As @Aeonn helpfully points out, there is a big difference between urine ketones and blood ketones. Each test measures a different kind of ketone and uses different units to express the value. The blood ketone test is a better indication for risk of DKA. I suspect you are using a urine ketone test. The chart I posted uses blood ketones but it illustrates the general concept of how far removed from DKA that nutritional ketosis is.
I know you’re stressed out and this diagnosis is still new to you. You need to relax! This is not an acute medical event; instead it’s the exact opposite – a chronic situation. You need to pace yourself and put in place a long-term plan.
Do whatever you know that can help you slow down, talk to a friend or relative, take a walk, or go to church or meditate. Your heightened emotions are not helping you. They are making things worse.
We are an empathic crowd and love to help new people regain their balance. We are even better at taking the next steps to regain your life. But hair-trigger emotions make that difficult. What will you do today to calm down? There are many relaxation techniques, like breathing exercises, that are highly effective. Do a google search and try one of them!
@jwhitty The short answer to your question is yes, I’ve had T1D for decades, was on BP meds since '96, and noticed immediately after getting into ketosis 18 months ago my body required significantly more salt.
I listened to my body and began using more salt, initially on food and then supplementing orally as required. Over the first 6 months of keto, I slowed and then completely took myself off of all 4 BP meds I was on.
T2 diabetes, along with many T1’s, causes your kidneys to retain salt as a result of hyperinsulinemia:
I wouldn’t worry about fixing your A1C this week, rather I’d set weekly goals.
Your metformin dose is still at the low end, and without more detailed testing it remains to be seen if you’re dealing with T2D or T1. As mentioned by someone above, the IA-2A and GADA antibody tests should answer this.
For what it’s worth, you can go fairly low carb without doing full on keto, and then you don’t have to increase sodium and hydration levels to the same extent. In fact, it doesn’t take a lot of carbs to kick most people out of ketosis, and while some people feel great on keto, others do not and/or find that it’s easier to not be in ketosis. Personally, I found eating low carb a helpful tool for diabetes management, but as someone who at baseline needs higher levels of hydration/electrolytes than most, ketosis was not comfortable and too difficult to maintain. If you’re already feeling overwhelmed, I’d probably target low(er) carb to start and not worry about keto, just keep some amount of higher fiber carbs in your diet, preferably only in the context of also eating protein and fat.
Well…I had a very high level of ketones in my urine last night, like an 8 out of 10, I got really scared and called the hospital who told me to call my doctor and if they don’t answer then that I should come into urgent care…it was almost 1am so of course, no doctor.
I went in and the doctor there did a blood test and a urine analysis and saw no signs of DKA, but the whole thing sent a chill up my spine, so I’m just looking at doing low carb high fat right now. I had to be up for work at 6:30am so getting home at 3am really sucked.
I went to my nutrition and education class today…it seems like a pretty easy way to eat, so I’m just going to do that for now and keep exercising each day and try to keep it under control and see where that gets me.
Thanks everyone for all the help, I’m afraid I have a tendency to panic about possible health problems.
Completely understandable, sorry you are having to deal with this.
FWIW, DKA is relatively rare in those with T2D unless there is some other precipitating event that suppresses insulin production.
You’re doing a good job of setting yourself up for improved results, you didn’t get where you are overnight, so focusing on small goals will be a big help.
Well, I’ve gone a few days trying to establish a routine and some semblance of comfort. I’ve got tons and tons of anxiety about my physical health, but I’m trying to just stick to it…low carb, high fat diet with lots of protein, and I work out every single day after work, doing cardio every day and a full upper/lower body workout every other day, 7 days a week.
The biggest problem I’m having right now is that during cardio for some reason my blood sugar drops like a rock, it goes from like 118 to 74 in 30 minutes of moderate exercise, I’m sweating sure but its not THAT bad. I was only doing 500mg of metformin today and it was still that way, very scary.
