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Keto diet for type 1?

M

mattrix

Well-Known Member
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63
Type of diabetes
LADA
Treatment type
Insulin
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Clock time.
saying 'in range' without specifying what range is.
Inspired by a thread of the same name, by @Colin of Kent

I moderately low carb, and I know what a keto diet is, but ketones?
I only see ketones if I skip an insulin dose or sometimes if I'm really late for a dose. But as soon as I take insulin they disappear.
So can you actually switch to using fat for energy, generate ketones, and still be taking insulin?
 
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If you don't have it, perhaps try getting Dr.Bernstein's book, The diabetes solution 4th edition. Great informative book from a type 1 doctor with decades and decades of experience and medical knowledge.
 
Tophat, I read it yonks ago, probably 1st Edition.
It is just that, for me, insulin on board and ketones are mutually exclusive. I can have either but not both at the same time.
 
mattrix said:
Tophat, I read it yonks ago, probably 1st Edition.
It is just that, for me, insulin on board and ketones are mutually exclusive. I can have either but not both at the same time.
Click to expand...

I'm moderately low carb (usually but by no means always less than 80g a day). My consultant gave me a meter that reads ketones as well as carbs a year ago, after I told her that I'd never tested for ketones and never had a DKA (now 50 years of T1). On low levels of carbs my ketones quite often go up to a max of 0.7 (usually more like 0.2). (Sorry, not sure what the units are.) My understanding is that this is a "normal" level, not even dietary ketosis, I'd need to be over 1 for dietary ketosis and over 1.5 to be concerned about ketones for DKA. I used to test ketones with urines strips occasionally, can't ever remember getting a positive reading. (I don't skip insulin doses, though I do run high when I mess up my carbs/versus insulin.)
 
Hello there @mattrix !
I'm at this time doing quite the same as @EllieM here above. Low-carbing, and going at more or less constantly on values between 0.3 and 1.8 mmol/L. If you keep your carb-intake low enough, but compensate with fat (mostly) and proteins (normal amounts), then your body will/has to switch to fat as an energy source, and you're soon in ketosis. As long as you take suitable amounts of insulin also, there is no risk for high ketone values. Only problem I had, when I was in deep ketosis was, that I starved. (And that was why I was deep in..., or how should I put it ).
I made the mistake to not eat enough fats, especially as I'm not too keen on drastically increase the amount of proteins, because of some kidney problems...
If your ketones disappear, after taking insulin, I think it's mostly because of too little fat, and probably a bit too much carbs still...

Let us know, how you proceed...

Edited only to switch my last "maybe" to a "probably"...
 
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If I am going to burn fat I'd like it to be my own, I've got enough to spare.
iirc insulin inhibits lipolysis, which is what I assumed was happening.

If my body wants alternate energy it seems more than happy to use protein, ultimately muscle, to make glucose, as long as there is insulin available.

ps I'm only using urine dipstrips to check ketones.

pps. Congrats @EllieM on avoiding DKA for 50 years. I have never seen high ketones and thought I was safe, but I went off the rails about 5 years ago, and ended in hospital with mixed acidosis and kidney failure.
 
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If you wish to reach ketosis, you have to be a little careful with the amount of proteins used - protein can be turned into sugar, via a process called gluconeogenesis. As a type 1, this also means, that if you eat much protein, you should also dose for it. Protein turns into glucose a lot slower than carbs/starchs, so the reaction can be seen after about 4 hours, or so..
 
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mike@work, it just seems that I have talked myself into a corner.

Here is my experience,

Went to bed with PG=5.2 mmol/L
no basal insulin
Discarded my first morning urine.

At Urine 2
Ketones: just under 4mmol/L of urine
Glucose: just under 28mmol/L of urine
PlasmaGlucose: 7.8 mmol/L plasma.
My Dawn Phenomenon has not let me down!!!
Took rapid acting correction insulin
it is about 12 hours since my last insulin.​

At Urine 3
Ketones negative
Glucose <14 mmol/L of urine
PlasmaGlucose 5.3 mmol/L of plasma

​
I won't see ketones again today.
I haven't eaten anything yet.
Had I taken basal last night, I would expect no more than trace ketones in the morning.

Hence my question, how can you maintain ketosis and be taking insulin.

PPS Even if I had let this go on for longer between insulins my ketones don't get much larger than this. They seem to level off at, some thing less than 6mmol/L urine. Not enough to push blood PH too low, but enough to cause other things to go wrong.

PS
I have never been able to identify a 'peak' due to protein. I'm certainly converting protein to sugar but it seems to be gradual over a longer time period.
 
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Good morning (well, almost DAY already, I admit ...) @mattrix !

Just a fast question - I'll get back later, but quite busy at work right at the moment...

What does your abbreviation PG, stand for?
You say, for example, "PG 5.3 mmol/L of plasma"

My mother tongue is Swedish, so that's maybe a reason for me not recognizing "PG"...


Edited to say:
AH - struck me a few moments later. I suppose it stands for Plasma Glucose, or...?
 
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mike@work

Yea, Plasma Glucose. Just habit. Had to be careful because I was using mmol/L also for urine.
 
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Hello again @mattrix !

Glucose and ketones in your urine, only shows what has been... The only really trustworthy meter is your glucose meter, as it gives the values that right at the moment are valid. Seems you do have high values now and then, so may I ask you. What Insulin do you use, how often, and do you use some other medicines also. Are you on Basal/Bolus-regime, or do you only use long acting.

