Ketogenic diet and diabetic ketoacidosis

[Yai]

To start with, I apologise for my ignorance, however Forum members have been so helpful, I wish to ask another question please:

I have read many threads saying how successful people have been in lowering their blood glucose and losing weight by drastically cutting their intake of carbohydrates. I believe that fewer than 30g of carbohydrates a day is classed as a ketogenic diet. As a type 2 diabetic of many years, I am worried to try lowering my carbohydrates so much in case I make myself ill. Can anyone offer any comfort please, or have I got my proverbials in a twist?

 

[BrianTheElder]

To start with, I apologise for my ignorance, however Forum members have been so helpful, I wish to ask another question please:

I have read many threads saying how successful people have been in lowering their blood glucose and losing weight by drastically cutting their intake of carbohydrates. I believe that fewer than 30g of carbohydrates a day is classed as a ketogenic diet. As a type 2 diabetic of many years, I am worried to try lowering my carbohydrates so much in case I make myself ill. Can anyone offer any comfort please, or have I got my proverbials in a twist?

Hi @Yai Ketosis is the state in which your body burns ketones instead of glucose for fuel.
Normally carbs supply glucose and insulin is produced by your body when it detects glucose so that the glucose can cross cell membranes and enter the system. Unfortunately, excessive carbs can lead to excess insulin and your body becomes insulin resistant, which is the start of T2D. One of the functions of insulin is to store fat, so this is a direct side effect.
An alternative, which was common in the diet in pre-modern times, was to eat more meat and fat (especially) rather than carbs. Without carbs your body produces ketones as fuel as a direct replacement for glucose, ie ketosis replaces glycolysis.
Ketosis is a natural state and not to be confused with ketoacidosis, which is a serious condition in T1D when the ketones are an order of magnitude higher.
Generally to achieve ketosis, you should eat less than 20g of carbs/day. You should also eat moderate protein, about 0.8g/kg of body weight. The rest of your diet is fat and you can eat what you like as fat is filling and you will reach satiety before you exceed any calorie limit.

 

[Resurgam]

As you are diabetic lowering your carbs should make you better - but it isn't a one size fits all level of carbs - I used to lose weight easily on 80 gm of carb a day and had to go up higher to stop it - on 20 gm a day I was in a state of collapse and could not walk up stairs, but crawled up on all fours.
When diagnosed diabetic I went to low carbing to control it, but did not try to get down to what for me are low levels, just went back to normal for me eating - and that seems to have fixed things, though I will be adding in more exercise as the weather improves.

 

[bulkbiker]

To start with, I apologise for my ignorance, however Forum members have been so helpful, I wish to ask another question please:

I have read many threads saying how successful people have been in lowering their blood glucose and losing weight by drastically cutting their intake of carbohydrates. I believe that fewer than 30g of carbohydrates a day is classed as a ketogenic diet. As a type 2 diabetic of many years, I am worried to try lowering my carbohydrates so much in case I make myself ill. Can anyone offer any comfort please, or have I got my proverbials in a twist?

Very little chance of you making yourself ill.. personally I am lower than 20g of carbs every day and have been for the best part of a year. Have lost weight and have fairly good blood sugar control. What meds are you taking? If they are blood sugar lowering you may need to be a bit careful if you cut out lots of carbs as your sugars may go a bit too low. If you aren't then cut out as many carbs as you can and see what happens to your bloods.

 

[ickihun]

Just wanted to add type2s can get ketoacidtosis especially on dapagliflozin and canagliflozin. Be aware.
Nothing related to keto dieting or reaching ketosis in dieting thou.
Ketoacidosis is acid forming due to high levels of sugar in the blood.

 

[AndBreathe]

To start with, I apologise for my ignorance, however Forum members have been so helpful, I wish to ask another question please:

I have read many threads saying how successful people have been in lowering their blood glucose and losing weight by drastically cutting their intake of carbohydrates. I believe that fewer than 30g of carbohydrates a day is classed as a ketogenic diet. As a type 2 diabetic of many years, I am worried to try lowering my carbohydrates so much in case I make myself ill. Can anyone offer any comfort please, or have I got my proverbials in a twist?