Has anyone else noticed anything similar? Its weird, it really is just with cardio, its not with the upper and lower body workouts at all. I even ate half a banana before I started to get my glucose up, but as soon as cardio starts it just drops rapidly.
Believe it or not that fast drop from cardio is a good thing. 74 isn’t actually low although with how high your A1C was it may seem like a pretty severe drop symptom wise. Cardio or aerobic exercise is well known for reducing insulin resistance and anaerobic exercise will actually temporarily increase insulin resistance followed by a drop in BG several hours later. Even a good brisk walk after meals will help your body use it’s insulin better.
BTW, you don’t need to do both high fat and high protein, you can just do one or the other.
According to everywhere, 70 is hypoglycemia, and if I can hardly work out without becoming hypoglycemic then how the heck am I supposed to lose 30 lbs?
I have scoured the net and I can’t seem to find anyone who’s been in this same situation.
Today I went to the gym after eating half a banana, 46 almonds, and 1 tablespoon of MCT oil. About an hour after eating my glucose was skyrocketing from a modest 89 to 122 and rapidly rising still, but 30 minutes of moderate cardio made it plummet to 74?
I only took 500mg of metformin. How can this be? Is my metformin causing my liver to be unable to produce the glucose it needs to keep me able to exercise? I’m showing up and doing the work but how can I do the work when I keep coming so close to hypoglycemia? What the heck am I supposed to do?
I’m thinking of stopping the metformin and trying to work out, but I’m not even hitting my calories during the day and need do double the amount of banana I eat or I won’t even hit 1900, so if I stop taking it then I can’t eat as much, but I might be able to work out more…but if I keep taking it I can eat more, but I can’t work out as much?
You need to take some deep breaths or meditate or do something completely unrelated to diabetes management because you are getting off into the weeds. 122 mg/dl is not high and 74 is not low. Non-diabetics routinely hit numbers both higher and lower than that throughout their day. Here is a blog post that a non-diabetic did on wearing a CGM and you can see on her daily graphs that she spent hours of everyday sitting at 70 and spiked to between 140 and 180 after every meal.
I didn’t read the blog BTW, I just scrolled to the graphs. Your BG could literally sit in the mid 60’s for the rest of your life without any complications arising from that level. The concern with a diabetic having a lower BG stems from those who are on insulin or more powerful type 2 medications (metformin is a very mild medication especially at a dose of 500mg per day) going severely low (under 55) which can be dangerous.
Keep monitoring and eating right and exercising. You are on the right path but going overboard will just burn you out and make you backslide. You are going to have this condition for the rest of your life and you have plenty of time to figure this out and slowly absorb the knowledge you need to take excellent care of yourself. You may benefit from a diabetic coaching service as they are trained to mentor you through the mental and physical hurdles of diabetes. Onedrop has a subscription service that includes coaching and I believe Integrated Diabetes does as well.
Chill out, your current numbers are awesome. Hitting numbers consistently at 70 and above is wonderful as long as you feel well. 89 to 122 and then plummet 74 is also just fine given that is happening based on your exercise routine. You are going to find that diabetic control is 90% what you eat and 10% exercise for fine tuning.
Even maintaining a BG of of 70 is about as dangerous as driving 57mph in a 55mph zone. The biggest problem with maintaining a BG of 70 is that it is very easy to slip down below 55 (which is like driving over 80 in a 55 zone) and if and when that happens needs to be dealt with swiftly. I don’t even start to think about doing anything about a low BG until it drops to 65 or below.
Relax, you are not going to “cure” anything, you are just going to learn to properly manage your condition. This comes one baby step at a time and trying to rush progress usually has both mental and physical negative consequences. The mind and the body work together. The only two items of importance are that 1) You continue to make modest improvements over time and 2) You are at peace with yourself over the long term control goals you have set for yourself. Please remember that these are your goals and those are the only ones that count, not your endo’s, dietitian’s, other members on this board, etc. It is your life, and only you can decide what is best for you and others can only make suggestions on how to better meet YOUR goals faster.
