Ketosis, ketoacidosis, proteins and insulin

It seems that there is a certain confusion, even among some doctors, between ketosis and ketoacidosis, being the first normal and the second lethal potential, but causing said confusion that feared to enter ketosis or make keto diet:

- Cetosis is the presence of ketone bodies as derived from the energy metabolization of fatty acids.
- That there are ketosis, typical of states of fasting and low intake of hydrates is not a bad thing.
-Cetosis evolves with Normaglucosa
- ketoacidosis (there are several types) only curses with high glucose levels.
- This hyperglycemia, breaking the electrolytic balance Na-K, dehydrate (polyuria and polydipsia), which in turn causes acidification, which is acidosis.
- But the keto of the word ketoacidosis is the part perhaps good because it means that such high glucose levels, and of low or null insulin, allow, however, that the metabolism uses fatty acids as a source of energy, in the absence of glucose.

So being in ketosis is not a bad thing in itself.It is normal.The important thing is that there is insulin entry and normal glucose levels.

On the other hand, keto or low -hydrates diets with a major protein ratio is not something that is bad for the kidney:

- Protein is essential for muscle
- Musculation reduces insulin resistance and fat
- Insulin is necessary for the entry of amino acids into the cell, which form proteins.
- Low dose insulin promotes fat storage.

Then a diet with moderate protein and fat, low insulin and under hydrate, which even causes a slight ketosis is a right path to reach blood normoglucose.

Greetings to Tutti

Hello,
I would like to point out a couple of things.
- In ketoacidosis what produces acidosis is the accumulation of ketone bodies, which are strong acids.Polyuria is given by hyperglycemia, and aggravates acidosis due to renal loss of K+.But acidosis is due to ketone bodies.
- Cetosis is not normal.Gluconeogenesis by way of ketones is not a normal path, but alternative of "survival" in case not between glucose to the cell (whether due to lack of insulin or due to lack of glucose).We can discuss the potential benefits and their risks, but it is dangerous for us to normalize it because I insist that it is not normal.

Finally, I would like to add that the objective of good control in diabetes, especially in type 1, is not to get normoglycemia, but the glucose enters the cell.The diet that you explain is catabolic, that is, you will get normoglycemia based on spending resources from the body itself (I eat the destruction of proteins or fats).It is better idea to eat the carbohydrates that your body needs next to the insulin corresponding, and in any case pull the excess or defect to get a catabolic balance (weight loss at the expense of muscle and fat mass) or anabolic (weight gainby fat and protein), within much more complex balances.I hope it was easy!

Of the three ketone bodies, the ketone is not acidic, if hydroxybutyric acid and acetoacetic acid, but neither of them are main responsible for the increase in blood acidity but dehydration caused by hyperglycemia.It is true that the K ion deficit is one of the pH falls.In ketosis (normal, and when I mean normal I mean non -pathological state but metabolic as second energy resource) the pH does not vary, which proves that the presence of ketone bodies should not cause blood acidification.
As for the Normaglucosa implies glucose entry into the cell, we agree.It is not about provoking ketosis, but about reducing hydrates by modulating them with an insulin contribution according to them and proteins.
The rule that indicates of "" carbohydrates that your body needs "is what has been prescribing for 50 years without success or achieving complications despite exhausting sacrifices. And that what needs is a barbarity, because it is a metabolic disorder that does notIt has been understood until a few years ago.
If not, ask in this forum how many DM 1 and 2 apply the hydrates counting and despite this living in a permanent roller coaster of insulin/ glucose corrections.
Greater intake of hydrates greater insulin, greater insulin greater number of fat deposits, and greater insulin resistance and greater increase in insulin and therefore greater oscillations and lower capacity to use fatty acids and worse muscle promotion capacity and use of theprotein.
I invite you to read the articles of SED magazine about low diet in hydrates.
It is a good source, although there are quite more, all of official guarantees and international medical corpus.

