Treatment of hypoglycemia in ketosis

I think Ketosis is dependent on the inslin level not the carb intake. (clearly both are normally linked)

Hi @Sorcil am not into keto but have dug up an interesting read from 4 years ago here: https://www.diabetes.co.uk/forum/threads/how-do-you-hypo-on-a-ketogenic-diet.66536/

Short answer - yes, lots of glucose for a hypo can knock you out of ketosis. But if you drop the carbs back to keto levels you’ll get back in within days. The longer you’ve been keto, and therefore fat adapted, the less time it takes.

But as hypoglycaemia is a bit of a medical issue that needs treating with glucose, we just have to live with it. Just take the bare minimum needed to do the job and don’t eat a whole bag of jelly babies. I’ve found that hypos are milder now and much easier to treat - a couple of dextrose tabs and a temp basal of 0% for half an hour usually sorts it - sometimes I need to repeat that once more. But that’s it.

Hi @Sorcil ,

T1 of 42.5 years checking in.
Interesting question. I don't do keto. However I do keep the carbs down. (Thus the amount bolused.)
Basal adjustments & managing requirements is the foundation to build from, whatever diet.

The hypos are less visible to the onlooker when I have them. Generally for me about 5g fast acting & I can keep going. Treat my lows when they occur, "on the fly." But still detectable above 3.5mmol. Just no "steel magnolia" issue. Like the old days.

That is a pretty good thread @jucy found.

Are you a pumper, or on MDI? @Sorcil .

Sorcil said:

I’ve had a pump for 8 years and find it great. Constantly encouraged by how much better things are compared to the bad old days of urine testing and no bgm’s!

Lucy’s post was spot on, and I look forward to hypos being easier to manage on keto.

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I'm actually on MDI. But I know they are easier to "treat & go" (keep going.) with what i do..

Wishing all the best on your keto journey.

Keep us posted on how you get on.

Hi @Sorcil, As a T1D of 52 years, the last 7 on an insulin pump with recent adoption of a low carb diet, mainly to see how hypos compare 100g carb per day vs lower carb 40 to 45 g per day), not as professional advice or opinion:
As indicated by others a hypo has priority over any other considerations (except maybe getting off a ladder, off the road first if one can etc).
As others have said, less insulin injected seems to make hypos less severe but no less treatable. And good control of BSL seems to help maintain or improve hypo awareness.
In theory less carbs in might appear to mean less storage of sugar (as glycogen in the liver - this is a favourite argument of anti-low-carbers including some dietitians) but since we know some protein is also made converted by the liver into glucose I think this objection is moot).
Hypos can cause brain damage, make injury more likely etc within minutes to hours, ketosis is a long term strategy due in this case to low carb. And any actual or theoretical temporary 'loss' of the ketosis state is not important in the big picture.
That ketones themselves might act as a source of energy for the brain is a possible point but nothing seems to beat glucose for correcting a hypo.
The best thing with exercise is to try to manage BSLs so that one does not go hypo in the first place. There are threads about this in the upper part of the Type 1 diabetes forum on this site. Best Wishes.

Sorcil said:

I have been type 1 for 36 years so am perfectly well aware of the potential seriousness of hypoglycemia thanks. My question stands. Perhaps someone with type 1 can advise?

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Another insightful read would be Dr. Keith Runyan's blog post #52, he is a T1D, medical doctor and a triathlete who keeps and publish meticulous records of his glucose readings.
https://ketogenicdiabeticathlete.wo...-diabetes-mechanisms-avoidance-and-treatment/

The key takeaway about hypoglycemia is that it is not just about low glucose. But really it is low glucose <3 mmol in the absence of ketones that makes it truly dangerous...

The other thing I forgot to mention last night is that a ketone fuelled brain doesn’t panic like a glucose fuelled brain does when you’re hypo. So you can think rationally even though your body is doing all the hypo things. Makes it so much easier to not overtrear and end up having to correct it later.

kokhongw said:

Another insightful read would be Dr. Keith Runyan's blog post #52, he is a T1D, medical doctor and a triathlete who keeps and publish meticulous records of his glucose readings.
https://ketogenicdiabeticathlete.wo...-diabetes-mechanisms-avoidance-and-treatment/

The key takeaway about hypoglycemia is that it is not just about low glucose. But really it is low glucose <3 mmol in the absence of ketones that makes it truly dangerous...

Click to expand...

Oh wow. Thank u for the link. I'm going to print this out and read to digest

Sorcil said:

I have been type 1 for 36 years so am perfectly well aware of the potential seriousness of hypoglycemia thanks. My question stands. Perhaps someone with type 1 can advise?

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1) There's no question that you need to treat hypoglycemia as a priority.
2) It's not a big issue to go in and out of ketosis.