Low carb and ketosis:

Hi Betics!

I am really serious about losing weight and maintaining my good control at the same time.I have been considering alow carb diet for some time and I feel i am ready.However I am alarmed as a tye 1 diabetic of the idea of inducing ketosis.Isnt this harmful for me as a diabetic?Or if it isnt harmful how would I get ketones at normal blood sugars?I am confused.Any advice would be appreciated!

Merry Xmas,


Your thinking of Ketoacidosis. That happens when your BG is high. Ketosis is a naturally occurring process that the body goes through in small amounts on a daily basis. Im sure others can elaborate more, but a slightly elevated level to keytones in your urine is fine so long as its not due to high BGs.

Have a look here

Thank You for your reply Onesaint.Im just concerned as the book which I am reading The High Protien Diet says that whwn dieters are in the fat burning stage the ketostix will turn purple and for me this sets off alarm bells!

Ketones are breakdown products of fats.They happen naturally and are usually harmless when not associated with high Bg.

there are RARE cases of DKA with low sugars, but they are RARE. So watch your sugars and yoiur BG and how you feel. If you feel fine, which I'm sure you will, Everything is Ok.

Go for it!! I've lost about 45 pounds, but slowly. It's taken a couple of years of low carb. I'm very weightloss resistant. I love going into a clothing store and seeing all the stuff that's TOO BIG for me to wear.. It's a pity I have such a lovely winter coat, which I can't use in this awful weather we are having. Last winter, I had to just wrap it round me and tie the belt. This year, even that isn't working. I shall just have to try eBay to see if someone else can use it.

I am t2, but I like to keep non-diabetic BG levels


Low ketones, a natural process of using fat for energy, is nothing to be concerned with. It's not harmful or risky. Almost everyone (diabetic or not) would show mild ketones in the morning simply from fasting overnight. With reduced carbs, your body burns fat--the goal of losing weight. This is the purpose of fat storage.

Ketosis is different from diabetic ketoacidosis (DKA). With DKA, the body is in starvation mode because a lack of insulin prevents glucose from getting into cells, thus intense hunger no matter how much food is eaten. Since cells aren't able to utilize glucose that's circulating (starvation) fat is burned to pump out more glucose, but this doesn't help. BG gets dangerously high, electrolytes are imbalanced (acidic blood) & dehydration occurs.

Good explanation of the differencess between DKA and ketosis


I have some more questions!!!I am on this eating paln to lose weight and to maintain my good control.My question is about nuts!They are very low in carbs (like brazil nuts) but they contain an unbelievable amount of calories and fat!!So what Im wondering is can I eat as many brazil nuts as I like or should I avoid them as I do want to lose weight!The brazil nuts have no effect on my blood glucose(even the large quantities I eat!)!My second question is abaout exercise!Is it essential to exercise on this eating plan in order to lose weight?The thing is I have been told by my endo that if I want to exercise I will need to increase my carbs!!My final question is about fruit!I worry that by avoiding fruit I am missing out on minerals and vitimans!I would really really appreciate any feedback on these questions!What has been your experience?One final thing…My basal rates have increased by 10% although my boluses are only covering the 30 g of carb per day…but my bg levels have improved so much since startimg this eating plan…so am i at risk of gaining weight due to the increase in basal and tighter control?xxxx

Since I have managed to gain weight since going LC I can't help you on the weight loss. I too eat lots of nuts and cheese as well. Both have low carbs but high calories the ideal diabetic snack .....almost..... I suspect this explains my weight gain.

On the plus side nuts have lots of vitamins and minerals and healthy fats.

Re exercise: your body stores a fair amount of energy in the form of glycogen in the liver and muscles. When needed your body changes the glycogen to glucose and uses it for energy.Your body can also burn fat during exercise which would help you meet your weight loss goals. Getting the insulin right can be tricky but as a non insulin user I can't offer an opinion beyond go slow and test test test until you can fine tune your insulin.

Here’s a link discussing the inter relationship between exercise carbs and insulin with suggestions for manipulating these variables to maximize weight loss. Pretty complicated but perhaps it will give you some ideas.

Just watch Brazil nut consumption. You'll have to look this one up, but more than two or three a day or even week, can be toxic due to the absorption of selinium with regards to the variability of soils where they are grown.


I eat lots of nuts, but the carb count varies - pistacchios, cashews, and pecans are higher than walnuts. Truthfully, I think the carb count varies within the same nut type.

Depends on how rigorous your exercise is. Dr. Bernstein's approach is to use glucose tabs, if needed for lows, during exercise rather than eating more carbs before working out. Many people lower their basal rates for exercise. Strenuous exercise sends me high & then low several hours later. Not uncommon for Type 1s. I eat protein before exercise to help keep things level. Exercise that increases muscle mass is the most helpful for BG control.

Here's a good calculator to help figure out protein needs with low carb.

http://www.phlaunt.com/lowcarb/DietMakeupCalc.php Any vitamins & minerals in fruit you can get from vegetables.
If you're eating more protein/fat than before, this may be why your basal rates have increased because of the slower digestive rate of protein & fat. Danny's TAGger's group explains how to bolus for protein. You shouldn't gain weight from a slight insulin increase, especially with regular exercise (which should lower your insulin needs).

