T1D, protein intake, low carb and ketosis

[kitedoc]

I am trying to work out how someone with TID:
on a recommended protein intake of say 80 g per day will ever get low enough in carb intake to go into ketosis?
I am assuming that 50% of protein will be converted by the liver into glucose = 40g
Does this person have to forego any carbs in order to attempt to go into ketosis?
Will extra fat intake like cream make it possible?
And will the diet contain sufficient of the essential minerals and vitamins?

 

[jpscloud]

I like this question - protein seems to give me a glucose spike, at least sometimes, and I'm a bit worried that I may have to cut right back on that too. I tend to overeat protein a little to compensate for less carbs. I know above ground veg should fill that hole instead but... protein is more attractive to me at the moment!

I tend not to see much in the way of ketosis unless I've fasted for more than 24 hours.

 

[Member496333]

My understanding is that only that protein which goes unused in cell repair may be turned into glucose for fuel. Emphasis to state that even that isn’t necessarily certain. I believe it is very much more complicated than a 50% calculation. If you were extremely active and not consuming enough protein then I imagine virtually none of it would end up as glucose. Your place on the ever shifting sands of insulin sensitivity (in everyone) also plays a role.

To be clear I know very little about autoimmune diabetes but I’m fairly certain that the biochemistry is the same.

 

[bulkbiker]

I am trying to work out how someone with TID:
on a recommended protein intake of say 80 g per day will ever get low enough in carb intake to go into ketosis?
I am assuming that 50% of protein will be converted by the liver into glucose = 40g
Does this person have to forego any carbs in order to attempt to go into ketosis?
Will extra fat intake like cream make it possible?
And will the diet contain sufficient of the essential minerals and vitamins?

Why would someone with T1 necessarily be looking for ketosis though?

 

[Member496333]

Why would someone with T1 necessarily be looking for ketosis though?

Glucostability to reduce and simplify bolus dosing?

Edit: also, as speculation, because ketosis brings many benefits besides just reduced glucose burden

 

[kitedoc]

Why would someone with T1 necessarily be looking for ketosis though?

Hi @bulkbiker , If a T1D wished to gain the benefits of ketosis/ketogenic diet as an informed choice.
Such as per Dr Bernstein for TIDs.

 

[bulkbiker]

Hi @bulkbiker , If a T1D wished to gain the benefits of ketosis/ketogenic diet as an informed choice.
Such as per Dr Bernstein for TIDs.

I don't think Bernstein looks for a ketogenic state though?..he advocates very low carb to avoid creating a need for extra insulin but don't think ketosis is one of his "things" .

 

[bulkbiker]

Glucostability to reduce and simplify bolus dosing?

Edit: also, as speculation, because ketosis brings many benefits besides just reduced glucose burden

But ketosis isn't necessary for that... simply ultra low carb.. which may or may not bring ketosis with it..

 

[Member496333]

But surely ultra low carb brings about ketosis? Ketosis a metabolic pathway, not a diet

I would think a T1 would benefit greatly from not defaulting to burning glucose, particularly in terms of bolus dosing.

 

[kitedoc]

I like this question - protein seems to give me a glucose spike, at least sometimes, and I'm a bit worried that I may have to cut right back on that too. I tend to overeat protein a little to compensate for less carbs. I know above ground veg should fill that hole instead but... protein is more attractive to me at the moment!

I tend not to see much in the way of ketosis unless I've fasted for more than 24 hours.

Thankyou. My question I guess hinges on whether 50% of protein would always be converted to carbs. and secondly how low in carbs and high in fat does one have to go to achieve ketosis.
I am assuming that the amount of protein eaten in this example meets all the body's protein needs adequately and has spare, non-essential protein to convert over into glucose. And if I am working off adequate protein intake being say, 0.8 g per kg body then the TID would be about100 kg in weight.. ? lose some weight first with calorie restriction or drop protein intake to lose weight?
I have read that protein is the most appetite satisfying of the three macronutrients but therein is the quandery - enough snacking on it might keep you or bounce you out of ketosis unless, as you say you do a 24 hour fasting.
One can do a 24 hour fast as a TID, at least I have but it has to be done carefully.

 

[Diakat]

@meldcp or @colinofkent may be able to help. Mel is certainly in ketosis a fair bit

 

[kitedoc]

But ketosis isn't necessary for that... simply ultra low carb.. which may or may not bring ketosis with it..

I find I can get to about 0.2 to 0.3 mmol/l ketosis but that is about it!!
The other issue is that the ketosis charts suggest that a ketone level of 4 or 5 is OK but in T1D we are warned to ring the alarms bells if we get above 3 mmol/l.
There have been rare reports of some persons developing euglycaemic DKA where the blood becomes dangerously acidic yet the BSL is less than 13 mmol/l. I gather this is usually on the background of inadequate insulin such as during illness and dehydration is a common accompanying problem.

 

[bulkbiker]

But surely ultra low carb brings about ketosis? Ketosis a metabolic pathway, not a diet

I would think a T1 would benefit greatly from not defaulting to burning glucose, particularly in terms of bolus dosing.

