How do you hypo on a ketogenic diet?

[jack412]

@diamondnostril I found this rat study interesting

http://www.ncbi.nlm.nih.gov/pubmed/15975714
Ketogenic diet reduces hypoglycemia-induced neuronal death in young rats.
Yamada KA1, Rensing N, Thio LL.
Author information

Abstract
Hypoglycemia is an important complication of insulin treatment in diabetic children and may contribute to lasting cognitive impairment. Previous studies demonstrated that 21-day-old rats (P21) subjected to brief, repetitive episodes of hypoglycemia sustain cortical neuronal death. The developing brain is capable of utilizing alternative energy substrates acetoacetate and beta-hydroxybutyrate. In these studies we tested the hypothesis that the developing brain adapted to ketone utilization and provided with ketones during hypoglycemia by eating a ketogenic diet would sustain less brain injury compared to littermates fed a standard diet. Supporting this hypothesis, P21 rats weaned to a ketogenic diet and subjected to insulin-induced hypoglycemia at P25 had significantly less neuronal death than rats on a standard diet. This animal model may provide insight into the determinants influencing the brain's susceptibility to hypoglycemic injury.

 

[Spiker]

Of course they can, but we cross the line when anyone suggests or implies that very low bg levels are not a concern when following a particular diet, low bg levels are dangerous and the long-term effects of frequent and prolonged episodes of hypoglycaemia are still unknown.

To be fair I don't think anyone is suggesting or implying that we should run low bg levels on purpose. Just that ketogenic diets may be an extra protective factor. This is not like saying we should run low BG. It's pointing out that the ketogenic diet might provide the equivalent of an extra tube of glucotabs in the other trouser pocket. No one is saying get into the car with no glucotabs at all, but it's nice to sometimes have a spare tube. If you see what I mean?

 

[noblehead]

To be fair I don't think anyone is suggesting or implying that we should run low bg levels on purpose. Just that ketogenic diets may be an extra protective factor. This is not like saying we should run low BG. It's pointing out that the ketogenic diet might provide the equivalent of an extra tube of glucotabs in the other trouser pocket. No one is saying get into the car with no glucotabs at all, but it's nice to sometimes have a spare tube. If you see what I mean?

I don't think any diet protects us Spiker, I've experienced very low bg levels following a low, moderate and high(ish) carb diet and functioned well, never came to any harm and never needed any third-party assistance, but that doesn't make things right and if anything I may have just been lucky as have other members who have contributed to the thread.

Hypo's are a potentially dangerous and we need to be careful what we say on the forum, as this could mislead people into believing that one particular diet somehow protects us from the long-term harm hypo's can do.

 

[smidge]

I don't think any diet protects us Spiker, I've experienced very low bg levels following a low, moderate and high(ish) carb diet and functioned well, never came to any harm and never needed any third-party assistance, but that doesn't make things right and if anything I may have just been lucky as have other members who have contributed to the thread.

Hypo's are a potentially dangerous and we need to be careful what we say on the forum, as this could mislead people into believing that one particular diet somehow protects us from the long-term harm hypo's can do.

I think this thread is an interesting discussion and as Spiker said, no-one is actually recommending running BG at too low a level. It's just a conversation around whether LCHF and/or ketogenic diets make any difference to hypos. No more dangerous than a group of people discussing whether eating chocolate, Big Macs and Chinese takeaways has short or long-term risks.

Smidge

 

[noblehead]

I think this thread is an interesting discussion and as Spiker said, no-one is actually recommending running BG at too low a level. It's just a conversation around whether LCHF and/or ketogenic diets make any difference to hypos. No more dangerous than a group of people discussing whether eating chocolate, Big Macs and Chinese takeaways has short or long-term risks.

Smidge

Yes but hypo's are best avoided Smidge wherever possible, as said earlier they can be potentially life-threatening and the long-term effects are unknown, plus if a diet leads to you have diminished hypo awareness symptoms you do have to be that little bit more careful.

