Worried about ketoacidosis

MillieT

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hi, I'm now over 2 weeks into doing this carb free diet, like i have said i have lost weight, my sugars are way down to what they were, i'm hitting 4's and 6's which i never did for over a year, trouble is i am on empagliflozin and after speaking somewhere else here on the forum and i'm told that this should not be taken when on a keto diet... now, i do have quite a few dizzy spells, i feel nauseous but never actually sick, i do go to the loo like i lost count how many times a day but then i also drink a couple of litres of fresh water every day too, i keep getting this nasty acid like tummy ache and have had diarrhea yesterday but only the one day and though it could be some form of cleansing due to the diet.

Anyway, these dizzy spells, the hot flushes and i do get very thirsty are symptoms of the KA but my sugars are not high at all, today i woke up on 5 exactly and after breakfast i went to 6.2, i have one of these urine testing kits (EconoTest) and it shows i have lots of ketones as i expected from the diet- but this test strip also says that i have high glucose and this is where i'm getting confused, how can i have high glucose when my sugars are low and sorry to seem thick- i get dreadful brain fog since radiotherapy. I have to admit, i feel thinner but also quite rotten, i have been really irritable too or more than usual.

I am due to see my nurse next week too so shall be mentioning all of this but due to my horrendous anxiety I kind of need some advice to try and at least settle down a bit, i have paced up and down, washed the same washing 3 times today and just don't know what to do with myself.




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kaylz91

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When on a low carb diet/keto diet people often go through what they describe as keto flu, I don't know anything about it but a google would help but they do say it makes them feel rotten

Urine strips aren't very reliable in anyway as they don't show what's currently happening, they lag behind and tell you what was going on at least a couple of hours ago
xx
 

Antje77

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i have one of these urine testing kits (EconoTest) and it shows i have lots of ketones as i expected from the diet- but this test strip also says that i have high glucose and this is where i'm getting confused, how can i have high glucose when my sugars are low
Empagliflozin lowers your blood glucose by making you pee out glucose, hence the positive urine test.
I don't know about the ketoacidosis but you there are reports of DKA with normal blood glucose, so it's not impossible, although it doesn't seem to happen often.
I am due to see my nurse next week too so shall be mentioning all of this but due to my horrendous anxiety I kind of need some advice to try and at least settle down a bit
I'm sorry, I'm afraid my answer doesn't really help you to settle down more.

If in doubt I think you'd best contact a HCP with your questions, good luck!
 
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HSSS

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Have you tested whilst dizzy to see what your numbers are doing at that time? It’s possible the combination of keto and medication could be taking you a bit too low. Or it could be that it’s a false hypo whereby your body is reacting to the drastic changes by having a tantrum. Still feels very real but the numbers aren’t in reality too low.

Also make sure you are having enough electrolytes, ideally from food and salts but supplement if necessary. Fewer carbs and a lot of water means they get “washed out “ a lot quicker. Potassium and magnesium as well as sodium.
Lastly adding in a lot of fats quickly can cause nausea and diarrhoea. Try easing back just a little or spreading it more evenly through the day til you adjust more.
 

DCUKMod

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@miffli - I'll cut to the point, but forgive the intrusive nature of the question; Do your poos loose and slimey? Do they smell really sour and acrid? If you look into the toilet, prior to flushing is there any sort of slick in there?

I seem to have a personal fat (intake) threshold, and if I over do it ^^^^ that's how my body reacts. It's rather horrid.

To remedy it, I just dial back on the fats a bit, which would mean I'd likely up the protein a but to ensure I don't lose weight.

Honestly, miffli, if you are worried about being keto, on your meds, then relax the carb restriction a bit, to just be low carb, until you can see your Doc to negotiate a way forward.
 

ert

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It sounds like your body's adapting to a new low carb diet regime.
However, for peace of mind, the article below is worth a read, so you can look for symptoms of DKA (which would be very rare and unusual) or so that you can contact 111 if you deteriorate. The patient recently changed his diet to low carb and was a type 2 diabetic on empagliflozin and metformin presented with the symptoms of a 2-day history of diarrhoea and fever, 24 hours of nausea and vomiting, and central chest pain. He was diagnosed with DKA.
https://diabetes.medicinematters.co...e-on-a-sglt2-inhibitor-and-keto-diet/16098452
The article's conclusion is interesting.
 
