Feedback on Wife’s Glucose & Insulin

(Danny) #1

Hey all,

This community has been very informative for me in my keto journey and my wife has come along with me on said journey. She just had her first blood panel since starting a couple months back and things look generally good/normal. But we’re unclear as to whether her fasting blood glucose and insulin levels are too low or not and would like your thoughts.

Total Cholesterol = 282
LDL = 186
HDL = 76.5
TRIG = 99
ApoB = 149
Glucose = 60
Insulin = 1.69

Note that this was after a roughly 16 hour fast and an intense Orangetheory morning workout but, nonetheless, those glucose and insulin figures are lower than I feel like I typically see, even on keto.

Plus, of course, the doctor raised concern about them and asked if she’s had symptoms of hypoglycemia. But, funny enough, had no elaborate commentary on the cholesterol numbers (just marked them “H” for high which is to be expected) and even called her ApoB in range.

(Joey) #2

Not really seeing a problem here … unless she ever feels symptoms of “low blood sugar” - in which case eating something (e.g., an egg) ought to give her system something to refuel with.

(Bacon is a many-splendoured thing) #3

Sixteen hours of fasting, plus intense exercise before the blood draw? No wonder her glucose was low.

Obviously, if she were experiencing symptoms of hypoglycaemia, that would be one thing, but with ketones to feed the brain in lieu of glucose, there isn’t any problem that I can see. If the doctor is really worried, then tell him or her to read “Starvation in Man,” by George Cahill and his people. At one point in their studies of a group of fasting subjects, they used a hyperinsulinaemic euglycaemic clamp to drive the people’s glucose down to levels that normally cause coma or death. But they were fine.

As Dr. Stephen Phinney likes to joke, “The only people sweating and trembling were the ones in the white coats.” I always feel obliged to point out that this was a highly unethical experiment, even back in the 1960’s, and no institutional review board in its right mind would permit such a thing, these days. But Dr. Phinney says they did report on the experience, though they buried it in the back of the volume.

(Bob M) #4

I’ve never seen my blood sugar go down after exercise. It has always gone up, even when fasting 36 hours (though the starting point is lower when fasting that long).

Though I wonder if I have overactive glucagon (makes blood sugar go up)? Or something like that?

I don’t think either the blood sugar or insulin are a problem, unless there are actual hypoglycemic symptoms (shakiness, etc.). I’ve seen people who have gotten into the 30s while fasting, with no symptoms. (If you were to take ketones, these would probably be high.)

(Joey) #5

If you’re a long-time carb-restrict’er (which I understand you are), then your glucose response to exercise will differ (viz., gluconeogenesis) than a heavy carb-eater.

The difference in how high-carb vs low-carb athletes need to refuel to replenish serum glucose is a good illustration. Without “fueling up,” some run into the wall, some just run over the finish line.

(Bob M) #6

That could be true. I never started taking data until I was well into keto (a few years), and you really need a CGM to see any real trends.

It would be useful to test a lot of people and see if this always (or nearly always) happens over time. Or am I an anomaly?

And this brings me to a (yet one more) thing I don’t understand. You exercise on a empty stomach in the morning. Only coffee, either black or with a small amount of cream. Your blood sugar goes up:

  1. Why?
  2. How?

I assume the “How?” is the liver kicking out blood sugar. Anything else?

I don’t really get the “Why” though. What is the body trying to do? Where is the higher blood sugar going? I assume for at least some glycogen replacement, but if you work out once a day as I do, can’t you make that up over time? Is there a need for the body to crank up glucose?

Before I got a CGM, I had just assumed blood sugar would go down, as that’s the way it’s portrayed everywhere: you exercise to lower blood sugar. (And this might be true for high carb folk.) And there are no studies of us long term low carbers showing what happens during exercise. Or at least none I could find.

Though I did find this, which is interesting:


Not even remotely surprising given 16hr fast then an Oranagetheory class. You don’t eat for almost a day, then do a glycolitic workout with no fuel in the tank. Not sure what the cholesterol would have been, but it was most likely not as bad as the numbers you got, especially the trigs.

(Bacon is a many-splendoured thing) #8

The triglycerides should have been very low, after all that fasting. It’s carb intake that the triglycerides come from. But in any case, look at the ratio of triglycerides to HDL: 99 / 76.5 = 1.29, which is fantastic. No insulin-resistance there!