All the best

pinkman said:
of the three ketone bodies the ketone is not acid, if hydroxybutyric acid and ocetoacetic acid, but neither of them are main responsible for the increase in blood acidity butDehydration caused by hyperglycemia.It is true that the K ion deficit is one of the pH falls.In ketosis (normal, and when I mean normal I mean non -pathological state but metabolic as second energy resource) the pH does not vary, which proves that the presence of ketone bodies should not cause blood acidification.
As for the Normaglucosa implies glucose entry into the cell, we agree.It is not about provoking ketosis, but about reducing hydrates by modulating them with an insulin contribution according to them and proteins.
The rule that indicates of "" carbohydrates that your body needs "is what has been prescribing for 50 years without success or achieving complications despite exhausting sacrifices. And that what needs is a barbarity, because it is a metabolic disorder that does notIt has been understood until a few years ago.
If not, ask in this forum how many DM 1 and 2 apply the hydrates counting and despite this living in a permanent roller coaster of insulin/ glucose corrections.
Greater intake of hydrates greater insulin, greater insulin greater number of fat deposits, and greater insulin resistance and greater increase in insulin and therefore greater oscillations and lower capacity to use fatty acids and worse muscle promotion capacity and use of theprotein.
I invite you to read the articles of SED magazine about low diet in hydrates.
It is a good source, although there are quite more, all of official guarantees and international medical corpus.

All the best

@pinkman I congratulate you for the clearest explanation impossible, carrying that HC count is an impossible task, you just have to look at the HB1 and you start to tremble, figures that many endorsers applaud, each one owns itself, the complications aredifficult to accept and live with them.The IDF (International Diabetes Federation is more than clear that eating less HC works and a lot. Greetings

Hi @pinkman, I see that we will not agree on certain issues.

Acidosis in ketoacidosis comes mainly from the generation of acid that derives from the production of ketone bodies, there is no production of ketones (which are bases, of course) without net production of acid.In initial stages it is the bicarbonate buffer system who neutralizes the increase in hydrogenions and that is why the pH is normal, not because the ketones are not acidic.
Dehydration contributes to acidosis due to lactate contribution, although the most common is to have metabolic acidosis with normal or almost normal lactate.

The situation that you describe in the end is just what I have explained, if you have an anabolic imbalance, what you say without a doubt and enter a vicious circle.When you understand the pathophysiology of diabetes, you see that the ration counting does not correspond to the carbohydrate needs, which depend on other quite complex balances (I take advantage to claim the concept of glycemic load, which is used little and is much more useful, towhat must be added the kinetics of the glycemic curve).
But on the other hand, entering cetosis is a catabolic imbalance in which fat and proteins are consumed, hence you have to increase protein consumption.As imbalance as the opposite end, so we must not normalize or banal it (if almost no one understands diabetes, how we will understand the catabolic states).

Maybe I am one of the confused doctors, but I usually take care of patients with diabetic ketoacidosis in the ICU where I work and something I will have learned.Believe me that doctors study from multiple reliable sources, although we are questioned continuously and everyone knows more than us.And no, we do not train with the Magazine of SED (which is a great tool of dissemination and would have to read much more among its target audience).

@Pau91 without entering controversy.I hate organic chemistry ... and read all my messages from the thread.
How many carbohydrates are the minimums to be in a "normal state"?
Each person is different, but there will be a common minimum multiple for that number of hydrates.

Hi @ruthbia,
In healthy patients, it was said that 2g of glucose is needed per kg of weight per day (for 70kg they are 140g).The problem is that for a diabetic this can be a barbarity, there is no figure, if so it would be wonderful to be diabetic, and I think it is not easy for anyone to bring excellent control (be a doctor or electrician).If in ICU patients with different monitoring systems (glycemia, calorimetry, metabolic parameters ...) it is difficult to find a value, you can imagine that we who are going through the world only with hair glycemia or sensors are "in balls."This is why carbohydrate counting diets do not work on all occasions (I don't count rations myself, but I am not an example of anything).There is a recent randomized trial that compares the vegan diet with that of ration counting and the greater the carbohydrate intake, the vegan diet provides better glycemic control and lower cardiovascular risk (and no, I am not vegan).

It is not the same 10g of sugar as 10g of complex carbohydrates, hence the importance of glycemic load (which is calculated as grams of hydrates by the glycemic index), and in turn the cynotics of the curve.And in the same way, the requirements of each are different and vary with age, activity, hormonal cycles, sleep, etc ... The ideal carbohydrate intake (and insulin contribution) is what at all times allows youEnter ketosis and at the same time not induce lipogenesis (creation of fats).But this is impossible to know in real time, the one who invent something like that will be lined.And here you could justify what @pinkman proposes, enter very mild ketosis (with very low or negative ketones according to the time of the day) surely indicates that we are close to equilibrium but towards the destruction of fat and proteins (that's why these diets gowith greater contribution of fats and proteins).But it has its risks, and it is that a sad fever or gastroenteritis can launch you in a few hours to ketoacidosis, not to mention the loss of muscle mass if it does not swing very well the diet and combines with the exercise of force.

