First Time Extended Faster Worried over low Blood Glucose

(John W Hawkins) #1

I am having to prep for a colonoscopy and decided it would be just as easy to do my first water only fast instead of the liquid diet they outlined.

I am currently on hour 54, procedure is tomorrow but had planned to go until Wednesday.

Everything has gone fine except for being cold, but out of curiosity I decided to check my Glucose and Ketone reading and they came back as Ketones 3.2 and Glucose of 26. I thought there was no way that was accurate so I tested it again with another meter and it read 31.

I was a type 2 diabetic many years ago before radically changing my lifestyle. I have been Keto for a year and fat adapted. I IF 18/6 every day.

Do I need to be concerned with readings this low ? do I need to seek medical attention ? I still feel fine.

(bulkbiker) #2

How old are your test strips?

(Karim Wassef) #3

I’m running into the 30s on my extended fast.

Are you exhibiting any hypoglycemic symptoms?

  • Shakiness .
  • Dizziness .
  • Sweating .
  • Irritability
  • Anxiety
  • Headache

I would add slurred speech and general confusion.

If the answer is NO and your ketones are high (over 3), then you’re fine. I’ve been there (n=1).

(Doug) #4

If you feel fine, that’s an important indication. My totally non-doctor opinion is that being in the 30s during extended fasting is relatively low, but not uncommon, and not necessarily to be worried about. If the 26 mg/dl (a hair less than1.5 mmol/L) is accurate, then that’s getting into a dicey area. Getting down to 18 or 1.0 is a real danger sign, again - in my opinion.

(John W Hawkins) #5

I am not experiencing any symptoms, so I will not worry. Thank you all.

The test strips are maybe a month or two, I keep on hand for the just in case.

(Herb Martin) #6

I think symptoms are the key (or lack of them.)

Also, watch out for electrolyte imbalance. I keep both sugared electrolyte (which I never drink) and sugar-free electrolyte on hand while fasting (and pretty much all of the time.)

You can make this cheaply with salt substitute: potassium and regular salt.

Preferably keep these close. If you have the serious symptoms of low-sugar drink some of the sugared one.

If you just feel crappy try the non-sugared electrolyte and keep your fast going.

You must decide what is safe FOR YOU, but do NOT neglect serious symptoms.

(Claire) #7

I saw my diabetic consultant last week as I’m type 2 diabetic He’s fully supportive of going keto and is monitoring me. He’s even considering rolling the keto diet out to patients with pre-diabetes to prevent diabetes developing. I asked specifically about the numbers as I’ve been getting lower blood glucose levels and he said if you go under 4 it’s classed as a hypo and not to go to bed under 6.5. The ketones optimum level for weight loss is 1.5 to 3, but diabetics run the risk of diabetic ketoacidosis which is very dangerous so he asked me not to go over 2. This is just his opinion but as I say he is very supportive so he’s just trying to do his best for me, and keep me safe on the keto lifestyle. Good luck x

(bulkbiker) #8

What meds are you taking? your consultant sounds a tad behind the times and ill informed…

(Claire) #9

Why do you say that? I’m in the uk. Does your consultant say differently? He seemed very up on it all to be fair. Explained keto in the same way they do on here. He suggested changing my old meds to newer ones that are out. I take metformin which is an old one of course, I was on daily victoza injection and there’s a newer weekly one out which I’m changing to. I’m just passing on my info and thoughts the same as everyone else to give a balanced view.

(bulkbiker) #10

DKA is fairly rare in T2 unless taking certain medications of which I’m fairly sure Victoza isn’t one.
If he doesn’t want you to hypo then surely the best thing to do is remove blood glucose lowering medications… how did he suggest you got above 6.5 before bed?
I have never seen a consultant about T2 but am in remission through keto diet alone.
What I meant was if he wants you to do keto then it might be an idea to remove all meds as the dietary impact on blood sugar can be quite dramatic.
What were your last HbA1c results?

