BG levels on a carnivore diet

[Oldvatr]

On a Carni diet, you are by definition intaking Low Carb (yup) as a result your body is creating glucose through gluconeogenesis where it converts protein (along with some other odds and ends) to synthesise glucose to keep your glucose levels high enough for your brain and nervous system to functtion correctly. So running at a level of 4 is not advisable since this is only just above hypo level and is not actually healthy as a goal. A level in the 4;s is a sign that you have exhausted your glycogen stores, and have little . depleted energy reserves.

 

[MissMuffett]

On a Carni diet, you are by definition intaking Low Carb (yup) as a result your body is creating glucose through gluconeogenesis where it converts protein (along with some other odds and ends) to synthesise glucose to keep your glucose levels high enough for your brain and nervous system to functtion correctly. So running at a level of 4 is not advisable since this is only just above hypo level and is not actually healthy as a goal. A level in the 4;s is a sign that you have exhausted your glycogen stores, and have little . depleted energy reserves.

But the nhs say the mmo/l to aim for if you‘re diabetic is between 3.9 & 5 . Interesting

 

[Oldvatr]

But the nhs say the mmo/l to aim for if you‘re diabetic is between 3.9 & 5 . Interesting

Given that the accuracy of BGL monitors is +/- 0.7 mmol/l at that level of readings, then a 4.6 reading could in reality be 3.9 (on a good day)

Not many people reading this thread will be considered to have Normal Metabolism, which is what the target recommendations are based on. So setting a personal target of 4.6 or below is liable to register a hypo event even if the meter does not show it. As a driver subject to DVLA regultions, I could be considered negeligent if I have an accident and my blood sugars are found to be that low. I am not supposed to be behind the wheel if I am below 5 mmol/l.

considering that a level of 6.8 is where potential damage from glucose overdose is purported to start, then why the rush to get to below 5? Short term drops into the 4's is presumably aceptanle, but should not be a design aim IMHO. As I stated, these levels are an indication of glycogen depletion and low metabolic rate so that if there is a sudden stress in your life then you may not be so capable of dealing with the adrenaline rush. Such things can happen

There are studies that have determined that extreme tight control of bgl is actually detrimental to health, due to the preponderance of hypo events that are not benign events, and which can lead to a build up of health issues in the longer term.

Low blood sugar effects on the body: Long-term and short-term effects

When blood sugar levels drop too low, it is called hypoglycemia. There are several short-term and long-term effects of this condition. Learn more here.

www.medicalnewstoday.com

 

[MissMuffett]

An extract from that article…
“The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)Trusted Source note that people with diabetes should aim for blood sugar levels of 80–130 mg/dl right before a meal”
Thats 4.4 - 7.2 mmol/l Interesting.

 

[Oldvatr]

An extract from that article…
“The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)Trusted Source note that people with diabetes should aim for blood sugar levels of 80–130 mg/dl right before a meal”
Thats 4.4 - 7.2 mmol/l Interesting.

It is also not the UK but is the ADA targets.
I am assuming this thread is mainly aimed at people not using hypoglycemic medication, since their targets have recently been raised to correspond to an HbA1c of 53 or above if they are on certain medications. Normal target is 48 mmol/mol. Note: NG 28 does not reference SMBG targets, but uses HbA1c as their only criterion. Also NG 28 does say that targets can be relaxed for the elderly, the frail. and drivers and operators of machinery.

 

[HSSS]

It is also not the UK but is the ADA targets.
I am assuming this thread is mainly aimed at people not using hypoglycemic medication, since their targets have recently been raised to correspond to an HbA1c of 53 or above if they are on certain medications. Normal target is 48 mmol/mol. Note: NG 28 does not reference SMBG targets, but uses HbA1c as their only criterion. Also NG 28 does say that targets can be relaxed for the elderly, the frail. and drivers and operators of machinery.

I think you are taking the advice your dr/practice/ICB has give you and are trying to make this the norm. It’s not always the case. We’ve discussed this before.

