High Blood Sugar In Ketogenic Dieters! Plus A Special Surprise (Hint: Genotypes And Metabolism)!

A while ago Michael and I were discussing future article topics. There are truly a plethora of avenues to go down in this area of research and there is no lack of things to research and comment on. But even though I have a couple of pretty cool MCT articles sitting around on my desk, I want an interesting topic. I want something new. Something challenging. Besides, everyone is drinking the MCT koolaid these days. It’s become passe. (Also, it upsets my stomach and I have a personal vendetta against it. So there.)

What’s new? There has to be something new!

Michael pointed me to one of his old articles on physiological insulin resistance as an idea. I brushed it off at first. Dismissed it as a quirk.

But then I thought about it. WHY does blood glucose rise in response to a low carb diet? It truly is an interesting question. What does it say about low carb diets if they induce an almost diabetic effect on circulating glucose?

Thus my research began. This short abstract  confirmed that it is normal for people on low carb diets to experience a rise in blood glucose levels. Because it’s a non-open journal (shame!), there’s a one-sentence explanation given:

A decrease in first-phase insulin secretion may partially contribute to the short-term LC/HFD-induced increase in postprandial plasma glucose levels.

First phase insulin secretion? There’s a first phase? So… There’s more than one phase to insulin secretion? I had no idea. Call me ignorant but I had no idea until this point that there was more than one phase to insulin secretion.

This article delves deeper into the signaling involved in (what I learned is called) biphasic insulin secretion. The first phase of insulin secretion lasts approximately 10 minutes, and the second phase of insulin secretion picks up after the first and lasts for several hours. This is initiated by the influx of glucose into the beta cells of the pancreas, leading to an eventual depolarization and activation of calcium channels that regulate insulin release.

Type 2 diabetes is associated with a shift from biphasic, to monophasic insulin release, and it is therefore important to establish the cell biology of insulin release kinetics.

O rly? This is where I become instantly hooked… Their experiment involved a particular calcium channel and studying a mouse knockout version of it, which was heavily responsible for the second phase of insulin release. The first and second phases are related, yet separate processes, it turns out.

The conclusion we can now make in low carb dieters: a similar process is happening. People become monophasic in their insulin releasing, like diabetics. Let’s tease out the particulars now…

When sugar is ingested, there are two very important proteins that are released: GIP and GLP-2. These two work in a similar manner, acting on the beta cells to release insulin. I would like to add now that GIP is also released in response to fat intake. We’ll come back to that point.

While infusions of GLP-1 seem to increase the insulin release in diabetics significantly (source), Lewis et al. argue that the rise in GIP levels following glucose is greater in magnitude and appears to be more insulinotropic than GLP-1 (source).

Indeed, it has recently been suggested that the primary physiological role of GLP-1 may be inhibition of upper gastrointestinal motor and digestive functions rather then potentiation of meal-induced insulin secretion.

I will let Ehses and Lewis duel that battle out. At any rate, the article goes on to find that GIP is very important to a rapid beta cell response to glucose, and it increases absorption of glucose in the intestines. Interestingly enough, neither acute nor chronic impairment of GIP seems to alter fasting plasma glucose levels, but in mice with disrupted GLP-1 receptors, they are often accompanied by fasting hyperglycemia. Even the null mutation in the GLP-1 receptor will exhibit high blood glucose levels.

Therefore, while GIP appears to act as an acute insulinotropic hormone in order that β-cells may anticipate the absorption of glucose from the gut, GLP-1 signaling appears to be additionally important for the maintenance of normoglycemia, irrespective of the site of glucose entry into the circulation. This ability to promote glucose disposal makes GLP-1 a candidate therapeutic for the treatment of the abnormal glucose homeostasis associated with diabetes mellitus.

Follow me here for a little bit: If low carb dieters are not intaking glucose (for the very purpose of reducing an insulin response!) and not activating GIP accordingly, possibly not activating a second phase insulin response (depending on the genetic variant), then according to science, the absolute natural reaction of the body would be to have higher blood sugar levels. While diabetics and ketogenic dieters have the same symptom, one is a purposeful manipulation of the chemical signaling in the body, and the other is a distinct disregulation caused by a complicated clusterfuck of issues (diabetes).

So that solves that question! Now to return to GIP, because I stumbled across something truly fascinating here: GIP is released from glucose…but also from fat consumption. Ah hah! Interesting!

In this article (http://ajcn.nutrition.org/content/95/2/506.short) the researchers examine the relationship between genetic variants of the GIP receptor in response to different diets (low carb, low fat, and low/high protein). If you have ever hated someone for their ability to lose weight on a low fat diet, if you have ever wondered why such huge gaps in beliefs and attitudes exist towards low fat and low carb diets, here’s why: different people respond (metabolically) differently to different diets.

Sometimes in papers, the graphs are worth a million words. Essentially if you have a certain allele (also depending on if you’re heterozygote or homozygote), it can dramatically shift weight loss, fasting glucose, fasting insulin, and insulin resistance (HOAM-IR) in response to fat and carbohydrate metabolism.

So in conclusion, having higher blood sugar levels on a low carb diet is a consequence of killing the insulin response, which looks similar to diabetics but is actually far, far different.

Also, there are some people who can eat nothing but oatmeal and potatoes and lose lots of weight, and it’s not their fault that they’re mutants. I’m quite sure there will be many more future studies showing other genotypes that affect fat and carbohydrate metabolism, but we can now all agree there is no one best diet for everyone.


102 Responses to “High Blood Sugar In Ketogenic Dieters! Plus A Special Surprise (Hint: Genotypes And Metabolism)!”

  1. Hello there and thanks for interesting the post. I follow a paleo ketogenic diet that also involves one single low carb high fat meal a day taken in the evening with no other foods consumed at all except water. To my knowledge the hyperglycaemia experienced when one switches gradually to a LCHF diet is a temporary event and should be so until ketosis is well established. I am assuming temporary here to mean short term and not temporary in the sense that sugar goes up at every meal even in a ketotic state.
    Also the paper your refer to that finds association between diet variants and weight loss the so called high fat diets are hardly that at only 40% (USDA has 30%). A ketogenic diet should go well above 65% preferably 80% and they may not be isocaloric with the lower fat higher carb variants. I ahve printed the paper and shall look a bit more closely at the experimental set up.
    Was not aware of the itnerplay between GIP and GLP and will look more into it. Thanks for

    • For the hyperglycaemia argument, Micheal has told me he’s consistently seen his blood glucose elevated on the diet- as well as lots of n=1 comments around the internet and on the article I linked at the beginning. Maybe he can further comment on this.

      You’re right, the diet variations article’s version of high fat is also fairly moderate carb. Not ideal ratios. However despite that what makes it truly fascinating to me is that it still showed a tremendous difference in weight loss and other factors. I wish they would have made it more low carb but I imagine they would have had more attrition from the study as well.

      • Indeed, my blood glucose has inched up year over year. I’m not seeing the dive that many others report, and out of concern for this, I started looking into it.

        It appears that I am not alone in this regard. 🙂

        • THis is really intriguing…do you consume dairy and specifically milk?
          I ahve not had my blood gluose measured and do not own one of those as I feel so stable and well…Somepeople say that high level of glucose=low ketones. What are you ketone levels and do they change with blood glucose? COuld it be that in some people gluconeogensis takes over? I am baffled and intrigued. I look a bit more into the muscle specific insulin resistance and that also whlould be a temporary event to prevent protein loss from muscle for gluconeogenesis whilst the ketones accumulate. I shall continue on this interesting trail…..

          • It IS fascinating, isn’t it?

            To answer your question: No milk. I do eat cheese. Use full cream for some things. No milk though.

            I don’t have a blood ketone meter, and I stopped measuring the urine ketones some time ago. Yes, I was consistently in ketosis…no, I def. noticed the reduction in urine ketones after about 6 months (guesstimating here…it was a long time). Phinney and Volek suggest that this is a natural transition…your body just gets better at not making _excess_ ketones. In theory, my serum ketones should still show the full story.

            Alas, at $5.00 a ketone test strip, I’m not likely to start measuring them soon.

          • Iv’e been low carb under 20 carbs a day and trying to get into ketosis since last October.
            A few months ago i had a suggestion to lower protein even more (It was by then between 30-60 grams a day) so first week ate these foods to try to induce ketosis. eggs, mct oil, avocado and butter. No ketosis and blood glucose still elevated. i check both with a blood meter. Second week I took out the egg abd in 3 days was finally in ketosis with a level over 1.5 but my glucose was 103. i notice when my glucose is up I dont loose when its down lower i loose better. I still struggle with keeping glucose low even when fasting it may remain the same or only decrease a little…super frustrating. I’m not diabetic and my A1C has improved. I feel like I’m a mystery and just want to loose weight with all the effort I’m putting in. i gain very easy which at least keeps me from bad food.

        • suealiaim

          i’ve been on low-carb/high-fat for weight loss for about 18 months. i’ve never had high blood sugar…that is until now. i check my glucose about every month…it has been around 85 for really all of my adult life (i’m 53), this week i did a fasting blood glucose and it was over 100! i eat NO added sugar, and almost no fruit, no simple carbs (rice, potatoes, bread, etc) . i ordered a new glucometer with new test strips and i’m still registering 90! i’m completely dumbfounded. what happens if i start consuming carbs again? have i f’d up my metabolism now?

