Worried about ketoacidosis

[MillieT]

Were any checks made for infection of any kind? Just trying to understand why with a good amount of insulin, and very few carbs, glucose is raised. Something is raising it and it’s not diet or lack of insulin. I would want to know what.

Did the dr actually explain why he thinks the keto diet wouldn’t work if overproducing insulin as you are, or simply state it as a “fact” ?

Vipidia is also known as Alogliptin and works in part by increasing the amount of insulin produced by your body, which then controls the level of sugar in your blood. It also reduces the amount of a substance called glucagon being produced by your pancreas. Glucagon causes your liver to produce more sugar; so, by reducing the amount of glucagon in your body, this also helps to reduce the levels of sugar in your blood.https://www.nhs.uk/medicines/alogliptin/

https://www.diabetes.co.uk/diabetes-medication/incretin-mimetics.html Glp1 medicines work by copying, or mimicking, the functions of the natural incretin hormones in your body that help lower post-meal blood sugar levels These functions include:

• Stimulating the release of insulin by the pancreas after eating, even before blood sugars start to rise.
• Inhibiting the release of glucagon by the pancreas. Glucagon is a hormone that causes the liver to release its stored sugar into the bloodstream.
• Slowing glucose absorption into the bloodstream by reducing the speed at which the stomach empties after eating, thus making you feel more satisfied after a meal

Both of these will hopefully address the symptoms of high blood sugars but doesn’t address the cause of why they are so high whilst not eating many carbs at all. As you say the reason your own insulin is already high would appear to be due to insulin resistance - its increased to try and compensate. The drugs will do more of this.

I'm confused too.

I was also confused because two of you said the same and I could not work out why, he said i was very insulin resistant and that the keto diet will have no effect on me at all so it is a waste of time doing it, I did say well i was really nervous about reintroducing carbs especially if my sugards are like 19.1 mmol...

ok, I returned home and put my message in here and i shall be honest, nothing apart from tea has passed my lips today, the last time i ate was 7pm last night, i have just been shopping and am sitting here with a cuppa and got the dinner on, i just checked and my sugars are 20.1 mmol, but as he would say, it still isn't any cause for concern as it is not life threatening yet. I did however when i returned home earlier take one of these new tablets along with about half a litre of water.

He said it as matter of fact that because of my insulin resistance that keto will not work, he has not asked about any possible infection and i do have issues with my waterworks, i also have some gum disease from packing up smoking, 3 or so years now without one.

I'd like to get the gum issue sorted out but i fell out with my local denstist for dodgy charging and have regeistered with one further away but they say i'm not actually registsered, i'm just on their system?!

if i had a heap of money then i could afford to go to all of them and get things sorted i'm sure. I don't know what to say or do now because i honestly thought i had a reasonable result today with him :|

 

[MillieT]

to add i'm so hungry i'm shaking and have butterflies and i'm absolutely terrified of eating when they're at 20.1

 

[HSSS]

Have you asked for a referral to a specialist? ask for one experienced in using keto/low carb. I think as the dr himself called you a complex case it is warranted. From your account he hasn’t explained why he thinks keto won’t work. I’m questioning his knowledge of it, and his lack of concern about your ongoing numbers concerns me. I’m concerned he hasn’t even investigated things like infection as a cause of high numbers.

Please see someone else, somehow. It may be in agreement with this first dr and be reassuring with better explanations, but it might lead to other options.

in terms of eating what about something high in fats and proteins. Meat, the fattier the better. Double cream, full fat soft cheese whipped together with a splash of vanilla essence is very nice and filling. Hard cheeses. You cannot starve yourself especially if it’s making you feel even worse. If they go up further I personally still wouldn’t rule out the 111 or a and e option either.

 

[Winnie53]

miffli, I get what you're saying. When I was unwell for four years, my friends felt my doctor had made me worse rather than better. I ignored their pleas. I trusted him, I lost four years of my life, and I no longer trust doctors. I check and verify everything they say, then, if they're right, my trust in them increases. Hoping we can find a health care provider to look at your labs and results. That's truly the best way forward.