Bgl in the 4’s
Mild excursions below 4 are totally normal in those unmedicated with hypoglycaemic drugs barring rare conditions. I’m not sure where you’re getting that 4’s are unhealthy etc. Every source I’ve seen shows it as the lower end of the normal experience. Why shouldn’t we aim to be as close to normal as possible, assuming we aren’t having harmful hypos?

Goals
Also you are only quoting selected parts of ng28. https://www.nice.org.uk/guidance/ng28/chapter/Recommendations#blood-glucose-management. 53mmol is not the only or baseline goal.

1.6.7 For adults whose type 2 diabetes is managed either by lifestyle and diet, or lifestyle and diet combined with a single drug not associated with hypoglycaemia, support them to aim for an HbA1c level of 48 mmol/mol (6.5%). For adults on a drug associated with hypoglycaemia, support them to aim for an HbA1c level of 53 mmol/mol (7.0%). [2015]

and even if your goal is 53, there is this too

1.6.10 If adults with type 2 diabetes reach an HbA1c level that is lower than their target and they are not experiencing hypoglycaemia, encourage them to maintain it. Be aware that there are other possible reasons for a low HbA1c level, for example deteriorating renal function or sudden weight loss. [2015]

Driving
The dvlc minimum is only applicable to those on specific medications that can cause hypos. Otherwise millions of metabolically healthy people would regularly be breaking the law as 3.9 is not unusual. There is no requirement or expectation to test unless on those diabetes medications either. Also you can drive above 4mmol but below 5 if you’ve taken a snack and are not recovering from a hypo This is specified for insulin users

https://www.gov.uk/diabetes-driving

https://assets.publishing.service.g...vers-with-diabetes-treated-by-non-insulin.pdf

https://assets.publishing.service.g...e-to-insulin-treated-diabetes-and-driving.pdf

https://www.gov.uk/guidance/diabete...etes- Which says for sulphonylureas and glinides for groups 1 (car) use should practise appropriate glucose monitoring at times relevant to driving (presumably as per insulin users).

 

[Oldvatr]

The problem with generalities applied to all is that there will be some who might try to achieve these levels, but are putting themselves at risk. Since SMBG is not an exact science, then it can mask problem levels.so they may not know. Sudden or intense exercise, endurance exercise, the presence of certain kidney or thyroid issues can become exacerbated by dehydration or inflammation / sickness.

The problem is not the short drop into low levels, but setting a target for achieving an HbA1c of 26 or so may seem like a good idea, but as I said previous, the closer one gets to 3.9 mmol/l then the headroom to recover from a hypo is reduced and for instance, a shock reaction may lead to loss of consciousn or cause confusion. I am speaking as a T2D here, where the liver will normally respond with a boost of stored glucose to compensate. If that store is depleted then that boost will be reduced or not available, and the gluconeogenesis process is not very quick acting or efficient.

The NICE SUGAR trial study showed that insulin users had lower mortality risk when their average level was 8-10 mmol/l compared to the trial group who were restricted to the 4.5-6 mmol/l range.

The EMcrit study showed that patients in ICU who had been tightly controlling their condition had a higher mortality rate than those controlling in the 80-100mg/dl (4.4 - 5.6 mmol/l). Of course, they were not taking into account the Carni diet, but it bears out the comment I made about headroom and stress/ shock.

 

[lovinglife]

this topic was started so as not to derail the thread they were initially posted.

 

[HSSS]

The problem with generalities applied to all is that there will be some who might try to achieve these levels, but are putting themselves at risk. Since SMBG is not an exact science, then it can mask problem levels.so they may not know. Sudden or intense exercise, endurance exercise, the presence of certain kidney or thyroid issues can become exacerbated by dehydration or inflammation / sickness.

