Ketogenic diet - failure

#1

In brief: T2 diabetic, 45 year old male.

Keto diet for 1.5 years. Minor lapses very occasionally, but in ketosis for 1.5 years. Verified by blood tests daily.

Medications: am on Metformin 1000mg 2x/day. I tried to go off all other meds, but my glucose remained too high. A1C went up to 6.4. I thus had to go back on Jardiance (makes you urinate glucose), which is very effective at lowering it.

My triglycerides were recently 670 (non-fasting) and 273 (fasting). Way too high. My PCP thus put me on fenofibrate.

Conclusion: for many people, going keto allowed them to stop taking all/most medication. That apparently is not true for me.

So, what now? Am I just genetically unlucky? What benefit is the keto diet to me? If I am having to take Jardiance to lower my glucose, then why should I bother to keep eating keto? Why not go ahead and eat some carbs, even if a lesser amount than the “standard american diet?”

Thanks for any/all input. I obviously am frustrated that the keto diet did not “fix” me, though I gave it 1.5 years.

(bulkbiker) #2

Have any of your health providers thought about an endogeous insulin test? C-peptide maybe? Might be an explanation… you may not be T2 at all…

(squirrel-kissing paper tamer) #3

I have to look this up, it sounds like it would be hard on the kidneys.

I guess I’m scratching my head and wondering if you’re not eating carbs where is THAT much glucose coming from? I know we can supply some of it via the liver, but enough to be a diabetic without dietary carbs?

Can you give us an example of the kind of stuff you eat?

#4

Breakfast is often an “egg bite” from Costco (basically same thing as Starbucks version), or an avocado + salt, or a small handful of walnuts and maybe a slice of cheese.
Lunch: usually a lettuce wrap burger (no ketchup) or scrambled eggs.
Dinner: fatty meat and salad.

I test ketones daily. Am in ketosis. Am not having the usual culprits for “hidden” carbs.

(squirrel-kissing paper tamer) #5

Have you lost weight since you started?

Also are you on any meds that can increase blood sugar (like corticosteroids)?

#6

C Peptide test on 7-13-2018 was 2.6 (normal).

#7

@petamarie: yes, though it came up some. Started at probably 245, went to 225. Jardiance causes fairly dramatic weight loss. . . absent the Jardiance, the weight was creeping back up to 230 or so.

(Jane) #8

Dr Fung recommends fasting for his patients. At a year and a half it should be no problem for you to cut out breakfast, reduce your eating window (but make sure you eat enough) or skip a couple of days of eating after you get the hang of it.

After 3 days of water fasting my glucose is in the 50’s and ketones 5-7.

What are your typical glucose/ketone readings during the day?

#9

I have done fasting in the past, but frankly lost it due to work/travel schedule. I will give this another try. thanks! I really enjoyed Fung’s books (Obesity & Diabetes code).

(hottie turned hag) #10

My first thought is, you’d be in even worse shape if eating more carbs.

As you probably know some folks’ diabetes is brittle and severe; if you consumed carbs your glucose may be even harder to control.

#11

Interesting observations.

Ketogenic diet puzzle rather than failure. Puzzles are great learning opportunities.

Normal C peptide suggests the pro insulin molecule production in the pancreatic beta cells is adequate. The nutritional ketosis indicates a low insulin state. But you have an elevated HBA1c, but only slightly above normal, if normal maximum is 6.

It would be interesting to know any results of fasting insulin tests to confirm they are in the low normal range.

Using medication to push glucose out of the body in the urine is concerning as it can lead to a change in the urinary tract biome and risk of urinary tract infections.

It would be interesting also to know what your fasting blood glucose tests results were as you measured the ketones. Did you measure blood ketones?

If fasting blood glucose tests (low) don’t correlate with the HBA1c, then you may have a unique situation in your body with longer lifespan glycated red blood cells.

(KCKO, KCFO 🥥) #12

Are you relying on ketosticks. They are not too effective for those who are fat adapted, they are better indicators of hydration levels than ketosis.

Also have you had your thyroid numbers checked, not the overly simple TSH test but T3 & T4 tests?

#13

It might be time to seek a referral to ask about you blood glucose concerns. See if you can consult with a low carb diet knowledgeable doctor.

That fenofibrate has a long list of potential adverse reactions. That plus the Jardinace, I can totally understand why you want to get off those medications.

If your primary care doctor is of the training ,or caught in the rut of, matching symptoms to medications, it really is time to seek helpful advice elsewhere. They may be a good person but don’t have the time to drill down to find answers. Medications aren’t always answers.

(Bunny) #14

Check this link out below maybe you can see some parallels with the metformin:

Hint: you may need more muscle volume along with the ketogenic diet to bring down those blood sugars and Metformin isn’t helping nor is it a permanent solution? You need more muscular hypertrophy? (to oxidize glucose)

And also maybe getting more choline in your diet from natural sources like eggs and calf liver? This will help bring down your visceral fat on the pancreas and liver, what might ultimately be blocking your insulin from being secreted to clean up that high blood sugar?

(Jane) #15

I agree on getting another opinion.

They didn’t answer about testing glucose/blood ketones but I would definitely invest in a KetoMojo and gather some fasting glucose/ketone data and also post-meal glucose data. Those are some serious meds and worth some individual research for ways to get off of them but stay healthy.

#16

Do you actually track what you eat?

In any case, I have to echo someone else’s question – even if you are getting blood glucose readings that high while sticking to 20 net carbs per day, how could eating more carbs be any kind of solution?

Maybe the question you need to answer is where is all of the glucose is coming from, if it’s not coming from food. That is – what is the real problem? You’d be better off treating the real problem than treating symptoms.

#17

No ketosticks. Blood test with ketomojo.

Have never had any thyroid test …

#18

Never tracked what I eat, but have verified ketosis consistently for 1.5 years. Also have been enrolled in the Virta Health program. My MD thru Virta is fairly mystified by my presentation, but ultimately said that some people still have high glucose/trigs despite a keto diet. He agrees w/ my PCP’s recommendation of Jardiance and fenofibrate. Virta is extremely pro-keto… No “old school” MDs there.

The gucose levels are only part of the problem. The triglycerides are arguably even worse. My liver obviously must be making the glucose. It’s possible that I’m eating too much protein. But not by any massive amount. I don’t eat lean chicken. Rarely eat fish, and when I do it’s fatty fish like salmon. Always go for fatty meat. So what’s causing the high tryglycerides?

#19

Have you been losing weight? Using stored body fat would cause triglycerides to go up.

(Cancer Fighting Ketovore :)) #20

Maybe you should try tracking what you eat for a few weeks. Sometimes its helpful to take a hard look at what’s actually going on. I’ve found for me personally that I have to be careful with my protein levels (or so it seems at times). I’d get a good digital kitchen scale so you can weigh and log your foods.
People here use a variety of apps, but Cronometer and CarbManager are two of the more popular ones.

What levels of ketones are you seeing?

Also, have you considered any fasts, say 48-72 hours, to try to “reset” things in your body?