Dehydration/Low Blood Pressure Emergency after starting LCHF - pls help!

[cz_dave]

Hi everyone,

I am 41 and recently diagnosed with T1. I started injecting 6 units of Lantus daily and 2 NovoRapid before main meals. I still have some insulin of my own, so I soon realized that by cutting carbs (e.g. to 15g per meal) I could actually have normal BS levels without injecting any NovoRapid before the meal. It is not so much that I want to stop injecting rather than my not coming to terms how many carbs I need to eat for each meal as my own insulin levels may vary each time and that is a variable hard to predict.

I have practiced a low-carb diet with daily intake of about 90g of carbs for a couple of weeks (reducing NovoRapid to just 1 unit before meals) and then taking it one step further: going ketogenic with daily intake of carbs ranging between 30 and 60 grams. I did this for about a week. I eliminated NovoRapid completely and my BS levels were in the range of 4.6 to 6.0 pretty much all the time.

One thing I did not like about LCHF was the need to eat lots of animal fat (I am not a vegetarian but I have never been a big meat/cheese eater, I would normally prefer grains, vegetables, fruits, etc.). I lost some more weight (which was not my goal really since my BMI is 22) and I was wondering actually how I could put on some weight with the LCHF diet (stuffing myself with fatty cheese did not seem to make a difference but perhaps more time is needed).

THIS MORNING EMERGENCY
I started feeling very strange this morning (extremely dizzy) to the point that I asked my wife to call the ambulance. My blood sugar was totally within the norm the whole time though (between 5 and 6). They ambulance came, took me to the hospital, did some tests to exclude heart-related issues but could not find anything wrong (except for slightly lower potassium). They put me on a drip which was basically just liquid plus some potassium. They released me after a couple of hours and I feel better now (just had a low carb lunch with about 25g of carbs and 1 unit of NovoRapid and post-prandial BS of 7.7 - actually quite high considering my post-prandial BS hovered around 6 in the past few days on LCHF).

HYPOTHESIS
As I think of it, I may have been dehydrated which combined with the lower blood pressure (115/70). I remember drinking quite a few glasses of water this morning but not really going to the bathroom so much. As a matter of fact, I had a late night dinner with friends yesterday with lots of food: meat, cheese...

PLEASE ADVICE
Should I stop with LCHF? If not, what am I doing wrong?

Thanks!

 

[Spiker]

Anyone doing LCHF must drink more fluids and include more salt in their diet. The "low salt" mandate only applies to high carb diets. Low carb diets require added dietary salt, just like in the Old Days (2,000,000 BC - 1970 AD).

 

[Ian DP]

It sounds you are LADA / T1.5, as you seem to be still producing some insulin yourself. In my opinion, if you stick with low carbing and keep your BG levels at normal levels, your insulin making beta cells will continue to make insulin for some time to come.... But if you don't low carb and don't keep your BG levels at normal levels your insulin requirement will increase as your last few remaining beta cells die off.
As Spiker says, you must have salt. I believe the Recommended daily amount of salt is around one tea spoon. If you are low carbing, you are probably not eating much processed food, thus not getting much salt, except that you yourself shake on your plate. One tea spoon is a lot of salt, try sprinkling salt onto a tea spoon.... A lot of sprinkling is required!.
Ample water is important. Although not 100% sure, I believe my diabeetes occurred when I became dehydrated on a hot September day, painting the house eaves up a ladder for 10 hours, forgetting to drink much at all.

 

[cz_dave]

Anyone doing LCHF must drink more fluids and include more salt in their diet. The "low salt" mandate only applies to high carb diets. Low carb diets require added dietary salt, just like in the Old Days (2,000,000 BC - 1970 AD).

Thanks for the tip, Spiker. I will make sure to drink more (water )

Also, I am thinking whether I should stick to the strictly ketogenic carb levels (up to 30g daily) or go more liberal for the time being to e.g. 90g carbs daily plus resuming those shots of NovoRapid before meals.

What would you consider a recommended daily carb intake for someone like me?

 

[cz_dave]

It sounds you are LADA / T1.5, as you seem to be still producing some insulin yourself. In my opinion, if you stick with low carbing and keep your BG levels at normal levels, your insulin making beta cells will continue to make insulin for some time to come.... But if you don't low carb and don't keep your BG levels at normal levels your insulin requirement will increase as your last few remaining beta cells die off.
As Spiker says, you must have salt. I believe the Recommended daily amount of salt is around one tea spoon. If you are low carbing, you are probably not eating much processed food, thus not getting much salt, except that you yourself shake on your plate. One tea spoon is a lot of salt, try sprinkling salt onto a tea spoon.... A lot of sprinkling is required!.
Ample water is important. Although not 100% sure, I believe my diabeetes occurred when I became dehydrated on a hot September day, painting the house eaves up a ladder for 10 hours, forgetting to drink much at all.

Ian, thanks for the detailed response. I really appreciate it.

Your footnote info indicates you follow "Dr Bernstein's 'normal' BG guidelines". Do you also follow his advice on max. daily carb intake? I believe it is a total of ca. 30 grams daily (8-12-12).

I am also quite confused about ketones measurement. Do I need to measure ketones when low-carbing?

 

[Spiker]

Dave I think you would benefit from staying on the lower carbs as it will spare your pancreas from pressure as much as possible. But don't try too hard to reduce your insulin. You should let injected insulin take the strain.