The problem is not the short drop into low levels, but setting a target for achieving an HbA1c of 26 or so may seem like a good idea, but as I said previous, the closer one gets to 3.9 mmol/l then the headroom to recover from a hypo is reduced and for instance, a shock reaction may lead to loss of consciousn or cause confusion. I am speaking as a T2D here, where the liver will normally respond with a boost of stored glucose to compensate. If that store is depleted then that boost will be reduced or not available, and the gluconeogenesis process is not very quick acting or efficient.

The NICE SUGAR trial study showed that insulin users had lower mortality risk when their average level was 8-10 mmol/l compared to the trial group who were restricted to the 4.5-6 mmol/l range.

The EMcrit study showed that patients in ICU who had been tightly controlling their condition had a higher mortality rate than those controlling in the 80-100mg/dl (4.4 - 5.6 mmol/l). Of course, they were not taking into account the Carni diet, but it bears out the comment I made about headroom and stress/ shock.

And generalising with such a wide margin will put others at risk of excessive glucose levels that are entirely unnecessary.

The risks of exercise etc you list are there for non diabetics who don’t monitor at all as well as well managed ones, who probably have a better chance of catching anything going astray than someone not monitoring.

Who talked about setting hba1c goals in the 20’s? No one. And again the situation you describe pertains to non diabetics as much as well controlled ones not on hypoglycaemic medication.

And if on a carni diet then you are likely in ketosis in which case you will have the flexibility to use fats for energy and not run out the way you described previously.

Damage chances increase significantly at 6.8mmol. Not that it starts there or doesn’t happen earlier in some cases. Personally I’d like to minimise the risks, so long as I don’t create bigger ones in the process.

You seem to be conflating genuinely good control with erratic control consisting of highs and hypos resulting in a similar hba1c. They are very different things. You are entirely correct if hypos are a significant part of the situation and extremely over cautious if they aren’t. Education and awareness of the differences is key. It’s also difficult when talking back and forth about both insulin use (and other hypo drugs) and with those not on such medications without being specific for each statement/claim which group you are referring to. The risks are quite different.

NB re the emcrit study - have you got that the right way round? If mortality was lower in the 4.4- 5.6mmol group I’d say that is a demonstration that tight control like this is a good thing. If it actually meant to say like the NICE sugar study looser control is better then I suspect it is worth considering HOW the hba1c was arrived at - with or without hypos

 

[Oldvatr]

To answer the comment on EMcrit study
"Tight glucose control refers to getting as close to a normal (nondiabetic) blood glucose level as you safely can. Ideally, this means levels between 70 and 130 mg/dL before meals, and less than 180 mg/dL 2 hours after starting a meal, with a glycated hemoglobin A1C level less than 7 percent."

And this group had Higher mortality than the more relaxed group, which is the point I am making.

One can be too low. For instance even when in ketosis, the energy from lipids is used by the muscles and mitochondria, but the brain and the nervous system (including autonomous functionality) require glucose that has to be generated by gluconeogenesis if the glycogen supplies in the liver are depleted. This process is not very efficient and is not fully supportive when under stressed conditions such as shock or trauma.

Does prolonged carni diet deplete the glycogen stores -Good question, no one seems to have studied it. The EMcrit study is the first I have seen that might provide something towards an answer. But there are other tight control studies that also show heighened mortality rates but mainly in insulin users.

T2 does not appear to have been studied for tight control much, but there was a study last year that did show that elderly T2 on tight control was not beneficial although I don;t think it went as far as detemining effect on mortality. Only looked at worsening health and collateral health issues such as dementia and amputations. This study I believe is the basis behind NICE increasing the HbA1c target for that group.

.As has been pointed out even normal people can suffer glucose level lowering when doing certain exercise routines. Fasting can also lead to fainting in that group. Alcohol is also a glucose lowering agent, as are some heart medicatiions. some supplements also lower bgl. will you notice if you are controlling to sub 4.6 mmol/l ? Are you sure your meter is giving an accurate reading below 5 mmol/l? can you trust your meter and rely on hypo awareness to warn you? Many forum members are probably not very hypo aware. Forum users on diet only and lifestyle, but not on a hypoglycemic med may not be aware of these factors either.

