Ketosis or Ketoacidosis???

There is a big difference. ketosis, as u said many low carbers go in when dieting. These things burn the body fat. This is ok as long as the sugar level is normal and enough insulin present to feed the body . Dka, diabetic ketoacidosis is caused by not having enough insulin in the body so the body will go In this state to burn anything it can to use for energy. Can cause serious damage to all organs, as well as extreme weight loss and can lead to a diabetic coma. If u have high sugars and ketones u need.to seek medical advice. Usually having a correction dose will bring sugar level down and ketones down. Sometimes of levels are too high it won't! And urgent medical treatment needed.

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Exactly what Brett said !

They do say with lantus to allow up to 3 days before making adjustments again, from my own experience this advice is spot on as it takes 2 days for any changes I make to show results.

It can never be said enough how important it is to get the basal dose right, without it everything else fails and you will never get any consistent bg control, once you get the dose right you can then look at your insulin to carb ratio's.


It's a shame you were made to feel singled out on the course for following a low-carb diet, how anybody eats is nobody's business and if they had concerns for your well-being this should have been discussed in private, most HCP's will say that carbohydrates are an important part of a healthy diet and shouldn't be excluded or severely restricted, on my DAFNE course I was low-carbing and eating between 90-120g of carbs a day, when I asked the Endocrinologist in the Q & A session about the minimum amount of carbs per day to stay healthy the reply was 130g, the figure 130g is one that has often quoted on the forum when members have asked the same question from their HCP's.

As for dietary ketosis, my HCP's give the same reply when I asked about very low-carb diets but wouldn't go as far as to say it would lead to coma or death, the opinion is it puts an added strain on the kidneys and as diabetics we are already susceptible to kidney disease this is something we shouldn't do, whether this is right or wrong I don't wouldn't like to say.

Gary Scheiner in his book Think Like a Pancreas when talking about a lack of carbohydrates in the diet says ''Ketone production is unhealthy for anyone, particularly those with diabetes. Maintaining at least a modest level of carbohydrate intake throughout the day should prevent ketosis.''

As for the chips, well as everyone knows its not a healthy option and certainly not something you should eat everyday, I'd imagine your huge bg swing was due to you following a VLC diet over a period of time, often I have read posts on the forum that those who VLC become sensitive to carbs the longer they follow the diet, I'll be having home-made chips tonight and my postprandial bg readings will hardly move for the first few hours due to the fat content of the meal, as with most people who don't restrict carbs the bg rise will come much later in the evening.....hence why I have to split dose on such occasions.

Hope you get the basal dose right soon and get those bg readings down!

mon
please ask this dietician what the specific deficiency symptoms are. I'll check back in my memory to see if I've ever experienced them in my several years of low carbing. Actually dietary carbs are NOT necessary at all. It's been known since 1926 and the Steffanson experiment. It's all bunkum!
Hana

hanadr said:

mon
please ask this dietician what the specific deficiency symptoms are. I'll check back in my memory to see if I've ever experienced them in my several years of low carbing. Actually dietary carbs are NOT necessary at all. It's been known since 1926 and the Steffanson experiment. It's all bunkum!
Hana

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For most people, absolutely not necessary at all, although the body metabolises carbs, they can be effectively generated from stored glycogen.

The exception I would give is endurance athletes, where gluconeogenesis (think I've got the right term here) and the breakdown of glycogen is not as quick as utilisation in the muscles. ALthough the free fatty acid mechanism is also there, some level of glucose in the bloodstream is also necessary, and may need to come from dietary sources.

I find I need about 15g every 15 mins on a long bike ride, but nothing for weight training.

Hi,

Like Brett said I wouldn't worry too much about ketones UNLESS your sugar levels are high as well. This means that if you are running on a low carb diet then you need to be even more obsessive about your sugar levels as soon as they rise you could run into trouble. I would say try to keep them max at 8 if you are going high ketone period too. But that's just from my own experiences. Also if you are exercising, as we all should without fail, maintaining sugar balance can become very tricky so checking often and adapting to the readings is key even if that means having some dextrose.

Now for the need some carbs argument I'm afraid I'd say we do, yes the body can metabolise the glycogens but the brain is an altogether different matter it's glucogen stores are much smaller and it is not only way way more demanding in terms of glucose requirement but is also far more sensitive to lack of glucose. This doesn't mean you can't low carb but I certainly would not go as far as going no carb for any length of time. The main problem is we don't notice the brain troubles until they become major issues and by then it's probably already crisis mode. Just a thought.