Well in T1's with no endogenous insulin it seems (from my reading here on the forum) that protein can bring about GNG which may lead to not being in ketosis. T1 people do indeed bolus for protein (as in @kitedoc 's question).. if that is the case then unless you only eat fat then ketosis will be more difficult to achieve for T1's? That's my thinking on the mechanism. You yourself have said that your own GNG can push you out sometimes.. or have I mistaken your thoughts on the matter.

 

[kitedoc]

But surely ultra low carb brings about ketosis? Ketosis a metabolic pathway, not a diet

I would think a T1 would benefit greatly from not defaulting to burning glucose, particularly in terms of bolus dosing.

Thanks Jim. It certainly reduces my bolus doses!! In answer to @bulkbiker I have explained further below about my ketosis efforts !!

 

[LooperCat]

I’ve pretty much been in ketosis for 15 months now. I don’t eat mammal or bird meat, but I do eat fish, eggs and plant protein. I haven’t noticed any significant drop in ketone levels on days I’ve had more protein than usual. I only need to bolus for lean white fish, prawns and pea protein shakes. Not sure if any of this is relevant to anyone, just my experience.

Since hitting ketosis it’s been remarkable how my mind has sharpened and general stamina increased. To the point I’ve been able to get a demanding job whereas before I was literally disabled by how terrible wildly fluctuating bg levels made me feel.

 

[Member496333]

Thankyou. My question I guess hinges on whether 50% of protein would always be converted to carbs. and secondly how low in carbs and high in fat does one have to go to achieve ketosis.
I am assuming that the amount of protein eaten in this example meets all the body's protein needs adequately and has spare, non-essential protein to convert over into glucose. And if I am working off adequate protein intake being say, 0.8 g per kg body then the TID would be about100 kg in weight.. ? lose some weight first with calorie restriction or drop protein intake to lose weight?
I have read that protein is the most appetite satisfying of the three macronutrients but therein is the quandery - enough snacking on it might keep you or bounce you out of ketosis unless, as you say you do a 24 hour fasting.
One can do a 24 hour fast as a TID, at least I have but it has to be done carefully.

I probably wouldn’t overthink it. Protein requirements don’t really change whether you are burning glucose or ketone bodies. Like everyone, you need to ensure you’re getting sufficient protein and not necessarily much more. Displacing the lost carbohydrate with fat is what will bring about ketosis. The only thing I’d be concerned with, as I am very sure you don’t need telling, is extreme vigilance with insulin dosing if trying out nutritional ketosis.

 

[bulkbiker]

I find I can get to about 0.2 to 0.3 mmol/l ketosis but that is about it!!
The other issue is that the ketosis charts suggest that a ketone level of 4 or 5 is OK but in T1D we are warned to ring the alarms bells if we get above 3 mmol/l.
There have been rare reports of some persons developing euglycaemic DKA where the blood becomes dangerously acidic yet the BSL is less than 13 mmol/l. I gather this is usually on the background of inadequate insulin such as during illness and dehydration is a common accompanying problem.

Well I would say that any reading of ketones means you are in ketosis.. so you are there already. Not sure higher numbers are particularly beneficial especially for T1's.

 

[Member496333]

Well in T1's with no endogenous insulin it seems (from my reading here on the forum) that protein can bring about GNG which may lead to not being in ketosis. T1 people do indeed bolus for protein (as in @kitedoc 's question).. if that is the case then unless you only eat fat then ketosis will be more difficult to achieve for T1's? That's my thinking on the mechanism. You yourself have said that your own GNG can push you out sometimes.. or have I mistaken your thoughts on the matter.

Yeah some good points well made. I had actually been pondering the insulin sensitivity with regards to exogenous insulin dosing. I’ve no doubt that T1 need to account for protein in bolus dosing.

 

[kitedoc]

Well in T1's with no endogenous insulin it seems (from my reading here on the forum) that protein can bring about GNG which may lead to not being in ketosis. T1 people do indeed bolus for protein (as in @kitedoc 's question).. if that is the case then unless you only eat fat then ketosis will be more difficult to achieve for T1's? That's my thinking on the mechanism. You yourself have said that your own GNG can push you out sometimes.. or have I mistaken your thoughts on the matter.

Thanks @bulkbiker . Snacking on protein does tend to ruin the ketosis party!! Adding in fat and reducing back off so much protein helps keep things nearer the ketosis end of things but I wonder whether the ketones also increase insulin resistance as my 'magical' reduction in insulin doses' has partly evaporated after the first 6 weeks - time 0 to 6 weeks 40 units total per day down to 26 now hovering about 36 units on 35 g carbs per day 3 meal day(including 50% of protein intake) and for 25 g carbs needing u30 units/day (2 meal day). But before time zero I was having about 80 g carbs (? protein amount) per day on 40 units of insulin per day.
Apologies to you and Jim, I know TID is not your usual stomping grounds, but I wondered whether even for T2D whether say a 100 kg person could easily reach ketosis on a 80 g daily protein intake?

 

[bulkbiker]

I wondered whether even for T2D whether say a 100 kg person could easily reach ketosis on a 80 g daily protein intake?

Well I'm a 93.5kg T2 who had 144g of protein yesterday and measured ketones at 0.4 last night before bed so.....
I tend to only get much higher readings when fasting for prolonged periods.
Edit to add
So far today I've only had a tea with lactofree milk and 3 coffees with cream.
Just tested BG 4.2 and ketones at 1.3
FBG this morning was 4.8 and ketones at 0.3