No Hypos on low carb

Hi minitata

dead right, the low carbs bring your BG down. Again right that diet or met can't induce a 'proper' hypo. But like any non diabetic person if you go too long without food it affects you.

For anyone it is best to spread your food throughout the day and not go hours on end without eating.

Mary x

Well, if you are properly keto-adapted (which I guess you are), then your body's requirement for glucose should be much reduced.

On a regular high-carbohydrate diet your brain requires about 100g a day of carbohydrate. On this type of diet your metabolism will protect your brain's energy suppy, by ensuring that it is prerentailly receives enough glucose to keep it running properly. Any carbohydrate that you eat above 100g will be used to supply energy to other cells in your body, principally to fuel your muscles with glycogen and (if necessary) to top up your liver's glycogen stores (which are dripped or dumped into your system in order to regulate your BG). If you eat more carbohydrate than your body can store, then some will also be stored as fat.

However, on your type of ketogenic diet, you aren't eating enough carb to meet your brain's glucose requirement, so what happens is that your brain will still preferentially use any carbohydrate you eat for it's own fuel and, after a period of adaption will switch to burning ketones to meet the rest of its energy requirement. If you ate zero-carbs, your brain would be running on about 75% ketones, and your metabolism could meet it's remaining energy requirement by manufacturing glucose from fat and protein (gluconeogenesis).

The point of all this is that (on about 50g a day)

1. Any carb that you eat will go directly to fuelling your brain.
2. Becuase there is no glucose left, almost all of the rest of your body will be fuelled by free fatty acids.
3. Your net glucose requirement will be greatly reduced.

You can see that, if you are eating less carbohydrates (and therefore less glucose) and using less glucose the level of fluctuation in your BG should be smaller (making hypos less likely*), which is one of the reasons why low-carb diets are great for diabetics.

Because your liver glycogen levels will be depleted (although not completely so), your liver is probably less likely to "dump" which might explain your lower levels (really just a reflection that your body is less glucose dependent).

You need to be a bit careful if you are going to be exercising. I'm on <30g, and when I run a 5k race I typically get a big liver dump, that will push my BG as high as 9mmol/l, before dropping down to about 4mmol/l for the rest of the day, as my muscles try and replenish their glycogen stores by mopping up any additional glucose from my blood.

Of course this doesn't mean that you can't hypo. You should continue carefully monitoring your BG and take action if you feel they are getting too low - always better to be safe than sorry.

*for T2 diabetics on diet and/or metformin, obviously hypos are a huge risk on insulin or drugs the promote insulin production.