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Any keto experts here?

Fenn

Well-Known Member
Messages
1,405
Type of diabetes
Type 1.5
Treatment type
Insulin
Hi, would anyone know please…

I am doing strict keto currently 20g roughly per day, I am also doing intermittent fasting 16-20 hours fasting per 24 hour.

This is working out great for me, I am finding it easy and my numbers, (which have recently (6 month ish) been terrible, 30% in 4-10 range)
have been amazing, 99% in range. Ketones 2.5 on average, 1-4.
My insulin has reduced a lot. I am often injecting 1 unit or 0 units for meals, my levemir is at 4 units am and pm

I am very keen to carry on doing this obviously, I have been going hypo in the night disturbing my sleep but didn’t want to Do anything as it was like 3.8,3.5, but from about 11:30am to 4pm today I was hypo all afternoon at work, I will attach picture if I can make it work.

So finally my question *phew* I didn’t want to treat the hypo as I ate a ham salad at 11am and figured this would eventually kick in and raise me up a bit (no novorapid) but it only popped me into the green for a bit then went back down grrr, I didn’t treat it as didn’t want to drop out of ketosis, But at 3.0 I felt fine, usually I feel ****** by then. Is it possible that the ketones are giving me (especially my brain) what I need to be ok without correcting the hypo? Can I keep reducing the insulin dose with ketones without fear of DKA? So basically am I good to go if it happens again?

Thankyou if you know, sorry for the long lead up to the question.

 
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I'd treat hypos as an insulin user. Some parts of your body and brain can work with low glucose if alternative fuels (e.g. ketones) are present - but not everything can. Damage being done at less than 4mmol/l on medication is unknown ...
It sounds like some adjustments to medication are required ... including possibly variation in basal requirement with time of day
 
While I've been doing keto for nearly four years on a similar sort of schedule to you, I don't feel I have the insulin experience to be able to answer your question.

I have however noticed that other things that lower an already low BG - eg exercise and alcohol - can lead to BG levels much lower than I'd like, and, on a couple of occasions, to what felt very like how people describe full-on hypos.
 
I treat all readings below 4.0 mmol/l so that I do not lose my hypo awareness. Hypo unawareness is what consultants are most worried about with the keto diet. I have reassured mine that I always eat fruit between 3.5 and 4.0 mmol/l and dextro below that. I continue to retest until my blood sugars are above 4.0 mmol/l. The article below covers what I'm told in my meetings with my specialist in terms of why they are concerned. My specialist always checks my time in target data to see how often I am below 4.0 mmol/l.

Dead in bed syndrome is a term used to describe the sudden unexplained deaths of young people with type 1 diabetes.

Dead in bed syndrome is a term used to describe the sudden unexplained deaths of young people with type 1 diabetes.
www.diabetes.co.uk
 
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I have been adjusting my basal downwards since being on this regime but my numbers are better than expected faster than my adjustments, I haven’t read tones about DKA but I remember reading it happens because a lack of insulin, not sure how low is ok, I guess 1 unit lol.

Thankyou
 
I had read here about the IF but didn’t realize how amazing it is, keto I have done loads but the combination is amazing huh, it feels like it is long term, you are proof, nice work. Apart from long working days, I have been topping up to 10k steps on the treadmill at home, this could be “helping”

Thankyou.
 
That sound very sensible, I was hoping the ketones were fueling everything, so my body was happy to be that low but you make good sense.

Thankyou
 
@Fenn , I'n neither T1, nor an insulin user, so feel very free to ignore my comment, but I have always thought the big flags for DKA were ketones, plus elevated blood sugars. That said, my gut feel is running at a clinically hypo level without any adjustment/treatment is bad news, and potentially very bad news.

I'm really pleased you are enjoying the keto lifestyle so much. I'm wondering if you have considered having a look at Type 1 Grit on the dreaded Facebook? You might get lived life experience answers in there, although, like here, I doubt they will be able to legitimately give medical advice.

I don't know id Dr Ian Lake has written much about experiences transitioning to keto, but he has a website, Type 1 Keto, and is active on X and other social media. Lovely man, living a keto lifestyle, on MDI, undertaking lots of exercise - some of it extreme.
 
Good advice and I will certainly have a look at those, much Appreciated not ignored

Thankyou.
 
Metformin will have the effect of reducing insulin requirements, I tried it a while ago and had to dramatically reduce basal and bolus insulin. It took about a week for the effects to start but they were rapid, I was on about 50U Levemir a day and had to initially drop to 2U Levemir a day over a 2 day period (dropped initially to 10U but still had hypos which I treated with glucose tablets). I had to start increasing the Levemir after that but the requirement was still much lower than without Metformin.
Unfortunately I started having issues a few weeks later so had to stop taking Metformin (reaction to Metformin).

I was monitoring blood glucose and started monitoring ketones more closely at the time of starting Metformin use - I figured the combination should spot problems like DKA early.
 
Sorry I can't really help, but would just like to add that I've read (probably in the book 'Fast 800') that once you've become ketone adapted, it's normal for ketones to ebb and flow, meaning that I wouldn't be too fearful of "dropping out of ketosis". I used to think people were either in ketosis or they weren't, our hormones work in a much more sophisticated way that we give them credit.
 
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