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Type 1 diabetic -- Low Carbing --- help :)

M

Matty_T

Member
Messages
9
Hi guys,

This is a little long-winded but I truly need some input.

I've read...then read...the read...then slept...then read...then read some more! And this Ketosis/Ketoacidosis still scares the B'jesus out of me!!

Here's a little background:
32 year old Male
Type 1 Diabetic, diagnosed at 15.
Began two injections of Human Mixtard 30ge - 19units morning, 20units evening.
Told to eat high carb blah blah blah.
5'9" tall.
At diagnosis I was severely underweight due to hiding symptoms etc. 7 1/2 stone (at 15).
Skip three years (18) I'm 14 stone with ****** controlled blood sugars.
I've tried this and that and had little/moderate success in lessening carbs/insulin.
2005 I took up running and cut down on carbs (still quite high though due to 'advice!'). Lost weight to 11st. Very happy with life despite blood sugar spikes still affecting my normality.
2008, Running injury and a bad relationship set me off track. Gained weight back due to carbs/insulin.
2012. 12 stone and looking to get back to 11stone just to 'feel better'.
2013. Tried all manner of things and simply couldn't lose a pound (even jogging 30 miles a week - me blames carbs!!)
After reading...and reading (you get the picture), I decided to give low carb a serious effort.

Last Friday I took the plunge and bought all the necessary high fat, low carby things. I weighed myself on Friday morning and I was 11st 13.5 lbs.

Friday I ate:

Brekky: scrambled egg with double cream (500cals, 2/3 carbs).
Lunch: Cheese stick, ham and fullt fat mayo. (500 cals 2/3 carbs).
Dinner: Bratwurst sausages (4), streaky bacon and salmon salad (700 cals, no carbs).
Daily drinks: 2x Tea with double cream. 1x coffee with double cream. A gazzilion glasses of H20 (posh for water you know..;p) Cream 200-300 cals, zero carbs)

I've had veg's etc since then but this has been my typical Cal's carbs (between 1,800 and 2,100).

I have been having my regular insulin (Humalin) but much less: 5 units morning, 7 units evening (still on two injections).

Today (Wednesday), I hopped on scales and I'm 11st 9 lbs. Great stuff.
My Blood sugars have been phenomenal: Fasting 5-6, pre meal 5-6, post meal 5-6. I thought my monitor was broke (it's not though because I used a 7.6mmol test strip and it worked fine).

Now, drum roll please.......I'M FREAKING OUT OVER KETOSIS/KETOACIDOSIS.

I've never read such conflicting advice from supposed experts in all my days. I bought some Ketone sticks and they light up purple almost all of the time. The only time they don't is when I have drank as much water as I can and even then they're 'almost' purple.

I know that only taking 12 units of insulin per day is significantly lower than most T1's, but if my blood sugars are fine do I really need to worry over Ketoacidosis? After reading some articles I may as well plan my funeral now. After reading other articles I may as well book my summer holidays - because I'll be feeling and looking great :)

I guess it's the purple that concerns me; but I'm not an illogical person usually. This Ketone business is a little like seeing your purple keys locked inside your car...then a friendly 'thief' walks by, skillfully opens the car door for you, and hands you back the keys...you see they're purple (which you already knew), toss them to the side and say "no thanks, I'll walk".

I've even read that people on here have had Ketoacidosis with normal blood sugars...

Any help would be greatly appreciated.

Cheers, and best of health to you all,
Matt
 
Hi Matt,
Firstly, I can't answer your question sorry. I'm a T1 and have been low carbing for about 8 months. I've never had ketones, but I think there's a difference between having ketones and being in ketoacidosis. Having ketones means that your body is using fat as its energy source, being in ketoacidosis is from a lack of insulin. Plus I think there are other symptoms of ketoacidosis. I'm not 100% certain, so hopefully someone else can come along and help.

I'm 13.5 stone and take 15u of Novorapid and 16u of Lantus, so our insulin dose us similar, but I'm a bit fatter!

Edited as I incorrectly said I'm on 16u of ketoacidosis instead of Lantus!
 
There is no comparison medically between being in ketosis and having the medical emergency of ketoacidosis. Ketoacidosis means you have no available insulin, your blood sugars go very high, your blood becomes acidic from the very high levels Of ketones and you become very ill (some symptoms might include having stomach pain, vomiting, very rapid panting breathing which is your body trying to "blow off" acid by lowering carbon dioxide levels, and eventually coma). Ketosis is the process of burning fat for energy rather than carbohydrates. It's completely natural. One does not lead to the other. The levels of ketones involved are of an entirely different magnitude, and they are caused by two completely different things. You can't have ketoacidosis with normal blood sugars. If your blood sugars are normal then by definition you have effective insulin action (whether that's your own insulin or injected).
 