 

[Fayefaye1429]

Hey Dave sorry to hear this and hope your ok. I'm not on this diet but I have experienced the type of thing you did my whole life. I have had 5 blackouts and it comes down to the same thing never diabetes obviuosly before diagnosed or after. I make sure to only have caffeine drinks/food in small amounts and to drink as much as possible of water. I diff though as I do suffer with low blood pressure but I guess I wanted to say it can be scary experience but all you can do is learn from it let yourself be as ok with it as possible at the time and find systs to support you for the future. Like sometimes I drink rehydration drinks or packets just to keep me up. It's working so far

 

[cz_dave]

Dave I think you would benefit from staying on the lower carbs as it will spare your pancreas from pressure as much as possible. But don't try too hard to reduce your insulin. You should let injected insulin take the strain.

Spiker, what level of daily carb intake is reasonable in your opinion? I do not want to go extreme but at the same time want to stay in the low-carb area.

(I asked my doctor and his response was "It is hard to say.")

 

[cz_dave]

Hey Dave sorry to hear this and hope your ok. I'm not on this diet but I have experienced the type of thing you did my whole life. I have had 5 blackouts and it comes down to the same thing never diabetes obviuosly before diagnosed or after. I make sure to only have caffeine drinks/food in small amounts and to drink as much as possible of water. I diff though as I do suffer with low blood pressure but I guess I wanted to say it can be scary experience but all you can do is learn from it let yourself be as ok with it as possible at the time and find systs to support you for the future. Like sometimes I drink rehydration drinks or packets just to keep me up. It's working so far

Thanks, I feel much better now. Also thanks to everyone's support here. My wife and kids got pretty scared as they had to call the ambulance for me... I will try to watch out more in the future. Also, I did not realize coffee can be a problem. I thought that would raise your blood pressure. But I guess you are suggesting these drinks can dehydrate you?

 

[Fayefaye1429]

Yeh caffeine can dehydrate increAse blood pressure can come from anything that will make your heart pump. I suffer from low blood pressure due to a lack of salt as many doctors have told me so I guess it would be cutting back in high blood pressure terms? O it must have been scary last time was at the gym for me. Don't worry though imagine it's a big puzzle it's just about finding the pieces in their place for you. Your dietain or go can help you look at this to find away to stay hydrated and control salt in take too

 

[Ian DP]

Ian, thanks for the detailed response. I really appreciate it.

Your footnote info indicates you follow "Dr Bernstein's 'normal' BG guidelines". Do you also follow his advice on max. daily carb intake? I believe it is a total of ca. 30 grams daily (8-12-12).

I am also quite confused about ketones measurement. Do I need to measure ketones when low-carbing?

I do follow Dr b's guidelines. Around 30g carbs per day, and have done for the last 9 months. I was on around 40g carbs for 3 months before following Dr b.
You don't have to worry about keytones if your BG levels are in the normal range. You do have to worry (measure) keytones if you have high BG levels.

 

[Spiker]

Spiker, what level of daily carb intake is reasonable in your opinion? I do not want to go extreme but at the same time want to stay in the low-carb area.

As low as you can handle comfortably and sustainably.

 

[Winnie53]

I just happened upon this dehydration story on Dr. Michael Eades blog; he also discusses electrolytes - (scroll down to the subtitle "Hydration" if you don't want to read the entire article)...

http://www.proteinpower.com/drmike/...ks-for-starting-or-restarting-low-carb-pt-ii/

Here's the Part I for anyone who wants to read it too...

http://www.proteinpower.com/drmike/...cks-for-starting-or-restarting-low-carb-pt-i/

 

[Fayefaye1429]

Sorry I couldn't see the hydration part. I guess for me only that article a bit scary

 

[Winnie53]

Faye, I'm so sorry...that's not good. Was it the medical illustrations of the human skulls at the top of the page that was scary? I'd be glad to copy and paste the article without pictures into a PM to you if that would help.

Dr. Eades and his wife are family physicians who have been teaching patients how to do the Low Carb High Fat (LCHF) diet for 30 years. They've also written quite a few books. This article is Part II of an article he wrote on what to do and not do on the LCHF diet.

Perhaps it would be helpful to list the headings and subheadings in Part II of the article...

ELECTROLYTES
Sodium
Magnesium
Potassium
HYDRATION
SUPPLEMENTS
Alpha Lipoic Acid
CoQ10
Vitamin D3
5-hydroxytryptophan
FATTY LIVER
TERRIFIC BONE BROTH

 

[cz_dave]

Faye, I'm so sorry...that's not good. Was it the medical illustrations of the human skulls at the top of the page that was scary? I'd be glad to copy and paste the article without pictures into a PM to you if that would help...

Winnie, thanks for the tip!

 

[cz_dave]

Thanks everyone for your help.

I have increased my daily carb intake to around 100g to be on the safe side for the time being.

 

[cz_dave]

An update: I have not gone ketogenic but managed to stay low-carb (currently around 90g of carbs per day). Two things helped:
- I switched from Lantus to Levemir
- And, perhaps more importantly, I inject NovoRapid even when eating a low-carb meal. I may inject just one or two units but I found injecting none made me feel weird (even though my BS stayed under 6 without the NovoRapid). Strange... Perhaps my pancreas complained about not getting that extra help from NovoRapid? Who knows.

 

[Winnie53]

That's good news!

I'm assuming that eating 90 g of carbs a day helping with the medication/insulin changes is helping you? Do let us know if and how it's helping your too.