Worrying

[Millie74]

Hi have been worrying as have only had one phone call since LADA diagnosis in Nov 2019 due to Covid. A consultant finally called me in May. They said they woukd arrange an appointment in 6 months with repeat c peptide and hba1c. I had my annual review in August and hba1c was 48mmol. At my diagnosis January 2019 my hba1c was 96 mmol and was told type 2. I had more tests later on as BMI ok and very active. I low carb 40-50g a day. My letter from consultant said must eat 50g minimum or will be at risk of DKA. Don’t really understand this and worries me as having trained myself to eat low carb, don’t always hit 50g. Just feel a bit on my own. On Instagram another Type 1 said you need to test ketones. Is this necessary? No means to do it and would worry me more I think. I keep trying my best to stay off insulin during a pandemic. Avoiding hospital visit etc. Sigh. Sorry. Coming across so negative. Have been trying to be the opposite. Don’t know who else to ask questions to.

 

[ert]

My letter from consultant said must eat 50g minimum or will be at risk of DKA.

In general, if you eat low carbohydrate (I eat about 30 grams a day and fast 18 hours) then your body can be trained to switch energy sources to be more predominately fat burning, which the end product is ketones. Nutritional ketosis occurs when blood ketones are 0.5 to 3 mmol/l.

However, your GP may be concerned that if you are ill or have an infection and your blood sugars are constantly above 13 mmol/l for an extended period of time, and you don't have enough insulin to clear them (if you are an undiagnosed type 1, honeymoon ending LADA not producing enough insulin, forgotten to take your insulin, on drugs such as SGLT2, ill and not following sick day rules to take extra insulin) you can run the risk of DKA, where you can no longer clear ketones away, and your ketones rise above 3mmol/l and spiral up to 25+ causing your blood pH to change.
You should have a blood ketone meter to check your ketones if you are ill and have high blood sugars for an extended time, and you should be following sick day rules to stay safe.

 

[Millie74]

In general, if you eat low carbohydrate (I eat about 30 grams a day and fast 18 hours) then your body can be trained to switch energy sources to be more predominately fat burning, which the end product is ketones. Nutritional ketosis occurs when blood ketones are 0.5 to 3 mmol/l.

However, your GP may be concerned that if you are ill or have an infection and your blood sugars are constantly above 13 mmol/l for an extended period of time, and you don't have enough insulin to clear them (if you are an undiagnosed type 1, honeymoon ending LADA not producing enough insulin, forgotten to take your insulin, on drugs such as SGLT2, ill and not following sick day rules to take extra insulin) you can run the risk of DKA, where you can no longer clear ketones away, and your ketones rise above 3mmol/l and spiral up to 25+ causing your blood pH to change.
You should have a blood ketone meter to check your ketones if you are ill and have high blood sugars for an extended time, and you should be following sick day rules to stay safe.

Thank you so much for explaining. My blood sugars are rarely over 13. They are generally 6 or 7 fasting. 6-8 post meals. If I get a spike it’s more of a 9/10 very occasionally than 13 as am low carbing. Last c peptide was 470 in March. So unless I am ill or running high I should be ok even on 30-40g of carbs? As my hba1c is going up slightly at 50g.

Are you on insulin now with your low carb diet?

Thanks for your explanation.

 

[Millie74]

How would I get a ketone meter? Is it finger prick too?

 

[ert]

Thank you so much for explaining. My blood sugars are rarely over 13. They are generally 6 or 7 fasting. 6-8 post meals. If I get a spike it’s more of a 9/10 very occasionally than 13 as am low carbing. Last c peptide was 470 in March. So unless I am ill or running high I should be ok even on 30-40g of carbs? As my hba1c is going up slightly at 50g.

Are you on insulin now with your low carb diet?

Thanks for your explanation.

I stayed off insulin for as long as I could but ended up on insulin overnight a year ago after my blood sugars finally wouldn't drop below 13 mmol/l through extreme diet and exercise.