We have to remember its an open forum and people do read these sort of threads and may get the wrong impression that running bg levels in the 1's and 2's is safe and without risk.

 

[phoenix]

'My problem with all this'
To rephrase
Since I don't eat a ketogenic diet but appear to function very well at low levels I wonder if indeed this somewhat protective 'phenomenon' is because of a particular diet or because of becoming habituated to lower glucose levels .There may be adaptive mechanisms that come into play regardless of diet. The paper I cited discusses this and indeed brings in the idea of alternative fuels using lactate as one such fuel'

Is there a level that is too low, do we know it? Will it be the same every time? In other words is it a good idea to rely on a somewhat untested safety mechanism?

 

[diamondnostril]

'My problem with all this'
To rephrase, since I don't eat a ketogenic diet but appear to function very well at low levels I wonder whether this protection is because of ketosis or because of other adaptive mechanisms which may occur when glucose levels are kept at relative low levels .
A second 'problem' is the question as to whether this is good or bad. It is obviously good if it protects brain function at lower than normal levels but it may be bad to rely on it in that it removes a safety net.

Hi @phoenix,

Thanks for your clarification. I hope my Post did not seem too antagonistic!

If you are eating around 150g CHO then I think that Ketosis will not be a part of your experience (although Ketones can be easily checked for, to confirm or deny this). I think it must be other adaptive mechanisms. But of course this doesn't invalidate the experiences of those who are in Ketosis. Evolution is a clever beast, doing its best to keep us all in balance. Different mechanisms can be employed to head towards similar results. As I mentioned in earlier Posts, I alternate between Ketosis and non-Ketosis each fortnight, and my body's very different reactions to blood-sugar levels in these different states is fascinating to me.

Personally, I see Ketosis as the addition of a safety net. As a T1, my primary strategy for keeping in good shape is to try my best to maintain blood-sugar levels in the normal, non-Diabetic range. But if I make a mistake and my levels drop too low, I very much appreciate the protection that Ketosis seems to offer me. In this respect I think of it like a seat-belt. When driving, my primary strategy for well-being is to not crash. But if I ever do crash, I very much want my seat-belt to be there.

Regards
Antony

 

[Spiker]

I think when we get into this discussion we need to be even more careful than usual about what we mean by '(being) hypo' and '(a) hypo'.

So we should distinguish: 1. blood sugar below a reference safety level 2. hypo adrenaline warning symptoms 3. hypo neurological effects 4. severe hypo requiring external assistance 5. hypoglycemic coma

One way of looking at this discussion is, to what extent are the relationships between these 5 things fixed, and to what extent do they vary between individuals and/or based on nutrition behaviour.

 

[smidge]

My consultant told me a few months back that the medical definition of hypoglycaemia is below 2.2 (he might have said 2.1 but I can't remember). The rest is padding - just there as a safely margin. Now for clarity's sake, neither he nor I was advising trying those levels out!

Smidge

 

[jack412]

My consultant told me a few months back that the medical definition of hypoglycaemia is below 2.2 (he might have said 2.1 but I can't remember). The rest is padding - just there as a safely margin. Now for clarity's sake, neither he nor I was advising trying those levels out!

Smidge

I think that makes sense, they have 4 as a safety margin to start hypo treatment. so that it is well under control and you wont hit 2.2. if you started treatment at 2.2 ..with the 15min time lag you could drop too low or even coma

 

[Spiker]

I think that makes sense, they have 4 as a safety margin to start hypo treatment. so that it is well under control and you wont hit 2.2. if you started treatment at 2.2 ..with the 15min time lag you could drop too low or even coma

In my personal experience if I ever see 2.2 on a meter before I start treating, my chances of remaining conscious are probably under 10-15%. The exception would be if I am coming back up and it's a time lagged reading after I've already treated. 2.2 is an incredibly dangerous reading if you are not already treating and have been for a while. It's pretty much game over.

