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How do you hypo on a ketogenic diet?

I was told and read 2.5 was the diagnostic for a hypo as opposed to a low blood sugar. My cousin just died from a hypo so 3.5 is too low in my book.
 
In my personal experience what makes a hypo acutely dangerous is not so much the level on the meter, as the speed with which it is dropping. This is something that does seem to be different between low carbing hypos and normal hypos. Normal hypos in my experience are much more likely to involve a dangerously fast drop. Probably just because of the larger quantities of insulin used on a higher carb diet. Hypos when I am low carbing tend to be slower, more gentle, less aggressive. I am more likely to be able to treat them with a small amount of glucose rather than eating a cupboard or shop worth of sweets in a panic.

I believe that hypo perception, the felt intensity of the warning signs, has been shown to be driven as much or more by the drop rate than by the absolute BG level.

Of course that only concerns the acute dangers. As has been said, there are suggestions, though not much data yet, that there are also long term negative effects of hypos (in addition to loss of hypo awareness which is a known medium term effect).
 
ronialive said:
I was told and read 2.5 was the diagnostic for a hypo as opposed to a low blood sugar. My cousin just died from a hypo so 3.5 is too low in my book.
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Sorry to hear about your cousin - that's awful.

These days DAFNE talks about hypo as 3.5, although they would call that level 'below target' i.e. aim higher. The low to mid 2s is clearly the clinical definition of hypo i.e. when it is actually immediately dangerous.

I was really surprised to see what @iHs said about the 70s and 80s - I had always assumed that the whole 4s the floor nonsense had come from that era when insulin wasn't so good, test kits were scarce etc - so the fact that lower levels were recommended then and the advent of better insulins and testing has seen a higher level being recommended really does astonish me.

Controversially, I wonder if the need to recommend higher levels to Type 1s for safety's sake coincided not directly with the use of basal/bolus, but more with the implication that Type 1s can eat what they like and jab to cover - i.e. the recommendation of a high carb diet and the increased use of insulin that brings?

I certainly agree with @Spiker that it is the speed of movement of BG rather than the actual level that causes the immediate danger. As I've said many times on the forum and have proven with my Libre, my BG generally creeps along very slowly - so slowly, Libre's directional arrows often miss it. I can hang around in the high 3s for several hours - but I don't take large doses of bolus. I actually find the basal hypos more scary. Having recently swapped to Tresiba, I'm now taking 9 or 10 units of basal in one shot - that's more insulin in a single jab than I've ever done before - and that scares me.

Smidge
 
I am surprised by that as well.
Your theory is interesting.
 
Spiker said:
I am surprised by that as well.
Your theory is interesting.
Click to expand...
I once was in hospital nil by mouth as needed to have an op done early next morning and did a bg test about 11pm whivh showed a bg of 2.6mmol so as I was wired up, I tried to get a nurse to get a glucose drip into me and it took ages for them to get the drip sorted and asked me if I could wait as they were busy seeing to a patient. I got a bit shirty and said if they dont hurry up.......
 
What happened?
 

They got to.......and got the glucose drip into the cannula in my elbow vein so that I didn't pass out and all was well
 
This is a really interesting discussion although I feel that a few people are relying on pseudoscience and potentially subjecting themselves to potential long term harm.

Hypo's are known to lead to a long term decline in cognitive function - more so the rapid drop type of hypo. This is because the major energy substrate of the brain is glucose. Deprive it of this and it will cause fits, but more importantly, lots of hypos over the years causes chronic damage to the brain.
Further to this, unfortunately Diabetes affects the micro circulation - peripheral nerves, small coronary blood vessels, retinal vessels and renal (etc,etc) Hence the common diabetic complications.
A big concern of mine is the long term risk of high ketone levels on the renal circulation associated with these diets, plus the significantly increased risk of Ischaemic heart disease associated with raised lipid profiles.

Are low BM's worth the risk of dying early from Nephropathy or Cardiac events? (and being too cerebrally challenged to notice) ?

One final note is that I have to say Spiker speaks a lot of sense.
 
Hey crashinduction! Are you @Spiker's glove puppet? LOL. Only kidding.

I can't speak for or against much of what you've said, but I must respond to your assertion that low carb diets (or are you talking specifically about ketogenic diets?) lead to a raised lipid profile and heart disease - my lipid profile is significantly improved since cutting out the carbs. I don't follow a ketogenic diet but I low-carb to around 50g carb a day and stay just out of ketosis so my ketones are not raised. I don't really add much fat to my diet, but I don't avoid fat. I'm happy with my BG dipping down to around 3.5 and I don't see how that can possibly cause cognitive impairment as it is actually normal blood glucose levels. Finally, it is the microvascular damage that we're trying to reduce our risk of by low carbing to keep our BG as close to normal as we safely can.

I haven't read back over the topic, but I don't think anyone on here was suggesting hypos are a good thing.

Smidge
 
"The long-term risk of high ketone levels on the renal circulation associated with these diets" -

Yes, we would all like some research on the safety of long-term ketosis. There's no evidence I've seen though pointing to ketosis damaging the kidneys. It used to be thought that too much protein was bad for the kidneys (not the same as ketosis, where most calories come from fat or gluconeogenesis ends it). But from what I've read, recent evidence doesn't support that.

And microvascular complications are *avoided* by low BG levels. As Smidge says, nobody is courting hypos.

The point about low carb, whether or not it includes ketosis, is that the range of BG fluctuation is much reduced. It becomes much more consistent. Which *avoids* hypos.

And I think there's some irrational ketophobia here.
 
If Dr Bernstein is ketogenic (which he must be), it hasn't done him any harm (now over 80). Indeed if I remember correctly he had kidney problems in his 30s and was given 5 years to live, his condition was eliminated through normalised BS levels, achieved through LcHf. As he points out, there is less chance of hypos through LcHf.
 
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