Type 1 & low carb

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Sorry to hear you had ketones @Evergreen Did you test your blood sugar at the same time? How are you feeling today?

If you bolus, eat and are then sick, it depends on how much you’ve injected and when. Usually when I’m sick like that I have a virus so the higher glucose of illness kind of offsets the lack of food. Occasionally it doesn’t, and then I have some glucose tablets dissolved in my cheek and eat something small but carby, eg a cake bar, etc.

There are conditions that can cause nausea eg coeliac, but unfortunately I too wonder if it’s a virus or food poisoning or intolerance. I’ve had a few dodgy reactions to food (due to some kind of food poisoning) over the years. I find them far, far more stressful with Type 1 so maybe they stand out more to me?
 
Evergreen said:
good morning everyone, I’m just hijacking my own thread with a different topic in the hope for some wisdom. Didn’t think I’d be back again so soon…

I wasn’t feeling great last night, thought it was just anxiety but then was sick. I measured my ketones and they were 1.9. I managed to get them down to 0.9, rang 111 but that wasn’t too useful.

I’m still not feeling amazing today and I am worried to eat. What do I do if I’m sick after eating and have just taken insulin?

Also I’ve never been sick as much as since diabetes. Could there be a link? HCPs are a little dismissive saying I’ve probably eaten something a bit off or unlucky to catch a virus. I was never very sick and now I’ve been sick twice in two months. Is there anything related to diabetes and issues like this if anyone knows?
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Has your team spoken to you about sick day rules?
 
Yes my team have given me a leaflet about sick day rules which I’m following. Ketones down to 0.6 this morning, so I suppose that’s good. I just don’t really understand why this keeps happening.

Last time my son had been sick a couple days before so it was put down to gastroenteritis which made sense (although I did seem to get it much worse than the rest of my family). This time I felt absolutely fine all day long until all of a sudden I didn’t feel right and I was sick. Ketones were up before I was sick though, could stress cause ketones to go up?

My blood sugar when I tested for ketones was 7, but it did go up after (to be fair I did eat something). Similar last time, normal blood sugar with elevated ketones.

It just seems such a coincidence that I keep getting sickness bugs when I’ve never really had them before and it’s yet another unexplained thing to add to my arsenal…
 
Evergreen said:
Yes my team have given me a leaflet about sick day rules which I’m following. Ketones down to 0.6 this morning, so I suppose that’s good. I just don’t really understand why this keeps happening.

Last time my son had been sick a couple days before so it was put down to gastroenteritis which made sense (although I did seem to get it much worse than the rest of my family). This time I felt absolutely fine all day long until all of a sudden I didn’t feel right and I was sick. Ketones were up before I was sick though, could stress cause ketones to go up?

My blood sugar when I tested for ketones was 7, but it did go up after (to be fair I did eat something). Similar last time, normal blood sugar with elevated ketones.

It just seems such a coincidence that I keep getting sickness bugs when I’ve never really had them before and it’s yet another unexplained thing to add to my arsenal…
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When had you last eaten when you first noticed the ketones?.
 
For me one of the scariest things about diabetes is when I am nauseous and my BG levels are low and dropping. It has happened a couple of times recently when I have had really bad migraines which cause severe nausea and vomiting and whilst I know that it should absorb through the cell walls inside my mouth if I chew my hypo treatment well, it is still a real worry as to whether it will work quickly enough. I've only once injected for breakfast and then started to feel really sick shortly afterwards when I was waiting for the insulin to kick in and again the key is to keep your hypo treatment in your mouth as much as possible. I think @Inka's suggestion of using glucose tablets or a liquid perhaps runny honey for such purposes might be easier than my standard hypo treatment of JBs which need quite a bit of chewing to release all their glucose.
As regards diabetes causing nausea or upset stomach, it shouldn't, but anxiety definitely can and as mentioned there are other autoimmune conditions which can. I am currently having problems with an almost constant upset stomach and I can't decide if it is anxiety, a gastric ulcer or something further down my digestive system. I am hoping it will settle soon, but if not I am going to have to go to the docs. I struggle with my mental health so I am always aware that it may be the issue and try to manage that and hope things settle down but important not to rule out there being a physical cause.
 
rayray119 said:
When had you last eaten when you first noticed the ketones?.
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Only just before, but I had quite a low carb day which might have caused a bit of it. I had a salad for lunch and then because I felt sick I just had some falafels and salad, which probably were only about 10 grams of carbs.