Unless you're hooked up to IV ketones of course. ;-)

 

[jack412]

In my personal experience if I ever see 2.2 on a meter before I start treating, my chances of remaining conscious are probably under 10-15%. The exception would be if I am coming back up and it's a time lagged reading after I've already treated. 2.2 is an incredibly dangerous reading if you are not already treating and have been for a while. It's pretty much game over.

Unless you're hooked up to IV ketones of course. ;-)

IV ketones? isn't it what they do with newborn for the first week, after they cut the cord, ?

 

[Spiker]

IV ketones? isn't it what they do with newborn for the first week, after they cut the cord, ?

You mean premature babies? I don't think they do that with all newborns. Not that I know of anyway.

 

[jack412]

You mean premature babies? I don't think they do that with all newborns. Not that I know of anyway.

sorry, I didn't put a smile [/joke], I was referring to newborns using ketones as fuel till the supply and their digesting of milk kicks in

 

[Spiker]

Sorry Jack just me being daft.

 

[jack412]

we both should use smiles more often
I find the whole subject of alternative brain fuel intriguing
https://www.google.com.au/#q=brain+alternative+fuel

although not ketones, it is alternate brain fuel and can provide 20% energy and likes to run on 10% baseline
https://www.dana.org/WorkArea/DownloadAsset.aspx?id=114320
One such alternative fuel is lactate, a byproduct of glucose, which is formed by muscles during sustained physical exercise. Under such conditions, the human brain takes up and uses lactate as a fuel, which can supply up to 20% of the total brain energy demands.
In both conditions increased plasma lactate results in a decrease in glucose utilization by the brain, raising the possibility that lactate is preferentially used by neurons over glucose as an energy source. In fact, even under basal conditions the brain extracts 10% of its energy demands from plasma lactate

acetate is another fuel ..drink?, you could be feeding your brain
Another, energy substrate that can be used by the brain is acetate. Acetate can be formed from alcohol in the liver through two enzymatic steps. Alcohol intake decreases glucose utilization and increases acetate uptake by the brain, suggesting, as shown for lactate, the use of acetate as an alternative fuel for the brain. Interestingly, a recent MRS study using labelled acetate has revealed that in heavy alcohol drinkers the brain markedly increases its capacity to take up acetate and to use it as an energy fuel.


it seems to be also dependant/limited to the livers ability to produce ketones, rather than the brains ability to use them for fuel and could go to explain why some people have different experiences?

https://books.google.com.au/books?id=gfkRnv20GtsC&pg=PA42&lpg=PA42&dq=brain+alternative+fuel&source=bl&ots=qDFQRE-Wlx&sig=c91KUzjpxyRQ9fN4go to6VqJ7NzeC3M&hl=en&sa=X&ei=0SoWVdm6G-HBmAXLrIKICQ&ved=0CD4Q6AEwBTgK#v=onepage&q=brain alternative fuel&f=false

 

[smidge]

In my personal experience if I ever see 2.2 on a meter before I start treating, my chances of remaining conscious are probably under 10-15%. The exception would be if I am coming back up and it's a time lagged reading after I've already treated. 2.2 is an incredibly dangerous reading if you are not already treating and have been for a while. It's pretty much game over.

Unless you're hooked up to IV ketones of course. ;-)

You see, that's what intrigues me - 2.2 is the clinical definition of hypo and yet Spiker (and many others I guess) has such an extreme reaction to it. I don't. TBH I've only ever seen that level about 3 times over my 5 years or so on insulin and it scared the bejeesus out of me - but not because of my personal experience - only because other people on the forum have told me it should do. In my personal experience it was unpleasant but very easily and quickly corrected with a few sips of Coke.

So what is it that makes some people's reaction so extreme and others' bodies cope pretty well? I'm pretty sure it's nothing to do with ketones - I LCHF at about 50g per day, but at my body weight, that keeps out of ketosis most of the time. Is it that I am LADA and not full Type 1? Does the fact that I still produce some insulin or some other aspect of LADA provide protection in some way when compared to Type 1s? Is it the length of time you've lived with the condition? I'm still a relative newbie. Or is it something as simple as my meter reads high so my 2.2 was actually a 3 and Spiker's reads low, so his 2.2 was actually 1.x if you see what I mean?

