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Ketosis and type 1 diabetes: The request could not be satisfied


Ketosis and Diabetic Ketoacidosis: How Do They Differ?

Ketosis and ketoacidosis sound similar and are sometimes confused, but don’t mistake these conditions for one another. These involve two different sets of circumstances with considerably different outlooks.

Both are triggered by an increase of ketones in the body, which are acids released into the bloodstream when the body burns fat for energy instead of carbohydrates. But it’s how the body responds to this increase that sets ketosis and ketoacidosis apart from each other.

RELATED: How to Tell the Difference Between Good and Bad Carbs

What Is Ketosis and How Does the Process Work?

“Ketosis is a natural state that occurs when you start to metabolize fat instead of sugar,” says Michael Greenfield, MD, endocrinologist and chief medical officer at El Camino Hospital in Palo Alto, California. “It occurs often when people fast and use up the stores of sugar in their body.”

To understand ketosis, it helps to understand how the body burns energy. Carbohydrates and fat are both energy sources, and the body typically burns carbs (sugar or glucose) first, and then fat. If there aren’t enough carbohydrates in your system, it begins to break down fat for energy, which puts your body into a state of ketosis.

While in this state, the body becomes a fat-burning machine. For this reason, ketosis is the goal of many diets, particularly those that restrict carbohydrate intake and rely on fat for energy, such as the ketogenic diet.

RELATED: What to Eat and Avoid on the Keto Diet

Understanding the Relationship Between the Ketogenic Diet and Ketosis

“The ketogenic diet is a high-fat (60 to 80 percent of your total daily calories), moderate-protein (10 to 15 percent of your total daily calories), and low-carbohydrate diet (less than 10 percent of your total daily calories) that forces your body into ketosis, where it burns fat as its primary source for energy,” says Deborah Malkoff-Cohen, RD, CDE, and founder of City Kids Nutrition, a nutritional consultation service for children in New York City. “Think of the old Atkins plan where your ex-boyfriend would eat slabs of bacon, eggs, and a porterhouse steak, and lose 21 pounds in a month.”

But although the ketogenic diet is similar to Atkins, it’s not the same. Atkins is a high-protein diet, whereas the ketogenic diet is a high-fat diet.

Malkoff explains that the ketogenic diet works by rewiring metabolism so that it can burn fat more efficiently over time, and it uses specific levels of macronutrients (fats, carbs, and proteins) to keep the body in a constant state of ketosis. Because the body can only go into ketosis when it’s using fat for fuel, this is a hard diet to follow, and it often means saying goodbye to starchy veggies, like potatoes, rice, corn, squash, dairy, some fruits, bread, and beans that are too carb-y, she says. The plan has become popular among people with type 2 diabetes because of its potential to lower blood sugar while leading to weight loss.

RELATED: Does the Ketogenic Diet Work for Type 2 Diabetes?

For people who are able to stick with it, the ketogenic diet can reduce appetite and lower triglycerides — a form of fat that can affect heart-disease risk — while contributing to weight loss and sharper brain function. But this doesn’t mean the ketogenic diet is right for everyone. Particularly, people with kidney damage, women who are breast-feeding or pregnant, and some individuals on certain kinds of medication should avoid ketosis. It’s important to discuss your diet goals with your doctor before trying to achieve this state.

Also important to note is there are no long-term studies on ketosis and the ketogenic diet, so it’s unclear what health effects the approach may have on the body if sustained. Some dietitians warn the ketogenic diet may lead to nutritional deficiencies in the long run.

People with type 1 diabetes should not try to achieve ketosis through the ketogenic diet or otherwise. Because people with type 1 diabetes don’t have insulin, they cannot metabolize ketones, which are gradually flushed through urine in people without the disease. For people with type 1 diabetes, ketosis can result in an accumulation of ketone acids in their bloodstream known as diabetic ketoacidosis (DKA), says Dr.  Greenfield.

What Is Diabetic Ketoacidosis Exactly?

“[Ketoacidosis] is caused by a lack of insulin available for the cells to adequately uptake the sugar (glucose) in the blood to use for energy,” explains Malkoff-Cohen. “Without enough insulin, your body begins to break down fat for energy, and ketones are then released into the bloodstream, where they cause a chemical imbalance in the blood called metabolic acidosis.”

Whereas ketosis is natural and harmless, diabetic ketoacidosis can be life-threatening if left untreated. Too much acid in the blood can poison the body, causing loss of consciousness and death. Ketoacidosis is most common in people who have type 1 diabetes, but it can sometimes develop in type 2 diabetes due to low insulin levels.

RELATED: Everything You Need to Know About Insulin if You Have Type 2 Diabetes

Ketoacidosis is rare in people without diabetes, but it might occur in cases of starvation. A study published in October 2015 in the Journal of Medical Case Reports found that a low-carbohydrate diet combined with lactation could potentially induce ketoacidosis in women without diabetes, but more research is needed.

Poor diabetes management, or not having enough insulin in your system, is one cause of ketoacidosis. Other factors include developing an infection (such as pneumonia or a urinary tract infection), abusing drugs or alcohol, or taking a medication that affects how your body uses sugar. For example, corticosteroids, which are used for Crohn’s disease and asthma, among other health conditions, can make it harder for your cells to use insulin, whereas diuretics, used for controlling heart disease, can increase blood glucose levels.

Diabetic ketoacidosis can develop quickly, sometimes within 24 hours. The condition is responsible for more than 130,000 admissions to the hospital, as well as 50,000 hospital days per year in the United States, according to an article published in the journal Diabetes Management. According to an article published in March 2013 in American Family Physician, diabetic ketoacidosis is the leading cause of death among people with diabetes who are under age 24.

Symptoms of diabetic ketoacidosis include:

How to Treat Diabetic Ketoacidosis

If you have diabetes, not only should you monitor your blood sugar on a regular basis, you should also maintain a supply of ketone urine test strips, and then check your ketone level whenever your blood sugar rises above 250 milligrams per deciliter (mg/dL).

If test strips detect ketones in your urine, begin self-treatment by drinking plenty of fluids to flush ketones from your body, and then take insulin to bring down your blood sugar. If your ketone level doesn’t come down, or if you begin vomiting, go to the emergency room.

Hospital treatment involves rehydration to replace fluids lost through excessive urination or vomiting, electrolyte replacement to maintain heart, nerves, and cell function, as well as insulin therapy to regulate your blood sugar level. Your doctor may also screen for infections or modify your medication.

RELATED: 10 Warning Signs of Low Blood Sugar

Tips to Prevent Ketoacidosis

Ketoacidosis is preventable in people who have type 1 and type 2 diabetes. To avoid this potentially life-threatening complication:

  • Take your diabetes medication as directed and don’t skip insulin doses.
  • Monitor your blood sugar and ketones every couple of hours while sick.
  • Drink plenty of fluids while sick to prevent dehydration, about 8 ounces of a caffeine-free beverage every hour.
  • Continue taking insulin while sick, even if you’re not eating a lot.

Physical activity is recommended for people with diabetes, but don’t forget to check your blood sugar level before a workout. Exercising with elevated blood sugar could trigger diabetic ketoacidosis.

RELATED: 6 Diabetes Exercise Mistakes and How to Avoid Them

A safe blood sugar level for exercise is 100 to 250 mg/dL. If your level is lower than 100 mg/dL, eat a preworkout snack to boost your blood sugar and energy (between 15 and 30 grams of carbs). Don’t work out if your blood sugar level is higher than 250 mg/dL.

The Takeaway on Ketosis vs. Diabetic Ketoacidosis

Ketosis and ketoacidosis may sound similar, but these conditions are totally different. Whereas the former can occur from eating a low-carbohydrate diet and isn’t harmful, the latter is a life-threatening complication of type 1 diabetes (and sometimes type 2 diabetes) that can cause a dangerous level of acid in the blood.

Starting Low Carb or Keto with Diabetes Medications – Diet Doctor

By , medical review by

Disclaimer: This guide is provided for general information and does not constitute medical advice. Every individual will have a slightly different need and should work closely with their healthcare team before making any changes. Please use this as a resource to help facilitate that discussion with your doctor and your healthcare team.

For instance, we want you to know that it’s very important to adapt diabetes medications when starting a low carb diet. In particular, insulin doses may need to be lowered to avoid low blood sugar, and SGLT2 inhibitors may need to be deprescribed (see below).

However, we also want you to discuss any changes in medication and relevant lifestyle changes with your doctor before making any changes. Full disclaimer

So you have diabetes and want to try eating low carb or keto? Good for you! Making these dietary changes has the potential to reverse type 2 diabetes. Or, if you have type 1 diabetes, doing so could dramatically improve your blood sugar control.

However, you need to know what you are doing, and you need to communicate frequently with your healthcare team. Once you start eating low carb you will likely have to lower your insulin doses as well as some other diabetes medications, frequently by quite a lot.

Avoiding the carbohydrates that raise your blood sugar level decreases your need for medication to lower it. Taking the same dose of insulin or insulin-stimulating oral medication as you did prior to adopting a low-carb diet might result in low blood sugar, something that can potentially become dangerous.

You need to test your blood sugar frequently when starting this diet and adjust your medication accordingly. This should always be done with the assistance of a physician or other health professional with expertise in diabetes (find a low-carb doctor).

No drugs

If you have diabetes and you’re treated by diet alone, there is an extremely low risk of low blood sugar on low carb. You can get started right away.

Insulin-treated type 2 diabetes

As a general guide, you will need to lower your doses when starting a strict low-carb diet.

Work with your doctor to find the right initial reduction. Many find they need to reduce long acting insulin between 30 and 50%. If you take insulin once or twice daily, consider reducing both doses by the same proportion. If you are on a basal bolus regimen (taking fast-acting insulin before meals, and long-acting insulin once or twice a day), you may want to reduce your mealtime doses more than your basal. This is part of the careful experimentation you should do in conjunction with your healthcare provider!

If you remain low carb, it is possible you will be able to stop mealtime insulin altogether. You can then begin to more aggressively reduce your long-acting insulin, if your blood sugar levels remain stable. Many people on a low carb diet are able to come off insulin completely.

Unfortunately, there’s no way of knowing how much insulin is required in advance. You will have to test your blood sugar frequently and, with the assistance of a knowledgeable physician or healthcare team, lower insulin doses based on your blood sugar readings.

Note that as a general rule, many feel it is better to err on the low side of insulin doses. If your blood sugar goes a bit high you can take more insulin later to help bring it down. That’s OK for the short-term. If instead you take too much insulin and end up having low sugar, that is potentially far more dangerous.

You’ll also have to quickly eat or drink glucose or another form of rapid-acting carbohydrate in order to raise your sugar to a safe level, and that likely reduces the beneficial effect of the low-carb diet.

Insulin in type 1 diabetes

Much of the above advice on insulin also applies to people with type 1 diabetes. A low-carb, high-fat diet can be fantastic for empowering people with type 1 diabetes to get steady blood sugars. It often results in much fewer and milder highs or hypos, as long as insulin doses are reduced appropriately.

However, eating low-carb with type 1 diabetes requires even greater attention to blood sugar levels and insulin adjustment, and an even closer working relationship between you and your healthcare team. This section will review general guidelines to help you discuss potential changes with your doctor.

Many people with type 1 diabetes use an insulin to carbohydrate ratio (ICR) for their mealtime insulin. In this case, with a low carb diet you may continue to give the same ratio of insulin to the carbohydrates you eat. But, as you eat less carbohydrate, you will automatically inject less overall insulin.

In some cases, a slightly higher ICR may be required due to the effect of protein increasing insulin requirements. In other cases, a lower ICR may be required as some people will lose weight with a low carb diet and become more insulin sensitive.

People who use relatively fixed mealtime doses of insulin, or those on twice daily insulin, should use the same approach as those with type 2 diabetes. The difference is of course that people with type 1 diabetes will always need some insulin, even on a very low carbohydrate diet.

It is important to be aware that a diet with less than 50 grams of carbs each day can lead to ketosis. This is a normal physiological state that results from the body burning fat for energy.

A very strict low-carb diet can result in physiologic (in other words, safe) ketone levels (e.g. between 0.5 and 3.0 mmol/L, but sometimes as high as 4 or 5mmol/L). This should not be confused with ketoacidosis, which is a dangerous complication of type 1 diabetes when there is insufficient insulin.

Ketosis is a normal response to using fat for energy. It is fine for healthy people, but in type 1 diabetes this means that you need to be sure you can differentiate ketosis from the much more dangerous ketoacidosis. The latter is associated with high blood sugar levels and dehydration, as well as high ketones.

We therefore recommend that when starting a low carb diet, a person with type 1 diabetes starts with a more liberal low-carb diet, with at least 50 grams of carbs a day. If you wish, you can then begin to reduce your carb intake to 30-40 grams of carbs per day while working closely with your healthcare team and carefully monitoring your ketone levels.

We do not recommend starting a ketogenic low-carb diet (below 20 grams a day) unless you’re certain of how to handle this risk and are working closely with a very experienced healthcare practitioner. You also have to be able to test your ketones often, and use extra care if you feel even slightly ill, practice intermittent fasting or have been exercising.

It’s also important to remember that while people with type 2 diabetes can often reverse their disease enough to stop taking insulin injections entirely, someone with type 1 diabetes will always need to replace the insulin they lack.

With that said, a low-carb diet can have fantastic results for people with type 1 diabetes:

Type 1 diabetes – how to control your blood sugar with fewer carbs

Is It Good for Diabetics?