          • Hi Sue,

            I can understand the concern, but the best I can offer is this: If you are truly limiting your carbohydrate consumption to ~20g a day, any glucose you are measuring should be of little concern.

            Now, it’s hard to understand exactly what you are doing, because you say “almost no fruit, no simple carbs.” It’s fantastic that you’ve cut out all refined carbs from your diet, but you could actually still be ingesting quite a bit (or hardly any) based on this description.

            IMO, “health carbs” is a misnomer. I think of them as “risky” carbs. Sure, some people can achieve fantastic results and live healthy under all sorts of varied carbohydrate loads. Others under the same load can be driving irreparable harm. There’s simply no way for us to know what’s going on with you, or how what that tells us in the context of your metabolic history or your bioindividuality.

            Generally speaking, I’d say that any carbohydrate reduction is likely to be healthy than unrestrained consumption of highly processed carbs. But, just limited your consumption to certain types of carbs might not be enough.

            If you have the energy and a mind for experimentation, why not try shooting for ~20g/day and see what happens?

            If you don’t have the energy, then I’d strongly encourage logging your food and getting an accurate estimate of your actual carbohydrate consumption. You can use that in conjunction with your glucose readings to see if there is room for improvement. More than one person I know has cut refined carbs and managed to compensate with (what they considered were) “healthier” carb options. Frustrated by the lack of improvement in their glucose numbers, they gave up and said, “low carb doesn’t work.”

    • Sam Palmer

      I am in my third week of Keto. As a ling term diabetic with meds of 1000mg 2x daily metformin, 10mg glipizide 2x daily and lisinipril 20mg 1x daily. I was still out of control due to bad eating habits. In the first 2 week, I cut my meds to 500mg metformin 2x daily. That is it. My sugar numbers are wonderfully normal. I try to eat a calorie restricted(1500-2000) cal, intermittent fast(eat only 8-9 hrs/day). When I eat longer with higher calories(2500 plus) my morning blood sugar numbers are in the 150 range. I am 60, male, 190lb. My sugar goes down to normal during the day. I do not yet know if the problem comes from too many calories or eating for too long during the day. my exercise and age suggested calories is stated as about 2600. For non diabetics, that I know on Keto, this isn’t a problem.

  2. Ehi thanks for your reply. I am intrigued as I genuinely did not know about this and I am always try to maintain ketosis through diet and fasting practices so i would not wish to have glucose spikes and I msut say I feel remarkably stable through the day even adding to the fact that I go to the gym three times a week in the evening usually well within 19-20 hours of water only fasting. Yet I exercise vigourosly including resistance with not adverse effects and no immediate urge to eat. When i do eat is fat/protien. So I have always assumed my blood glucose is stable by now (have been on this regime for 6 months now).
    Thanks again very mind opening and will look at comments on previous post and do some research of my own. Report back if I find anything of interest.

  3. Report back if I find anything of interest.

    Much obliged. I’m fascinated by this topic. I had assumed my fasting glucose would have lowered as well, which is why I was surprised when it went up year over year.

    From my reading: this is not something that everyone experiences. I wouldn’t be alarmed if I were in your shoes and had no reason to suggest otherwise.

    Physiological insulin resistance may provide a helpful explanation for others who are seeing their readings go the wrong direction.

  4. Please re-read the Japanese abstract within your blog above. The High fat (low-carb) diet did NOT decrease GLP-1 (You said “If low carb dieters are not intaking glucose (for the very purpose of reducing an insulin response!) and not activating GLP-1”). Instead, it increased GLP-1 activities compared to Low fat diet.

    Which means good.

    Your long term (fasting) glucose tolerance (glucose control ability) becomes better if you follow low carb., because your GLP-1, -2 and other various incretin and gastrointestinal hormones become active than ever.

    Only when you change from HFD to HCD suddenly (which is usually unnatural because they don’t change their eating patten easily), the glucose level goes-up.

    But, anyway, the extreme HFD could have also some stress to the body of glucose metabolism slowly and/or suddenly, especially to the people, you mentioned, of genetic weakness.

    So be careful, everybody. We could be different from Inuit people or HFD prone gene.

  5. If you follow HFD couple of week, the GIP hormonal activity decrease (body adaptation to new enviro.), because it is strongly related with carcohydrate digestion and initial glucose (peak) response than fat digestion and hormonal signal (fat and/or protein digestion are more related with GLP-1 instead).

    The 2nd phase (long running and also the most important) insulin secretion induced by GLPs and other GI hormones after becomes dominant for blood sugar control and be looked to be monophasal insulin secretion. This is completely different from diebetic monophase of strong GIP (which is usually no good).

    In this new adaped body condition, if you take glucose test and check the value, the answer is clear. Oh.

    The surgical stomach by-pass treatment of diebetic patient is the same hormonal technique. The weaked GLP-1 activity is stimulated, because it is secreted at below (not upper) intestine. If the GLP secretion is activated than ever, the satiety hormonal pathway is also activated. The glucose answer then? Clear.

    Bye and cheers.

    • katkinsk

      Actually I agree completely with you, which is why I was stumped for the last hour figuring out where I went wrong. Oh I used the wrong hormone, that’s why! I wrote and edited this post in several different parts of the weekend- thus why that sentence made no sense. I fixed it for you: “Follow me here for a little bit: If low carb dieters are not intaking glucose (for the very purpose of reducing an insulin response!) and not activating GIP accordingly, possibly not activating a second phase insulin response (depending on the genetic variant), then according to science, the absolute natural reaction of the body would be to have higher blood sugar levels.”

      I’m sorry to have made you write out such an elegant comment for such a base mistake.

  6. Geoff Smith

    Having just been to ER for what turned out to be a a bladder stone I was shocked to find out my BS was 12.6 because I have been very low carb for 6 years.
    So by explanation “consequence of killing the insulin response, which looks similar to diabetics but is actually far, far different.”
    But high blood sugar has detrimental affects we are told does it matter the cause?

  7. Steven Fussner

    I’m not sure if anyone else has pointed this out yet. But in the paper looking at different genotypes for the snp rs2287019 that you got all the graphs from is not at all applicable to a ketogenic diet. If you look at the methods section for the paper and the macro-nutrient breakdown, you’ll see that there is no way any of the subjects were in ketosis. There were two “Low Fat” diets. The first was, (20% fat, 15% protein, and 65% carbs). The second “Low Fat” diet consisted of (20% fat, 25% protein, and 55% carbs). The “High Fat” diets consisted of (40% fat, 15% protein and 45% carbs) for the first and (40% fat, 25% protein, and 35% carbs) for the second. All four diets were caloric restriction diets which explains the weight loss. If you want to compare a “Low Fat” diet to a true ketogenic diet it needs to be “High fat, low carb” with carbohydrate composition of around 10% or less.

    Here is an article looking at exactly that. A “high fat, low carb” ketogenic diet has been shown to be more efficacious for weight loss than a low-fat diet and improved other serum markers such as a greater decrease in triglycerides and an greater increase in HDL cholesterol.

  8. Teresa Mallory

    I would love a follow-up, as this is complicated – Volek & Phinney’s book says that between 30-60% total fat calories, there is a reduction in insulin resistance. That’s a very easy range to fall into if you’re not counting – is it likely many keto-dieters who are experiencing raised blood sugar might be responding to this range?

  9. Teresa Mallory

    Oops, error on last comment, I meant to say reduction in insulin SENSITIVITY (not resistance).

  10. Geoff Smith

    Yes Teresa it says that but goes on to say above 50 it gets better “What we do know is that, pretty consistently, as dietary fat percent is increased from 30% to 60% in animals and in humans, insulin sensitivity does get worse. But once above 60% of energy as fat, which typically translates to less than 20% of energy as carbohydrates (assuming 1 5-20% from protein) , insulin resistance turns around and starts to improve.
    I’m thinking that we are looking at this physio insulin resistance out of it’s correct context. We tend to have people that are office bound or for a large majority of their life or athletes who are performing their exercise or not. We are not looking at from the hunter gather aspect of how their day would play out, all day every day.

  11. I’m not a medical nor science person, just a diabetic, type 2. I’ve begun a ketogenic diet, less than 20 gr carbs, about 25-30 gr protein, which leaves fat at 65-70%. I take 40 pen units of Lantus Solostar daily in the morning, 850 mg Metformin 3x a day. Before I started the diet 2 weeks or so ago I only took the most Glipizide I took was 2.5 mg and now I take 5 to 7.5 mg of Glipizide daily because my bsl’s won’t drop. I get up in the morning and the bsl’s are around 200, take all the meds and if I’m lucky, at bedtime they’re around 135. Then I take another 2.5 mg of Glipizide hoping they’ll drop overnight. I don’t know if I’m eating to much protein. my cells are completely locked, my pancreas can’t make any insulin (the Glipizide doesn’t seem to be working as well, same for Metformin) or ?. I’ve talked to my doctor but no help there, nor the last two doctors. Have I not waited long enough? Does anyone have any idea what is at play here, I would be very grateful. I need to lose about 40 lbs as I gained 20 just by being on insulin. Thank you in advance.