It is nothing to do with the diet, it is everything to do with the target level of control being as low as possible, with the assumption that normal people going 3.9 to 6.8 are comparable to a diabetic doing the same. The confounders of Insulin resistance and insufficiency are probably significant differences between the groups. We have not had enough evidence and studies to say that tight control while using a carni diet with ketosis is safe.

finally. what does your HbA1c chart show an average daily bgl that corresponds to an HbA1c of 26? Mine says 4.6 mmol/l Most charts do not go below 5% or 31 mmol/mol considering the meter accuracy 4.6 seems to be a more suitable bottom rung rather than 3.9

 

[Bcgirl]

Super interesting conversation!
here’s my update. my initial diagnosis back in October of 2022, was because I had A1C of 6.5. I attributed it to the tamoxifen I was taking for breast cancer…it is a side effect. I doubled down on the low carb, ditched the tamoxifen, and for six months my diet was super, save for a few holidays where food was an issue (Mexico and India). Carbs count did go up a wee bit. After six months my A1C was 6.0…I was hoping for way lower. I went carnivore (and quite enjoyed it) but my next A1C , three months later. Was 6.3! What the heck! This was just a few weeks ago. My LDL is a little scary but everything else is perfection.
I am continuing with this carnivore diet. I can’t find any info but maybe someone out there can answer this….are some people just genetically programmed to exist with higher than average glucose levels? I just can’t get numbers less than 5.5 and seem to better after eating than before a meal..really!
I do know I have a damaged pancreas from an episode of severe acute pancreatitis 16 years ago….cause unknown.

 

[HSSS]

To answer the comment on EMcrit study
"Tight glucose control refers to getting as close to a normal (nondiabetic) blood glucose level as you safely can. Ideally, this means levels between 70 and 130 mg/dL before meals, and less than 180 mg/dL 2 hours after starting a meal, with a glycated hemoglobin A1C level less than 7 percent."

And this group had Higher mortality than the more relaxed group, which is the point I am making.

One can be too low. For instance even when in ketosis, the energy from lipids is used by the muscles and mitochondria, but the brain and the nervous system (including autonomous functionality) require glucose that has to be generated by gluconeogenesis if the glycogen supplies in the liver are depleted. This process is not very efficient and is not fully supportive when under stressed conditions such as shock or trauma.

Does prolonged carni diet deplete the glycogen stores -Good question, no one seems to have studied it. The EMcrit study is the first I have seen that might provide something towards an answer. But there are other tight control studies that also show heighened mortality rates but mainly in insulin users.

T2 does not appear to have been studied for tight control much, but there was a study last year that did show that elderly T2 on tight control was not beneficial although I don;t think it went as far as detemining effect on mortality. Only looked at worsening health and collateral health issues such as dementia and amputations. This study I believe is the basis behind NICE increasing the HbA1c target for that group.

.As has been pointed out even normal people can suffer glucose level lowering when doing certain exercise routines. Fasting can also lead to fainting in that group. Alcohol is also a glucose lowering agent, as are some heart medicatiions. some supplements also lower bgl. will you notice if you are controlling to sub 4.6 mmol/l ? Are you sure your meter is giving an accurate reading below 5 mmol/l? can you trust your meter and rely on hypo awareness to warn you? Many forum members are probably not very hypo aware. Forum users on diet only and lifestyle, but not on a hypoglycemic med may not be aware of these factors either.

