Low carb - but high sugars - advice please!

Oldvatr

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Fleegle

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Hi @Fleegle - I also didn't know that either, until today - my dietician tells me that low carb diabetics often need to increase their carb/insulin ratio - but didn't know why this is. Following @azure's comments above, I've done some googling, and although it's too early in my research for me to recommend a reliable source of information (as is often the way with the internet!) I can see that it's certainly a "known" issue. It appears that insulin resistance can happen when carbs are very low - but what constitutes "very" low seems to vary from person to person. Also, it may well be different between T1s and T2s.
I find these things fascinating @Odin004 so do tell as you learn more.
 

catapillar

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Hi @Fleegle - I also didn't know that either, until today - my dietician tells me that low carb diabetics often need to increase their carb/insulin ratio - but didn't know why this is. Following @azure's comments above, I've done some googling, and although it's too early in my research for me to recommend a reliable source of information (as is often the way with the internet!) I can see that it's certainly a "known" issue. It appears that insulin resistance can happen when carbs are very low - but what constitutes "very" low seems to vary from person to person. Also, it may well be different between T1s and T2s.

I think it's essentially due to lack of practice. If your body isn't used to you eating carbs, it forgets how to process and deal with them as efficiently and effectivly as it was doing when you were eating carbs. That's why they say before doing an oral glucose tolerance test (you're never going to do one because you have type 1) you should eat the RDA carb intake for a week or two before hand because someone on a low carb diet is much more likely to "fail" an OGTT, possibly with a false positive.

I have noticed a change to my ratios on a low carb diet and would prefer to reintroduce carbs to get my I:C ratio back to where it was. I have read that it will readjust as carbs are reintroduced, but there may be a period of flux.
 

ickihun

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Yes, your 45-65g is extremely low, but, as you say, your 'sweet spot' for carbs may be different than another person's.

I don't know precisely why the IR happens, but I believe it's to do with the fact that Type 1s have little/no insulin so VLC doesn't work for us in the same way that it might work for Type 2s who have adequate or even extra insulin production. Our metabolism reacts differently. In addition, the higher level of fat can impact blood sugar. Added to that, I believe the body can see the lack of carbs as 'starvation' so induces IR.

If you've ruled out the obvious things like dodgy insulin, infection, etc,,etc, then perhaps you could try upping your carbs ever so slightly across the day and see if that helps get back your sensitivity.
@Odin004 I think what happens is in the absense of enough carbs (as in too severe a low carb diet) the injected insulin starts processing protein more instead of the carbs (energy food) absence. Then if not enough protein the liver and other organs and muscles cause IR (releasing glucose into the bloodstream. The glucogen gets stored far much easier and first). To compensate.
 

Kristin251

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I haven't measured my ketones in YEARS so I have no idea. What I do know is on a vlc I can take very low doses of insulin and don't fear the hypos as I did while eating some carbs. I dose for half my protein.

No clue why or how things happen but my eating plan and menu keep me very insulin sensative and very steady without peaks and troughs so something is working for me. I don't digest carbs well at all so even if I wanted to I couldn't eat many.
 
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Odin004

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https://ketodietapp.com/Blog/post/2013/11/30/Ketosis-Measuring-Ketones

Not necessarily a reliable internet source, but the levels are consistent with other reseach I have done. I believe that a keto diet with strenuous exercise can push it up to around 5 mmol/l. The danger levels from ketoacidosis are significantly higher

Thanks - I have to say, I'm quite dubious about the information in that link; see the below link here, which states that levels above 3.0 mnol/L are "a dangerous level of ketones which will require immediate medical care":

http://www.diabetes.co.uk/diabetes_care/testing-for-ketones.html

It's also important to note that the link you provided isn't tailored to diabetics - who have to be careful about the difference between nutritional ketosis, and DKA!
 

Odin004

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I think it's essentially due to lack of practice. If your body isn't used to you eating carbs, it forgets how to process and deal with them as efficiently and effectivly as it was doing when you were eating carbs. That's why they say before doing an oral glucose tolerance test (you're never going to do one because you have type 1) you should eat the RDA carb intake for a week or two before hand because someone on a low carb diet is much more likely to "fail" an OGTT, possibly with a false positive.

I have noticed a change to my ratios on a low carb diet and would prefer to reintroduce carbs to get my I:C ratio back to where it was. I have read that it will readjust as carbs are reintroduced, but there may be a period of flux.

Thanks @catapillar, I agree, lack of practice may also be a factor; but whatever the precise cause of the higher sugars and increased ratios, the issue seems to be very firmly diet related, rather than the result of some underlying physiological change; and I'm quite sure therefore that the ratios can be normalised again, on the reintroduction of a little extra carb.

I've decided to reintroduce a small amount of extra carb to see how it goes - which does seem somewhat counter-intuitive, when the problem I'm trying to rectify is high sugars - the question is how best to go about it? I wonder if the best way would be to keep insulin dosage the same, and just eat the amount of carb that such a dose "should" be appropriate for - in which case, sugars may go very high - but hopefully only until things resolve..? If you have any thoughts on how you're going to reintroduce the carb, do let me know!
 
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Odin004

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@Odin004 I think what happens is in the absense of enough carbs (as in too severe a low carb diet) the injected insulin starts processing protein more instead of the carbs (energy food) absence. Then if not enough protein the liver and other organs and muscles cause IR (releasing glucose into the bloodstream. The glucogen gets stored far much easier and first). To compensate.