    • Geoff Smith

      Rita I would think that the first issue is the stress to your body. It depends on how much carbs you were ingesting and how quickly you switched to low carb. Most people will get something called Keto flu or low carb flu as your body switches from burning glucose to using ketones as fuel. This can take easily 2 weeks sometimes longer.
      Are your grams of fat/protein/carbs per per meal? On the Ketogenic Diabetics Facebook page we do get people coming off the ADA diet thinking per meal. I try to stay at 10-15 grams per day of carbs and have for just over 3 years.
      Once you get into ketosis it will take some time to become fully keto adapted and then it will take some time for your body to reset sort to speak. During that time numbers will get progressively better but there will be some weird spikes off and on.
      I would say give yourself 3 months to see numbers really getting good. Weight however should start to melt off now.

      • Art De Vany

        Rita, exercise and intermittently fast, particularly overnight. Note that the keto diet caused an elevation in glucagon, which releases glucose from the liver. What goes in may not be what comes out. Being a diabetic means that your liver is locked into a FOXO stress response, making glucose and fatty acids and packaging them into chylomicrons to be transported into your blood vessels. IR makes your brain and liver think you are starving and, thus, the strange activities of simultaneously producing glucose and fatty acids, as would be the case if you truly were starving. Nothing seems to “follow the rules” when you are insulin resistant. Exercise to elevate insulin sensitivity and to cut the inflammation that is messing up your metabolism. Eat moderate fat only, move a bit to protein, at least a gram per pound of lean tissue and fast over night.

    • I to was slowly gaining weight over the course of the last 4 years and I was not eating anything carby, I gave up the dairy and my numbers went from fastings over 100 to way down, upper 60’s lower 70’s. Not really sure what it was, since I was eating cream, high fat yogurt ect… But I lost 18 pounds withing the course of 2 months so it came off fast once I could convince myself to quit. I actually think it is the whey protein that caused my high numbers, but I am not sure, it is not calories since I eat over 3,000 a day and I am still able to lose. Just maybe something to try, I struggled for years trying to get my numbers down and listening to most forums they say to eat cheese and yogurt and it is good for you, but in my case that is not true.

      • Did you cut grass fed butter too? What are your main foods you eat or your daily diet? I just started trying the keto diet again, but in the past I have high BS with it and struggle losing weight on it without at least some non-startchy vegetables in my diet(y.squash, cabbage)

        • I did bring butter back in since it did not seem to effect me, I find eggs are the best sort of protein for me, it does not seem to raise my glucose numbers like protein, I do eat non starchy vegetables and they work for me.

    • When my mother takes too much insulin at night she wakes up with really high blood sugars above 200, on the dose her doc prescribed but when she cutd that in half she would wake up on the 130s maybe your taking too much insulin at night and it’s causing your blood sugar to drop too low. When its too low your liver pumps out some glucose, but being a type 2 on insulin your own body cannot bring it back down. You wake high and stay highish, then you repeat the cycle.

  12. Mumsie

    I have a puzzle and I am hoping someone here can shed a little light on things for me so I will list everything that I can think of in order to present a more complete picture so please bear with me.

    I have been following Dr. Bernstein’s diabetic dietary guidelines of 6+12+12 carbs for breakfast, lunch, dinner respectively, 4-8 oz protein per meal (he recommends using the protein to improve satiety at whatever level you determine works and then to keep it consistent for the same meal time daily) and no limits on fat. No sugar; I am using xylitol or erythritol for any cooking and some splenda syrup for my coffee. The only dairy I have is full cream in the coffee. I have been refining this since the first of the year to get to those levels. Supplements that I have begun experimenting with include: Amla, Curcumin, fiber as inulin or psyllium, cinnamon, apple cider vinegar. Fats I am consuming other than saturated animal are coconut oil or olive oil. I am grain free and consume flax, nuts and no fruit unless a few random blueberries in a flax muffin. I drink about a gallon of water a day atm. I am also usually seeing small amounts of ketone activity on ketostix daily.
    At first I saw an improvement in my glucose levels but lately they have been inching up slightly. I have yet to see numbers like he says are possible but my A1c has dropped from 7.9 to 6.5 as of March (most current result) which puts them squarely back to previous levels (before events listed below occurred). I want much better numbers so I keep plugging away at this. I am trying to figure out what the culprit might be and here are some possibilities:
    1. A year ago March I had a thyroid attack out of the blue with a reading of 102 so basically no thyroid at that point. The doctor put me on 50mcg levothyroxine then cut that in half then dropped it completely after I became hyperthyroid. After that my readings have been all in the normal range as they have always been. The doctor couldn’t explain it and said it was the first time in 25 years of practice that a patient recovered like that without being permanently hypothyroid. My thyroid might be messing around or it might not. I am not noticing any symptoms of being hypo like before.
    2. Last September one of my brothers died suddenly and this caused a lot of familial stress, of course. His 54th birthday falls tomorrow on Mother’s Day and I have had him on my mind a lot lately and also my 85 year old mother to whom I am quite close. I am worrying about her. This could also be a culprit but I feel like I am just worrying not really stressed. My 85 year old dad is having some health issues but nothing major-mostly not taking proper care of himself despite all of my mother’s efforts.
    3. I may be experiencing an increase for reasons I have yet to determine related to the diet and maybe I’m not doing something right.
    4. Since starting this in January, I have lost a total of 20 lbs with a plateau that began about 3-4 weeks ago. That caused me to be even more particular about my dietary numbers in an effort to get things going again and this is when I started to notice the small uptick. What confuses me there is that even with the lost weight my A1c is only back to where it was prior to the thyroid attack and losing my brother. I was hoping for better numbers after losing that much weight so far. I am working on being a daily exerciser with walking, dumbbells and rebounding being the most common activities for me for now but I have not been as consistent as I need to be to date.
    Any suggestions?

    • Geoff Smith

      First worry is stress so can affect hormone levels.
      I find his carb levels too high. I stay at 15g or less a day. Watch the nuts they can cause carb creep. I put min in a 1/4 measuring cup to eat and have that only once a day.
      I’m not sure why your dairy free but butter has good nutrients and is a great fat to add.
      I have been in ketosis for just over 3 years and stopped seeing anything on a ketostik after about 4 months of being keto adapted since I was burning them. HOWEVER after 2 years I saw my numbers creep up a bit and doing research found out about “physiological insulin resistance” . There are many articles about it and one is right here on Ketopia http://ketopia.com/physiological-insulin-resistance/
      What I am not happy about is how high can the blood sugar go from this AND does is elevated glucose level without the presence of insulin make it less destructive to the body

      • Mumsie

        Thanks Geoff for your reply. I will correct my “dairy free” to mean only milk products as I do regularly consume organic grass fed butter and some cheese. My mother is from Ireland so I would be disowned if I didn’t love my butter and cream, lol. I have cut the nuts back to a 1/4 cup serving just this week as I was overindulging I think. I soak then dehydrate them and consume them raw. I am hoping that you are right in that the stress is playing a big factor here but only time will tell if the holiday/birthday stress is the culprit. I find all of this much more difficult being female than my other brother or my dad due to the hormone nonsense. All of my health issues all of my life have been hormonally connected. I read the physiological insulin resistance article on here that you referred to and that is quite interesting. I also want the same answer to your last concern. To me any elevated glucose is not good unless someone can prove otherwise but then try and convince a doctor of that when they still tell you that 6.5 A1c is your miracle goal number. I will try skimming off some more carbs and see if that helps, too. Again, thanks!

        • Geoff Smith

          Once I was under 15g a day and mostly around 10 My numbers settled right down to where I saw no peaks from a small carb meal like a slice of pizza. It took a year and a half that low to get there but everyone’s pancreas will be different. Some may need longer to recover, some less time.
          From our ancestors point of view having a elevated glucose level may have been very normal. They had to get up in the morning and hunt down breakfast.
          It is so hard to know what is the correct way for the body to be since most of the studies have been on higher carb feed people. For me even 50g a day now seems high so look at what is being studied in the general population.
          The other issue is activity level. I don’t think our bodies were designed for the kind of workout we get in the gym. We are endurance animals. LOL

    • rdzins

      I quit the dairy and lost 25 pounds. My fasting insulin went from over 100 to 75.(I am going on month 2.5 of no dairy and the numbers just came down to the 70’s) I don’t know what it was the cream in the coffee and I ate full fat yogurt also. Even when I tried the low carb shakes my numbers creepup again, the shakes have whey in them which is a dairy product so no dairy for me. I saw results within the first week and the 25 pounds came off really fast within the first 6 weeks. I don’t know if it is the casein in the dairy or what it is, I now only use butter and nothing else. I think at least for me dairy causes a insulin reaction, I don’t really know but cutting it out was really hard but it made all the difference for me. I try to stick to a high fat diet for the satiety part, but unfortunately it no longer includes dairy, maybe you could try it for two weeks and see if it makes a difference.

    • Michael g

      Restrict carbs to no more than 30grams. Eat no sugar.drink no sugar.restrict alcohol. Eat higher amounts of saturated fats in animal fat,eat butter,eat coconut oil, eat moderate protein say 6oz max no more than 3 servings. Keep the fat coming, don’t count calories.begin walking once or preferably twice daily. You will get into ketosis within 3 days, it will improve blood sugars over time as you keto adapt. Insulin is your enemy, the only way off it is to eliminate the carbs and sugar and to lose fat weight around your mid section and this takes time. But once in ketosis fat starts to melt off your body. People successfully lose 100 lbs or more in a year on this diet all whilst eating more calories due to the high fat content. Another side effect of the diet is lab results usually improve for ketogenic minded people. GOOD LUCK.

