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Just Back From My Appointment With My Endocrinologist - Confusion

  • Thread starter Thread starter asparagusp
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I think you would probably find it useful to do some reading on two different things - ketoacidosis (the harmful effect of high ketones that can occur in people with high blood glucose, high ketones and low insulin), and nutritional ketosis ( the beneficial state of having lowish levels of ketones due to eating low carb, while having low blood glucose and sufficient insulin).

People doing LCHF often actively try to get into nutritional ketosis, because it it helpful to us, and makes us feel good.

I have heard several stories here on the forum where health care professionals have warned people off even the slightest hint of ketones - because they have a basic MISunderstanding and think that ketoacidosis (bad) and nutritional ketosis (good) are the same thing. I find that very worrying in a highly qualified health care professional supposedly advising people on their health!
 
The trouble is that I am indecisive!

I have been diabetic for 16 years taking full strength Metformin and Gliclazide apart form the Lantus. I am getting far more hypos in the last few months. I stopped Propranolol, a beta blocker, prescribed for fast pulse, which is known to cause hyperglycaemia. Since stopping it a few weeks ago, my usually good fasting levels are much better in the 4s usually and post breakfast within the range, both timings with blips still!

Thanks everyone for your input.
 
asparagusp said:
Had any of them suffered side effects like ketones?
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The point of Low carbing for a diabetic is to bring the BS within "healthy perimeters". When one is covering the diet with the right dose of insulin (either by injection or pacratic production.) then there should be no dangerous keytones..
Too much insulin wheather LC or not will cause hypos...
 

Then the sensible answer is to reveiw the Met, Glicazide & Lantus dosage with your doctor regarding the dosage...
 
I have spoken with the nurse and dropped the evening Gliclazide and the insulin has come down by three units to 7 units!
 
Yes I have low level ketones which is normal for someone on a ketogenic diet such as LCHF. These are what are called dietary ketones since they relate directly to diet inputs, They are not the more dangerous ones associated with DKA acidosis, which can come about when excess glucose cannot be got rid of by the body (usually due to lack of insulin , but can be triggered by certain medications.)

The LCHF diet will not produce DKA by itself and is considered to be safe in this respect, even for T1D, since it actually leads naturally to lower bgl levels, thus reducing DKA risk. I am not using insulin, but there are many here who do and who also Bant (i,e, use LCHF)

I am not slim yet, but I have reduced from around 17 stone to 10 stone, which is my optimum weight (BMI - 21). It is stable now, and I use LCHF to control it as well as my bgl. I now find 32" waist jeans need braces to stop them falling down whereas I was wearing 38" waist last Xmas.

My latest HbA1c was 41, which is as low as my GP wants me to go, but I have my own target of 36 which I know I can achieve without any pain.

Hope this helps put your mind at ease. Read what others have posted in the Success Stories thread.
 
This might be helpful:
  • Benign nutritional ketosis is a controlled, insulin-regulated process which results in a mild release of fatty acids and ketone body production in response to either a fast from food, or a reduction in carbohydrate intake.
  • Diabetic ketoacidosis (DKA) is a potentially dangerous condition driven by a lack of insulin in the body, causing a large amount of ketones to build up in the bloodstream. Without insulin, blood sugar rises to high levels and stored fat streams from fat cells. This excess amount of fat metabolism results in the production of abnormal quantities of ketones.
Ketones are a normal by-product of the breakdown of fats for energy. They can build up in the blood when you:
  • don’t have enough insulin
  • can’t use the insulin you have
  • aren’t eating enough
Ketone levels can range from negative or none at all to very high levels. While individual testing may vary, some general results for ketone levels can be:
  • negative: less than 0.6 mmol/L
  • low to moderate: between 0.6 to 1.5 mmol/L
  • high: 1.6 to 3.0 mmol/L
  • very high: greater than 3.0 mmol/L
Examples of early symptoms of ketone buildup include:
  • a dry mouth
  • blood sugar levels greater than 13.3mmol/L
  • strong thirst
  • frequent urination
You should test your urine or blood for ketones when any of the following occurs:
  • your fasting blood sugar is higher than 13.3mmol/L
  • your blood sugar exceeds 16.7mmol/L
  • you feel sick or nauseated, regardless of your blood sugar reading
Moderate ketone levels can often be treated before they worsen. A doctor can help you create a plan when your ketone levels get too high, such as administering additional insulin and drinking more water.

Sources: Various online resources - Google search
 
@asparagusp Your Endo could have been referring to the anti-bodies that are attacking your thyroid. I paid for a private blood test that shows I am not converting T4 to T3 and my TPO anti-bodies are killing my thyroid gland. My Doctor has finally referred me to an Endo, I think because he was impressed by how much I know about the working of the thyroid (entailed a lot of reading) If the Endo follows the NICE guidelines I won't get an treatment so will have to go private.
 
