Hypoglycemia low blood glucose while highly fat adapted with high ketones Research?

(Herb Martin) #21

This one is excellent with blood glucose as low a 9 (not just 30), and ketones in the range of 3.8 to 12.6

These subjects were in a metabolic ward and being closely monitored so “don’t try this at home kids” is perhaps good advice but it does indicate that if there is significant fat adaptation with ketones sufficiently present that technical hypoglycemia is not likely to be a health issue in subjects that remain symptom-free.

Still working my way through all that is above. Thanks again everyone.

(Bacon by any other name would taste just as great.) #22

The study by Drenick et al. to which I linked earlier claims that “Glucose concentrations as low as 0.5 mmoles/liter (9 mg/100 ml) failed to precipitate hypoglycemic reactions.”

(Karim Wassef) #23

Herb - I finally got around to Paul’s post about glucagon…

I really recommend reading it since it changes the paradigm to a glucagon dominant model and insulin as the co-pilot.

Basically (my interpretation) - the first function of metabolism is to provide critical energy to critical organs … brain, red blood cells, kidneys. To do that, there is a minimum threshold of glucose needed since those cells don’t have mitochondria. So… if glucose drops below that threshold, glucagon steps in to “liberate” glucose from glycogen, amino acids or fat.

He draws the line at 2mmol/l (36 mg/dL) but I’ve gone below that.

More interestingly - he says that without glucagon, the glucose excisions stop. Likewise, not having insulin doesn’t seem to cause a problem and glucose will naturally get depleted.

I would LOVE to hear Dr Bikman’s response to this. I’m not sure what the alternative mechanisms that regulate blood glucose would be.

Then he goes on to say that very low blood glucose (through drug use) was positively correlated with higher mortality!! This is where I just need someone else to read the article and confirm my reading.

(Bacon by any other name would taste just as great.) #24

I’m not sure I fully agree with Dr. Kendrick’s picture of glucagon and its role in diabetes, though I’m not sure he’s wrong, either. I definitely respect him, however, and it occurs to me that I never watched the lecture by Professor Unger that he mentions early in his post, so I think I’d better do that and reserve judgement in the meantime.

However, I also know of no reason to doubt Drenick’s study, either, which would seem to contradict Kendrick. Something to bear in mind, on the other hand, is that Drenick’s subjects were all in ketosis, whereas the normal understanding of what levels of glucose are safe is based on people eating the standard Western diet, and the rules often do appear to change when we eat ketogenically.

To add to the confusion, Professor Bikman has challenged the notion that the brain requires glucose, saying that he has been unable to find any data to support it. Whereas George Cahill, the seminal researcher on fasting, is pretty clear that the brain needs glucose, and I can’t imagine that Bikman is unaware of his work.

Sorry to sound to back-and-forth. More study is called for, obviously. Damn you, keto! Am I really going to have to get a graduate degree in biochemistry? Really?


I have same issue with high ketones. Constantly above 4+ mmol if I’m ~keto carb (10-20g). Also they just go off the measuring range (8mmol) after 2 days of fasting or prolonged very low carb. I see my hypoglycemia symptoms appear BG values between 2.3-2.7 mmol (41.4 - 48.6).

I haven’t measured it from the blood with ~high carb tactic, but at least Ketonix plummets down when eating more carbs, more quickly if it’s more juicy carbs. So I guess my insulin production is somewhat still working.

I also have weird values from the moment I started keto (3 years ago). I wish I would have measured before the day when I started as I was on ~0% added fat, the only fat coming from meat, with just about half fruits and half green leafy vegetables for about a year. This also showed up on first yearly control (fasting BG at 7.0mmol). No one had any clue how to direct me, because “I was eating healthy”, so I found about keto and started on it. After first day of keto: BG 3.7 mmol (67) and ketones 5.9 mmol. And the values haven’t really changed. Joint pains (especially in fingers) vanished within a week (was a problem for a ~decade), so never going back to constant high processed carbs.