      • Not always, everyone is different may have worked for you but it actaully spiked my blood sugar so high I went to the hospitol.

  13. Mumsie

    Hi Geoff, I am going to trim the carbs further for awhile and see what happens. I think it might just help and I am hoping that after some time that I can add a few back. I actually am quite happy on 15-30 a day so a little more won’t really matter much to me. Mostly it is my veggies that I want. Do you have any experience or opinons on the erythritol or xylitol affecting glucose levels? Bernstein is not a fan but I don’t think that they are an issue for me. Just curious.

    • Geoff Smith

      Mumsie the best thing to do is eat to your meter. If having something new test at one hour and then again at two hours. Some things take longer to digest and can cause a huge spike but not until the second hour. Most people seem to experience a rise from the alcohol’s but some do not. I have no problem with Splenda but some people do so it only safe to test to determine.

  14. thanks for this article! My type 2 husband went vlc Jan 2014 and his March check up showed fbs 176 and hga1c 8.2, never happened in 15 years of control by diet, doctor panics, I find that this happens to vlc, we have been on wheatbelly diet, but cheating on it and not having enough fat, his numbers came down to normal for 2 months after we quit stevia in the raw and splenda, they they crept back up July, am so glad for your website, I am hoping we can do this, don’t want to go back, also found his iron pills had elevated iron in blood which antagonizes Insulin, found research in Finland and Spain, cuttting out the iron pills, avoiding liver, he was on iron for severe anemia when he got type 2 and the iron pills were just ongoing, but I think getting off gluten let the pills absorb and his ferritin was 88, never been over 30 in 15 years, thanks for the talk on GLP-1, etc, I found out about them and found they have seperate power from Insulin itself, we haven’t checked glucose at all, taking olive oil and coconut oil with us to lunch, looking for fet, just got new book today, The Big Fat Surprise at B and N, can’t remember how to spell author name, I think it will be the scriptures for putting fat back, my spouse was raised on lard, butter, whole milk, pork, on a family farm, I think they were ok until they left, Western diet caused 2 older brothers to pass, age 55 and 72, 2 sisters have type 2, also, no family history, love ketopia. thanks!

  15. Thanks for the article; it is very thought provoking. I have tried ketogenic diets several times and they simply do not work for me. I have held closely to the macronutrient guidelines of 80/15/5 and have tried various food restrictions, e.g. – no nuts, or no dairy, etc, and various lifestyle variants, e.g. – exercise, no exercise, raising calories, lowering calories, etc.

    I have noticed some very interesting things during these experiments. The first thing that I notice is that I do not get “keto flu”, regardless of how fast I switch from high carb to keto. Considering that other people have described it as feeling “as though they are dying” (yes… I do know some drama queens), I found it very strange that I was asymptomatic with good energy levels.

    The second thing of note was the rise in blood glucose, despite taking 1000mg of metformin per day. Fasting glucose is elevated, as well as postprandial.

    The third thing is no significant production of ketones according to the blood ketone monitor.

    Lastly – no weight loss. I have actually gained weight on a ketogenic diet.

    My ketogenic diet attempts varied in duration from 5 days to 3 months.

    I have been in touch via email with some of the “keto gurus” (Moore, Wortman, Westman), and all stated that they have never seen anything such as this.

    But after reading this, I am beginning to think that my body is producing sugar from fat. This would explain the lack of keto flu, lack of ketones in the blood, rise in BG and the failure to lose weight. Surely it would be considered unusual to be on a diet of 80/15/5 (paleo… no processed foods, so no sneaky carbs) for 3 months with no results.

    Currently, I am following Dr. Bernstein’s carb recommendations of 6/12/12, with moderate amounts of fat and protein and am having much better blood sugars and am seeing some weight loss.

    Anyones else experience something similar?

    • Barb
      I am having the exact same issue. I just finished Whole 30 – following perfectly. I lost no weight and my blood sugars have gone through the roof (some post prandial have been >200! I have NEVER had that before). Any further input on what you have tried would be so appreciated.

    • Rachael

      Oh. My. Gosh. I thought I was the only one! I’ve been searching and searching as to why I haven’t changed my meds other than to lower my insulin, but my numbers are staying right around 200 in week three, as I was seeing great numbers before! I’m not crazy!

  16. Folks who do not know, when TAGs are hydrolyzed they are broken down into fatty acids which travel into the serum being carried by different proteins and glycerol which is the backbone of the previous TAG. Glycerol, as Geoff mentioned, and as seen in quite a few papers…can contributed to gluconeogenesis.

  17. Do you know of any data showing high fasting blood sugar in ketogenic dieters? The only published data I am familiar with has shown ~10% lower fasting blood sugar in ketogenic dieters compared to normal dieters.

  18. Your whole article is based on a false premise, you missed the phrase “short term increase”. This means when the person or animal goes into full ketosis there is no more rise in blood glucose and the reason for that is the glycogen stores are drasticly lower in the liver.

    • But Marc, how long is “short term” because I am 40 weeks into solid ketosis without cheats and my fasting numbers just keep going up and up and up! This is nuts! My liver should have no stored glycogen. I keep reading about others who have my issue and so far, no solution!

  19. And low carb is not equal to ketosis. Ketosis is when all you eat is pure protien and pure fat and chloryphyll (which is a protien). If you are eating any carbs at all you are not in full true ketosis which is required to have very small glycogen stores.

  20. THANK YOU THANK YOU THANK YOU. I did labs the other day and was in the diabetic range and it really freaked me out, to say the least! I eat zero sugar, so I was struggling. I SOOOO needed to have this information. Not that I could explain this to another, thus I pinned it to my pinterest account for future info and to take to the Dr to read.

  21. I went from taking 100-150 units of insulin a day to 40 units. Went from 355lbs to 320 in 2 weeks. All by limiting to only 30g of carbs. My blood sugar went form almost 300 14day average to 142. But then when I woke up and throughout the day, till I went to bet it was always over 200, high as 400. I went back up to giving 100+ units of insulin to keep the my blood sugar down. It didnt work. I even dropped to 10g carbs a day. Nothing

    This is very fucking frustrating. Even gained some weight back. Still under 30g carbs, still crazy high insulin for everything. I am about to give up and just accept an early death.

    • Geoff Smith

      John how long were you at 10g of carbs a day?
      First thing to remember you did not get to where you are today in a short period of time and it will not be a short period of time to get back to healthy.
      Congratulations on the los of weight. 35 lbs in 2 weeks is not the norm at all so I can not say why that would happen but doubt it was solely due to low carb.
      SO action to take going forward. Carbs 10-15g a day. Protein low…. very low. Don’t care about what any charts say they are based on a non diabetic carb eating human. You must keep your protein to no more then 4oz per meal. Your body WANTS to burn glucose and is going to fight to keep that way. Any excess protein will be converted to glucose and mess with your numbers.
      Now the good news. Eat as much fat as you like. Coconut oil, butter, lard, bacon fat, avocados. I eat about 1.5 lbs of butter a week by the spoon, can’t be bothered to put it in my coffee.
      You want to get into ketosis. Once you are your burning your fat. Now the simplest way to lose the weight and control the blood sugar is go on a water fast. I have been on one for 56 days. I have a physical job and I do 2 sessions of HITT for 30 mins twice a day as well. If you are in ketosis when you start it will be easier and no hunger issues.

  22. I’m new to this and am trying to follow along. Sorry for the basic question… When you say “high” fasting blood sugar, are you talking about numbers that are considered “normal” for people not on keto too? So “high” fasting would be anything over 100? I feel like I’m “high” fasting BS when I’m over 80. The last few days I’ve been in the 90s, but my ketones are still 1+. Is that OK? Not sure why BS is up, but sometimes it is in the 70s. Need to read more to understand, but just don’t want to be hurting myself in these early stages.

  23. Hi, I have been following a HFLC life style for the last 3 weeks and initially my blood sugar was in the normal range. I stick very strictly to a 5% carbs, 20% protein and 75% fat. I also do intermittent fasting, Skipping breakfast as i’m not hungry and eating lunch and light dinner. I lost 2kg in the first week and 1.5 in the second week. This week my weight seems to have stalled and my BG was 6,1 this morning?!! Where did this come from? How do I fix this and get the weight loss started again? I need some advice.

    • Geoff Smith

      The first thing I would say is cut the protein and increase the fat. 80 percent at least, if your diabetic lowering the protein in very important.
      Second anytime you get stuck one of the tricks you can try is a fat fast to rev up the metabolism. Honestly I am not sure why you would be losing so slowly.
      Another good way to melt the weight is add in coconut oil. Making fat bombs is a good way to get butter and coconut into your diet.
      3 weeks is not very long and depending on how you ate previously to this your body needs to go through some big changes to be keto adapted… burning ketones for fuel. At this point your body maybe trying to continue using glucose for fuel and to do so breaks down some muscle protein. The morning high can be from the liver dump that happens in humans to get us moving in the morning. It still thinks we have to get up and hunt for our meal. LOL

  24. I have been on Keto diet for over a year since I was diagnosed as pre-diabetic. But now my glucose has moved UP into the diabetic range!!!! Am I understanding this article correctly that this is temporary? Should I be doing anything different?

