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Balancing low carb diet and ketones

F

Fatimshaider_

Newbie
Messages
2
Type of diabetes
Gestational
Hi all,
I am 34 weeks pregnant and was diagnosed with GBD about 2 months ago. Since then i really cut down on carbs and sugar in my diet and was also put on 1500mg glucophage per day. I monitor my blood sugar levels a couple of times a day and they have been more or less under control (average under 100 when fasting and depending on the food i eat, the random blood sugar ranges from 115-140. There have been a few times when sugar has gone up to 170 or so, but those have been rare cases). I recently got my HbA1c test done and it was 5.1, which my doctor was really happy about. However, i also got a urine test done, which shows my ketone levels at 5. My doctor showed a little bit of concern at this level and said i need to increase my fluids and not starve myself (which i have not been doing, just avoiding carbs and sugar). When i looked up this level of ketones on the internet, it seems really, almost dangerously high. I am just wondering if anyone else has been in this situation. How does one remove ketones without adding carbs to the diet?
 
ketones are a natural result of eating low carb foods, they are excreted naturally and efficiently when your blood glucose levels are under control.
When glucose levels are high all sorts of things start to go wrong, and then elevated ketones are a danger signal - but not vice versa. As long as your glucose is OK, ketones are OK too.
 
Ketones at that level are not dangerously high unless you are an insulin dependent diabetic (or someone taking one of the SGLT2 inhibitors) and your BG is concurrently running very high.

https://www.diabetesdaily.com/blog/2014/11/dka-nutritional-ketosis-are-not-the-same/

Most likely your raised ketones are the result of the reduced carb diet. Your doctor is right about hyration being important though.



Warning regarding SGLT2 inhibitor drugs:
http://www.diabetes.co.uk/forum/thr...-on-the-risk-of-diabetic-ketoacidosis.104325/
 


Thanks for your reply. However this chart that you have shared shows that 5mmol is a high level and I may have entered starvation ketosis. Am I misunderstanding it?
 
It's not dangerous until you get over double that amount - it's most likely a hydration issue in the absence of high blood sugar. Still, if you're worried, maybe you should see your doctor again.
 
Resurgam said:
As long as your glucose is OK, ketones are OK too.
Click to expand...

Not if someone is taking a SGLT2 Inhibitors e.g.
Dapagliflozin Forxiga
Canagliflozin Invokana
Empagliflozin Jardiance
​
Then a very high level of ketones must be investigated with a blood gas test regardless of the BG level.

Also there has been no research on levels of ketones when pregnant, as the legel setup means no one will every get the insurance to do it.

However @Fatimshaider_ I think you are doing OK, but drinking more water would not be a bad ideal. By testing your BG before meals and 2hr after a meal you can find the meals that most effect your BG and modify them.
 

Ketones CAN be dangerous in pregnancy. No one who has replied to you has been pregnant with diabetes, to my kmowledge.

Listen to your doctor. You might also want to,ask to speak to a dietician as too few carbs isn't recommended during pregnancy.
 
azure said:
Ketones CAN be dangerous in pregnancy.
Click to expand...

Maybe, maybe not, the research to find out has not been done. Remember we were all told a few years also that ketones where dangerous for everyone, once again based it not having been proved otherwise. No one can tell someone else if they should choose to take this risk for the benefits it provide.
 

You are responding to a pregnant lady. Pregnant ladies are warned against ketones because they can damage the baby.

And no, they obviously don't do research on pregnant women, but they DO have reason to give that advice.
 
Indy51 said:
I'd like to see the evidence that ketones harm babies. Do you have links?
Click to expand...
There is plenty of links to researches if you google by "ketonuria in pregnancy" for instance. I cannot post any links yet, since I am a new member (unfortunately, got diagnosed with gestational diabetes just recently, being on 28 weeks) - but I can quote some:
"Previous studies have shown that ketones elicit alterations in amniotic fluid volume and composition in sheep6 and also elicit potentially detrimental changes in the neurologic status of human.7
"
The part about detrimental neurological changes in fetus is scaring me most. I was on low carb diet for some time now, and just bought ketostix strips, and surprise - I've got ++. Feel awful now.
I will still exclude fast carbs from the diet, but I will definitely add more good ones. Especially that my blood sugar is normal now being on a low carb diet, I think I can afford more carbs (carefully obviously)
 
Hi,
With a help of some articles, I found out that there are tricks to eat more carbs and same time not drastically increase sugar levels - 1) try to eat fresh vegetable salad 15 minutes before main meals. and to the actual meal add some slow carbs (good or middle GI) - not much though, lesser than a normal person ratio. That way you will be still eating your carbs but at the same time they will be released at a slower rate during the digestion thanks to the fibres in the salad.
2) eat something before going to sleep, and maybe eat in the early mornings, don't delay breakfasts, so fasting night interval should not be too long
3) drink more...
4) don't eat too much fats
 
You may find that just by eating more protein you can reduce your ketones levels.
 