Another problem could also be your food choices. What do you eat, in a normal day?

These questions, could be a step forward, in solving why you are unable to get into ketosis, so if you don't find them too intrusive, then please tell a little more about yourself...

Edit: Corrected a spelling misstake / Don't like them, if I only notice them ...
 
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mike@work,

You are missing the point,

IF I am in ketosis, THEN as soon as I take insulin I drop out of ketosis.

I admit it is not a very good test, I had to skip my basal to get ketones. But even if I start with good figures, 5.2 last night, my Dawn effect means I have to take insulin in the morning.

I have provided both urine test results and my meter test results.
I can only measure ketones with urine sticks.
Urine 2 shows what has happened since urine 1, ie in the first hour after waking.
Urine 3 shows what has happened since urine 2, in this case a 2.5 hour period.

This whole test was done fasting. My last meal was 15 hours before urine3.
 
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Insulin is a fat storage hormone so of course it will temporarily slow or block ketosis when circulating in quantity. It enables lipogenesis, the polar opposite of ketosis. Any level of insulin resistance will also be a factor in determining how long and by how much ketosis is limited or entirely blocked.
 
Ketone bodies in the urine only tell you that which your body is excreting because it can't or doesn't want to use. Even blood ketones don't really tell you how good your body is at using them for fuel.
 
@mattrix

mattrix said:
You are missing the point,

IF I am in ketosis, THEN as soon as I take insulin I drop out of ketosis.

.
Click to expand...


My bad - I should have phrased myself better. STAY in ketosis, was what I meant, really...

mattrix said:
I admit it is not a very good test, I had to skip my basal to get ketones. But even if I start with good figures, 5.2 last night, my Dawn effect means I have to take insulin in the morning.
.
Click to expand...

As @Brunneria and @Jaylee points out here, the urine sticks are not too accurate, but a lot cheaper, if you have to buy them yourself.
Back to some more questions: Do you split dose your long acting insulin? If not, this could be a part of the problem. Bigger dose insulin, could have a better chance, to revert a beginning ketosis, but if you split, it is easier to control how much is needed, and possible to correct faster, in my opinion. Keep in mind, though - we are all different, and this is possibly not working for you. Secondly- we are not able/allowed to make any kind of diagnoses, nor can we really recommend any changes, so if you think there is something we propose, that could help, you have to discuss it with your GP/Doctor/corresponding. I'm only trying to point out a few possibilities here...

mattrix said:
But even if I start with good figures, 5.2 last night, my Dawn effect means I have to take insulin in the morning.
Click to expand...

Yup, it's a wonderful thing, that Dawn Phenomenon. I have similar problems. Ketosis seems to mitigate the Dawn effect a bit, but it takes some time, before that positive effect starts to show up - if it ever does...
If insulin levels are low enough, to match a keto low-carb diet, then just a bit extra insulin in the morning should not be a big problem in my opinion. But to borrow something @Jim Lahey already pointed out here: "Insulin is a fat storage hormone so of course it will temporarily slow or block ketosis when circulating in quantity." , and I'm mostly refering to the last part "in quantity". I have a suspicion, that this is another part of your problem, but why, that question can be a harder nut to crack.


Hmm - I am of the opinion, that both "Urine 2" and "Urine 3", has still a lot of sugar in it. Do you know what your night time BSLs are? High BSL, sometime at night, could force up your ketone values also, but I suppose you already have thought bout that...
Could it be, you are still i your "Honeymoon phase"? The honeymoon phase, can be quite long, for people diagnosed with LADA?

mattrix said:
Hence my question, how can you maintain ketosis and be taking insulin.
Click to expand...

Probably the best answer to all your questions - low enough carb intake.
Do you keep your carb amount at less than 20g a day?

Edited to insert Tag...
 
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Seems, it is ME that is missing the point.

It is my experience/assumption that ANY insulin is enough to "suspend" ketosis.
However it appears in some people who are taking low enough insulin that ketosis is not interrupted.
mike@work said:
Probably the best answer to all your questions - low enough carb intake.
Do you keep your carb amount at less than 20g a day?
Click to expand...
Or more to the point low enough insulin intake to sustain ketosis and then see if I can match it with CHO. But I fear that won't be enough insulin to cover the dawn effect. Though I have read on here somewhere that in sustained ketosis the liver becomes "glucagon resistant", and fasting PG can drop to around 2mmol/L!!.
mike@work said:
Hmm - I am of the opinion, that both "Urine 2" and "Urine 3", has still a lot of sugar in it. .
Click to expand...
To be expected, my PG is still elevated and it takes time for insulin to reduce the glucose. Ketones however disappeared quickly.
You have to remember that kidneys concentrate glucose ( and, probably ketones) and you don't pass much urine at a time.

A quick calculation: your urine is 18mmol/L and you pass 500ml (that is a lot), then if that glucose were put back into your extra-cellular fluid it would increase your PG reading by around 0.5 mmol/L.
 
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@mattrix I don't believe it's necessarily a switch, as such. More of a sliding scale. Certainly lots of insulin will block ketosis temporarily, but it's not an all or nothing scenario. Also, although at any given moment the liver may stop releasing ketones, it doesn't mean there will instantly be none in the blood.
 
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