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Low carb struggle

J

JMcB

Well-Known Member
Messages
125
Type of diabetes
LADA
Treatment type
Insulin
Hi,
I’m was diagnosed LADA in March and am on insulin (Basaglar and Humalog). I’ve been following a low carb diet as I found grains and legumes send me through the roof then cause a crash. Too stressful for my mind and my body. So I’ve been doing low carb and am able to maintain stable BS. Because of morning rises after I get out of bed and insulin resistance in the morning I limit my carbs to 4-6. At lunch I have 12 and dinner about 6. I don’t bolus at dinner because I am terrified of going low in my sleep and I live alone. I do have a Libre and MiaoMiao so I have an alarm that will wake me.

Aside from the stress of doing this alone while in lockdown, I am super stressed about the number of carbs I intake and ketone levels. I struggle to eat 12 g of carbs at lunch as it’s all veg and that is about 2 cups worth. I have to force myself to eat it all to cover my insulin.

Question: is this too low on carbs? My ketones are about 2.5. Am now afraid if I suddenly spike high I will get DKA.

Any advice appreciated.
 
For a non-type 1, nutritional ketosis is useful for weight loss, with ketones 0.5 – 3.0 mmol/L. But it's not recommended for type 1's as if dehydrated, ill or high blood sugars, ketone numbers can spiral, making the blood acidic, which can lead to DKA.
Although I'm on low carb, and intermittent fast I don't seem to have ketones above 0.5, and I put that down to having enough background insulin. I think you need to contact your specialist or GP asap.
  • lower than 0.6mmol/L is a normal reading
  • 0.6 to 1.5mmol/L means you're at a slightly increased risk of DKA and you should test again in 2 hours
  • 1.6 to 2.9mmol/L means you're at an increased risk of DKA and should contact your diabetes team or GP as soon as possible
  • 3mmol/L or above means you have a very high risk of DKA and should get medical help immediately

https://www.diabetes.co.uk/in-depth/nutritional-ketosis-vs-dka/
https://www.nhs.uk/conditions/diabetic-ketoacidosis/
 
DKA is extremely dangerous, but you are NOT at risk of this on a low carbohydrate diet. You will get something else called ketosis, which is perfectly healthy. Ketones and blood sugar levels have an important thing in common: both are great for providing energy, but toxic at very high levels. You'll only get dangerously high ketone levels if your blood sugar levels have spiked massively, so a low carbohydrate diet will actually protect you against DKA. Google Dr Richard Bernstein and search YouTube for Dr Troy Stapleton for some amazing information about low carbohydrate diets, and their safety and effectiveness.
 

Running at 3.5 ketones currently and BS at 6.4. Called endo just to be sure this is OK. Seems kind of high on the ketones. Only managing about 20 g carbs a day and may be too extreme. But my BS profile is great. Hmmm.
 
I'd have to disagree. Unlike normal people type 1's don't have homeostasis for ketosis. Unlike a normal person's ketones, they need monitoring with a blood ketone monitor. I'm a fan of Stapleton and Bernstein and they both advocate monitoring blood ketones.
 
Fair point: monitoring ketones is a good idea. The main point I was trying to make was that ketosis is natural, and that low levels of ketones are healthy. However, I typed my message out quickly without thinking about how I was phrasing it. Apologies for the confusion!
 
I am monitoring with a blood ketone meter and have reached out to my endo this morning regarding my current levels.
 
This chart is an oldie but a goodie, showing how there is a significant difference between nutritional ketosis and DKA.
Basically, you only get DKA if your blood glucose goes high while you have significant ketones (or there are other factors involved like other health conditions or certain medications).

You haven't mentioned how high your blood glucose peaks, but if it is not too high, then you are extremely unlikely to develop DKA from the ketone levels you will get from nutritional ketosis.

Please note that the scale along the bottom of the graph is not constant. There is a significant contraction between 5 and 10+

 

I am typically between 4.8 -7.2. Looks like I’m in starvation mode based on your graph.
 
JMcB said:
I am typically between 4.8 -7.2. Looks like I’m in starvation mode based on your graph.
Click to expand...

DKA is a terrible thing, and I certainly wouldn't want anyone to dismiss it. If ketones are present, then checking bg and ketones regularly, staying hydrated, and watching for the symptoms of DKA are always going to be important, but hopefully, if you are doing all those things, and your bg is ok, and you are using insulin appropriately, then that graph could give you some measure of reassurance.
 

Thank you. I am doing all those things but very concerned about the high ketone. Endo still has not called me back.
 
JMcB said:
I am typically between 4.8 -7.2. Looks like I’m in starvation mode based on your graph.
Click to expand...

Are those ketone levels or blood sugar levels? Asking just because you mentioned ketones of 2.5 and 3.5 which are well below the starvation levels shown on the bottom axis (can never remember which is x and which is y!).
 
Goonergal said:
Are those ketone levels or blood sugar levels? Asking just because you mentioned ketones of 2.5 and 3.5 which are well below the starvation levels shown on the bottom axis (can never remember which is x and which is y!).
Click to expand...

Those are BS levels. Ketones currently at 3.5.
 
JMcB said:
Those are BS levels. Ketones currently at 3.5.
Click to expand...

Thanks for clarifying. Obviously good to keep monitoring but those BS levels are in a good range, and the ketones quite a way from DKA levels based on the graph.
 
Goonergal said:
Thanks for clarifying. Obviously good to keep monitoring but those BS levels are in a good range, and the ketones quite a way from DKA levels based on the graph.
Click to expand...

Thanks. Will try to carefully add more carbs to get the ketones down a bit. Not comfortable with them over 3.
 
This is a very basic question but I need to ask it because I haven't seen the answer anywhere, not even on the Miaomiao website.

I understand that the Miaomiao device turns the Freestyle Libre sensor into a de faco continuous glucose monitor.

However, am I correct to assume that if you use a Miaomiao device with one of the various apps (tomato, xdrip, xdrip+ or glimp) then the Miaomiao also automatically continues to transfer data from the Freestyle Libre sensor to the Freestyle Librelink server without the need to also scan the sensor with either a Libre Reader or a mobile phone?

Or do you still need to scan the Freestyle Libre Sensor in the usual way so that data is sent via the Librelink app?

Thank you.
 

You will still need to scan the Libre at least every 8 hours to capture the data for the Libre link server, unfortunately. But I just set up a reminder in the Libra app so I don’t forget.
 
Thank you JMcB. Nothing I have read so far made that clear, so thank you.

I am due to start using a Miammiao in the next couple of days and I wouldn't want to upset my DSN and consultant by failing to send data to the Libre link server!
 
DavidDK said:
Thank you JMcB. Nothing I have read so far made that clear, so thank you.

I am due to start using a Miammiao in the next couple of days and I wouldn't want to upset my DSN and consultant by failing to send data to the Libre link server!
Click to expand...

You will love it! Be aware that you should calibrate with finger sticks after the first 24 hours when the reading is stable. There will be a difference between the Libre and your BS. Usually the Libre reads lower than my BS but the difference changes w each Libre sensor. I also typically install a new Libre 24 hours before I activate it so the readings are more stable when I start it up. Has to do with the internal inflammation caused by the insertion.
 
Thank you again, that is really very helpful.
 
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