KETOSIS Vs. KETOACIDOSIS in Type 1 and Type 2 Diabetes

[MAMZELLE]

QUOTE posted on the "about portions'' thread:
"The presence of ketones is called "ketonuria," and further dehydration and ketone build-up can result in ketoacidosis which is a medical emergency. The bottom line is that the presence of ketones in someone with type 1 diabetes shows a dangerous lack of insulin and the immediate need for more insulin. Exercise, at this time, will only burn more fat and produce more ketones. "

"AN's" Response to that post, on same thread:
"ketoacidosis is not something that you [NON-diabetics] need to worry about. Levels of ketones will never build up to the point that they would in a diabetic."

As a [PROBABLY and only assuming] Type **2** Diabetic, every time I read about 'ketoacidosis' around these boards I find it very frightening, am still in the dark about it, and now figured I'd better get it straight once and for all.

The first quote above refers to only [?] "type 1"? Or can type 2 also go into ketoacidosis? I have to assume that I'm not type ONE since I've made it to this age without insulin, nor 'incident', and am still 'alive' and have never been told in the past that I have diabetes at any checkups, though they weren't specifically checking for that, obviously having no reason to be, I have to assume when looking back. But now I do definitely have it,, which is why I need to know about ketoacidosis and what the threats, dangers, and signs of it are....

I didn't go to doctors regularly as an adult because was never sick, nor had any physical problems but a few totally unrelated emergencies showed sugar a ''little high'' but nothing they seemed concerned about.... and I only recently remember Dr. Atkins saying that I was hypoglycemic in early teens, but HE didn't make an issue of that either, [which I now wonder why, after I know so much more about the subject, and would have paid more attention to that pre-diabetic state.].

The other times that I was told ''a little high'' [emergency room, etc.] I had to ASK how my sugar was, and they answered as though my sugar was of no consequence, nor concern and only said ''a little high'' as though they were even wondering why I was asking.. so I assumed it was high because of my anxiety of the issue I was there for.... stress of the emergency issue raised my sugar, they led me to assume, and dismissed it.

My mother had been on insulin ever since I can remember, problably since my teens or maybe even longer, [don't recall, and she died so can't ask her], though she later chose to go back on insulin to be able to eat more freely, and was on insulin for the following decades of her life, and did fine until her death after also acquiring [in the last 4 years of her life] a very slow growing breast cancer and alzheimer's, then a fatal heart attack during her last hospital stay. She didn't die of diabetes, nor have ANY complications from it.

We both went to Dr. Atkins when his first book came out and he got her off insulin with diet, so I'm assuming she was type 2, and wasn't born with it [do you have to be BORN with type 1, and would she have been able to go off insulin with mere 'diet' if she were type one?].

Does the above quote "Danger of Ketoacidosis" at the top of page, also apply to type 2? What are the signs of ketoacidosis as opposed to keytosis and HOW DOES ONE KNOW THE DIFFERENCE.

I am a diabetic trying to control it with diet and am OF COURSE always in keytosis on Atkins. How do I KNOW it's not ketoacidosis, and the presence of ketones ISN'T also showing a ''dangerous lack of insulin'' and a ''need for more insulin'' or insulin at all.... since I'm not taking any.

Okay.... let me make my questions more concise, and easier for you....>

1- Is Type 1 diabetes always congenital [have to be BORN with it], or can it also be developed later in life?

2- Can Type 1 be controlled with only diet?

3- Can Type 2 go into Ketoacidosis?

4- If so, what are the signs and how does one KNOW it isn't just plain 'ketosis' from dieting showing on the ketostix?

5- Can ketosis in a diabetic INDICATE ketoacedosis or the posibility of it in the future [in type 2.... OR type 1].

6- Can a diabetic being IN ketosis be dangerous and bring on ketoacidosis if ketosis continues, and especially at a high level..... and indefinite time, like months... or ALWAYS being in ketosis in future.

7- Can too many keytones from dieting actually CAUSE ketoacidosis in a diabetic?

8- [And just adding, since I'm also on the sugject of type 1 & 2].....How does one KNOW if they're type 1 or 2, I'm assuming #2 is acquired later in life, but can type 1 ALSO be acquired later in life, and if I had type 1, wouldn't I know it by now and be dead without treatment? What ARE the signs of type ONE. [i know the signs and symptoms of type 2].

