Is Ketone testing required for a T2D on a LCHF diet

NEIL.MAYMAN

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This is my first post and although I was diagnosed with Type 2 Diabetes 4 years ago I have only recently been given a BG tester. What an eye opener, I had no idea how food was affecting me throughout the day and was of the ill informed opinion that the medication I was on was treating my Diabetes. The highest reading of 18.8 mmol/L and a jump from 9.7 to 16.3 after a plate of chips made me re-examine what was actually happening to my BG levels. For the first time I really rresearched my condition and discovered this website and forum. After reading posts and articles and discovering the 7 day low carb diet booklet, I have been following the recipes and with medication which consists of 2 Metaformin and 80mg of Glicazide (up from 40mg 20days ago). My pre breakfast BG levels have been averaging 5.3 for the last 6 days and I have lost almost 1 stone in weight in the last month.
So to my question, with ketosis being an almost unavoidable and (if I am reading the posts correctly) desired effect to promote weight loss when you are undertaking a LCHF diet is there any need to monitor ketones. Unless I am misunderstanding what I have read then I can already predict they will be high and the LCHF advocates say this is nothing to worry about for a Type 2 diabetic.
I know that the NHS do not encourage LCHF diets because of ketosis, should I worry or not.
 
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muzza3

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Hi @NEIL.MAYMAN
Welcome to the forum and congratulations on taking control of your diabetes and the great job you are doing so far. No you do not need to monitor your ketones. Using your meter and weighing will keep you aware if you are on track. Great to see you on here and keep up the great work
Cheers
 
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eldergarth

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This is my first post and although I was diagnosed with Type 2 Diabetes 4 years ago I have only recently been given a BG tester. What an eye opener, I had no idea how food was affecting me throughout the day and was of the ill informed opinion that the medication I was on was treating my Diabetes. The highest reading of 18.8 mmol/L and a jump from 9.7 to 16.3 after a plate of chips made me re-examine what was actually happening to my BG levels. For the first time I really rresearched my condition and discovered this website and forum. After reading posts and articles and discovering the 7 day low carb diet booklet, I have been following the recipes and with medication which consists of 2 Metaformin and 80mg of Glicazide (up from 40mg 20days ago). My pre breakfast BG levels have been averaging 5.3 for the last 6 days and I have lost almost 1 stone in weight in the last month.
So to my question, with ketosis being an almost unavoidable and (if I am reading the posts correctly) desired effect to promote weight loss when you are undertaking a LCHF diet is there any need to monitor ketones. Unless I am misunderstanding what I have read then I can already predict they will be high and the LCHF advocates say this is nothing to worry about for a Type 2 diabetic.
I know that the NHS do not encourage LCHF diets because of ketosis, should I worry or not.
welcome to the forum when I was diagnosed I had very high keytone readings and like yourself I found this site and with the help of the people on here and going on the lowcarb high fat diet at my last diabetes review I had managed to get my ketone reading to zero @muzza3 is correct in saying that there is no need to check keytones regularly but do check your BG levels before a meal and 2hrs after
I will tag @daisy1 who will give you some useful info on how to take control of your diabetes
 
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Brunneria

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Hi, welcome and WELL DONE!!!,

I expect you are feeling very different (hopefully much better) too?

The reason the NHS wants to avoid ketones is because there is a common misconception that ketones = ketoacidosis which can be life threatening.

But in order for someone to develop ketoacidosis they must have high ketones AND low insulin, with knock on high blood glucose. This is a situation that is much more likely for type 1 diabetics, or type 2s on insulin.

If you are controlling so well with diet (being in the 5s is tremendous after such a short time), then you have enough naturally produced insulin to cover your low carb diet, so ketoacidosis just won't happen. If you have ketones, they will indicate a state of 'nutritional ketosis' not 'ketoacidosis' and will not do you any harm.

I try to be in nutritional ketosis as much as possible, because I find that I have more stamina, lower appetite, better concentration and just generally feel better that way. :)
 
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kokhongw

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I reversed my Type 2
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I know that the NHS do not encourage LCHF diets because of ketosis, should I worry or not.

There is often this confusion between ketoacidosis(dangerous) and nutritional ketosis (desired). Do check out on the explanation of these two terms and it will put your mind at rest. We really want to switch our body from the sugar burning (dependent) to the fat burning mode.

