What Causes Diabetic Ketoacidosis (DKA)

300Diabetic ketoacidosis.  Diabetics everywhere know this term, . . . I hope.  What is diabetic ketoacidosis?  How is it different than ketosis?

I’ll start by explaining ketosis, and try to keep the sciencey (Yes it’s a word.  It’s MY word.) stuff to a minimum.  Ketosis is a natural body process that occurs when your muscles require fuel, but there’s none in your system.  That fuel starts out as carbs.  If you don’t get enough carbs, your body will naturally enter ketosis when your body starts to break down your fat, thus producing ketone bodies which it can use as fuel.  Your brain and your heart actually run more efficiently on ketones, than they do on glucose.  Our bodies were built to do this, to survive when there was no game to hunt, no plants to forage, no food nearby.  This is NOT dangerous, . . . it’s natural, unless you’re diabetic.  Why is it only dangerous for diabetics?

Because ketone bodies are acidic, and when they reach a certain level, a non-diabetic will secrete insulin, which reduces the ketones just like it does blood glucose.  We of course don’t have this mechanism.  When a diabetic gets ketones, and their blood glucose is above 250, this is the formula for diabetic ketoacidosis.  I know what you’re thinking.  I still haven’t told you what causes it.  Well, here we go.

What causes it is simply a lack of insulin or fuel.  A lack of insulin caused by a faulty infusion set, simply not taking your insulin, being sick and dehydrated, or not eating enough carbs.  The reason your body would enter ketosis is that it doesn’t have enough fuel in the form of carbs, OR . . . it has plenty of fuel, but not enough insulin to get it into the muscle cells.  If the body cannot process or does not have fuel, it will create it by breaking down fat.  This is ketosis.  NOW, your body can’t use the carbs you’ve eaten due to lack of insulin, AND ketones are rising because of lack of insulin.  Rising ketones turn your blood acidic.  This is what can kill you.  If you’re sick and you’re vomiting or have diarrhea, it’s even worse because that creates dehydration which causes insulin resistance!  Ever had ketones while you’re sick, and wonder why in the heck you have to take 3 times the insulin to bring down your blood sugar and ketones?  You need insulin for the blood sugar, for the ketones, and to compensate for the insulin resistance.  Now I can see the wheels turning in your head.

When you go to the hospital, they’re going to treat you with a saline IV, an insulin drip, and electrolytes.  These treat all of the symptoms of DKA all at once, and bring you back to normal.  Your dehydration, your high blood sugar, your high ketones, and your low electrolytes.  So . . . clear as mud now?  Well, I hope it’s clearer than mud for you.


********** Now ya know, and knowing is half the battle.  Go Joe!!! **********

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More Paleo and Ketosis for Diabetes Observations

I haven’t been working out for about a month now, as I was trying to ease into a ketosis lifestyle.  I stopped my workouts because I was already stressing my body with the ketosis.  In the past when I tried this lifestyle, I found that when I did try to exercise, I had zero energy, and usually couldn’t complete my workouts.  So I’ve realized the same thing again.  Plus, when I workout on the ketosis diet, my blood sugar spikes like crazy.  It doesn’t do that if I’m not in ketosis, and it actually falls like it should.  My guess is that my liver is either entering gluconeogenesis (converting protein to glucose), or it’s just dumping whatever glucose it has left, so that my muscles can operate to the best of their ability.  I’ve just decided that ketosis for diabetes is not my thing.

The other thing that happened to me again, is that after about 10 or 12 days, just like the last time I tried this, I had a bout of DKA (diabetic ketoacidosis), where my ketones went off the scale, my blood sugar spiked, and I had to literally OD on insulin to bring it down, then I had to scarf down gobs of carbs (yeah, I don’t care about grammar right now) to keep me from seriously crashing.  This is a process that can take anywhere from 6 to 18 hours to treat, so you can’t sleep if it’s happening to you.  Don’t worry, I know how to treat DKA.  I do the same thing they’d do at the hospital.  I’ve been doing this for 42 years, so I know how this works.  Those are scary days even so.  Both times I’ve tried ketosis, after 10 or 12 days, I have this DKA fight.  Then I go high carb for a few days because I get paranoid.  Then I come back to at least eating normal paleo.

So I’ve decided that ketosis is not for me.  I’m going to stick with paleo for sure, and I’ll keep my carbs to under 100, but not under 50 which causes ketosis.  I’m a Beachbody coach, and I get paid to workout, so I have to workout.  My income depends on it!  Besides, working out to Les Mills Pump is fun, and those female trainers are hott!  What really sucks though, is that on ketosis my blood sugars were almost normal.  My 30 day average blood glucose dropped by 100 points from 265 to 166.  I’m still kind of eager to get my A1C done at the end of the summer though.

If you’re a type 1 diabetic that’s on a ketosis lifestyle, please comment below with your experience.  I wish I could find a community of T1D’s that live in ketosis?

