Glucose sparing?

(Tony H) #62

I just got off the phone to my GP having requested a blood test to look at my fasting insulin levels. I was told they dont do it and that they only look at HbA1c. She tried to tell me it’s basically the same thing. Anyone else in the UK found this? I have been referred to endo who I am assuming have the capacity to look at this but that may be a few months. My concern is that they will do a MMTT and I will just fail and be labelled diabetic due to me being on keto. I have read quite a lot about Physiological insulin resistance and how apparently it goes back really easily once you start to eat carbs again which was certainly not my experience. Whenever I eat any reasonable amount of carbs I feel very sick, muscle weakness and brain fog. So much so I felt I had no choice but to go back to keto. I am on day 5 of keto now and those symptoms have cleared up so I feel much better but long term my aim is to get my weight off and return to more of a balanced diet. Maybe I’ll change my mind in the mean time maybe I wont, we’ll see. The main reason for being alarmed about not being able to switch back is cus apparently it’s very easy so why wont my body switch back? My HbA1c as of last month was 5.1 so Im nowhere near diabetic but I am 50 lbs overweight. The only thing I could think of was that If I throw in 150g carbs but continue to eat 80g of fats then my body will choose the fats and leave the glucose with nowhere to go?

(A fool and his bacon are soon parted) #63

Not sure what an MMTT is, but it sounds as though you are talking about an oral glucose tolerance test (OGTT)?

This is not clear. What are you referring to, by the phrase “switch back”? Cells never lose their ability to metabolise glucose, if that’s what you are talking about. On the other hand, their ability to metabolise fatty acids does get shut down from lack of use over time. The brain fog goes away as soon as you get back into ketosis, because ketones are now feeding the brain again, but your skeletal muscles might need some time to readapt to using fatty acids in place of glucose and ketones (this is called “adaptative glucose-sparing” and “physiological insulin resistance,” the latter term being rather confusing).

Your doctor is right that HbA1C is a better overall marker of diabetes (though it isn’t perfect), so I’m not sure why you feel the need of a fasting glucose test. Try asking her for a continuous glucose monitor, and see what she says. Does the NHS give people the option of paying for certain things out-of-pocket, or would you have to try to see a private physician?

The last sentence is also confusing. If 150 grams of carbohydrate is enough to push your insulin above the fat-storing threshold, then both the fat in your diet and the excess glucose resulting from the carbs are likely to be stored as fat. The reason insulin does this is twofold: first, excess glucose in the blood stream can be dangerous, even fatal, so the excess needs to go somewhere safe (muscle and fat tissue, usually); and second, this is part of the mechanism, seen in other mammals, by which we fatten up for the winter. Human beings don’t hibernate, but apparently there has been no evolutionary pressure to dispense with this mechanism.

(Tony H) #64

MMTT is mixed meal tolorence test, Idk weather this is the same as OGTT. Im not sure I’ll be having one yet tbh I just know I have been referred to endo and just assumed this is what they will do. My biggest concern about endo is they they dont understand keto and what it does and just label me diabetic when they ram 75g of glucose into my system and my body freaks out.

By switch back I just mean my body be happy metabolising glucose as appose to just rejecting it which is what I assume is happening with me. I’ve been recording my BG levels quite a lot the past few weeks. Since going back to keto I’ve not seen them outside of 4.4 to 6.5 at any point. Last week when I was trying to consume 150g of carbs they fluctuated between 5.3/7.6 but almost immediately after eating Id get brain fog, muscle weakness, fatigue and sometimes nausea and if I ate too many carbs or fast releasing carbs it would be followed by a hypo.

I saw @lfod14 talking about this just being my body’s natural over reaction to reintroducing carbs which is very intuitive. I also saw him talking about him getting the same thing a few years back on a thread about physiological insulin resistance. So is that just something I have to fight through for my body to get used to carbs again? If so how slowly does this need to be done to stop the big overreaction. I am generally an all or nothing guy and I think I have a tendency to just go from 1 extreme to the other which obv my body will be shocked by.