Another couple of observations to add to the discussion; I met a girl (full Type 1 who had had diabetes all her life - she was 27 when I met her) about a year ago who woke up hypo, went to get something to treat it but collapsed and had a fit - first time in all those years this had happened to her - she was treated by paramedics and was fine - but they recorded her BG at 2.2 as they were treating her - obviously no idea whether she had been lower; the consultant who told me that 2.2 was the clinical definition of hypo also told me that as a non diabetic he tests his BG fairly frequently out of interest and the lowest he has ever seen his was 2.1 - obviously with no ill effects.

So is it just an individual reaction? Some people's bodies work within slightly different ranges than others?

Smidge

 

[Spiker]

You're right to point out there is a big margin of error on the readings, as well as probably lots of variation between individuals and circumstances. All the more reason to set the safety threshold higher.

A third factor, that we rarely get to consider (unless wearing a CGM), is whether BG is rising or falling. The girl who was reading 2.2 was probably rising rather than falling. I freak out when I see 2.2 because in that situation it's almost always falling, and falling rapidly.

Another possible factor I remember discussing with @phoenix is that a serious hypo is a type of clinical shock, insulin shock as it used to be called. Shock will affect peripheral circulation, shifting circulation to the body core. So a finger prick (capillary) blood test (or CGM) may be much more lagging than usual during or after a bad hypo. It's even possible (pure speculation) that glucose could somehow be preferentially distributed to core organs and away from the peripheral circulation during a bad hypo.

 

[ann34+]

My consultant told me a few months back that the medical definition of hypoglycaemia is below 2.2 (he might have said 2.1 but I can't remember). The rest is padding - just there as a safely margin. Now for clarity's sake, neither he nor I was advising trying those levels out!

Smidge

i find this very strange - i have always been told that anything under 4.0 is hypo, whether you get the adrenaline symptoms then or not. and there is lots of research showing that the neurological symptoms kick in at about 3.3 mmol/l, whether we recognise them or not.
Of course we can adapt, especially re automatic functions - though less so re executive ones - - but that does not mean all is actually functioning 100% though we may feel it is, and relatives/friends/partners etc may not notice a thing.- maybe things are different on different diets, but i have had way too much experience of hypos and consider any hypo potentially dangerous - i agree with Noblehead. and I would not advise anyone to experiment. They may not be able to get back.
I adapted in the 1980s - there seemed no way out as i was so insulin sensitive, and had different daily insulin needs, and was still using human insulin, and doctors at that time did not seem to think hypos too bothersome unless you collapsed, and there were few testing strips - i never needed assistance, but i still recall the worst hypos now. The experiences are imprinted on my brain - i think, because the brain when hypo knows it is under threat and puts so much effort into trying its utmost to just survive - i wish they were not imprinted - I do think hypos may have a permanent effect , in the sense that the experience of one's consciousness being split in two cannot be taken away, and neither can the experience of going right to the bone re ones self - having all ones self removed completely other than very basic feelings including the need to survive - not pleasant, but fits with what is known of the structure of the brain. Ann

 

[iHs]

Back in the 70s and 80s, most people were using twice daily insulin and it was common for most to think of 2-3mmol as a hypo. DUK did some articles in Balance mags all about hypos being under 3mmol and how to treat them with glucose tabs, hypostop and lucozade. In todays world, because bolus insulin works fast, the 4mmol safety margin has been set to try to prevent people from losing their awareness and to try to keep the recognition of the hypo feeling around 3.4 to 4.00mmol which usually comes about with an hba1c of 6.8% and higher. For those who want to achieve a lower a1c, then its either more insulin which might mean hypos or less carb, less insulin so the large swings are not so much.