 

[ert]

How would I get a ketone meter? Is it finger prick too?

In the UK the GP's give them to LADA/Type 1's - the GlucoRX HCT. It's a glucometer and ketone metre, as it has two different types of strips (one for BS and the other blood ketones) that you insert into a monitor and collect a droplet of blood on the end. You use the same lancet device as you do for testing your BS.

 

[Millie74]

In the UK the GP's give them to LADA/Type 1's - the GlucoRX HCT. It's a glucometer and ketone metre, as it has two different types of strips (one for BS and the other blood ketones) that you insert into a monitor and collect a droplet of blood on the end. You use the same lancet device as you do for testing your BS.

 

[Millie74]

Great thanks for the info. Interesting that it seems to give up overnight in some instances. Mine used to drop well at times with the low carb and diet. Last week not been under 7 at all. Tonight it’s 8 on konjac noodles that are virtually zero carb. Do you test for ketones or get advised to as low carbing?

 

[Millie74]

I stayed off insulin for as long as I could but ended up on insulin overnight a year ago after my blood sugars finally wouldn't drop below 13 mmol/l through extreme diet and exercise.

 

[Millie74]

How do you find it on insulin?

 

[ert]

How do you find it on insulin?

I fought so hard to stay off insulin. For me, when I had no choice but to take insulin, it stopped being the elephant in the room, the thing larger than life, the worse thing in the world and faded into the background. The variability - not being able to get repeatable results, is hard at first. But having a Libre and Miao Miao made it so I don't need to think about my BS's, the technology follows the numbers for me and signals if there are any changes I need to respond to.

 

[Millie74]

I fought so hard to stay off insulin. For me, when I had no choice but to take insulin, it stopped being the elephant in the room, the thing larger than life, the worse thing in the world and faded into the background. The variability - not being able to get repeatable results, is hard at first. But having a Libre and Miao Miao made it so I don't need to think about my BS's, the technology follows the numbers for me and signals if there are any changes I need to respond to.

 

[Millie74]

The libre sounds great. Hope I can get one. Teach dance for a living and worry about hypos. I woke up early today as was starving after the zero cal and carb konjac noodles last night. I had breakfast at 5am. 2 livlife slices of low carb bread (7.6g carbs for 2 slices) now 12.1. It seems to be failing me all of a sudden. Despite my efforts. Appreciate the advice. Probably fearing the unknown.

 

[Rokaab]

In the UK the GP's give them to LADA/Type 1's - the GlucoRX HCT.

Though some doctors will not without instruction from your hospital/consultant - mine wouldn't - it's probably down to the CCG's rules for the area.

 

[lessci]

The libre sounds great. Hope I can get one. Teach dance for a living and worry about hypos. I woke up early today as was starving after the zero cal and carb konjac noodles last night. I had breakfast at 5am. 2 livlife slices of low carb bread (7.6g carbs for 2 slices) now 12.1. It seems to be failing me all of a sudden. Despite my efforts. Appreciate the advice. Probably fearing the unknown.

It may seem contrary to everything you've been taught about "healthy" eating, but if you're low carbing you need to get your calories from other sources, fat is the answer without it affecting your BG's, Avocado, tree nuts, olive oil, cheese if you're feeling really naughty pork scratchings, You don't need a lot as they're nutritionally dense foods, and help you feel fuller for longer

 

[Millie74]

It may seem contrary to everything you've been taught about "healthy" eating, but if you're low carbing you need to get your calories from other sources, fat is the answer without it affecting your BG's, Avocado, tree nuts, olive oil, cheese if you're feeling really naughty pork scratchings, You don't need a lot as they're nutritionally dense foods, and help you feel fuller for longer

 

[Millie74]

Yes. Should have added protein or fat. Not sure why I forgot. Have found some weird alternatives to pasta etc in the konjac noodles and got carried away.