The ketogenic, or keto, diet is popular as a way to help people lose weight. But is it a safe, effective method to keep diabetes under control? Scientists are still studying how the diet affects people with the condition, but here’s what we know.

What Is the Keto Diet?

It’s a low-carb, high-fat eating plan. Most of what you eat is fat, whether that’s unsaturated fats like nuts, seeds, and avocados, or saturated fats like butter and coconut oil. About 20%-30% of your diet is protein, either lean (like chicken breast) or fatty (like bacon). You’re supposed to strictly limit carbs, even those that are typically considered healthy, such as beans, whole grains, milk, and many types of fruits and vegetables. On the keto diet, you eat less than 50 grams of carbs a day. To put that in perspective, one medium apple has 25 grams of carbs.

How does it work? Normally, your body fuels itself from sugar, or glucose, that it gets from carbs. After a few days of the keto diet, your body runs out of glucose. So it starts burning body fat instead. This is called nutritional ketosis. It creates fatty acid substances called ketones, which your body can use for energy.

Ketosis vs. Ketoacidosis

If you have diabetes, it’s important to understand the difference between nutritional ketosis and ketoacidosis. Both involve ketones. But ketoacidosis is a dangerous condition that happens when your body doesn’t have enough insulin and ketones build up too much. Symptoms include excessive thirst, urinating often, confusion, and weakness or fatigue. It’s more common for people with type 1 than type 2.

Ketosis happens with much lower, safer levels of ketones than ketoacidosis. In fact, this process happens in the course of everyday life, depending on the amount of carbs and protein you eat. It’s the state that can lead to weight loss, especially belly fat, and lower A1c for many people with diabetes.

Does Keto Work if You Have Diabetes?

Research suggests that people with type 2 diabetes can slim down and lower their blood sugar levels with the keto diet. In one study, people with type 2 lost weight, needed less medication, and lowered their A1c when they followed the keto diet for a year.


If you’re insulin resistant — which means you have higher blood sugar levels because your body isn’t responding properly to the hormone insulin — you could benefit from nutritional ketosis, because your body will need and make less insulin.

There are fewer studies looking at the keto diet for people with type 1 diabetes. One small study found that it helped people with type 1 lower their A1c levels, but we need a lot more research to get the full picture of the diet’s effects.

Keep in mind that most studies have only looked at the short-term results of the keto diet. It’s unclear if it works as a long-term way to manage your diabetes.

If you decide to try the keto diet, be aware that it may be hard to stick to. The very low amount of carbs in the plan is a big change for many people. It also can make you feel tired for a few weeks until your body adapts. To make it a success, it’s a good idea to make a meal plan you can follow, including keto-friendly meals and snacks to keep on hand.

Is Keto Safe if You Have Diabetes?

That depends on the type of diabetes you have. In general, people with type 2 who are overweight seem to get good results safely. If you have type 1 and want to try the keto diet, it’s essential that you talk to your doctor first. You’ll need to carefully monitor your health and watch for signs of ketoacidosis. For either type, it’s a good idea to work closely with your doctor, since you may need to change your medications.

The keto diet has some side effects that are worth knowing about, too:

Hypoglycemia: Though the diet can lower A1c levels, that may mean you’re at a higher risk of blood sugar that dips too low, especially if you’re also taking medicine for your diabetes. Let your doctor or diabetes educator know if you try the keto diet. They can advise you about checking your blood sugar, taking your medicines, and what to do when your blood sugar drops too low.


Heart disease: The diet emphasizes eating a lot of fat. If you eat too much saturated fat (the kind in foods like bacon and butter), that could raise your cholesterol, especially LDL, which is linked to heart disease. This is a special concern for people with diabetes, since the condition itself makes you more likely to get heart disease. Make sure that healthier sources are providing your fats — the mono- and polyunsaturated kinds, such as those in foods like avocados, nuts, and olive and canola oils. If you do it right, your LDL cholesterol and triglyceride levels could go down. If you take medicine for heart problems, such as high blood pressure, check with your doctor to see if you need to make changes to your medications.

Lack of nutrients: Since many foods are off-limits, including some fruits, vegetables, and dairy products, you could miss out on the important nutrients you’d get from them. Work with a nutritionist familiar with nutritional ketosis to make sure your body gets what it needs.


Liver and kidney problems: These organs help your body process fat and protein. Some experts worry that the keto diet could overwork them. Others say that if your organs are healthy, you’re probably fine.

Constipation: Since you’re not eating foods like whole grains and beans, you could miss key sources of fiber.

Gallstones: If you lose weight quickly, you could be more likely to get gallstones. Some foods, like those high in fiber and those with healthy fats, could help you prevent them. Talk to your doctor about other ways to avoid gallbladder trouble.

Should You Try It?

Talk to your doctor before you sign up for the keto diet. For some people with diabetes, especially those who need to lose weight, this way of eating can help improve symptoms and lessen the need for medication. But for others, the keto diet could make diabetes worse.

You’ll want to be careful when you transition off of it; adding carbs back in all at once can cause blood sugar spikes and weight gain. Your best bet is to start slowly with carbs that are high in protein and fiber.

Ketogenic Diet – How To Go Keto, Side Effects & Suitability

Ketogenic diets are very effective at achieving two common aims of diabetes control, lowering blood glucose levels and reducing weight

What is the ketogenic diet?

A ketogenic diet is a very low-carb diet, considered to be when you eat a level of carbohydrate of around 30g of carbohydrates per day or below.

This encourages the body to get its energy from burning body fat which produces an energy source known as ketones.

The diet helps to lower the body’s demand for insulin which has benefits for people with type 1 and type 2 diabetes

Note that it is important that you speak to your doctor if you are considering following the diet as precautions may need to be taken before starting.

How a ketogenic diet works

On a ketogenic diet, blood glucose levels are kept at a low but healthy level which encourages the body to break down fat into a fuel source known as ketones

The process of breaking down or ‘burning’ body fat is known as ketosis

People on insulin will typically require smaller doses of insulin which leads to less risk of large dosing errors.

The diet helps burn body fat and therefore has particular advantages for those looking to lose weight, including people with prediabetes or those otherwise at risk of type 2 diabetes.

How to follow a ketogenic diet

Based on the understanding that carbohydrate is the macronutrient that raises blood glucose the most, the primary goal of a ketogenic diet is to keep consumption lower than that of a traditional low carbohydrate diet with moderate protein and a very high fat content.

This will determine the nutrient density of the ketogenic diet as well as how to follow it, as different foods will have different effects on insulin and blood sugar levels.

There are a number of different types of ketogenic diet with variations in the level of carbohydrates and protein allowed in the diet and/or the amount of time someone is looking to spend in ketosis.

Note that some of the types of ketogenic have been designed specifically for people that are athletes or are otherwise working out very hard and often.

Benefits of a ketogenic diet

Ketone bodies produced from burning fat for fuel have been shown to have potent weight loss effects, help lower blood glucose levels and reduce people’s reliance on diabetes medication.

The diet has also shown evidence of having benefits on:

  • Reducing high blood pressure
  • Reducing triglyceride levels
  • Raising HDL cholesterol levels (a good sign of heart health)
  • Improving mental performance

Read more about the benefits of ketogenic diets

In addition to that, there has been a lot of interest in therapeutic ketosis for other long-term conditions, such as cancer, epilepsy, Alzheimer’s disease or dementia.

Do I need to measure ketones?

Significant weight loss and blood glucose control benefits can be derived from even a mild state of ketosis. There are a few methods you can use to measure the levels of ketones in your blood, urine or breath – each having their pros and cons.

Side effects of a ketogenic diet

With every change in the diet comes an adaptation period. With a ketogenic diet, the adaption is significant as the body has to switch its fuel source from glucose to fat. When this happens, it is not uncommon to experience a collection of side effects called ‘keto-flu’. This usually goes away within about four weeks.

Ketosis and ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) is when someone with type 1 diabetes, or very late-stage, insulin-dependent, type 2 diabetes, can’t produce any insulin and make very high amounts of ketones without stopping to prevent an effective state of starvation, which can lead to that person becoming critically ill.

Keto-adaption is a state, achieved through significant reduction of carbohydrate where the body changes from relying on glucose as its main source of energy to relying on ketones from fat burning.

Ketosis should only be a danger to someone on insulin if they have missed a dose of insulin or they are rationing their food intake, and therefore their insulin doses, too severely.

This is another good reason to ensure you have spoken with your doctor before starting the diet.

Safety on a ketogenic diet

There is generally a lack of long-term studies into the safety and effectiveness of ketogenic diets and, this is why a doctor’s opinion is needed before starting the diet.

There are a few groups of people for whom a ketogenic diet may not be suitable, or at the very least, warrants close supervision.

These include pregnant women, children, people at risk of hypoglycemia, people with a very low BMI, and those with conditions that a ketogenic diet may exacerbate.

Diabetic ketoacidosis – Symptoms and causes


Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones.

The condition develops when your body can’t produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated.

If you have diabetes or you’re at risk of diabetes, learn the warning signs of diabetic ketoacidosis and when to seek emergency care.


Diabetic ketoacidosis signs and symptoms often develop quickly, sometimes within 24 hours. For some, these signs and symptoms may be the first indication of having diabetes. You may notice:

  • Excessive thirst
  • Frequent urination
  • Nausea and vomiting
  • Stomach pain
  • Weakness or fatigue
  • Shortness of breath
  • Fruity-scented breath
  • Confusion

More-specific signs of diabetic ketoacidosis — which can be detected through home blood and urine testing kits — include:

  • High blood sugar level
  • High ketone levels in your urine

When to see a doctor

If you feel ill or stressed or you’ve had a recent illness or injury, check your blood sugar level often. You might also try an over-the-counter urine ketones testing kit.

Contact your doctor immediately if:

  • You’re vomiting and unable to tolerate food or liquid
  • Your blood sugar level is higher than your target range and doesn’t respond to home treatment
  • Your urine ketone level is moderate or high

Seek emergency care if:

  • Your blood sugar level is consistently higher than 300 milligrams per deciliter (mg/dL), or 16.7 millimoles per liter (mmol/L)
  • You have ketones in your urine and can’t reach your doctor for advice
  • You have many signs and symptoms of diabetic ketoacidosis — excessive thirst, frequent urination, nausea and vomiting, stomach pain, weakness or fatigue, shortness of breath, fruity-scented breath, and confusion

Remember, untreated diabetic ketoacidosis can lead to death.


Sugar is a main source of energy for the cells that make up your muscles and other tissues. Normally, insulin helps sugar enter your cells.

Without enough insulin, your body can’t use sugar properly for energy. This prompts the release of hormones that break down fat as fuel, which produces acids known as ketones. Excess ketones build up in the blood and eventually “spill over” into the urine.

Diabetic ketoacidosis is usually triggered by:

  • An illness. An infection or other illness can cause your body to produce higher levels of certain hormones, such as adrenaline or cortisol. Unfortunately, these hormones counter the effect of insulin — sometimes triggering an episode of diabetic ketoacidosis. Pneumonia and urinary tract infections are common culprits.
  • A problem with insulin therapy. Missed insulin treatments or inadequate insulin therapy or a malfunctioning insulin pump can leave you with too little insulin in your system, triggering diabetic ketoacidosis.

Other possible triggers of diabetic ketoacidosis include:

  • Physical or emotional trauma
  • Heart attack or stroke
  • Pancreatitis
  • Pregnancy
  • Alcohol or drug abuse, particularly cocaine
  • Certain medications, such as corticosteroids and some diuretics

Risk factors

The risk of diabetic ketoacidosis is highest if you:

  • Have type 1 diabetes
  • Frequently miss insulin doses

Uncommonly, diabetic ketoacidosis can occur if you have type 2 diabetes. In some cases, diabetic ketoacidosis may be the first sign that you have diabetes.


Diabetic ketoacidosis is treated with fluids, electrolytes — such as sodium, potassium and chloride — and insulin. Perhaps surprisingly, the most common complications of diabetic ketoacidosis are related to this lifesaving treatment.

Possible complications of the treatments

Treatment complications include:

  • Low blood sugar (hypoglycemia). Insulin allows sugar to enter your cells, causing your blood sugar level to drop. If your blood sugar level drops too quickly, you can develop low blood sugar.
  • Low potassium (hypokalemia). The fluids and insulin used to treat diabetic ketoacidosis can cause your potassium level to drop too low. A low potassium level can impair the activities of your heart, muscles and nerves. To avoid this, electrolytes, including potassium are usually given along with fluid replacement as part of the treatment of diabetic ketoacidosis.
  • Swelling in the brain (cerebral edema). Adjusting your blood sugar level too quickly can produce swelling in your brain. This complication appears to be more common in children, especially those with newly diagnosed diabetes.

Left untreated, the risks of diabetic ketoacidosis are much greater. Diabetic ketoacidosis can lead to loss of consciousness and, eventually, death.


There’s much you can do to prevent diabetic ketoacidosis and other diabetes complications.

  • Commit to managing your diabetes. Make healthy eating and physical activity part of your daily routine. Take oral diabetes medications or insulin as directed.
  • Monitor your blood sugar level. You might need to check and record your blood sugar level at least three to four times a day, or more often if you’re ill or stressed. Careful monitoring is the only way to make sure that your blood sugar level stays within your target range.
  • Adjust your insulin dosage as needed. Talk to your doctor or diabetes educator about how to adjust your insulin dosage in relation to factors such as your blood sugar level, what you eat, how active you are, and whether you’re ill. If your blood sugar level begins to rise, follow your diabetes treatment plan to return your blood sugar level to your target range.
  • Check your ketone level. When you’re ill or stressed, test your urine for excess ketones with an over-the-counter urine ketones test kit. If your ketone level is moderate or high, contact your doctor right away or seek emergency care. If you have low levels of ketones, you may need to take more insulin.
  • Be prepared to act quickly. If your blood sugar is high and you have excess ketones in your urine, and you think that you have diabetic ketoacidosis, seek emergency care.

