Confused

[Pixielula]

Hey guys, so briefly T2 diabetic, went LCHF 3 years ago and have been in nutritional ketosis since all but once when I slipped out for 48 hrs. So my question to you all is this. I got up this morning and tested my urine 0.8 ketones, came down and tested my blood 10.5 😳 this has happened before normally sugar is lower but also sometimes higher. I don’t understand how I can have high sugar readings whilst also being in ketosis? Can anyone help me with this......... may not be relevant but yesterday I did nearly a two hour walk on the Brecon Beacons and a 30 min spin class

[AnnieW55]

Im no expert and don’t have diabetes but have you heard of the Dawn Phenomenon? It’s possible that that is what you experience occasionally.

[TheAwfulToad Ambassador]

There could be any number of reasons for the blip - including measurement error. A single-point reading doesn't mean a whole lot. To get a reliable picture of what's going on generally, you'd want an HbA1c test and a whole set of instantanous blood sugar readings over 24 hours (preferably repeated for a few days). How does this one-off reading compare to previous ones? If it's an outlier, I'd just ignore it.

Being "in ketosis" doesn't mean your body has stopped using glucose; you still have a certain minimum requirement for it, and your body will manufacture what it doesn't get from your diet. Your reading of 10.5mmol/L, if it's real, is a result of your liver producing large amounts of glucose and the rest of your body not adequately taking it up. Up to a point a small uptick is normal because your liver responds to the complete lack of food while you're asleep, but you would not expect to see that sort of large excursion unless you still have severe, widespread insulin resistance ... which seems a bit unlikely under the circumstances. So, again, I'm thinking measurement error.

Somewhat unrelated to your question ... I would suggest not being quite so strict with the keto diet. Give your body a few carbs now and then; unless you were seriously ill at diagnosis, your liver and pancreas are probably undamaged and you should be able to handle modest amounts. Aim for the 50g/day ballpark, and see if you maintain blood sugar stability.

[Pixielula in reply to TheAwfulToad]

I think I am super sensitive to carbs, I have been diabetic for over 20 years and at one point was injecting a lot of insulin, I know sugars are usually high in the morning but I am confused that my body still keeps in ketosis with that level of glucose in my blood...... I have done this with only my own research, and have no input from my diabetic nurse or GP apart from horror really.... I asked my nurse if there was anyone who could give me advice on low carb, and she made me an app l, only to discover she was promoting low calorie shakes.... so it’s hard to even get people to listen to what your asking.

[TheAwfulToad Ambassador in reply to Pixielula]

Ahh .. OK. I misunderstood your post. I was under the impression you were diagnosed three years ago and immediately transitioned to LCHF.

Since your diabetes was essentially uncontrolled for 20 years, you probably have extensive damage to both your liver and pancreas. It's possible you're not producing much insulin, and/or that you still have "leaky liver" syndrome (it carries on synthesizing glucose even when commanded not to, particularly at night).

Why are you still in ketosis? Because that sugar in your bloodstream is inaccessible as a source of energy; that's why it's rising uncontrolled. My guess is that you have a very poor insulin response as a result of beta-cell destruction. Remember that gluconeogenesis and the associated ketone output is controlled by (low) insulin, not blood sugar (your liver has no means of measuring blood sugar directly). Your liver is under the impression that you have very low blood sugar. It therefore kicks out lots of glucose and lots of ketones.

Another way of looking at it is this: you must be in ketosis because the glucose in your bloodstream is being used very inefficiently, yet you are still alive

Stories like yours make me really upset. Who the hell do these quacks think they are? They could have cured you years ago. But they made you sicker instead, because politics and arrogance. Fortunately you still have enough remaining pancreatic function to maintain ketone control, so that's something.

Anyway, it sounds to me as if you're doing all the right things to keep this under control.