I know low carb eating can put ketones up, but can they go up to 1.9? Just with low carb eating?
 
rebrascora said:
For me one of the scariest things about diabetes is when I am nauseous and my BG levels are low and dropping. It has happened a couple of times recently when I have had really bad migraines which cause severe nausea and vomiting and whilst I know that it should absorb through the cell walls inside my mouth if I chew my hypo treatment well, it is still a real worry as to whether it will work quickly enough. I've only once injected for breakfast and then started to feel really sick shortly afterwards when I was waiting for the insulin to kick in and again the key is to keep your hypo treatment in your mouth as much as possible. I think @Inka's suggestion of using glucose tablets or a liquid perhaps runny honey for such purposes might be easier than my standard hypo treatment of JBs which need quite a bit of chewing to release all their glucose.
As regards diabetes causing nausea or upset stomach, it shouldn't, but anxiety definitely can and as mentioned there are other autoimmune conditions which can. I am currently having problems with an almost constant upset stomach and I can't decide if it is anxiety, a gastric ulcer or something further down my digestive system. I am hoping it will settle soon, but if not I am going to have to go to the docs. I struggle with my mental health so I am always aware that it may be the issue and try to manage that and hope things settle down but important not to rule out there being a physical cause.
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I did wonder about anxiety. I’ve never been sick due to anxiety, but then again I don’t think I’ve ever struggled with anxiety like I do now.

Taking insulin and then vomiting scares me. And it’s really putting me off my food. I’ve just had some breakfast and taken half insulin with the meal and half after. Fingers crossed.

Do people generally eat less carbs with something like this? To avoid having to take large quantities of insulin?
 
Evergreen said:
Only just before, but I had quite a low carb day which might have caused a bit of it. I had a salad for lunch and then because I felt sick I just had some falafels and salad, which probably were only about 10 grams of carbs.

I know low carb eating can put ketones up, but can they go up to 1.9? Just with low carb eating?
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@Evergreen I was just going to ask what you’d eaten when I saw this post. Ketones and normal blood sugar are a sign of not eating enough carbs. Rarely, people without diabetes can get ketoacidosis if they don’t eat enough carbs.

Ketones were up before I was sick though, could stress cause ketones to go up?

The ketones themselves could have caused the nausea and sickness. I felt very sick when I had ketones some years ago.

You don’t have to eat vast amounts of carbs but you really do need to eat more. They’ll keep the ketones away, hopefully stop the nausea/vomiting and just make you feel a lot better too.
 
Evergreen said:
Do people generally eat less carbs with something like this? To avoid having to take large quantities of insulin?
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Some do, but the majority don't. There are lots of aspects of diabetes which cause anxiety in people. Some people fear long term complications but that one doesn't seem to bother me. Fear of hypos is I think the biggest one and justifiably so, and it can affect what we eat or drink (alcohol in particular can cause hypos) or in fact discourage us from exercising. Gradually you learn to manage these fears by slowly building up your confidence. It affects some people worse than others. I have probably gone slightly the other way now with hypos, having had so many that I am mostly probably overly confident of managing them and perhaps sail a little close to the wind at times as a result. But, when I am ill and hypo, that is still very scary to me, especially as I live alone. I now generally ring a friend or family member and let them know and ask them to check up on me later, if I don't get back to them in a couple of hours.

