3.6mmol while on Keto

SO I had a pretty Keto day yesterday and a kind of extended fast, 14 hours from last main meal (which was liver, raw garlic and yoghurt) but 9 hours from a small bowl of semi-fermented cabbage (sauerkraut), so really only a 9 hour fast.) I breastfed my 6 week old several times during this period and when I finally got up to start the day I checked for what had recently been a higher dawn phenomenon reading of between 5.1 and 5.6, this morning I got 3.6 mmol. I checked again and it was 3.8, which I think is just the low end of completely normal and healthy fasting blood glucose. Checked ketones and they were around 1.0 - 1.5 mmol (small).

So, just to be on the safe side, I ate some sweet potato and a mandarin, tested within 10 mins, still 3.7 mmol. So I ate a bit of honey, checked again within 15 mins and was 4.1mmol, then went on with my usual eggs, cheese and avocado for breakfast. One hour later I was 6.0 mmol. Two hours later, back to 4.1 mmol.

My question is, does this sound just like fine and normal blood glucose (maybe slightly low because I'm breastfeeding while eating keto) but really what you expect when you are in nutritional ketosis, or should my blood glucose really stay between 4.0 and 5.5mmol ideally?

And this is different from the 3.4 mmol I once had while gestationally diabetic and had eaten a carby meal that took me to 8 or 9 mmol in the peak but landed me back in the 3s as a kind of hypo crash.

Do I have anything to worry about and was eating honey the right thing to do?

kitedoc said:

Hi @Cocosilk, if you are breast feeding and thus having to feed yourself and baby why would you fast?
And are you really surprised that your bsl would fall?
Whilst some if us might use honey for a low bsl, the fructose in it might take longer to work and tends to stay as fat in the liver, so fruit, glucose tabs etc is a mire likely remedy.
Please be as sensible as you can. You and babe need nutrition, all those fats and protein plus minerals and vitamins.
Best Wishes and please keep both of you fed.

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I didn't really mean to fast that long. The liver I ate for dinner the night before was quite filling but at 1am, I was up with the baby and felt a bit peckish so I checked my bs and it was 4.7 so I thought I would eat something. I guess the cabbage wasn't enough to get me through till morning. I'll have to have a bigger snack next time... I was quite surprised that it went into the 3s
That’s only the second time I have seen that.
My fasting bs has been stubbornly higher but I guess the pregnancy hormomes must be settling down and just suddenly I can go that low . The previous days I'd overeaten and had 5.1 fasting. I also think if I ate a meal with carbs it might just spike again so I'm trying to find a balance. But snacking while breastfeeding seems to be the safest thing.

kitedoc said:

Hi @Cocosilk, if you are breast feeding and thus having to feed yourself and baby why would you fast?
And are you really surprised that your bsl would fall?
Whilst some if us might use honey for a low bsl, the fructose in it might take longer to work and tends to stay as fat in the liver, so fruit, glucose tabs etc is a mire likely remedy.
Please be as sensible as you can. You and babe need nutrition, all those fats and protein plus minerals and vitamins.
Best Wishes and please keep both of you fed.

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And now reading this it sounds like a hypo is not a good sign as far as my blood sugar regulation returning to normal after giving birth goes.. It does sound like a diabetic response so maybe I am prediabetic...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4428539/

But then again, maybe it was just too long without food ( I was sleeping while I had a chance!)

Guess I'll only know if I do the GTT again.

Back to a dawn phenomenon this morning after going to sleep with 6.0 after 8pm dinner of homemade chicken liver pate, almond & sesame crackers (keto), olives & cheese, then at midnight a bowl of cabbage, cucumber, capsicum and chickpeas to add carbs this time. (Also had a few extra carbs in the day but only saw 6.7 as my highest reading).
After 6 hours I was up to breastfeed. Didnt check till baby had finished one side. I was 4.8. Fed him the other side, checked again as I was starting to feel hungry, now 5.6...
So I can't trust my own hunger. I'm now going back to sleep for an hour without eating just to see where that lands me. Then I'll be at 8 hours without food.

Yesterday I measured before and after one breastfeeding session and I'd dropped only 1 mmol. So I thought I shouldn't go to sleep with a BS in the 4s in case it takes me down into the 3s again. But only a few extra carbs on one day apparently brings back a dawn phenomenon in the almost prediabetic range. It's a hard balancing act, especially when baby has just slept the longest he's ever slept overnight.

kitedoc said:

I am wondering whether cabbage and other plant foods might block uptake of minerals and vitamins? Could a dietitian maybe advise on adding in more meat?

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I haven't heard of that with cabbage but good to know. We are trying to make sauerkraut but it's only half fermented at the moment but we are eating it anyway. I heard sauerkraut is a good source of vit K.
I am eating meat and eggs everyday too though. Either liver, lamb steaks, osso bucco, minced beef,pork belly, chicken, salmon.. we have a range. Not sure about the chickpeas anymore though. Don't like all the wind
By the way, the dietitians here are likely to scold me for not eating more carbs, including the cornflakes in the diabetes diet recommendation booklet.

My biggest challenge so far eating keto/low carb while breastfeeding has been staying hydrated, and probably getting enough electrolytes. So I've been adding a bit of himalayan salt and seaweed to miso soup before bed to get me through the night. Seems to help.

Jim Lahey said:

You seem to be using carbs as a means to balancing blood sugar? This shouldn’t be necessary. The liver is perfectly capable of manufacturing all the glucose that your body requires. Granted this process can malfunction, but to be honest ~3.5mmol/L is not abnormal in truly healthy people. If you have hypoglycaemic symptoms then you should seek medical advice, but the chances of you having a hypo in the absence of hypoglycaemics or exogenous insulin are very slim. If you get hungry then eat, but it doesn’t necessarily have to be carbohydrate. Unless you suspect something like reactive hypoglycaemia, there is no need to consider topping-up with exogenous glucose.

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I was hoping 3.6 mmol was just on the low end of normal and that a good day of really limited carbs followed by a proper overnight fast (I'll need to make it to 8 or 9 hr if I do the GTT again) would give me a proper fasting reading ( otherwise I'd been snacking on nuts or cheese if my 3am breastfeeding sessions left me hungry so it was hard to get a true fasting reading.) I probably just went too long without enough food. It'd been 14 hours since my liver for dinner and 9 h since a very small bowl of semi-fermented cabbage (wannabe sauerkraut).

I still reach for carbs sometimes if I think my bs is on the lower side because psychologically I still haven't got my head around no carbs while breastfeeding. It should be fine but I'm still finding a balance..

I'm also not sure if I had any real symptoms of hypoglycaemia at 3.6mmol. I felt slightly euphoric and carefree if anything but I also kept forgetting what I was doing while trying to make breakfast. But that happens to me often anyway with 3 little kids asking for different things at the same time "Mummy!!!!!! Who left this banana peel on the floor? Mummy! I see a spider! Mummy, I've done a poo!! ....And then I can't remember if I've put salt on my eggs or not, or I've just poured cold water on my teabag.. This morning my 4yo daughter threw up in the middle of the dining room floor while I was still trying to enjoy the rather yummy chicken liver pate I'd made for the first time ever. Mmm appetizing...
And my daughter just poked her head in now saying " Mummy, I've got too much diarrhea.. when I farted just now, I pooed in my undies... ha ha