T1D, protein intake, low carb and ketosis

[kitedoc]

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.

Thank you Mel,
The mind sharpening is awesome. I cut back my antidepressants (with the psychiatrist's blessing)!! But keeping BSLs even with further attention to protein and upping fat has not helped me return to the magical low insulin days of the 6 week mark. I am dosing for 50% protein, otherwise my BSLs would be too high. Perhaps time to readdress the protein amounts, keep going with the probiotics and added magnesium and see what happens - plus keep hydrated.
The rare cases of euglycaemic DKA I read about featured dehydration as a factor.

 

[bulkbiker]

@kitedoc
Might be worth you joining the T1 grit facebook group as I'm sure they are far more clued up on your questions than me?

 

[Member496333]

Interestingly I’m almost always rolling 3-4mmol/L for ketone bodies but that’s with around 70g of protein.

 

[kitedoc]

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

Thank you @bulkbiker, So if you counted 50% of your protein as carbs, the carb count on this basis would be 72 g.
And one would wonder whether the insulin your body produces to deal with that would prevent ketosis?
So the 50% protein formula is an approximation, dependent maybe on insulin levels and gluconeogenesis.
May being T1D and/or a variation in the myriad factors making my particular or peculiar liver make more glucose than someone else is at work here??
I have felt better since taking magnesium supplements and am trying a probiotic to see if that will improve my insulin sensitivity.
Mel is not eating meat or dairy (due to allergies) and only increases the carb count for things like eating white fish and can stay in ketosis may be the type of protein plays a part in the explanation??

 

[kitedoc]

@kitedoc
Might be worth you joining the T1 grit facebook group as I'm sure they are far more clued up on your questions than me?

Thank you, that is a great idea. I shall report back !!

 

[Bluetit1802]

I don't understand why a T1 needs to bolus for protein. (although some on here report that they do). Protein takes ages and ages to digest and any percentage that ends up as glucose won't appear in the bloodstream for many, many hours. It doesn't digest quickly like carbs do. If it has any effect it will be the following day most likely. Also, just because a percentage CAN convert to glucose, doesn't mean to say it WILL.

http://www.tuitnutrition.com/2017/07/gluconeogenesis.html

 

[kitedoc]

Interestingly I’m almost always rolling 3-4mmol/L for ketone bodies but that’s with around 70g of protein.

Jim, I am begiing to think the 50% protien into carbs depends on ther type of protein. As Mel reports above, she cannot eat meat or dairy due to allergies but does not find she needs to count 50% of things like egg protein as carbs, only things like white fish.
It may also be that my liver is more prone to gluconeogenesis than others.
As Bulkbiker suggests I should ask the True Grit Type 1 forum and see what they suggest - and report back !!

 

[Member496333]

Jim, I am begiing to think the 50% protien into carbs depends on ther type of protein. As Mel reports above, she cannot eat meat or dairy due to allergies but does not find she needs to count 50% of things like egg protein as carbs, only things like white fish.
It may also be that my liver is more prone to gluconeogenesis than others.
As Bulkbiker suggests I should ask the True Grit Type 1 forum and see what they suggest - and report back !!

Yeah this is all kinds of voodoo, really. As a T2 I have a functioning pancreas so my only experience with protein is relative to measurable results in the context of insulin sensitivity. That is to say that I cannot measure how much insulin my pancreas is secreting in order to cover any glucose response from protein, only whether or not it’s working. You T1 have to cover everything by injection, so your measurable responses are going to differ to those of a T2. In other words I will shut up. @bulkbiker ’s suggestion is a good idea. You definitely need wisdom from more very experienced T1 keto people.

 

[kitedoc]

I don't understand why a T1 needs to bolus for protein. (although some on here report that they do). Protein takes ages and ages to digest and any percentage that ends up as glucose won't appear in the bloodstream for many, many hours. It doesn't digest quickly like carbs do. If it has any effect it will be the following day most likely. Also, just because a percentage CAN convert to glucose, doesn't mean to say it WILL.

http://www.tuitnutrition.com/2017/07/gluconeogenesis.html

Thank you. Dr Bernstein suggests 50% of protein be counted as carbs where the protein intake is adequate (about 0.8 g/kg body weight per day). There have been studies showing the glucose from converted protein appearing in bloodstream from 45 minutes after a meal with a gradual low peak around the 3 hours mark. I am guessing this is happening because some parts of protein are not essential to repair work, other body systems and metabolism but serve this useful function when carbs are scarce!!
I appreciate there are a lot of variables at work here, including whether my liver makes more glucose than others or is less easily suppressed by insulin.

 

[kitedoc]

Yeah this all kinds of voodoo, really. As a T2 I have a functioning pancreas so my only experience with protein is relative to measurable results in the context of insulin sensitivity. That is to say that I cannot measure how much insulin my pancreas is secreting in order to cover any glucose response from protein, only whether or not it’s working. You T1 have to cover everything by injection, so your measurable responses are going to differ to those of a T2. In other words I will shut up. @bulkbiker ’s suggestion is a good idea. You definitely need wisdom from more very experienced T1 keto people.