That is why if diabetes is already difficult by itself, I do not think that ketosis should be recommended or naturalized because it is very easy to enter it but not so much to handle it well and know/assume its risks.Hopefully one day a test or device is discovered that indicates the ideal figure of carbohydrates and insulin, while we will continue with the less bad options for each one, which cannot be generalized (ration counting, vegan diets/keto/low in HC,etc…).

@Pau91 I find this thread super interesting because information is also being treated that as @Pinkman says rarely detailed.

The issue is that standing users, that they do not have such technical knowledge often we are lost in ... why if as fats .. then it is difficult for me4 parts of the same with the protein.

On a personal level I have tried the Keto, and I went from 87kg to 95kg ... I increased my insulin needs and yes .. the variability was very good, but with a management of .. increasingly insulin and it cost more and morehave a 170 nailed.

Now I have greatly reduced that grease intake .. I am gradually reincorporating low glycemic indexLess corrective bowling than before for what ...

Where is that magic of the oto?Is it depending on each person ???I understand that yes and that this is not for everyone,

What I have clearer every day is that in balance is the key, the extremes have never been good.

Totally agree @marine
Those of us who know of the topic at the most technical level are equally lost, we understand it better but one thing is knowledge and another practice ...
So many variables intervene that either explodes our heads or we accept simpler options and applicable to our day to day.And in the end it is as simple as that if the oto does not work for you, you have to do something else, and vice versa.So simple and at the same time as “little scientific”, each diabetes is a world and if there was an ideal option it would be the one that we would all do, but since there is no multitude of options to choose the least bad for each one.

@Pau91 But taking the simple option that is "each diabetes is a world" does not help us ... and I explain: Smile:

-For years I have thought that only the hydrates had an impact on glycemia and not that the fats and proteins also had it .... it ends it to see but to the brave ... because it would go up and 2+2 = 4.

-For years I knew that the nerves for an exam raised the blood glucose ... or that if I was nervous but for another reason I lowered me ... and that to the brave ....

There are many issues that have a why but from the medical team it is not explained ... you go to the endocrine and you find that maybe it tells you that if ... or also "that cannot be."

That is why I say, that this thread like others of this same scientific nature say ... They seem super interesting because if we talk in the same way ... applied to sport ... to emotions ... to types of insulin ....

The people who take this time and if we need that explanation we have it.

Jo, how interesting everything!@Pau91 I try not to spend much with hydrates, and replace the less healthy with vegetables especially.The fats does not go with me much, since they don't feel good to me, so such a diet would not be my style.But how difficult it is to find that balance you are talking about: when I take more account of the account (especially flours and the like), everything becomes a roller coaster, difficult to manage and control: Smirk:

It is still interesting that after scientific data and biochemical criteria and others, some comments are closed with that cunic, "and well, it is complicated, diabetes is a world and each patient is different."

@Pau91 Thanks for your exhibition equally.

Then later I will comment on some things that you indicate, that I disagree greatly, and that unfortunately it causes that we still walk, with Rollercoaster everywhere, even the most painted.

And by the way, challenge to facilitate a Paper, a document, a test, a patient who has suffered it, a doctor who has treated him in the emergency room on the case of passing from ketosis to zeroacidosis in hours through a simple fever or whatMay it be.It would really be enlightening, a full -fledged epiphany to have that reliable fact.

Thank you so much

A exciting this whole theme, the motto of more sole and less casserole is important, since as you know the insulin falls empadz, that is, you need much less, today what is seen is the opposite, extremes of over use of insulins, and justWe have magical muscle receptors if used, they just do it without almost insulin need.Here lies everything, then the substrate because to taste, you like to live with HC you know what there is, you are cool the proteins/fats/vegetables because I am from this race and I do not change it for anything, evenThe date is still very alive.Hey eleven years of madness.