Thank you @ickihun - this seems to suggest that adding carbs to the diet may work to reverse the situation - let's hope so!
 

DCUKMod

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@Odin004 - I'm not T1, so won't comment on your specific query, but I know @tim2000s has done quite a bit of reading and research into this phenomenon.
 
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Odin004

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@Odin004 - I'm not T1, so won't comment on your specific query, but I know @tim2000s has done quite a bit of reading and research into this phenomenon.

Thank you - since posting, I've also seen some of the previous posts from other members; I will also post if I manage to reverse the situation (with an explanation of how I did it!)
 

noblehead

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I'm quite confident I'll never go back to a high carb diet - I think my goal should be to have just enough carb to avoid any of the above issues; if I've gone too low with the carbs, then hopefully by adding some carb, I can reverse the situation. I'd rather try to deal with it by dietary changes before thinking about medication, although I appreciate that's not possible for everyone.

No I wouldn't go back to a high-carb diet as that's not necessary, very few type 1 members follow a high-carb diet and most try and control their carb intake somewhat.

Understand your reasons for not wanting to introduce more drugs, hopefully with a few dietary adjustments it won't be necessary @Odin004

I'm going to tag in a very experienced and knowledgeable member (who follows a low-carb diet with great success) who may be able to assist @robert72

Good luck.
 

Odin004

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No I wouldn't go back to a high-carb diet as that's not necessary, very few type 1 members follow a high-carb diet and most try and control their carb intake somewhat.

Understand your reasons for not wanting to introduce more drugs, hopefully with a few dietary adjustments it won't be necessary @Odin004

I'm going to tag in a very experienced and knowledgeable member (who follows a low-carb diet with great success) who may be able to assist @robert72

Good luck.

Thank you, that is much appreciated.
 

ickihun

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There was a study published recently that showed that meals containing high fat content can acutally increase IR in T1D.

Its known colloquially as the Pizza Effect.
I'd go further and say even type2s on insulin injections!
 

azure

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@Odin004 I wouldn't do a sudden leap in carbs nor would I tolerate high sugars. I'd gradually add tiny amounts of carbs spread across the day, and take the insulin I needed to get reasonable sugars. It might take a few weeks to get your sensitivity back, so it's a gradual thing and no need to rush :)
 
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ickihun

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Thank you @ickihun - this seems to suggest that adding carbs to the diet may work to reverse the situation - let's hope so!
Only if there is sufficient good insulin. Whether type1 or type2.
Once IR resolved after a few weeks (as takes persistance, IR isn't an instant process) then you reduce insulin slowly, as of protein and carbs, to match.
In my experience fat confuses the whole process but only needed if you need more body fat to burn by sweat and exercise. Type2s with IR who are overweight don't need extra fat. Too slim a type1 does. Fat slows the whole process even more. Including digestion. I find.

Editted to add. @Kristin251 has great success as a not overweight type1 with plant/mono fats not restricting IR dispersion.
 
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Oldvatr

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Thanks - I have to say, I'm quite dubious about the information in that link; see the below link here, which states that levels above 3.0 mnol/L are "a dangerous level of ketones which will require immediate medical care":

http://www.diabetes.co.uk/diabetes_care/testing-for-ketones.html

It's also important to note that the link you provided isn't tailored to diabetics - who have to be careful about the difference between nutritional ketosis, and DKA!
According to Phinney and Volek the normal level for a LC keto diet is <0.6 mmol/l, for light ketosis, but for Optimal ketosis, the levels need to be between 1 and 3 mmol/l, The important thing to note is that the bgl levels for dietary ketosis will be low, whereas for diabetic DKA they will be high (> 15 mmol.l usually) so as an insulin dependant, then the signs of DKA comes from having HIGH bgl levels. then testing for ketones. I think the level of 5 mmol.l I quoted came from Tim Noakes, who was talking about diabetic athletes in HIT training.

<<<<According to Volek and Phinney in their best-selling book "The Art and Science of Low-Carbohydrate Living", nutritional ketosis is defined by serum ketones ranging from 0.5 to 3.0 mM. ... The level of ketones in ketoacidosis are 3-5 times higher than in ketosis resulting from a ketogenic diet.>>>>>


And from Tim Noakes trial transcript
http://www.openfuture.biz/evidence/InsulinResistance-Ketones.html
 
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kokhongw

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Thanks - I have to say, I'm quite dubious about the information in that link; see the below link here, which states that levels above 3.0 mnol/L are "a dangerous level of ketones which will require immediate medical care":

I believe that recommendation needs to be taken in the context of high glucose.
People with insulin dependent diabetes should take a ketone test:

  • Any time your blood sugar is over 17 mmol/l (300 mg/dl)
  • If sugar levels have repeatedly been over 13 mmol/l (230 mg/dl)
  • If you are unwell and have any of the symptoms of ketoacidosis

When glucose and insulin is low, ketones is often needed at a higher level as alternative fuel. Eg up to 8 mmol in the context of extended multiday fast for a relatively healthy individual.
http://www.diabetes.co.uk/forum/blog-entry/extended-fasting.1605/

For type 2, a slice of bread would likely end the ketosis quickly as there would be over secretion of insulin.

The danger for type 1 on a keto-like diet is that in the absence of insulin production/response it may easily cross into the danger zone if glucose is not being monitored closely and end up with a high glucose high ketones situation.
 

ringi

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Does the processing of ketones "use up" any insulin?

I know in a "normal person" ketones results in a very small insulin response hence the ketones cycle can't get out of control if someone can produce any insulin of their own.
 
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