3

votes

Using a low carb diet for Type 2 Diabetes, and ways to prevent ketoacidosis/hypoglycemia?

Answered on August 19, 2014
Created September 24, 2012 at 5:32 PM

My dad is type 2 diabetic, and also has heart and blood pressure issues. I'm really trying to get him to eat a somewhat low/moderate carb paleo diet. My main concern is if a low/moderate carb diet will put him at risk for ketoacidosis and hypoglycemia. Is anyone familiar with implementing a low carb diet for a type 2 diabetic, and how to prevent ketoacidosis and hypoglycemia (if it is even a risk at all), along with any other potential complications?

Other related questions:

  1. How should I prepare or help him through the low carb flu?
  2. Should he check his blood sugar and ketone levels regularly?
  3. What are some red flags I should look out for?
  4. What's a safe range of grams of carbs per day for a man? I assume if I keep his carbs around 100g a day he shouldn't be at risk for hypoglycemia. I think 100g is a safe range for a healthy woman but I'm not sure if a man needs less/more.

More background:

Medication: (Metformin HCL ER 500MG, Kombiglyze xr 5-1000mg, Glyburide 5MG)

His Background: Chinese

My goal for him: To improve his way of eating and a bit of weight loss although he lost a lot of weight (not intentionally, but not sure how) when he was diagnosed.

He was diagnosed with type 2 diabetes when he was in his late early 50s, and takes meds for them, but also uses Chinese herbs which he says has helped him control his blood sugar more than his meds (he kept track on a chart). He was thin when he was younger but became overweight when he came to the States from China. Currently he eats a really high carb diet of rice, and cereal (he loves Corn Pops -_-) and some protein (mostly pork and fish). I don't think it'll be easy convincing him but I hope he'll give it a shot.

Be157308a0438e382b88d9db4c12ab30

on December 20, 2013
at 03:47 PM

Just wanted to clarify that rice and corn do not actually contain gluten (a protein found in wheat, barley and rye). Furthermore, it is the high carbohydrate load in corn and rice that causes dramatic blood glucose elevations, not their minuscule protein content.

Bdcb4ecc75f7b6867b785a7eadf25ece

(38)

on December 20, 2013
at 10:09 AM

Currentyl I am on circa less than 25 carbs per day

3654b5b893e312b69f8db05e4e5175b5

on September 25, 2012
at 02:55 PM

I just wanted to chime in that I'm Chinese, and eat around 100g of carbs a day (not sure what the net carbs are, I don't calculate that) and I've been able to lose weight and feel really great. But I think ZC and VLC can work for some, and sometimes I cycle with VLC and moderate carb and am able to lose weight. Although rice is a big part of our traditional foods, I think American portions of our traditional foods have really negatively affected the community's health. So although I think we should still eat what we normally eat, somethings such as portion size really has to be tweaked.

B3173217a49b5b0116078775a17eb21d

(11488)

on September 25, 2012
at 05:06 AM

There is always a risk of side effects - but this is very small compared to the risk of getting your feet amputated or your eyeballs bleeding if you do not get your T2 under control.

B3173217a49b5b0116078775a17eb21d

(11488)

on September 25, 2012
at 05:05 AM

Newell Wright? The "ex-low-carber" that lost 55lbs using VLC and then decided to slowly add the carbs back to find their comfortable level after getting their diabetes in control? This is a testimonial on exactly how you SHOULD treat diabetes using a low-carb diet.

5e92edc5a180787a60a252a8232006e9

(345)

on September 25, 2012
at 04:55 AM

These are low-carb zealots who claim that all diabetics should be doing sub <50g carbs because carbs are poison. Sorry, it's not as simple. If you wanna see an actual diabetic who's following a sensible plan along the lines of PHD, check out Newell Wright, ex-low-carber: http://lowcarbwisdom.blogspot.com/2011/10/safe-starch-debate-diabetics.html Your best bet is to avoid the underside of low-carbing, especially if your metabolism and ethnicity do not fit such a diet. Low-carbing often spawns pernicious sideeffects and autoimmune reactions which you could regret as much as your diabetes.

