I started keto 7 days ago and it has been smooth sailing until last night when I woke up in the middle of the night, shaky and having trouble thinking. I also felt a lot of muscle twitching all over and never got an actual cramp but felt like I was on the verge. Panicky. I took a BG reading and it was 63. Low. (I don’t officially have blood sugar issues but I have a monitor from past dieting.) I actually had to stay home from work today and still feel “off”.
I’ve read hypoglycemia can be an early side effect and it’s important to monitor electrolytes. But I’ve also read you can overdo it with those and cause problems too.
So my question is how do you know if you are getting the right amounts? What are the right amounts? And how do you get past this stuff? I was really worried I’d have to go to the ER. I don’t want to abandon keto as I am having good success otherwise.
I should add that I have been making very frequent trips to the bathroom all week, even getting up several times each night. I also have hashimotos and take Armour thyroid. Thanks for any advice!
Hypoglycemia question - newbie
63 is not low enough to cause harm but it was new to you and your body was not used to it and reacted as it did. I have seen the same with a random high reading but not with low ones…I think 66 is my lowest. As far as the muscles twitching and such that is almost always electrolytes. You may want to supplement with lite-salt for potassium and maybe a magnesium pill or lotion or even Epsom salts.
Its really hard to overdo salt as your body can get rid of it easily. Too much magnesium can give you bathroom issues. Potassium requires care as too much is BAD. You can add a little of each and see when you feel better.
Obviously stay hydrated. Seems your body is dumping fluids if you are peeing more than normal. This also flushes electrolytes.
***I say all of this not knowing how hashimotos changes things…so take my notes with a grain of salt 
Hey Mandy,
I have “reactive hypoglycemia” and have been “officially” keto since the last week of January. before keto, as an example, I have never been able to drink orange juice or I’ll shake like a leaf and be desperate for something to eat. I have had bajilians of recommendations from doctors and I have naturally stayed away from sugary carbs unless I eat protein. The blood sugar count does not matter, its if your body is very sensitive to blood sugar dropping quickly or low. its like my body does not recover from a low blood sugar very quickly. What I have done since starting keto is to up my protein to near the top of the recommendations until you know you are fat adapted and then bring the protein down. It worked for me. I did have a couple emergencies and slipped a couple of crackers but mostly it has worked for me.
It sounds like you washed out all your salt, it took me about weeks to get to that point. I was going through a gallon of water a day at that point. I have no experience with hashimotos or thyroid issues. My BG is rock solid between 60-70 fasted and never has much in the way of issues although don’t monitor it closely, for you it could also be carb detox withdrawals.
Salt is probably the most important 4-6 g a day, roughly speaking 1-2 teaspoons a day
BP may also be effected as was in my case at 2 weeks in. You do intake salt is some foods so do the math but as @matt says you can expel it as well assuming you have no kidney issues. I am not sure it will work for you yet but try putting salt on your tongue if its not real salty you need more salt.
Potassium is about 1000mg there is no RDA
If you have no known issues or medications that can strip away potassium its not as much of a worry as it is stored in fat. If you go to long with out salt this can be more of an issue. Tally your daily intake in your food. After talking to my health coach I may have been getting too much potassium at first based on my body reactions and my intake of foods previous to keto.
Magensium is about 3500mg a day, most people don’t get enough, if you get too much it can be problem as matt said also. I only worry about it if I am getting cramps or if I plan on fasting for a while, you should not have to many issues with that at the moment but down the road maybe.
Thanks @In2steam for the numbers. I’ve been tracking all food on Carb Manager and I’m pretty well below those in all categories even though I was taking a supplement so that is something I can work on. I was drinking over a gallon of water a day partially because I stopped drinking all other drinks, but also because everything I read seemed to say “drink more water and then keep drinking it”. So I think I need to slow down a bit on water and increase my electrolytes for sure. Thanks for the advice!
Thanks @IF_keto_lifestyle. Why do you think increasing the protein helps the glucose drops?
Thank you! I will look into the keto lemonade. Looks like there are a bunch of recipes.
No keep the water flowing, for the next week or so, follow your bodies clues. Add salt to the water I get a teaspoon a day that way it is something you will need to get used to unless you want drink raw blood to get the salt.
Also even when I had that reaction I didn’t want to eat anything to “ruin” my progress. I did have an apple and some nuts. Seemed to help a little. Do you still have drops and if so how do you treat them when they occur? Hopefully things stabilize soon.
The best thing I can think of is getting some coconut oil or mct oil in. They are not going to work through the glucose pathway but they will work through the ketogensis pathway and increase ketones. They go directly to the liver once they pass the gut wall so they act pretty quick.
Also something that happens when you wake that is called dawn phenomena that spikes your glucose a little. If you were to early this may play into it some. Keep in mind every time you spike your insulin (apple) you will shut down the ketosis until you have diminished glycogen in the liver and the insulin is low again, at only 7 days in you could take a while to be back into keto.
KCKO
I have been taking about 2 tablespoons of MCT oil each day. Should I take more? Also, I don’t know much about them but from what I’ve read it sounds like exogenous ketones would serve that purpose as well? Is that something to use or just a sales pitch? And one more question. …how would I know if I got kicked out of ketosis? Keto strips still showed moderate range this afternoon.