Have to put a spanner in the works here. When I had the noro virus bug before Christmas i was obviously very ill and vomiting but my blood sugars remained under 7. I spoke to my DSN who told me that even with these BSs I had to check for ketones and sure enough they were at 1.6 and rising. She told me that ketoacidtosis in T1's can occur with normal blood sugars when we are unwell. I was told that day that if I continued to be sick with ketones I would need to go int hospital. Luckliy the bug cleared within 24 hrs and I was able to keep enough water down to flush the ketones out. So an underlying illness with normal sugars but high ketones is dangerous. So the way I read it, if ketones are showing and being a T1, then this can be a problem even with stable BSs. I have to say I always thought previously that ketones would only develop with high blood sugars too!
 
No spanner thrown, I'm not certain and this thread needs experienced people to comment!
 
I always assumed what Finzi said was correct, no matter whether we are diabetic or not, if its diet induced ketosis thats perfectly normal/okay, but DKA is a complete different ballgame.
Before i became pregnant i was very low carb and had ketones for almost 3 months, i drank plenty but was always showing dark purple on the ketostix, my bloods remained between 3.9 and 6mmol (i was in my honeymoon period needing no insulin)

Doesn't the Atkins promote ketosis? I've read on the boards alot of them purposedly enter ketosis to burn fat making weight loss quicker.
 
Riri, Samjb et al, thanks for the input. This is what I was looking for really. Someone who had actual hands on experience of 'the opposite' i.e. low blood sugars, ketones and DKA.

Doesn't seem many stories out there though - and the noro virus that you had was obviously an extreme case. Seeing as I'm not feeling unwell or don't have underlying illness (sickness, diarrhea etc) then I'm guessing the Ketones are a normal part of buring fat for fuel (I'm having less than 20g carbs most days and never above 40g).

If I were to become unwell then I should abandon the low carbing, up my insulin and eat carbs. Flushing myself out with water would also help shift the ketones I guess.

Whatever you guys say, it all helps anyway. Cheers


Riri said:
Have to put a spanner in the works here. When I had the noro virus bug before Christmas i was obviously very ill and vomiting but my blood sugars remained under 7. I spoke to my DSN who told me that even with these BSs I had to check for ketones and sure enough they were at 1.6 and rising. She told me that ketoacidtosis in T1's can occur with normal blood sugars when we are unwell. I was told that day that if I continued to be sick with ketones I would need to go int hospital. Luckliy the bug cleared within 24 hrs and I was able to keep enough water down to flush the ketones out. So an underlying illness with normal sugars but high ketones is dangerous. So the way I read it, if ketones are showing and being a T1, then this can be a problem even with stable BSs. I have to say I always thought previously that ketones would only develop with high blood sugars too!
Click to expand...
 
In general ketones with normal or low blood glucose are harmless: simply a normal metabolite. Ketones with HIGH blood Glucose are risky. DKA also causes symptoms of being VERY unwell.
If your bg is normal and you feel OK, you are probably experiencing the kind of ketosis, which is reagrded as weightloss success by many weightloss dieters. ANd you are losing weight.
All sounds good to me, but then I'm only a diabetic with years of experience, NOT a healthcare professional!
Hana
 
Thundercat said:
Sent from the Diabetes Forum App
You need to speak toa doctor about this. There is nothing 'normal' about ketoacidosis. It is very serious.
Click to expand...

I think it's fair to say that the above ill-informed response is the very reason there is so much confusion surrounding the issue. It's like a 'yahoo answers' response.

I think if they altered the name from Ketoacidosis to stinkyacidosis (you get my drift) then the distinction between 'ketosis' would be more clear.

I told my Mum that I was on a Ketogenic diet and that I was buying some Ketone sticks to check on them. She looked horrified. She was with me all those years ago when the Doctor scared us all to death! He basically said that if you have Ketone's you better get help quickly or you'll die. :wave: :thumbdown: :crazy:
 
Riri said:
Have to put a spanner in the works here. When I had the noro virus bug before Christmas i was obviously very ill and vomiting but my blood sugars remained under 7. I spoke to my DSN who told me that even with these BSs I had to check for ketones and sure enough they were at 1.6 and rising. She told me that ketoacidtosis in T1's can occur with normal blood sugars when we are unwell. I was told that day that if I continued to be sick with ketones I would need to go int hospital. Luckliy the bug cleared within 24 hrs and I was able to keep enough water down to flush the ketones out. So an underlying illness with normal sugars but high ketones is dangerous. So the way I read it, if ketones are showing and being a T1, then this can be a problem even with stable BSs. I have to say I always thought previously that ketones would only develop with high blood sugars too!
Click to expand...

