Keto And Type 1 Diabetes – Some people think diabetic ketoacidosis and ketosis are the same thing. But while one is the leading cause of death in people with type 1 diabetes, the other is the fat burning process that makes the popular ketogenic diet work.
You can test to see if you’ve reached ketosis, which in the short term isn’t a problem for most people, with a urine test strip (left). On the other hand, diabetic ketoacidosis is a medical emergency that is more common in people with type 1 diabetes than type 2. Wikimedia Commons; Thinkstock
Keto And Type 1 Diabetes
Ketosis and ketoacidosis look similar and are sometimes confused, but do not confuse these terms with each other. These involve two different situations with very different perspectives.
Diabetes And The Ketogenic Diet
Both are caused by an increase in ketones in the body, which are acids released into the bloodstream when the body burns fat for energy instead of carbohydrates. But it’s how the body responds to this increase that sets ketosis and ketoacidosis apart from each other.
“Ketosis is a natural state that occurs when you start to learn to replace fat with sugar,” says Michael Greenfield, MD, an endocrinologist and chief medical officer at El Camino Hospital in Palo Alto, California. “It usually happens when people fast and use up their body’s sugar reserves.”
To understand ketosis, it helps to understand how the body burns energy. Carbohydrates and fats are both energy sources, and the body usually burns carbohydrates (sugar or glucose) first, then fat. If there are not enough carbohydrates in your system, it starts to break down fat for energy, which puts your body into a state of ketosis.
During this condition, the body becomes a fat burning machine. For this reason, ketosis is the goal of many diets, especially those that limit carbohydrate intake and rely on fat for energy, such as the ketogenic diet.
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“A ketogenic diet is a high-fat (60 to 80 percent of total daily calories), moderate protein (10 to 15 percent of total daily calories), and low-carbohydrate (less than 10 percent of total daily calories) diet.” that forces your body into ketosis, where it burns fat as its primary source of energy,” says Deborah Malkoff-Cohen, RD, CDE, and founder of City Kids Nutrition, a nutrition counseling service for children in New York City. York. “Think of the old Atkins plan where your ex-boyfriend would eat bacon, eggs, and porter meat, and lose 21 pounds a month.”
But although the ketogenic diet is similar to Atkins, it is not the same. Atkins is a high-protein diet, while the ketogenic diet is a high-fat diet.
Malkoff explains that the ketogenic diet works by reprogramming the metabolism so that it can burn fat more efficiently over time, and uses specific levels of nutrients (fats, carbohydrates, and proteins) to keep the body in a steady state. of ketosis. Because the body can only enter ketosis when it uses fat for fuel, this is a difficult diet to follow, and it often means saying goodbye to starchy vegetables, such as potatoes, rice, corn, squash, milk, certain fruits, and bread. , and very carb-y beans, she said. The plan has become popular among people with type 2 diabetes because of its ability to lower blood sugar and lead to weight loss.
For people who are able to stick to it, the ketogenic diet can reduce appetite and lower triglycerides – a type of fat that can affect the risk of heart disease – while helping with weight loss and sharper brain function. But this does not mean that the ketogenic diet is suitable for everyone. In particular, people with kidney damage, women who are breastfeeding or pregnant, and some people who take certain medications should avoid ketosis. It is important to discuss your dietary goals with your doctor before attempting to achieve this.
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It is also important to note that there are no long-term studies on ketosis and the ketogenic diet, so it is not clear what health effects this method can have on the body if continued. Some diet experts warn that the ketogenic diet can lead to malnutrition in the long run.
People with type 1 diabetes should not try to achieve ketosis using the ketogenic diet or otherwise. Because people with type 1 diabetes do not have insulin, they are unable to metabolize ketones, which are slowly excreted in the urine of people without the disease. In people with type 1 diabetes, ketosis can lead to a buildup of ketone acids in their blood called diabetic ketoacidosis (DKA), says Dr. Greenfield.
“[Ketoacidosis] is caused by a lack of insulin available to the cells to take up enough sugar (glucose) from the blood to use for energy,” Malkoff-Cohen said. “Without enough insulin, your body begins to break down fat for energy, and ketones are then released into the bloodstream, where they cause a blood chemical imbalance known as metabolic acidosis.”
While ketosis is natural and harmless, diabetic ketoacidosis can be life-threatening if left untreated. Too much acid in the blood can poison the body, leading to unconsciousness and death. Ketoacidosis is common in people with type 1 diabetes, but it can sometimes occur in type 2 diabetes because of low insulin levels.
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Ketoacidosis is rare in people without diabetes, but it can occur in starvation conditions. A study published in October 2015 in the Journal of Medical Cases found that a low-carbohydrate diet combined with breastfeeding may reduce ketoacidosis in women without diabetes, but more research is needed.
Poor diabetes management, or not having enough insulin in your system, is one cause of ketoacidosis. Other factors include having an infection (such as a lung or urinary tract infection), abusing drugs or alcohol, or taking medication that affects how your body uses sugar. For example, corticosteroids, used for Crohn’s disease and asthma, and other health conditions, can make it harder for your cells to use insulin, while diuretics, used to control heart disease, can increase blood glucose levels.
Diabetic ketoacidosis develops quickly, sometimes within 24 hours. The condition is responsible for more than 130,000 hospitalizations, as well as 50,000 hospital days per year in the United States, according to an article published in the journal Diabetes Management. According to an article published in March 2013 in American Family Physician, diabetic ketoacidosis is the leading cause of death in people with diabetes under the age of 24.
If you have diabetes, not only should you monitor your blood sugar regularly, you should also keep a supply of ketone urine test strips, and then check your ketone level whenever your blood sugar rises above 250 milligrams per deciliter (mg /dL) ).
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If the test strips detect ketones in your urine, begin self-medication by drinking plenty of fluids to flush the ketones out of your body, then take insulin to lower your blood sugar. If your ketone level doesn’t go down, or if you start vomiting, go to the emergency room.
Hospital treatment involves rehydration to replace fluid lost through excessive urination or vomiting, electrolyte replacement to maintain heart, nerve, and tissue function, as well as insulin therapy to regulate your blood sugar levels. Your doctor may also check for infections or change your medication.
Ketoacidosis is preventable in people with type 1 and type 2 diabetes. To avoid this potentially life-threatening problem:
Physical activity is recommended for people with diabetes, but do not forget to check your blood sugar level before exercise. Exercising with high blood sugar can trigger diabetic ketoacidosis.
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A safe blood sugar level for exercise is 100 to 250 mg/dL. If your level is below 100 mg/dL, eat a pre-workout snack to increase your blood sugar and energy (between 15 and 30 grams of carbohydrate). Do not work if your blood sugar level is above 250 mg/dL.
Ketosis and ketoacidosis may sound similar, but these conditions are completely different. While the former can result from eating a harmless low-carb diet, the latter is a life-threatening complication of type 1 diabetes (and sometimes type 2 diabetes) that can lead to dangerous levels of diabetes. acid in the blood.
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