question about ketosis
 

Doreen, you probably would know this:
Is Dr. Bernstein's Diabetes Solution supposed to be a ketogenic diet? He does not focus on ketosis, but it seems that with an upper limit of 30g carbs per day, it would be...however, I was wondering if the fact that some of us still need to inject insulin with this WOE would maybe prevent ketosis from happening. I can test my urine for ketones, but I am not to the point of perfect control yet where I can be sure they are the good ones (and not the bad ones from high blood sugar. I think I still go high in the night sometims, and I don't know how long ketones stay in your body after they are produced).
I definitely don't FEEL like I am getting the benefits of ketosis that many people describe--the energy, clear-thinking, loss of appetite, etc. I feel tired and hungry most of the time still. I'm kind of discouraged.

Hi there Puma_Power!

Since you've only been low carbing a few weeks, it may be that your blood sugars haven't quite stabilized yet which would explain the lower energy levels and hunger (these are both symptoms of diabetes). I've been doing this for 18 months and still feel tired sometimes, although I'm rarely hungry. I suspect that I have a sluggish thyroid, but since my TSH keeps coming back normal, my doctor will not put me on thyroid medication, but I'm toying with the idea of going to an endocrinologist on my own and just paying for it out of my own pocket (I have HMO, so if I go out of network without a referral, it won't be covered).
Since being in ketosis isn't an important part of Dr. Bernstein's plan and my blood sugars are tightly controlled, I don't even test for it, although it stands to reason that most people would be in some level of ketosis at 30 grams of carb per day. His focus is on maintaining tight control of blood sugars, not on ketosis or even necessarily on weight loss although he does address those that need to lose weight in his book.
Keep at it and don't worry too much about the dietary ketosis thing (definitely do keep testing for diabetic ketosis) and you'll probably see some improvement in your symptoms once your blood sugars stabilize more.

Thanks, Lisa...
 

for your words of encouragement. I guess I just feel like, as long as I'm taking these draconian measures and basically not eating any foods I really like, it would be nice if I could lose a few pounds as a kind of side benefit! I am not outside of the "normal" weight range for my height, but in the last few years I have had trouble keeping off those extra 10-15 pounds that I never used to have...I guess, more than weight, I would like to see a change in body composition--fat/muscle ratio. Especially because this would help my body process what few carbs I eat more effectively. I know that the best way to do that is through exercise, but I'm finding that--at least right now--exercise makes it more difficult to control my BG, not less. Dr. Bernstein doesn't really emphasize exercise for T1's. In fact, he says that it is not that important. But I don't feel good about myself not exercising--I've been doing it, off and on, for most of my life.
I have visited the exercise sections of this forum, but there aren't many others in my specific situation (i.e., Type 1 diabetic on Dr. Bernstein's diet). I don't find exercise advice for non-diabetics on LC very helpful.
Also, maybe I am aiming for perfect BG levels too soon--maybe I shouldn't be expecting to get always in the 80-95 range that Dr. Bernstein recommends, for now? I mean, my BG's are better than they were, most of the time. Yet I read all of these testimonials where people say how their blood sugars became perfect and stayed that way almost immediately once they started this diet...it makes me feel really frustrated that I can't get the results everyone else seems to be...
Re: thyroid-related energy problems: I have been tested for thyroid function numerous times, as thyroid problems are common in people with autoimmune diseases. Soon after my diabetes dx, one doctor actually put me on synthroid, but it seemed to have no effect so I stopped taking it. In my most recent bloodwork (a month or so ago) my thyroid function came up normal. So...I don't know. It seems like a logical source of problems for me, but also nothing to be done about it. Have you tried taking kelp supplements (for iodine)?

Ketones from burning fat because you're not using blood glucose at all pretty much would only kick in at a sustained BG of 300 mg/dl or higher (usually higher, like around 400 mg/dl or more). If you're keeping your sustained (not counting the odd spike) BG at 180 mg/dl or less then any ketones you see are *real* honest fat-burning ketones. The ketones produced by the body being desperate for fuel would be accompanied by a LOT of other bad symptoms as well. That idea scared me too when I was first diagnosed as I had a LOT of ketones in my urine and a LOT of sugar in it as well. But then, an FBS of 309 would do that!! (I use the keto-diastix which test for urinary sugar and ketones at the same time) Ketones with no sugar showing up is good....ketones AND sugar showing up in urine is not so good. Sugar starts to be filtered by the kidneys at about 180-210 mg/dl or higher on BG readings (sustained, not spikes), so even if you don't test your blood, you can still get an idea of your readings by what's going into the porcelain throne. If you've got pretty good sugar control, and see a light pink or lavender on the ketostix, I'd say you're doing just fine. There's a WORLD of difference between ketosis and ketoacidosis.