I have another question for you. When you injected insulin, it made no difference? Can you share more about that?

 

[Winnie53]

miffli, HSSS just made me think of something. Could it be possible you're eating too much fat? If you have more than adequate fat reserves, no offence intended, what would happen if you upped your protein intake from meat, reduced your fat intake, and increased your intake of raw non-starchy vegetables which also can be satiating?

Based on your ketone levels, you're clearly fat adapted. Just a thought.

 

[Winnie53]

A few days ago, I posted on this thread two videos by Dr. Ted Naiman. He explains why he doesn't encourage his obese patients to load up on fat while losing weight on the keto diet.

 

[Winnie53]

He explains in the video that high protein diets are good for weight loss. He goes on to say that diabetes and obesity are caused by consuming too much energy from fat and carbohydrates. He also says that reducing carb intake is good, but for some people reducing both carb and fat intake is better, particularly for weight loss stalls.

Would be very interested in hearing what you think after you listen to the videos.

 

[HSSS]

miffli, HSSS just made me think of something. Could it be possible you're eating too much fat? If you have more than adequate fat reserves, no offence intended, what would happen if you upped your protein intake from meat, reduced your fat intake, and increased your intake of raw non-starchy vegetables which also can be satiating?

Based on your ketone levels, you're clearly fat adapted. Just a thought.

How would eating too much fat raise bgl? And render keto ineffective for bgl control? Might prevent weight loss, possibly cause nausea or diarrhoea if truely excessive but shouldn’t increase bgl

 

[Winnie53]

HSSS, I hear what you're saying. It is really important to consume fat when starting the keto diet because it's satiating and it reduces cravings as the body switches over from burning glucose to burning ketones and glucose. Agreed. And some fats are essential, the body can't make them, so those need to be consumed too.

That said, once we're firmly in ketosis and fat adapted, dietary fat can be reduced because the body is now getting the amino acids it needs from your "adequate fat reserves". And this is what leads to weight loss.

(To be clear, I'm not talking reducing fat intake in cases where the person is not overweight and does not have fatty liver.)

I eat a low carb/keto diet, but I have a hard time losing weight because I love fat, and eat too much of it. But if I skip three breakfasts a week on Mondays, Wednesdays, and Fridays, the weight falls off me.

Why? Because I've reduced my intake of calories/energy not just from carbs but from fat too.

Energy/calories can be from carbs, from fat, or from fat and carbs.

HSSS I would be very interested in hearing your opinion on what Dr. Naiman is saying too. He has 20 years of clinical practice experience using the low carb/keto diet with his patients.

If miffli is NOT suffering from an illness or an infection, increasing protein intake (or at minimum, insuring adequate protein intake) and reducing fat intake while continuing to eat non-starchy vegetables might be a game changer for her.

 

[Winnie53]

Here's another question HSSS. Why are miffli's glucose levels high? Could it be because her fat cells can't absorb any more glucose or fat? Doesn't Jason Fung talk about that?

 

[MillieT]

I'm overweight but not that fat, i can categorically state that I'm eating more protein than fat, i have always been potty over eggs and can easily eat them twice a day no problem at all, yes i do eat bacon but usually the zero nitrate type and usually more back baccon than streaky. I have lactose free milk. I use sweetener. I do use butter in some things but when making a stir fry i use rapeseed oil so it is low in cholesterol, it is quite fatty though i believe. I have cabbage, cauliflower, broccoli, fennel root, spring onions, celery, lettuce and some tomoato I do use almonds to make this keto pudding / bread but maybe once a week now since my apetite is quite low. When i make the pudding with almond flour, it is pretty much like a cake, i use lemon rind in it and have cream with it as a treat, again, maybe twice a week.(i hope that has no bad reports amongst you all) i just hope in all of this i'm actually allowed a keto treat.

@HSSS I must admit today i felt really sick whilst at the surgery and extremely wobbly on my feet, i'm not usually that bad, i don't have any other bathroom issues.

