diabetics who stay in ketosis because they keep their carbohydrate consumption down to almost nothing. They deliberately shift their metabolism to burning fats, and at least that's a big help in keeping bgs under control.

Quite often they start typing about how even saturated fats are good for you, and I have trouble believing that one. I also have some personal experiences indicating very strongly, that they are not good for me.

Ketones with normal BGs are ok. They are "starvation ketones" and just show that you're burning fat. Ketones with high BGs are BAD.

Keep in mind that there are children and adults who stay on ketogenic diets for years as a method of treating severe seizure disorders. However, I have been told that for T1s, even though producing moderate ketones with normal BGs isn't an immediate problem, there is some suspicion that it could be harder on the kidneys. I am not exactly sure if this is true, but I have been told this a doctor and dietician now. Not that I put much stock in everything doctors and dieticians say, but that's what I've been told.

I do find that sticking to a moderately low-carb diet works best for me. HOWEVER, I find that a moderate amount of carbs is really necessary for me to feel normal (I find that sticking to around 120 per day is a good number for me). This is still under the ADA's recommendation and far below what the average American probably consumes. But I don't feel like it's so extreme that I'm deprived. I do work out a lot and going under 100 g/day makes me feel a bit sluggish.

Yeah, the strain on my kidneys is what scares me the most, I think.
I ate 147 carbs yesterday (probably lower than I have eaten in years) and my bloodsugars were near perfect (for me: see my history)
I only spiked above 200 a couple times during the day and brought myself back within an hour.
My goal is not perfection, again, see my history... but if I could get an A1C of 8-ish at the end of this month (183 md/dl) I would be ELATED.
So staying under 200 is a manageable goal for me right now.

Good luck with your goals! I average about 150 carbs a day and do OK. Going low carb is one way to manage T1 but it isn't the only way.

I've been eating LC for a little over 2 months. ~35 - 40g / day. Trying to be as scientific about it as possible. For the first week, I was getting high levels of ketones, but negative for glucose in my urine. The ketones eventually stopped appearing.

Other than that, my experiences have been positive. I reduced my daily insulin by about 50%. My BG used to easily fluctuate between 30 - 300. Now, I am almost always around 100. I have been doing a better job testing and keeping on top of things, though.

I do have some concern about the long term consequences of the diet, but they are probably less likely than the long term consequences of elevated BG.


I've been crossfitting and eating paleo for about 3 years now. Its actually inspired me to start my master's degree in nutrition!

I im in Ketosis most of the time, and also have very low blood sugars.. I rarely spike above 150, even after eating. Take a look at my blood sugar reading on my CGM for a 24 hour period---
Pretty cool, yeah?
As far as I can see it, ketosis with well controlled blood sugar is perfectly safe. Ketosis with high blood sugar is dangerous! I think its very easy to stay away from high BG, especially if you are eating right, and regularly checking your blood sugar (or have a CGM like me).

Many believe that ketosis is actually the optimal human condition. The brain thrives off of ketones. I definitely am way more sharp when I am studying in ketosis then when I have had some carbs. (just remember, that it does take some time to get fat-adapted, and during that adaptation time you can feel sluggish and slow)

Also, I have insane energy for crossfit while burning ketones. If you know the WOD's, I did "Cindy" last month for 26 rounds!

Dont be scared of ketosis! be safe, try it out and see if it helps you.


The ketosis damage to kidneys might be just a theory. (I haven't looked into it and don't know, but I think I will Google it soon.)

But at about 140 (very close for me, but it varies for different diabetics) sugar starts to spill into your urine. That does result in kidney damage, and it's not fun. I do have some.

Just Googled it and found this interesting link. A state of ketosis repaired the damage to kidneys caused by high blood sugars, in diabetic mice.

Diet 'can reverse kidney failure' in mice with diabetes

So that seems to be a good indication that you don't have to worry about damage to kidneys from ketosis.

If mice were a better model of diabetes in humans we'd all be cured. It is a great time to be a mouse with diabetes

squeeeeeeeeeeeeeeeek (sorry, couldn't resist!)

I would like to be a honey badger with diabetes.... You know why? Cause honey badger don't care.