Keto diet and ketones

Hello

Those of you who follow a keto diet with type 1 diabetes wanted to know how your ketone levels are.

Hello @monicagf2576

It is a very interesting question, because in people with type 1 diabetes, ketones always raise many doubts.In a keto diet it is normal for nutritional ketones to appear (low or moderate levels), since the body uses fat as its main source of energy.This is not the same as ketoacidosis, which occurs when there is a lack of insulin and ketones become too high along with high blood sugar.

From what I have seen in other people with T1D who follow keto, it is common to find stable low or moderate ketones, especially if blood glucose levels are controlled and there is no insulin deficiency.Even so, many recommend measuring them from time to time, especially if glucose rises or if you feel unwell, to avoid scares.

We must also keep in mind that each body responds differently.There are people with type 1 diabetes who do very well by reducing carbohydrates a lot and others who prefer a more moderate approach because it is easier for them to manage.

Let's see if anyone on the forum who follows keto can share their experience and the levels of ketones they usually have, I'm sure that together we can clarify the topic a lot.

Hello!

I have been following an adapted ketogenic diet for some months (Less fat and more protein than the "canonical" Keto, but maintaining very low levels of HdC).The approximate range of ketones in the blood, measured with the Freestyle Libre 2 strips, is 1.0 - 2.9 mmol/L, also depending a lot on the exercise I do and whether I fast or not (I usually eat 3 meals a day).

Despite consuming very few carbohydrates and doing sports, I always take basal in the morning and evening (Lantus) and in case of hyperglycemia, I correct it with Fiasp boluses.Ketoacidosis can occur when insulin levels are very low and hyperglycemia persists, but ketone bodiesBy themselves they are simply a valid alternative energy source to glucose.

Good morning, I brought up this topic because I have had LADA diabetes for three years until two months ago, controlled only with exercise and the keto diet.I've been using 11 units of Toujeo for two months now, and the truth is that my life is becoming easier.But the other day I was at an endocrine clinic for my son and he made the comment that the keto diet for type 2 diabetes was great, but that for type 1 it was dangerous, that you had to be careful with ketones.In the three years that I have been with another endocrinologist, he has never talked to me about this.Following that comment, I measured my blood ketones and it was 2.6.I was alarmed to see the levels they marked as adequate, less than 0.6.I have made an appointment with this endocrine, but I have it in April.I have also read that even if you have an adequate TIR or blood glucose, you can have euglycemic acidosis without knowing it, and this scares me, because I have an average blood glucose of 123, but high ketones.And it is true that throughout these years I have had episodes of vomiting and discomfort that I did not understand, and I maintain a terrible thirst that my endocrinologist told me was not normal and now I am wondering if it is not because I am in ketosis.I would like to know what the risk levels are for entering into acidosis, because the levels I have seen are from 3 on a test strip.And also, if you get sick, whether it is easily reversed or not and/or whether it leaves consequences.

My experience with the keto diet has been positive in terms of blood sugar, but the doctor told me that with type 1 diabetes, it is better to eat a minimum of 70 carbohydrates.In my case it is impossible to introduce that amount, otherwise my blood sugar would skyrocket, and it would no longer be keto, it would be lowcarb.I try to eat as much carbohydrate as I can, but I estimate that I will eat between 20-30 a day.

In my case, the experience with most endocrinologists has been quite bad.Fear of going off script, almost complete ignorance of other protocols, restrictions on sport...

Throughout these years, as soon as you propose a protocol that goes beyond what is generally accepted (which does not have to be ideal or valid for all people, ages or lifestyles), the most common reaction is to try to discourage you.There are things that do not make sense, such as for example that we continue to be prescribed 5 meals a day (more possibilities of altering blood glucose, more need for control, more insulin, more mental work...) or that the pillar of nutrition continues to be Carbohydrates (70 grams of Maria cookies at breakfast prescribed by an endocrinologist, as I have seen in some cases, seems like a crime to me, at a nutritional and diabetes care level)

The same thing happens with ketones, it seems that as soon as they are positive they must be interpreted as an imminent risk and nothing could be further from the truth.The danger is ketoacidosis, not ketones!

Among the symptoms you mention, it is very important to get used to drinking a lot more water (in addition to supplementing in some cases with electrolytes), because this type of diet causes us to lose a lot more water (as we lose glycogen, we lose water in large quantities. Thereforeeach gram of glycogen, the body retains up to4 grams of water, which is why you lose weight so quickly at first with this diet.Vomiting and other symptoms may fit what is known as "keto flu" eitherketo fluduring the first days, while the body gets used to obtaining energy mostly from fatty acids.

My recommendation is that you look for professionals (both nutritionists and endocrinologists) who are open to adapting the treatment to the patients and not the other way around as happens in most cases.Compare information, look for evidence, read studies... It is also true that the more information we have as patients, the more critical we can be and make better decisions regarding our life and treatment.

I take this opportunity to update the topic regarding eglycemic ketoacidosis and share a couple of interesting articles.It is a rare complication, but if you are using iSGLT2 (empagliflozin, canagliflozin, dapagliflozin and ertugliflozin) hExtreme caution should be taken since there is evidence that the use of these drugs together with low-carbohydrate diets can increase the incidence.

CASE ANALYSIS:

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GENERAL INFO:

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https://diabetesforo.com/es/thread/3194/dieta-keto/

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