Thanks in advance for your time.

[Atkins_Nutritionist]

Thanks for listing your specific questions, makes it easier to answer.

1- Is Type 1 diabetes always congenital [have to be BORN with it], or can it also be developed later in life?
Type 1 diabetics aren’t born with it. They may be born to a genetic predisposition to it that some sort of event (such as an illness, or medication, or environmental factor) sets it off, shutting the pancreas down, and this usually occurs when they are children (that is why it has been referred to as juvenile diabetes). But even those who are predisposed to it may not ever develop it, although it can occur later in life if the event that shuts the pancreas down occurs later in life.

2- Can Type 1 be controlled with only diet?
What happens in type 1 is that the pancreas completely shuts down so that insulin is not produced at all. Therefore it cannot be controlled only with diet and Type 1’s must take insulin.

3- Can Type 2 go into Ketoacidosis?
Diabetic Ketoacidosis (DKA) is seen primarily in patients with type 1 diabetes. The incidence is roughly 2/100 patient years of diabetes, with about 3% of type 1 diabetic patients going into ketoacidosis when their pancreas first shuts down, and they are first diagnosed as diabetic. It can occur in type 2 diabetic patients as well if blood sugar is very uncontrolled. I have seen type 2 patients with DKA who have had blood sugars as high as 800.


4- If so, what are the signs and how does one KNOW it isn't just plain 'ketosis' from dieting showing on the ketostix?
Someone following a controlled carb diet in ketosis would never be in ketoacidosis so this is something you don’t have to be concerned with. DKA is typically characterized by hyperglycemia over 300 mg/dL, low bicarbonate (<15 mEq/L), and acidosis (pH <7.30) with ketonemia and ketonuria. The ketonuria (ketones in the urine) is a result of the DKA, not a cause. Ketones in the urine of those following a carb controlled diet would never reach the amount of ketones in the urine of someone in DKA.

5- Can ketosis in a diabetic INDICATE ketoacedosis or the posibility of it in the future [in type 2.... OR type 1].
Not at all. Ketoacidosis in a diabetic is a result of extremely high blood sugar which interferes with the ph of the blood. It does not cause ketosis. The only similarity between ketosis and ketoacidosis is that they both result in ketonuria.

6- Can a diabetic being IN ketosis be dangerous and bring on ketoacidosis if ketosis continues, and especially at a high level..... and indefinite time, like months... or ALWAYS being in ketosis in future.
A diabetic needs to be concerned with their blood sugar, as this is what can trigger ketoacidosis. Ketosis will not trigger ketoacidosis.

7- Can too many keytones from dieting actually CAUSE ketoacidosis in a diabetic?
Not at all, for the reasons I described above. Ketosis and ketones do not cause ketoacidosis. They are two separate things which are often confused because of the similarity of their names.

8- [And just adding, since I'm also on the sugject of type 1 & 2].....How does one KNOW if they're type 1 or 2, I'm assuming #2 is acquired later in life, but can type 1 ALSO be acquired later in life, and if I had type 1, wouldn't I know it by now and be dead without treatment? What ARE the signs of type ONE. [i know the signs and symptoms of type 2].
The pancreas of Type 1 diabetics do not work, they do not make any insulin. A type 2 diabetic may have decreased insulin production which means there pancreas isn’t working correctly or the pancreas can eventually stop working too, but they will also have insulin resistance (muscles don’t recognize the insulin and don’t let blood sugar into the cells) or the liver may be putting out too much glucose into the blood. Type 2 was acquired later in life in the past, but recently, with the obesity epidemic, people are being diagnosed earlier in life, as their obesity is causing them to become insulin resistant. Symptoms of type 1 diabetes will begin to present soon after the pancreas shuts down and include increased thrist, increased urination, weight loss despite increased appetite, nausea, vomiting and abdominal pain and fatigue. If after a person’s pancreas shuts down and they are not given insulin, they may go into DKA and could go into a coma and could die.

[MAMZELLE]

Appreciate your extensive response and thank you so much.... and for being so CLEAR and detailed!

Ok, so the diet's ketosis alone can't result in ketoacidoses for a diabetic, but dehydration is also mentioned [above in the first original quote] along with and in addition to "too many keytones" [which still makes the ketones sound ominous to me]... could not enough water in a diabetic also be a risk, as dehydration is also mentioned above.