  25. I see a few people struggling with this issue and thank the commenters for the different ideas. That dairy protein can be the trigger in some cases seems likely as exorphins can interfere with paracrine signalling, and at the level of signalling on a keto or low carb diet this may be more obvious.
    Also the idea about glycerol spilling out during weight loss or high-fat feeding; how is GNG from this regulated? Glycerol and aminos are the source of excess sugar in uncompensated/unmedicated diabetes.
    As for the harm the high BG does – it’s high because it’s not getting into cells, and it’s in the cells that it does harm. There’s no reason to think that glycation of hemoglobin is harmful in itself. Hb is replaced regularly and – critically – RBCs have no mitochondria. What about kidneys? Has anyone seen glycosuria with this phenomenon?
    People who have a genetic defect that prevents them from metabolising glucose normally (I forget what this is) run high HbA1cs with no complications. Is this the right model for what we are seeing with LCHF in some people?
    The strategies we can use to lower this BG include IF, vinegar before meals, HIT. Maybe coconut oil.
    Also, first phase insulin response is harmed by excess omega 6 and inadequate omega 3. If this is going on, then a fish-and-coconut diet (limit omega 6 – no nuts, no olive oil, use coconut and tallow, butter, but plenty of fatty fish) might be needed for a time to flush out the omega-6 stored in the body from previous diet.

  26. I’ve read this post and all the replies, and unless I’m missing something, I haven’t heard anyone mention what happens to their BG following a bit of carbs 2 hrs post meal. I started seeing these elevated PPBG numbers when I finally started monitoring my BG after LCHF for the past 3+ months. I’ve been in ketosis this whole time save for the early days when I first started out. I’m a 40 yo former highly competitive road cyclist who can’t exercise like that even for fun due to chronic fatigue which is due to damage to the hypothalamus. My waking BG has been high and climbing to the point it was 138 this morning despite getting super strict with my carbs and taking fat bombs in my tea in the form of coconut and Irish butter. I know I’m keto because the meter tells me so and my thinking is only clear when I am in keto. The funny thing is I’m not IR. A few nights ago the wife an I had a dinner out and along with my fatty beef ribs and small salad I decided to eat the lil scoop of white rice on the plate to see what would happen. About 2 hours later when we got home I tested my BG…80! I can’t remember the last time I was that low while keto. So my insulin response works. But here’s the rub…no weight lost since day one 3+ months ago. I am able to do very light exercise not exceeding 65% of HRM without pushing myself over the fatigue cliff for weeks. I figure the rice may have pushed me out of ketosis but I fat bombed my way back in quickly. My question is like most, what’s up with the PPBG and why can’t I drop weight?

      • Hi Eric,

        Yes I walk. Nearly everyday I take my dog for at least a half hour walk. He runs off leash around the park and I walk along. Also, 3x/wk I get to workout during work hours. I usually get about 2 miles of walking in while doing some type of body weight exercise every 1/4 mile. (Push ups, dips, pull ups, planks). I stopped worrying about my BG levels for a long time and since there has been a push of comments lately I started checking again. I still have high BG levels upon waking and in the afternoon after work and before dinner (at least 8 hours since last intake). AM (138), PM (110), on avg. One thing I didn’t mention is that since I started Keto 5.5 months ago, my sleep has been bad. I wake after about 5 hours and can’t fall back to sleep. I’ve tried GABA, Passion flower, MagCit, and more fish oil. The only benefit has been great vivid dreams from the fish oil. (1+ tbsp. Carlons-1.8g DHA/2.4g EPA.) Dr. recommended this level to help lower TGF-beta 1 and possibly raise VEGF. I’ve been doing that pretty consistently for the past 3 years even before keto. Okay, back to the HFLC stuff. I eat about 80% fat, 10-15% protein, and 5-10% carbs. Some days I don’t even get this much protein, which gets replaced with fat if I’m lazy and don’t make a meat source for dinner. I’ll usually just go for some fat tea (3c h2o, 1 tea bag, tbsp. coconut oil and tbsp. Kerry Gold butter). So gluconeogenesis should not be happening. I’m considering doing cyclic keto to see if it helps with the sleep and BG, but I love the mental clarity of being keto all the time. Also, forgot to mention that I have lost no weight. While body weight is stable ( I do have fat to lose), my shirts are tighter in upper body and belt has gone down a notch so I am pleased about those changes. Though this plateaued out about 2 months ago.

        • hi KB,

          It sounds like you are not sedentary.

          I re-read your initial post. I sounds like you started monitoring your blood sugar only after having started eating low-carb (pardon my quoting you, but just so you know what I am referring to: “…started seeing these elevated PPBG numbers when I finally started monitoring my BG after LCHF for the past 3+ months.”). Is it true that you did not monitor your blood sugar with that same monitor before starting low-carb? If so, then you have no baseline with the instrument you are currently using, Unless you have a baseline and current blood sugar measurement from the same instrument, either a commercial or clinical one, I wouldn’t say there is strong evidence for an effect of your diet on your fasting blood sugar; from what you’ve shared, you might have had high fasting blood sugar even before you started eating low-carb.

          Another thing I noticed that you wrote is that you have damage to your hypothalamus. Damage to your endocrine system is known to have the potential to affect blood sugar regulation. Do you have blood sugar clinical tests from before and after this damage? I am wondering if your hypothalamus damage is a causal factor here. What do you think?


          • PS Difficulty sleeping sufficiently and soundly on low-carb is something I have seen reported anecdotally frequently… That doesn’t help you solve that problem, but just so you know (in case you d di not already) that a lot of people report the same thing.

          • Hi Eric,

            Yeah, my original post wasn’t good. I had gotten my PPBG and Fasting BG all mixed up. Sorry about that. As for monitoring BG prior to starting keto, that is a big fat negative. I’m sure I could dig up some labs from previous years that would show I didn’t have high FBG, but I can’t say for sure because I never self monitored before. A number of years ago I was part of a research study and had to do an OGTT, VO2Max, and had muscle biopsies in response to glucose intake etc. I don’t recall the exact results, but everything was within range. This was long before the current “illness” though.
            I can say that in 2014, after reading “Grain Brain” I was pretty strict with carbs without monitoring and would eat huge hunks of cheese as my only meal at work often times. I lost weight with no problems and was pretty lean. I was even less active then than now. Since “rediscovering” keto thanks to my wife getting on board with it, I started monitoring BG and ketones. My wife had the same problem with rising FBG. She gave up keto and now when she randomly tests with me, she gets FBG in the 80s.
            I think my approach is going to either be slowly ratcheting up the carbs and yet maintain ketosis (for the beneficial brain effects), until the FBG normalizes and the sleep improves. Either that, or I may go cyclic keto. Of course all t his could magically correct itself once I get the hypothalamus regulated again as you mentioned the endocrine system. (Hope to start a med to correct this in the next month or so). Then again, who knows. Maybe all the stressing out about having a higher FBG level and being “pre-diabetic” might be wasted effort. There could be things going on in the body that we just don’t know about yet. What if having a higher FBG in some people could be a temporary or permanent response to some kind of repair or prevention of damage that might be taking place in the body? Maybe some genetic types require more carbs?

            Without getting to far off topic here, I can say that my low VEGF creates blood flow problems and leads to poor diffusion of oxygen and nutrients to muscle. The reason I “fall off the cliff” for a week or more following a prolonged bout of exercise well above 65% HRM is because glucose takes way to long to replenish in me. That’s why keto seems to make me feel so much better and has improved my exercise tolerance. My body may have rather rapidly adapted to being an efficient fat burner

            I do know the “illness” has caused significant sleep problems for me, however since being keto, it’s gotten much more pronounced. I would have to conclude the keto and sleep trouble coincides. Trying to sum this up, Hypothalamus damage (low MSH) = poor sleep, and for me at least keto further exacerbates the problem. Hypothalamus damage however I don’t think accounts for the high FBG because it didn’t before keto. However, poor sleep could account for elevated FBG as I think that’s been documented.
            Btw, did you see a recent study saying protein helps aid in sleep? Of course there are likely problems with the methods involved, but that could be an avenue too. Keto always says to keep the protein intake moderate and getting too high leads to gluconeogenesis, but I’ve wondered if maybe my protein intake wasn’t high enough. I avg about 1g/1kg, sometimes less. My last alkaline phosphatase was quite low and the BUN/Creatanine ratio was off even though the individual numbers were normal. What are your thoughts on increasing the protein intake? Do you think it might lead to an actual reduction in FBG? Though this might sound strange for a keto paleo eater, I do find it hard to get enough protein throughout the day without consuming too much at any one given meal. I don’t like the idea of whey shakes or anything that’s not real food.

  27. Try again your research is flawed. I’m a type 1 diabetic trying to loose weight and on a low carb diet my blood sugar went through the roof! I’m a very well controlled diabetic and the diet caused me to spill heavy amounts of ketones I first thought it was an infection got on an antibiotic and waited. I Tried the diet again a few weeks later day one blood sugars ran upper 170-200 range 2nd day 250s 3rd day 300-500! And I was hospitalized with DIabetic ketoacidosis something I haven’t experienced in 20 years as a diabetic. So something else is going on because I manually have to inject all insulin. I should also mention I only have 5lbs to loose and I’m only 10%away from my goal body fat %. I did the carb. Cycle first and then the keto diet. Both same thing happened.

    • George Henderson (@puddleg)

      Hi Nicole,

      I’m trying to understand this reaction, which I’ve never come across in the literature or T1D low carb forums.
      You don’t mention your insulin use and my first thought is that this seems like a failure of insulin.
      Insulin inhibits glucose production and lipolysis (the fat release that increases ketones) though it won’t necessarily suppress ketosis completely on a ketogenic diet.
      It could be that the carb cycling plus keto is too volatile and unpredictable in the way it influences liver insulin sensitivity, low carb T1Ds are usually very consistent about carb intake. Have you tried the Bernstein diet, with high protein, low carbs? There is less fat in this diet, and the protein will limit ketosis.

  28. Satriana


    thank you for this article. This explains what’s happening to me. I am really frustrated. Low carb diet, exercising but wight stays the same and blood sugar going up. I mean, from pre-diabetes to diabetes. Is there a solution to this?
    Thank you.

    • Geoff Smith

      Satriana here is what I have learned going into my 12th year of LCHF and from helping others.
      No one should even think about physiological Insulin Resistance (PIR) if they are diabetic or otherwise metabolically challenged ie over weight. This is a condition that affects someone who has normal or low insulin levels and regular low blood glucose levels over an extended period of time…. like year or more. Then slowly due to the constant lack of insulin being triggered we see glucose build up a bit in the blood. When this article first came out I did a lot of research and found no way to resolve this and the opinion floating around at the time was it is normal and not a concern….. Hmmmmm
      Now however we have Intermittent Fasting (IF) and just like that the problem is resolved.
      This makes perfect sense from our ancestors point of view. They simply did not get as many meals as we do on a daily, hell, weekly basis. I eat 5-6 meals/ week… yes week. No problem with PIR. I probably could eat more but I do not find I need more.
      Others I talk with found 18-6 resolved their PIR and the every other day diet does as well.
      Hope that helps!

  29. Geoff,

    I’m not clear on what you are suggesting about PIR add IF?

    I IF most of the week eating the occasional breakfast with my family on the weekend. Besides that one breakfast I typically do not eat lunch until one and dinner around six but don’t eat anything after 9. When I’m not in ketosis my blood sugar is normal. But in ketosis I can get morning readings between 89 and 106, sometimes higher. Yet my ketones can range from .6 to 2.1. Are you saying that IF should solve this?

    I track my macros daily eating 70-75% fat most days and 20-26 carbs. This keeps me in ketosis. I’m 5′ 9″, 205 pounds (45 years old) trying to get to about 195 eating +/- 1600 calories per day.

    I’ve read that in some people the body produces glucose if required and that it’s not anything to worry about. That it’s just a natural response to low sugar intake. I track my sugar intake with My Fitness Pal and am always under 10 grams of sugar per day, usually 6 grams. Is that too low? Should I be eating a little more? Or am I worrying about nothing? I certainly didn’t cut sugar from my diet to see my fasting blood sugar increase.

    Diet info: I’m following a Paleo Ketogenic diet. I eat lots of eggs, grassfed beef, bacon, salmon, lettuce, broccoli, cauliflower, Kerrygold butter, cheeses, heavy cream, coconut milk and coconut cream.

    Your help is appreciated



    • hi Peter,

      1600 calories per day is about 50% of maintenance calories for someone of your size. Not sure if you are aware of that. Unless you lie in bed all day, I don’t think it is a good idea to eat so little.

      • Geoff Smith

        Well so they say Eric and we read that everywhere but why. Turns out it is more of a North American…. maybe Western World point of view.
        Part of the reason I have been trying to go with the feeling of my body instead of some chart is to see just what I might really need. Would my body suffer in some if I am low. Do I lose muscle mass, hair etc.
        Turns out I have been stuck at 173lb since I started eating again last Sept with an active day as stated above.
        I was watching a documentary about sugar cane workers last summer while I was fasting and they showed what these people eat for a meal each day…A MEAL. Many of the men were born and raised on the plantations and they are in there 50’s now. They work a lot harder then I do that’s for sure.
        I think it comes down to what food consumed that chart is based on and no one has done the science on how a LCHF diet is different. We know that keto diet is muscle sparing as is fasting. From my personal experience I now know that we can thrive on way less then modern life has been pushing. LOL

    • Geoff Smith

      Hi Peter. Since we Don’t need any carbs there really is no such thing as too low.
      I have read the same about the slight elevation in morning BG but seriously this is new stuff, no one can make such a defacto statement. It does seem to give us some morning sugar to get on with the hunt. BUT if we are not going to be burning that off hunting should we allow it to persist.
      Many people are finding that IF will over come PIR yes. Finding the pattern that works best is different for everyone. The fact that you mention dinner at 6 but don’t eat anything after 9 implies that you may have some snacks or something after dinner but not after 9. You may be just saying dinner might be later but never after 9 though. Hmm
      Anyway…. the only IF diet that has had scientifically controlled testing done is the Every Other Day Diet. From that some people borrowed the concept and adjusted to fit their…… rhythm shall we say. The 18-6 is exactly that and the originator is very open about that. OK no issue there except that I do not we are hearing that is does not work so well for all. Many T2 diabetics are finding this and have gone to 20-4 and some even say only 23-1 works for them. There is an article by Chris Kresser saying people with sugar control issues should not fast until they have that under control because the cortisol issue makes it even harder for them to get that control. This may be the reason IF times are so different.
      So the every other day is the one tested and sees great results on numbers.
      I did a long water fast last spring and summer and now only eat 5-6 meals a week. I seriously can not get above 800 cal a day. I just can not eat that much. I run a cottage resort on several acres. We are just coming out of winter so there was shoveling walking through 2ft deep snow to fish huts, up and down hills etc. Lots of physical exercise. I am 5’9 and have been 173lb since last Sept. I actually did feel hunger on very cold days due to the increased calories burned by brown fat http://www.livescience.com/49652-what-is-brown-fat-facts.html
      I don’t wear a coat until it gets below zero and sleep in a room that is only 60F with a summer comforter on. On cold days I can feel the system using up fuel and will eat an extra meal so might make it to 1000cal.
      I never eat on the same schedule. I may eat a dinner then a breakfast within 14 hours then not eat for 2 days then eat one meal a day for several. No plan, actually remembering to eat is the big issue.

      • I’d like to ask a question about high morning BG if any has tested or can test this – what happens to this BG if you eat a meal of fat, or a high-fat, low protein meal such as a one egg omelette made with cream and cooked with butter?
        This would tell you something about the cause of the elevation in BG, especially with pure fat feeding which has no insulin response but which may limit FFA release via somatostatin 28 inhibition of glucagon and lipolysis.

  30. Hi Eric,

    I’m trying to drop about 10 pounds. Since I’m in ketosis I’m trying to use my body fat as fuel until I reach 195. Once I’m it my ideal weight I will increase my caloric intake to about 2600+ calories or so. Are you suggesting that my higher blood glucose readings are because I’m eating to few calories?


  31. Geoff,

    Dinner is around six and not eating after nine is usually the occasional snack.

  32. Oops, I hit send by mistake.

    That snack is always something keto like a fat bomb or sugar free mug cake made with almond flour. For sweetener I use swerve or stevia. The few carbs in these snacks makes me drowsy and helps me get a good night’s sleep.

    I agree with you that you can’t be too low carb. I’m just reaching for something and thought I’d ask what you thought. Can I possibly need to add a bit of sugar. I know that sounds silly add well, but in the original article it mentions two phases of insulin release. Is there a possibility that a little more sugar would allow for the second insulin release that I may not be getting? Again, just an idea.

    Should I stop IF and see what happens? I do agree that we don’t NEED 3+ meals a day as society tells us. I usually have two but sometimes just one. So i don’t really believe this to be a solution either.

    Can you recommend anything else to try? If nothing works should I stop eating this way our do you think these slightly elevated levels of blood glucose are ok? The hard part for me to understand is that I don’t eat any sugar. No fruit at all either. The only sugar I consume it’s what is naturally occurring in fruits and veggies.

    Could it be the heavy cream or cheese? I’ve heard some on this thread mention coming those up and setting a change and others doing it with no benefit.

    Any advise is much appreciated.


    • Geoff Smith

      Protein is the other source of blood glucose through gluconeogenesis.
      Just occurred to me to ask if you are diabetic. Then the other thought was you mention you don’t eat fruit and the next line is the only sugar is from fruits and veggies.
      If your T2 and your trying to get this reversed then mug cakes are out. Give an inch take a mile… for many people it is the small things that add up because we justify them but forget to keep good track of how many. For many T2 almonds are a problem and almond flour has a lot almonds in it. Never sure why some people get a sugar spike from a food item and others don’t.
      It does seem strange to have ketones in the 2’s and bg that high but usually ketones are lowest in the morning.
      First things first is get an Fasting Insulin test done to see what that level is. If you are losing weight slow but still steady it is probably in the OK range. The fastest way to knock the weight down and lower the insulin level and reset the body is do a 14-21 day water fast.

      • Geoff,

        I am not diabetic. Before going ketogenic my last fasting blood glucose was 87. That was about 1.5 years ago. I don’t eat fruit, I just have a bad habit of using the term “fruits and vegetables” together like they are the same thing. Once or twice a year (during the holidays and for a few weeks in summer) I’ll go strictly primal, only then will I eat some fruit. I am due for more blood work soon, Is fasting insulin something special I should ask my doctor to add to my blood work?

        This morning around 10 my blood glucose was 111 and my ketones were 1.1. I checked a little later and it was 117 and again two hours after lunch and hit a 104.

        Should I try removing the almonds for a few days and see what happens? Or is that more of an issue for a diabetic. Do you think I should get out of ketosis and see if my blood glucose returns to normal? At least if that happens I’ll know it’s PIR. Then I’ll just have to decide if I go back to my ketogenic diet. I’m happiest eating this way and feel great mentally and physically and find it effortless to maintain my weight. I was out of ketosis for a month or so until late January then started back in February. In that six week period I dropped from 217 to 206 and felt great. My only worry was the PIR that started about four weeks after entering into ketosis (the beginning of this month).

        Does the ability to lose weight make you think about my insulin is not a problem after all?

        What would you think if my fasting BG returns to normal after a few days out of ketosis?

        I really appreciate all your insight and help. I really want to figure this thing out.


        • Geoff Smith

          You will probably need to push for the fasting insulin test but do push for it. We know that we want to be around 5 (mcU/ml or mIU/ml) , The higher you are from that the more insulin resistant, T2 you are whether the doc has proclaimed it or not. They base that on your BG and that only rises when the insulin system fails.
          Stress alone can affects your BG numbers and the fact that you are not diagnosed T2 but are so involved in testing means you are thinking about it all the time and just getting the the equipment together to test can be stressing you.
          I think you have some metabolic syndrome going on based on your weight and height and that is why the bouncing around with numbers. One thing you can check easily is your hip to weight ratio. http://www.bmi-calculator.net/waist-to-hip-ratio-calculator/

          • My waist to hip ratio is .98.

            I am stressing because my BG should be lower on this diet. I’m just trying to figure out why.

            Mentioning I might be diabetic hasn’t helped. I was only trying to figure out why I have PIR.

          • Geoff Smith

            Sorry to stress you more by mentioning the D word but the point is one can not jump to the conclusion that it is PIR unless one knows exactly what state the body is at hence the need for the fasting insulin test.
            I agree with the problem of BMI. I use to be a power lifter so it was very wrong in my case.
            The hip ratio does have more validity and sure works for me.
            If it is only PIR then finding which fasting schedule will be the trick.

        • biohacker

          Hi Peter,

          I have had the exact same issue as you have for the last couple of years while going in and out of keto. A few things about me:

          •31 year old male
          •8% body fat, 175 lbs, 5’11”
          •Walk an average of 40 miles /wk, run 15/wk, lift 3-4x /wk
          •Approx. 80% fat, 15% protein, 5% carbs
          •Eat between the hours of 12 or 1pm to 9pm
          •IF for 18 – 20 hours once or twice per week

          My FBG is regularly 100 – 120. My 1 hour PPBG is typically higher (120 – 140), but 2+ hr PPBG is the only time I see my BG dip below 100. My HbA1c is 5.2.

          I feel great on keto, with the exception of when I don’t eat enough (which disrupts my sleep), or don’t consume enough sodium (happens more often than I’d like, considering how much I fast and exercise). The only other issues I have are entirely subjective, but I notice my motivation is somewhat lower (work, sexual) while on keto; perhaps lower dopamine?

          With the exception of cholesterol, all of my blood markers are extremely good (I’ve had 25+ markers tested, from inflammatory markers to minerals, vitamins, kidney enzymes, etc.). LDL is “high”, but that’s a controversial topic. Since my HDL is also high and triglycerides low, I’m not particularly concerned right now.

          My exercise performance is as good as ever. I can deadlift at 95% of my max, sprint at nearly the same speed as while on carbs, and run long distances more easily.

          Reading your points, I would suggest that you focus on fixing your sleep before anything else. Poor sleep messes with your blood glucose levels in as little as one night (I also have sleep issues). I find upping my total caloric intake helps, followed by a moderate amount of carbs (1 sweet potato every now and then). I also follow immaculate sleep hygiene (f.lux, HUE lightbulbs, 67 degree temp, HEPA air filter, ear plugs, etc.).

          I’m curious to know where you find yourself now and anything you’ve learned. Hope my account at least brings you comfort, and ideally, some guidance.


      • Geoff, I have many similar features with you. A lot of things you mention I have expetiensed too.
        Please let me know if you seen anything like this:
        I have new BG data on my PIR (I hope its just PIR and not some strange illness). As many of you, I wake up with 90-105 mg/dl FBG. When I start to move around (some stairs) etc., my BG
        drops to ~80-85 in 20-30 minutes. If i choose to do light exercise (push ups, sit ups )I can easily drop my BG to 60-70 depending on exercise intensity. All this without eating in fasted state (I do not do breakfast).
        However, if I stop be active and lay down or sit down in front of computer for ~30 minutes, my BG builds up back to 90-95. Same things later at work- after working/sitting BG aroung 90-95. Moving and walking brings it down 80-85. Getting more intensity bring it down to 65-75. Getting back to the chair for 30 min gets me back to 95. Similar picture after eating, activity bring down whole BG profile by ~10 points.
        I am in mild ketosis 0.3 mmol/l in the morning and it slowly builds up to 0.5-0.8 in the evening. My ketones do not react to these wild BG swings at all. My HbA1c is 5.1%. Fasting insulin was 4.8 last time measured (2 month ago). I lost 25 pounds in 18 months by eating 1500 Cal (20-30 grams of carbs,~80 grams of proteine). Current weight-170lb, height 174 cm. Feel good, not starving at all, sleep well. Walk 5 miles everyday, with HIIT 2 days a week.
        I am observing this pattern for 3 months now, since the moment I discovered it. It is very consistent. I wander if glycogen shortage is doing this to me, since I have a little buffer and body taps directly in to BG for its urgent needs and then slowly restores BG back?

  33. I just checked this morning after eating a little less protein and actually 15 more carbs. My bg was 114 and ketones at 1.8. Then I decided to check BG again and it was 94. I’m not sure what’s up with those different BG readings just a few minutes apart. I’m wondering if it may be the protein causing the higher readings. It still doesn’t make any sense. FYI, I subbed almond butter with sun butter yesterday. I wonder if that means anything?

      • I’m not into that whole weight, height metabolic syndrome thing either. BMI charts are great for some body types and completely unreliable for most people. I’m about 20 to 22% body fat.

        This forum is called Ketopia and is filled with people who check their BG and ketones regularly. Especially in this particular thread. Maybe I am
        stressing myself out, but because I’m trying to solve this PIR issue. I wasn’t thinking about being T2, overweight, or having metabolic syndrome. Now I can add those to my list of things to stress about.

        I think I’ll just see what my next blood work turns up.

  34. So go figure, all this time it was my Nova Max blood glucose meter giving me problems. It had happened once before but new test strips seemed to fix the problem. After trying to figure this out my PIR issue for so long I decided to buy a Precision Extra meter to compare. I just did two side by side tests using both and got the following readings:

    128 Nova Max 88 Precision Extra
    123 Nova Max 82 Precision Extra

    These readings were taken from the same blood sample seconds apart. Has anyone else noticed this? Needless to say I am very relieved. I’m having blood work done this week as well and will verify these readings with my lab results to get a more accurate assessment.

    • Mishele

      I’ve noticed the same thing! I also have both meters, but what I’ve found is the Nova registers lower than the precision xtra. This morning the Nova read 82 and the precision xtra read 98. I got blood work done about 30 min after testing at home, so I’m curious to see what that says. Also, I can take my levels multiple consecutive times and get completely different readings. A few days ago, my Nova registered : 102, 82, 74, 94, 89…wtf? I truly question how much good these blood glucose monitors are if they’re so random? It would be one thing if the were consistently high or low, at least you would have a baseline, but when you get readings like I got, there is absolutely NO way to know what is right. I emailed the company a few days ago and never got a response.

  35. Hi Katkinsk, just wanted to say thank you for an excellent article, and the injection of humour! Love the clusterf*ck comment. If I’d have had a mouthful I’m sure it would be all over the computer screen. Anyway, a good article and answered my new-to-keto question about slight rising blood sugar. Awesome 🙂

  36. Wowzers. Well, this article (fantastic!) answered some of my questions, but leaves more. My glucose spikes (that’s a relative term) after nearly every meal. 111 or so an hour after eating seems to be the new norm. I’m not diabetic, but do have symptoms of metabolic syndrome, and am looking to the keto diet to even things out (shrink my trunk, adjust sugars and cholesterol). Seems like the high(er) sugars after a meal could indicate a problem though. I’m still new to keto (about 8 weeks) so maybe time will help adjust the glucose? I’m just concerned that higher sugars are doing other types of damage. More to learn and read. Thanks!

  37. Michael Davies

    Nice breakdown….I think. I missed the punchline. Does this suggest the ketogenic diet is not a good fit if, after say 6 months, and person starts getting high glucose readings? I get that this is different that a diabetic’s response, but it still seems like an issue to deal with. How should a person deal with this?