@Winnie53 When i was taking the insulin twice a day it had very little effect, yes i did see sugar levels reduced to around 8 and 10 but it was only when i started the Jardiance that I had readings of 4.. that was exciting for me anyhow, but the uti's were constant and unbearable.

I had a very late dinner tonight, what with the surgery and shopping, i left it later so less diseased people, or that was the idea, i'm trying to stay away from crowds if possible, anyway, i'm not likely to go to bed before 3am, i'm far too pent up.

 

[HSSS]

Why? Because I've reduced my intake of calories/energy not just from carbs but from fat too.

Energy/calories can be from carbs, from fat, or from fat and carbs.

I’ve agreed entirely til this section. And don’t disagree with your theory as one possibility. Also the extend fast allows insulin levels to fall further. This too may be the reason as insulin inhibits fat burning and encourages fat storage.

Dr. Naiman

. I’ll look at your links over the weekend.

If miffli is NOT suffering from an illness or an infection, increasing protein intake (or at minimum, insuring adequate protein intake) and reducing fat intake while continuing to eat non-starchy vegetables might be a game changer for her.

Or maybe protein could be raising her levels as it does for a few type 2? But she is fasting and still has high levels making me think it’s something other than food perhaps.

 

[HSSS]

I'm overweight but not that fat, i can categorically state that I'm eating more protein than fat, i have always been potty over eggs and can easily eat them twice a day no problem at all, yes i do eat bacon but usually the zero nitrate type and usually more back baccon than streaky. I have lactose free milk. I use sweetener. I do use butter in some things but when making a stir fry i use rapeseed oil so it is low in cholesterol, it is quite fatty though i believe. I have cabbage, cauliflower, broccoli, fennel root, spring onions, celery, lettuce and some tomoato I do use almonds to make this keto pudding / bread but maybe once a week now since my apetite is quite low. When i make the pudding with almond flour, it is pretty much like a cake, i use lemon rind in it and have cream with it as a treat, again, maybe twice a week.(i hope that has no bad reports amongst you all) i just hope in all of this i'm actually allowed a keto treat.

@HSSS I must admit today i felt really sick whilst at the surgery and extremely wobbly on my feet, i'm not usually that bad, i don't have any other bathroom issues.

@Winnie53 When i was taking the insulin twice a day it had very little effect, yes i did see sugar levels reduced to around 8 and 10 but it was only when i started the Jardiance that I had readings of 4.. that was exciting for me anyhow, but the uti's were constant and unbearable.

I had a very late dinner tonight, what with the surgery and shopping, i left it later so less diseased people, or that was the idea, i'm trying to stay away from crowds if possible, anyway, i'm not likely to go to bed before 3am, i'm far too pent up.

Which sweetener? Have you checked the ingredients , some have maltodextrin and spike us. Quite a few others spike me.

did you tell the dr how you felt whilst there?

insulin only had a limited effect? You need better help than you’re getting from the gp!

 

[MillieT]

I just wish to clarify from my post right above somewhere, i said "He said it as matter of fact that because of my insulin resistance that keto will not work, he has not asked about any possible infection and i do have issues with my waterworks, i also have some gum disease from packing up smoking, 3 or so years now without one"

I'm wondering if these are effecting me aswell somehow.

 

[HSSS]

I just wish to clarify from my post right above somewhere, i said "He said it as matter of fact that because of my insulin resistance that keto will not work, he has not asked about any possible infection and i do have issues with my waterworks, i also have some gum disease from packing up smoking, 3 or so years now without one"

I'm wondering if these are effecting me aswell somehow.

Could well be, particularly if you have a uti. Please get it addressed and treated if necessary. It might just help!

I’ve not heard of gum disease having this big an effect but maybe a cumulative add on effect to other issues

 

[MillieT]

Which sweetener? Have you checked the ingredients , some have maltodextrin and spike us. Quite a few others spike me.

did you tell the dr how you felt whilst there?

insulin only had a limited effect? You need better help than you’re getting from the gp!