The NHS only funds continuous glucose monitors for people with diagnosed diabetes so I would not qualify but I am assuming you can buy them but Im not sure. My blood glucose levels are not really something that concern me tbh as I feel that both with and without carbs they are OK altho my fasting with carbs a few weeks back were mostly mid to upper 5s territory but I have read if you have physiological insulin resistance that your numbers will be higher temporarily. This makes sense to me cus a month ago I got HbA1C of 5.1 and when looking a couple of weeks ago I rarely saw my sugars that low whilst trying to reintroduce carbs.

I didnt find my way to keto due to being diabetic or IR altho now I’ve learned a lot more about blood sugars I will absolutely have some level of IR cus I am for sure a sugar addict and always have been, I’ve been overweight my whole life. I’m currently 60lbs above my ‘ideal’ weight according to the NHS guidelines so was just attempting to get ahead of the game and start looking after myself, Im 34 and about to become a dad for the first time so getting healthy has become very important to me and it just appears to me that Ive caused way more problems than I started with! I will say tho I have started to lose weight on keto at a solid rate so I am very open to staying on keto short term but I would then like to be able to safely transition more to a low carb diet in time.

(Robin) #65

Although many here understand that keto or carnivoor is best as a lifelong commitment to your health… there are always going to be people like yourself who decide to use it temporarily for weight loss etc. There’s nothing wrong with that. You do you.
Having said that, after losing 60 pounds, you may observe that you feel so much better that you want to maintain a level that keeps you feeling better overall. Or you may start gaining back the weight and decide sweets aren’t worth it. Who knows?
Either way, congrats on being a new dad! What a ride! Glad you’re here.

(Jane) #66

If you have been overweight your entire life you will likely gain the weight back as you add carbs back in. Once you get to your maintenance weight you can experiment. You can always cut the carbs back again… just be aware it may (or may not) trigger the sugar/carb cravings again.

You need to give it at least 3-6 months to get over the craving for sugar and carbs. My husband went keto when I did to support me, even though he was not overweight and not diabetic. He was miserable the first 3 months and was so cranky I was almost to the point of begging him to go back to eating what made him happy.

And then one day after about 3 months… he was ok with keto. The cravings were gone, his brain fog gone, joint pain much reduced, sinuses clearer… He never went back to a SAD diet (thankfully) but added some carbs back into his diet that I cannot afford, like a bowl of oatmeal once a week.

He can still do a 42-hr fast with me easily so adding some carbs back hasn’t affected his fat-adaptation. And for him - it hasn’t triggered the sugar/carb cravings so that has worked for him and sounds like where you would like to get to. You won’t know until you try down the road.

(A fool and his bacon are soon parted) #67

As I believe I mentioned already, cells never lose their ability to metabolise glucose. Skeletal muscles will refuse glucose and ketones in favour of fatty acids, when insulin is low, but glucose (i.e., carbohydrate) intake sufficient to evoke an insulin response that exceeds the threshold will shut down fatty-acid metabolism and promote glucose metabolism instead, and the muscles will respond.

As I understand it, the hypo is a sign that you are still insulin-resistant. In other words, your pancreas has overcompensated for the carbs with too much insulin, which has inhibited ketone production while driving your glucose level too low. As long as there are enough ketones to feed the brain in the absence of glucose, you will not have hypos, which is why it is important not to overdo the carbs. If you keep carbohydrate intake low enough, you will not need so much insulin, and ketone production will be able to continue (too much insulin halts the production of ketones). And over time, insulin resistance diminishes, and the insulin response to carbohydrate becomes more normal.

(Tony H) #68

Does that mean you think it’s more pathological than physiological? And if so why would that not show any issues pre keto/LC?

I have ordered some keto strips. I currently have some general urine strips which show 8 different things. Ketones being one but it appears negative when I test. Are keto strips more sensitive?

