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September 24, 2001

Meal Planning, Food and Diet

Question from Miami, Florida, USA:

I am a 28 year old who has had type I diabetes for six years with no complications, and, four days ago, I started the low carbohydrate diet advocated by Dr. Richard K. Bernstein. My diet is now high in protein and fat, and low in carbohydrates (less than 30 grams per day). With this diet, my blood sugar control has been nothing short of spectacular (with postprandial blood sugars not exceeding 150 mg/dl [8.3 mmol/L] and no hypoglycemia), but I tested positive for large amounts of ketones this morning. I have never ever tested positive for ketones before, even when my blood sugars were very high. I read your previous posts on ketone production that state ketones are produced when your body is starving. I am consuming at least 2000 calories per day on this diet, so how could my body be starving? I would like to continue on this diet, but, as I understand it, ketones are a bad thing. What do you think is happening? Is there something I could do to continue on a low carb diet, without producing ketones?

Answer:

One of the things about this diet is that it induces ketones which decrease appetite. The high ketone production is not a surprise. This diet was not meant for people with type 1 diabetes. In addition to the increased fat eaten with the high protein diet, you are eating increased protein. The increased protein may have a negative effect on the development of diabetic nephropathy.

Your body is telling you that you need more carbohydrate calories. Although insulin suppresses ketogenesis, your sugars are not high enough to tolerate increases in the amount of insulin you are taking with the concern you will become more hypoglycemic.

My advice is see a physician and a dietitian and liberalize the carbohydrates. The increased ketone production is a marker of a problem.

JTL