It is nothing to do with the diet, it is everything to do with the target level of control being as low as possible, with the assumption that normal people going 3.9 to 6.8 are comparable to a diabetic doing the same. The confounders of Insulin resistance and insufficiency are probably significant differences between the groups. We have not had enough evidence and studies to say that tight control while using a carni diet with ketosis is safe.

finally. what does your HbA1c chart show an average daily bgl that corresponds to an HbA1c of 26? Mine says 4.6 mmol/l Most charts do not go below 5% or 31 mmol/mol considering the meter accuracy 4.6 seems to be a more suitable bottom rung rather than 3.9

Just off to bed so super quick answer. Yes some groups do benefit from a higher target. I’ve never disagreed with that. My point was you originally were seeming to suggest we all should have looser control and highlight dangers that are much the same as for the rest of the population as far as we know currently. It was also to highlight that in such discussions we should be clear about which groups face which risks and why. Your comments seemed to me to muddle it all together.

And as far a trying to correspond a bgl 4.6 mmol to an hba1c of 26 - that’s a straw man argument. As we all know no one maintains a consistent bgl throughout the day. That equivalency between two different tests is artificial. It’s a comparison used “as if” a constant bgl was maintained. Or an average of 4.6mmol. Any dips into the 3’s are likely to be short lived and time will be spent above 4.6 and likely into the 5 and 6’s immediately after food too. Just how many have you seen aiming for or achieving an hba1c of 26? It’s rare even amongst non diabetics.

And again no one has suggested we aim for 3.9. Just that occasional short forays into the high 3’s for someone not on hypo meds and not at risk in other ways is not something to get so worked up over. Do these people need a warning from a super accurate meter or will the body do its homeostatic job and raise levels back up? What person hasn’t had the odd small wobble after intense exercise or some of the other situations you describe? I’ve seen too many newbies (not on such meds) panicked by anything at all under 4 and pumping themselves absolutely full of sugar after reading posts like yours or articles online about anything under 4 being unhealthy or dangerous without further explanations and discussion. At worst all most need is a tiny nudge and further observations. And again I agree - for those on hypo meds it’s definitely not something to ignore.

 

[Oldvatr]

Super interesting conversation!
here’s my update. my initial diagnosis back in October of 2022, was because I had A1C of 6.5. I attributed it to the tamoxifen I was taking for breast cancer…it is a side effect. I doubled down on the low carb, ditched the tamoxifen, and for six months my diet was super, save for a few holidays where food was an issue (Mexico and India). Carbs count did go up a wee bit. After six months my A1C was 6.0…I was hoping for way lower. I went carnivore (and quite enjoyed it) but my next A1C , three months later. Was 6.3! What the heck! This was just a few weeks ago. My LDL is a little scary but everything else is perfection.
I am continuing with this carnivore diet. I can’t find any info but maybe someone out there can answer this….are some people just genetically programmed to exist with higher than average glucose levels? I just can’t get numbers less than 5.5 and seem to better after eating than before a meal..really!
I do know I have a damaged pancreas from an episode of severe acute pancreatitis 16 years ago….cause unknown.

Hi. Welll done so far thats a good set of figures. We cannot diagnose on this forum. all I can say is that it takes a while to reset the glucose control thermostat to a lower average. at the moment your liver is probably working hard to maintain the bgl levels it had gotten used to over the past few years. Carni diet and ketosis may well help to reset the control line so that it feels happy with a lower average.

The other method we can use is a soup and shakes diet (known here as The Newcastle Diet) which is an ultra low calorie crash diet. Trouble with the Newcastle diet is that any improvement gained by the diet can fall away unless one is very careful with the follow on support.

Carni is a viable alternative, and is sustainable after the initial success. But it may take a bit longer to bed in. I am not sure if genetics defines the baseline but I believe one can shift it by diet. However, technically the beta cells are electrically driven and there will be differences in switching thrsholds which is why we are all different. I use a sulfonylurea med, and that changes the electrical levels in my beta cells to make them act as if the glucose levels are higher than they actually are, so the beta cells pump faster and for longer.

 

[Bcgirl]

Thanks oldvatr, I absolutely cannot go low calorie! I’m tiny! Five feet seven and i weight 115 lbs….I need lots of food!