Yai - When considering changing your diet, any medication you take must be taken into account, as the blood glucose numbers can change dramatically, fairly quickly.

It would therefore be useful to know which medications (if any) you take.

Please do not radically change your way of eating without any meds being taken into account.

 

[Yai]

Very little chance of you making yourself ill.. personally I am lower than 20g of carbs every day and have been for the best part of a year. Have lost weight and have fairly good blood sugar control. What meds are you taking? If they are blood sugar lowering you may need to be a bit careful if you cut out lots of carbs as your sugars may go a bit too low. If you aren't then cut out as many carbs as you can and see what happens to your bloods.

I a

Very little chance of you making yourself ill.. personally I am lower than 20g of carbs every day and have been for the best part of a year. Have lost weight and have fairly good blood sugar control. What meds are you taking? If they are blood sugar lowering you may need to be a bit careful if you cut out lots of carbs as your sugars may go a bit too low. If you aren't then cut out as many carbs as you can and see what happens to your bloods.

I am on 5 Metformin per day (which my new Drs practice says is 1 more than they like to prescribe), plus 150mg Irbesartan for blood pressure and 10mg Simvastatin. Both of these latter two medicines were given me as "preventative" rather than "curative" medicine. When I wanted to start LCHF eating, the Diabetic Nurse was not happy to stop my blood pressure tablet, but agreed to re-test bloods in 3 months.

 

[Daibell]

I a



I am on 5 Metformin per day (which my new Drs practice says is 1 more than they like to prescribe), plus 150mg Irbesartan for blood pressure and 10mg Simvastatin. Both of these latter two medicines were given me as "preventative" rather than "curative" medicine. When I wanted to start LCHF eating, the Diabetic Nurse was not happy to stop my blood pressure tablet, but agreed to re-test bloods in 3 months.

I've just stopped my BP meds with the agreement of my current DN. I did some home tests, having stopped the BP tablets, which were below 140/80 so it showed I didn't need the meds. You might like to try the same. There are too many 'preventative' meds being handed out. Have you also tested your lipids breakdown numbers without the statins? Also why 5 x Metformin when I believe 4 is the max?

 

[bulkbiker]

I'd personally do some reading up on statins..
As a female your longevity should be improved by higher cholesterol levels according the the latest research.. so your preventative could be preventing you living longer!

 

[Resurgam]

Yes - watch the statins - they have had a very bad effect on my memory and intellect and I only took them for five weeks. I was on Atorvastatin, but it would be a cold day in Hell before I'd take any sort of statin again.

 

[ickihun]

I've just stopped my BP meds with the agreement of my current DN. I did some home tests, having stopped the BP tablets, which were below 140/80 so it showed I didn't need the meds. You might like to try the same. There are too many 'preventative' meds being handed out. Have you also tested your lipids breakdown numbers without the statins? Also why 5 x Metformin when I believe 4 is the max?

Probables absorption why 5 tablets. Although I agree research stated more than 4 showed no benefit.
Be careful @Yai when changing to less carbs you most likely will need less metformin too. Reducing back to 4 then 2 after 6 weeks. Keep testing, testing, testing , testing throughout. If getting reoccuring highs reintroduce the lost metformin, for now. Increased exercise later can reduce metformin again.

 

[kokhongw]

Ketones like glucose and insulin are damaging and dangerous at excessive levels. That is often highlighted when there is a discussion about ketones in relation to diabetes.

What has often been dismissed is the fact that maintaining the appropriate levels of ketones is very therapeutic for many of us. It empowers us and enable many of us to be medication free.

Because most of us have spent years if not decades in high carb lifestyle, we may not have the necessary enzymes to produce and utilize ketones efficiently. So getting into a comfortable state of nutritional ketosis would require a few days to a few weeks of adaptation depending on the individual.