Puma, if you are tired and hungry frequently, you may not be eating enough food.

An opinion and suggestion: For exercise, you could try modifying Bernstein a bit. You could start by experimenting with carbing up before, and maybe during, exercise. By carb up I mean only a few grams, not a whole dessert. A little juice, sport drink, glucose tablets, life savers, etc. would be good things to use. You might also adjust your insulin down a little if you plan to exercise. Of course, then you are stuck having to not blow off your planned exercise because you've already adjusted your insulin for it. Another part of your plan needs to be timing of exercise, food, and insulin injection as well as the location of the injection (unless of course you are on the pump). Here are two examples:

Suppose a person takes NPH at 7:00 a.m. and eats dinner at 6:00 p.m. By 6:00 p.m., the morning NPH is pretty much gone so he/she relies on Humalog to take care of dinner. An hour or maybe two after dinner is the perfect time to exercise since it would be way easier to figure out how to balance Humalog, food, and exercise than it would be to balance things with NPH doing its thing of being in the blood at different concentrations throughout the day. This person would have to be very sure to also adjust his/her bedtime NPH, and perhaps have a bedtime snack with carb and protein to avoid nightime lows when glycogen re-packing is seriously happening. Nightime testing would definitely be advised following an evening exercise session.

Suppose the same person above injects morning NPH into his/her leg or arm. He/she chooses the leg or arm because the stomach will absorb the NPH too quickly, the butt is in an awkward location for self-injection, and the spouse refuses to help out by giving a butt injection and in fact runs from the room anytime a syringe appears. The person decides to exercise at 9:00 a.m. since there is this really great class that includes step, kickbox, and weights. The exercise greatly increases the absorption rate from the pool of NPH lying under the skin of the arm or leg. The person thus gets a low in the morning. In the early afternoon, the NPH is all used up due to the early increased rate of absorption; therefore, that morning low is followed by an afternoon high.

Thanks, guys!
 

kj and cyprinodon,
your posts were very helpful!
Re: not getting enough to eat, I guess you may be right, except that, calorie-wise, I make sure I don't drop too low (since there have been times in my life where I have no appetite, for emotional reasons, and don't eat much and I invariably lose lots of weight and then of course put it all back on as soon as my appetite comes back). The problem is, the way I add calories without adding any more carbs or having too much protein (since Dr. Bernstein says to have 4-6 oz. of protein per meal) is to add olive oil to things--which is good for you, but doesn't really satisfy hunger. The thing is, I can't add more vegetables, since that would go over the carb limit; too much cheese or any dairy product adds too many carbs as well; and I don't really feel like it's okay to eat, like, a pound of meat in one meal! (Not to mention, I just don't like meat enough to do that regularly.)
I don't really know what to do. Before doing Bernstein, I'd try to fill up by eating alot of non-starchy veggies, and I feel frustrated that I can't even do that now--imagine, broccoli as a "forbidden fruit!" :daze:

I only know bits and pieces of Dr. Bernstein right now based on what I've read at his site, what I've read here, and what my son's father has told me as he is currently reading the book.

That being said:

Although Bernstein's strict way of eating may be the absolute best for managing your disease, the major idea is to get those carbs down lower than your endo would have you do. Also, my son's father told me that so far in what he has read, Bernstein hasn't mentioned anthing about subtracting out fiber from the carb count. You might consider eating a little bit more carbs than he suggests so that you can have those veggies that satisfy your appetite. Also, you might consider not including fiber in your carb count (if indeed Bernstein doesn't address this issue).

Other fats you can add if you need additional calories: butter on your steak, mayo on your turkey, whole whipped cream sweetened with Splenda on top of diet Jello (yeah, diet Jello made with NutraSweet I know), whole cream and Splenda in De-caf coffee.