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MillieT

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@DCUKMod I'm not sure what happened but it was only for 24 hours and things have changed since then and i'm more the other way now as in somewhat constipated, I am eating keto, however, my gp took me off the empagliflozin and this morning i have woken up on 10.5 which just never happens, two days without meds, i'm shocked only i did not have anything that untoward last night either, however my gp has also mentioned the fodmap diet.. i'm not sure if i wish to try anything else new right now, i did have 3 strawberries and 8 raspberries last night with heavy cream after a cauli cheese dinner- home made sauce made with lactose free milk almonds and parmesan

I have had bouts of acid reflux and still feeling quite strange , i have high / pre high blood pressure- or have had in recent months so am being monitored, i am taking supplements, plenty of water, ACV plus Himalayan pink salt very sparsely on food. I am so tempted to take the Empagliflozin because something has taken my sugars through the roof and i can only think it must have been that fruit so i shall be taking that out, trouble is when i take the Emp i was getting really nasty tummy aches whilst doing keto.
 

lucylocket61

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@DCUKMod I'm not sure what happened but it was only for 24 hours and things have changed since then and i'm more the other way now as in somewhat constipated, I am eating keto, however, my gp took me off the empagliflozin and this morning i have woken up on 10.5 which just never happens, two days without meds, i'm shocked only i did not have anything that untoward last night either, however my gp has also mentioned the fodmap diet.. i'm not sure if i wish to try anything else new right now, i did have 3 strawberries and 8 raspberries last night with heavy cream after a cauli cheese dinner- home made sauce made with lactose free milk almonds and parmesan

I have had bouts of acid reflux and still feeling quite strange , i have high / pre high blood pressure- or have had in recent months so am being monitored, i am taking supplements, plenty of water, ACV plus Himalayan pink salt very sparsely on food. I am so tempted to take the Empagliflozin because something has taken my sugars through the roof and i can only think it must have been that fruit so i shall be taking that out, trouble is when i take the Emp i was getting really nasty tummy aches whilst doing keto.
When did you stop the empaglifozene? It can take three or four days for your body to adjust to changes. Our bodies get used to doing certain responses and need adaptation time.
 

MillieT

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That's about right then, it was Jardiance brand 10mg.
 

NicoleC1971

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hi, I'm now over 2 weeks into doing this carb free diet, like i have said i have lost weight, my sugars are way down to what they were, i'm hitting 4's and 6's which i never did for over a year, trouble is i am on empagliflozin and after speaking somewhere else here on the forum and i'm told that this should not be taken when on a keto diet... now, i do have quite a few dizzy spells, i feel nauseous but never actually sick, i do go to the loo like i lost count how many times a day but then i also drink a couple of litres of fresh water every day too, i keep getting this nasty acid like tummy ache and have had diarrhea yesterday but only the one day and though it could be some form of cleansing due to the diet.

Anyway, these dizzy spells, the hot flushes and i do get very thirsty are symptoms of the KA but my sugars are not high at all, today i woke up on 5 exactly and after breakfast i went to 6.2, i have one of these urine testing kits (EconoTest) and it shows i have lots of ketones as i expected from the diet- but this test strip also says that i have high glucose and this is where i'm getting confused, how can i have high glucose when my sugars are low and sorry to seem thick- i get dreadful brain fog since radiotherapy. I have to admit, i feel thinner but also quite rotten, i have been really irritable too or more than usual.

I am due to see my nurse next week too so shall be mentioning all of this but due to my horrendous anxiety I kind of need some advice to try and at least settle down a bit, i have paced up and down, washed the same washing 3 times today and just don't know what to do with myself.




View attachment 37550 .
As far as I am aware ketoacidosis does not happen as a side effect of an sglt 2 inhibitor nor with low insulin and low bgs. You would be more at risk for a urinary tract infection because of peeing out excess sugar.
Urine test strips just show that you are peeing out glucose (good) and the ketones are just what your body is not using so as you become better adapted they will go down in any case.
If you feel you've jumped off the deep end into keto you could ease back a little and probably still get great results with weight loss and blood glucose levels. If you carry on and still feel rubbish after 6 weeks then I'd say this may not be for you (6 weeks is the amount of time it is reckoned to take to get into nutritional ketosis fully).
A word of warning, diab nurses can get panicky if you mention ketones in your urine but you do not have keoacidosis from what you've said.
 