My endo is not supportive of low carb, but he also can't argue with success. He knows that I'm going to continue doing what works for me. I've heard his myths (& the same myths from two other endos & a CDE) & logically, factually disputed them. I refuse to discuss it with doctors any more. I smile & do what I need to do. Yep, I'm thin & my weight has been the same, within around 5 lbs., my entire adult life.

Dr. Bernstein's book is Diabetes Solution. Don't bother buying his other recipe/diet book. Not worth it, but Diabetes Solution is brilliant.

Eating sufficient protein will prevent weight loss. I lost weight at first & slowly added more protein to each meal to gain weight & maintain it.

Insulin is dosed according to carbs, not visa versa, an insulin:carb ratio. Eating low carb doesn't cause lows.

I never check for ketones. Since I'm not losing weight, it's unlikely that I'm burning much fat (ketones) for energy. Low ketones are no cause for concern.

I'd like to add a few comments to what Gerri said. You bolus to cover your dietary glucose load, and protein is also important (fat is essentially "free"). Dr. B says to increase protein to gain weight. Since more than half of protein is converted to blood sugar, many people find that they also need to account for that in their bolus calculations. In fact, some Dr. B followers prefer R since it acts slower and matches the glucose load better.

And while Dr. B has his recommended diet, he actually advocates a "holistic" treatment and provides a wide range of advice. He basically invented home testing of blood sugar and the basal-bolus regime. And he has something to suggest for almost everything diabetic, including lows.

Being on only a basal, it appears that your basal settings are higher than your actual basal needs and thus you need to eat to feed your insulin. That is not what you want. With such a regime, you will continue to go low if you don't eat on schedule (and eat enough carbs).

In general (for a properly established insulin regime), a low of 69 should be treated, but it should be treated with the minimum glucose needed to restore normal blood sugar (83 mg/dl). That is "not" a fatty pillsbury biscuit. I rise 2-3 mg/dl for every gram of carb I eat, you probably rise 5-10 mg/dl. Thus to rise from 69 mg/dl to 83 mg/dl (15 mg/dl rise), you need 1.5-3g of carbs. A good way to treat, smarties. Each roll is 6 grams of pure dextrose and contains 15 tablets (0.4 grams each), thus you would eat 4-7 smartie pills.

I've never met a doctor or endo who accepted my diet, and instead, I just say I am following a low carb or carb restricted diet and decline to offer further information. I have more important things to discuss at my appointments than my disagreements with doctors on nutrition and exercise.

As to your insulin regime, I have to caution you, without changing your insulin regime to match you actual basal needs and dietary carbs, you are going to experience lows and will need to treat. I would not attempt Dr. B's diet without first gaining control of your insulin regime.

I have to reread the book, now, s-l-o-w-l-y. My whole diabetes diagnosis came out of nowhere, so I had a lot to learn in a short period of time. I do not qualify for a diabetic educator because my A1c is between 5.2 and 5.5 not on insulin. I went low carb before I got the official diagnosis because someone referred me to Dr. B - let me tell you - I thanked that person so much. My symptoms improved right away, and then, I knew that the improvement meant that I was diabetic so I could advocate for myself with the Endo. Certain topics didn't apply to me a couple of years ago. There is so much to learn.

At 4am, you have a cortisol rise.

I'm sure that the learning process is lifelong. I have been diagnosed T2 since 2003, but my husband has had T1 since about 1975. thus my information package and understanding have been grwing for nearly 40 years. I started out by believing doctors. I no longer do.


I didn’t mean to accuse you of mistreating a low. I think most Dr. B followers would consider a blood sugar of 77 to 80 to be perfect. Not something you treat, but something you try to cruise with.

BSC, I had an appointment with a new endo last week. He is the department head at a big hospital in Pittsburgh. He asked me what I had my target range set for on my pump. When I told him 85, he seemed very surprised and said that he never had a patient set their target that low before. My first thought was that he obviously did not have any patients that follow Dr. B!

A pump target of 85 is impressive. Surprisingly Dr. B does not like pumps. His position is that the insertion sets are a constant wound and will over time create far more scarring and accompanying absoprtion problems than injections. I suspect that it is also about “real men” not needing that stuff.

bsc, I agree with Dr. B about the scaring. Although, since having much lower BGs, my skin/wound is irritated less. That said, I dont think I would be able to cover protein well at all if it werent for the pump.


Something to bear in mind is that lowest BG for non-diabetics is typically between 2-4 AM. 69 isn't low.

A caveat about Lantus, though most endos seem to prefer this. Their pharm reps must be very effective:) Lantus is not a stable basal. You can read discussions here about Lantus & Levemir. Like many others, I experienced persistent lows on Lantus because it peaks. Changing the dose, changing the timing & taking it in split doses didn't change the frequency of lows. I argued with my endo to switch to Levemir. He finally agreed. Levemir made a huge improvement in my life. Levemir is best taken in two doses. It's not acidic so doesn't sting like Lantus. A vial also lasts longer. Lantus potency starts declining at 26 days & is kaput at 28 days. Levemir remains potent for 6-8 weeks.