@Pau91 I don't tell rations either.
I had a good diabetological formation but in 6 months I "independent" of the counting of hydrates and the 130g HC/day rules.
Diabetes evolves with us, hydrates give me less problems than fat/protein unit, with the years fats are the worst.
I have not diet Keto, I put myself in the hands of an endocrine to lose weight and made a protein diet with 30g of HC.It is very good but it is difficult to cope with it, the hydrates is very rich.
Ketoacidosis I did not have despite being in ketosis 2 months, I only had in the debut.
In the end my balance is about 70g HC and lower more if I need to lose weight

@Pau91
- It is hypervolemia that aggravates metabolic acidosis by alteration of electrolytes.
- Acidosis is also aggravated by decreased some bases
- Two of the three ketone bodies (ketone is not acidic) lower the pH but they are not the precursors: serum hyperosmolarity contributes to dehydration and acidification only with hyperglycemic states
- It is hyperglycemia the essential factor in understanding acidosis.
- In diabetic ketoacidosis, ketone bodies are the response to fatty acids are the only energy catabolism from lipids, otherwise there would be failure and death, but they are the test of survival, not the cause that also currencies by the topindicated.
- From ketosis to ketoacidosis, it can only occur with high or very high blood glucose levels, either by infection or other causes, but eye, when we talk about ketosis we are not saying more than 1 or 2 mmol/l, when ketoacidosis is cured with 15mmol/L and more.
- To the opposite sensu, hyperglycemia of 180, 250, 300 with ketone bodies of 1 or 2, nothing weird, very common with exercise, they would be at the same risk of moving to ketoacidosis with an infection, when it is not unless unless, key in everythingThis, there is no insulin entry.
- By the way, I always talk about low diet in HCS, non -ketogenic that is high fat content low HC and low protein.
- Low HC and low insulin entry, simply modulated is the ideal is not understood how more pedagogy is done on this.

Thank you

@Davidcasinos thank you very much.
I'm glad you get along.
I think there are two issues always reason for controversy in this:
- One is the one discussed
- Another is that of proteins and the kidney

There I leave it;By the way we have not talked about hyperosmolarity or we have not addressed the matter as it deserves, a fascinating theme within physiology.

Another issue is that of chrononutrition.

I advocate the roller mountains of end, even the most disastrous can achieve it, the roller coach is chaos, increases insulin resistance to the dessert and induces severe hypos among other things beyond those A1c of 6 to 7 that the truth that the truth, 6 is already wrong, it brings complications in a few years.

I think this is like spending/ saving.You can save now, austere life, and make sure a modest but quiet future.Or you can spend believing that everything is fine, wasting, and not reaching the future or getting badly.

Sincerely

pinkman said:
@davidcasinos thank you very much.
I'm glad you get along.
I think there are two issues always reason for controversy in this:
- One is the one discussed
- Another is that of proteins and the kidney

There I leave it;By the way we have not talked about hyperosmolarity or we have not addressed the matter as it deserves, a fascinating theme within physiology.

Another issue is that of chrononutrition.

I advocate the roller mountains of end, even the most disastrous can achieve it, the roller coach is chaos, increases insulin resistance to the dessert and induces severe hypos among other things beyond those A1c of 6 to 7 that the truth that the truth, 6 is already wrong, it brings complications in a few years.

I think this is like spending/ saving.You can save now, austere life, and make sure a modest but quiet future.Or you can spend believing that everything is fine, wasting, and not reaching the future or getting badly.

Sincerely

@Pinkman I collect the theme of the AIC, the second cause of affiliation to eleven is diabetic retinopathy, ask if a 6 glyc works, in my opinion not resounding.Not to mention other complications.

An A1C is on average around 125. But of course, there is the famous issue of variability, because various glycations are promoted with higher variability indices.
You can give someone's paradox with A1C equivalent to average 120 and IVG 30% and problems and someone with 130 and an IVG of 15% without complications.
I think that the self -complacency of every diabeticThey are in chronic depression, as 40% between the DM1 whose effort-reompensses binomial is for the soils ...

All the best

@Pau91 Thanks for the explanation, never stop eating hydrates and I see that I was right explained by you, I am really dt1 20 years ago and I feel great for paying attention to those who study and understand food since there are forum there are forumIlluminated that recommends things without knowing, thanks for participating in the forum and giving an opinion from the certainty of knowing what is talked about !!

pinkman said:
an a1c is on average around 125. But of course, there is the famous issue of variability, because several glycations are promoted with higher indices of variability.
You can give someone's paradox with A1C equivalent to average 120 and IVG 30% and problems and someone with 130 and an IVG of 15% without complications.
I think that the self -complacency of every diabeticThey are in chronic depression, as 40% between the DM1 whose effort-reompensses binomial is for the soils ...

GREETING

@Pinkman: I would appreciate that you will comment where you have found that 40% chronic depression in type 1 diabetics.
The topic interests me.Thank you!