Paleo and Ketosis for a Type 1 Diabetic

ketosis-ketostix-ketoacidosisjpgKetosis and diabetes are 2 words that instill fear in the hearts of most diabetics.  It used to instill fear into me as well, until I started reading about paleo and primal living, and how ketosis doesn’t always mean you’re gonna die.  When I started to read about ketosis, and how some diabetics have taken control of their diabetes with it, I began to get excited.  I studied and studied for weeks.  Trying to understand everything I could about paleo and ketosis, and I was slowly starting to believe that there’s a way to be in ketosis as a type 1 diabetic, without it killing you.  I have a lifetime of beliefs, drilled into me by my doctors,  that ketosis means death.  It does, “IF” you’re in ketosis and you’re blood sugar is over 250 mg/dl.  Most diabetics know this as DKA, or Diabetic KetoAcidosis.  Your blood literally becomes toxic with acid created by the lack of insulin in your body.  This is a life threatening condition, and must be avoided at all costs, by all diabetics.

So why on earth would a type 1 diabetic want to intentionally enter ketosis? What is ketosis?

Let me start by answering the second question.  Ketosis occurs when you’re body doesn’t have enough fuel.  Your bodies primary fuel comes from carbohydrates that the body turns into glucose to feed the muscle cells and the brain.  If you’re body doesn’t have enough glucose, it has to get fuel from somewhere so it starts to burn or break down fat.  When a fat cell is broken down, that creates ketone bodies.  3 types to be exact.  2 are used for fuel, and the 3rd is just waste.  (Which you can smell on the breath.  It’s called Acetone.)  The brain and the muscles can run on ketone bodies.  Actually, the heart runs close to 30% more efficiently on ketone bodies.  When ketone body levels get to high, the body produces insulin, and they are reduced.  If no insulin is sent into the bloodstream, the ketone bodies rise, and so does the blood glucose.  Since the 2 ketone bodies that are used as fuel are acidid, this combination causes the blood pH to become acidic, and toxic, causing Diabetic Ketoacidosis, or DKA.

I wanted to go on a ketosis diet, because I read story after story of type 1 diabetics that got off the rollercoaster by going low carb (which naturally causes ketosis).  By low carb, I mean around 50g or less per day.  Low carbs = steady bloodsugar.  This means you eat mostly fat and protein.  (Hello butter and bacon!)  I know, I know, you think I’m going to clog my arteries.  Well I’m not, but that’s another story.  Anyway, I tried this for a week back in March as an experiment, and it worked great after about 7 days, but for those first 5 days something weird happened.  I wasn’t in ketosis continuously.  I kept jumping in and out of it.  Whenever I’d be in ketosis, my blood sugar would spike, dangerously high, over 250!  When I’d bolus, it wouldn’t go down!  (I had never been in ketoacidosis in my entire life, so I didn’t know how to treat this.)  Tons more research about treating ketoacidosis, and I got it under control.  I discovered that if I bolused, AND did a 4 hour temporary basal with my pump, everything worked great and the blood sugar would come down.  Perfect!  Nothing had I read warned me about this, and when I went looking for answers, I didn’t find any on the big name blogs.  Where I found answers was in the forum at Marks Daily Apple.  Other T1D’s told me this happens to a select few type 1’s when they start a ketogenic diet (lucky me) and it will go away in a few days.  It’s caused by the body being stressed due to what I’m doing to it, and that stress creates cortisol, which tells the liver to dump what little glucose it’s storing, or to convert protein into glucose (called gluconeogenesis).  After 5 days, everything was running smoothly.

But then I tried to come out of ketosis.  To end the experiment.  I increased my carbs back to around 100c per day.  Well, that didn’t go so well.  If I went for more than 3 hours without carbs, I’d get ketones, and my blood sugar would spike, and I developed dawn syndrome.  (Ketones early in the morning because you’ve been without carbs for hours.)   So I did a lot of fighting my blood sugar for a while.  Adjusted my basal rates, and my carb ratio, and got back to normal (the normal highs and lows I mean), but still had dawn syndrome.

Then I got a Metronic continuous glucose monitor (CGM).  I had become even more paleo over the last few months, and even more strict with my food choices.  Loving my bacon and butter, and all the steak, burgers, etc.  So I decided to do this again, but go even more hardcore into it, and NEVER COME OUT OF IT.  The CGM sure makes it easier to do this that’s for sure, because you can see your blood sugar change in almost real time.  I went with no carbs for 3 days at the suggestion of 1 particular blog, to effect the conversion from carbs to ketones more quickly.  It worked!  Smooth transition with no spikes, and my blood sugar hasn’t climbed above 150 for 7 days straight.  Most of the week my blood sugar has been around 80-90 mg/dl.  I used to be afraid of that low of a number!  I’d start eating glucose tabs, afraid of a crash.  Now I’m annoyed if it goes above 125!  I’ve been in ketosis 100% of the time all week now.  It’s been emotionally uplifting too.  Not that I have any kind of depression problems, but it just feels good that I’ve found a way to control my diabetes that’s actually working.  I keep seeing carbs everywhere, and thinking “No Rich, that will make your blood sugar spike, today, AND tomorrow, and the next day.”  Then I just walk away happy that my blood sugars are normal now.

Now, I feel the need to say this . . . . . DON’T TRY THIS AT HOME.  There’s a lot of things about starting a ketosis diet that you need to learn, and it can be really dangerous if you don’t do insane amounts of research.  I’m a little crazy, and don’t believe mainstream medicine, and this is MY LIFE, but I definitely don’t want you to try this just on a whim because you read my blog.  I wanted to tell you my story, so you can see what happens, because I didn’t see this in any of my research, and had no idea that it might happen with all of the hours of research I did before I tried (maybe 50 hours I think).

I hope this article was helpful to you.

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