3654b5b893e312b69f8db05e4e5175b5

on September 24, 2012
at 08:43 PM

Thanks so much for your tips!

61844af1187e745e09bb394cbd28cf23

(11058)

on September 24, 2012
at 08:40 PM

I use Jiang Tang Wan, a mixture of herbs.

B3173217a49b5b0116078775a17eb21d

(11488)

on September 24, 2012
at 08:40 PM

Yes - both of these drugs promote insulin production, so there is a risk of hypoglycemia. You're going to have to wean him off the carbs slowly, and measure his BG often to make sure that it isn't too low. Eventually you might have to get his Doc to reduce the dosage.

3654b5b893e312b69f8db05e4e5175b5

on September 24, 2012
at 08:24 PM

Thank you both for the confirmation. I'm curious if you're familiar with the other medications he's taking, Kombiglyze xr 5-1000mg, and Glyburide 5MG. I've only heard of Metformin so I'm not familiar with these otehr ones.

3491e51730101b18724dc57c86601173

(8395)

on September 24, 2012
at 07:54 PM

No, metformin does not increase the risk for hypoglycemia or ketoacidosis. See http://www.phlaunt.com/diabetes/14045911.php "Metformin is not supposed to cause dangerous hypos. A very few people have found that it causes their blood sugar to drop low enough to make them uncomfortable. This may be because of the phenomenon called False Hypo." "Further confirmation that Metformin does not cause lactic acidosis at a rate higher than occurs in people NOT taking the drug was found in a study of 50,048 people with diabetes taking either metformin or a sulfonylurea drug."

B3173217a49b5b0116078775a17eb21d

(11488)

on September 24, 2012
at 07:52 PM

Not at all, metformin works by controlling the release of glycogen from your liver (and perhaps by increasing insulin sensitivity), it doesn't promote insulin production. At most it's good for knocking 1 or 2 mmol/l (18 to 36 mg/dl) off your BG. It's a great drug, but it's only mildly effectice.

3654b5b893e312b69f8db05e4e5175b5

on September 24, 2012
at 07:42 PM

Hi, Not to sound dense, but just for clarification: He does take Metformin, but this shouldn't increase his risk for hypocglycemia or ketoacidosis?

B3173217a49b5b0116078775a17eb21d

(11488)

on September 24, 2012
at 07:35 PM

My advice is not to listen to anyone who is not well-controlled T2 diabetic. 150g a day of (net) carbs is enough to blow the socks off most T2 diabetics. As Stepan Guyenet says "when carbs are poison, you're better off eating fat".

3654b5b893e312b69f8db05e4e5175b5

on September 24, 2012
at 07:26 PM

Thanks so much for the insight. I clearly still have a lot to learn (like what normal levels are for him etc.). I'm not really sure how to broach the subject at all. Out of curiosity which herbs are you taking?

3654b5b893e312b69f8db05e4e5175b5

on September 24, 2012
at 06:37 PM

Thanks so much! I hope a few type 2 diabetics will be able to shed some light too.

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10 Answers

4
3491e51730101b18724dc57c86601173

(8395)

on September 24, 2012
at 07:50 PM

A low carb diet is a great way to stablize blood glucose at a good level. Low carbing does NOT make you hypoglycemic, overeating carbs DOES. Diabetes Type 2 is an advanced form of insulin resistance. That means the cells don't respond to insulin very easily. When you eat carby food, insulin levels have to get so high to get the cells to respond that once the cells do respond, the high insulin levels drop your blood sugar precipitously--that's hypoglycemia. It's like riding a roller coaster that never ends. It feels MISERABLE!