As for chips and sandwitches they should be ashamed, chips I would have said ok passable but sandwitches too boot! omg are they intentionally trying to make you fat? bread is a bit no no in my books

Hope that helps,
Frankie

mon said:

Noblehead you mentioned you split the dose for your chips. Does that mean you take half before eating and half after the meal? Is that only for certain foods? I've also noticed BG steadily increasing into the evening after dinner and wonder if this would help?

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No not immediately after eating otherwise I'd be hypo in no time. I split the dose by injecting just before eating a high fat meal and again 3 hours after the food, as you no doubt know a meal that is high fat slows down the absorption of carbohydrates and you get a delayed effect many hours later, Gary Scheiner talks about a Secondary bg rise in his book which explains it much better than I can, I'll try and look for it later and post what he says.

Here's an extract of a article that is taken from another site where Scheiner talks about the delayed effect:


''It has long been known that adding fat to a meal will slow down the digestion/absorption of carbohydrates. This is due to a slowdown in gastric emptying the rate at which food passes from the stomach into the intestines, where the nutrients (such as glucose) are absorbed into the bloodstream. This is why the carbohydrates in high-fat meals tend to take longer to raise the blood glucose level. But the difference is generally an hour or two: Whereas a low-fat meal will raise the blood glucose level quickly (usually within an hour), a high-fat meal may take two to four hours to produce a blood sugar peak.

So what about after the carbohydrates are finished doing their thing? That's when the fat itself begins to exert its effects. The process goes something like this:

You eat a high-fat meal or snack (this is the fun part).
In a few hours, the fat begins to digest; this continues for several hours.
The level of fat in the bloodstream (triglycerides) rises.
High triglycerides in the bloodstream cause the liver to become resistant to insulin.
When the liver is insulin resistant, it produces and secretes more glucose than usual.
The blood glucose rises steadily as the livers glucose output goes up.

This is what causes the gradual, delayed blood glucose rise after consumption of large amounts of fat. The response seems to be dose-dependent the more fat you consume, the more insulin resistant the liver becomes, and the more glucose it produces. The type of fat also appears to play a role. Saturated fats (the type found in dairy and animal products) seem to cause more insulin resistance than monounsaturated and polyunsaturated fats (the type found in vegetable products).''

What a great explanation of fat digestion that is Nigel, I never realised the part about trigs in the blood affecting the liver in that way before. I had been under the misapprehension that it was just the fat delaying digestion that led to a delay in the bg peak.

I know you have often recommended the Gary Scheiner book in the past but I had not considered it before, being a T2, but if its full of information like that I shall have to reconsider and get a copy :thumbup:


Although I still have the last two Game Of Thrones books to get through yet :lol:

Very interesting read noblehead. Also thought it was just fat delaying digestion of carbs. Trig bit does make sense. Thanks

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Well thats two of us at least that have learned something today Brett :thumbup:

Always nw things to learn sid

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Noblehead thanks for your explanation. That makes so much sense to me and explain why just carbscounting sometimes is not enough.


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missed that bit first time around, may go back and have a re-read.

Hi guys. I've not been on here for a while but after doing a DAFNE style course myself about 6 months ago, I experienced the exact same response as you, Mon. I used to keep to max 50g carbs per day and had near perfect control. Was made to feel I should eat Carbs so introduced them and increased insulin dose to compensate. End result? Put on 2 dress sizes and HbA1c has gone up to 8.6 from 6.4. Currently on holiday and gone back to low carb. Ketones are fine, as long as you're not suffering with high sugar levels. Also, low carb means any dose miscalculations are going to be minimal so hypos are a lot less likely, once you have background levels right. :smile:

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hit the nail on the head there so to speak, as to making sure basal insulin dosage is correct. I personally struggled to do this on mdi. That its why I'm now pumping and since I sorted by basal out, things are so much easier. That is why I feel pxxxxcd off at the nhs for refusing others the pump. Surely if they are given the pump, with adequate support to get basal doses right and bolus doses right there would be alot less complications cause of it, instead of just leaving people to get on with it themselves often with misguided and harmful advice.

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