Congratulation on your success. Keep exploring.
 
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PatsyB

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Hello and OMG always soemthing else to get my head around I had no idea there was nutritional ketosis and fat burning one to :eek:
 
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Mep

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You should be right I'd imagine. the only exception would probably be if you're type 2 like me with hardly any insulin being produced (that's why I'm on insulin after a really low reading in my c-peptide test result). I was in ER last night and got told I had ketones and therefore I had to eat. So if I had sufficient insulin this probably wouldn't be a problem I would think (although I do recall years back being on diamicron & metformin and being told to eat in hospital before when they found ketones... maybe it is the sick thing that makes it different). But on saying that my sugar wasn't super high, just on 9.6 after not eating for 12 hours.... so yeh high for me considering as normally I would've had a hypo by that time. But doc discussed what I was going to eat and made me promise to do it basically because she said otherwise I'd wind up back in ER with the DKA. But then I got asked last night if I have ketosticks to test my urine for ketones at home... I said no. I did try buying them here and couldn't find any. I will have to keep looking as I suppose I should be more careful these days.
 

dbr10

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But then I got asked last night if I have ketosticks to test my urine for ketones at home... I said no. I did try buying them here and couldn't find any. I will have to keep looking as I suppose I should be more careful these days.
Home Health UK do glucose testing strips which do keytones too. Available direct or via Amazon.
 
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Robbity

Expert
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Hi Neil!
  • ketoacidosis and nutritional ketosis are two completely different things
  • type 2s who are not taking insulin are unlikely to end up with ketocidosis anyway as it's a combination of very high glucose levels and a severe lack of insulin and we normally have plenty of that floating around
  • an LCHF diet doesn't need to be ketogenic to work; you can lose weight and reduce glucose levels quite nicely by eating an LCHF diet without being in ketosis. Conversely you can still maintain weight while in ketosis
  • You can (and probably should be) in a state of nutritional ketosis without having higher ketone levels. See below:
image.axd

Robbity
 
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Mep

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Hi Neil!
  • ketoacidosis and nutritional ketosis are two completely different things
  • type 2s who are not taking insulin are unlikely to end up with ketocidosis anyway as it's a combination of very high glucose levels and a severe lack of insulin and we normally have plenty of that floating around.
And that possibly was a problem for me when I was on oral meds only as it was in 2009 when I was hospital and being forced to eat when they found ketones. But then it wasn't long after that (only months later) they found I hardly have any insulin production. So in that situation I guess it could be serious. I was going through a lengthy period (I'd say at least up to 2 years of me complaining) of not managing too well on oral meds before they agreed to do the diagnostic tests on me again. That's probably why it's always a good idea to know the state of insulin production as it can change. I have often wondered why they don't do the c-peptide regularly like they do with the hbA1c for type 2's.... and even the GAD if there is changes.
 

daisy1

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@NEIL.MAYMAN

Hello and welcome to the forum :) Here is the basic information we give to new members although I can see that you are already doing very well. Ask more questions when you need to and someone will be able to help.

BASIC INFORMATION FOR NEW MEMBERS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you’ll find over 150,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.
There are two approaches to controlling your carbs:

  • Reduce your carbohydrate intake
  • Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

Another option is to replace ‘white carbohydrates’ (such as white bread, white rice, white flour etc) with whole grain varieties. The idea behind having whole grain varieties is that the carbohydrates get broken down slower than the white varieties –and these are said to have a lower glycaemic index.
http://www.diabetes.co.uk/food/diabetes-and-whole-grains.html

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes

LOW CARB PROGRAM:
http://www.diabetes.co.uk/low carb program


Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes
  • Before meals: 4 to 7 mmol/l
  • 2 hours after meals: under 8.5 mmol/l
Blood glucose ranges for type 1 diabetes (adults)
  • Before meals: 4 to 7 mmol/l
  • 2 hours after meals: under 9 mmol/l
Blood glucose ranges for type 1 diabetes (children)
  • Before meals: 4 to 8 mmol/l
  • 2 hours after meals: under 10 mmol/l
However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

  • structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
  • self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to bloodglucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic

Note: This post has been edited from Sue/Ken's post to include up to date information.