Oldvatr

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Keto acidosis can occur when using an SGLT-2 Inhibitor such as Empagliflozin
https://www.diabetes.co.uk/forum/th...-on-the-risk-of-diabetic-ketoacidosis.104325/

Note that ketoacidosis has been recorded when bgl levels are as low as 10 mmol/l wheereas diabetic DKA is only associated with very high bgl levels in the 20's and above.

There is advice not to use low carb when on this medicine. One thing is that jardiance is flushing out not just glucose in the pee, but also sodium, potassium, and other minerals from your body. It is also dehydrating you, and you seem to be meeting the water intske, but maybe need some electolytes too so maybe use a sports drink. Two weeks is early days for your body to fully adjust, so as mentioned above, try a bit longer, or maybe ease the carbs back in at a moderate level istead of going flat out keto. That is what I did, and I had not ill effects at all. I ran my diet so that one slice of toast in the morning contolled whether I went keto or remained just above. Either way my bgl dropped to the seweetspot.

One thing I have discovered with that particular journey is that I have a slight lactose intolerance in that I am fine with full fat milk, but too much double cream gives me similar wide effects to the ones you describe . Just a thought, are you overdoing the bulletproof coffee thingy? Too much cheese?

According to the FDA, Empagliflozin is the mildest version of SGLT-2 med on the market. The others have stronger effects apparently. I was on Forxiga and it did me in with severe UTI and my bgl did not drop much, so I stopped it quite quickly, especially after I read what the FDA was saying about it. Especially the bit about genital gangrene. OOOPsie - No WAY
 

MillieT

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It's ok as @Goonergal answered in a previous post and put my mind at rest, like i said, I have ceased taking the Empgliflozin, I had spoken elsewhere on the forum about this and the keto and what have you.
 

NicoleC1971

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It's ok as @Goonergal answered in a previous post and put my mind at rest, like i said, I have ceased taking the Empgliflozin, I had spoken elsewhere on the forum about this and the keto and what have you.
You may want to update your status which says Sill On empglifozin x
 

Winnie53

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@miffli I had lots of scary things happen when I started the keto diet in 2015 too.

While I knew the diet was the right choice for me because nothing else worked, and the keto diet had a long and rich history of working well for type 2 and type 1 diabetics, I had so much fear to work through due to all the keto myths: "risk of kidney damage", "increased risk of heart attack", "worsening insulin resistance due to increased fat intake". ALL myths, but they scared me because I hadn't yet learned how the keto diet works, and how much my health would improve within months.

It wasn't easy for me to do the opposite of the dietary guidelines, the American Diabetes Association's guidelines, and to reject the guidance of my endocrinologist, doctor, and diabetes dietitian.

Glad you're off the diabetes medication. As shared above, there is a rare possibility of developing ketoacidosis on that medication when on the keto diet. I know the upswing in glucose levels is upsetting and likely feels like you're doing something wrong, but as others said, it will take some time for your body to adjust to being off the medication and to complete the transition to becoming a "fat burner".

When I started the keto diet, thank goodness I had this forum. Forum members here stepped me through each concern as I continued to stick with the diet. I became a YouTube warrior!

They introduced me to the leading experts around the world. As I listened and learned, my fears slowly began to ease.

Six weeks into the keto diet, when presented with my lab test results by my doctor, we were both taken by surprise. The results exceeded our expectations. My doctor had only seen results like mine with one other patient previously and was at a loss as to what to do because I continued to refuse medication, and I was determined to stay on the diet. So he chose to continue monitoring me. And as my results continued to improve over the next months, he eventually stopped monitoring me. My diabetes was in remission, and my status was changed to non-diabetic.

Incredibly, I achieved this after having had untreated type 2 diabetes for 10 years. Supposedly, that's not possible. But it is. Everything we thought we knew about what's possible and not possible with type 2 diabetes is changing.

Virta Health, here in the US is helping those who have had type 2 diabetes for 8, 15, or even more years, many who had been on diabetes medications and/or injecting insulin for years. Even they are achieving remission. It's just taken longer. In cases of longstanding type 2 diabetes, in some cases, two to three years.

So be patient. Stay the course. Keep asking questions. I think you too will be surprised by your progress in just a few short months. :)

For encouragement, search for 2018 and 2019 presentations by Sarah Hallberg, D.O. on YouTube. She's the Medical Director of Virta Health, and regularly reports the results of their 5 year study on treating type 2 diabetes with the ketogenic diet. What they're achieving is so exciting!