One problem is that the level of ketones someone gets with diabetic ketoacidosis can be well over 100 times as much as someone gets on a no carb diet. Its like saying rain is bad for the garden because when you get 2 feet of rain the garden is washed away. I don't know of any useful research on the effect of low levels of ketones to a fetus, they have just looked at the effect of diabetic ketoacidosis. (I don't know what the "++" level is on your test strips, or how dependable the test strips are.)

However one of the low carb experts that uses ketones to track someones progress, says that a reading of "trace" is as good as a higher reading .e.g there is no need to reduce carbs below the level that gets the smallest possible amount of detectable ketones. So even the persons that is promoting ketones as good good, would say your level is much more then is needed.


Seems like a sensible plan, because anything that gets you stressed is bad just because it makes you stressed. However don't think about fat, just eat as much as you need to feel like you have had a good meal, e.g. listen to your body it will tell you when you have had enough fat.

Expect that drinking more water may be the most important action to take.
 
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Hi @Fatimshaider_ ...I get that people have views and opinions on this and have considered research etc. Personally, I have been more than ready to experiment a little to find what works for me...but I am not pregnant, not do I have any expertise regarding (never mind basic experience of) pregnancy. I do know I would take no chances and largely disregard theory or less than conclusive and entirely specific medical research. Honestly, I would take it all on board...and follow your doctors advice. Stay hydrated, avoid stress, eat a little more (not necessarily a lot more carbohydrate) and notice that he/she is not freaking out at the ketone level...he/she is only a little concerned and keeping an eye on it because that is the responsible thing to do. This doesn't look like major issue at all...do nothing drastic and consult with your doctor regularly.
 
That is not true.

Studies have specifically looked at 'normal' ketones (ie not DKA level ones) on the foetus. Research suggests that ketones can cause cognitive delays in childhood, as well as other potential issues. That's the reason ketones are tested for in pregnancy in all women not just those with pre-existing diabetes or GD.

I'm at a loss as to why anyone here is implying that ketones are to be ignored when there's a potential effect on the foetus and the pregnancy. Even if that potential risk was low, it's still irresponsible to imply that women could maybe ignore ketones during pregnancy.

Any pregnant women here should listen to their doctor. The guidance re ketones is there for a reason and is based on studies looking at the effect of ketones on the foetus as demonstrated by later cognitive deficits in childhood. There have also been suggestiins that ketones can have additional negative effects, for example in early pregnancy...
 

@azure, I am not getting what it is that is "not true" in my comment. Actually...if rather ineffectively, I was trying to support your position by encouraging @Fatimshaider_ to "follow your doctor's advice" as other advice appears to be coming from those with little direct experience of this specific issue while pregnant and to urge her to "take no chances"...while not worrying her...perhaps it was not clear enough in my comment that the "theory or less than conclusive and entirely specific medical research" I was advising her to disregard was the kind of advice you also appear to be telling her not to listen to. It is obviously crucial that a pregnant woman doe snot do anything based on anything other than strict medical advice on such a matter.
 
@pleinster I was responding to Ringi's comment that no studies had been done on 'normal' levels of ketones.

You're quite right to say that the OP should follow her doctor's advice.
 
++ is not low, on the scale, where "-" is negative (not found), +/- - traces, and then it goes +, ++ (one I've got), +++ and ++++ being the highest. So having ++ is definitely not good, but I wouldn't risk even having a traces. As far as I understand, ketonuria is diagnosed when there is ANY amount of ketones is found. Because normally, in a healthy human urine ketones are simply undetectable.

btw those strips are pretty dependable, I've tested them on my other family members - all had negative results same day I had a positive one. Also I've seen that day how gradually ketones are leaving my body, where I saw + around a lunchtime, then traces, and then finally negative in the evening.

I think fat contributed a lot to that ++ reading I had. Day before I had a rib-eye steak, single cream, nuts, etc.. lots of fats and proteins.
 
azure said:
@pleinster I was responding to Ringi's comment that no studies had been done on 'normal' levels of ketones.

You're quite right to say that the OP should follow her doctor's advice.
Click to expand...

Ah...sorry...I misunderstood. Thanks for the reply
 
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