Diabetes complications are scary. But don’t let fear keep you from taking good care of yourself. Follow your diabetes treatment plan carefully. Ask your diabetes treatment team for help when you need it.

Nov. 11, 2020

Ketogenic Diet and Type 1 Diabetes

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Quick Summary tl;dr

There are people who live with type 1 diabetes and follow a ketogenic diet as a safe way to improve quality of life. Controlling carbohydrates may be a vehicle for avoiding large fluctuations in blood sugar and extreme low blood sugar reactions from incorrect guessing on insulin dosing.

A ketogenic diet seems to help maintain a more stable dynamic between at least two critical factors (food and insulin) in Type 1 diabetes care, underscoring its value for clinical use and quality of life in diabetes self-management.

You should always consult with a doctor or other health professional who has expertise in diabetes prior to adopting a new diet, as you may need an adjustment to the medication you are taking.

What is Type 1 Diabetes?

Type 1 diabetes is an autoimmune disease. The immune system is a defence that guards the body against viruses, bacteria, fungi, parasites and toxins.

A combination of genetics and an environmental trigger (potentially a viral infection, low levels of vitamin D, cow’s milk or increased insulin demand) engages the immune system to attack and destroy the insulin-producing beta cells of the pancreas. After these beta cells are destroyed, the body is unable to produce insulin.

Type 1 diabetes is the result of the inability of the pancreas to produce insulin. In type 2 diabetes, the pancreas produces insulin, although cells are often resistant to its effects

Who Gets Type 1 Diabetes?

Type 1 diabetes can affect all age groups. Although historically 1 diabetes was considered to be a disease that appears during childhood, current research has found that adults are just as likely to be diagnosed with type 1 diabetes; half of type 1 diabetics are diagnosed after age 30 (1).

Yet the rate of Type 1 diabetes in children in the US has increased by almost 60% in 11 years (2), and approximately 1 in 300 children in the US will be affected by type 1 diabetes by 18 years of age ( 3). There are thousands of children who are affected globally.

The highest rates are in northern Europe and in individuals of European decent. Men are more commonly affected in early adult life (2). Data suggests the incidence of T1D has been increasing by 2–5% worldwide (5).

What Happens When Your Body Does Not Make Enough Insulin?

In type 1 diabetes, beta cells in the pancreas are destroyed by the body’s immune system. As a result, very little to no insulin is produced (a hormone released by the pancreas) produced.

Without insulin, glucose (sugar) from food cannot enter the cells. Instead of fueling the cells, this excess sugar circulates in the blood causing high blood sugar levels (also known as hyperglycemia).

If there is no insulin to shuttle blood sugar into the cells, excess blood sugar increases critically, and this is called diabetic ketoacidosis (DKA) as opposed to nutritional ketosis. In DKA, severe high blood sugar shifts the blood from having a pH of 7.3-7.45 to a more acidic pH of less than 7.3.

Constant high blood sugar increases risk of diabetes complications such as kidney, nerve and eye disease, heart disease and stroke. Maintaining blood sugar as close to normal is the goal to avoid these complications.

What Are the Symptoms of Type 1 Diabetes?

Until one is diagnosed and lying in a hospital bed, it is unlikely the signs and symptoms of type 1 diabetes will be recognized. This is why, especially for those with a family history, being aware of the symptoms is crucial. If you notice any of these symptoms, schedule a doctor’s visit immediately.

  • Extreme thirst
  • Frequent urination
  • Behavior changes (moody, less tolerant)
  • Drowsiness, fatigue or lethargy
  • Increased appetite coupled with weight loss
  • Sudden weight loss
  • Sudden vision changes
  • Fruity odor on the breath
  • Nausea and vomiting

Is There a Cure for Type 1 Diabetes?

There is no cure for type 1 diabetes. A ketogenic lifestyle can help people with type 1 diabetes avoid blood sugar fluctuations and optimize their quality of life.

Living With Type 1 Diabetes

Self care is of the utmost importance in the successful management of type 1 diabetes. Coordinating life skills (activity, nutrition, blood sugar monitoring, medication) — along with increased awareness of low blood sugar symptoms — analytical skills helps to keep blood sugar within target range. Sadly, less than one-third of people with type 1 diabetes in the U.S. are achieving target blood glucose control (6).

Type 1 diabetes can be a life-long burden, but consistency and commitment makes living with diabetes much easier. What you eat has a significant impact on blood sugar and the amount of insulin you need to inject.

Why is Type 1 Diabetes Difficult to Manage?

According to type 1 diabetic Dr. Keith Runyan in this presentation there are two main underlying factors as to why type 1 diabetes is difficult to manage:

1. High Variability of Absorption of Carbohydrates

Digestion and absorption of the different types of carbohydrates (rapid-digesting, slow-digesting, or processed) are almost impossible to time. ( 7)

There may be as much as a 50% variation in carbohydrate absorption from various types of carbohydrates. If you miss that peak blood sugar window of opportunity, the insulin will not be as effective, or work as expected, therefore resulting in blood sugar levels that are either too high or too low.

2. High Variability of Absorption of Insulin

Injected insulin can have as much as a 30% variability in absorption. How is one to determine this factor? Again, this is not easily determined, and in fact impossible to predict accurately.

Why Following a Low Carb Approach Works for Type 1 Diabetes

In essence, the high variability of absorption for both food and insulin makes it almost impossible to target treatment. If you lower carbohydrates and thus lower the amount of insulin required, the variability is less and there is a much better chance you will achieve target blood sugar.

Managing Type 1 Diabetes with the Ketogenic Diet

Health risks for people living with type 1 diabetes significantly decline with consistent and normal blood sugar levels. Life expectancy can also be similar to those without diabetes.

A ketogenic diet helps improve quality of life of patients living with type 1 diabetes. While low blood sugar is always a concern for type 1’s, it seems those who use a ketogenic diet find it is much more manageable (compared to the low resulting from an excessive bolus of insulin) because the symptoms are not as overwhelming and mental acuity is not affected.

Consensus amongst type 1 keto dieters seems to be to treat a low blood sugar with one standard glucose tab that provides 4-5 grams of carbohydrates (the total amount will depend on your situation and how low the blood sugar number is) to provide a necessary steady reliable rise in blood.

How to Follow the Ketogenic Diet to Manage Type 1 Diabetes?

Although not actually new, using a ketogenic diet to treat type 1 diabetes is becoming more popular. Importantly, you should work with a knowledgeable healthcare professional when attempting to switch from a high to lower carbohydrate diet to help select the appropriate foods and manage insulin dosing.

Dr. Richard Bernstein uses a very low carb ketogenic diet of 30 grams of carbohydrates per day to manage his and his patients’ blood sugars. He found that his blood sugar would stay in the normal range when he minimized his insulin injections consuming a carbohydrate regimen as follows:

  • 6 grams for breakfast
  • 12 grams for lunch
  • 12 grams for dinner

Source: Dr. Bernstein’s Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars

Ketogenic Menu Examples for Patients with Type 1 Diabetes

Breakfast (6 grams of carbs):
Lunch & Dinner (12 grams of carbs each):

Other Approaches

Troy Stapleton is another medical doctor using a ketogenic diet for better health (from Dr. Troy Stapleton’s presentation: I Manage My Type 1 Diabetes By Eating LCHF). Others consume closer to 50 grams of carbohydrates per day. You’ll need to consult your doctor and work with an expert to find a carbohydrate target that works for you.

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Ketones :: Diabetes Education Online

In a person without diabetes, ketone production is the body’s normal adaptation to starvation. Blood sugar levels never get too high or too low, because the production is regulated by just the right balance of insulin, glucagon and other hormones. However, in an individual with diabetes, dangerous and life-threatening levels of ketones can develop.

What are ketones and why do I need to know about them?

Ketones and ketoacids are alternative fuels for the body that are made when glucose is in short supply. They are made in the liver from the breakdown of fats.

Ketones are formed when there is not enough sugar or glucose to supply the body’s fuel needs. This occurs overnight, and during dieting or fasting. During these periods, insulin levels are low, but glucagon and epinephrine levels are relatively normal. This combination of low insulin, and relatively normal glucagon and epinephrine levels causes fat to be released from the fat cells.

The fats travel through the blood circulation to reach the liver where they are processed into ketone units. The ketone units then circulate back into the blood stream and are picked up by the muscle and other tissues to fuel your body’s metabolism.

However, the situation is VERY different in type 1 diabetes, where the presence of EXCESS ketones can be dangerous and life-threatening. In type 1 diabetes, when there is not enough insulin, the fat cells keep releasing fat into the circulation, and the liver keeps making more and more ketones and ketoacids. The problem is too many ketones! The rising ketoacid levels make the blood pH too low (acidotic/diabetic ketoacidosis), which is an emergency medical situation and requires immediate care.


Self-assessment Quiz

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90,000 Keto diet and diabetes

Ketogenic diet (keto diet) – food with a minimum of carbohydrates, unlimited amount of fat and a moderate intake of protein in the diet. With a keto diet, you don’t need to count calories.

What can you eat?

  • No restrictions – foods rich in fats: meat, lard, yolk, fish, unrefined vegetable oils, avocados, nuts and seeds, whole fat dairy products, which include sour cream, butter, cream, cheese.
  • Proteins are limited in moderation – up to 1 g per kg of body weight in the form of meat, fish, cottage cheese.
  • Consumption of carbohydrates is significantly limited – up to 20-50 g per day in the form of non-starchy vegetables.
  • The ratio of fat to total carbohydrate and protein is 4: 1 by weight.

History of origin

The ketogenic diet has been used since the 1920s to treat children with epilepsy.The goal of the diet was to achieve ketosis, a state in which the brain “feeds” on ketone bodies rather than glucose. It was believed that under conditions of ketosis, the number of seizures decreases. Along with ketone bodies, decanoic acid is formed, which reduces the frequency of seizures on a par with medication. After the advent of anticonvulsants, the frequency of dietary intake decreased. Now the diet is used in only 30% of patients in whom standard treatment is ineffective.

What is ketosis?

Glucose is the main source of energy.It can be stored as glycogen in the muscles and liver and used up as needed. Glucose is formed not only from eaten carbohydrates, but also from proteins and fats. This happens when cells “starve,” for example, when a person excludes carbohydrates from their diet. Ketone bodies are formed from fats in the liver. They “feed” the brain, as well as other tissues in the absence of glucose. The condition in which ketone bodies accumulate in the blood is called ketosis. Ketone bodies are formed normally during fasting.You can read more about ketones here.

Do not confuse ketosis with ketoacidosis. Ketoacidosis is a life-threatening condition that occurs in the absence of insulin, with a change in the acid-base balance of the blood and a shift in pH to the acidic side. Ketoacidosis requires emergency treatment.

Differences between ketogenic and other low-carb diets:

  • ketogenic diet allows the use of 20-50 g of carbohydrates, that is, less than 5-10% of the daily calorie content;
  • The first stage of the popular Atkins diet is ketogenic, in the future it is distinguished by less fat and more proteins and carbohydrates;
  • According to adherents of a strict ketogenic diet, with an increase in protein intake, glucose can be formed from it, then ketosis will not be achieved;
  • The

  • paleo diet is also a low-carb diet, it can be a ketogenic option; Paleolithic nutrition is based on natural historical development before the emergence of agriculture.

Ketogenic diet for type 1 diabetes

No studies have been conducted on the effectiveness of the ketogenic diet in patients with type 1 diabetes. Alertness increases the risk of hypoglycemia, as low-carb diets deplete liver glycogen and the body has nothing to respond to when glucose levels drop.

Remember that proteins and fats affect blood glucose levels.Insulin delivery and blood sugar measurements should not be stopped. It is necessary to discuss the diet with your doctor, find out if there is a need for additional vitamins. Keep in mind that a ketogenic diet leads to weight loss, which can affect insulin doses.

How many carbohydrates do you need to eat for glycogen formation ?

If you follow a low-carb diet and eat at least 100-150 g of carbohydrates per day, then the supply of glycogen in the liver will be restored.Sticking to a strict ketogenic diet and eating less than 50 grams of carbs per day with moderate protein intake will not replenish glycogen stores. The main source of energy will be ketone bodies.

Ketogenic diet for type 2 diabetes and obesity

The desire to lose weight as quickly as possible, get rid of excess fat, without tormenting yourself with a feeling of hunger – the reasons for choosing a ketogenic diet. There have been many studies that prove the efficacy and safety of the ketogenic diet in patients with type 2 diabetes and obesity.In this group of patients, the keto diet made it possible to reduce glycated hemoglobin, body weight, and the amount of antihyperglycemic drugs taken. In some studies, the lipid profile has also improved by increasing the “good” HDL cholesterol and reducing the “bad”. It is worth noting that body weight on this diet has significantly decreased over the next few weeks.

However, low carbohydrate diets failed to demonstrate superiority over other high carbohydrate diets over the long term.No study on keto diets has followed followers for more than 1 to 2 years, as opposed to the Mediterranean diet.

In a 2017 meta-analysis with a total participation of 1376 people, studies were analyzed from 2004 to 2014 regarding the effect of ketogenic and other low-carb diets on the course of type 2 diabetes. In the first year of follow-up, glycated hemoglobin significantly decreased. The lower the amount of carbohydrates consumed, the better the blood glucose control was.However, after a year of observation and later, glycated hemoglobin was the same in all groups. The effect of a low carbohydrate diet on body weight, cholesterol, LDL, and quality of life was similar to that of a medium carbohydrate diet (40-60% daily calories).

