New Diabetic - starting keto

#21

If your concerned about ketoacidosis, probably not a concern for a T2D. T1D’s on the other hand, who have non-functioning pancreas, produce zero insulin so their ketones can skyrocket with low carb intake. Their bodies already use ketones to some degree. However we are talking a level of ketones magnitudes higher, like 15-20 mg/dl.

As his body adapts metabolizing higher fat and lower carbs (and it will) and the mitochondria regain better/proper function and energy production (ATP) relying on ketones more easily you will find ketones go down below where you see them early own. It’s about your body totally hitting stasis and leveling out. When I started keto and fasted 24-48 hours I would see ketones 3.5+ sometimes. Now when I fast 24-48 hours they rarely get above 1.5 and with low fasting glucose on the 80-90 mg/dl range.

Also another way to prove this is this: at first if you use the pee strips you will get a purple result (higher ketones) and generally after months on keto/intermittent fasting that will become less and less evident, again, as your body reaches stasis. The excreted ketones drop, but your level of ketosis is still very viable. You body is just using ketones more efficiently and excreting less.

Hope that is helpful

(Bacon is a many-splendoured thing) #22

I share a bit of your concern. And even Phinney and Volek admit that using 0.5 as the beginning of nutritional ketosis is fairly arbitrary. It’s just the level at which, in most of their subjects, they began to see the benefits of ketosis. As long as we don’t obsess about it, and we remember that the ketoadapted athletes they studied tended to have readings around 2.0 yet were still clearly in ketosis, we’ll be fine.

(Maria Cruz) #23

Hey guys,

Quick update - hubby was admitted to hospital with ketoacidosis - his ketones where 7 and his sugar levels where 7. He has nausea and vomiting continuously for a week in hospital (but started at 3 days of vomiting at home). I was completely baffled by this - he also got dehydrated after taking hydration supplements. I still cannot believe what has happened. He is back home and i am still in shock about this whole ordeal, to say the least he is off the keto diet and wont be going back on it. After all the research i read on this forum, apparently ketoacidosis starts at 3 for some diabetics type 2. It depends how your body responds to things. But still in complete shock about what has happened to him. He did well for a month and when the nausea started it couldnt be controlled or stopped. Soon after there was heart burn … which was aweful. Has anyone experienced this before in type 2 diabetics ?

(Bacon is a many-splendoured thing) #24

Ketoacidosis is not likely if the pancreas is producing any insulin at all. Has his diabetes gone untreated for a long time? His pancreas may have stopped producing insulin, in which case, he would now be considered Type I and have to take daily insulin.

On the other hand, there are a couple of drugs that can also produced ketoacidosis, such as SGLT-2 inhibitors. In that case, the ketoacidosis would not have been the result of a ketogenic diet, but rather a reaction to the drug.

(Jane) #25

Sorry this happened to your husband!

The highest ketones I’ve ever had was 7.6 and that was on day 3 of a fast. My glucose was 56 (3.1) and I felt fine.

(Jane) #26

My 88-yo T2D dad improved his blood sugar by keeping his carbs under 100. He is not In ketosis at that level of carbs but his insulin response is much lower. His doctor recommended that.

(Bacon is a many-splendoured thing) #27

In American measurements, ketoacidosis only starts to be a concern when serum β-hydroxybutyrate reaches 10.0, and symptoms don’t become apparent until it reaches 20.0.

(Robin) #28

Good answer. There’s no reason to offer up that info, especially when you are cruising along and doing well.

(Robin) #29

That’s terrible news! I understand why he is dropping keto. Hopefully he can still eat healthier than most, cut out the sweets, and do well. I sure hope you find some answers! Let us know.

(Michael - When reality fails to meet expectations, the problem is not reality.) #30

Just my opinions. 7mmol is not ketoacidosis. If you read somewhere that 3mmol is ketoacidosis for some T2D patients, please cite it so we can investigate. A lot of very knowledgeable people are involved in keto research - not only on this forum - but reputable scientists doing constant research to understand exactly how ketosis functions healthily and what can go haywire and why.

I agree with @PaulL that keto is not your husband’s problem here. Keto is being pilloried because he got a high side of the normal range ketones. This happens more frequently among new ketoers whose ketogenesis processes are out of practice and fat adaptation is zip to nada. In the presence of any insulin, ketones will not and can not cause acidosis. So blaming keto is a red herring.

Something else is mysfunctioning and keto is being held up as the culprit… ‘See, see, I told you that keto stuff would kill you…’ So your doc doesn’t have to bother trying to figure what the actual problem is. But again, as I noted above, I’ll let the more competent/experienced address the diabetic issues specifically. Please prepare a list of medications your husband currently ingests. That will likely be helpful. Best wishes.

(Joey) #31

@Maria_Cruz This is a shocking turn of events. It seems quite likely (as @PaulL suggests) that other unique (perhaps previously undiagnosed) factors are involved with your husband’s current health situation.

It is hard to imagine how restricting carbohydrates (starches/sugar/grains) could produce a health issue. Managing glucose while taking various medications can be a challenge to some during transition, but ketoacidosis is fairly well-understood and arises only under unique circumstances - outside of which it’s not thought to be possible.

Please do keep us posted on his progress - perhaps we can all learn something important in whatever additional details you are willing to share. Meanwhile, we wish your husband the very best for a speedy recovery and improved health going forward!

(Jane) #32

What treatment did your husband receive while in the hospital?

(Marianne) #33

Agreed!

(Maria Cruz) #34

To be honest @PaulL i have no idea what happened. They have switched his meds - he use to be on metaformin/injection/daplaflozin (spelling) - he is now just on 2 injections. one in the morning and the other 10mins before he eats. @robintemplin he is good - sweets are the not the problem but bread / rice and potatoes seem to be his issue. After hospital his portions are controlled and he eats out of a side plate. I am still in shock of his ketoacidosis. He was doing well until the nausea started thats when it went all downhill. @amwassil - i hear what your saying and this is why i am confused too with his condition. We are based in the UK so i think there could be a different declaration of ketoacidosis. He was vomitting everything liquid and food for a week in hospital, only after his ketones and sugars where stablised then he felt better. But he had about 4 drips stuck in his arm. Saline/potassium/Insulin and something else i cant remember @Janie

(Allie) #35

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The UK guidelines.