No idea if I’m fat adapted, but the more ketones are in my blood, the worse I feel. I tried multi day water + electrolyte fasting and had to stop after 4 days because of internal chills started appearing. Maybe because even thou I have ~25% fat, my absolute fat weight is very low and those fat cells can’t churn out energy fast enough. Although why are my blood ketones sky-high then? Not able to being used?

So far on this modified 5:2 (what Mercola is talking about in KetoFast) my gut feels way better as I can finally fast periodically without symptoms (out side of gut symptoms, gut always felt good while fasting). So for me it might be that I need to cycle the macros. Also I’m pretty sure I have been destroying my gut for a ~decade before going keto.

Sadly I have never seen any mentions about this issue on any source. Also this is my first time ever discovering someone else having this “problem”!


If we’re going to the mouse experiments he mentioned, they started with Type-1 diabetic mice, so no insulin at all. Then they wiped out their pancreatic alpha cells to kill glucagon production. I guess someone could try doing this in a human T1D model but… no way that’s getting approved soon.
The mechanisms of natural depletion may involve physical activity? I’d also not try to overload the system with exogenous glucose as us humans are likely to do.
On the other hand, it does tell us useful information about how an excess of FFA released from adipose can drive glucose higher. Which brings me back to my pet theory that an individual’s I:G ratio says a lot about what their GKI will look like.

As to this part, I believe he’s talking about increasing the insulin to “solve” the high glucose problem of diabetes by getting glucose in a normal range, not having naturally low glucose due to ketones in the system. The problem is that insulin is the cause of many other issues that lead to all cause mortality so increasing it is counter-productive.

researchers, doctors and every medical professional has believed for decades that if people with diabetes lowered their blood sugars to normal levels, they could not only prevent the complications from diabetes, but also reduce the risk of dying from heart disease.

(Karim Wassef) #27

He’s going against this though… arguing that too low blood glucose increases risk of all cause mortality.

‘Until last week, researchers, doctors and every medical professional has believed for decades that if people with diabetes lowered their blood sugars to normal levels, they could not only prevent the complications from diabetes, but also reduce the risk of dying from heart disease. But the Accord Study, (for Action to Control Cardiovascular Risk in Diabetes), a major NIH study of more than 10,000 older and middle-aged people with type 2 diabetes has found that lowering blood sugar actually increased their risk of death.2’


Yes, he’s against using insulin to lower a T2D glucose into normal range. Doctors never prescribe an amount of insulin that gets you to subnormal. They’re happy if they can reduce A1C to 6 or 7. They typically leave you a good margin above normal so you don’t have unintended hypoglycemic episodes. It’s the added insulin, not low glucose, that’s bad for mortality.

[keep in mind, most T2s can see 300 glucose easily]

Here’s the linked article: http://www.diabetes-book.com/normal-blood-sugars-questioned/

Due to the surprising results of the ACCORD study, they abruptly halted that part of the study which aggressively tried to manage blood sugars to normal levels, which calls into question just how patients with type 2 diabetes should be managed.


You might enjoy reading about how insulin relates to heart disease here: https://cholesterolcode.com/beyond-the-lipid-hypothesis-insulin/


Think I have found the cause for my constant high ketone values. Way too much oxalates (everyday spinach, cacao snips, many more) keeping my body in some “sick”-state that is causing liver to make ketones. Assuming this as when I have had clear fever and sickness, my ketones skyrocket even if I have had some carbs like yogurt, which in less sick-state would lower the ketone production. My CRP values (ESR and Ferritin too) were also elevated for at least last 5 years (10-60) and doctor couldn’t link it to anything because no other values were out of range (even CT scan provided a healthy person). I linked some of the CRP fluctuations to eating too much cacao nips year ago.

Haven’t measured my ketone blood levels, but my ketone breath meter results have plummeted down to “normal to low”-range (tells how much liver is producing ketones). BG at 4.5mmol (81), which is my average before this discovery too.

So far 2 weeks on ~0 oxalates (spoon of sauerkraut + slice of lemon), rest sensible animal products and oxalate related mitigation. As an added bonus, hunger gone instantly.

So in summary: I think being “sick” might make body to produce lots of ketones to at least expect elevated energy needs.