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Low carb high ketones confusion!

Discussion in 'Type 1 Diabetes' started by saz1902, Oct 8, 2014.

  1. saz1902

    saz1902 · Well-Known Member

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    Hello all, I have not used this forum for a while and I do apologise! I hope some one can help me and end my worry and confusion.
    I was recently on a low carb diet for weight loss. It was going really well and I did lose a fair amount of weight and my blood sugar numbers were the best I had ever had! But then I started feeling really funny and randomly did a ketone test which told my my levels had gone up by 2! I freaked out, called my diabetic nurse who told me how to bring it down and told me not to low carb again! I also asked my regular doctor about it and explained what had happened. She said that it was perfectly fine to have high ketones- as long as my blood readings were good!
    I am now confused who is right! I want to go back in the diet as I have soooo much weight to lose, but am scared I will end up having more problems due to the ketones!
    Sorry it's a long post and thank you for reading. Any advise would be so much appreciated!
     
  2. shedges

    shedges Type 1 · Well-Known Member

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    Hi Saz,

    My understanding is that raised ketones is not a problem as long as your blood sugar levels are find. It means that the insulin is continuing to do its job and you're not putting yourself at risk.

    When blood sugar rises and rises, and ketones are present that's when you go into DKA, which rings alarm bells with all nurses... basically means you're going to end up in hospital.

    Hope that helps until someone more experienced in LCHF comes along.

    Sam.
     
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  3. saz1902

    saz1902 · Well-Known Member

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    Hi Sam!
    Thank you for replying. Your comment has made me feel more confident about going low carb again!
    It's all to confusing for my little brain to take! Lol! Thanks again.
     
  4. the_exile

    the_exile · Well-Known Member

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    The part I've quoted seems a bit dangerous to me, it's NEVER ok to have high ketones (high ketones is obviously subjective, your reading of 2 I wouldn't class as majorly worrying but certianly need bringing down, I think in DAFNE they consider anything under 3 as a "minor illness" when dealing with the sick day rules), regardless if you're blood sugar level is fine, I recently had glandular fever and my sugar levels were fine but my ketones were high, it was the most uncomfortable thing in the world to bolus 4 units of insulin when my sugar levels were reading 7.1 but it had to be done to control and lower my ketones. Have you done DAFNE? If so, follow your sick day rules for dealing with ketones.

    edit: Forgot to add, there's a thing called "starvation ketones" which you can get when you're not eating, so not sure if this may be linked to low carbing? Anyway, they way to deal with these is to get some carbs down you and bolus as normal for them, that should lower your ketones in that specific situation.
     
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    #4 the_exile, Oct 8, 2014 at 12:31 PM
    Last edited by a moderator: Oct 8, 2014
  5. Totto

    Totto Type 2 · Well-Known Member

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    When low carbing you need ketones. Ketones are sort of the whole point. Low carb, normal bg, ketones around 1-3. Few would deem 2 as high ketones, would they? I think it sounds perfect.
     
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    #5 Totto, Oct 8, 2014 at 12:35 PM
    Last edited by a moderator: Oct 8, 2014
  6. saz1902

    saz1902 · Well-Known Member

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    I have not done any courses. Probably should try and get into one!
    Thanks again all for your responses! Will try the low carb again and try not to worry. Is there any tips for keeping ketones low-ish while I'm on it? Or should I worry if they keep going up?
     
  7. the_exile

    the_exile · Well-Known Member

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    As Totto said above, ketones are a by-product of fat burning and a reading of 2 wouldn't be considered a huge worry, (from a purely personal standpoint I wouldn't want ketones that high), but alas it can be dangerous for a type 1 diabetic, which is why I think I'm right in saying diets such as Atkins are not recommended for us.
     
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  8. paul-1976

    paul-1976 Type 2 · Well-Known Member

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    I've been showing as high as ++++ on the ketostix at times over the last couple of years with no ill effects simply due to my LCHF diet,however,as an insulin user myself I DO take them seriously if my BG is elevated,say above 12 and/or I'm unwell.
     
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  9. saz1902

    saz1902 · Well-Known Member

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    So, does everyone on low carb get higher ketones and how do you lower them with out losing the low carb? Sorry if it's a silly question, I'm still a little confused
     
  10. Alice233

    Alice233 Type 2 · Active Member

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    This is a serious problem in diabetes. When you don't have enough insulin circulating your blood sugar becomes elevated. Since your body now has no way to use glucose, it starts breaking down fats as an alternative energy source. This causes ketones to build up in the blood which is toxic. If they test your urine they can see if you are dropping large ketones.
     
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  11. Indy51

    Indy51 Type 2 · Expert

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    If you are not on insulin, low ketone readings are not an issue, especially if your BG is not elevated. Low ketone readings are normal if you're following a LCHF diet. Dr Stephen Phinney explains it in this video:

     
  12. Robbity

    Robbity Type 2 · Expert

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    Do some reading up on the difference between (diabetic) ketoacidosis which can be very dangerous (mainly I believe for type 1s), and dietary/nutritional ketosis which is what happens and is quite natural when you are eating a low carb high fat diet. In this case your body goes into fat burning mode and produces ketones which it uses for energy instead of carbohydrates, and this is what you're aiming for particularly when you're trying to lose weight. There is apparently a lot of confusion over these two different ketone states!