Effects of the ketogenic diet

  • Diuretic effect – loss of the first kilograms due to fluid. Including there is a loss of salts in the urine. It is necessary to replenish the fluid, and for this – drink enough water.
  • Decreased appetite: Less calorie intake leads to weight loss.
  • Side effects – “keto flu”, constipation, nausea and vomiting, loss of energy, fatigue, drowsiness or insomnia, retarded thinking, dizziness, heart palpitations while lying down, leg cramps, bad breath. Most of the side effects are observed during the first weeks of the diet.


  • In patients with type 2 diabetes mellitus, the keto diet leads to a decrease in glycated hemoglobin, rapid weight loss, good glucose control, a decrease in the amount of hypoglycemic drugs, and an improvement in the lipid profile.These effects are observed during the first year of such a diet. Long-term benefits of this diet over other high-carb diets have not been proven. Given the number of side effects, such a diet may not be recommended for all obese and type 2 diabetes patients. It is necessary to monitor your diet by your doctor.
  • There are no studies on the benefits of the keto diet for people with type 1 diabetes.If you are on a low-carb diet, be especially careful about possible hypoglycemia and their timely relief. Discuss your plan of action with your doctor.
  • The ketogenic diet is restrictive. It is not balanced in vitamins, trace elements and fiber. Add dietary fiber, vitamins as needed.
  • Due to its pronounced diuretic effect, it is important to drink enough fluids. Don’t limit your drinking regime.
  • Main conclusion: the keto diet needs mandatory medical supervision, it is not suitable for independent use and requires further long-term study.
  • 90,022 90,000 Ketosis and ketoacidosis. Pathobiochemical and clinical aspect | Lukyanchikov V.S.

    For citation: Lukyanchikov V.S. Ketosis and ketoacidosis. Pathobiochemical and clinical aspect.Breast cancer. 2004; 23: 1301.

    Overweight and obesity are one of the most pressing medical and social problems of our time. These are the most significant risk factors, or rather the cause of cardiovascular disease, diabetes mellitus and a number of other diseases and syndromes. The severity of this problem is growing everywhere in connection with the general trend towards aging of the population, and in many countries also because of the low standard of living, which, as you know, negatively affects the structure of nutrition and contributes to obesity.From the point of view of the main medical requirements – safety and effectiveness – the most acceptable method of fighting obesity is to limit food intake. In this regard, the best results are obtained by a low-calorie protein-saving diet with an energy value of about 800 kcal per day and a protein content of at least 50 g [2,8]. However, some researchers see the connection of such diets with certain undesirable and even dangerous consequences, such as hypoglycemia, hyperuricemia, hyperlipidemia, cardioarrhythmia, cholelithiasis, osteoporosis, etc.[3,5,9,11]. Among these consequences, perhaps the greatest concern for doctors and patients is ketosis (apparently by association with diabetic ketoacidotic coma). Definition, biochemistry and pathobiochemistry of ketosis Ketone bodies are a group of organic compounds that are intermediate products of energy metabolism, i.e. metabolism of fats, proteins and carbohydrates. The term ketone bodies refers to three compounds: acetoacetic acid (acetoacetate). ? –Hydroxybutyric acid (? –Hydroxybutyrate) and acetone [1].The formation of ketone bodies, or ketogenesis, is a physiological process, in other words, an indispensable part of energy metabolism. In the process of this exchange, “combustion” and inter-transformation of carbohydrates, fats, proteins and other energy substrates occurs with the formation of energy, which either turns into heat in order to maintain an optimal body temperature, or accumulates in the form of AMP, ADP and ATP. These compounds, as energy accumulators, have a low capacity, since they are located inside the cells, moreover, they are constantly consumed to ensure cellular life.Moreover, the synthesis of these energy carriers requires more energy than that stored in them. Therefore, the real energy reserves of the body are glycogen, adipose tissue and protein structures. Biological feasibility gives glycogen the last place in the ranking of spare energy substrates. Firstly, because in the body glycogen has no other functions besides energy functions. Secondly, glycogen is difficult to stabilize; stored in living tissue, and storage requires a large amount of water, which greatly reduces the energy content of glycogen, which is already less than that of protein and fat.Obviously, for these reasons, the reserves of glycogen in humans are small, amounting to approximately 500-700 g. The energy equivalent of these reserves is 2-3 thousand kcal, which does not even cover the daily energy requirement of a person. The proteins of the body have the greatest energy potential. In an adult, their total mass reaches 35–40 kg, which is equivalent to 150–170 thousand kcal. But for obvious reasons, it is highly undesirable to use one’s own proteins as an energy source. As a result, the most optimal way to preserve energy reserves is to synthesize and store fat.Apparently, this is precisely the main reason for the propensity of people to obesity and its high prevalence. The amount of adipose tissue in an adult is a very variable and highly individual characteristic. According to rough estimates, the mass of adipose tissue in a person of average fatness is 15-18 kg. Taking into account the high energy content (9 kcal per 1 g), the total energy value of this amount of fat is practically not inferior to the energy content of body proteins. At the same time, adipose tissue performs many other important functions in the body: synthesis and metabolism of hormones and bioactive substances, heat production, insulation and preservation of heat, giving elasticity to soft tissues, fixing organs, and much more.Thus, a person has a good reason to be concerned about maintaining fat stores. And it is no coincidence that the system of regulation of energy metabolism is more focused on the creation of fat reserves than on their waste. This priority is the second major reason for the high incidence of obesity and why obesity is so difficult to combat. A schematic diagram of energy metabolism, including the formation of ketone bodies, is shown in Figure 1. The main regulators of energy exchange are shown in Table 1.Analyzing the schema and the table, two key points should be highlighted. First, energy metabolism is conventionally divided into an anabolic phase (synthesis of fat and glycogen) and a catabolic phase (glycolysis – oxidation of fatty acids, mobilization and deamination of amino acids). In this case, insulin is the main stimulator of the anabolic part of the metabolism, while catabolic processes increase numerous counterinsular hormones. Secondly, acetyl-CoA is the key substrate of energy metabolism and at the same time the initial substance for the synthesis of keto acids.It is the content of acetyl-CoA that determines the direction of cellular metabolism at a given moment, namely, the synthesis and accumulation of glycogen, fat and protein synthesis will occur, or, on the contrary, the previously accumulated energy reserves will be consumed. And this, first of all, depends on the amount of food entering the body. If there is a lot of food and its quantity exceeds the current energy consumption, part of the food energy carriers is converted mainly into fat, since the reserves of glycogen, as already noted, are small, and this “pantry” is quickly filled.If there is little or no food, the body replenishes the deficit by spending previously made reserves – first glycogen, then fat. It is known that some tissues and organs, in particular, the cortex of the kidneys, erythrocytes and, most importantly, the brain use only carbohydrates (more precisely, glucose) as an energy source. This requires about 200 g of glucose per day, which the body receives by splitting glycogen. True, when 100 g of adipose tissue breaks down, about 10 g of glycerin is also released, but this is too little.As a result, lipolysis and? –Oxidation of fat breakdown products, which are the main source of energy in conditions of lack of food, are not able to provide energy to a number of the most important structures of the body. There are two alternative ways to solve this problem. First, gluconeogenesis, i.e. endogenous synthesis of glycogen. Secondly, the synthesis of keto acids, which are successfully absorbed by the brain and other tissues with limited metabolic capabilities, and thus serve as a substitute for glucose. Let us recall that keto acids are a product of the metabolism of acetyl-CoA, which, in the event of a shortage of food, is formed either from its own proteins or from fat.Of these two endogenous sources of energy supply to the brain, ketogenesis is preferred. The fact is that gluconeogenesis requires the amino acid alanine, which, under conditions of food deficiency, the body receives only through the destruction of its own proteins, carried out by glucocorticoid hormones of the adrenal glands (Table 1). Therefore, it is quite natural, or it would be more correct to say, in accordance with the law of biological expediency, energy exchange with a shortage of food is accompanied by an increased formation of keto acids and an increase in their concentration in the blood, i.e.e. ketosis. It should be noted that these metabolic events are not only expedient, but even preferable for the body, and at the same time are rationally organized. Accumulating in the blood, keto acids suppress the secretion and specific activity of glucocorticoids [10], thereby preventing proteolysis, i. E. destruction of structural proteins of the body. Along with this, ketosis inhibits the secretion and action of glucagon [1,6], the main stimulant of gluconeogenesis and ketogenesis. Thus, by inhibiting proteolysis and gluconeogenesis, keto acids preserve the structural proteins of the body, and by suppressing glucagon, they prevent excessive formation and dangerous accumulation of ketone bodies in the blood.Unfortunately, the intensity of ketogenesis and the rate of absorption of keto acids by tissues are extremely variable, individual values ​​that cannot be predicted and quantified. Further complicating the assessment of ketosis is which of the three keto acids, namely? –Hydroxybutyrate, synthesized both from acetoacetate and directly from acetyl – CoA (Fig. 1). Meanwhile, the nitroprusside method used in the clinic for the determination of keto acids reveals only acetoacetate, and when its concentration reaches 2.5–3 mmol / L.Obviously, therefore, there are no clear laboratory criteria for the upper limit of the normal content of keto acids in the blood, i.e. physiological ketosis, which is a compensatory-adaptive reaction designed to eliminate the lack of glucose, which is necessary for the nutrition of the brain. For the same reason, in clinical practice, the terms ketosis and ketoacidosis are often equated, which, of course, is incorrect. Acidosis, including ketoacidosis, is definitely a pathological condition, namely a form of violation of the acid-base state of the body, when the ratio between acid anions and base cations shifts towards anion increase [7].By definition, acidosis is a laboratory term. Its laboratory criteria are a blood pH below 7.35 and a standard serum bicarbonate concentration of less than 21 mmol / L. To verify metabolic acidosis, which includes ketoacidosis, the anion difference index is used [1,7]. Normally, the anionic difference in blood serum does not exceed 14 mmol / l, and in ketoacidosis it increases to 15–20 mmol / l. Thus, increased ketogenesis and moderate ketosis accompanying prolonged fasting or chronic malnutrition initially represent not a pathological disorder of energy metabolism, but a compensatory-adaptive response.At the same time, it must be admitted that in clinical practice there are many cases when over-expressed compensatory reactions acquire a completely pathological character, turning into so-called adaptation diseases. With regard to the problem under discussion, such a possibility is considered below. Clinical forms of ketosis and ketoacidosis Given the compensatory and adaptive role of ketogenesis, there are obviously many clinical situations that may be accompanied by the development of ketosis and ketoacidosis.The most common of them, in other words, the etiological classification of ketosis and ketoacidosis with an assessment of the probability of transition from ketosis to ketoacidosis is presented in Table 2. The most common cause of ketosis and ketoacidosis is decompensation of type 1 diabetes mellitus. Enhanced ketogenesis in this case is due, on the one hand, to insulin deficiency, and on the other, to an excess of counterinsular hormones: glucagon, catecholamines, cortisol, and growth hormone (GH). As already noted, counterinsular hormones mainly activate the catabolic part of energy metabolism, therefore, in conditions of a lack of insulin, glycolysis, glycogenolysis, gluconeogenesis and lipolysis increase.Massive lipolysis is accompanied by an increase in the level of free fatty acids (FFA) in the blood, from which ketonic acids are synthesized in excess in the liver under the action of glucagon. And since with a lack of insulin, all anabolic processes slow down, including the utilization of keto acids, the latter accumulate in the blood with the inevitable development of metabolic acidosis, i.e. ketoacidosis (Fig. 2). Ketosis, especially ketoacidosis in type 2 diabetes mellitus, is a rare phenomenon, since there is no insulin deficiency in this type of diabetes.It is more correct to say that there is a relative insulin deficiency, which implies a weakened effect of insulin in organs and tissues. It should be taken into account that the effect of insulin on adipose tissue is tens of times stronger than on other tissues, therefore, with decompensation of type 2 diabetes mellitus, glycemia increases (mainly), while lipolysis and ketogenesis are almost not enhanced [1]. At the same time, if the decompensation of type 2 diabetes mellitus proceeds against the background of ketogenic factors or conditions (tab.2), ketosis and even ketoacidosis are quite likely. Overproduction of keto acids and ketoacidosis in chronic alcohol intoxication, more precisely, after 1–2 days after excessive consumption of alcohol – the phenomena are so frequent that even the special term “alcoholic ketoacidosis” is adopted. The metabolism of ethanol in the body is carried out by the hepatic enzyme alcohol dehydrogenase. This enzyme converts ethanol into acetaldehyde, which, in turn, activates the formation of NAD-H, and the latter promotes the synthesis of acetoacetate and especially? –Hydroxybutyrate.Another consequence of alcohol intoxication is the inhibition of gluconeogenesis and a decrease in blood glucose levels. Hypoglycemia stimulates lipolysis, which also contributes to enhanced ketogenesis. In addition, withdrawal symptoms are characterized by dehydration, which also contributes to the development of ketoacidosis. Unlike ketoacidosis of a different nature, patients with alcoholic ketoacidosis are usually in a soporous state. Moreover, due to the predominant education. ? –Hydroxybutyrate, a nitroprusside test for the determination of keto acids in them usually gives a negative result.All this greatly complicates the diagnosis of alcoholic ketoacidosis. Ketosis with prolonged vomiting, malnutrition or starvation is a classic compensatory process designed to compensate for the energy deficit, more precisely, the lack of carbohydrates, due to alternative energy substrates – keto acids. This mechanism was discussed above. It is appropriate to repeat here that keto acids inhibit their own production according to the principle of an allosteric mechanism, therefore, their excessive accumulation and the development of ketoacidosis in this situation is unlikely.At the same time, if severe dehydration occurs with toxicosis of pregnancy or indomitable vomiting of a different nature, then ketoacidosis is possible [4]. The pathogenesis of ketosis in thyrotoxicosis, excess glucocorticoids or deficiency of gluconeogenesis enzymes is, in essence, similar to the already considered mechanisms of hyperproduction of keto acids due to an excess of counterinsular hormones or due to a deficiency of endogenous glucose synthesis. Interest in ketogenic diets continues unabated as it is ketosis that is the most effective mechanism of adipose tissue catabolism.Given the popularity of diet therapy and at the same time the acute problem of obesity, the European Parliament has instructed its Commission on Food Safety to consider the most popular and scientifically based diets in Europe. A group of 18 scientists from 12 European countries was formed. This group comprehensively reviewed about 15 low calorie diets (LDCs) in terms of safety of use, indications, absolute and relative contraindications, side effects, complications, and other aspects [12].Three chapters in this report were devoted to ketosis; ketosis and protein catabolism with NCD (6.4), ketosis and calcium balance with NCD (6.5) and ketosis and hyperuricemia with NCD (chapter 6.6). In September 2002, the expert report was approved at a meeting of the European Parliament commission [12]. The report indicates that despite obvious contraindications, most diets are distributed through grocery stores or pharmacies. Four diets are distributed through medical consultants and one is used only under medical supervision.Only a doctor can prescribe this low-calorie diet. This diet is the French Insudiet – better known in Europe as Eurodiet [13,14]. According to the manufacturers, the first two phases of this diet are ketogenic, therefore, the diet should not be accompanied by a feeling of hunger and should be effective enough. Like any medical technology, procedure or drug, any method of getting rid of excess weight must be registered, certified and clinically tested on the territory of the Russian Federation.In the Department of Clinical Diagnostics and Prevention of Nutritional Disorders of the Clinic of Nutritional Medicine, State Research Institute of Nutrition of the Russian Academy of Medical Sciences, in the summer of 2003, clinical trials of high-protein products “Eurodiet ®” were carried out using the “Eurodiet ®” method, produced by the company “Eurodiet ®”, France [15]. Clinical analysis of patients’ urine confirmed the appearance of ketone bodies against the background of diet therapy, which confirms the mechanism of weight loss due to lipolysis while taking hypocaloric high-protein foods “Eurodiet ®”.The formed ketone bodies, acting on the center of hunger, contribute to the manifestation of their double action. The anorexigenic effect was that the ketone bodies, in addition to stimulating the saturation center in the hypothalamus, caused the effect of physiological appetite suppression. Ketone bodies provide about 80% of all brain energy needs and have psychotonic properties in the form of an antidepressant effect. In conclusion, it should be emphasized once again that ketosis is an initially compensatory phenomenon, which means it is physiological.Usually, ketosis is not dangerous when fasting or on a low-calorie diet. does not reach the degree of ketoacidosis. Such development of ketosis is possible only as a result of the action of additional ketogenic factors, for example, dehydration or alcohol intoxication. Accurate adherence to dietary conditions in combination with qualified laboratory and medical monitoring ensures the safety of a hypocaloric diet, at least in relation to ketoacidosis.