I would still have a slight quibble with what your DSN said. Ketones of 1.6 would be entirely expected in somebody with norovirus who was vomiting, diabetic or not. It is a physiological response to burning fat instead of sugar, and occurs both in low carb diets and if somebody is vomiting and so is not having their normal intake of glucose. That still is not the same as having ketoacidosis. Where your nurse is certainly right is that DKA can occur quite readily in T1 diabetics who are ill and not eating, because they may as a result not be taking any/enough insulin. But it isn't ketosis per se that puts you at risk of DKA, its the illness that caused the ketosis. And it's also very good advice to drink lots of water in that situation (providing you can keep it down; if you can't then you absolutely should go into hospital). Aside from the acidosis, one of the greatest dangers of DKA is the dehydration that goes along with it, and one of the initial emergency treatments, alongside insulin, is very large quantities of intravenous fluids.


Type 2 on Metformin, diagnosed Jan 2013, ultra low carber, Hba1C at diagnosis 8% (11mmol), now between 5 and 6 mmol. 13kg lost so far :)
 
Hey Matty!

Have you read Dilinger's post at the top of this Low-carb Diet section? It has a very good explanation of Ketosis and Ketoacidosis. He posts on a few forums/blogs and is very knowledgeable. Here's a link:

viewtopic.php?f=18&t=9427

The bottom line is that ketones with normal blood sugars are not harmful to you and are natural on a very low-carb diet. Ketoacidosis is entirely different and is very dangerous. I have LADA and I've low-carbed (about 50g a day) for around 4 years. I usually stay just above the level of carb that would put me in ketosis, because I don't want to lose weight, but on occasions when I do need to lose a few pounds, I drop my carb level to around 30g a day - when I do this, I go into ketosis and the sticks turn purple - it is perfectly natural and not at all harmful. give Dilinger's post a read if you haven't done so already.

Take care and good on you for taking control of your diabetes!

Smidge
 
Good post smidge.

Real shame Dillinger isn't on here anymore. It's down to him an xyzzy's advice on low carbing that my levels are so good now.
 
Hi Matty,
Seems like you've already got all the info you need but just to say you still can get ketoacidosis with normal blood sugars it happened to me. Over my wedding I was really stressed trying to make sure everything went ok and kept going low in the end my basal setting on my pump was down to -80%. I kept it like that until I woke up on the Monday morning in the house we had rented with a blood sugar of 8.3 (which is higher than normal but nothing scary) I had no clue what was wrong as I felt like I was in DKA but my BG was 8.3 and going down every time I chundered. I spent most of the morning with guests from the wedding trying to say goodbye to me huddled round the toilet. feeling really **** it wasn't until my hubby came and checked on me and gave me my ketone meter that I twigged it was DKA just without the high sugars. I turned my pump up and gave a bolus of insulin with some sips of lucozade. I felt better quite quickly although still rubbish considering I was on honeymoon.
This seems however to be different to you as you are feeling fine. When you are in DKA you know about it, several hours of chundering out of both ends hyperventilating and usually quite hot skin, your body aches all over main reason for that is that your blood is turning to acid, the vast majority of people will get all if not the majority of these symptoms before they slip into a coma. So if you're feeling fine then I wouldn't worry. Ketosis is different from ketoacidosis main reason being the amount of acid present in the blood. Ask you DSN for a blood ketone meter it's far more accurate than the pee strips ketones can build up in the urine and would only give a picture from quite a few hours after the ketones have gone from the blood. If you've only just started a low carb diet then I would expect ketones to be higher but they should reduce over time, but if you stay low carb you will always have some present.
Hope that's of some help, Laura
 
SamJB said:
Good post smidge.

Real shame Dillinger isn't on here anymore. It's down to him an xyzzy's advice on low carbing that my levels are so good now.
Click to expand...

Thanks, Sam. Dillinger does actually still post on here occasionally. He was definitely my inspiration to low-carbing and I owe him a lot.

Smidge
 
I am T1 and have been low carbing for about 2 years now after believing all the NHS drivel about healthy diet (high carb) and exercise being the key to weight loss, the weight just kept piling on. It is now a life style choice and I slowly lost 2.5 stone to get me to healthy bmi at 5ft 8" and 10.5 stone (female). I have never bothered to test my ketones since I feel fine.
When I was in my teens back in 1976 I ended in hospital with DKA and my mum was told I had a 1 in 10 chance of dying. My sugars were just into double figures and the medical staff were surprised at how low they were. This was during my A levels and believe it was stress related but also related to hormonal changes (I was a very late developer). As Laura says, there is no mistaking DKA you feel absolutely terrible, I was barely conscious and if you are on insulin I don't think there is a simple formula for the condition developing except maybe stress (backed up by post from Laura).
I think the advice should be to chill out Matty, keep up the low carbing and don't worry about DKA, test your ketones if you want to see how much fat you are burning but only test for health reasons if you are ill.!
 
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