    To lower your ketone levels you'd need adjust your ratios of carbs and fat, so less fat and possibly more carbs. But I'm type 2 and so I don't know how high a type 1s ketone levels can go in ketosis to keep safe, if your glucose levels are OK, but hopefully ( @shedges ) Sam's post has reassured you.

    Robbity
     
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  13. donnellysdogs

    donnellysdogs Type 1 · Master

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    Type 1's are really only told to test for ketones if going out of target ranges.. (4-8). Really recommended if above 12bg to test as this with bg levels that start to seriously rise is dka.
    Apart from that as I understand if in normal range, low carbing and ketones show from diet.. Then no prob..
     
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  14. saz1902

    saz1902 · Well-Known Member

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    Thank you all for your help. Much appreciated! You lot in this forum are brilliant! X
     
  15. Charles Robin

    Charles Robin Type 1 · Well-Known Member

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    Yeah there is huge confusion between ketosis and ketoacidosis. Think of ketones and blood sugars in a similar way; you can have some in your system and this is a very good thing. However, too much is dangerous. Some people believe you have to eat carbs to give your brain the power to function. This is incorrect. The brain can run beautifully on fat, and ketones are the result of the fat burning process. So long as you have sufficient insulin in your system, ketoacidosis should not be a danger.
    Ketoacidosis results when the body is starved of the fuel it needs. Without insulin, the cells in your body cannot take glucose out of your blood to use as fuel. Therefore you are effectively starving. The body tries to get any form of fuel it can, so it burns its fat stores, producing ketones. However, without insulin the cells still can't get their energy, so more and more ketones are produced, creating massive levels in the blood; ketoacidosis.
    So you might think 'But if glucose is so important to my cells, why would I want to cut it out by eating low carb?' The wonderful thing is, low carbing is not cutting out glucose at all. The body can also convert protein into glucose, but it does it more slowly through a process called gluconeogenesis. The ratio of conversion varies from person to person, but some low carbers work on the basis that 50% of the protein they eat will be converted into glucose. Because it does it more slowly, it makes it easier for your insulin (naturally produced for type 2s, injected for type 1s) to match the rise in glucose levels and stop blood sugars rising significantly. In the meantime, the body mobilises its fat stores, producing ketones to fuel the body. Because your cells are getting the fuel they need, you will not overproduce ketones, so ketoacidosis should not occur as long as your blood sugars are in a normal range.
    Hope that helps.
     
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  16. phoenix

    phoenix Type 1 · Expert

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    It;s also important to test when ill. If you are vomiting or have diarrhoea and continuing to take insulin then levels can be reasonably low. However because the liver is depleted of glycogen ketones are produced and because of the fluid loss they can reach higher concentration. This can, albeit rarely, be sufficient to lead to acidosis ie DKA Normalglycemic or euglycemic DKA can also sometimes happen in pregnancy .
    http://www.pjms.com.pk/issues/janmar08/article/bc2.html
    That's one reason that people who are vomiting and can't keep anything down and have ketones are told in the UK to get medical advice

    ( I'm not advocating it because it's obviously a difference but I actually have a bit in my protocol about sipping sugary drinks ie flat cola if below 150mg/dl , coupled with specified amounts of insulin when sick with ketones present . This doesn't seem to form part of DAFNE sick day rules I notice )

    The ketones produced in a low carb diet are absolutely no different to the ketones produced in DKA. It is the amount ie the concentration in the blood that leads to acidosis.
     
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    #16 phoenix, Oct 9, 2014 at 8:50 AM
    Last edited by a moderator: Oct 9, 2014
  17. LucySW

    LucySW Type 1 · Well-Known Member

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    Yes, that's how an LCHF diet works. LCHF diets are also called ketogenic diets, because ketones are produced and metabolised by your body *instead* of blood glucose, of which there is less because of limited carbohydrate and only slow conversion from protein. There is nothing harmful about this - it's an alternative way the body has to fuel itself. And remember, our bodies can't handle carbohydrates - that's the whole point.

    So long as your BS is under control and not regularly over, say, 12, you CANNOT develop ketoacidosis. It is high BS **plus** high ketones that should ring the alarm bells. So long as you are monitoring BS and it's low, you are not in any danger of acidosis from eating LCHF.

    I was very worried about this in the early days because I'd been given misleading advice, until I calmed down and did some reading. Then I realised that ketogenesis and ketoacidosis are often confused.

    Just keep checking your blood. And to understand the whole picture, I really recommend Jenny Ruhl's book, http://www.amazon.co.uk/gp/aw/d/B0080JVKMK?pc_redir=1412683185&robot_redir=1. It's very clear and well written and after reading this I understood the whole metabolism thing for the first time.

    Good luck!

    - Unless you're sick, or vomiting - then everything changes - take your ketones seriously and get help.
     
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    #17 LucySW, Oct 9, 2014 at 9:57 AM
    Last edited by a moderator: Oct 9, 2014
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