Fasting glucose and Kraft tests

(Utility Muffin Research Kitchen) #1

A technical question, as there are so many helpful knowledgable people here :slight_smile:

(1) Is a fasting glucose of 110-120 normal for someone on a ketogenic diet, after a 14h fast? I know about the dawn effect, but this is in the middle of the day and looks a bit on the high side to me. What normal range would you expect (for someone still losing weight)?

(2) Is there a variant of the Kraft test using only glucose measurements? The test is unknown over here in Germany, and fairly expensive because it requires several insulin measurements. As I’m trying to advise a few people who might be insulin resistant or not (talking about potential TOFIs) I wondered if something could be done with a glass of sugary water and a device to monitor blood glucose…

Background:
I never measured blood glucose, because I transitioned from ignorant (undiagnosed prediabetic with a 5.7 HbA1C) to low-carb and later ketogenic (5.0 HbA1C, HOMA-IR still at 1.7). So after a year of low-carb/keto I’m still insulin resistant.

However, I tried to transition to Carnivore and found that I got hungry and had to eat twice a day (compared to once a day with moderate-protein keto), so I wonder if I belong to the people who kickstart their glycogenesis with protein. (I know Dr. Bikmans talk that there is little insulin response to protein on keto diet, but there are case reports on diabetic patients reacting different, and I was wondering if I belong to this group.)

Anyway, I finally got a cheap device to measure blood glucose, and naturally wonder where I could learn more about expected glucose levels. (I’d prefer to monitor insulin, but I don’t know any cost-efficient way unfortunately.)

A calorie is not a calorie. But why?
(Bob M) #2

You could test your response to protein by eating some “protein”, then testing. I would test at least every 15 minutes. I say this because I wore a continuous glucose monitor for a while, and my “high” levels only last about one hour, then my blood sugar is back to where it was.

Can you get the Free Style Libre Continuous Glucose Monitor over the counter (without a doctor’s prescription)? I got my original one from Sweden. If it’s not too expensive, this is much easier than taking pin-prick blood sugar readings.

Unfortunately, for a Kraft test, you need insulin. You could do a two-hour test with glucose and insulin measured before taking a glucose drink, 1 hour afterwards, and 2 hours afterwards. This will give you a really good idea, and is not as long as the 5-hour, true Kraft variety.

110-120 might be high. Did you exercise before that (exercise causes higher blood glucose).

You also have to be aware of this pattern:

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See how my blood sugar goes up until about noon, then goes down? That’s normal for me.

(Utility Muffin Research Kitchen) #3

That’s the plan. With Christmas, family and whatever my eating pattern is a bit different than usual, so all I’m doing right now is establishing a baseline.

Yes, I could get it. But I consider glucose a value of limited interest because insulin is what we should monitor, so I just got a cheap device. And insulin sensitivity should return with time, so whatever I see now might look different in 2 years so it will have little therapeutic consequences. But I had no idea that a continuous sensor is that cheap, otherwise I might have bought this one :slight_smile:

No exercise, just computer work. But glucose values can go up if we transition to keto, my fasting morning glucose was always around 95 when I still ate carbs but has went up to ~105 with keto. (HbA1C dropped from 5.7 to 5.0, so I don’t worry about that.) Still, it’s high enough that I start to wonder.

But I guess we simply haven’t enough data for people on a ketogenic OMAD regime to establish what is normal :slight_smile:

(Bob M) #4

You have to watch with HbA1c, which varies. That is, you and I could have the exact same blood sugar, but we could get different HbA1c values.

I usually have blood sugar near/above 100 in the morning, but then it drops after about noon. If I do a ton of “exercise” (including just working on the house), it can stay high the whole day, over 100. If I sit in my office all day, it’ll be much lower.

The Free Style Libre allows you to really learn your patterns. It’s a lot easier to use than pin-prick varieties. It can cost $65-$75 (US)/month, though I went to a place in the US, and they wanted $70 for a single sensor (two weeks).

It’s really too bad we don’t have an insulin meter.

(Utility Muffin Research Kitchen) #5

Exercise is out of the question as I have ME/CFS. If I take a walk (the best I can do) my blood sugar seems to fall below 100…

I still wonder. Obviously glucose can tell us only if our pancreas can still produce enough insulin, but the oral tolerance test ist done using glucose. Certainly we should see different glucose patterns too if we do the Kraft test, shouldn’t we? I’m still looking for some DIY test for insulin resistance, complementing HOMA-IR (which is covered by insurance over here)…

(Bob M) #6

You will see different glucose patterns, but that’s only half the story. See this:

(Utility Muffin Research Kitchen) #7

Yes, I’ve been arguing for a long time that glucose monitoring is useless unless you’re one step away from a failing pancreas :slight_smile:

But the issue here is practicality. The Kraft test is completely unknown over here, and it’s nearly impossible to convince a doctor to do what you want even if you know exactly what you’re doing. (Gods in white they’re called, and that’s how they behave. They don’t care what mere mortals want.)

