My blood sugars were not normal, and we found a book, Diabetes Solution, which said that you shouldn’t have carbohydrates. I tried it and my blood sugar stayed normal or in the low 100s (mg/dl) [around 5.6 to 6.0 mmol/L]. Well, I was not feeling well, so I tested for ketones, and they were small to moderate. My grandmother called my doctor, and my doctor said I need to start eating carbohydrates again. As soon as I did, my blood sugar skyrocketed. What should I do, and why are ketones important?

Your question suggests that you should also follow up with your own Diabetes Education team

The issue of ketones is exceptionally important in my mind when I care for someone with type 1 diabetes. Ketones are naturally produced as the body burns fat. Ketones can be used, under specific conditions, by the brain for energy. But, by and large, ketones are waste products. In accumulating concentrations, ketones often make people feel ill with symptoms that usually include headache, nausea which can lead to vomiting, and sometimes abdominal pain, which can, on occasion, be severe. High levels of ketones can lead to loss of your ability to concentrate.

When do we make ketones? EVERYONE makes ketones when they have to utilize fat for energy? Who utilizes fat for energy? Everyone does, if they do not have access to carbohydrate containing foods and insulin. But, in the person with type 1 diabetes, although the glucose levels are high, the lack of insulin makes the glucose inaccessible to the body tissues as fuel. In turn, the brain “feels starved” as it can’t use the available glucose, and, then, fat is burned to produce ketones. In the person with type 1 diabetes, and sometimes those with type 2, the accumulation of ketones can be extremely dangerous and leads to a potentially life-threatening condition called Diabetic KetoAcidosis (DKA). DKA is associated with severe dehydration, acid build up, and often a decreased level of consciousness. DKA can lead to brain swelling and death! DKA is to be avoided and absolutely is avoidable in the person with type 1 diabetes. How? By taking insulin.

So, by decreasing your carbohydrate intake, you were able to decrease the glucose levels, but if you have type 1 diabetes, you still can’t use that glucose without appropriate insulin. So, your brain still felt “starved” and you felt unwell. Your options were to take a bit of insulin (and therefore risk hypoglycemia but allow the ketones to start to reverse), or to eat some carbohydrates and give your insulin you take something to work on.

Low carbohydrate diets can be very successful in causing weight loss in the heavy person. The long term risk or outcome of these diets is not well known and certainly not well studied in children and teens. They are probably relatively not indicated in the person with type 1 diabetes.

DS