MCT oil can act like a laxative, I prefer coconut oil almost all the time, I use it in hot water with lemon, and salt, some people put it in coffee. I average 2-3 tablespoons a day that way alone, one thing you can do is melt the coconut oil and put into ice cube trays, it makes measuring and handling easier. The too much of coconut oil, meehh I can have half a cup some days if I am eating fat bombs. It is a great source of energy during keto adaption but its not working the same way that LCT(animal fats) work so I don’t eat a lot of animal fat and follow it with coconut oil or the results have well let just say you know when you have had too much fat early on, your body will let you know by means of the toliet.
I think you well get the same response from most avoid all exo ketones, your body is making them, and they are questionable at best for weight control and may even be down right dangerous.
If your pee strips are still showing ketones than you probably did not, keep in mind the pee strips are showing the lower level acetoacetate and not BHB which is what is normally cited for keto purposes via blood tests. So that is a good thing, it means you used all that sugar right of way, and your liver stores are still low. Its a little early but in the next few days hopefully you will feel changes in perception, energy and stamina. This is keto adaption you will now be running off of ketones and only a small amount of glucose. If you keep insulin down and ketones flowing you should make fat adaption by about 8 weeks which a whole different ball game. When you loose all those feeelings at least in my case that is when I know for sure I was kicked out, i did it about half dozen times in the first month. I did yesterday for the first time in a major insulin spike (I had a lot of carbs) and the head ache was the worst I have ever had. Keep in mind that is 4 months into fat adaption with only a couple real minor screw ups so don’t panic I was pretty hard core after jan 1. I had the reverse of what you had this morning in a way.
our bodies can make some glucose from the protein. If we aren’t fat adapted and insulin resistant, we can’t get energy out of our fat and our blood sugar decreases. at least thats what I understand.
Actually GNG is happening all the time when keto, even when fat adapted as our bodies need to keep that basal glucose level of around 60-70.
Our bodies can use other substrates beside amino acids(broken down protein) to make glucose but I believe that is the easiest way to do it. It is one of the reasons you need medium amounts of protein.
If insulin goes too high(and glycagon too low) GNG make not uptake quick enough if there is just a spike without any glucose to back it up and low ketones in the blood. That is why the first few days can be a real bummer since our BG is often coming down lower without a quick response from the pancreas to produce glucagon. It is a good reason to avoid one meal a day (OMAD) and fasting at first because any protein will give a insulin response, but since there is not any glucose with it your glucose could crash for a whlie. And you don’t have much in the way of ketones to back up the loss.
I had problems with electrolytes/minerals as well. At its worst my ankles were so badly swollen I feared I had done real damage to my organs. Not so. I was just not getting the nutrient content that I needed from my diet.
As it turned out all the veggies I was eating wasn’t good enough because in the US our soils are nutrient deficient. I added roasted salted sea weed and spirulina to my diet and the problems resolved in two days.
I know a lot of people are proponents of supplements but I think it’s better to get nutrition from natural sources.
Do some research on minerals and electrolytes and such
I hope you find this helpful
Keep calm and keto on
I’ll add my general recommendations and also mention something about insulin response. I’m not sure what sort of extra sweeteners or other sweet things you’re intaking. In some people, they can have an insulin response to things that do not raise blood sugar such as sweeteners like stevia, sucralose, etc. Even slightly sweet foods like 95% chocolate or some nuts can cause this for the group that responds. If those same responders also have insulin over production due to insulin resistance and their blood sugar doesn’t go up, it ends up being unnecessarily lowered without anything to replace it. The only way to get around this for those people is to avoid anything you’d consider even slightly sweet, including keto approved sweeteners. Instead of keto ade, one might do a keto chicken broth drink. Raising your blood glucose by adding carbs might feel better in the short term but, that’s like treating a cold with cough syrup. You’re merely covering up the symptom and ignoring the underlying issues. That one apple is about the recommended carb allowance on its own.
We have a few sayings here, “keep calm, keto on” and “trust the process.” Keto isn’t a quick weight loss diet. It’s a health gaining way of eating with fat loss as a side effect. If the scale is an unhealthy obsession, put it away for a couple of months or give it to a neighbor you don’t like.
There are two phases to ketosis and a ketogenic lifestyle.
Nutritional ketosis is phase one. Your body begins to produce and uptake some ketones while dumping the rest. It will still search for glucose to use as fuel. In this phase it’s not an efficient process. It has to work actively to get rid of stored glycogen, clean up excess blood sugar, and turn on the ability to use ketones.
Fat adaptation is phase two. Your body is efficiently producing ketones from intake and stored body fat and is also using them efficiently for energy. It takes around 6-8 weeks of strict keto to achieve for many but not all.
The basic “rules” I go by and many others can agree with especially for beginners are:
*20g net carbs max (you might tolerate more but, starting out, 20g net carbs or less will get you into ketosis.)
*Moderate protein (1g-1.5g per kg of lean bodyweight is a good goal based on the 2 Dudes recommendations.)
*Fat to satiety (add fat to every meal and, if you are hungry, eat more fat. Don’t be afraid of fat. It is energy.)
*Do not restrict calories
*Do not exercise excessively
*Drink plenty of water
*Get plenty of sodium and other electrolytes