Good morning y’all, I have a question for those who have been eating low carb for awhile. I am trying something new and have done a lot of reading, but would like to know more from those who have ‘gone before’.
When my diagnosis was changed, I was in lactic acidosis (assumption from my ER docs was metformin + lack of insulin circulating). I was discharged and went home with insulin. At first I was super careful about what I ate and lost almost 30lbs…
When I went on the pump, and even more so with the Dexcom, bad habits came back because I could monitor and correct my blood sugar more aggressively. The ease of giving myself a bolus and then being able to correct if need be, did a serious number on my insulin usage and my weight. I gained back 15 of the previous 30, all in my thighs, hips, and behind (which is not where it came off of, my abdomen is my weight holder).
So after some research and seeing a lot of posts from people here about their low carb eating style, I decided to try it. I’m following Atkins to start because I have to have a plan and a tracker to stay motivated (data!).
So my question is this, do any of y’all check for Ketones? Is it okay to have small to trace Ketones if your blood sugar is completely in range? I do, but my blood sugar has been sitting between 70 and 110 the two days I have been doing this. I’ve lost a few pounds in a couple of days, so it seems to be working, and I feel great not having bs spikes. Drinking 100oz of water, so not dehydrated.
dietary ketone rough rule. normal BG and ketones under 5, normally trace 0.6 to 3
be aware that because the brain will use ketones as fuel, you may not feel hypo, as usual/ asymptomatic… some would say this is protective. You may need to monitor more closely, I will still treat 70 as low and adjust accordingly.
if you return to full glucose, the full hypo symptoms will again return.
In these sick day rules, they are called starvation ketones, and shows when this becomes insulin depleted ketones.
https://c.ymcdn.com/sites/www.ispad.org/resource/resmgr/Docs/CPCG_2014_CHAP_13.pdf
Ketones are perfectly normal when you fast, exercise or follow a low carb diet. Trace, marginal or even moderate ketones can occur. They don’t mean anything. I would not suggest testing ketones as a way of monitoring your diet. Bernstein says not to.
You should test ketones in two key situations, a high blood sugar (> 250-300 mg/dl) particularly if you may have become insulin deficient. High ketones and high blood sugars are a hallmark of DKA.
You should also monitor ketones if you become concerned about dehydration (such as being very sick and spewing out both top and bottom). You can develop Hyperosmolar hyperglycemic State (HHS) when you become severely dehydrated and this condition is just as serious as DKA. There is also a related condition to DKA and HHS called euglycemic DKA which is usually associated with SLGT2 drugs. Euglycemic DKA occurs with high ketones and blood sugar < 300 mg/dl. It is treated with hydration (IVs) and electrolyte replacement (and you do need insulin).
Thanks Brian! This is super helpful. I’ve read a couple of conflicting ideas on Ketones and Diabetes (avoid it, don’t avoid it, monitor, don’t monitor). I’m going to order Dr. Bernstein’s book. The Atkins induction phase is working for me, I’ve lowered my bolus numbers and am slowly decreasing my basal because I’m catching lows and using temp basals to bring them back up. I’m finding the comfort eating may have had more to do with changing insulin needs than any of my previous infection/surgery concerns.
Ketosis and diabetic ketoacidosis are two radically different things. Ketosis often happens when we fast, even sleeping will lead to ketosis. Alarmists who remain skeptical about the benefits of a carb limited diet will often point to simple ketosis as evidence that you are doing harm.
Ketoacidosis is an extreme form of ketosis. I use an Abbott Precision Xtra blood test kit to measure ketones. I only test when my blood glucose exceeds 300 mg/dL and is sustained for more than an hour or two. Urine testing is also available. Here is a table of ketone levels take from the Diabetes UK website:
When I monitored my ketones shortly after starting a carb limited diet, a 1.2 mmol/L level was often seen.
@Terry4 when your ketones sit around 1.2 maybe 2 after exercise. if you have high BG for a while and see 3, you know you have a problem.
Being T1 with high BG and ketones over 3 is a big issue and may rapidly lead to DKA
Full on in hospital, on a drip, in danger DKA is about ketones 10-20+
dietary ketones of 5 [can get to 5 after extreme exercise] and below are fine.when T1 BG is in normal range.
EDIT found a clearer picture
The operative word in your statement is “and.” Thanks for that chart. Is the number in the orange ketoacidosis range image x-axis, 50? If it is, then the next number in line would seem to be 100, not 10+. I do see the x-axis non-linear breaks.
the 50 is actually 5.0, though there is 5=50 on another scale, the 10+ indicates DKA.
Dietary ketones, fasting, extreme exercise will never see “blood” ketones above 5 on the 0-16 scale
edit, I found a clearer picture that I posted, you can now see the decimal points
I find this confusing and may cause issues when talking about ketones. also I read, dehydration can skew urine numbers more than blood.
0.05 0.5 5 can all be the same number, depending on the scale used.
