Does a healthy ketogenic diet cause irreversible insulin resistance?

(German Ketonian) #42

That’s the issue: is don’t have a pre-diet benchmark, because I’ve never worried about it. But since T2D runs wild in my family, I switched to the keto diet (and for other reasons, obviously). I just wonder what my doctor will tell me tomorrow. I think if all indicators (HOMA, HBA1c, fasting insulin) come back low, I will breath a sigh of relieve somewhat. I might be upping my carbs in the evening and see if that lowers the dawn effect at least. I think having elevated BG levels during the day might be normal (for reasons of the body staying “aware”), but the morning and fasting readings really disturb me.



Yes that’s a tough one without knowing earlier numbers. Please keep us posted when you get your results!


This is exactly what I’m wondering. It might be that we understand the mechanism, and that it all makes sense and isn’t the usual path of insulin resistance - but from what (little) I understand about blood sugar, it does seem like lower circulating levels of glucose are better.
You’ll let us know your A1c when you get the results?

(German Ketonian) #45

Will do, guys and gals! Thanks for the support and encouragement!


Even if that is true which I have no idea, the people in question had fasting sugars in the 140s or 200 and that was on insulin or other medication. If after 10 years keto someone who was previously on insulin is at 110 without meds, not horrible



Agreed so long as this creeping up of blood sugar doesn’t continue and take them back to their pre keto levels. This is a very important point and question. Alas we live in a time when these things have not been well studied.

(VLC.MD) #48

To that I reply … KCKO.

(VLC.MD) #49

Have you ever had an A1c ?


This depends on who you are. If you are 30 and have 20 lbs to lose but have a fasting glucose of 80 while eating SAD, then perhaps this might not be the diet for you if you are concerned that this article is correct (again I have no idea).

The vast majority of people on here are not in that category, they either have 100 lbs or more to lose, are over 40 and possibly over 70 and have fasting blood glucose that indicates they are T2 or at least PreT2. Lets face it, if you lose 100 lbs on keto, you are not eating carbs again and if you do, chances are you will gain everything back so whether or not you can metabolize carbs does not matter. Same with the 70 year old diabetic, conventional treatments are worse and will result in weight gain from insulin and eventually some type of diability due to kidney or heart disease or worse. Modern medicine views T2 as a progressive irreversable disease. If keto puts it into remission or even just halts the progression for 10 years, that is huge

Take the example of someone I know, he is 79 and a year ago had an A1C of 8.4 while on sulfonurea. With better low carb dietary habits he got it to under 6 without medication. Even if 10 years from now his A1C goes up somewhat, he still had 10 years of unmedicated T2! Thats 10 years of avoiding further kidney decline, decreasing his risk of heart attack and so on

(German Ketonian) #51

OK.just got back from my doc. Here’s what I got:

Fasting blood glucose [mg/dl]: 103

HbA1c [%]: 5.0

Homa-Score [Index]: 1.4

Fasting insulin, basal [μIE/ml]: 5.34


Thanks for keeping us posted, Zimon!

I don’t know enough about fasted insulin levels (or Homa) for those numbers to mean much to me, but how can you have low A1C if your glucose readings tend to be high? You’re not the only one who has this but I just don’t understand how that works…

What are your thoughts? Are you relieved?

(German Ketonian) #53

Can’t tell if I’m relieved or not. According to my doc, my results are OK, but not optimal. I just don’t know what to make of it. He said I was somewhere in no-mans-land in between normal and pre-diabetic. My fasting blood glucose readings I told him about worry him. However my insulin level is very low, he said. My HbA1c is not low but rather mid-ranged. It’s a mixed bag, I think… not really shedding light on my most burning questions (1) if I am insulin sensitve or not, that is whether my high BG readings are really just a function of keto adaptation and (2) whether high BG readings are harmless and a healthy response as it relates to keto adaptation.


This is confusing!

HbA1C looks rather low to me by US standards, though I realize that what’s normal for human beings is kind of hard to know these days … In any case, I’m still wondering how you get an average of 5 (which is 90, right?) when your readings tend to be so much higher throughout your day.

You’ve read Chris Kresser’s blog post series on fbg/A1c/GTT and how we can have such different readings? It’s not geared toward your situation in much detail but he often has links that are really useful. (Disclaimer: I haven’t read it recently so I’m not sure it it will be helpful to you…)

(Todd Allen) #55

One possibility is shorter than average red blood cell life span. If they don’t live long they don’t get as glycated. Another possibility is his blood sugar was higher than normal when tested. It can go up and down quite a bit for a wide variety of reasons.

(Nicole Sawchuk) #56

This topic fascinates me. My BG’s are creeping up as well the past month and I’m trying to understand why as my diet has probably gotten cleaner and better.

For right now I am just keeping an eye on things but loving the discussion and the various points!

(German Ketonian) #57


(Todd Allen) #58

Since you eat strict keto I wouldn’t expect a lot of variation between fasted or eating. At least not with short daily fasts. I get a significant drop on my 3rd day of fasting and I think most people do within their first week of fasting. And if you eat more carbs I’d expect it to go up though there are exceptions.

(VLC.MD) #59

A1c of 5.0 is fantastic.
Great news.
Zero diabetes !
You are in very great health and I know you’ll enjoy the relief you got of such good news !

Congrats !!!
Enjoy the relief.

(Take time to smell the bacon) #60

I’m confused a bit by the intense focus on serum glucose level in this thread. Isn’t the point of the whole exercise to keep our insulin down? Who cares about glucose if insulin is okay? At least that was the whole point, I thought, of the blog post we were discussing at the top of the thread. He ends by asking “Am I worried about an insulin level of” whatever it was and answers by saying, “No, not when my HbA1C is” (whatever).

If our serum glucose is a little high because the rest of the body is using ketones and saving the glucose for the brain processes that require it, isn’t that what we want to be happening? Why is this so worrisome? I believe it was Amber O’Hearn who wrote in an article that I recently read about the danger of getting fixated on a marker, instead of concentrating on the process it’s a marker for. Dr. Phinney mentions in one of his lectures that half his job at Virta Health is to discourage the employees from competing to see how high they can get their ketone levels, since the point is not to have high ketone levels but to be fat-adapted and ketones are just a marker for that. (In fact, he said he tells them it’s okay to compete at the office, but they must never convey even a hint of that competitive attitude to their patients.)

So again, apart from the bacon, isn’t the point of being keto to be eating in such a way as to keep insulin low, and isn’t the point of keeping insulin low (a) to allow fat to be metabolized instead of stored and (b) to keep the insulin from causing inflammation all over our bodies? If not, then I have grossly misunderstood what the scientists and physicians who are promoting a ketogenic way of eating are talking about and might as well start listening again to those glazed doughnuts that keep calling my name.

(Todd Allen) #61

Serum glucose is easier to measure than insulin. And in general insulin follows serum glucose. If glucose rises insulin does too, assuming one isn’t severely diabetic with a failing pancreas.