Refusal mode/Glucose sparing

(David Jones) #1

I’m a 57 year old diabetic and have been doing keto for 11 month. I was able to stop Truelicity and Metformin within a month. I slowly increased my exercise as my health improved and weight loss increased. What I have found with exercise is that it is an ever increasing threshold that must be achieved to hold my glucose down. After becoming fat adapted my muscles appear to be in glucose refusal mode unless I push to aneroblic levels of exercise or High Intensity Intervals. This is fairly easy to measure if you have a CGM and blood Keytone meter. Following a rest day the night time glucose drifts up (as does Ketone levels). I regularly find glucose levels 130-140mg/dL with keytones 1.0-2.0 when waking up. Eating or drinking nearly anything triggers insulin and takes the glucose down under 100mg/dL. This may be just the way my body works but it pisses me off. Following a day with some HIT level workout my glucose stays nice and low with some oscillations which I suspect are my liver producing glucose and my muscles willing to accept the glucose with normal or low levels of insulin. Exercising at Aerobic levels (HR 120-130) for .5, 1, 1.5 hours and as much as 3 hours showed no benifit for suppressing my night time glucose levels. When fasting this all changes after the first day. My glucose continues to slowly drop until the 3rd day and levels out around 80-85mg.dL. Exercising while fasting causes a big wrinkel (big overshoot and then undershoot) before normalize back to a little lower than before the workout (based on CGM).

 

I wounder what happens with non-diabetics? How high does thier glucose go when keytones are elevated apon waking up. (no food 3 hrs before sleeping 7-8 hrs)

 

My glucose sparing/refusal mode increased in the 3rd month of ketosis. From what I can measure it hasn’t changed better/worse since then.

 

I know that by adding in a few carb’s every few hours I can keep my glucose average down but I’m sticking to this until I can’t achieve it with HIT or get an injury. I hoping to see another adaption that may be impossible.

 

 

(Raj Seth) #2

Wouldn’t that be like getting your weight down by cutting off a limb? Adding in some carbs every few hours would cause an insulin response, that would then lower your glucose. My understanding of the solution is to lower the insulin as much as possible. If you are staying keto, then all the blood glucose is from gluconeogenesis. This is a demand driven process - so I don’t think the levels you are seeing are problematic.

I was diagnosed diabetic for 10 years with A1c high of 9. After going Keto - I was A1c of 6.0 in 2 months. I stopped all diabetic medications, in consult with my endocrinologist, at 2.5 months. When I asked him what I should watch for - he said “BG readings consistently above 150”. At 130-140 - I think you are fine…

(David Jones) #3

Thanks for the feedback. That’s how I see it also, but I would like to see better results.

BTW
Starting HbA1c: 8.2
Current HbA1c: 5.3
How much weight I’ve lost: 63 lbs, 20 lbs to go
When I began Keto: Jan 15, 2018

Never giving up!

(Justin Jordan) #4

It depends.

Near zero carb diets tend to produce physiological insulin resistance/glucose sparing. If you want maximal insulin sensitivity you may need SOME carbs. It’s probably nothing to worry about.

But gluconeogenesis being demand driven…well, so is insulin. Which is to say: just because it’s demand driven doesn’t mean it’s operating properly in a metabolically damaged person. I know for certain that raising protein above a certain point causes my blood sugar to rise - fairly dramatically.

(Bunny) #5

HIIT takes seconds to get the effect you would really want as far as weight loss and to get HGH levels up but being diabetic may impair IGF-1 from burning body fat, but to what extent I don’t know?

The time you are taking (too long to be HIIT) to exercise will elevate your glucose and lower your ketones (for how long I’m not sure?) not that, that is a bad thing but if you were to take some resistant starch right before you exercised you might see an increase in blood ketones and drop in blood glucose but not sure how that would work if your diabetic and how that would affect your night time glucose numbers?

Resources:

3 Types of Carbohydrates:

  1. Fiber (a major source of micronutrients; excluding bread)
  1. Sugar (including all bread, grain types/bleached flour; galactose)
  1. Starch (below)

Types of Resistant Starch; Not all resistant starches are the same. There are 4 different types (2):

  • Type 1: Is found in grains, seeds and legumes and resists digestion because it’s bound within the fibrous cell walls.
  • Type 2: Is found in some starchy foods, including raw sweet potatoes and green (unripe) bananas. (THE KIND YOU WANT ON KETO!)
  • Type 3: Is formed when certain starchy foods, including potatoes and rice, are cooked and then cooled. The cooling turns some of the digestible starches into resistant starches via retrogradation (3).
  • Type 4: Is man-made and formed via a chemical process. …More

Insulin & Glucagon:

  1. Insulin is a anabolic (synthesis) hormone (anabolism is powered by catabolism, where large molecules are broken down into smaller parts and then used up in cellular respiration) = CARBOHYDRATES
  1. Glucagon is a catabolic hormone (stimulates breakdown, production of glucose). = PROTEIN

Effect of eating vegetables before carbohydrates on glucose excursions in patients with type 2 diabetes

I am stumped, falling out of orbit, can anyone puzzle this out?
(David Jones) #6

Thanks for the info! The link on eating order was interesting. I had noticed the similar effect even with very low 4-8 grams of carbs by adding full fat cream. (cottage cheese with 1.5 oz cream added)

I have found with me anyway using my CGM and HRM that I have to do intervals no less than 20 minutes. I use the rowing machine, cable weights or inclined tread mill. If I workout to where my glucose spikes to 160-170 mg/dL my recovery glucose level will be great. However my BHB drops to zero for a few hours (3-5) but with the bonus of being more than 2x higher until waking the next day. My BHB always drops in the morning to ~ .3 mmol.
I messed around with MCT but I for some reason produce higher glucose at the same time as higher ketones,
My intervals are defined my heart rate transients of 85% maximum heart rate. with recoveries being less than 55%.

I always mix aerobic level in of 40-60 minutes and 10 minutes of yoga stretching at completion.

Anyway thanks for the feedback.

(You've tried everything else; why not try bacon?) #7

The first point to remember is that diabetes is a disorder of insulin, not glucose. Dr. Joseph Kraft was able to show that people were already in metabolic trouble long before their serum glucose reached a point where most doctors would consider a patient Type II diabetic. We know now that insulin resistance is the true problem, and that it is a spectrum. The real goal is not so much keeping glucose low as keeping insulin low, not to mention reducing or eliminating insulin resistance.

@DMJ With an HbA1C of 5.3, you are no longer diabetic. If your muscles are sparing glucose for those organs that need it (in particular, the red blood cells, which lack mitochondria and hence cannot use fat or ketones), then it means you are fully fat-adapted. Higher glucose levels are not a problem when your HbA1C indicates that your red blood cells are not becoming glycated. Here is an excellent discussion of what’s going on, from the Hyperlipid blog:

Have you had an oral glucose tolerance test, to determine your Kraft pattern? That would be an excellent way to determine whether you have anything to be concerned about.

(David Jones) #8

Thanks, I will check it out. I see the doc in 2 days.