Thanks for suggestions, Cyprinodon.
Actually, I believe that Dr. B. does talk about the fiber/overall carb ratio...in any case, I have been doing the fiber subtraction thing for my morning cereal (flaxomeal: 12gram carb/serving w/ 10g being fiber, thus I only count 2grams of carb). I don't really eat anything else to which this rule would apply (since I believe he already does the subtraction for you with the vegetables he recommends. Maybe I'm wrong, though--I'll have to re-read).
Re: eating more carb (vegetables) than Dr. B. recommends, I believe that I probably will end up doing that, but I am trying to get totally stabilized before adding anything in; I also will only be doing it if I am exercising to compensate--and I so far have been having major trouble with exercise making my BG's tweak out!

Puma_Power...

It took at least 3 weeks for my blood sugars to normalize once I started low carbing and that was on 1,000 mg. of Glucophage a day. Of course...my A1C was 11.8 with a fasting blood sugar of 250 when I started. :thdown:
What type of exercise are you doing? It may be that strenuous cardio is too much for you at this point, but a moderate level of weight resistance training would work out okay. Dr. B does address excecising for type 1s and adjusting insulin dosages and using glucose gel or tabs during to compensate for drops on pages 169-190 of his book and he tends to stress weight resistance over cardio for the purpose of blood sugar control. Since I don't use insulin, a lot of it went right over my head but you may find that information useful.
I can't recall if he addresses deducting fiber, but it makes sense since you can't digest it in any way. As for increasing veggies, just be wary of the "chinese restaurant effect" from overfilling your stomach. I don't think Dr. B strictly limits protein but more "bargains" with his patients (for lack of a better word) by asking them how much protein it would take at each meal for them to feel satisfied (not stuffed) and goes from there. Increasing your fat intake will also help with the hunger. You can do that by using olive oil (as you already are), butter, and mayonnaise.

where were you guys?
 

this thread answered tons of the questions that I have been having! Lisa N I was so grateful to see you put down that it took three weeks of this to see results in sugar readings! I am new.. just started the first and my bs has stayed at 240 24 hours a day even though I have been eating 20 or less carbs a day! I take 1000 of glucophage and my fastings are 240's as well.
I was eating anything I wanted before the first of this month when I started atkins and I was into 12 or so pepsi's a day, tons of cakes and starches with every meal because no matter what I did it seemed I couldn't win. I saw you say it takes about three weeks and I want to thank you for the hope!!! I can hang on if there is hope. I had begun to wonder....if I was just a hopeless case.


thanks guys :thup:

Christena, hang on because your blood sugar will drop!

I'm a type 2 diabetic who's not on medications. My early morning fasting bg was 305 the day that I started Atkins/Berntein. By one week, it was at 180. By two weeks, it was at 140, by three weeks, it was at 130. The drop then slowed and it took about two months to reach 100-110. But, I see a pronounced "Dawn phenomena" and my waking bg is often the highest that I measure all day. So, my bg during other times of the day (pre-and post- meals) was consistently under 140 within about three weeks of starting low carb.

oh Carolyn it did!
 

This morning my fasting is 199!!! oh I want to dance and shout and fly!!!! I know it isn't perfect but WOOHOO! it is soooo good for me!

last night I sent a lil prayer off to God and just asked that He let it be below 200 and WOW it is!!!!

Carolyn, so you control your sugar with this WOE? without any meds? that is awesome! I heard a lot of horrer stories about the meds messing with people. I won't be a horrer story but A low carb success!!!

Glory to God!!! I am soooo happy!

Hey, Chrissy!

Way to go on getting those blood sugars below 200! :cheer:
I know how encouraging it is to see those blood sugars responding to what you are doing in a positive way. :D
I'd be willing to bet that in another 3 weeks or so, you'll be seeing blood sugars a lot closer to the normal range than you ever thought possible. Keep it up!

Well, everybody is different. My doc just had to up my glucophage dosage because my blood sugars are NOT controlled by this diet, yet. However, I was on glipizide for three years or so before starting Atkins, which definitely did some damage to my islets. I'm hoping if I lose enough weight, things will change. But, I may not be that lucky.

Hey freydis, try also adding the 'alkaline lifestyle' to your diet. I started doing that about 2 months ago and I am now definitely getting better results. I drink a 'green' drink daily and add sodium chloride ("Prime pH") to everything I drink and since I started doing that my numbers have dropped significantly. See "The PH Miracle'. (I also went to a kind of 'energy' healer 3 weeks ago and my numbers also dropped again significantly--in fact I halved my meds that day and am still halved with great readings--but I digress, that is 'off topic'")