Type 2 Ketones, good or bad ?

DeadlyCatch · Jan 24, 2021

So I am T2 and started a loose carnivore diet (a few carbs still but <10g) 2-3days ago.

Loosing weight and bloods are way way better, measured my ketones with urine strip and it shocked me at 3.9mmol, now I know generally speaking ketones means ketosis and good for weight loss and glucose. However about 3weeks when last at the GPs he did a ketone test and said "good no ketones in urine, thats ok". So I am confused a little, why was GP happy to see no ketones? I have high blood pressure too, if its relevant.

Should I be worried now im reasonably high ketones (although I believe urine not so accurate). I know ketoacidosis is a thing, so is it a case of getting a balance between that and safe ketosis? I feel great right now, in fact best ive felt in months, in just 2-3days of cutting carbs!

Thanks

Jaylee · Jan 24, 2021

DeadlyCatch said:
So I am T2 and started a loose carnivore diet (a few carbs still but <10g) 2-3days ago.

Loosing weight and bloods are way way better, measured my ketones with urine strip and it shocked me at 3.9mmol, now I know generally speaking ketones means ketosis and good for weight loss and glucose. However about 3weeks when last at the GPs he did a ketone test and said "good no ketones in urine, thats ok". So I am confused a little, why was GP happy to see no ketones? I have high blood pressure too, if its relevant.

Should I be worried now im reasonably high ketones (although I believe urine not so accurate). I know ketoacidosis is a thing, so is it a case of getting a balance between that and safe ketosis? I feel great right now, in fact best ive felt in months, in just 2-3days of cutting carbs!

Thanks

Hi,

Do you use a BG meter. That would confirm what you blood is doing to understand which ketone state you are in..

bulkbiker · Jan 24, 2021

DeadlyCatch said:
So I am T2 and started a loose carnivore diet (a few carbs still but <10g) 2-3days ago.

Loosing weight and bloods are way way better, measured my ketones with urine strip and it shocked me at 3.9mmol, now I know generally speaking ketones means ketosis and good for weight loss and glucose. However about 3weeks when last at the GPs he did a ketone test and said "good no ketones in urine, thats ok". So I am confused a little, why was GP happy to see no ketones? I have high blood pressure too, if its relevant.

Should I be worried now im reasonably high ketones (although I believe urine not so accurate). I know ketoacidosis is a thing, so is it a case of getting a balance between that and safe ketosis? I feel great right now, in fact best ive felt in months, in just 2-3days of cutting carbs!

Thanks

What are your blood sugar levels doing?.. you are eating low enough to be creating extra ketones that are being wasted in your urine. If your bloods are ok and you aren't taking meds that can induce ketoacidosis then you're fine.. in fact exactly where you want to be.
Pee strips are relatively unreliable as indicators though long term.

DeadlyCatch · Jan 24, 2021

Jaylee said:
Hi,

Do you use a BG meter. That would confirm what you blood is doing to understand which ketone state you are in..

Yes, a week ago it was averaging 15-17mmol, now since starting loose carnivore its averaging 7-8mmol so good improvement on bloods. But ketones?

DeadlyCatch · Jan 24, 2021

bulkbiker said:
What are your blood sugar levels doing?.. you are eating low enough to be creating extra ketones that are being wasted in your urine. If your bloods are ok and you aren't taking meds that can induce ketoacidosis then you're fine.. in fact exactly where you want to be.
Pee strips are relatively unreliable as indicators though long term.

Bloods currently about 7-8mmol before meals, so a vast improvement and feel WAY better in just a few days, just worried when the doctor said "good, no ketones" when he checked a few weeks back! Meds I am on are Metformin and Invokana ?

So far I feel great, bloods are better, have no symptom's off ketoacidosis, maybe im just paranoid..

bulkbiker · Jan 24, 2021

DeadlyCatch said:
Bloods currently about 7-8mmol before meals, so a vast improvement and feel WAY better in just a few days, just worried when the doctor said "good, no ketones" when he checked a few weeks back! Meds I am on are Metformin and Invokana ?