I have a few friends that I suspect to be TOFIs, and there is simply zero chance to convince them to (a) find a doctor that does the Kraft test and (b) pay for it. So it seems natural to ask if we can do something with glucose, which costs a just few cents and is easy to do if you know someone who is diabetic (or has a glucose monitor anyway, like me).

As to myself, I would certainly be interested to see how my Kraft test looks, but not enough to go through the hassle of obtaining it. I know that I was prediabetic, I know that I’m improving, and I may do a Kraft test once my HOMA-IR has dropped below 1. It would be interesting to know how Kraft pattern are changed by a low carb diet from a researchers point of view, but I won’t do a n=1 experiment here. (We know that low carb does treat metabolic syndrome, so the situation is different then say a calcification score where there is no proven way to lower it, and we simply need the baseline and followups to check if our therapy works.)

Interesting though is the suggestion to carb up before the test in that link. A week, really? This shouldn’t be necessary with metabolic flexibility. I’ll have to do some reading on the second meal effect. I never realized that (again) only glucose is measured while the more relevant insulin levels are omitted. Does the second meal effect simply come from “exhaustion” of the pancreas from the previous meal, that has trouble fabricating the required amount of insulin to control blood glucose? Is the second meal effect even a thing for insulin sensitive low carbers with a “rested” pancreas? Ah, questions, questions, questions :slight_smile:

(Bob M) #8

I got a short OGTT with insulin done. I did not carb up. Here are my results, below. They were supposed to take glucose at before, 1 hour, then 2 hours, but they only took before and at two hours:

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You can see based on that webpage, however, that both my blood sugar and insulin responses are normal. The “glucose” column is the “real” test done by taking blood at the testing facility. The other two are my own tests, one a CGM, the other a pin-prick monitor.

This shows the results from my CGM. I had the test early Saturday morning, January 20th. You can see a pretty normal rise and fall for glucose.

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(Victor Larsen) #9

Some observations for you, not scientific anecdotal.

I’m a T1 diabetic bee doing keto for aprox 1 1/2 years and very pleased with the great results I’ve gotten.

Observations: prior to keto when planning my insulin shot prior to a meal the only factor I considered was the carbs I would be consuming, protein was a non issue as far as I was concerned. In point of fact if for instance my blood glucose normal and I was having only a meal like bacon & eggs I would not shoot insulin at all and 2 hours+ later I would still be ± 1 point of my original reading.

Post Keto: I now have to shoot something even for a meal like bacon and eggs (no carbs) because it can raise a normal reading up 4-5 points. Also an interesting effect for me is exercise, if I go to the gym in the morning with a fasting glucose of 5.4 not consume anything not take any insulin work out for1 1/2 hours and come away with a BG of 8.9 all without having consumed anything? By the way before keto I would never have gone to the gym without consuming something because it wasn’t safe and I would/could go low…
Probably raising more questions for you but because of my diabetes I keep a very close eye on my BG.

(Bob M) #10

Even though I"m not diabetic (T1 or T2), I also get a blood sugar rise after/when working out. I even get a blood sugar rise if I do a lot of work around the house, when my blood sugar can stay >100 all day long. Normally, I’m around 100 in the morning, then it falls after about noon to the low 80s or so. You can see that above, where I started at 5.8 (= 104.4) then got down to 4.3 (= 77.4). I think this is basically my body trying to replace glycogen stores in the muscles, and potentially for other reasons not clear to me and my knowledge.

(Cancer Fighting Ketovore :)) #11

Yes, but look how high your glucose shot up, around the 1 hour mark. How much glucose did they give you?

(Bob M) #12

75gm.

(Bob M) #13

According to this, I have a normal response at 2 hours:

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They don’t say what the “height” should be.

(Victor Larsen) #14

Absolutely it’s my glycogen store dumping back to offset the demand for exercise and because I don’t produce insulin to offset it nor had I shot any(which would be a risky thing to do), but the observation I’m making is that in my mind it’s a lot, it was very rapid. And pre-keto it wouldn’t have happened.

Being in ketosis seems to have altered physical responses radically and now I am going through a whole new education in how to deal wit my diabetes (but in a good way).

(Bob M) #15

It would definitely not have happened, pre-keto. Your body “knows” that it’s not relying on fat, so wouldn’t need to make glucose. I believe one function of insulin is to shut off the liver from making blood glucose. If you aren’t making insulin, then nothing shuts off the liver, and in fact exercise probably causes a request for the liver to make more blood sugar. (This is likely what happens in my case, which is why my blood glucose goes up.)

I’ve seen people on Twitter who are T1s, who have lower HbA1c values less than mine and who are keto. And they use a lot less insulin while keto, sometimes close to none.