Jim, I really appreciate your input!! Comparisons between us can help understanding - and at the moment the confusing elements of all this remain -but learning is about clearing up the confusion - so I shall report back with whatever I can find out !! My thanks again !!

 

[kitedoc]

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" .

Thank you a good point. I shall look up his book. I know he emphasises protein over fat intake.

 

[Brunneria]

Hi @kitedoc

I suggest you have a good google around the Insulin Index of various foods - including the proteins.
You will see that different types of protein (beef or white fish, chicken or pork, hard cheese or tofu) have different places on the insulin index charts.

Therefore, the choice of type of protein carries a different insulin requirement, and this is possibly where @Mel dCP 's insulin requirements differ from your need to allow for 50% of protein.

I imagine that by selecting proteins with lower places on the Insulin Index, you could reduce your insulin requirements - but it would be a very trial-and-error personal thing, with lots of testing involved.

In the past, I have seen a magnificent chart showing the Insulin Index of nearly every food known to man, all sub divided into food groups for easy comparison. But I am afraid I didn't keep the link. The link I will include below is a v basic one, and I haven't looked at the site in depth to see if it is a good one.
https://optimisingnutrition.com/2015/03/30/food_insulin_index/
But it should give you an idea of what I am talking about.

 

[Bluetit1802]

Here is another insulin index that I find easy to follow.
https://public.tableau.com/profile/christoffer.green#!/vizhome/InsulinogenicFoodData/Dashboard1

 

[LooperCat]

Just tucking into a bowl of chopped avocado, 150g king prawns and mayonnaise. The meal contains 6g carbs, so have dosed for that at my usual 1:10 ratio ie 0.6u. The prawns contain 15g protein, so I have added 0.75u over four hours to account for those. If I don’t dose for them I get a stubborn, slow rise over the subsequent hours after eating.

T1s only need to dose for protein in the absence of carbs, as the usual large doses that accompany a carby meal mask the rise.

 

[RAPS_od]

You might find some answers in this book:

It's available on Amazon.

 

[StewartH]

Bulkbiker, great numbers! What do you test for ketones with?
Kitedoc, I have been VLC for over 3 years now. I do notice an insulin load if I eat a good portion of protein, especially chicken. Have not noticed this so much with fish or red meats though. No idea why.

 

[JAT1]

Certain proteins don't seem to affect my blood sugar, such as cheese (thank Goodness there's something I can stuff myself on), also bacon, roasted chicken legs and pork shoulder. I think it's because of the amount of fat going down at the same time as the protein. Whereas lean meats will raise my BS.

 

[kitedoc]

Hi @kitedoc

I suggest you have a good google around the Insulin Index of various foods - including the proteins.
You will see that different types of protein (beef or white fish, chicken or pork, hard cheese or tofu) have different places on the insulin index charts.

Therefore, the choice of type of protein carries a different insulin requirement, and this is possibly where @Mel dCP 's insulin requirements differ from your need to allow for 50% of protein.

I imagine that by selecting proteins with lower places on the Insulin Index, you could reduce your insulin requirements - but it would be a very trial-and-error personal thing, with lots of testing involved.

In the past, I have seen a magnificent chart showing the Insulin Index of nearly every food known to man, all sub divided into food groups for easy comparison. But I am afraid I didn't keep the link. The link I will include below is a v basic one, and I haven't looked at the site in depth to see if it is a good one.
https://optimisingnutrition.com/2015/03/30/food_insulin_index/
But it should give you an idea of what I am talking about.

Thank you @Brunneria, I had forgotten about insulin index. From refreshed memory it is from the same mob who developed the glycaemic index and glycaemic load at Sydney Uni. I shall look it up and send you a link in return. Instead of glucose as the comparator in the GI/GL I think they use white bread (of all things)!!

 

[bulkbiker]

Bulkbiker, great numbers! What do you test for ketones with?
Kitedoc, I have been VLC for over 3 years now. I do notice an insulin load if I eat a good portion of protein, especially chicken. Have not noticed this so much with fish or red meats though. No idea why.

I have a blood ketone/glucose meter.. On Call GK Dual which I use for ketones (strips too pricey for glucose!).
https://www.valuemed.co.uk/collecti...n-you-buy-50-on-call-blood-ketone-strips-here

 

[Rustytypin]

I also use an On Call Dual for testing ketones and also occasionally for testing BG as a comparison to my other meters. It seems to compare well but it has a high strip failure rate - about one in five. It will take up blood and start counting down, then gives an error code indicating not enough blood. Is it just me or is this commonplace with this meter? I don’t have the problem with the other meters. Sorry if this is hijacking the thread.