Once you get adapated to lowering the carbs, the blood sugar quits riding the roller coaster and stabilizes in a good range, not a hypoglycemic range. Make sure his doctor is on board to monitor, as his meds may need adjusting. Typically blood pressure will come down along with blood sugar, so if he's taking any BP meds his BP should be watched carefully, too. He will probably still need some metformin at this stage, but may be able to get rid of the other medications with a doctor's supervision. It is crucial to monitor blood sugars, because of the medications he's on to keep it low.

I can't tell you how great it feels not to be riding that blood sugar roller coaster. I was constantly swinging from starving, grumpy, irritable, shaky, to a brief period of calm after eating something (usually candy, cookie, cake, because those were easy to find in an office environment), and then back to hungry grumpy again. It's a miserable way to live.

I think the best way to reduce carbs is SLOWLY, especially given your dad's age and medical status. If you can just get him to drop the Corn Pops, that will be huge. See if you can entice him with other good breakfast foods that are low carb. Gradually replacing or reducing his carbs (perhaps progressively smaller servings of rice) is probably going to have more success than trying to convince him to go all or nothing. And make sure he has plenty of sodium (broth or soy sauce) and potassium (leafy greens) on board because as the glycogen stores deplete low carb has a diuretic effect that can make him feel lousy for a few days--it won't help convince him to stick with it if he's not motivated in the first place.

The suggestion of having him "eat to the meter" is a good one. If he can SEE what effect food is having on his body, he may be more willing to bring his diet in line to keep his blood sugars in a healthy range. You could try working with him to do it that way, tackling one food at a time.

3654b5b893e312b69f8db05e4e5175b5

on September 24, 2012
at 08:43 PM

Thanks so much for your tips!

4
B3173217a49b5b0116078775a17eb21d

(11488)

on September 24, 2012
at 07:33 PM

Unless he is taking insulin or some insulin production enhancing medecine (NOT metformin), then he is at almost zero risk of hypocglycemia or ketoacidosis.

Even if he is on insulin the risk of ketoacidosis is small for a T2 with even a little pancreas function, because it only takes small amount of insulin to put a brake on the production of ketones.

I'm a T2. I eat less <25g a day, and I run half marathons.

3491e51730101b18724dc57c86601173

(8395)

on September 24, 2012
at 07:54 PM

No, metformin does not increase the risk for hypoglycemia or ketoacidosis. See http://www.phlaunt.com/diabetes/14045911.php "Metformin is not supposed to cause dangerous hypos. A very few people have found that it causes their blood sugar to drop low enough to make them uncomfortable. This may be because of the phenomenon called False Hypo." "Further confirmation that Metformin does not cause lactic acidosis at a rate higher than occurs in people NOT taking the drug was found in a study of 50,048 people with diabetes taking either metformin or a sulfonylurea drug."

3654b5b893e312b69f8db05e4e5175b5

on September 24, 2012
at 08:24 PM

Thank you both for the confirmation. I'm curious if you're familiar with the other medications he's taking, Kombiglyze xr 5-1000mg, and Glyburide 5MG. I've only heard of Metformin so I'm not familiar with these otehr ones.

B3173217a49b5b0116078775a17eb21d

(11488)

on September 24, 2012
at 07:52 PM

Not at all, metformin works by controlling the release of glycogen from your liver (and perhaps by increasing insulin sensitivity), it doesn't promote insulin production. At most it's good for knocking 1 or 2 mmol/l (18 to 36 mg/dl) off your BG. It's a great drug, but it's only mildly effectice.

B3173217a49b5b0116078775a17eb21d

(11488)

on September 24, 2012
at 08:40 PM

Yes - both of these drugs promote insulin production, so there is a risk of hypoglycemia. You're going to have to wean him off the carbs slowly, and measure his BG often to make sure that it isn't too low. Eventually you might have to get his Doc to reduce the dosage.

3654b5b893e312b69f8db05e4e5175b5

on September 24, 2012
at 07:42 PM

Hi, Not to sound dense, but just for clarification: He does take Metformin, but this shouldn't increase his risk for hypocglycemia or ketoacidosis?

4
61844af1187e745e09bb394cbd28cf23

(11058)

on September 24, 2012
at 07:00 PM

I am T2 diabetic, take 1000mg of Metformin a day, and consume fewer than 50g carbs each day with many days being below 25g. Acupuncture, Chinese herbs, and eating VLC helped get my glucose levels under control and my last A1c was in the normal range. I bounce out of ketosis when I consume more than 50g carbs.

Please note that ketosis and ketoacidosis are two different beasts. Ketosis is where your body burn ketones for fuel instead of glucose and ketoacidosis is uncontrolled ketosis where the body is not using the ketones for fuel, e.g. both ketones and glucose are present in the body and the body uses the glucose first, has no use for the ketones and no way to get rid of them.

When glucose levels are not completely controlled, hypoglycemia is less of a concern unless he drinks alcohol to excess. Also, the number of carbs needed to maintain control over his glucose levels varies from person to person. He may do well on 100g and he may need to go lower. He will have to monitor his numbers before and after he eats. Current American Association of Clinical Endocrinologists is less than 100 fasting, less than 140 one hour after eating, and less than 120 two hours after eating.

Both Corn Pops and rice are gluten bombs that should be avoided by T2 diabetics, which it sounds like you already know. Have him eat his normal serving of rice or Corn Pops and then test his blood with a glucometer. Please prepare yourself for a battle. Changing eating habits gets harder the older you are.

61844af1187e745e09bb394cbd28cf23

(11058)

on September 24, 2012
at 08:40 PM

I use Jiang Tang Wan, a mixture of herbs.

3654b5b893e312b69f8db05e4e5175b5

on September 24, 2012
at 07:26 PM

Thanks so much for the insight. I clearly still have a lot to learn (like what normal levels are for him etc.). I'm not really sure how to broach the subject at all. Out of curiosity which herbs are you taking?

Be157308a0438e382b88d9db4c12ab30

on December 20, 2013
at 03:47 PM

Just wanted to clarify that rice and corn do not actually contain gluten (a protein found in wheat, barley and rye). Furthermore, it is the high carbohydrate load in corn and rice that causes dramatic blood glucose elevations, not their minuscule protein content.

2
B3173217a49b5b0116078775a17eb21d

(11488)

on September 24, 2012
at 08:08 PM

Ketosis is your metabolisms way of protecting against hypoglycemia. Forget about a zero carb diet, even if you "ate" a zero calorie diet for a few weeks, you still probably wouldn't go hypoglycemic.

(Don't try this at home kids).

Ketones are an alternative fuel for your brain, when there isn't enough glucose around. The small amount of glucose that your brain does need (about 25g a day), can easily be generated from gluconeogenesis (making glucose from fat and protein).

2
3846a3b61bc9051e4baebdef62e58c52

(18635)

on September 24, 2012
at 06:30 PM

Here is a good book http://www.diabetes-book.com/. Ketoacidosis and hypoglycemia really are not things that you should need to be concerned about. Heres a bit about it http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001363/. You could eat virtually zero carbs without issue. I know we got a couple type II diabetics on the forum that are very health eating in the sub 50 carb range. Hope they chime in for you.

"So to be clear: you simply cannot get into a state of ketoacidosis by eating low-carb. In fact, even Type 1 and Type 2 diabetics cannot enter into a ketoacidic state by eating low-carb. You can only get into that state by consuming too much high-glycemic food and producing little to no insulin to stabilize this out-of-control-high blood sugar (or by being so insulin-resistant that the insulin does no good... and low-carb eating fixes insulin resistance)."

3654b5b893e312b69f8db05e4e5175b5

on September 24, 2012
at 06:37 PM

Thanks so much! I hope a few type 2 diabetics will be able to shed some light too.

0
Bdcb4ecc75f7b6867b785a7eadf25ece

on December 20, 2013
at 10:08 AM

Side note recently I started a higher protein very low fat low carb diet I will try to flush my liver of the fat in it ,tried this before with high fat low carb but my lipids went berserk, there were too many variables to try and adjust it so i am starting from scratch again.

So I will air on the safe side reduce body fat ,especially visceral.

A few months after my optimal weight is reached.

I will get lipids breakdown. and hb1ac tests done.

I expect to be in ketosis, perhaps my bloods will not show it with test sticks as my muscles hopefully will be using the keytones for energy if all goes to plan.

then i will go back to a low carb higher fat diet,

I exercise quite hard too, have been doing this a few weeks I feel absolutely fantastic..

btw my morning sugars are now often sub 5 conversion

5 mmol/l = 90 mg/dl

and during the day between 5.5 and 4.2

conversion

5.5 mmol/l = 99 mg/dl

4.2 mmol/l = 75.6 mg/dl

if all works out.

goodluck all

chessguy

Bdcb4ecc75f7b6867b785a7eadf25ece

(38)

on December 20, 2013
at 10:09 AM

Currentyl I am on circa less than 25 carbs per day

0
Bdcb4ecc75f7b6867b785a7eadf25ece

on December 20, 2013
at 09:35 AM

hmm I am type 2 diabetic have been for 5 years i came of all meds (metformin)

this was within in a few weeks , before real weight loss, I was never really over weight much ,perhaps 6 kg max.Guess it was the sedentary life style,

(when I was admitted to hospital my sugar levels were extremely high in excess of 30 off the scale

conversion

30 mmol/l = 540 mg/dl yikes

normal home meters could not read it), I went to hospital as I got headaches , which i have never had in my life.

They gave me insulin for next few days to bring me down slowly. my HB1ac was approx 17.

They endocrinologist let me know within the next weeek that i am on metformin , and this will not really help in my case and soon they expect i will be on insulin..with in a few months..

I accepted this til i spoke to my cousin..

I spoke to my cousin he said stop mall the medication , and take bitter melon,

Now at this time i wsa on metformin i was still seeing snow infront of my eyes sugars were all over the place.So I thought why not..yes i was naive...

How... i drank fresh bitter melon juice every morning freshly squeezed before any meal ,circa 30 ml it is very bitter never eat any of the bitter melon if it is red, inside discard it,for circa a month,

this helps kill cravings for sugar /carbs. this has been used for thousands of years , in Asia .

just one of the studies many more in pubmed

http://www.diabetes.co.uk/natural-therapies/bitter-melon.html

Next was weight loss i reduced carbs by half for circa 6 weeeks so i could adjust , next 6 weeks i added a little exercise 3 hours a week brisk walks .

side note

Many measure their meter after circa 1 -2 hours saying particular carbs are safe , but note many of these causes spikes , like coke (potatoes etc and the meter cannot read this spike after 20 mins .

these spikes are very bad for you period..yes i reckon there are safe starches but i would not recommend them in excess in the initial stages..of trying to loose weight.

If you have say 60 of these spikes in 90 days as the hb1ac is done after 90 days they will not really reflect the spikes distinctly , so watch these spike carbs they do not reveal themselves easily,as they are sudden , and vanish quick..

Carbs are important and good for you too, best sources green veg , red pepper etc , 1 bell bepper red has circa 250% RDA vit C as well as many other goodies :)

Around this time i cut my total carbs to circa 100 spread out over 3 meals.for a couple of months ,

I have to be careful as i have hypothyroidism too so too low carbs could affect my thyroid one to watch..

Next 2 months my cars are down to 75 daily, feeling great weight loss going good.

exercise is max 3 hours a week brisk walks only.

But the special one is freestanding squats 2 -3 times a day til my thighs burn .

Next 2 months 50 carbs daily all feeling good , my hb1ac has been and still is from 5.2 5.6 circa I can lower it but i feel good here ..and never touched any medication for it so recap i came of all meds in circa 2-3 weeks from my initial diagnosis ,

I know quite a few others who followed this regime and have been like this for many years too.

this may not work for all ,

This needs strong will , and a bit of luck I reckon

goodluck all

chessguy

0
F39d2594f5e193c46e306dbe18bd836a

(0)

on March 06, 2013
at 06:07 AM

A good diet is important for a person diagnosed with type 2 diabetes. I would recommend to ask your dad to try a type 2 diabetes diet. This are planned specially for type 2 diagnosed people.

0
E2db1519690001648433e8109eb2c013

on September 25, 2012
at 12:11 AM

My blood glucose has been under control for nearly two years now. No drugs for about a year. When I stopped Metformin, my glucose levels didn't budge. I went from A1c of 9.2 to 5.4.

My carbohydrate intake stays under 100 gr per day, almost always under 75. I fumbled my way into something rather like Ferriss' 'Slow Carb' scheme. Not 'paleo' per se, but without grains or 'normal' American Diet.

No problems with 'paleo flu.' My carbohydrate intake is not so low, nor did it drop all at once. It took maybe a month to settle into my current eating pattern.

-1
5e92edc5a180787a60a252a8232006e9

(345)

on September 24, 2012
at 07:05 PM

My advice is not to fall prey to those zero-carb zealots. Even though your old man might be diabetic, he may need some carbs to function optimally. Don't confuse glucose deficiency for false hypoglycemia, which these low carb zealots would argue until blue in the face is a form of "low carb flu". Non-whites used to eating rice typically do not do well on a ketogenic diet. His best option is to limit the portion of rice he eats, not mix rice with other starches like potatoes.

This is especially the case if diagnosed with T2 recently. Net carbs around 100-150g are fine for a recently diagnosed T2, if not consumed all at once. That should control his BG, fulfill glucose deficiency, and ward off falling prey to other conditions such as hypothyroidism.

Say no to a one-size fits all diet, especially if you're of another ethnicity. Ketogenic diets are not for everyone, even if you may be diabetic.

B3173217a49b5b0116078775a17eb21d

(11488)

on September 24, 2012
at 07:35 PM

My advice is not to listen to anyone who is not well-controlled T2 diabetic. 150g a day of (net) carbs is enough to blow the socks off most T2 diabetics. As Stepan Guyenet says "when carbs are poison, you're better off eating fat".

B3173217a49b5b0116078775a17eb21d

(11488)

on September 25, 2012
at 05:06 AM

There is always a risk of side effects - but this is very small compared to the risk of getting your feet amputated or your eyeballs bleeding if you do not get your T2 under control.

5e92edc5a180787a60a252a8232006e9

(345)

on September 25, 2012
at 04:55 AM

These are low-carb zealots who claim that all diabetics should be doing sub <50g carbs because carbs are poison. Sorry, it's not as simple. If you wanna see an actual diabetic who's following a sensible plan along the lines of PHD, check out Newell Wright, ex-low-carber: http://lowcarbwisdom.blogspot.com/2011/10/safe-starch-debate-diabetics.html Your best bet is to avoid the underside of low-carbing, especially if your metabolism and ethnicity do not fit such a diet. Low-carbing often spawns pernicious sideeffects and autoimmune reactions which you could regret as much as your diabetes.

3654b5b893e312b69f8db05e4e5175b5

on September 25, 2012
at 02:55 PM

I just wanted to chime in that I'm Chinese, and eat around 100g of carbs a day (not sure what the net carbs are, I don't calculate that) and I've been able to lose weight and feel really great. But I think ZC and VLC can work for some, and sometimes I cycle with VLC and moderate carb and am able to lose weight. Although rice is a big part of our traditional foods, I think American portions of our traditional foods have really negatively affected the community's health. So although I think we should still eat what we normally eat, somethings such as portion size really has to be tweaked.

B3173217a49b5b0116078775a17eb21d

(11488)

on September 25, 2012
at 05:05 AM

Newell Wright? The "ex-low-carber" that lost 55lbs using VLC and then decided to slowly add the carbs back to find their comfortable level after getting their diabetes in control? This is a testimonial on exactly how you SHOULD treat diabetes using a low-carb diet.

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