Can I just clarify? You are a T2 diabetic on Metformin, Gliclazide and Lantus and have recently started on LCHF? As soon as you start on LCHF you need to reduce the medications that are likely to cause hypos or you will be in trouble. Personally, if I was going to go 'proper' LCHF, of, say 20g per day, I would be looking at seriously reducing / eliminating Gliclazide / Lantus on a trial basis for, say 3 months. Test your fasting blood sugar every morning to make sure that the numbers are slowly heading in the right direction - and if not, re-consider this approach. You will probably want to do this with the approval / supervision of your 'diabetic professional'. With no Gliclazide / Lantus you should not be in danger of hypos. You may go into nutritional ketosis, but that is not dangerous - up to a level of about 4.

KetoACIDOSIS is dangerous, but that involves ketone levels above 5, high blood glucose levels and an absence of insulin. If you are a T2 diabetic and are still producing Insulin, most likely your basic problem is Insulin Resistance (way too much Insulin in circulation and your bodies cells, in muscles etc, are simply not reacting to it. The way to improve / resolve this is to drastically reduce your carbs, such that the body is not constantly producing more and more insulin and over time your cells will become more insulin sensitive.

There is a thread running at the moment called 'Are Ketones Dangerous?' And the relevant graph of ketone levels is on there.

I have already been told off once this week for talking about something I know nothing about! As I have not experienced the situation you are in, I would just like to qualify that this advice is based on my extensive reading (Richard Bernstein, Tim Noakes etc etc) and my experience of reversing Pre-diabetes and living in moderate ketosis on a HFLC diet for 6 years.
 
@AtkinsMo my insulin resistance is so bad I didn't/don't hypo on lchf. However I could reduce my 120-180units of insulin to 60units. I was on 30g carb but now on 100g as I experienced other problems. I will do a 30g carb lchf again after xmas but I've reduced my insulin to 44units by adding metformin and stopped insulin but it caused uncomfortable higher bgs so reintroduced til the new year. After reducing to nil I have a better insulin resistance. No extreme dieting just careful eating pattern to do successful liver dumps and jiggling metformin doses. I don't recommend stopping insulin like I did but it has definitely helped with insulin resistance. No weight loss on any diet, even lchf.
 

@ickihun more than happy to pass on any snippets I might have read relating to your other problems. PM me if you like. I'm a bit of a research nerd (like one or two others on this forum!).
 
Goodness all that wealth of experience here posted in my absence. Many thanks Tutti!

I am not on the LCHF diet as such. However my carbohydrates are around 50 g daily. I read somewhere that is a safe level.

I drink semi skimmed organic milk, (Full cream is too heavy for me), around 1 pint a day, eggs practically daily, go through phases of eating full fat cheese, Wensleydale as it's the least salty. low fat organic yoghurt from time to time, only chicken breast, the occasional tin of tuna, avocados, salad vegetables at the moment, nuts, extra virgin, olive oil, nuts and super seeded oatcakes, cocoa. Spices include turmeric and cinnamon.

In fairness to my Endocrinologist, he did say that the NHS guideline of HCLF conflicted with the actual medics and that I ought to discuss this with a nutritionist and my Diabetic Consultant. Fair enough.
 
asparagusp said:
Thanks azure. I take on board what you say. My original question was are there any inherently slim people here following the LCHF diet with success of otherwise.
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Well I have always been slim but no question of me being T1 or Lada I am definitely T2. Yes I have lost more weight than I wanted to since lowering my carbs I don't do high saturated fat no red meat not to my taste so I get my fat from good oils and avocados My weight has evened off now but I would still like to gain a few pounds back but not happened yet
 
Well what you are eating is good not everyone wants to do high fat some because they can't tolerate it others because they simply do not like full fat stuff. We all have to tailor our diet to what suits us best
 
I have far far too much insulin, I am very low (20ish) carb and have never once had a hypo. Hyperinsulinemia is very common in type 2's and is part of what drives insulin resistance. Too much insulin in someone who is not insulin resistant can certainly cause hypos, as can exogenous insulin or pancreas stimulating drugs like gliclazide but type 2's who are not taking those drugs rarely go hypo no matter how high their natural insulin goes.
 
Generally what you say here holds, but I believe that it is possible to hypo on Metformin only, or even without diabetic drugs at all (i.e. normal non diabetics) I think high levels of exercise or exertion, or a starvation diet, or excessive fasting can become significant factors. It is rare for a T2D to suffer one, but I believe it can happen,

I am currently overdosing on Gliclazide, so I do suffer low bgl, but I am only gently visiting hypoland so it is not a worry. I am juggling my doses but think I will need to invest in a pill splitter since it seems I need to drop by half a tab. I have retimed my meds and maybe this will work instead.
 
Yes I agree I did not say it never happens, I said it rarely happens and although metformin does not cause hypos it can slow the liver from responding to prevent them. There will always be people that do not fit into the norm.
 
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