Almost five years later, a day doesn't go by without listening to a new lecture or re-listening to an older lecture by one of my favorite experts. I guess I just can't get over the knowledge and personal experience that what was once thought to be a progressive disease...doesn't have to be. We have choices available to us now that those with diabetes previously didn't. We are so fortunate! :)
 
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Winnie53

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@miffli there are two practical bits of info I neglected to mention.

My glucose levels were significantly higher than yours when I started keto. A1c was 9.9, my first glucose reading in the afternoon was 282 mg/dl so it was a full 4 weeks before I was able to get my glucose levels down to a less scary levels. I logged my glucose levels for 8 to 9 weeks daily to maintain my motivation because the downward trend took what seemed forever.

I also developed muscle cramping and constipation. I addressed that by taking 150 mg magnesium citrate with breakfast, then again with dinner. Over the years I've continued taking 300 to 450 mg a day.

Another challenge was salt intake. I never added salt to my food so had the hardest time remembering to do it.

On keto, I wasn't eating any processed foods so this became a challenging problem. I finally settled on dissolving 1/4 teaspoon of salt in a cup of hot water to sip on. Eventually I worked up to a 1/2 teaspoon.

Two clues that my sodium levels were bottoming out was feeling like **** and developing intense cravings for 5 corn chips topped with grated cheddar cheese that I briefly heated in the microwave, the only salty food I'd previously eaten. When I started sipping on hot water with salt, that problematic craving resolved.

I also took 99 mg of potassium a day for insurance, but because I always ate some type of non-starchy vegetable with all meals, that probably wasn't necessary. I also would include half an avocado with a meal or as a snack once a day too. I recently have resumed eating avocado a few times a week.

We each have to find our own way when it comes to keeping the electrolytes in balance as we become fat adapted. If you ask, others here may offer suggestions too. :)
 

MillieT

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@miffli there are two practical bits of info I neglected to mention.

My glucose levels were significantly higher than yours when I started keto. A1c was 9.9, my first glucose reading in the afternoon was 282 mg/dl so it was a full 4 weeks before I was able to get my glucose levels down to a less scary levels. I logged my glucose levels for 8 to 9 weeks daily to maintain my motivation because the downward trend took what seemed forever.

I also developed muscle cramping and constipation. I addressed that by taking 150 mg magnesium citrate with breakfast, then again with dinner. Over the years I've continued taking 300 to 450 mg a day.

Another challenge was salt intake. I never added salt to my food so had the hardest time remembering to do it.

On keto, I wasn't eating any processed foods so this became a challenging problem. I finally settled on dissolving 1/4 teaspoon of salt in a cup of hot water to sip on. Eventually I worked up to a 1/2 teaspoon.

Two clues that my sodium levels were bottoming out was feeling like **** and developing intense cravings for 5 corn chips topped with grated cheddar cheese that I briefly heated in the microwave, the only salty food I'd previously eaten. When I started sipping on hot water with salt, that problematic craving resolved.

I also took 99 mg of potassium a day for insurance, but because I always ate some type of non-starchy vegetable with all meals, that probably wasn't necessary. I also would include half an avocado with a meal or as a snack once a day too. I recently have resumed eating avocado a few times a week.

We each have to find our own way when it comes to keeping the electrolytes in balance as we become fat adapted. If you ask, others here may offer suggestions too. :)

@Winnie53 I really appreciate this too though is it wrong to be this much higher when off the medication, apologies but i have copied what I have said over on another post below due to my sugars being high. I have no problem with taking Himalayan pink salt due to high blood pressure so i don't have it in excess, i'm also taking supplements like you said above just to try and be on the safe side but have had constipation this week.

When you say 'Processed' is that all of them?

Ok, so regards the other thread, i pasted this = "When i got home today i picked on some cheeses, a small piece of Stilton and piece of brie and a cup of tea and i have passed out since then which is odd, i just woke up again and i'm on 9.0 mmol so must have been higher to pass out, I have mentioned before that i go a little potty when my sugars go above 8mmol and i did a bit today but i have woke up with the nastiest headache... I have checked and those cheeses are ok for low- 0 carb diet, i can't understand why my sugars should increase, i was even tempted to take an empagliflozin to help take them down because i feel so bad.."

to add i have a horrid tummy ache, like acid on steroids
 

HSSS

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@Winnie53 I really appreciate this too though is it wrong to be this much higher when off the medication, apologies but i have copied what I have said over on another post below due to my sugars being high. I have no problem with taking Himalayan pink salt due to high blood pressure so i don't have it in excess, i'm also taking supplements like you said above just to try and be on the safe side but have had constipation this week.