What helps me is knowing that insulin works relatively slowly and hypo treatments work remarkably quickly. So 15 mins after a hypo treatment, my levels will be back up (if I check with a finger prick.... Libre will falsely tell me I have dropped lower still, so always rely on finger pricks in that situation) If I inject 4 units of insulin they will take 4-5 hours to fully work, so whilst 2 units might have worked in the first hour and 3units by the end of 2 hours and then the last 1unit might take another 2-3hours to finally fizzle out, that still gives my hypo treatments lots of time to soak them up if it need to and 2 JBs will cope with 1 unit for me, so at worst I am going to have to chew and eat 8 JBs over 3-4 hours to deal with that insulin, so I have plenty of time. It is the panic which makes it seem like the clock is ticking and we have to do counteract it all at once.
 
Evergreen said:
Taking insulin and then vomiting scares me. And it’s really putting me off my food. I’ve just had some breakfast and taken half insulin with the meal and half after. Fingers crossed.
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This is completely understandable.
We are usually advise to inject before eating but if you are concerned about vomiting or not eating all your meal, you could take your insulin afterwards. This is likely to cause a spike in your BG but, if it doesn't spike too high and returns to normal levels within 4 hours, it should not be a big concern as you are getting used to it.

The longer answer is about (more) graphs and profiles.
If you google "NovoRapid profile" (or whatever fast acting insulin you use), you will get a graph showing when the insulin is active. For fast acting insulin, this will peak after about 30 minutes and then gradually fall for the next 4 hours.
Theoretically, there is a similar graph for digestion of food and release of glucose. I say "theoretically" because this can vary from person to person and different food types. But you can still picture a peak with a trailing decline.
A healthy human pancreas will release exceptionally fast acting insulin (fasting than any we inject) once it sees the glucose starting to go up and follows the glucose release curve very close behind resulting a small peak.
Ideally, with Type 1, we attempt to replicate the pancreas reaction by matching the peak of the insulin activity with the peak of the glucose release curves. If we inject the insulin too early, our BG falls. If we inject too late, there will be a spike.

(I hope that all made sense. I can picture the curves in my mind but not sure if I describe them clearly.)
 
Evergreen said:
I know low carb eating can put ketones up, but can they go up to 1.9? Just with low carb eating?
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As others had said you cam get starvation ketones when not eating carbs. I had aweful flew like thing a few weeks ago and one day I had virtually no appetite and really wasn't feeling up to proper meals so stacked on fruit to try and keep ketones at bay(I knew I would get confused when checking for them weather it was the illness or the fact I hadn't eaten).
 
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Thank you everyone, as always I really value your advice. Fruit might be a good one.

I am still very confused about the ketones. I understand eating low carb can cause starvation ketones, but if my vomiting was caused by having two low carb meals on a given day, how come people who eat low carb as a standard don’t get DKA?

I will obviously try and eat more carbs and have done over the last weeks, but I’m truly sad to say the enjoyment is completely taken away from eating
 
Generally Ketones do not cause a problem unless your BG levels are high causing acidic conditions in the blood which leads to DKA. Ketones without acid conditions are not harmful I believe, hence a Keto diet not causing DKA. However there was some talk at the start of the pandemic about Covid causing DKA at lower/normal BG levels, so perhaps the virus was causing acidic conditions in the blood in a few people due to something other than high BG levels.

I can count on one hand the number of times I have tested for ketones in 4.5 years and those were mostly curiosity when strips were going out of date rather than circumstances where I felt I needed to. I follow a low carb way of eating but I proactively keep my BG levels in range and I am not frightened of using my insulin to do so by stacking corrections if necessary, so I really don't give ketones or DKA any consideration and when I am ill with a migraine I am usually too unwell to be capable of testing for a couple of hours, so my Libre is a godsend for keeping track of my BG levels in that situation, but I believe it would take longer than that for ketones to develop and become a problem, so as long as I keep my BG levels mostly in range I shouldn't have to worry about DKA. That is my understanding of it.
 
@Evergreen They inject for protein and usually have lots of little corrections. They amount of insulin they take isn’t small. You’ll remember that @Tdm (I think - apologies if not) said they actually ate more carbs and took less insulin. I found that too on the occasions I’ve tried very low carb. I also felt nauseous and headachey a lot.

