Whether you are a Type 1 Diabetic, Type 2 Diabetic or a non-diabetic, ketones and blood sugars are not a straight forward topic. Let’s dive deep into my life, insulin, blood sugars, ketones and the intricacy to which they are intertwined.
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Ketones and Blood Sugar
I want to give a little background before I dive into our topic for the day for those that don’t know who I am or what my history is. Many of you do, but just bear with me for those that don’t.
I had Gestational Diabetes with all 4 of my pregnancies. Insulin was necessary on the last one when I was 38 (which was 5 years ago). I was reasonably low carb at this time but still could not get my blood sugars down with diet and exercise alone.
I’ve always been “retested” for fasting blood sugars after pregnancy to make sure I’m “fine”. I use that term loosely because my fasting blood sugars have not been the issue for me until about a year ago. I was always stamped with the seal of approval and sent on my way.
To back up even further, my 16-year-old son was diagnosed at age 8 with Type 1 Diabetes so when I’m tasked with keeping my child alive, you can imagine that I went to the end of the Earth and back researching and learning everything I could.
Ok, so fast forward to a little over a year ago. I was constantly irritated and my head always felt foggy. I was just tired and cranky nonstop for no reason. You can ask my hubby on that one and he’ll be the first to agree. Poor guy.
One night my son’s blood sugar was super high and he was pretty darn irritable and cranky. A lightbulb went off and I decided to check my blood sugar. It had been a few hours since I had eaten dinner and when I looked at the number I almost passed out. It was either 215 or 250 – I can’t recall. BUT either one is horrendous for a nondiabetic (and even for a diabetic).
I snagged a bottle of test strips from my son and drove to Walgreens to get my own test kit. I tested my fasting numbers and after meal numbers for the next week and it pretty much confirmed my fear. My fasting numbers were just over 100 which is prediabetic and my after meal numbers were 175-250 ish.
I went to my doctor and was misdiagnosed initially as Prediabetic, or soon to be a Type 2 Diabetic.
I immediately went on the keto diet to bring my sugars down consistently and I instituted intermittent fasting to try to reverse what I thought was insulin resistance. Turns out I’m not insulin resistant, but I’ll get to that in a moment.
My naturopath did a fasting insulin test as my A1C was rising. She started to do some further diagnostic testing as something just didn’t feel right with the diagnosis.
My A1c was still not too high, but it was somewhere in the 6s. Anyway, my fasting insulin came back just above 0. She said she wasn’t all that concerned since I was eating keto and it can lower insulin requirements.
We waited 3 months and tested again. Same result. Only this time, I went off keto for the 2 weeks leading up to the test to eliminate a variable.
3 months later, same result. Blood sugars still going crazy for my planned carb up days.
She decided to do some Type 1 Diabetes testing with my prompting because I was doing a lot of research about adult onset Type 1 and I pretty much fit the bill.
Long story short, she did one last fasting insulin test with a C-peptide test and an antibody test and then sent me off to an endocrinologist as we waited for the results. I got the results a day before my endo visit.
The lovely endo walked in and said “Alrighty, so Type 1 Diabetes! Did you doubt that?” I said “Nope. I already knew”. And that was that.
She said I could continue coming to her every 3 months for an A1C test or continue on with my naturopath until which time I need insulin. And to continue keto and monitoring my blood sugars closely.
I opted for a Freestyle Libre Continuous Glucose Monitor so I didn’t have to keep pricking my fingers. PLUS I suspected my blood sugars were going high when I wasn’t aware.
To be 100% transparent, I was barely checking anymore and with the Type 1 Diagnosis AND being in nutritional ketosis, that has to be monitored closely.
I’ll use this opportunity to clear up confusion about nutritional ketosis and diabetic ketoacidosis.
Nutritional Ketosis is when ketones are produced due to a low carb diet and are generally in the low-moderate range. Ketones are the byproduct when fat is broken down and is used for energy.