Here is a paper that discussed the value of ketones as alternative fuel for our brain:-
Can Ketones Help Rescue Brain Fuel Supply in Later Life? Implications for Cognitive Health during Aging and the Treatment of Alzheimer’s Disease
http://journal.frontiersin.org/article/10.3389/fnmol.2016.00053/full

 

[Brunneria]

@kokhongw
Thank you for that link to the study.
Fascinating.
And of particular interest to me because I also have PCOS.
Thank heavens I have a ketogenic way of eating!

 

[kokhongw]

@kokhongw
Thank you for that link to the study.
Fascinating.
And of particular interest to me because I also have PCOS.
Thank heavens I have a ketogenic way of eating!

You are welcome @Brunneria . I believe that this paper correctly identify the issues that most of us fellow T2D will face within our lifetime. And that there needs to be a deeper discussion and appreciation of ketones, other than that it may be life threatening at excessive levels...

We suggest that the energetic (glucose) deficit confronted by the aging brain today is essentially the same as the challenge faced during brain expansion at the dawn of our species and that ketones were part of the solution then as now. Hence, it makes physiological sense to apply what we know about the importance of ketones in early brain development to the challenge of maintaining brain energy supply and brain function during aging.

 

[donig]

Hi @Yai Ketosis is the state in which your body burns ketones instead of glucose for fuel.
Normally carbs supply glucose and insulin is produced by your body when it detects glucose so that the glucose can cross cell membranes and enter the system. Unfortunately, excessive carbs can lead to excess insulin and your body becomes insulin resistant, which is the start of T2D. One of the functions of insulin is to store fat, so this is a direct side effect.
An alternative, which was common in the diet in pre-modern times, was to eat more meat and fat (especially) rather than carbs. Without carbs your body produces ketones as fuel as a direct replacement for glucose, ie ketosis replaces glycolysis.
Ketosis is a natural state and not to be confused with ketoacidosis, which is a serious condition in T1D when the ketones are an order of magnitude higher.
Generally to achieve ketosis, you should eat less than 20g of carbs/day. You should also eat moderate protein, about 0.8g/kg of body weight. The rest of your diet is fat and you can eat what you like as fat is filling and you will reach satiety before you exceed any calorie limit.

Careful on the type of fats though heh - no trans fats - long chain polyunsaturated or essential fatty acids high omega 3 oily fish shown to have anti-inflammatory properties, avocado high in fibre magnesium vitamin E.

 

[BrianTheElder]

Ketones like glucose and insulin are damaging and dangerous at excessive levels. That is often highlighted when there is a discussion about ketones in relation to diabetes.

What has often been dismissed is the fact that maintaining the appropriate levels of ketones is very therapeutic for many of us. It empowers us and enable many of us to be medication free.

Because most of us have spent years if not decades in high carb lifestyle, we may not have the necessary enzymes to produce and utilize ketones efficiently. So getting into a comfortable state of nutritional ketosis would require a few days to a few weeks of adaptation depending on the individual.

Here is a paper that discussed the value of ketones as alternative fuel for our brain:-
Can Ketones Help Rescue Brain Fuel Supply in Later Life? Implications for Cognitive Health during Aging and the Treatment of Alzheimer’s Disease
http://journal.frontiersin.org/article/10.3389/fnmol.2016.00053/full

Hi @kokhongw Thank you very much for directing me to this study. I am hopeful that my continued use of nutritional ketosis will keep dementia at bay. I found the following excerpt encouraging.

Nutritional ketosis is a physiological response to sustained low carbohydrate intake resulting in low plasma glucose and insulin, and plasma ketones of 2–5 mM after a week or so. Nutritional ketosis has never been shown to induce ketoacidosis, i.e., to alter acid-base balance or to lower blood pH whether after experimental ketone infusion (Hasselbalch et al., 1995) or during medically supervised starvation lasting as long as 60 days (Drenick et al., 1972).​

That seems to be a particular concern of many posters.