I do succeed in getting 2 liter containers of water down per day most of the time, [one gallon] but sometimes, as we all know, life just isn't that 'pat' and perfect, and many times neglect and forgetfulness makes it somewhat less, like half. Could that be as detrimental as it sounds above.

It still bothers me that it says ''too many keytones'' and my sticking close to induction indefinitely, still makes me a little apprehensive. But I do feel relieved and you have basically convinced me, thank you, and I do, nevertheless, understand fully what you explained about that, and you did an excellant job of doing so!

Also, you mentioned a sugar reading of 300.... I WAS 300 [morning fasting reading] when first taking my sugar about 2 years ago, and it took every bit of Strict Atkins for 3 WHOLE days to get it down to 127 on the evening of the third day and not before, so 300 is not a number totally unfamiliar to me. Been there, and probably many times [and even higher] when I wasn't taking my sugar and not being careful. :-( But those days are long ago overwith.

After a while back then, I guess insanity took hold and I then went off the diet for a while [many problems keeping my mother alive and HER drastic, life & death threatening fluctuating readings, so neglected myself] but went back on strictly after a few months and stayed there and haven't faltered one inch and feel that now I have to strictly live on
induction if not being treated in any other way.... only proteins, fats, and veg, salad, cheese, and sneak a handful of walnuts and/or macodamian nuts after 6 or 7 months on the diet, when I GET desperate for a different taste, but the few nuts are my ONLY deviation..... and dreamfields pasta once in a while which doesn't affect my dual function
"keto-Diastiix" either [and which Bayer said means the blood, at least on 'most' people, shouldn't be over around 180 if the diastix portion shows negative..... 180 is no consolation, I know, but the constant negative stix do show that my blood is nowhere near 300 anymore [?] nor constantly out of control, wouldn't you say?

I will be starting to take my actual blood readings soon, but until then, can I safely assume that I'm not in any danger, immediate or otherwise, since eating so strictly and cutting practically EVERYTHING out food-wise, with NO exceptions on ANY day for at least about 7 months, except the few lowest carb nuts sometimes?

I have NO thirst at all, which is a good sign, I believe, and which is also why I sometimes 'forget' to drink my filled water containers that are shamefully even always right NEXT to me at all times! So Bayer also told me [on that call only about a technical question about their stix months ago, but which extended to other things] that my pancreas seems to still be functioning well. I'm just very tired all the time, but never was a high physical energy person, to begin with, even as a child, and although It's hard to lose weight [only 9 lbs so far] is that any sign, good or bad that I CAN even lose anything at all, and that my body is still functioning on SOME level? I basically feel fine, except for the fatigue, nothing else...... WOULD I feel other problems if I WERE in trouble?

I can't hold water at all, it runs right out of me shortly after drinking ANY liquids and so MUCH, is that a sign of anything good or bad diabetically? With so much liquids/water, it's hard to judge urination 'frequency'. Does 'quicker' emptying indicate anything sugarwise.... higher possibly, or does the mere condition of diabetes cause that frequency from so much water, not the actual sugar "LEVEL"? I never really had excessive frequency before drinking so much becauseof the diet in the last few months, nor thirst, as I've said.

Also constipation.... is the severity ONLY a result of Atkins diet OR is the diabetes also causing that and to any degree? I've remedied it with 2 magnesium doses of 250 per day [500 total] and Metimucil tablets. But still wondering about why it WAS so severe and if that has anything to do with high sugar, in addition to the diet also causing it.

I'm also wondering if diabetics should be eating a much LARGER fat to protein ratio per day [80% fat per meal] as I'm seeing here around the boards? What is your opinion of that and the Atkins' school of thought on much higher fat in general for diabetics? Which I'm finding a little difficult, since protein has always been my mainstay on this diet for
decades, and other than oil and butter [which are carb free] I don't know how to get the fat UP to 80%.... mayo, sour cream, cream cheese, and heavy cream have too many carbs to help raise the fat and the natural ratio in proteins [meats] are lower in fats than proteins.