Diabetic Ketoacidosis is when ketones are produced due to a lack of insulin and high blood sugars and can be a very dangerous state. Why is it dangerous? Several reasons. It indicates that insulin is not around. Did you forget a shot? Kinked pump line? But did you also know that insulin regulates ketone production . Lack of insulin can equate to crazy high ketone levels which is what makes the blood become acidic.
Day 1 with my new CGM and I did a test. I had breakfast for dinner and choose to do my carb up day a bit different. Normally I’d have a sweet potato or something like that. This time I decided to do 2 pieces of French toast, some hash browns, eggs and sausage for my carb up meal. Not something I’d normally have, BUT it was experiment time.
Time to break in the new CGM. You all know I love doing experiments, right?
I expected my blood sugars to jump way up for 1-3 hours and then come back down. I wanted to see just how high.
The experiment commenced at 6pm. Delicious and naughty dinner was finished up. So I started the testing every 60 minutes to see what happened. I decided not to test every hour in the night even though I was up peeing all night.
As you can see my blood sugars were high (at a minimum) from 7pm until 3am straight. That is (at a minimum) 8 hours. 8 long hours that my blood sugars were high. If you aren't familiar with blood sugars, they really should be between 80 and 120. I'm simplifying, but for this purpose, it is fine.
SO here is the kicker…. I was still in ketosis the next day. This got me thinking…..
Over the last 2 weeks, I have been unable to kick myself out of ketosis. I know, I know, great problem to have, right? Many people struggle to get in and stay in. I didn’t think too much of it until last night. AT first, I was thinking “cool, I’m so fat adapted that my body is just rocking this ketosis thing and doesn’t want to let it go”.
What I realized may be happening is that while most the time I am in nutritional ketosis, when I am having my carb up days, unable to get out of ketosis, I think it is because my body is not really utilizing the glucose due to lack of insulin so most are getting filtered out via my kidneys, hence why I was up all night peeing.
Now, here is I now have to be careful given the line between nutritional ketosis and ketoacidosis. I could choose to use insulin on my carb up days, or decrease my carb consumption on my carb up days or not have carb up days at all.
My pancreas is still producing just enough insulin so that my fasting blood sugars are hovering around 100 which is on the higher end of acceptable. But acceptable none the less. So I choose to continue keto and no insulin.
What to do then?? Give up my carb up days? Maybe. We shall see. The reason for my carb up days is that I firmly believe that knocking yourself out of ketosis once a week (as a woman especially) helps with metabolism and hormones. But if I’m unable to get out of ketosis without sacrificing my health in other ways, then it is an easy choice.
My whole point for this little glimpse inside my life is that while we set out on one path, that doesn’t mean that is the path we must stay on.
I believe in carb up days for a healthy, sustainable keto lifestyle. But at this point, unless I want to start insulin (which I don’t want to do yet) then I have to give them up. When my pancreas does it's final send-off, then I will bring my carb up days back since I'll be on insulin and will be able to manage the blood sugars. Or at least attempt to.
[UPDATE - I decided to use insulin for my carb up days in order to continue]
Keto can be a great tool for diabetes, both type 1 and type 2 – but it is important that you don’t assume you are in nutritional ketosis when measuring ketones. Check your blood sugars often.
And honestly – I’m a HUGE advocate of blood sugar testing even for non-diabetics. I’ve helped a few people realize they were prediabetic long before any doctor would have tested for it.
The reality is that there are a whole lot of people out there with undiagnosed Type 2 Diabetes and even some undiagnosed Type 1, walking around with high blood sugar. It is dangerous for the body. Then combine uncontrolled diabetes with ketosis and trouble can occur.
As I said, ketosis is a great tool, but you do need to have a GREAT understanding of your body at all times.
Know your body. Knowledge is power.
Trina Krug is a Holistic Nutritionist, Integrative Health Coach and host of the Carbless Conversations Podcast. With a Master’s Degree in Complementary and Alternative Medicine, her single mission in life is to facilitate self-healing in herself and those around her through awareness, lifestyle shifts and low-carb eating. As a current Doctor of Science student, she continues her studies in functional nutrition.