  38. Cocobolo

    I’m new to this but it’s a great site full of knowledgeable people so I wonder if anyone can help?
    I was diagnosed T2 in 1994, and have ‘controlled’ my blood sugar through diet since then. Controlled is the word I use, but often it has meant a rocky ride for a few weeks of not looking, followed by a period of being good as the time for hba1c approached. The reality has been that my BG has probably been baseline around 11-12, (with big spikes). I am over 60 and except one, all my friends are diabetic T2. four of my friends, aged 54-61 have died. They are/were all on medication and I am not,(despite pressure to strat them) but I seem to be the one with the fewest health problems. I have been wondering if I could be an anomaly, or one of those at the edges of the Bell curve for normal blood glucose, 11 being a normal blood glucose level for me? Is that possible? Has there been any research into the range of normal glucose levels as compared to the average? So far I am never ill, I am able to care for sick people and not catch their bugs, I have none problems associated with T2, and with which i am threatened if ever I see a doctor.
    I would be really interested to know if there is a control group of T2 diabetics who have raised blood sugar but no other symptoms, medically treated compared to not treated?
    My doctor told me that I am in diabetes denial, but these are surely serious questions.
    Thanks to all who read this

    • Hi Cocobolo,

      there is a genetic condition that gives high glucose and HbA1c with low risk of complications. It depends what the metabolic fate of the glucose is, this condition inhibits glycolysis – but unfortunately I can’t remember what it’s called.
      Wait, here it is –
      This British study looks at a set of individuals who are genetically programmed to run at a higher “normal” level of blood glucose than the rest of us, because they carry heterozygous, inactivating glucokinase (GCK) mutations. They run at a mean HbA1c of 6.9% and provide an interesting insight into the long-term significance of high sugar in isolation: “Despite a median duration of 48.6 years of hyperglycemia, patients with a GCK mutation had low prevalence of microvascular and macrovascular complications.” By contrast, a cohort of similar age who had developed type 2 diabetes of youth had a horrific rate of macrovascular and microvascular complications. There is so much more to “type 2 diabetes” than sugar.

      From http://blogs.bmj.com/bmj/2014/01/20/richard-lehmans-journal-review-20-january-2014/

      the study itself is at http://jama.jamanetwork.com/article.aspx?articleid=1814212

  39. RosemaryG

    Thanks everyone, especially Michael, and Geoff and George. This site is now part of my daily life. IN SUMMARY, need help to understand the 100-120 morning glucose readings. IT seems the only time I get consistent readings below 90 is when I’m water fasting – which is also the only way I can seem to get BHB meter readings of 1.5 or higher. I am worried and frustrated by this – as others have commented – and not sure what to do. My diet is LCHF 70/25/5, portion measured. I self-assessed in a state of metabolic syndrome at the start of my KETO journey on 7/8/16. Blood work on 7/20/16 showed A1C at 5.4 / fasting glucose 83, fasting insulin at 8 – I was on a 3 day water fast at the time of this blood work. , I started learning about a Keto lifestyle in June when after 9 months of cross fit, logging all food, calorie restricting per old school teachings, wearing a FitBit averaging 11000 steps/day since 1/1/16 ——– AND AND AND my “lose weight” journey resulted in the GAIN of 8 pounds — when the OLD MATH should’ve showed a lose of 42-45 pounds (my actual goal.) After a lifetime of working out but slowly gaining weight every decade, I had a minor emotional breakdown. SO BACK To the story. I am turning to those of you on this site to guide me and help me think about what to do — I’ve appreciated and have watched every Volek and Fung YouTube video. I am feeling like the only prayer I have is a lifetime of water fasting – which completely works as I’ve lost 23 pounds in this time with combination of 3-5 day water fasts and IF. But I can’t figure out how to EAT. CAN you help me think about what to do??? Many Thanks —

    • Hi RosemaryG,
      can you please after getting your FBG 100-120 in the morning, do light physical activity such as stairs , sit ups, a little gymnastics and stretching for 20-30 minutes and remeasure BG again. Mine drops 20-30 units and stays there if I am active. This is how I keep my BG low through the day- stand up and moving every 10 minutes. When I wake up my FBG is around 100. It is 65-85 when I on the move. Also, what is your calories intake? I eat 1400 (25 carbs, 80 protein) calories to maintain my 170 lb. I am gaining weight very quickly by eating more. I also like fasting once a week for 36 hours and IF every day(18:6). It is difficult but doable.
      Walking 5 miles daily and HIIT (running) twice a week. That is how I stay slim. Tough life. Victor

  40. Mariano Gutierrez Alarcon

    I am in a LCHF diet with the idea to reverse my fatty liver… For what I read so far all the aspect of the diets is going according to plan I am waiting to do a scan on my liver in a few months time.
    in 45 days I reduce the triglicerides levels to normal values
    Global cholesterol went down just a bit still high ( 247)
    Creatinine went down to 0.7 but sugar levels went up to 115.
    As far I read in this article it seems that LCHF diet may increase the blood sugar like in diabetes (although for different reasons)
    It seems logical if our diet goes hard on making the body to produce less insulin, in so achiving this we produce less insulin than desired hence higher sugar levels… The question is,
    Could we do an irreversible damage to our insulin production with the diet? and create us an undesirable diabetes problem that it could not be fixed later on? simply by eating carbs again?

  41. Freyner G

    Very interesting article. Still leaves me on the dark about what to do about it, if a Ketogenic diet is good overall for health but HBS is an issue with it, is there any food change or supplement to add to the diet to make it better.
    Some mention of a temporary HBS but some mention years.
    I am really tickled into the topic since I am on the ketogenic diet myself and struggling keeping glucose under control.

  42. Julia W

    Went strict ketogenic, lowered protein as prescribed, lowered fat such as vegetable oils, increased nut butters and yogurt and lost 27 pounds within no time. Am now too skinny, but blood sugars are the same or worse than when I was eating a little more carbs. Why? Am too afraid to fast since last CMP showed protein was low and BUN and sodium. Can’t seem to gain a little weight back again.

  43. sherry crawford

    I’ve been keto for about a month and a 30 yr diabetic type2 on insulin. I stopped insulin 2 weeks ago and fasting glucose just keeps rising. This morning it was the highest ever at 328. My daily carb intake is 30 grams or less, usually less. My dr knows what I’m doing and says he’s afraid I’ll really screw up my health. I see him again in a month to assess any damage so far. I feel the best I’ve felt in years, just scary glucose readings.

    • Hi Sherry,

      I can’t imagine how terrifying and disappointing that must be. To finally have a “solution” and to be so compliant, yet to watch your biomarkers respond the way they have…ugh. One thing I’d want to discuss with my doctor right away is whether you’ve gone of insulin entirely too soon. While many diabetics report being able to reduce or remove their reliance on exogenous insulin when they go on a ketogenic diet, such steps often need to be carefully orchestrated over a period of time. In fact, every medically trained physician I’ve read who writes on this subject appears to be quite adament: a ketogenic diet is an extremely powerful tool, but if you are diabetic you need to utilize it in careful coordination with your MD.

      It may take more time until you should stop your insulin. Something else might be going on. There’s simply no way to tell. But a blood sugar of 328 would have me trying to get that under control first and foremost.

      A couple things come to mind. These might not be specific to you, as it sounds like you may have some of this covered already…but there are a lot of people who will read this who have questions or concerns that it might be helped by the following:

      1. Work through this with your doctor. No website (or book, or podcast, etc…) is a suitable substitute. While some resources are immeasurably valuable, you really need to tackle health and weight with a team of experts. This includes you (of course), and a properly informed/trained doctor.
      2. Make sure you have the right people on your team. Sadly, there’s as much fear, uncertainty and doubt about ketogenic diets as there is uninformed optimism about them. If you have a doctor that doesn’t seemed up to speed with how low carb as a viable treatment modality and seems stuck repeating useless dietary nostrums and approbations, perhaps it’s time to have a conversation with him/her about whether their reservations are coming from an uninformed place of fear, or they are about your unique medical context at the intersection of a low carb/ketogenic intervention. There is enough quality evidence out there about the health promoting potential of low carb that it becomes imperative for you to understand where your physician is coming from. On the flip side, there very well may be something more or less unique to you that is guiding your physician’s recommendations. Try to find out the difference. Willful ignorance of any treatment modality appropriate to my condition is not something I’d entertain.
      3. With all that said, since you are a 30 year diabetic it is possible that your context is substantially different than the average person. One of the best resources on low carb for diabetics that I am aware of is Dr. Bernstein’s Diabetes Solution. He’s a diabetic and an MD who has successfully used low carb interventions as a critical pillar of his own treatment plan, and that of his patients. This might be a great resource to consult with in concert with your doctor (if he is not already familiar with it).

      In the end, I know how disappointing it is to have your body act so counter-intuitively to what you are doing. I could sit back and say, “Don’t worry. Everything is fine. Your rising glucose numbers don’t matter because x, y, and z.” But really, the most important thing you can do is find someone willing to help you find answers and understand. Sadly, that is often much more difficult than it should be these days…and it gets increasingly difficult to discern the uninformed provider from the uninterested. But before you open that can of worms, maybe it’s worth getting your insulin numbers in a more comfortable range. Even if that means medication.

    • After 30 years with type 2 diabetes, it is very likely that damage to the pancreas is not reversible, even on keto. If this is the case you will still need some insulin to cover your protein requirements; but you will need much less, and its effect on you will not be harmful (as it could be if you were using extra to cover carbs).


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