Hba1c and glucose rise on keto

(Deborah Meghnagi Bailey) #1

Hi,
I have been helping my mother in law go keto. She’s always been slim, she only wanted to lose less than ten pounds, but she has always had problems controlling a sugar addiction. She’s in good health, 70 years old. She’s been keto now for five months and she loves it. But she recently did blood tests and the results are mystifying. Before she started keto her hba1c was 5.7 and now it is 6.3! Her fasting glucose was 110. They didn’t take her fasting insulin. Her cholesterol and triglycerides were great, exactly what you’d expect with keto, low trugs and high hdl. But how can her hba1c have moved into the pre-diabetic range from being normal after she started eating keto? Can anyone give some insight? Understandably, she’s worried.

A1C going the wrong way on long term keto
(Omar) #2

you may want to take a confirming test

(Rob) #3

Insulin may be the missing piece of this puzzle… if she was high FI and has been reducing that steadily through keto, it is possible (others have mentioned this), that their BG goes up.

Admittedly, I haven’t heard of it going to near diabetic levels (only heard anecdotes anyway) but it is “only” a 10% rise so maybe not a big cause for concern or needs a follow up test to confirm. The other thing to think about is that successful, long lived, T1D’s don’t seem to have low BG (still diabetic range), but they do take the lowest insulin, suggesting that the insulin level is more important than the BG level. Hopefully this is what is happening to the MIL?

(Deborah Meghnagi Bailey) #4

Yeah, that’s one of my thoughts too – and she’s going to order a fasting insulin test soon to see what it is, although unfortunately she doesn’t have a previous result to compare it to. But what would the mechanism involved be?

(Rob) #5

Not sure but it would make sense that IF your insulin response changes… carbs don’t create such a big insulin response per gram (eaten or made by GNG)… BG goes up BUT your body isn’t worried about it (because you are keto). I doubt after 5 months that whatever processes are working have finished their journey.

#6

Hi Deborah,
I completely agree with what Rob has said already. As a T1D myself, in the absence of carbs (I eat less than 20g /day) I now have to take into account the effect of protein on BG levels. So, I’m wondering if your MIL is just a little more sensitive to this phenomena also(although not diabetic). Does she eat a lot of protein? Perhaps she may want to reduce very slightly and see if this makes a difference. Personally I wouldn’t stress about it as her body is most likely still adjusting, plus everyone has their own “normal range” for their body. https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html Check out this link re levels, GTT etc ; its a good site for information or the American diabetes society will no doubt have a similar link :smile: Ali

(GINA ) #7

Had she had regular tests before? Maybe It was already on the way up and would have been even higher if she had not changed her diet.

(Deborah Meghnagi Bailey) #8

The hba1c reflects the previous three months. So if it was at 5.7% just before she started keto, it means that at least for those three months, her blood glucose was normal/fine. And now it is at 6.3%, having done keto for five months. So no, I don’t think it was on the way up. And she is slim, in good health, and ate a reasonably healthy diet, just more carb centered than fat centered before.

(VB) #9

Hello Deborah,
I’m having the same symptoms. I was at HbA1c = 5.2 , 4 months ago, and i have graduated to 5.7 as of today. Fasting blood sugar = 87 to 108, as of today.

What has been your assessment, about why this is happening?

(VB) #10

The HbA1c and Fasting Sugar of 5.2 and 87 was on the day of starting Keto.

Though I’ve lost 10kgs and feeling good, this sugar thing has got me a little worried.

All other parameters are absolutely normal incl Lipid profile.

#11

Hi Debmeg.

Please, what is the formulation for her ketogenic diet?

The HbA1c is a proxy biomarker of blood glucose. It can be increased if the circulating red blood cells stay in the circulatory system longer than the usual lifespan. The longer they stay in the system, the higher the HbA1c will rise because the older the red blood cell, the more oxidised it becomes (main job is carrying oxygen, after all).

The biomarker to reconcile the HbA1C against is fasting, morning blood glucose, or even better, the results from a continuous glucose monitor (CGM). If the direct measurement of blood glucose is reduced, or does not track the HBA1c rise, then the likelihood of extended red blood cell life span is the top mechanism to consider on the list.

@VBCOL VB tracked their blood glucose fasted and postprandial (after eating) and saw a rise in the direct measurement and the proxy HbA1c biomarker.

People eating very low carbohydrate diets, or attempting zero carb diets will see a discordance between the blood glucose tracking and HbA1c. In that their direct blood glucose tests at home will be steadily in the low range, but the HbA1c result is high. I think Dr. Paul Saladino mentions this in a recent interview discussion with Dr. James DeNicolantonio = part 3 of their carnivore vs omnivore exploration.

HbA1c is just one proxy biomarker. The totality of the accumulated blood test results and subjective feelings trump the one marker. But I agree that it is nice to know why a number in a series of tests changes.

Here are some ideas:

  • Repeat the HbA1c at 3 months.
  • Monitor the other biomarkers, such as lipids and minerals.
  • Triangulate what is found with a low carb medical practitioner who understands the variability of tests. Doing these at home as a layperson can become confusing when expected results don’t appear. Get that first, then serial, fasting insulin tested to check trends.
  • If a blood panel is being done on a sample look at inflammation markers as they may help explain an elevated HbA1c.
  • Monitor what can be done at home for data and interest - journaling how one feels and foods discovered and eaten, blood glucose tests, blood ketones (finger prick test), clothes fit, strength and physical ability observations (e.g. stair climb, or ability to get up from the floor). It all depends what is individually available and accessible.

My mum is 78 soon. She gets so annoyed with me. I’m pretty sure it is socially acceptable to experiment on our parents or elders.

This thread has some good links to understand the variability of the HbA1c test: