Ketosis for Type 1 Diabetes - dispelling the myth on ketoacidosis - PART 2

Thanks for checking out PART 2 of this post! In this part I outline all the benefits and important considerations with adopting a ketogenic approach for management of type 1 diabetes.

How can keto benefit T1D?

Now back to the fun stuff! So how can a ketogenic diet/lifestyle benefit someone with T1D? There are so many ways. I’ve categorized some of them below for you through my own personal experience.

Tighter BG control and Lower Glycaemic variability

The freedom from blood sugar and insulin swings is hard to put into words. Unless you’ve lived with T1D, it’s hard to understand how it feels to be in a “roller-coaster” state with your blood sugars. You are constantly chasing highs and lows and it’s very wearing on your physical and emotional well-being. Since adopting a strict approach to my diet, I’ve noticed about an 80 – 90% drop in fast acting insulin need, and a 20% reduction in basal insulin need. This has several benefits: The less insulin one needs, generally the less taxing on the system. This means that there is less chance of over-treating a high and causing a low. This also means that there is less chance of causing a high from over-consumption of carbs and under bolusing of insulin. Not to mention that insulin itself is an anabolic hormone that stimulates lipogenesis (turning energy from glucose into fat) and slows basal metabolism. The result? An increase in fat accumulation. So it can be assumed that with lower need of insulin, calories aside, one will store less fat and access stored fat more easily.

Lower glycaemic variability is definitely one of the top perks of utilizing a ketogenic approach for T1D management. I’ve been able to lower my HbA1C from the 8s down to 6.1. Before fully understanding the insulin needs of the separate macronutrient groups, I would under-bolus, have skyrocket blood-sugars for extended periods (thanks to mixing high carb with fat – think Chinese or Thai food), and have to treat with massive amounts of insulin – thus leading to insulin resistance, poor HbA1C, and fat storage. Since ingesting a reduced amount of carbohydrates, my glycaemic variability has gone from 3.0 mml/l – 25.0 mml/l to maxing out around 14 (which to be honest, is rare). My body has also become attuned to this new range, and even if I wasn’t wearing a CGM, my body starts telling me I’m heading high when my BG gets to 10 (180 in the USA).

More insulin sensitivity and lower insulin resistance

I touched on this before, but insulin sensitivity and resistance really need their own section. Insulin resistance has been cited by TONS of research (too many to cite to be honest, but mine is listed in references) as the leading cause of obesity, cardiovascular disease, and diabetes. Now I need to add in here that my personal case study for a ketogenic approach is in conjunction WITH an increase in physical activity. Physical activity on its own raises insulin sensitivity, which would lead one to believe it would lower insulin resistance. So imagine the impact that doubling down on this would have? Significant impact. As stated above, my insulin need has drastically lowered, which has led to lower glycaemic variability and significant weight loss.

Lower blood pressure

A perk that I wasn’t expecting to develop was a lowering of my blood pressure. My blood pressure was never an issue, always measuring within range. After adopting the ketogenic approach mind you, I actually noticed a significant drop; to the point at first where I would get light headed if I stood up too quickly. This has corrected itself over time and I haven’t had a dizzy spell in a long time. My last blood pressure test (granted this was a while ago thanks to machines being closed due to COVID-19) was 110/70.

Pallet changing – lowers cravings and increases satiety

This has been a really interesting benefit of adopting the ketogenic lifestyle. I used to be plagued with cravings – both salty and sweet (lethal combination – salty-sweet popcorn was my FAVOURITE!). Since changing my diet, I’ve noticed a huge decrease in cravings, and I’ve actually noticed that when I have sweet things, for correcting a hypo, I’ve actually found them sickeningly sweet at times. As you’ll discover on this site, I love to cook and have found ways to satisfy cravings with low-carb alternatives, and if they include sweeteners, I actually half the amount for I find them overly sweet otherwise.

Increased satiety is also a huge perk. By simply increasing the amount of fat in the diet, one is able to go longer periods without feeling hungry as fat (and protein too) takes far longer to digest than carbohydrates, which leads to less need to snack, or “fill the void”. This has a downstream effect of needing to eat less, having less chance of the “insulin roller-coaster”, and being freed from food being the boss of your day. This also leads to high levels of energy and productivity!

Heartburn relief

This was really interesting. I’ve discovered that heartburn is actually quite common in people living with T1D. I have suffered from heartburn for years, and I mean YEARS! I remember bringing a bottle of Tums with me to high school. I was put on proton-pump inhibitors in my 20s, but after learning about the long term side effects, I switched to a lower-risk drug called ranitidine (which interestingly has been recently taken off the market due to evidence of carcinogens). Now I didn’t achieve heartburn relief the day I started keto, but cleaning up my diet certainly did help. I entered the keto diet with a pretty broken metabolism and GI tract. Imagine what over a decade of antacids did to my system? I was worried about nutrient deficiencies on top of everything else, so I made it a priority in the summer of 2020 to get off all antacids and find a natural remedy. After some research I learned that antacids had actually created a highly alkaline environment, which leads to undigested foods and nutrient malabsorbtion. Through daily doses of apple cider vinegar and betaine-hydrochloride with meals, I’ve been able to reset my system so that now, if I forget to take apple cider vinegar in the morning, I can still have a day without heartburn. I can also rest easy knowing that I am now absorbing all the nutrients from the nutrient-rich foods I’m eating. I should mention that I no longer take the betaine-hydrochloride. Is any of this thanks to keto? I do believe it is as I eat whole foods, have reset my GI pH levels and interestingly, the only time that heartburn flares up is when I take glucose tablets to correct a hypo…

Important considerations

As I have outlined, ketosis and diabetic ketoacidosis are two separate things. This isn’t, however, to say that one can’t lead to the other. If you are considering adopting a ketogenic lifestyle and have T1D, it’s very important to understand how each of the two is caused, and how to avoid DKA. The key is that DKA is caused by elevated glucose thanks to insufficient/unproductive insulin. The ketones that are therefore produced because your system isn’t getting enough energy cause the bloodstream acidification. DO NOT STOP TAKING INSULIN if you are planning to try out a ketogenic approach. Insulin dose numbers should be played with in small increments, and under the supervision of your diabetic health care professional. We need to take insulin for more than just carbs, and this is imperative to understand.

Test test test! And I mean blood glucose levels AND ketones. To be in nutritional ketosis, blood ketones should be between 0.5 and 3.0 mmol/L. To enter DKA, ketone levels need to be over 8 mmol/L. By testing frequently and having a clear picture of your normal levels, you will get advanced warning of elevated ketones (that you may develop thanks to infection fighting or illness) and elevated blood sugars so you may correct accordingly.

Be prepared to challenge your understanding of cholesterol and fats. We will be delving deep into fats and their misconceptions in a future post, and I will DEFINITELY get into the cholesterol conundrum, as there are SO MANY differing perspectives on the subject and I still find it confusing. I haven’t delved deep into the actual research yet so I won’t get into it here, but I do know that the “hate-on” for cholesterol all came down to some really bad science that went down in the 50s to come up with an answer to the massive uptick in heart disease (hmm…every soldier was given cigarettes in WWII to “cope”…could that have been a cause?). Fat and cholesterol were the intended targets (and were still blamed even though the study was flawed and cherry-picked) and the ramifications of this have had serious, global health consequences.

It’s also important to mention that in my research for this post, I happened upon a risk I hadn’t heard of before. This is when a patient has a disorder with fat metabolism and may develop a devastating catabolic crisis (potential coma or death) in the setting of fasting or a ketogenic diet. If you think this may be you, or you know of someone in your family history that has this disorder, perhaps hold off until you can get screened for a disorder of fatty acid transport and oxidation.

In closing

The ketogenic diet really has saved my life. If you read my introduction post, you’ll see the direction that my health was headed. I’m not a “pusher” in any respect – I honestly don’t think that there is a “one-size-fits-all” for everyone out there. Our bodies are all unique and individual. Mine, as a type 1 diabetic is inherently intolerant to carbohydrates, so why use them when there’s an alternate fuel source? I picked up that notion from Ellen Davis and Dr. Keith Runyan in their book “The Ketogenic Diet for Type 1 Diabetics” (which I highly recommend!) and it really resonated with me. Even in their names, it can be inferred that the “essential” nutrients don’t come from carbohydrates – they come from fats! Essential-fatty acids, they’re called, and we’ll get more into this in a future post.

So If you’re interested in ketosis and adopting a keto-approach to your T1D management, do your research, make sure you understand what will be happening in your body, consult a diabetes medical professional (don’t expect fully-endorsed support though!) to discuss your insulin needs, and don’t hesitate to reach out to me should you have any questions about my personal experience.