(A fool and his bacon are soon parted) #69

The glucose and ketone sparing by fat-adapted skeletal muscles is evolutionary and normal, as evidenced by the low HbA1C that accompanies it.

Insulin-resistance is detectable long before glucose gets out of control. The late diabetologist, Dr. Joseph Kraft, used to maintain that diabetes could be diagnosed as much as two decades in advance, simply by analysing the patterns of glucose levels and insulin response in an oral glucose tolerance test.

You don’t need a lab test, however, since among the effects of insulin-resistance are cardiovascular disease, hypertension, atherosclerosis, obesity, Type II diabetes, acanthosis nigricans, skin tags, polycystic ovarian syndrome, impotence, gout, Alzheimer’s diseease, and many other conditions.

(Allie) #70

No they’re exactly the same, but cost more and just as unhelpful. Seems you’d be best off going as close to zero carb as possible until things settle down for you.

(Tony H) #71

Today is day 7 back on keto. I defo feel better than I did eating carbs cus I was reacting so badly with brain fog/muscle weakness, blurry vision at pretty much every meal. My BG reading are not that dissimilar atm but I know that when I eat more carbs my blood sugars go up and then down lower so having them on the lower end whilst keeping my insulin much lower is likely a big win.

I’ve been eating very samey samey so prob need to start mixing things up a little but this morning I didnt feel great after eating my breakfast. Ive been having 15g chia seeds, 15g almonds, 15g pumpkin seeds, 15g walnuts and 15g pecans with 80g thawed berries and 100ml of unsweetened almond milk for a total of 493 cals according to myfitnesspal. 16gP 10g C 41g F with 10g fiber so a net of zero. I enjoy nuts and this is just a quick easy thing to throw together so I dont have to stand cooking on a morning which I prefer but I had some of those unwanted symptoms after eating it today so I may have to look at other options but I dont enjoy eggs for breakfast and prefer a cold breakfast. I’ve also been getting some bloating last few days and think it may be from breakfast. My BG was 6.2 upon checking, was 5.2 when I got up this morning so not a major spike but defo felt a bit odd again.

Overall my energy levels are not great but not in the gutter either and for the most part those pesky symptoms are much improved after eating. Yesterday was the first day that for my 3rd meal I wasnt actually hungry for. I ate it anyway and was weirdly more hungry after I ate it than before but it goes away again after an hour or so. Wasnt particularly hungry when I woke up either but Im trying to stick to my 3 set meals to start out.

Yesterday totals were 1700 cals, 119gP, 36g C, 121g F with 26g fiber and I am losing weight which is nice so hopefully moving in the right direction. Likely just need to mix my food up a little so I dont get too bored of eating the same things everyday. I also saw a little movement on my keto strip today, nothing major but measured more 0.5 which is the first day I’ve saw it register anything up to now.

(Allie) #72

I was doing a similar type mix but without the berries and it totally messed me up. Net carbs were reportedly fine, but very clearly wasn’t a good idea for me at all. Much easier and better for me to throw four eggs into a frying pan and sprinkle cheese on top. Most days now though, I just throw two raw eggs into my coffee and blend it - breakfast and coffee sorted in one. Must remember to feed those left over seeds to my chooks… best place for them :rofl:

(A fool and his bacon are soon parted) #73

You don’t have to eat, if you’re really not hungry. We often advise people to eat when hungry, and not according to the clock. This early on (or back on), you don’t want to force yourself into a given eating pattern, but it is okay if you find yourself naturally falling into two meals a day, or whatever. The point is to let the body dictate what happens, not to force things on ourselves.

Also, I was looking over your macro calculations, and I can’t tell whether you are falling into a trap that others have fallen into. The net carbs calculation only works when the fibre involved comes with the food. So if I eat a food with total carbs of 10 g, 8 g of which are fibre, then my net for that food is 2 g of digestible carbohydrate; but if I eat one food with 10 g of digestible carbs, and then eat a separate 8 g of fibre, my net carb count is still 10 g (in other words 10 + 8 - 8 = 10, not 2). This is why many people find it easier to count total carbs rather than net.

