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Ketones?

Tootse

Well-Known Member
Messages
65
I have been tring to stick to a low carb diet since type 2 diagnosis In July this year. However, I have just read on another site that cutting carbs cause ketones and they recommend that complex carbs are required to keep ketones at bay?


Ketones and Diabetes

What are ketones?

Ketones are produced when the body ‘burns’ some of its own fat for fuel. This happens when the body cannot utilise the glucose in the blood to meet its energy needs.

Why should you be aware of ketones?

Insulin is a hormone produced in the pancreas that helps the body to use glucose as an energy source. As people with diabetes do not produce insulin, or their insulin doesn’t work as it should, the body may have to start burning fat for energy in situations where glucose isn’t being used, and this produces ketones. The presence of ketones in the bloodstream is therefore a possible complication of diabetes. If left untreated, this can result in a condition called diabetic ketoacidosis (DKA). Blood becomes acidic which is a serious problem that can lead to diabetic coma.

There are a number of things that you can do to help prevent raised ketone levels and DKA:

Eat sensibly and regularly

If you regularly skip meals, particularly carbohydrate based ones, your body will naturally start to produce ketones. A sensible mixed diet with a regular source of starchy or ‘complex’ carbohydrates will help to prevent the production of ketones.

Preferred carbohydrates

Starch and sugars are both types of carbohydrate. Starchy or ‘complex’ carbohydrates are the preferred source of energy in the diet of people with diabetes, such as:

•Whole grain cereals
•Vegetables
•Beans
•Nuts
•Wholemeal bread
•Brown rice
•Potatoes
•Pasta

Maintain your diabetes therapy

It may sound obvious, but be sure to stick to the treatment plan prescribed by your doctor, using insulin and/or taking your oral medication as instructed. Poor glucose control contributes to ketone production, so make sure you regularly check your blood glucose and let your doctor or nurse know if it is outside your target range.

Take regular exercise

Regular exercise is good, but build up gradually and make sure your body has enough carbohydrates to meet your energy needs. Fat will be broken down and ketones produced in the absence of adequate carbohydrates during sudden exercise.

Take extra care during illness

If you don’t feel like eating when unwell, try to match your normal carbohydrate intake with milk, fruit juice or glucose drinks. As illness may affect your diabetes therapy, carefully monitor your blood glucose and report any changes to your doctor or nurse.
If you start vomiting - particularly if you have high blood glucose, are passing a lot of urine, feel cold and have rapid breathing - seek medical advice immediately, as these symptoms could be due to DKA.


Is this advice correct and should I be eating carbs?
 
Well here is a link that describes what Ketones are from this very site:

http://www.diabetes.co.uk/diabetes-and-ketones.html

It would seem therefore that as has been said they are a serious concern for T1s but not so much for T2s in most cases.

I suppose the problem for T1s is that if you are low carbing and then you do exercise or really anything strenous then your bosy will use Glucagon to fuel your muscles. Your cells will then require these stores to be replensihed. If you don't have enough or any insulin in your system then the body will revert to fat as a means to get this energy and ketones will be the by-product of this process. This is turns makes you pee to try and flush them out and can cause a viscous cycle with dehydration and peeing ultimately leading to Ketoacidosis.

So in principle a LC diet would be fine on T2 and could be worked on T1 as well but i think for the latter it would seem to make sense just to cover your (healthy complex) carbs with an appropriate bolus dose. For diabetes there is no magic bullet and it is always the same result, hard work.
 
Firstly, the article doesn't apply to T2 diabetes.

As people with diabetes do not produce insulin, or their insulin doesn’t work as it should, the body may have to start burning fat for energy in situations where glucose isn’t being used, and this produces ketones. The presence of ketones in the bloodstream is therefore a possible complication of diabetes.
That is technically correct: Untreated T1 diabetes will (eventually) result in ketones regardless of diet. What it fails to mention is that ketones are not, as such, dangerous - they are, in T1 diabetics, merely an indicator of a much more serious absolute insulin deficit.
Edit to add: "insulin doesn’t work as it should" clearly points to T2, but because of the phrasing ("the body may have to") is consistent with the fact that T2s can very very rarely get DKA as well.

Eat sensibly and regularly
That's nonsense. T1 diabetics in DKA have plenty of glucose (your liver can produce more than enough, which is why people don't drop unconscious after fasting for 72h)

I suppose the problem for T1s is that if you are low carbing and then you do exercise or really anything strenous then your bosy will use Glucagon to fuel your muscles. Your cells will then require these stores to be replensihed. If you don't have enough or any insulin in your system then the body will revert to fat as a means to get this energy and ketones will be the by-product of this process. This is turns makes you pee to try and flush them out and can cause a viscous cycle with dehydration and peeing ultimately leading to Ketoacidosis.
As you have said, DKA is caused by lack of insulin. What you eat or do is immaterial. Remember, your liver can make more than enough glucose even when you're not eating carbohydrates - the problem is that, without insulin it can't be used, overwhelming the various buffers that normally prevent DKA.
 
I thought that by low carbing I was getting my body to use fat instead of carbs for energy. Won't that produce ketones?

I'm overweight so I need to lose a few pounds. I have found that cutting down carbs and replacing with protein and fats seem to be helping. So I'm quite happy to continue with this lifestyle change. :)
 
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