(Danny) #9

She fasts for about that same amount of them ever day. We eat dinner around 6pm and she doesn’t eat anything until about 10am the following day. As for Orangetheory, she went at 5am and didn’t get her blood drawn until about 10am. Not sure if the impact from an intense workout would still have the same affect after that long, if the time gap even makes a difference.

(Joey) #10

The “why crank up glucose?” answer would seem to be that the muscles (including the heart) are demanding more fuel through exercise (i.e., healthy stress). So it’s our miraculous capacity to provide what’s needed in the moment.

As for why not just “make it up over time” instead of in that moment of stress, I guess you haven’t successfully convinced your body that very shortly you’re planning to take the rest of the day off - so it doesn’t have to bother with that whole gluconeogenesis thing. :wink:

FWIW, I’ve found exercise can make my glucose level either rise or fall, seemingly dependent upon how strenuous/aerobic my exercise is. Rowing/jogging seems to produce different effects than HIIT body strength training. :man_shrugging:

(Michael) #11

(Michael) #12

Here is the one I was originally looking for

(Bob M) #13

Ok, I have to say that Peter Attia’s results do not, will not, and cannot apply to me. For God’s sake, this was his cycling:

“This was a tempo ride covering 104 miles (167 km) with 5,600 feet of climbing. Average pace was 17 mph (about 28 km/hr) with lots of headwind.”

When I was cycling, it took me over 8 hours to ride 100 miles. I averaged 12 miles an hour. It took him 6 hours with 5,600 feet of climbing and headwinds. That’s nearing elite-caliber riding.

He’s nowhere near obese and has very little fat on him. I’m still obese. He’s in way better shape than I am. I’ll never be anywhere near the shape he is in.

In fact, this post by him was one of the (many) reasons I stopped listening to him. It’s really only applicable to people like him, and I’m nowhere near him.

I just jogged on the treadmill this morning, 20 minutes. While I did not test beforehand, my blood sugar was over 120 afterwards.

I have yet to see any occasion where my blood sugar goes down for ANY exercise, including just working on the house. I could be wrong, maybe when I go walk the dog after eating dinner, my blood sugar goes down. I’ll have to remember to test. (The benefit to a CGM is that it tests for you.)

Now, it could be that there’s something different about me, and I’m an anomaly. But we’d need obese (but muscular) people who have been keto for 9+ years (or at least years) and who exercise to tell. Some younger, non-obese freak of nature like Attia should not apply, because what happens to him likely does not happen to me.

(Danny) #14

I feel like we’ve strayed a bit off topic here. Should we split these into two different threads?


Total other way, I’ve done it a handful of times at this point, go in really fasted, terrible results. Go in with normal fasting (timeframe) comes out great. The more fasted you are, the more fatty acid stores are being released for fuel. Add in a workout to that and you put gas on the fire.


Remember this guy??? Sounds like a Commander McBragg moment to me!

Yup, he’s a really lean small framed guy with minimal muscle, yet I’ve also heard him go on about a bunch of complete nonsense when it comes to muscle building. I stopped listening to him a long time ago over that crap. He also talkes a big anti aging game, yet refuses to break conflicting mainstream medicine views on a lot of things which is incompatible with half the stuff he promotes.

(Bacon is a many-splendoured thing) #17

If you can see a wrench to the left beneath the last reply, then have at it. Otherwise, if you could give me the post numbers, I can move them.

(Alec) #18

Bob, my opinion is this is what I would expect. I think a carnivore body at rest will have pretty low blood sugar. But as soon as you start cranking up the exercise, I think the body says “Eyup! What’s he doing, he might be going for a long time… we’d better start cranking up the blood sugar to feed the muscles he’s using!” Cue gluconeogenesis at an appropriate level to feed the muscles.

When you stop, does some of that sugar remain, or does the body keep making glucose a little after you’ve stopped, my guess is yes… hence your 120 blood sugar. This is really not high, just higher than it normally is under carni. I am sure it would drift downwards pretty quickly… you have done some exercise to empty some space in the muscles, that glucose should get converted to muscle glycogen pretty quickly.

Your wife’s numbers are awesome. Nothing to see here… :+1::clap::clap::clap:

(Bob M) #19

I can see where we diverted from the main topic. Sorry about that.

(Danny) #20

No worries! Was more thinking a separate thread for you might lead to more insights/responses. But I’m not concerned about it if you aren’t :slight_smile: