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Ketogenic Diet and overnight low blood sugars

Kirbster

Kirbster

Active Member
Messages
41
Location
Twickenham
Type of diabetes
Type 1
Treatment type
Insulin
Hi all,

I've been T1 diabetic since 1982 and was 10 years old when diagnosed. I've always had relatively good control (ish) but am looking at ways to lower my HBA1C. I recently discovered the ketogenic diet and after a huge amount of online research and purchasing of books I started to give the diet a go a couple of weeks ago.

Prior to the diet I was having frequent hypos, often 3-4 times a day. Whilst this didn't particularly bother me, and I've never been hospitalised with one, it was of course a worry for me and a hindrance more than anything else. Since starting the diet I no longer have any day time hypos and my sugar levels and stayed on an even keel, although a little higher than I would like but I'm keeping them around the 8-11 mark until I figure out more how the diet affects me, and how much insulin I need to take for the carbs/protein/fat I'm eating. It's very much trial and error for me at the moment, having had it drummed into me by dietitians in the past that you only need to bolus for carbs I'm realising I also need to take into account the protein as well. I'm almost having to count the grams of protein like they are carbs, a huge learning curve and change of mindset for me.

Although I've got many, many questions about LCHF/keto diets and how they affect Type 1's, I thought I'd start with my most pressing problem at the moment and that is how to stop the overnight hypos. I have started using the FreeStyle Libre over the last few weeks and love it for being able to see patterns and check what has happened to my blood sugars overnight. I've found that although I'm going to bed with sugar levels around the 8 mark, I'm dropping down to around 3 to 3.5 in the early hours of the morning. After reading the great blog from Stephen Richert, a Type 1 who follows the ketogenic diet (http://livingvertical.org) I learnt that for a moderate hypo he treats it by taking protein rather than carbs, so he'll have almonds, peanut butter, beef jerky, etc. I tried that for the first time last night when I woke with a reading of 3.2 at 4.50am and had 2 slices of ham to treat it. At 7.10am when I got up, I was 4.7 so it seemed to work.

However (hope you're all keeping up!) because I'm going low overnight, my levels are then spiking early-mid morning. After getting ready for work, and before breakfast, I was up to 11.2.

So I guess my question is, for those who are following a LCHF diet are there any suggestions from you as to how I can stop the overnight hypos? I take 8 units of Lantus at 10pm every night (this has come down from 10 units which I changed about a week ago to try and stop the overnight hypos), and am also on Humalog for my bolus. Maybe I need to change my basal somehow....the type I'm on, the time I take it, the amount I take?? Or maybe it's something completely different and nothing to do with my basal at all. Any thoughts? Sorry for such a long post!

Erin
 
Hi @Kirbster - no worries about the long post ;)

My concern is your night- time hypos, which we have to try and avoid as much as we can. Have you done any basal testing ? it's repeated time and time again but it really is the foundation to good control,

The guidelines from Salford Diabetes Care (http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007) gives the following information:

Evaluating the results and Suggested Changes

For each time period:
  • Compare the BG readings for the three times you have tested a particular time period and look for a pattern
  • BG changes of more than 2.0mmol/l between readings indicate the need to adjust the basal rate
  • Make basal rate changes in small increments, typically 10%
  • The basal rate should be increased 1-2 hours before the BG begins its rise or the basal rate needs to be decreased 1-2 hours before the BG begins its fall
  • Make one change at a time
  • Re-evaluate that time frame after any changes to the basal rate are made
  • Then move on to the next time period
Personally I would also consider splitting your lantus, it's supposed to be 24 hours but can range from 18-26 hours, I used to use Lantus and split my dose. As with any possibly changes please speak to your DSN. Hope this helps ;)
 
Thanks @Juicyj! I've never done basal testing and wasn't even aware of it, so thanks for the info. Doesn't that apply to people who are using a pump though? I have an appointment next Friday with my DSN so I will talk it through with her then. :happy:
 
Hi @Kirbster it applies to all insulin users, I tend to do it every so often when I struggle with my bg levels. Another consideration in regards to your background insulin is to ask your DSN about using Tresiba, it's a very stable background that lasts approx 36 hours so only one injection a day but it's a good one for those who have overnight lows, your DSN can tell you more, but your DSN should focus on eliminating those overnight lows as a priority.
 
Thanks @Juicyj, that's really helpful and I appreciate your advice. I'll ask my DSN about Tresiba too, she was talking about changing my background insulin when I saw her last month so I'll see what she says about Tresiba. Thanks!!
 
I had the same but now half hour before I go to sleep I have a piece of fruit, this works for me but it could be your basal needs to be changed
 
I highly recommend Tresiba (or its counterpart Toujeo) for background insulin. :) I am extremely stable on Toujeo and have no issues with night time hypos now that I found my correct dose. (Fingers crossed it won't change too much!)

The spiking in the morning you're describing sounds like dawn phenomenon to me. I have the same, so I end up doubling my insulin for breakfast. Some people can stop it by eating immediately after they wake up, too. In part I remain level because my background insulin is well adjusted to my needs so I always get a head start on DP and can curb it before it gets bad. I hope you'll find it works similarly to you once yours is adjusted properly!
 
When I was low-carbing I quickly had to cut my basal about 60%. Went from about 16u a day to about 6.

Just remember that because Lantus can last up to 3 days in your system, a change in your Lantus dose won't reach its full effect for a couple of days. If I wanted to reduce my Lantus by 2 units, I would reduce it by 4 units on the first night and then go back to a 2 unit reduction the next night so that the change would take effect more quickly.
 
Hi. I am a type 1 of similar vintage (diagnosed age 10 1981) and have done 3 long time fasts so similar to keto in terms of impact on insulin needs. I hve pump with humalog in it and have a fasting rate which works out to be 2.4 units less over the course of a day. I have good hypo warnings so if I wake up low I will simply unplug the pump but thats not an option for you. DR Richard Bernstein (a type 1 himself since 1946) talks about tresiba on his You Tube films (he advocates a diet of 30g cho so its ketogenic in all but name) and mentions that you can dilute it though that may not be necessary.
Otherwise I;d say I only need a tiny bit of sugar etc. to bring my levels up now that my body is better adapted to low carb/fasting!
 
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