When you say 'Processed' is that all of them?

Ok, so regards the other thread, i pasted this = "When i got home today i picked on some cheeses, a small piece of Stilton and piece of brie and a cup of tea and i have passed out since then which is odd, i just woke up again and i'm on 9.0 mmol so must have been higher to pass out, I have mentioned before that i go a little potty when my sugars go above 8mmol and i did a bit today but i have woke up with the nastiest headache... I have checked and those cheeses are ok for low- 0 carb diet, i can't understand why my sugars should increase, i was even tempted to take an empagliflozin to help take them down because i feel so bad.."

to add i have a horrid tummy ache, like acid on steroids
I can’t seem to find the other post. In future it might be better to paste a link to it rather than repeat things on different threads as it can get confusing. That said I’ll reply here cos I can’t find the other.

EDIT. FOUND IT! https://www.diabetes.co.uk/forum/threads/strawberries-raspberries-keto.170979/#post-2194147 post number 11.

Do you mean fainted or fell asleep when you say passed out? Big difference. Sleepy with high numbers is common as are headaches.

Alternatively if you did more of a faint I guess it’s possible you went hypo and that’s the reason for the headache. The high numbers afterwards maybe could be your body dumping glucose like mad to revive you. Though without the meds and with the numbers you’ve been getting it seems less likely to me.

Personally I think it’s still only a few days without meds and far too soon to know what’s going to happen once your body settles down. It’s probably a bit confused without the meds and needs some time to work it out, hence odd symptoms.

What had you eaten and when earlier in the day? Maybe the previous meal had put you much higher, rather than the cheeses being to blame. Or some other event/medication/stress/tiredness/exercise.

are you taking regular readings before and 2 hrs after each meal as well as when you feel unwell? I think it might help a great deal sort out what’s actually happening, then you can work out “why” once you know the “what”

Lastly other than meds have you changed anything else food wise to go from diarrhoea to constipated? Though both are quite common whilst adjusting to keto. Make sure you are drinking plenty right now to help and if you cut fats to prevent the diarrhoea add some back in.
 
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Winnie53

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Am at work on my lunch break so am going to follow up with you after dinner tonight (long after you've gone to bed!).

What you're describing sounds more like an electrolyte issue (but I haven't looked yet to see if your symptoms could be due to coming off the medication; will take a look at that after dinner tonight).

Here's a link to where you can learn more about electrolytes and keto, also sodium specifically...

https://hvmn.com/blog/ketosis/keto-electrolytes-tips-and-concerns

Here are the symptoms they list for sodium deficiency...
  • Weakness
  • Fatigue
  • Headaches
  • Nausea
  • Vomiting
  • Muscle cramps
  • Brain fog
  • Irritability
A dietitian told me a few years ago that the body is good at recycling sodium, which is probably why it took a while before I began having some of the above symptoms.

Two things you can start doing today while waiting for me to get back to you...

Increase your salt intake today to see if you feel better. Try a 1/4 teaspoon. If you don't feel better, try one more 1/4 teaspoon. (I just dissolve it in hot water.)

Consider eating "PFC" each time you have a meal or snack, which means include a source of protein, fat, and carbs (in the form of a non-starchy vegetable or leafy greens). Perhaps that will help to address "the horrid tummy ache".

[Edited to add]

Also might be a good idea to figure out if you're getting some potassium rich foods daily. Here's another link, but it's just the one that came up first on my search - (haven't read it yet)...

https://perfectketo.com/potassium-rich-foods/

More later...
 
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MillieT

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@HSSS
Well, if i had carbs (i.s. bread or porridge) even on the empagliflozin within an hour or so i would start to feel hyper as if i was on drugs, talking fast and off the wall, after a little while longer i would have to go to bed else i would literally just pass out, i go into a deep sleep and sometime sit may be for only an hour and i wake up in a grouch with a bad head and can be quite abrupt. After then and a cup of tea and a few glasses of water i'm starting to feel normal again whatever that is.