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    12. Report of medical experts on special nutritional care for the European Parliament Commission on the Safety of Medical Low-Calorie Nutrition: http: // europa.eu.int/comm/food/fs/scoop/7.3_en.pdf
    13. Website link: www.eurodiet.com
    14. Website link: www.eurodiet.ru
    15. Product clinical trial report Eurodiet® according to the method
    Eurodiet® France. Prepared by A.N. Stenin, Head of the Department of Clinical Instrumental Research Methods, Doctor of Biological Sciences. A.V. Vasiliev, head of the department of clinical diagnostics and prevention of alimentary disorders M.V. Chebotareva; approved by the Director of the Research Institute of Nutrition of the Russian Academy of Medical Sciences, Academician of the Russian Academy of Medical Sciences, Professor V.A. Tutelyan. Moscow, 2003.

    Content available under a Creative Commons Attribution 4.0 Worldwide license.

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    90,000 Diabetes Keto Diet – Important Rules for Type 1 & 2 Diabetics

    The ketogenic diet is a special type of food in which carbohydrates are almost completely eliminated, and the protein food in the diet decreases, but the fat content increases.When you switch to a keto diet, your body enters a special state called ketosis.

    Ketosis is largely a physiological state of the body, manifested by an increase in the level of ketone bodies in the blood above 0.5 mmol while following a ketogenic diet. And ketone bodies are alternative sources of energy. Metabolism of ketone bodies enhances metabolism, has an anticonvulsant effect, improves cellular metabolism, has a beneficial effect on diabetes mellitus and other disorders of carbohydrate metabolism.

    Keto diet for diabetics

    The effect of the keto diet on diabetes is confirmed by scientific data from American scientists, since it is the majority of Americans who suffer from carbohydrate metabolism disorders.

    Following the usual diet, the body receives energy mainly from glucose metabolism. The brain alone consumes up to 25% of the supplied glucose. When access to glucose intake is limited, as is the case with a keto diet, the body adapts to receiving energy from an alternative source – ketone bodies, which are formed when fat is broken down.In this case, the brain is able to consume up to 50% of the released metabolic energy, which in turn shifts the metabolism towards the production of ketones to maintain homeostasis.

    The state of prediabetes is a metabolic syndrome, characterized by the resistance of body cells to insulin. More insulin is produced than needed, but it does not have the necessary activity to properly promote glucose uptake by cells.

    A diabetic keto diet will be optimal, especially in the early stages of type 2 diabetes.Since during the formation of the metabolic syndrome, insulin is released more and more, but by and large it is not fully active, then it accumulates in the blood. Which, in turn, leads to the development of obesity.

    When you switch to a keto diet in diabetes, the process of breaking down your own fat is triggered and, as a result, weight loss, which improves insulin resistance.

    Carbohydrates and the keto diet for diabetes

    Carbohydrates are divided into simple and complex.Simple or harmful carbohydrates include common food sugars, glucose, fructose, and complex or useful ones – starch and fiber. Excessive consumption of simple carbohydrates leads to the development of obesity and type 2 diabetes. Since a lot of free glucose circulates in the blood, and its absorption and assimilation is impaired.

    Complex carbohydrates are considered healthy because they consume a lot of energy and provide a lasting energy effect.When carbohydrates are consumed, the pancreas secretes a hormone called insulin, which is a key that opens cells for glucose uptake. In recent years, the amount of carbohydrate intake has increased significantly, as a result, the incidence of diabetes has increased, especially in America and European countries.

    The keto diet for diabetes mellitus allows the use of no more than 20% of carbohydrates from the total daily diet.

    Ketosis and ketoacidosis

    During periods of fasting or excessive physical exertion, glucose reserves in the body are consumed, and the inability to replenish them forces the body to produce ketone bodies to satisfy the energy deficit.This condition is called ketosis.

    The rapid formation of ketone bodies, a change in blood pH and an electrolyte imbalance in the acidic direction, leads to ketoacidosis – a condition that is dangerous for the body.

    Ketoacidosis is diabetic, when the production of insulin decreases, and the number of ketone bodies with glucose and alcohol increases in the blood, when, after increased consumption of alcohol and fasting, the level of ketone bodies increases, but an increase in blood sugar is not observed.

    The state of ketoacidosis is especially dangerous for people with type 1 diabetes mellitus, as the level of glucose in the bloodstream rises, the level of insulin is insufficient, in addition, fat is burned for energy, releasing the increased content of ketones into the blood. At the same time, glucose is not absorbed by cells, and it circulates in the bloodstream, while the blood is oversaturated with ketone bodies, the pH of the blood shifts to the acidic side, disrupting the acid-base balance. This condition is very dangerous and can lead to a ketoacidotic coma.Ketoacidotic coma is a state of severe intoxication with damage to the cardiovascular and hepatic-renal systems.

    In controlled dietary ketosis, the body burns large amounts of fat for energy after using up all the glycogen stores in the liver and muscles.

    The keto diet in diabetes mellitus has a difficult transition to the ketogenic state, since glucose starvation is both physically and emotionally difficult even for strong-willed people.

    Type 1 diabetes and the keto diet

    Type 1 diabetes mellitus is an autoimmune disease in which the hormone insulin is produced in the pancreas by beta cells, or is produced, but the body perceives them as foreign and destroys them with the help of immune cells.And such patients are forced to receive hormone replacement therapy with insulin injections all their lives. Typically, type 1 diabetes affects young children and adolescents during puberty, that is, it manifests itself only at a young age. To maintain life, constant hormonal therapy with basal and bolus insulins, that is, insulins of short and prolonged action, is required. Pills given to type 2 diabetics are not suitable for type 1 diabetes because they can cause serious pancreatic dysfunction or poisoning.

    On the effect of the keto diet in type 1 diabetes mellitus, studies have not been sufficiently conducted, since the state of hypoglycemia, in which the liver cannot respond to the release of glycogen due to its absence, is quite dangerous and risky for the health of patients. Since they cannot stop insulin therapy and need to carefully follow a diet that must contain carbohydrates along with proteins and fats, adherence to the keto diet for type 1 diabetes is not recommended.

    A patient with type 1 diabetes should receive at least 150 grams of carbohydrates with food to replenish glycogen stores. If you follow a keto diet for type 1 diabetes, then an acceptable carbohydrate intake of less than 50 grams will not cover the body’s needs and will be fraught with negative health consequences. For example, hypoglycemia can occur and, if it is not stopped in time by taking glucose, the condition can turn into a hypoglycemic coma. And this coma is a dangerous condition for the brain and carries serious risks to life.

    However, studies were conducted in two patients with type 1 diabetes mellitus – a girl with concomitant epilepsy and a teenage boy. In the course of following the keto diet, the girl significantly decreased the frequency and severity of attacks. The guy had a strict keto diet for six months with a restriction of vegetables, vegetable oils, sweeteners, dairy products and lean meat and eating only fatty meat and eggs, the production of his own insulin in the pancreas was restored.In addition to strictly adhering to the diet, the patient also took vitamin D. Further, the fate of these subjects is unknown.

    Other studies have shown that even reducing your carbohydrate intake leads to good glycated hemoglobin results, but you don’t have to follow a keto diet, just a low-carb diet is enough.

    Glycated hemoglobin shows the combination of hemoglobin with glucose over a period of three months. The higher the constant blood glucose level, the higher the glycated hemoglobin value will be at its maximum allowable rate of up to 6%.

    Type 2 diabetes and the keto diet

    Type 2 diabetes mellitus is an acquired disease due to a violation of the diet, a sedentary lifestyle, manifested by a decrease in the activity of its own insulin produced by the pancreas. For the treatment of such diabetes, endocrinologists prescribe special drugs – pancreatic stimulants, a strict diet with the exception of fast carbohydrates and physical activity.

    Therefore, the keto diet for type 2 diabetes, on the contrary, is considered one of the optimal and is recommended for use.There have been many independent studies that have proven the effectiveness of the ketogenic diet in reducing glycated hemoglobin in the blood and reducing body weight. Especially in the first year of switching to the keto diet. In older patients with diabetes, when following the keto diet, there were improvements in cholesterol tests, an increase in high-density lipoproteins and a decrease in low-density lipoproteins, and the load on the pancreas decreased by reducing the doses of antihyperglycemic drugs.

    But when following the keto diet in type 2 diabetes for more than 2-3 years, positive dynamics were not particularly observed and glycated hemoglobin remained at the same level. Also, with the termination of the ketogenic diet, the body’s ability to break down and absorb carbohydrates decreased.

    With the keto diet for type 2 diabetics, studies were also carried out, as a result of which it was found for certain that long-term, up to a year, adherence to the diet improves cholesterol, blood glucose, weight loss and a significant reduction in the dosage of the used antihyperglycemic drugs.For comparison, a group of patients adhering to a low-carb diet and a group using a ketogenic diet were used. The difference was huge: in the first group, the indicators of weight, glucose, lipids remained unchanged, while the second group showed very good results in all parameters.

    The keto diet for type 2 diabetes assumes a long and stable remission of the disease, if all the rules are strictly followed.

    The Keto Diet for Type 2 Diabetics also requires daily monitoring of blood glucose levels as blood glucose levels can drop rapidly and suddenly.In such cases, the use of fast carbohydrates will become an emergency aid, but if you follow a keto diet, this is an unacceptable option, therefore, in consultation with an endocrinologist, you will have to reduce the doses of antidiabetic drugs.

    Disadvantages of the keto diet in diabetes:

    • Poor diet, monotonous food;
    • Deficiency of nutrients in food, vitamins;
    • Insufficient or lack of fiber, which is especially necessary for patients with diabetes;
    • Digestive problems, in particular impaired intestinal motility, constipation;
    • Increased consumption of protein foods can lead to kidney problems, which are especially vulnerable in diabetes mellitus;
    • Risk of dehydration.With keto and diabetes, it is very important not to leave the body without fluid, as this can lead to problems with blood vessels and increase blood pressure;
    • Diabetes mellitus patients find it difficult to tolerate carbohydrate withdrawal, especially emotionally.

    The phenomenon of the “morning dawn”

    With adherence to keto and diabetes, fasting glucose can often be elevated. This is due to adaptive glucose levels or the “morning dawn effect”. This syndrome is equally characteristic for both type 1 and type 2 diabetics, when in the morning hours before waking up, the glucose level itself rises, despite sleep and lack of food during these hours.Also, absolutely healthy people without metabolic syndrome or with no history of diabetes mellitus are also susceptible to this phenomenon.

    This condition is explained by the disturbance of circadian rhythms, the stress suffered the night before, the excessive consumption of carbohydrates for dinner and the increased formation of counterinsular hormones such as cortisol, adrenaline – stress hormones; somatotropic and thyroid-stimulating – thyroid hormones and glucagon – the antipode of insulin.Due to these hormonal fluctuations, the synthesis of glucose by the liver increases, and excess glucose is released into the blood. To stabilize this condition, it is recommended to shift the hours of taking antidiabetic drugs or insulin injections to a later evening. Also, limit foods at dinner that can cause your blood sugar to rise.

    The danger of this syndrome is that constant fluctuations in glucose levels from low to high levels and vice versa, have a very negative effect on blood vessels and peripheral nerve endings, which leads to diabetic complications.

    Diabetic keto diets should also remember that when the blood glucose level is abnormally low, the body carries out a compensatory response. This condition is called the Somoji effect and manifests itself at any time of the day, regardless of the time of taking the drugs.

    The keto diet for diabetics, although it assumes the absence or insignificant amount of carbohydrates in the diet, the liver will still produce glycogen synthesis through gluconeogenesis.Gluconeogenesis is the formation of glucose from non-carbohydrate compounds – amino acids from muscle tissue or glycerin from fat breakdown.

    However, the transition to the ketogenic diet should be gradual, without trying to get into ketosis as quickly as possible, so that the blood glucose decline remains smooth. The level of glucose in the blood, which is kept for a long time in a patient with diabetes mellitus, speaks of physiological insulin resistance, that is, it is his “working sugar”.The keto diet for diabetics, if followed for a long time, reduces the level of “working sugar” and normalizes the sensitivity of cells to insulin.

    Examples of the keto diet for diabetes

    Swedish doctor Andreas Enfeldt gave an example of changes in blood glucose levels when eating foods recommended for diabetics and foods from the keto menu. After eating a cereal sandwich with a cucumber and low-fat yogurt with an apple, his blood glucose jumped to 9 mmol one hour later. And after meat fried in oil with a fat sauce and stewed vegetables, the sugar index was 4 mmol.Which shows the true benefits of the keto diet for patients with type 2 diabetes.

    The keto diet for diabetes involves the use of foods such as meat, fatty fish, lard and fats, heavy cream and cheese, eggs, olives. Nuts, especially fatty ones, vegetable oils, leafy greens, avocados, cucumbers, and cabbage. Minimum consumption of seasonal berries is also allowed.

    Of drinks, water is allowed, including mineral water, teas and coffee.

    The menu should be compiled for a week at once and carefully think over the list of necessary products.Also, diabetics adhering to a keto diet are advised to take into account the peculiarities of their metabolism, physical activity and calorie intake.

    Recommendations for the ratio of protein-fat and carbohydrates are, in principle, the same for everyone and for patients with diabetes as well. If you eat food 5-6 times a day fractionally, then each meal should have no more than 5 grams of carbohydrates, 25-28 grams of protein and 30 grams of fat.

    It is recommended to switch to a keto diet for diabetes mellitus in consultation with an endocrinologist and under his close supervision.

    Diabetes Keto Diet: How to Take Medication

    Disclaimer: It is very important to adjust your diabetes medication dosage when starting a low carb diet. In particular, it may be necessary to lower the insulin dose to avoid a sharp drop in blood sugar levels, and dose adjustments may be necessary for SGLT2 inhibitors (see below). Talk to your doctor about any lifestyle changes and related changes in your medications.Full disclaimer


    1. Starting a no-drug diet
    2. Starting a low-carb diet with type 2 diabetes
    3. Taking insulin for type 1 diabetes on a low-carb diet
    4. Drugs that release insulin

    So you want to start a low carb or keto diet for diabetes? Congratulations! This may be one of the best decisions you will ever take to combat type 2 diabetes, as well as control your blood sugar levels if you have type 1 diabetes.

    Once you start a keto diet, you will have to adjust your diabetes medication, in particular, reduce your insulin dose, and quite significantly. The dosage of some other types of antidiabetic drugs also needs to be reduced.

    Reducing the amount of carbohydrates consumed, which increases blood sugar, reduces your need for drugs that lower it. Taking the same dose of insulin or insulin-stimulating oral medication that you received before starting the low-carb diet can lead to a sharp drop in blood sugar, which can potentially be hazardous to your health.

    Starting a keto diet, you need to carefully monitor your blood sugar levels and adjust the amount of medications you take accordingly. You will need the help and advice of your healthcare professional (ideally, try to find a healthcare professional with experience in low-carb diets).

    Starting a keto diet without medication

    If you have diabetes, but you do not use various medications, but simply follow a diet, there is practically no risk of falling blood sugar levels to critical values.You can start your diet now.

    Starting a low-carb diet for insulin-dependent type 2 diabetes

    Remember that after starting a strict low-carb diet, you need to adjust your medication dosage.

    Correction of dosage can be carried out in the range from 30 to 50%. If you are taking insulin once or twice a day, both doses must be reduced by the same amount. If you are on a basal bolus (fast-acting insulin before meals and long-acting insulin once or twice a day), the first step is to lower your insulin dose with meals.

    If you stay on a low-carb diet for a long time, you may be able to stop taking insulin before meals altogether. After that, you can start cutting back on long-acting insulin if your blood sugar remains stable. Some people on a low-carb diet are able to stop taking insulin altogether. If you are taking other diabetes medications with insulin, the dosage should not be changed until you have adjusted your insulin dosage accordingly.

    Decrease in insulin dosage is based on blood sugar readings. Be sure to consult with your doctor.

    It is always best to take a lower dose of insulin. If your blood sugar is slightly elevated, increase your insulin dose the next time you take it. If you take too much insulin right away, your blood sugar can drop dramatically, which is much more dangerous.

    In this case, you need to eat a fast carbohydrate in order to raise your sugar to a safe level.The effect of a low-carb diet is reduced.

    Insulin use for type 1 diabetes on a low-carb diet

    The above recommendations for insulin dose adjustments apply to people with type 2 diabetes. A low-carb, high-fat diet can be very successful in allowing people with type 1 diabetes to achieve stable blood sugar levels. The diet promotes smaller and smoother changes in blood sugar levels, provided insulin doses are reduced accordingly.

    If you experience symptoms of hypoglycemia (dizziness, headache, hunger, weakness), you should immediately adjust your insulin dosage before reducing your carbohydrate intake. Most people with type 1 diabetes are treated with a basal bolus regimen as described above.

    Many people use the Insulin to Carbohydrate Ratio (ICR) to determine their pre-meal insulin dosage. This keeps the keto diet in check. Reducing the amount of carbohydrates consumed automatically leads to a decrease in the required dose of insulin.

    In some cases, a higher ICR may be required due to the protein consumed, which increases the need for insulin. Some people lose weight on a low-carb diet and their insulin sensitivity increases. If this happens, it will be necessary to lower the insulin to carbohydrate ratio as well as the basal insulin doses.

    People who use standard daily doses of insulin, or those who only take insulin twice a day, should use the same approach as for type 2 diabetes.The difference is that people with type 1 diabetes need insulin, albeit in minimal amounts, even on a very strict low-carb diet.

    It is important to be aware that a diet with less than 50 grams of carbs per day can lead to ketosis. This is a normal physiological condition that occurs when the body burns fat for energy.

    A very strict low-carb diet that restricts protein intake can lead to fairly high, but still physiological (in other words, safe) ketone body levels (e.g. 1.5 mmol / L, but sometimes up to 4) …This condition should not be confused with ketoacidosis, which is a dangerous complication of type 1 diabetes with insufficient insulin intake.

    Ketosis is the normal response of oragism to the use of fat for energy. This is a wonderful condition for healthy people, but in type 1 diabetes, it is important to distinguish ketosis from the much more dangerous ketoacidosis. The latter is associated with high blood sugar and dehydration, as well as high levels of ketone bodies.

    Therefore, it is recommended for those with type 1 diabetes to start with a looser, low-carb diet , consuming more than 50 grams of carbs per day.If you wish, you can start reducing the amount of carbohydrates to 30-40 g per day, provided that you consume enough protein, which will protect you from the development of deep ketosis (> 1.5 mmol / L).

    Do not start the ketogenic low-carb diet (less than 20 grams per day) unless you are sure how to deal with the risk of developing deep ketosis. If you do decide to start a ketogenic diet, check your ketone levels often, especially if you notice a deterioration in well-being, are practicing intermittent fasting or have previously done it.

    It is important to remember that people with type 2 diabetes can overcome their illness by stopping their insulin injections altogether, and people with type 1 diabetes will always need the artificial insulin they lack.

    On the other hand, the low carbohydrate diet can perform amazingly in people with type 1 diabetes.

    Insulin-releasing drugs

    Some drugs for type 2 diabetes stimulate the pancreas to produce more insulin.These medications can lower blood sugar levels on a low-carb diet.

    Such agents belong to the group of sulfonylureas (this includes gliclazide, glipizide, glibenclamide, glyburide and tolbutamide), as well as in the group of meglitinides (repaglinide and nateglinide).

    Before starting a low-carb diet, you will need to either reduce doses or stop taking this type of medication altogether to avoid low blood sugar. Be sure to consult with your doctor.


    Metformin can be safely taken on a low-carb diet. There is virtually no risk of a drop in blood sugar levels with this drug.

    GLP-1 agonists (eg Victoza) and DPP-4 inhibitors (eg Januvia)

    These drugs alone rarely reduce blood sugar levels in those on a low-carb diet. But be careful, regularly check your blood sugar with a glucometer and discuss the situation with your doctor as needed.

    SGLT2 inhibitors (eg, Forsiga, Jardins, Invokana)

    These drugs lower blood sugar levels in type 2 diabetes, may be beneficial for people on a more liberal, low-carb diet as they directly remove glucose from the bloodstream. However, they can increase your risk of developing a dangerous condition called ketoacidosis.

    A strict low-carb diet can cause this condition. Therefore, it is recommended that you stop taking SGLT2 inhibitors before starting a strict low-carb diet, making sure to discuss this with your doctor.

    When ketoacidosis occurs with SGLT2 inhibitors, blood sugar does not need to be high, making it difficult to detect.

    If you develop symptoms of ketoacidosis: intense thirst, nausea, vomiting, stomach pains, disorientation, etc., you should stop taking your medication and consult a doctor immediately.

    Recommended reading:

    How to Overcome Type 2 Diabetes

    Low Carb Diet for Beginners

    Diabetes Ketosis – A Chemist’s Handbook 21

    All three compounds, acetoacetate, acetone and 3-hydroxybutyrate, are known as ketone bodies.Their concentrations increase strongly with various pathological disorders, of which the best known is diabetes mellitus (supplement P-V), as well as during fasting. The developing ketosis with its strong manifestations is very dangerous, since the formation of ketone bodies is accompanied by the release of hydrogen ions [see. equation (9-7)] and blood acidification. [c.315]

    Whenever glucose oxidation is restricted in any way, ketosis can occur.Thus, ketosis and, consequently, acidosis are caused by a violation not of lipid metabolism, but of carbohydrate metabolism. The most common causes of such a violation of carbohydrate metabolism are hunger and diabetes. Fasting stops the intake of carbohydrates from food. In diabetes, glucose cannot be oxidized because it is unable to pass through the cell wall. When the need for energy (i.e., for ATP) cannot be met by the oxidation of glucose, the body switches to oxidation of fatty acids, which are mobilized from fat stores and delivered by the blood to the liver.Large amounts of lipid products in the blood cloud up a condition known as lipemia. In this case, there is an accumulation of fat in the liver. Since the oxidation of fatty acids increases, the formation of ketone bodies exceeds their utilization, and this leads to the development of ketosis. Until the body’s ability to oxidize glucose is restored (for example, by the administration of insulin), acidosis, with all its attendant phenomena, will develop. [c.398]

    This condition is called ketosis or acidosis.Acidosis, a decrease in blood pH, is caused by the excretion of these two acids in the urine in the form of their ammonium or sodium salts. Ketosis and acidosis are seen in diabetes, liver disease, starvation, alcoholism, and the consumption of ketogenic food (in which fat is significantly more prevalent over carbohydrates). [c.407]

    These substances from the liver enter the bloodstream and in peripheral organs, including the brain tissue, can be used as energy sources. The content of ketone bodies in human blood serum is normally low (0.03-0.2 mmol / l).An increase in the concentration of ketone bodies in the blood – ketosis develops at a high rate of fatty acid oxidation, excessive accumulation of acetyl-CoA, when its amount exceeds the requirements of the tricarboxylic acid cycle. This state occurs during fasting, diabetes mellitus, eating food rich in fats, that is, with a lack of carbohydrates (glucose hunger, when the oxidation of fatty acids becomes the body’s main source of energy). The concentration of ketone bodies in the blood serum in pathology can reach 16-20 mmol / l. [c.334]


    If fatty acids serve as the only source of energy (when the body cannot use glucose, for example, in diabetes or starvation), ketosis may develop. [c.400]

    Lack of insulin in the body causes metabolic disorders and leads to diabetes, accompanied by hyperglycemia, glucosuria and ketosis. The lack of insulin can be compensated for by the administration of bovine, porcine or ovine insulin. [c.469]

