Newly diagnosed and on keto - worried about ketones / blood sugar

[MrOrsom]

I was diagnosed with T2D a couple of weeks ago. I've met with a diabetes nurse twice who has put me onto metformin. At the moment I'm on 500mg in the morning only, working up to 500mg in the evening as well.

My first instinct was to get onto a ketogenic diet, as I have had success with this in the past. My nurse is very anxious about this however, suggesting that it could send me into ketoacidosis. Although everything I read online reassures me that this won't happen with early-stage T2D.

The nurse gave me a blood sugar / ketone reading device and told me that, if my ketones go above 1.2, I should go straight to A&E. I have however chosen to believe what I've read on DietDoctor and on here that 0.5-3.0 is normal reading and so not to worry.

However, I'm aware that my blood sugar is also high - 12-15 mmol/litre on my device. I'm therefore a bit worried that I've giving myself high blood sugar and high ketones, and that that will indeed put me at risk of ketoacidosis. This is coupled with me feeling quite unwell in the afternoons (weak, clammy, bit of a headache) at the moment, a while after eating lunch.

Now it's very early days for me as I've only just been diagnosed, so I don't expect to feel great overnight. But I guess I'm after some reassurance that my combined ketone and blood sugar levels are safe. Because if I was to believe my diabetes nurse I'd get off keto right away.

I am seeing a pro-keto doctor next week on Thursday so expect to get some good advice there. But that's over a week away so I'm hoping someone on here can tell me if I'm possibly heading for trouble in the meantime.

 

[bulkbiker]

My first instinct was to get onto a ketogenic diet, as I have had success with this in the past.

Great idea will benefit you greatly both in terms of blood sugar control and weight loss (if required).

My nurse is very anxious about this however, suggesting that it could send me into ketoacidosis. Although everything I read online reassures me that this won't happen with early-stage T2D.

Nursey is talking nonsense. It's almost impossible to develop ketoacidosis with T2 as you are producing too much insulin rather than too little

This is coupled with me feeling quite unwell in the afternoons (weak, clammy, bit of a headache) at the moment, a while after eating lunch.

Have you tested your blood glucose when having these episodes? It might be what we call a "false hypo" where your blood glucose is lower than usual (although not actually being at hypo levels) your symptoms sound like that might be the case.
.

 

[MrOrsom]

Thanks for this, and I just watched your video on DietDoctor earlier today - great stuff!

I did take a reading when I was feeling awful and it was high - about 15 mmol/litre - so no idea if that would be a false hypo. Feeling better now though.

Some Googling has suggested that too high and too low blood sugar after eating can result in tiredness, so maybe it's just me regulating poorly. I really hope it can correct given time.

 

[Resurgam]

For an ordinary type two eating a diet of low carb foods should result in lower blood glucose quite quickly - however some people who are diagnosed as type two are in fact more interesting types of diabetic.
What sort of things are a typical day's menu for you now?
Are you testing before and after meals?

 

[MrOrsom]

For an ordinary type two eating a diet of low carb foods should result in lower blood glucose quite quickly - however some people who are diagnosed as type two are in fact more interesting types of diabetic.

I'd rather not be an interesting type of diabetic! I am only a week into treatment and a week into keto so I guess it's too early to see any real results?

What sort of things are a typical day's menu for you now?

Mainly meat and eggs to be honest. I tend to go animal food-heavy. Had a couple of burgers with keto bread buns, and a few fat bombs I bought. Otherwise chicken wings, lamb chops, egg foo yung.

Are you testing before and after meals?

No, the nurse hasn't asked me to track my blood sugars at all at the moment. He told me to check my ketones every three hours, as he was expecting imminent ketoacidosis. I ran out of test strips almost immediately though so haven't checked since last night, at which point I was at 2.8; far above the nurse's level of concern of 1.2!

 

[Antje77]

Can it be the nurse isn't sure yet what type of diabetes you have and therefore is wary of possible DKA?

 

[EllieM]

Hi @MrOrsom

There's a big difference between dietary ketosis and diabetic ketoacidosis.

But it isn't unknown for new T2s to have DKA (just very rare) and if you were one of the minority of T2s who are in fact misdiagnosed T1s (unfortunately it happens) those levels would be raising big red flags.

So I can understand the nurse's point.

Are those readings of 15 constant, or are you getting lower ones too?

 

[JoKalsbeek]

I was diagnosed with T2D a couple of weeks ago. I've met with a diabetes nurse twice who has put me onto metformin. At the moment I'm on 500mg in the morning only, working up to 500mg in the evening as well.

My first instinct was to get onto a ketogenic diet, as I have had success with this in the past. My nurse is very anxious about this however, suggesting that it could send me into ketoacidosis. Although everything I read online reassures me that this won't happen with early-stage T2D.

The nurse gave me a blood sugar / ketone reading device and told me that, if my ketones go above 1.2, I should go straight to A&E. I have however chosen to believe what I've read on DietDoctor and on here that 0.5-3.0 is normal reading and so not to worry.

However, I'm aware that my blood sugar is also high - 12-15 mmol/litre on my device. I'm therefore a bit worried that I've giving myself high blood sugar and high ketones, and that that will indeed put me at risk of ketoacidosis. This is coupled with me feeling quite unwell in the afternoons (weak, clammy, bit of a headache) at the moment, a while after eating lunch.

Now it's very early days for me as I've only just been diagnosed, so I don't expect to feel great overnight. But I guess I'm after some reassurance that my combined ketone and blood sugar levels are safe. Because if I was to believe my diabetes nurse I'd get off keto right away.

I am seeing a pro-keto doctor next week on Thursday so expect to get some good advice there. But that's over a week away so I'm hoping someone on here can tell me if I'm possibly heading for trouble in the meantime.

I'm a little surprised your numbers are that high on your current diet, which is leaning more towards carnivore from the sound of it, than keto. Can you give an exact breakdown of your meals and drinks in a single day? I get you've been on keto before, so you know what you're doing, but just in case... While nutritional ketosis is perfectly fine (If it wasn't, I would've been dead for years now), diabetic ketoacidosis could be problematic if it's not the diet that's bringing the ketones up, but rather a lack of insulin production... Have you lost weight without trying prior to diagnosis? I think it'd be really, really worth it to request a GAD and a C-peptide test to check whether you truly are a T2. Because if you're not, things could turn ugly quite fast if all you're on is metformin. Maybe put in a call to ask for those sooner rather than later.

Good luck eh.
Jo