Today, I was 10mmol when i got up, it started going down and i was 8.2 before i had breakfast which was egg and bacon plus a cuppa, i went out shopping, when i came back i was @ 10 which is odd, even in the shop i was feeling faint or just rough i guess, i got back home and snacked on some cheese and had another cuppa and had to go to bed, when i'm laying there i feel like you do when you are drunk, spinning fast and it is a horrid feeling, jumping up because i'm worried that i'm going too fast.. i hope you can understand that.

Re the runs and constipation, i'm not sure whether it was a one day tummy bug or something to do with going keto but i was ok the day after albeit a little constipated and i really should not be because i do eat a lot of greens and what have you and also @Winnie53 i always used Himalayan pink salt on food and definitely a spoonful a day but I can't overdo it due to high blood pressure.

Potassium, i don't think many would eat as much spinach and other greens as i do. I also eat Pak Choi and mushrooms due to having stir fries weekly, especially since doing the keto thing. (i do eat an awful lot of mushrooms) Most of the symptoms above for deficiency I got long before doing the keto and i also take multivits and a manner of other nutrients daily and without fail, not so much the cramps, i was like this since having radiotherapy a year ago where they zapped my head and i don't think i have been the same since. Everything has been a real battle since and hence why my Hb1ac was over 100 for over a year and has slowly started to come down. Oh and i drink a lot of spring water daily to keep myself hydrated, that was another thing about the cancer treatment, i have drank more water since than i ever did before, i don't think that is a bad thing though.
 

Winnie53

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@miffli I've been reading and rereading your posts in this thread. I don't feel I know you well enough to help you, so I'm going to lay out what I do know...

The three minerals that are depleted with the keto diet are sodium, potassium, and magnesium.

According to an article from the American Heart Association, pink Himalayan salt has 1700 mg sodium per teaspoon; sea salt has 2000 mg sodium per teaspoon; and table salt has 2300 mg sodium per teaspoon.

To get the equivalent of 2300 mg sodium in table salt, you'd need about 1.35 teaspoons of pink Himalayan salt to equal 2295 mg of table salt.

Here's what one of the leading researchers on the ketogenic diet recommends for sodium intake...

"How much sodium, potassium and magnesium should I have on a ketogenic diet?

By Dr. Stephen Phinney and the Virta Team


In short, 3000-5000 mg of sodium and 3000-4000 mg of potassium on average are needed as part of a well-formulated ketogenic diet. For sodium and potassium (aka electrolytes), rather than trying to track them directly (which is frustrating at best), we recommend salting food to taste, adding 2 grams of sodium as broth or bouillon, and eating 5 servings of non-starchy vegetables daily. For magnesium, 300-500 mg is an initial recommendation. Muscle cramps are our best indicator of depletion, and to replenish one’s intracellular magnesium, we generally recommend 3 tabs per day of Slow-Mag or the generic slow-release equivalent for 3-6 weeks."
Link: https://blog.virtahealth.com/sodium-potassium-magnesium-ketogenic-diet/

What he's saying is to take 2000 mg of sodium in addition to salting all your foods to taste. I personally have never had to take that much, perhaps because I'm not an athlete and not particularly physically active other than walking every day or every other day. That said, when I'm having keto flu symptoms, I do take additional sodium.

Potassium is trickier. I don't think I've ever met the minimum requirement for potassium. Interestingly, animal protein is also a good source of potassium:

3.5 oz beef...315 mg potassium
3.5 oz pork...420 mg potassium
3.5 oz chicken...221 mg potassium
3.5 oz salmon...361 mg potassium
3 oz tuna...201 mg potassium
1 egg, whole, cooked...67.6 mg potassium

Other keto friendly sources of potassium:

1/2 avocado...487 mg potassium
spinach, frozen, 1 cup...540 mg potassium
spinach, fresh, 3 cups...501 mg potassium
swiss chard, fresh, 3 cups...408 mg potassium
Brussels sprouts, cooked, 1 cup, 494 mg potassium
white button mushrooms, raw, 1 cup...223 mg potassium
zucchini (corgette), raw, 1 cup...325 mg potassium

Medications on the keto diet

It's good your doctor took you off the empagliflozine due to the possibility of ketoacidosis on the keto diet. Blood pressure medications may need to be adjusted too. If you have a way to regularly check your blood pressure, that could be helpful so you can inform your doctor if you notice a change.