@rebrascora has just replied above. She takes plenty of insulin, as you say (plenty might be the wrong word, Barbara, but I hope you know what I mean) and doesn’t eat extremely low carb.

Ketones can develop with normal blood sugar. It’s called euglycaemic DKA so don’t ever be falsely reassured by an in range blood sugar. If you feel rough, test for ketones - always. Some people are more prone to develop ketones than others.

Don’t let diabetes steal your enjoyment of food. Do what you need to so that you can eat properly. If this means injecting after eating, or splitting your bolus so you have some before some after, then do it. When I had severe hypo anxiety, I did this and it helped a lot. Yes, you might get a spike but it comes down, and the mental pay-off of reduced anxiety is huge and worth it.

Keep you meals simple for breakfast and lunch. I have two or three options for each but generally have a favourite option that I have most days: cereal for breakfast, then sandwich, fruit and yogurt or similar for lunch. I don’t have to think, I know the insulin will work ok without a hypo, and it makes a big difference. You can then have an evening meal of your choice - again, I’ve built up a library of meals where I know the insulin and know everything should be ok.

You don’t have to leap into this. You can edge into it slowly, by bolusing after or by taking ever so slightly less insulin than you need so that you build up confidence.
 
There’s lots about euglycaemic DKA on the internet, but here are a few pages:

www.ncbi.nlm.nih.gov

Euglycemic Diabetic Ketoacidosis Precipitated by a Keto Diet: Importance of Dietary History in Diagnosis

Diabetic ketoacidosis (DKA) is one of the serious complications of diabetes, especially type 1. It is defined by the triad of hyperglycemia (>250 mg/dL [>13.9 mmol/L]), high anion-gap metabolic acidosis, and increased plasma ketones. Euglycemic ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov


Euglycemic diabetic ketoacidosis: A missed diagnosis

Euglycemic diabetic ketoacidosis: A missed diagnosis
www.wjgnet.com

People without diabetes can occasionally get it too - sometimes because of alcohol problems, due to reduced calorie and carb intake, when pregnant or breastfeeding and not eating sufficient carbs, etc etc.
 
I am another person who tried low carb but gave up on it.
I found it challenging to calculate my insulin dose and the diet, not the diabetes, took away my enjoyment of food.

I returned to my normal diet and focused on working out how much and when to take my insulin to get to a level that I was happy with. This was far from perfection but I was back to enjoying my food and finding socialising much much easier.

I no longer restrict my carbs and eat a very varied diet including varying my breakfast and lunch most days which I think it is unusual for most people but my boredom level is low when it comes to food.
 
I’m taking everything in and really appreciate all the advice. It still feels really fuzzy and confused in my head but I think I’ll try and eat more carbs, slowly edging my way up. Currently on about 30 grams per meal, but have often opted for a low carb dinner to not have to deal with the blood sugar issues into the night, maybe I need to change that.

I’ve made a list of things I feel comfortable to eat usually and I’ll stick with that/expand slowly. Splitting my dose if that feels more comfortable.

Something else that I really appreciated was something both @rebrascora and @helli mentioned about novorapid. If I would throw up after injecting that doesn’t mean I need to eat the same amount in sugar straight away, but I actually have time to deal with this due to the working of it. I’m going to try and remember this.
 
Evergreen said:
@rebrascora, just out of interest, when you did test your ketones what were the values?
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Sorry, I have only just seen this question. I don't think I have had a reading above 1, but have to be honest I really can't remember, as it is at least 2 years ago since I checked.
 
rebrascora said:
Sorry, I have only just seen this question. I don't think I have had a reading above 1, but have to be honest I really can't remember, as it is at least 2 years ago since I checked.
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I also went low carb but found my insulin sensitivity went down. I also missed bread. I can get as good control with high carb as low carb, but still do low carb midday as i don't need the drama at work! My insulin sensitivity returned pretty quickly.
Also, hard to keep weight on when low carb.
Obvs different for t2 people...
 
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