I’m sad to hear that you are having these problems. Dropping that rapidly can be frightening, because you can get low symptoms even while you’re “in range”, AND you don’t have a good view of how low you might go!
I would want to talk with my doc a bit. Maybe you could get a pill cutter and take a smaller met dose?
I might also caution against having a strict “calories in/calories out” view of weight loss. Increasing your fitness level will help your body work for you, even when you aren’t working out. Also, I would suggest having some fast-acting carbs (like glucose tablets) with you when you work out. Others use gels, smarties, etc.
In my T1D world, I expect to have an increase and often a significant increase after eating a banana. Right now, for example! I ate a banana this morning @ 90. One hour later, I’m @ 195, and slowly dropping. For me the key is that I don’t stay @ 190 for hours and hours.
It can be hard to find folks in your situation, but let me assure you that virtually everyone has been in your situation. Hopefully one of those someones on this board will chime in.
You may have answered this elsewhere, but were you exercising this much before your diagnosis?
Here’s my radical solution to the same thing: stop exercising so hard for now. I am working on stabilizing with food first, and will add harder exercise after I get the hang of that. Walking is great and some exercise is fine, but for myself, I’m waiting on tougher training until it is one new variable, not one of several new things at once.
And yes, I need to lose some weight. No, I’m not worried about that right now. Losing the weight is important, but it isn’t the MOST important thing for me to focus on right now. Once my BG is more stable it’ll be easier to take the weight off anyway.
My journey has been different from yours but it’s all variations on a theme. Feel free to inbox me if you’d like.
You’re going to figure this out. It probably won’t be today. But every day you’ll learn and get better, and that’s all anyone can expect themselves to do.
Agreed with everyone who thinks 74 on its own is not concerning, as long as you are not continuing to drop, and it’s unlikely you will drop severely without being on insulin. But it’s easy enough to have a little juice or something handy to sip to bring it back up if that makes you feel more comfortable exercising. Just remember a little goes a long way, so try not to over-treat and end up with a rebound high.
This is not an option if you, like most of us, take Metformin ER (most likely the case if you take it only once a day). You cannot cut those without killing the extended release effect and changing metabolism of the drug (and likely increasing risk of GI side effects).
Small suggestion…get regular oatmeal instead of instant. Regular oatmeal has more fiber and is lower glycemic. Lower glycemic foods don’t raise blood sugar as fast. Regular milk is lower glycemic than fat free. Tangerines, orange juice and such, are what we take to raise low blood sugar.
I just wanted to thank everyone, including the originator, for all of the posts - this has been a very informative and helpful thread to me. I’m had T2 for about 10 years (I’m 54), but it was always manageable by diet/exercise. My A1C took a real nosedive recently (12) so I also was a little freaked out. I was put on a stronger dose of Metformin six weeks ago than JWhittney, and I totally changed my eating habits - my regular reading is now around 7 or under most of the time. Like Jules mentioned above, I haven’t done any significant exercising yet (in 6 weeks) because I wanted to isolate the benefit of the Metformin and change in diet first. I’m going to start exercising in January, at which time I hope to see how much better my readings can be with frequent exercising. There’s a lot to figure out, but I really appreciate the very kind and helpful comments that people post here. Jim
I was diagnosed type 2 back in September, A1c of 12.6
Started metformin 750er daily with a goal 7.5 in 3 months
I did away with white bread, potatoes, pasta, and rice and all sweets with sugar (I miss my ice cream).
I started reading and understanding food labels and selecting items with high dietary fiber and watching saturated fat, protein and calorie content.
My diet now includes lots of berries, lowfat greek yogurt, nuts, sunflower and pumpkin seeds, daily salad with plenty of raw veggies, eggs, turkey bacon, chicken and fish.
I started seeing a decrease in glucose readings fairly early on. I was checking 2-4 times daily, especially after eating out.
I got results from latest A1c yesterday - 5.8!
I find that I prefer many of the food changes I’ve made and plan to keep them for the long haul