    Various hexoses, both aldoses and ketoses, are extremely common. Many of them, as already noted, are free in various sweet fruits. Glucose is normally found in the blood of animals, and in pathological cases passes into the urine (sugar disease, diabetes). The main part of bee honey is a mixture of equal amounts of glucose and fructose. [c.373]

    Ketosis is a high content of ketone bodies in the blood, which is observed during prolonged fasting, physical work and diabetes mellitus. [c.490]

    In conditions of a positive caloric balance, a significant part of the potential energy of food is stored in the form of glycogen or fat energy. In many tissues, even with a normal diet, not to mention the states of caloric deficiency or starvation, fatty acids are mainly oxidized, and not glucose. The reason for this is the need to preserve glucose for those tissues (for example, for the brain or red blood cells) that constantly need it. Therefore, regulatory mechanisms, often involving hormones, must ensure that all tissues are constantly supplied with a suitable fuel under conditions of both normal nutrition and fasting.Failure in these mechanisms occurs with hormonal imbalance (for example, under conditions of a lack of insulin in diabetes), with metabolic disorders during the period of intensive lactation (for example, with ketosis in cattle) or due to increased metabolic processes during pregnancy (for example, with toxicosis of pregnancy in sheep). Such conditions are pathological abnormalities in the syndrome of starvation, it is observed in many diseases, accompanied by a decrease in appetite. [c.287]

    Severe hyperlipemia develops in diabetes mellitus.It is usually accompanied by acidosis. Lack of insulin leads to a decrease in phosphodiesterase activity, which ultimately contributes to the activation of lipase and increased lipolysis in fat stores. Hyperlipaemia in diabetes mellitus is of a transport nature, since excessive breakdown of fats in the periphery leads to an increased transport of fatty acids to the liver, where lipid synthesis occurs. As noted earlier, with diabetes mellitus and starvation, an unusually large number of ketone bodies (acetoacetic and p-hydroxybutyric acids) are formed in the liver, which are transported with the bloodstream from the liver to peripheral tissues.Although peripheral tissues in diabetes and starvation retain the ability to use ketone bodies as an energy material, however, due to their unusually high concentration in the blood, the organs cannot cope with their oxidation and, as a result, a state of pathological ketosis occurs, i.e. the accumulation of ketone bodies in the body … Ketosis is accompanied by ketonemia and ketonuria – an increase in the content of ketone bodies in the blood and their excretion in the urine. An increase in the concentration of triacylglycerols in blood plasma is also noted during pregnancy, nephrotic syndrome, and a number of liver diseases.Hyperlipidemia, as a rule, is accompanied by an increase in the content of phospholipids in the blood plasma, a change in the ratio between phospholipids and cholesterol, which is normally 1.5 1. A decrease in the content of phospholipids in the blood plasma is observed in acute severe hepatitis, fatty degeneration, liver cirrhosis and some other diseases. [c.357]

    In ch. 24 described a number of other metabolic changes observed with a lack of insulin.Thus, in diabetic patients or in animals with experimental diabetes caused by the removal of the pancreas or destruction of the islet tissue by the administration of alloxan (Fig. 25-18), the ability to synthesize fatty acids and lipids from glucose is lost. In this case, the rate of oxidation of fatty acids exceeds the norm, which leads to the formation of an excess of ketone bodies that accumulate in tissues, blood and urine, i.e., to the so-called ketosis. In animals with experimental diabetes, the rate of transfer of amino acids from the blood to the cells of peripheral tissues also decreases, as a result of which the biosynthesis of proteins slows down.Instead, amino acids undergo deamination in the liver, and glucose is formed from their carbon chains during gluconeogenesis (Section 20.1), after them of toxic substances. Non-communicable disease is the result of a violation of key chemical reactions in the body. In this chapter, we must consider how such disorders can occur, this can be done using the example of a disease such as diabetes mellitus.With diabetes, the formation of only one chemical component in the pancreas, the hormone insulin, decreases, and this entails a whole chain of phenomena that can lead to death. In general terms, this chain of sequential phenomena can be represented in the following form: lack of insulin leads to increased oxidation of fatty acids (as a source of ATP), and this in turn leads to ketosis, accompanied by acidosis, which suppresses the transfer of oxygen by hemoglobin. which leads to the onset of fainting and, ultimately, to death. [c.396]

    Ketosis. The intermediate products of the fatty acid cycle do not accumulate normally, they are further degraded. In fasting or diabetes, some of these intermediates are produced faster than they are used. These compounds include two four-carbon substances acetoacetic acid and a-hydroxybutyric acid. The appearance of acetoacetic acid is always accompanied by the appearance of acetone, into which it easily passes. To some extent conventionally, these three compounds are called ketone bodies.They are formed as follows. [c.396]

    Treatment of acidosis. Treatment of acidosis that occurs in diabetes mellitus is reduced to the elimination of ketosis. Treatment of acidosis is a very long process and is prescribed only after the cause of the disease has been established. [c.398]

    When the metabolism of carbohydrates is disturbed, as, for example, in diabetes or starvation, the animal’s glycogen stores in the liver are depleted, after which energy can be produced only due to accumulated lipids.In this regard, excessive amounts of fat must enter the liver, as a result of which the normal functioning of the liver will be disrupted. A lack of carbohydrates leads to insufficient glycolysis, as a result of which the amount of energy released is reduced and acetyl-CoA cannot synthesize long-chain fatty acids. There is ketosis, or excessive accumulation of acetoacetic acid, P-hydroxybutyric acid and acetone in the blood. The kidneys have to use sodium ions from the bases contained in body fluids to neutralize acids excreted in the urine.Ultimately, ketosis can lead to acidosis – a decrease in the reserve alkalinity of body fluids. Together with the neutralization products, a large amount of fluid is lost in the urine. In the case of severe dehydration, the central nervous system suffers, a state of depression, coma and loss of turgor occur. [c.354]

    Oxidation of fatty acids in normal mode proceeds without significant accumulation of intermediate products, in particular acetyl-CoA. However, under certain pathological conditions of the body (diabetes mellitus) and with sharp deviations in the normal diet (fasting, diet), the so-called ketone or acetone bodies accumulate in the blood.These include the three substances acetoacetic acid (acetoacetate), -hydroxybutyric acid -hydroxy-butyrate) and acetone. They are under-oxidized intermediates of fatty acid breakdown and are mainly formed in the liver from acetyl-CoA. In the normal mode of metabolic pathways, ketone bodies are delivered with blood to the peripheral organs, where they are oxidized in the Krebs cycle. But the loss of the body’s ability to utilize these substances (ketosis) leads to their significant accumulation in the blood (ketonemia) and in the urine of ketonuria), which is a diagnostic sign of a number of diseases. [c.434]

    The course of oxidation and biosynthesis of fatty acids in various compartments allows you to selectively control each process in accordance with the needs of the tissue. During fasting and diabetes mellitus, fatty acid oxidation proceeds more intensively, as a result of which ketone bodies are formed in the liver (ketosis). Ketone bodies are acidic in nature, therefore, if they are excessively formed for a long time, as, for example, in diabetes mellitus, ketoacidosis develops, which can ultimately be fatal.Since gluconeogenesis depends on the oxidation of fatty acids, disorders of the latter, caused by various reasons, lead to hypoglycemia, which occurs, in particular, with a lack of carnitine or a decrease in the activity of enzymes involved in the oxidation of fatty acids, for example, carnitine palmitoyltransferase, as well as inhibition of fatty acid oxidation. acids with poisons, for example g- [c.225]

    Ketosis develops at a high rate of fatty acid oxidation in the liver, especially when it occurs against the background of a lack of carbohydrates (see.from. 292). A similar condition occurs when eating food rich in fats, starvation, diabetes mellitus, ketosis in lactating cows and toxicosis of pregnancy. [c.229]

    fatty acids. Qualitatively, the states of ketosis that occur under different conditions do not differ much. Significant metabolic disorders leading to pathological conditions are observed in diabetes, pregnancy toxicosis in sheep and ketosis in lactating cows.Non-pathological forms of ketosis are observed with a diet rich in fat and with strenuous physical activity in the period after a meal. [c.289]

    Most of the data indicate that the cause of ketonemin is an increase in the formation of ketone bodies in the liver, and not their insufficient utilization in extrahepatic tissues. At the same time, the results of experiments with rats whose pancreas was removed show that in severe diabetes, ketosis can be increased as a result of the reduced ability of the body to catabolize ketone bodies.With moderate ketonemia, only a few percent of the total amount of ketone bodies formed is excreted in the urine. [c.292]

    The ketosis observed during fasting and when consuming fatty foods is relatively mild compared to ketosis, which develops in uncontrolled diabetes, pregnancy toxicosis in sheep or in cattle during lactation. The main reason for this, apparently, lies in the fact that in these diseases the amount of carbohydrates available to tissues is significantly less than during fasting and the consumption of fatty foods.So, with moderate diabetes, the intake of fatty foods and chronic starvation, glycogen is retained in the liver (its amount varies), the decrease in the level of free fatty acids is less pronounced. This probably explains the less severe form of ketosis that occurs in these cases. In ruminants, ketosis occurs against a background of significant [c.294]

    Diabetes, dementia and even migraines. The ketogenic diet is more effective than drugs

    Charlie, the son of American film producer Jim Abrahams, suffered from severe refractory epilepsy.The number of daily seizures was measured in tens or even hundreds, and the drugs did not help much. Worse, if without drugs Charlie could be a normal child between seizures, then with them he turned into a “zombie living in a car seat.”

    Charlie was saved by a diet invented in the 1920s that fell into oblivion after the widespread use of the anticonvulsant phenytoin in the late 1930s. Within two days, the seizures that prevented him from living and developing for a whole year, completely stopped. Almost instantly, Charlie turned into an ordinary child.The attacks never returned – even after stopping the diet after 5 years.

    This was in the early 1990s. Since then, his father founded a fund, made a film, and even Malysheva told about it on Channel One. But epilepsy, like other diseases, is almost always treated with medication.

    Donald Shields, Charlie’s physician, was well aware of the ketogenic diet. But he kept trying different doses and combinations of drugs. After all, a diet is, it seems, too difficult. “There are also drugs that we have not used,” he said.But Jim Abrahams wonders: “Where in medical school they were taught a course on what is considered too difficult for the parents of a seriously ill child?”

    In short: what is the ketogenic diet The ketogenic diet is a diet that promotes the production of ketone bodies or ketones by the body. In this diet, the proportion of carbohydrates in the diet is reduced to about 5% of calories, and about 70-90% of calories come from fat.

    It was developed at the Mayo Clinic in the 1920s to replicate the effect of fasting, which was then widely recognized in the United States in the treatment of pediatric epilepsy.

    Ketone bodies are produced by the liver from fatty acids, can be used as an energy source by almost all tissues, including the central nervous system, since they easily cross the blood-brain barrier (therefore, the brain can feed on not only glucose ), which is very their important property, as will be seen below. They also have a variety of effects on the body and nervous system, which may explain the anti-convulsive effect of the diet, although the exact mechanisms are not yet known.

    The production of ketones is suppressed by insulin. Since it is most actively produced when carbohydrates are eaten, the ketogenic diet is primarily a low-carb diet.

    Simply put, this diet eliminates sugar, flour, cereals, grains and high-starch vegetables. Typical foods are green vegetables and vegetables growing above the ground, fatty fish and meat, eggs, dairy products and oils.

    Earlier, when I understood very little in medicine, I perceived conversations about diet and, moreover, fasting, as something ridiculous.The dictum of Hippocrates “Let food be your medicine” belonged not only to his pen, but also to his time . This “alternative” approach to treatment has always seemed to me a relic of the past and, in general, shamanism, unworthy of a modern person. We still live in the days of double-blind, randomized, placebo-controlled trials.

    But then I realized that medicine is not pharmacology, and diet may be the only effective treatment to this day.

    Type 2 diabetes mellitus curable

    Type 2 diabetes mellitus (D2T) is a chronic disease characterized by high blood glucose levels due to a relative lack of insulin production, which leads to a large number of complications (WHO definitions, Wikipedia).Complications can be delayed or partially prevented, but on average diabetics still live shorter lives. Mainly due to the greater risk of cardiovascular disease.

    Although almost no one directly says that, diabetes is considered an incurable disease, because once the disease has manifested itself, it seems to be like for life, with slow progression and a gradual increase in the doses of drugs taken.

    My dad is also diabetic. When he was diagnosed with the disease at the age of 49, the doctor said: “In 10 years, in any case, you will sit on insulin.”There was a comforting impression that there was nothing special about this, and everyone who received a diagnosis was slowly but surely moving in this direction. Among his roommates were experienced patients who used an injection of insulin as a “dessert” to a slice of cake brought by relatives. Yes, modern medicine has saved them, and now they only have to monitor glucose and regularly “knock” it down.

    14 years of illness have passed, and after another analysis of HbA1c, my dad – as predicted – was prescribed insulin injections, since large doses of glimepiride and metformin were no longer enough to keep glucose within the normal range.

    But he had to refuse the endocrinologist in writing. At that time, he and I had already decided to use “alternative” therapy. It was 5 months ago. As a result, now, in April 2018, he has already stopped taking glimepiride and drinks only metformin. The glucose level is usually kept normal, with the exception of the morning 8 mmol / l (this is due to the phenomenon of dawn). But morning indicators are also gradually normalizing.

    How did we get a diabetic with 14 years of experience to stop taking insulin injections, stop taking medications and get better glucose control? They just turned to common sense and, most importantly, to science.For example:

    Study 1, duration 4 months. The ketogenic diet improved glucose control in patients with T2T so that antihyperglycemic drugs were discontinued or reduced for most of the participants. At the same time, the average level of triglycerides in the blood decreased – an important risk factor for heart disease.

    Study 2, duration 1 year, controlled. A very recent study of the ketogenic diet in obese diabetics. After 1 year, all patients in the test group stopped taking sulfonylurea derivatives (stimulating insulin production), 94% of those taking insulin reduced or stopped taking it.Moreover, in parallel, there is an improvement in all markers (lipid profile, glycated hemoglobin, weight). In the control group with standard disease management for all markers, the expected deterioration with increasing doses of drugs.

    Comparison of treatment results. Virta treatment involves a ketogenic diet. Source – data from Virta Health

    I have not yet seen modern studies of fasting on people with D2T, but they will surely appear soon, because given the results of a ketogenic diet, fasting should not have the worst effect.And there is an interesting publication from 1916 just about the good results of this approach.

    It turns out that the recommended initial therapy (high carbohydrate diet, avoidance of fat and oral medications) generally gives no or negative results. Doses of drugs increase, then insulin injections begin. It is not surprising that almost any expert will tell you about the “progressive” nature of diabetes.

    But if you use a ketogenic diet, then D2T for most patients goes to full remission.It’s a shame we didn’t know this 14 years ago. And a huge number of doctors, both in our country and in the West, still do not know.

    Attention: consult a specialist! Do not go on a low-carb diet or starve if you are taking anti-hypoglycemic drugs other than metformin.

    High blood pressure (hypertension)

    Hypertension in the world, like diabetes, overweight and non-alcoholic fatty liver disease, is increasingly common. This may be due (and even probably connected) with the fact that in many cases these diseases have a single cause – insulin resistance.

    Typically, the treatment of hypertension includes diuretics (promote changes in water-salt metabolism), adrenergic blockers (reduce the sensitivity of tissues to adrenaline), ACE inhibitors (inhibit enzymes that contribute to vasoconstriction) and a large number of other drugs with different mechanisms of action. The very variety of medications speaks of the complex nature of the disease and the not always clear reasons for its development (95% of hypertensive patients suffer from essential or idiopathic hypertension, i.e. hypertension without precisely established causes).

    Therefore, without changes in diet and lifestyle, these drugs do not cure the disease (after all, it is unknown), and often after the termination of their use, the intake must be resumed soon. Why not then do the opposite? Start with a diet, and use medications if it doesn’t work? This is a chronic illness, not an acute event, of course.

    Study 1, randomized, duration 1 year, overweight women before menopause. The Atkins low-carb diet (less than 50 grams of carbs per day) was compared to other diets on many parameters, including blood pressure.As a result, the Atkins diet gave the greatest effect: systolic blood pressure decreased by an average of 7.6 mm Hg, diastolic pressure by 4.4 mm Hg.

    Study 2, randomized, duration 48 weeks, overweight people. Two groups of subjects were prescribed a calorie-restricted diet and exercise. One group was on a high-carb diet and took Orlistat, the other on a low-carb ketogenic diet (40-60 grams of carbs per day) and without Orlistat. As a result, the mean systolic blood pressure in the low-carb group decreased by 5.9, and diastolic – by 4.5 mm Hg. In contrast, the high-carbohydrate group showed a slight increase in mean blood pressure (+1.5 and +0.4 mm Hg, respectively).

    Perhaps in these studies, the patients were helped only by the fact that they lost weight on a low-carb diet. But there is also research on short-term fasting that has been shown to help lower blood pressure quickly. Since the effects of the ketogenic diet and fasting are similar, it can be assumed that the ketogenic diet can also provide rapid results in lowering blood pressure, and that it is not only about being overweight.For example, the low insulin levels seen with medium- to long-term low-carb diets promote more sodium excretion from the body.

    Headaches, migraines

    Recurrent headaches: migraines, tension headaches and cluster headaches have no clear cause (so called “primary headaches”). The main methods of disease management involve the use of non-steroidal anti-inflammatory drugs (aspirin, paracetamol, ibuprofen), as well as opioids and other drugs.

    But there are some very interesting research results related to food.

    Study 1. 18 migraine patients were prescribed a month of calorie-restricted ketogenic diet and vitamin and mineral supplementation. As a result, the frequency and duration of pain decreased significantly.

    Study 2. 5 people suffering from migraines received dietary supplements – ketone salts for 4 weeks. Thanks to this, ketones appeared in their blood in moderate concentration without the use of a ketogenic diet or fasting.In this preliminary study, the average frequency of migraines was halved.

    Study 3. 18 patients with chronic refractory cluster headaches were placed on a ketogenic diet (Modified Atkins Diet) for 3 months. As a result, in 11 people the pain stopped, and in 4 more the frequency of pain decreased by more than 50%.

    I want to emphasize that cluster headaches are one of the strongest – they are even called “Suicide Headaches”. And in said study, they were cured by diet .

    Multiple sclerosis

    This is another disease on our list that is considered incurable. In multiple sclerosis (MS), the immune system attacks the central nervous system, destroying the myelin sheath of neurons. Different parts of the central nervous system may be affected to varying degrees, and symptoms may vary. Basically, motor impairment (up to the inability to walk on their own), vision loss, and impaired cognitive functions develop slowly.

    Disease management involves drug treatment: corticosteroids, as well as agents used in chemotherapy to suppress immunity.But at the moment it is not clear what initially causes it (immunity) to work strangely.

    There is a strong theoretical basis for using the ketogenic diet as a treatment and prevention for MS. A ketogenic diet improves the function of mitochondria (cellular powerhouses), and a problem with mitochondria may even be the main cause of MS. The ketogenic diet generally promotes healthy functioning of the nervous system.

    In addition to the energy problems mentioned (or due to these problems), MS is characterized by systemic inflammation.But ketones also reduce inflammation. For example, the skin of MS sufferers has a pronounced effect of the NLRP3 inflammasome, and the ketone body beta-hydroxybutyrate is its inhibitor. Therefore, a ketogenic diet, fasting, or even ketone supplements can help people with scleroderma as well.

    While there is still no full scientific study of the use of a ketogenic diet for people with MS, there is at least one very remarkable story. Professor of Medicine Terry Wahls (Terry Wahls) in 2007, after several years of illness, moved in a wheelchair.And already in 2008, her illness receded so much that she was even able to ride a bike.

    Left photo – October 1, 2007 (Robin Hibbs). Right photo – October 1, 2008 (Jonathan David Sabin Infinity Photographic Productions)

    She wrote a book and developed a treatment protocol. I have not read the book itself yet, but the essence of the method can be understood from its title (“… using paleo principles”), from the article, and I also heard interesting clarifications in her interview for Dave Asprey’s podcast.According to her, she has and continues to use a low-carbohydrate diet very rich in vegetables, and is actively adding coconut oil to her diet in order to stay in ketosis.

    Alzheimer’s disease

    Alzheimer’s disease or dementia of the Alzheimer’s type is the most common neurodegenerative disease, that is, a disease characterized by progressive neuronal death. In the patient’s brain, amyloid plaques and neurofibrillary tangles are formed.These formations grow, disrupt the work of nerve cells, which is why the latter cease to function.

    The reasons for the development of dementia are not fully understood, but one of the important symptoms is chronic inflammation of neurons (the number of markers of inflammation in the brain is increased).

    Medical management of the disease practically does not change its course. Pfizer announced in early 2018 that it was scaling back its search for new drugs.

    But there is a remarkable feature of the brain of dementia patients.It does not absorb glucose well, so that Alzheimer’s is even called Type 3 Diabetes. High levels of glucose in the brain and inhibited its breakdown indicate an energy deficit that can be experienced by the central nervous system. And here lies a way, if not to reverse dementia, then at least to reduce the manifestation of symptoms and stop the progression by providing the brain with energy from ketones.

    Description of the case of Stephen Newport. Mary Newport, having studied the properties of ketones, decided to add coconut oil to the diet of her husband Stephen, who suffers from Alzheimer’s disease (stimulates ketogenesis, regardless of the reduction of carbohydrates in the diet).On the first day of admission, Stephen Newport broke his MMSE cognitive ability record with 18 points out of 30. Dr. Newport also documented the change in her husband’s ability to draw a dial one month after starting therapy: coconut oil. Source – Mary Newport article

    Also, a double-blind, randomized, placebo-controlled study was conducted in 152 patients.It showed that caprylic acid supplementation, which causes a marked increase in blood ketone levels, leads to a significant improvement in cognitive performance. However, the effect for patients with the APOε4 mutation turned out to be almost zero, which may be due to their reduced ability to “burn” ketones.

    So far, we are not talking about curing the disease, but about a significant improvement in the quality of life and mental abilities, which can be especially important at the early stage of neurodegeneration. But there is potential in reversing dementia – a study in mice has shown that a ketogenic diet can help reduce the amount of amyloid plaque in the brain.

    Convenience versus health

    The pharma industry trying to create “health in a pill” is fighting primarily for our convenience . And medical practitioners really need it. After all, getting a 50-year-old diabetic with obesity and hypertension to suddenly start “right” eating and dilute his routine with morning jogging is another task.

    And this benefit, which both the doctor and the patient is satisfied, has a price. An overabundance of drugs is already a problem in the modern world.It is not uncommon for one drug to be prescribed to compensate for the side effects of another. Add to this the epidemic of excess weight, which is a risk factor for all chronic diseases, and we have our world of conquering convenience. But did not health remain in the vanquished?

    I am very glad that the time of healers and psychics is becoming a thing of the past, however, many people have just switched all their hopes to pharmacologists. In my opinion, this is premature. Someday a doctor will treat diseases even before they arise, but for now our health is in our own hands.And, as can be seen from these studies, in our plates.

    This article is not a recommendation for action and is written for educational purposes only. For treatment, contact a specialist.

    Links to main sources All sources are in the body of the article in the form of hyperlinks.

    As mentioned:

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    diabetes.org. Diabetes Myths. [http://diabetes.org/diabetes-basics/myths/]. “Fact: For most people, type 2 diabetes is a progressive disease. When first diagnosed, many people with type 2 diabetes can keep their blood glucose at a healthy level with oral medications.But over time, the body gradually produces less and less of its own insulin, and eventually oral medications may not be enough to keep blood glucose levels normal. Using insulin to get blood glucose levels to a healthy level is a good thing, not a bad one. ” (accessed March 24, 2018)

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    Carretero OA, Oparil S. 2000. Essential Hypertension. Part I: Definition and Etiology [https://doi.org/10.1161/01.CIR.101.3.329] “Essential, primary, or idiopathic hypertension is defined as high BP in which secondary causes such as renovascular disease, renal failure, pheochromocytoma, aldosteronism, or other causes of secondary hypertension or mendelian forms (monogenic) are not present. Essential hypertension accounts for 95% of all cases of hypertension “

    Levinson PD, et al.1982. Persistence of Normal BP After Withdrawal of Drug Treatment in Mild Hypertension [https://profiles.nlm.nih.gov/ps/access/XFBBHM.pdf]

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    Yancy WS, et al. 2010. A Randomized Trial of a Low-Carbohydrate Diet vs Orlistat Plus a Low-Fat Diet for Weight Loss.[https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/415539]

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    90,000 Causes of ketosis and ketoacidosis in diabetes

    Causes of ketosis and ketoacidosis in diabetes mellitus

    Diabetes mellitus is the most common cause of ketosis, and subsequently ketonuria. In type 1 diabetes mellitus, on the one hand, there is an insulin deficiency, on the other, an excess of counterinsular hormones (glucagon, catecholamines, cortisol).Under conditions of a lack of insulin, the processes of glycolysis, glycogenolysis, and lipolysis are activated. Massive lipolysis leads to a rapid increase in the concentration of free fatty acids in the blood, from which ketonic acids are synthesized in the liver under the action of glucagon. The inhibition of all anabolic processes in conditions of insulin deficiency leads to a slowdown in the processes of ketolysis and the development of ketoacidosis. In type 2 diabetes mellitus, there is a relative insulin deficiency, therefore, in the case of decompensation of this disease, an increase in glycemia is observed, and the intensity of the processes of lipolysis and ketogenesis does not change significantly.While maintaining a ketogenic diet, certain metabolic changes occur that provoke the synthesis of ketone bodies: on the 1-2nd day of fasting, glycogenolysis processes in the liver and muscles are activated, on the 3-4th day, the production of keto acids significantly increases and reaches a maximum by the end of the 2nd week , at the 1st week, the processes of gluconeogenesis are enhanced, and from the 2nd week, the activity of gluconeogenesis decreases and the use of ketones by the brain increases. Thus, vital protein stores are conserved through the predominant use of fat as an energy source.Diagnostic value of determination of ketone bodies in blood and urine. The content of ketone bodies in the blood serum of a healthy person varies from 34.4 to 430.5 µmol / L in terms of acetone, in urine – 20–54 mg per day. Such concentrations of ketone bodies are not determined using routine methods in clinical practice, therefore, it is generally accepted that ketone bodies are normally absent in the blood and urine. In clinical practice, for the detection of ketone bodies, mainly qualitative and semi-quantitative tests are used, which quickly determine the pathological increase in the concentration of ketone bodies in the urine.In accordance with these methods, the presence of aceto-acetate in the clinical analysis of urine can be measured from “one plus” (+) to “four pluses” (++++) .00 In addition, the result reflects the level of ketones in the body for 2-4 hours before the study, i.e. at the time of receipt of the results from the laboratory, the true severity of ketosis may exceed the established values.