Written for physicians from DietDoctor.com:

"Carbohydrate restriction is an effective way to lower blood pressure. However, the change happens more slowly than the change in blood sugar, potentially occurring within days or months. Therefore, you do not have to automatically adjust blood pressure medications as you need to with glucose-lowering medications.

Instead, this is something to assess during the follow-up. Start by making sure your patient is aware of potential symptoms of hypotension (such as experiencing dizziness, fatigue, or nausea) and knows to contact you immediately if they occur."

What can happen in the morning when your body thinks you don't have enough glucose during the first month or so on the ketogenic diet

After I started the keto diet and my glucose levels began coming down. If I didn't eat as soon as I got up, I'd sometimes become very shaky and distressed, and it came on suddenly without warning. It felt like I was having a hypo, but when I checked my blood glucose level it wasn't low at all. This is called a "false hypo" and it can be very distressing.

Read more about it here from Jenny Ruhl's website...

"Why Do I Feel Shaky and "Hypo" When I Achieve Normal Blood Sugars?
If you have had high blood sugars for a while--even only moderately high blood sugars--when you start lowering your post-meal blood sugars you may find that you feel shaky and even downright sick. This can happen even before you bring your blood sugars down into the normal range.

This is because over time, your body has become accustomed to those much higher blood sugars and it interprets the normal blood sugar as being dangerously low. When this happens, the body secretes fight or flight hormones in order to push the blood sugars back up to what it erroneously thinks is the safe zone. This phenomenon is called a "false hypo."

The stress hormones associated with this counter-regulatory response can make you feel dreadful. However, if you test your blood sugar during a false hypo, you will see that it is not below the 70 mg/dl (3.8 mmol/L) level that defines the beginning of the mild hypo range. That is why it is very important to test your blood sugar when you feel hypo. If you are not using insulin or one of the
pills that stimulate insulin secretion you should only treat a hypo when it is a true hypo below 70 mg/dl. With higher "lows" your body will recover on its own.

The symptoms you feel during a false hypo may include a pounding pulse, shakiness, a raised blood pressure and other symptoms very similar to those of a panic attack. (NOTE: If you are using insulin or an oral drug that causes increased insulin secretion you should treat hypos below 80 mg/dl (4.4 mmol/L) because it is always possible that the drug will continue to lower your blood sugar to an unsafe level.)

After a experiencing this kind of counter-regulatory response you may feel shaky for another hour or two, because of the changes the stress hormones have made in your body. You may also become a bit more insulin resistant than usual. But after some period of time which varies from person to person, your body will get used to these new, normal blood sugars and you will only develop hypo symptoms when you are having a true hypo, which, if you are controlling using diet alone, should almost never happen.

So no matter what you feel when you first reach normal levels, try to wait it out. Your body is getting all the glucose it needs when your blood sugar is above 70 mg/dl (3.8 mmol/L). Doctors do not consider true hypoglycemia (low blood sugar) to begin until under 70 mg/dl (3.9 mmol/L). It does not become dangerous until it reaches levels like 45 mg/dl (2.5 mmol/L).


If your blood sugar has been very high for a while, you can make the adaptation process a bit easier by proceeding in stages, setting your blood sugar targets progressively lower, a step at a time. But don't stay at higher than normal levels for any longer than is absolutely necessary. Once your body does adapt, you will probably feel much better and much more energetic than before.

So be patient while your body becomes accustomed to new, healthy, blood sugar levels. Don't respond to feeling as if you were having a hypo by eating carbs to push up your blood sugar as long as your blood sugar tests at 70 mg/dl (3.9 mmol/L) or above if controlling with diet alone or 80 mg/dl (4.4 mmol/L) if using insulin or an insulin stimulating drug. Give your body a chance to adapt and eventually you will feel completely normal when you have a normal blood sugar and may feel surprisingly toxic when your blood sugar reaches the dangerously high levels at which you used to feel normal at."

Link - (you'll have to scroll down to the section)... https://www.bloodsugar101.com/healthy-blood-sugar-targets

Three more thoughts...

As some have already pointed out, it may take days to a week for the effects of the medication you stopped taking to ease, so give it some more time.

When you feel energized, you could be having a false hypo as described above.

When you feel low energy, you could be experiencing "keto flu" due to not getting enough sodium each day. If that's the case, see how you feel after you've had some sodium.

- OR -

You could be having a hypotensive episode. The only way to know is to check your blood pressure.

Hope this gives you the information you need to continue sorting out what is happening to you. :)
 
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