So far I feel great, bloods are better, have no symptom's off ketoacidosis, maybe im just paranoid..

Was it when you were first diagnosed?
Might have been they thought you were a T1 who can often get into ketoacidosis with high blood sugars (due to a lack of insulin production) and ketones.

bulkbiker · Jan 24, 2021

DeadlyCatch said:
Meds I am on are Metformin and Invokana ?

Watch out for going too low.
If your bloods start to come down faster maybe check with the doc about stopping or reducing the Invokana dose and trying metformin only.
Watch out for bladder infections too you'll be peeing out lots of sugar.

DeadlyCatch · Jan 24, 2021

bulkbiker said:
Was it when you were first diagnosed?
Might have been they thought you were a T1 who can often get into ketoacidosis with high blood sugars (due to a lack of insulin production) and ketones.

No, just a general checkup 3wks ago

DeadlyCatch · Jan 24, 2021

bulkbiker said:
Watch out for going too low.
If your bloods start to come down faster maybe check with the doc about stopping or reducing the Invokana dose and trying metformin only.
Watch out for bladder infections too you'll be peeing out lots of sugar.

Yes indeed, due to the new diet and changes i am testing 3-4times a day to be safe!

bulkbiker · Jan 24, 2021

DeadlyCatch said:
No, just a general checkup 3wks ago

In that case maybe he just wanted to check you weren't following one of those "faddy" low carb diets that could take his captive customer away!

LittleGreyCat · Jan 24, 2021

DeadlyCatch said:
measured my ketones with urine strip and it shocked me at 3.9mmol,

As far as I know that is more or less spot on for nutritional ketosis and well below any risk level.
It just shows that your eating plan is working and you are generating ketones.
Anyone who is losing weight generates ketones - that is how fat is used up.

kokhongw · Jan 24, 2021

DeadlyCatch said:
Bloods currently about 7-8mmol before meals, so a vast improvement and feel WAY better in just a few days, just worried when the doctor said "good, no ketones" when he checked a few weeks back! Meds I am on are Metformin and Invokana ?

So far I feel great, bloods are better, have no symptom's off ketoacidosis, maybe im just paranoid..

It is not adviseable to go low carbs when you are on Invokana which is a class of drug call SGLT2 inhibitor. You run the risks of getting into DKA at normal glucose level... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5023342/

Treatment with SGLT2 inhibitors (canagliflozin, dapagliflozin, or empagliflozin) has been shown to improve weight loss and glycemic control and to provide cardiovascular protection.4 Given the favourable clinical profile of SGLT2 inhibitors, health care providers are increasingly prescribing these antihyperglycemic agents. However, recent FDA and Health Canada warnings have cautioned about the possibility of patients developing ketoacidosis with their use.5,6 More important, most cases of ketoacidosis occurred in settings of mildly elevated or normal blood glucose levels (ie, euglycemic diabetic ketoacidosis [DKA]).6 We report a case of ketoacidosis in a patient with T2DM, taking canagliflozin, presenting with a serum glucose level of 11.9 mmol/L.

Please consult your doctor to discuss discontinuation of the drug or changes to your diet.

Understand that SGTL2-i works by excreting excess glucose by inhibiting our kidney re-absorption and lowering its excretion threshold. So you need more carbs to maintain a "safe" higher level of glucose to prevent DKA.

Do be watchful and take care.

DeadlyCatch · Jan 25, 2021

kokhongw said:
It is not adviseable to go low carbs when you are on Invokana which is a class of drug call SGLT2 inhibitor. You run the risks of getting into DKA at normal glucose level... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5023342/

Please consult your doctor to discuss discontinuation of the drug or changes to your diet.

Understand that SGTL2-i works by excreting excess glucose by inhibiting our kidney re-absorption and lowering its excretion threshold. So you need more carbs to maintain a "safe" higher level of glucose to prevent DKA.

Do be watchful and take care.

Thankyou, that is interesting indeed, I will give the GP a call and ask him. Only actually started Invokana last week so should be easy to stop.

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