(Tony H) #74

Yeh I think tomorrow I’ll maybe have a coffee and walk the dog before coming back and having eggs instead. I’ll cook mine tho, the thought of throwing raw eggs in my coffee made me sick in my mouth a little bit :rofl: prob will help me to simplify it as well going for 20g total rather than net so thanks for clearing that up Paul, 0g of net carbs just didnt feel right to me there. I had to read it twice to understand it but makes perfect sense now.

(Allie) #75

Hey don’t knock raw eggs in coffee until you’ve tried it, just makes it really nice and creamy :rofl: My eggs are from my own hens though so I know exactly how hearty they are and what’s gone into them, not certain I would be as trusting if I’d bought them elsewhere.

I’ve found it easier just to focus on keeping carbs as low as possible rather than aiming for any particular number,’just so much simpler and less stressful.

(Robin) #76

Speaking of hens…. How are the new girls doing?

(Allie) #77

The three outside are doing well and learning to live with the flock, but still got little Youbee inside with me trying to fix her prolapse. She’s lots better, but it just keeps popping back out. I’ve been assured by many people that the treatment is correct but that it just takes a long time sometimes. Feel so bad for her being locked away when she should be enjoying her freedom :pensive:

(Tony H) #78

Interestingly having spoke to my other half she finds it odd that during the 6 week period this all started. Twice I went out, first to a BBQ where I ate 3 or 4 burgers and had 3 beers and the 2nd was to play a poker tournament. Probably had 7 or 8 beers and then a curry when I got home with a big portion of rice. Both times, no hypo. Is it possible that it is glucose sparing and when I try and reintroduce carbs I don’t eat enough to flip that switch? For me putting carbs back in is 150g a day which is still considered low carb by some. I also spread that out through 3 or 4 meals during the day. I have made the decision that I will stick to keto for at least 3 months anyhow to get some weight off and improve my insulin sensitivity but it is an interesting theory.

(A fool and his bacon are soon parted) #79

“Glucose sparing” usually refers to fat-adapted skeletal muscles that pass up glucose and ketones, in favour of fatty acids, so as to spare the former for muscles and organs that really need them. Another term for this phenomenon that you will often see is “physiological insulin resistance.”

Assuming that by “hypo” you mean “hypoglycaemic episode,” they are unheard-of in the case of someone eating a ketogenic diet, because there are ketones to feed the brain in the absence of glucose. The brain doesn’t actually need much glucose, if any, when there are ketones available to fuel it.

It is possible, however, that the hypos you experienced were from eating enough glucose (carbohydrate) to raise your serum insulin above the threshold to halt ketogenesis (25 μU/mL), but not enough to adequately feed your brain. How much insulin is secreted in response to a given load of serum glucose depends on how insulin-resistant the person in question is, but the threshold doesn’t seem to vary much from individual to individual, from what I understand. Someone who is very insulin-sensitive will be able to eat more carbohydrate and still stay under the insulin threshold than someone who is very insulin-resistant.

If insulin is low enough to permit ketogenesis, serum glucose can safely drop to levels that in carb-burners would cause coma or death, and the person will still be fine. George Cahill, as part of a famous set of experiments he and his team performed on fasting subjects in the 1960’s, used a euglycaemic hyperinsulinaemic clamp to drive his subjects’ serum glucose down to abnormally low levels, without ill effects. This sort of experiment would never be permitted by an institutional review board today, but the subjects were unharmed. Dr. Stephen Phinney, talking about this experiment, made the wry comment that “the only people who were dizzy and perspiring were the ones wearing the white lab coats.”

(Robin) #80

If we get into a heated debate about this, would it be Glucose Sparring?

(Tony H) #81

Yeh today is the first time I’ve dropped into technically hypo ranges and felt OK. 4.8 upon rising this morning. 5.7 an hour or so after lunch and now just before my 3rd meal of the day I got 3.8. Lowest Ive seen since going back on keto.