Type 1 lower carb, exercise and ketones

[n1cla]

Hello everyone,
Apologies if the answers to my questions are here - I've scoured the forums for answers or ideas but here goes:
I need to lose weight. I am 196lbs so 14 stone there abouts. I have about 3 stone to lose.
I started doing much more exercise at Christmas and its going well. I dropped my carbs back to 80g - 120g a day and am on about 1400 calories a day. Im consciously sticking to a 35% protein a day which gives me about 100g a day.

All was going well. I had been able to reduce my daily insulin by about 15 units ro about 20 units a day and 28 over night which over the last 3 weeks with exercise resulted in small weight loss of 4lbs.
No ketones.
Until yesterday. Then had a most horrendous day with ketones and trying to reduce them which I did successfully with water and eating with normal insulin levels. This morning - no ketones.
The only thing which had happened was I did 30mins on my spin bike Friday eve which resulted in only needing 2 units to cover my evening meal.

Have i reduced insulin too much? My bloods when I got up yesterday were low at 3.3mml then up to 5.2mmol an hour later therefore not high or low just normal. My hba1c is 6.5 or 48. So why the ketones? And how do I stop this happening again or am I just meant to stay larger forever...

Any thoughts greatly appreciated as I'm nervous to carry on if im damaging myself.

 

[Katiel1]

Hello,

I might be able to help here!

I went uber low carb (virtually zero carb) about 5 years ago, not for weight loss reasons but for a quick fix to lower my Hb1ac without having to be aggressive with insulin doses.

I was on MDI so didn't think I had the need to check ketones unless feeling poorly.
Had one episode a few years ago where bloods were stubborn the whole day, couldn't get below 12mmol but didn't think to check ketones. Avoided any sort of carb (eating purely protein and fats) for the whole day whilst continually giving corrections which wouldn't seem to do anything. Finally thought to check my ketones well into the evening and they were 3+ so went to A&E.

They ran all the usual blood tests and nothing at all sinister going on. They didn't even need to administer any additional insulin, just a quick drip for hydration and went home a couple of hours later. When I told them I hadn't eaten any carbs all day to try to get bloods to come down with corrections, they said that's why I'll have ketones!

Even non-diabetics have ketones when on restricted diets, especially when combined with exercise, it's a sign your body is in starvation mode and you're losing weight.
It's why you may find your bloods spike and you have ketones present when exercising on low carb, it's because your liver pumps out glucose to make up for the lack of carbohydrates you've consumed.

I'm on the pump now so generally more ketone aware and definitely no where near as low carb as I used to be (aim for minimum of 80g carb per day) but will sometimes find I have ketones of around 0.8 on days where I haven't had enough carb. The only solution to budge these is to bolus for some proper carbs, 30g minimum, plus a little bit extra to mop up the ketones and it sorts out the problem

It's always important to understand why you might have ketones present but if you can rule out illness and dehydration and your bloods are under 12-13mmol, it's most likely your body in ketosis (starvation / losing weight), which is different from DKA.

It's still definitely worth talking to your clinic when starting a keto / paleo / low carb diet as physiologically it creates all sorts of changes to your body but if tackled in the correct way with the correct knowledge, won't necessarily cause damage.

I hope that helps!

 

[Jaylee]

Hi @n1cla & @Katiel1 ,

Welcome to the forum, both.

I'm rolling with "nutritional ketosis" if your BG was fine..
A natural byproduct if fasting or lower end of the carb intake spectrum diet.

 

[n1cla]

Thank you both - I'm hoping its nutritional ketosis I just didn't expect it with a reduction in insulin but I guess its happened due to reduction in overall carbs - many thanks for your help

I got full bloods to do again at hospital on Tuesday so will see if they also highlight anything...

 

[Medina27]

Exactly the same situation as me

Notice how @Katiel1 did it to lower her Hb1ac, you are doing it for weightloss, and I am doing it to avoid insulin resistance

So many birds.....with only one stone

The ketones made me worry too but it's just our body burning the excess fat caused by carbs over the years. It will first do this around the Liver. But stay vigilant & good luck

 

[NicoleC1971]

Hello everyone,
Apologies if the answers to my questions are here - I've scoured the forums for answers or ideas but here goes:
I need to lose weight. I am 196lbs so 14 stone there abouts. I have about 3 stone to lose.
I started doing much more exercise at Christmas and its going well. I dropped my carbs back to 80g - 120g a day and am on about 1400 calories a day. Im consciously sticking to a 35% protein a day which gives me about 100g a day.

All was going well. I had been able to reduce my daily insulin by about 15 units ro about 20 units a day and 28 over night which over the last 3 weeks with exercise resulted in small weight loss of 4lbs.
No ketones.
Until yesterday. Then had a most horrendous day with ketones and trying to reduce them which I did successfully with water and eating with normal insulin levels. This morning - no ketones.
The only thing which had happened was I did 30mins on my spin bike Friday eve which resulted in only needing 2 units to cover my evening meal.

Have i reduced insulin too much? My bloods when I got up yesterday were low at 3.3mml then up to 5.2mmol an hour later therefore not high or low just normal. My hba1c is 6.5 or 48. So why the ketones? And how do I stop this happening again or am I just meant to stay larger forever...

Any thoughts greatly appreciated as I'm nervous to carry on if im damaging myself.

My thoughts are that on a moderate carb diet as described and blood sugars as described there may be no causal link between diet/exercise changes and ketones.
How many ketones did you have? Be aware that nutritional ketosis can be a sign that your body is turning to fat for fuel (your own hopefully) but in type 1s higher ktones can indicate illness/dehydration or not taking enough insulin but in the latter case you'd have uncontrollable blood glucose highs too.
Very often high intensity exercise can spike you so doing intervals on the bike or lifting weights might have provoked the higher blood sugars but if those came down I would not necessarily worry about the ketones.
Note that if you mention ketones as a type 1 your doctor will generally panic and there is no guarantee that he or she will understand the difference between nutritional ketosis (good) and keto acidosis (bad and very dangerous) so if you get the chance to discuss it I'd mention low carb since this is what your diet is.
Best of luck and try not to drop too much fat and calories from your diet. If you stick rigidly to a calorie limit then your weight loss may stall as your body adapts to reduced rations plus you may end up ravenous so I'd advise prioritizing the protein, filling up fat and keep being careful with your carbs!

 

[n1cla]

It was ketones in the 4 region so not as high as it could have been but definitley more than 1.5 ...
They returned to normal by the evening but it was a worry. Maybe I could have been dehydrated.
I wondered if I had reduced insulin doses too quickly over 4 weeks - would that be an issue? but everything I read suggests you only take the day time insulin to cover the carb needs - therefore I had hoped with good control it wouldn't be a problem.
I'm very regularly checking bloods and daily ketones at the moment just in case...