 

[Oldvatr]

Just off to bed so super quick answer. Yes some groups do benefit from a higher target. I’ve never disagreed with that. My point was you originally were seeming to suggest we all should have looser control and highlight dangers that are much the same as for the rest of the population as far as we know currently. It was also to highlight that in such discussions we should be clear about which groups face which risks and why. Your comments seemed to me to muddle it all together.

And as far a trying to correspond a bgl 4.6 mmol to an hba1c of 26 - that’s a straw man argument. As we all know no one maintains a consistent bgl throughout the day. That equivalency between two different tests is artificial. It’s a comparison used “as if” a constant bgl was maintained. Or an average of 4.6mmol. Any dips into the 3’s are likely to be short lived and time will be spent above 4.6 and likely into the 5 and 6’s immediately after food too. Just how many have you seen aiming for or achieving an hba1c of 26? It’s rare even amongst non diabetics.

And again no one has suggested we aim for 3.9. Just that occasional short forays into the high 3’s for someone not on hypo meds and not at risk in other ways is not something to get so worked up over. Do these people need a warning from a super accurate meter or will the body do its homeostatic job and raise levels back up? What person hasn’t had the odd small wobble after intense exercise or some of the other situations you describe? I’ve seen too many newbies (not on such meds) panicked by anything at all under 4 and pumping themselves absolutely full of sugar after reading posts like yours or articles online about anything under 4 being unhealthy or dangerous without further explanations and discussion. At worst all most need is a tiny nudge and further observations. And again I agree - for those on hypo meds it’s definitely not something to ignore.

I apologise if I was being obscure.I was originally responding to a poster who clearly wanted their levels to be in the 4's. It was also in a general purpose non specific section of the forum, so is not specific to any group or condition. So my reply did try to simply say that setting a target so that results were in the 4's is possibly not a good idea. Someone with good control under those circumstances will probably return an HbA1c not far removed from 26 which was indeed a strawman response. And the study I reviewed on tight control was indeed controlling in that band of 3.9 to 5 mmol/l. It was performed on patients admitted to ICU, so under stress or ahock conditions. So anyone of us could sadly end up in a similar situation at a moments notice. They found in that study that the more relaxed group of diabetics survived the ordeal better than those on tight control. I would suggest that that information is of interest here.

 

[Oldvatr]

Thanks oldvatr, I absolutely cannot go low calorie! I’m tiny! Five feet seven and i weight 115 lbs….I need lots of food!

One of those delivery jobbies delivered a Macdonalds meal to my house tonight (in error) so maybe I should have set it aside for you. Enjoy your meat+ 0 veg

 

[Oldvatr]

One thing we often find being asked on the forum is "what level of damage does hyper or hypo glycemiua do to us?"

The following study does not provide a complete answer, but does answer the sort of damage that can occur when the body is stressed or in trauma, which is an extreme condition.The test cohorts are ICU patients and post operative patients.

Management of Diabetes and Hyperglycemia in Hospitalized Patients - Endotext - NCBI Bookshelf

It discusses tight glucose control as being 4.4 - 6 mmol/l and at that level the consensus seems to be favourable when compared to ,say, the range 8-10 mmmol/l. They do not cover the 3.9 mmol/l to 5 case as discussed in this thread. (and as studied in the EMcrit study)

note: when I was in hospital recently, I was being encouraged to control between 12 and 20 mmol/l and my usual control of 4.5 to 8 mmol/l was strongly discouraged. Seems they need to read this study? As a matter of note: I was put on insulin pump therapy while in post op recovery, and I had the worst and most frequent hypo's ever while in their care. as the report noted, these tended to be in the early hours of the day (5 am) when staffing levels were low and snacks are not available.

The reason why Carni diets are the subject of this thread is that being a ketogenic diet plan, there is potential to actually achieve levels in the 4's range. however, other keto diets may also be applicable and it is not the diet itself that is under scrutiny.

 

[JAT1]

Extremely interesting and informative thread !!!