Well i was slurring and slow to reply to his questions, he must have noticed i was wobbly.
Sweetener : Hermesetas, sometimes canderel if the other is unavailable and yes that does have maltodextrin in it.
Yes, but they were low doses to start with and then they were upped significantly and still no massive improvement.

i had dinner, i've gone down to 18mmol..yippee

 

[MillieT]

With regards the UTI's, i have had them over 18 months, i keep complaining, the other day when i spoke to the nurse i told her i was weeing clouds, cotton wool, like shredded tissue paper... she just looked at me gone out and said awwww. nobody whatsoever seems concerned by this and yet in all honesty is terrifies me, one man doctor said, well i you're bound to urinate some odd pieces of discharge and it is nothing to worry about.

 

[MillieT]

its so bad i took photos for crying out loud what am i reduced to..

 

[Winnie53]

Yes HSSS, it would definitely be better to hear Dr. Naiman explain it. It's very likely I'm not summarizing his Protein:Energy Ratio correctly. Apologies...

miffli, apologies to you too. Didn't mean to suggest that you're running high glucose levels because your carrying some excess weight. I should have been more thoughtful in my choice of words. I'm not that overweight either. I'm 5'3" and weigh 150 pounds so my BMI is 27, which is the mid-range of overweight. Here's a BMI chart if you want to calculate where you are... https://bmicalculator.mes.fm/bmi-chart

Too much fat intake can be a problem for some people on the keto diet. I'm one of them. You may or may not have that issue. I don't know. Without seeing your lab work and knowing more about you, I'm flying blind.

I also have no way of knowing how insulin resistant you are. To answer that question, I'd have to know your fasting insulin level and your fasting glucose level, convert the units to what's used in the US, and enter those numbers into a HOMA-IR calculator... https://www.thebloodcode.com/homa-ir-calculator/ I think there's a way to calculate insulin resistance with a fasting C-peptide level and fasting glucose level too. I'd have to look for it.

Did your doctor calculate your actual level of insulin resistant you are or is he just assuming you're insulin resistant?

There is a limit to how much fat cells can hold. Once they hit their limit, glucose levels start climbing. I looked around on the web. All I could confirm is that both carbs and fat stored in fat cells.

An excerpt from an article on Diet Doctor...

What happens if an overweight person overeats fat?
Now, the situation for the obese, leptin resistant person. As you eat lots and lots of fat, insulin does not go up. However, that ‘fat bomb’ does indeed go directly into your fat stores. You respond by increasing leptin levels in your blood. But here’s the difference. Your body doesn’t care. It’s resistant to the effects of leptin. So, your metabolism does not go up. Your appetite does not go down. None of the beneficial weight loss effects of eating that ‘fat bomb’ happens. And yes, you will need to eventually burn off that extra fat you’ve taken in.

The practical implication is this. If you are lean and leptin sensitive, then eating more dietary fat, like cheese, will likely not make you gain weight. However, if you are trying to lose weight, and have some problem with obesity/ insulin/ leptin resistance, then adding extra fat to your meals is NOT a good idea. Once again, you can see that we do not need to go back to that outdated, and useless notion of calories. Obesity is a hormonal, more than a caloric, imbalance.

What can you do instead? Well, eating more carbs is not a good idea. Neither is over eating protein. Nor is eating more fat. So, what is left? That’s what we call fasting.
​

For those who are members of Diet Doctor, here's a link to the entire article... https://www.dietdoctor.com/eating-extra-fat-make-fat

 

[Winnie53]

With regards the UTI's, i have had them over 18 months, i keep complaining, the other day when i spoke to the nurse i told her i was weeing clouds, cotton wool, like shredded tissue paper... she just looked at me gone out and said awwww. nobody whatsoever seems concerned by this and yet in all honesty is terrifies me, one man doctor said, well i you're bound to urinate some odd pieces of discharge and it is nothing to worry about.

miffli, they haven't checked you for a UTI? And you think you've had one for 18 months? That's not good.

Did they check your kidney and liver function? I can try to list the specific tests to look for if that would help.