(Claire) #11

I’ve only been doing keto for a few weeks so they will take me off victoza, or the new replacement, when I’m getting too low. I have my next hba1c in 6 weeks. Last one I had was 51.8, and as I can see my readings going into the 5’s I know this time it will be lower. They suggest staying on metformin as it protects from hypos. I just want to stay safe, so I asked him the question about glucose and keto levels. Staying within his figures doesn’t mean I can’t do keto lifestyle, he’s all for it, , It just means I’m doing it safely and I wanted to share that with the gentleman who asked the question. In the uk there’s a lot of opposition to low carbing and keto in the NHS so I’m delighted to have found one that’s pro.

(bulkbiker) #12

I’m in the UK too and am in fact off to a meeting at my surgery this afternoon to try and push for a Low Carb approach for patients here.
Sometimes it’s like pushing water uphill.
Very impressive that your doctor is pro keto but it sounds like they aren’t very experienced in it so I’m slightly concerned that you aren’t getting the best info.
Metformin doesn’t protect against hypos but it is very hard to go too low when taking it. If they are putting you on a keto diet then metformin should really be all you need (if you even “need” that) so in your shoes I wouldn’t go onto the new injection just come off the Victoza. With a 51.8 mmol/m HbA1c level you are probably going to be quite close to being in remission anyway especially if you are seeing bloods in the 5’s so the extra injection should be unnecessary.

(Herb Martin) #13

My wife was getting very sick on Januvia due to what we interpreted as low blood sugar.

I don’t think it was DKA (at all) but this was happening at what I now believe to be reasonable glucose levels though low (50-70-ish).

She would develop sweats, confusion, extreme weakness, significant discomfort until she restored her blood sugar. (She’s off Januvia and doing fine, no low or excessively high blood sugar excursions on paleo initially and not keto.)

Do you have any idea if these low blood sugar events are serious (beyond the obvious) or related to DKA or anything else?

(Karim Wassef) #14

The big unknown is ketones. If glucose is low and ketones don’t rise to compensate, that’s a real problem. Ketones cross the blood brain barrier directly and can mitigate the impact of low glucose. Not a doctor, but that’s definitely been my experience.

Any time there’s low energy availability to the brain, that can starve brain cells. Excessive alcohol can have a similar effect, so it’s not the end of the world but it should be avoided.

https://pubs.niaaa.nih.gov/publications/aa63/aa63.htm

(Herb Martin) #15

Just last night I read something near the end of Dr. Boz’s book about this.

She was very clear that it was a problem to take blood sugar way down without first allowing your body to become fat (ketone) adapted during at least 2 weeks of ketogenesis. (IIRC).

If tissues do take time to “switch” then this makes sense. You much allow enough tissues to switch over so the remaining low levels of glucose are sufficient for the brain and other critical organs that have not yet made the transition sufficiently.

(bulkbiker) #16

I think that any artificially lowered blood sugars may be “odd” for the body especially if used to higher readings most of the time. If they were short term and no longer a problem then I’m guessing there probably wasn’t any long term harm. DKA is high blood sugar and high ketones combined so shouldn’t have been a problem.

(Claire) #17

Yes you’re right, I didn’t quite describe that right about the metformin. That’s my skewed interpretation of what she said, but it’s the way the drug works that means your less likely to have hypos. It’s so much to take in but I am indeed lucky with both my GP and the consultant. Hope you get on ok with discussions with yours for low carbing.

(bulkbiker) #18

I’m educating mine about low carb not the other way round! I’ve been doing this for over 3 years. Trying to get the surgery to adopt a low carb approach for other patients. Trying to get a group of newly diagnosed together to try non medical diet only treatment. Luckily the NHS is finally starting to wake up to the benefits of low carbing but it sure is a struggle.

(Claire) #19

Yes, I meant I hope you got on ok trying to educate your doctors. I need to be clearer on these lists lol

(bulkbiker) #20

No worries… yes we seemed to make a bit of progress today I seem to have the area Diabetes Nurse on side so we just need to get at the doctors… There is still such a bad understanding though in the medical profession generally and they are so resistant to change!
I’m so lucky that I have my own personal results to show them which as they did all the testing themselves they can’t really question…