I know that I am again asking a lot of questions but this time it's much more difficult to isolate, and number them as I more easily was able to last time where nature of questions were different and more succinct[also especially now at 4 am lol], but just do as best you can, and anything would be appreciated. OR if impossible to make heads or tails of all of this.... let me know and I'll break it down later today. Thanks again so much.

At what point am I going to be sent a BILL for all this lol.... sorry, but it's just difficult NOT to take advantage when finding someone so knowledgable and generously forthgiving! One consolation is that so many others with perhaps the same problems will be helped by also reading, which is the beauty of this whole system!

[MAMZELLE]

Forgot..... another thing that I AM very concerned about is that I can go for so long not being hungry if not eating anything, but as soon as I do, that triggers more hunger which was NEVER my experience with Atkins through the years when just wanting to take off a few pounds, and having no sugar problems then.

Does this presence of hunger after eating indicate that ANY and ALL foods could be raising my blood sugar even the most strict INDUCTION foods like bacon & eggs? I am only satisfied and NOT hungry after eating a meal like a BIG portion of meat and small handful of vegetable in the evening [not enough veg to spike sugar]. Any other time I am
often more hungry after eating than before I even touched food.

I TRY to eat many times per day even when not hungry, and am not a 'meal' eater, more of a nosher of little bits, and always have been, but why is the STRICTEST induction food triggering my hunger, which I KNOW is an indication of sugar spikes. I am definitely not eating too MUCH, if anything, too little, and I'm not eating ANYTHING that should spike sugar and when I eat a big portion of meat [which I'm hearing NOT to do] then I am NOT hungry anymore.... but also hearing that too much meat / protein DOES spike sugar.... with me it fills me up and therefore indicates it DOESN'T, since I'm not hungry after that!

Only when I DON'T eat enough of it, [I've tried to cut down the meat portions] ..I'm then still hungry! it seems that the way I've always USED to do Atkins [heavy on the protein and just the fats that 'naturally' come along with meat proteins] used to work much better for me. Is this an indication that ALL foods are spiking my sugar into hunger.... or moreso than they should? Could that be a sign of it being out of control.... that even inductions foods are spiking my sugar more than they should be?

I am also reading many others are 'always' hungry. I'm not 'always' hungry, but immiately after eggs in the morning or afternoon as my first meal [just as an example] I AM .....and at some other times too. I then of course, only resort to protein [tuna, sardines] or nibble the 4 oz. of cheese that I pre-weigh out stretched through the day.... sometimes up to 5 oz., if I need more, which is the ONLY cheating I do, aside from the few nuts [no more than 5-10, which I know isn't on induction, but after 6-7 months on strict induction, I do allow those sometimes, the heck with it.... if it's a choice between going insane or dying from eating a few nuts, then I choose dying! lol But that's the ONLY exception. Nothing else. So what the HECK is triggering these occasional bursts of hunger, EXCEPT when I eat a big portion of MEAT?

Always thought that's the way it's SUPPOSED to work and always DID for me. Why is everything different now.... and when lowering the protein, I DO get hungry. Even the eggs with bacon cooked IN the bacon grease doesn't prevent me from getting hungry right after it, and fat SHOULD prevent hunger.

[Atkins_Nutritionist]

Like I said, ketoacidosis is a serious condition that occurs in uncontrolled diabetics when their blood sugar is extremely high AND the bicarbonate is low (<15 mEq/L), AND they are in acidosis (pH <7.30). Ketones in the urine and the blood are results of this. It's not that a blood sugar reading over 300 at one time will trigger all this, it is a constant uncontrolled blood sugar that throws off the bicarb and the ph of the blood that will trigger this. It occurs in roughly 2/100 patient years of diabetes- these occurances being in uncontrolled diabetics (which you are not) and after the pancreas shuts down upon diagnosis of type 1 (which you do not have). I understand your concern about this because it is very serious, but you have a control over your diabetes and are very aware of your blood sugars. It occurs in diabetics who do not have control.

[MAMZELLE]

Thank you again, But the point is that I do NOT actually 'know' if I 'have it under control", and I am NOT "aware of my actual blood sugar readings", [which is why I described that I feel 'fine' except for fatigue, and that's really only when I'm standing for too long, like at the sink, etc.].... both of which you're assuming by your statements? Or did those statements come from 'asumming' that I've been testing my blood, which I said I haven't been, other than strictly controlling my foods, and what the keto-diastix are always saying, [which are sugar negative, but does not show the accurate 'blood' level] and that's why I asked all those questions. Or are you considering my taking just 'those' two
steps [diet and monitoring the mere keto-diastix] as having it under control even if not testing my blood?

How do I know [and why are you considering] that it's 'under control' and that diet alone is working..... do you think the diastix are showing that just because THEY are always negative? Is that enough of a berometer, which IS what I've been wondering?

Once long ago when the diastix were negative and I took my sugar, it WAS high, even though the stix were negative, I forgot exactly WHAT the count on the meter was at that time but remember that I was startled that it was high when I WAS watching my foods.... it was about a year ago, and since then I haven't strayed off the diet but was on it then too although just beginning. Does staying on the diet have a cumulative effect over time. I mean, having been restricting foods for so LONG now, could that have made the overall situation better?

Actually when growing up, my mother never tested her blood with a 'meter' in the house, only with the TAPES [as opposed the 'stix'.... but which are the same thing], but as I said, she WAS on insulin and at the doctor's constantly, which I'm not.... and when I was a kid and seeing that Atkins get HER off insulin with only diet, I figured that would
work for me too... by your statements [that I have it in control and am aware of my blood sugar].... do you think it IS under control just by what the STIX are showing?

[I'm not specifically talking about ketoacidosis right now, nor was I in my last post... I do understand all you said about that]. I'm basically wondering if it is in control with only diet, according to the stix and without having tested the blood and if that's what you're referring to when saying "I have it in control"? Wouldn't I feel worse and have lots of bad signs.... If I didn't? That was really the nature of my last group of questions. I wasn't asking about ketoacidosis again..... you did a great job of that the first time around, and I did fully understand what you had explained about that.

But the next natural step [which was in my last email] is if I could have the POSSIBILITY of approaching DKA if my blood sugar ISN'T really under control without my knowing it, and I was surprised that you said it 'is'..... so I'm wondering if you're saying it IS under control, was a conclusion stemming from my just being on the diet and the diastix consistantly showing negative, and if that is ENOUGH of an indication of having it 'under control'? I'm getting tangled with words now and getting repetative, but trying to be very clear.

[Joycelyn]

Mamzelle, this may not be the right place to post, but may I say your posts about the Atkins diet are so interesting and informative to read.

It is awesome to read posts from someone who had actually been a patient of Dr. Atkins patient for many years. I lived in New York for many years and now I can kick myself for never availing myself of the Atkins Center services.

Just a note of appreciation for your advice and input on this forum.

[Atkins_Nutritionist]

The cases of ketoacidosis I had seen while working in a clinical setting were in two situtations. First, in children who presented with type 1 diabetes-meaning that their pancreas shut down and stopped producing insulin causing blood sugar to rise and cause the domino effect on their bodies before their parents were able to notice something was terribly wrong that need to be treated immediately and when they arrived at the hospital, were diagnosed with having type 1 diabetes. The second situation was in type 1 or 2 diabetics who were completely negligent with caring for themselves properly with the medication and nutrition regimine advised my their health care team. Very sad cases. I apologize for assuming you had your diabetes under control, as you fit neither of those situations- you are extremely knowledgeable about your condition and are very concerned with following your regimine. It is inappropropriate for me to give out medical advice on a bulletin board. If you are that concerned about your diabetes not being in control, I would strongly suggest that you discuss this with your endocronologist.

[MAMZELLE]

Originally posted by Joycelyn
Mamzelle, this may not be the right place to post, but may I say your posts about the Atkins diet are so interesting and informative to read.

It is awesome to read posts from someone who had actually been a patient of Dr. Atkins patient for many years. I lived in New York for many years and now I can kick myself for never availing myself of the Atkins Center services.

Just a note of appreciation for your advice and input on this forum.

I just want to thank you for your lovely words, Jocelyn [beautiful, unique name]. Didn't see your post till now.... been busy over on the political boards last few days. :-(

Thanks to you again, too AN. I understand. I was just hoping that you meant that anyone controlling it so strictly with food would automatically have it ''in control'', at least in most cases..... it sounded encouraging to me, therefore just was wondering if that's what you meant, and what you're 'assumption' / 'conclusion' was coming from. Thanks