blood ketone and glucose levels in ketosis

  • Insulin levels are an even better indicator of metabolic health than blood glucose.
  • You can have “normal” blood glucose levels while still having high insulin levels.
  • Reducing the insulin load of your diet (by reducing net carbs and moderating protein) will reduce blood glucose levels which will lead to reduced insulin and increased blood ketones.
  • Once blood glucose levels are under control and you are registering significant blood ketone levels, the glucose : ketone index (GKI) may be a useful indicator if you want to further fine tune your metabolic health.
  • The GKI provides an approximation of your insulin levels for people who are already fat adapted.
  • A GKI of less than 10 is considered to be a low insulin state. A GKI of less than 1 is the goal for cancer patients using therapeutic ketosis.

background

Since I wrote this article in which I plotted my relationship between blood glucose and ketones I have had some interesting discussions and learned a lot.  Particular thanks go to Raymund Edwards from the Optimal Ketogenic Living Facebook group and Jeff Cyr of the Ketogenic Diabetics Facebook group for sharing their knowledge and experience.

My hypothesis, in the absence of more data, was that for me at least, excellent blood glucose aligned with ketone values of greater than 0.5mmol/L and optimal blood glucose aligned with ketone values of around 1.3mmol/L.

image001

Armed with this information I figured that there was limited benefit in doing the more expensive ketone tests regularly.  Monitoring blood glucose to ensure that the average is less than 5.4mmol/L (100mg/dL) seemed like a pretty good way to track my metabolic control.

The table below shows the relationship I developed between HbA1c, average blood glucose and ketone values based on my n = 1 data.  (Check out the Diabetes 102 article for more details on the basis for the blood sugar level categories and the article Ketosis the cure for diabetes for more details on my learnings measuring ketones and blood glucose).

  HbA1c average blood glucose ketones GKI
 (%)  (mmol/L)  (mg/dL)  (mmol/L)
low normal 4.1 3.9 70 2.1 1.9
optimal 4.5 4.6 83 1.3 3.5
excellent < 5.0 < 5.4 < 97 > 0.5 11
good < 5.4 < 6 < 108 < 0.3 30
danger > 6.5 7.8 > 140 < 0.3 39

the importance of insulin levels

High levels of insulin (hyperinsulinemia) are dangerous and are linked to a wide range of health issues including obesity, heart disease, Alzheimer’s, impotence and cancer. [1]

People with higher insulin levels tend to be more obese as demonstrated by this chart. [2]

image004

As illustrated in the figure below, the insulin levels in an obese person tend to be more constantly raised, rather than the more pulsative characteristics in a normal weight person.  Insulin isn’t bad in and of itself, however constantly elevated insulin is a problem.

image005

The official reference range for fasting insulin pegs “normal” at less than 25 mIU/L [3]; however given that the average insulin levels are 8.6 mIU/L and the western world is going through a crisis of metabolic health, it is probably safe to say that this cut off level is too high. [4]

Stephan Guyenet suggests that, based on healthy populations, optimal fasting insulin levels are likely to be between 2 to 6 mIU/L.  Ron Rosedale says that the lower we have our insulin levels the better. [5]

You are not considered to be ‘pre-diabetic’ until your fasting blood sugars are greater than 5.6mmol/L (100mg/dL) and post meal blood sugars greater than 7.8mmol/L (140mg/dL) however given there is a big gap between optimal blood sugar levels of 4.6mmol/L (83mg/dL) and pre-diabetic there is a good chance you will have higher than desirable insulin levels even if you are not considered ‘pre-diabetic’ (see the Diabetes 102 article for more details on the difference between ‘normal’ and optimal blood glucose levels).

the glucose ketone index calculator

When I joined the Optimal Ketogenic Living I came across Raymund Edwards’ link to this paper by cancer researcher Thomas Seyfried which looked at the relationships between ketones and blood glucose as a possible indicator of metabolic health.

The paper suggests that if someone’s glucose to ketone ratio (GKI) is low then you are metabolically healthy and “fat adapted”.  The GKI value is calculated by dividing the glucose value by the ketone value measured at the same time (both in mmol/L, so those in the US using mg/dL will need to first divide their blood glucose readings by 18 to get to mmol/L).   I have shown the GKI values in the table above based on the average corresponding blood glucose and ketone levels.

According to Seyfried, the goal for cancer patients using a therapeutic ketogenic diet is to have a GKI of less than 1.0.  Patients with chronic disease like cancer typically have glucose to ketone index values of 50 or more.

For most people who are not trying to slow cancer growth or combat epilepsy through a ketogenic diet, anything under 10 is considered to be a “low insulin condition”.  This is indicative that you are not significantly insulin resistant.

my data over time

I have plotted my GKI, along with blood glucose values, in the chart below. In January I managed to improve my blood glucose values by adding some intermittent fasting to what was already a fairly low carb type approach. This caused my blood sugars to come down and ketones to go up. Once my blood glucose reduced and I was showing some ketones, my GKI value was sitting at around 10.

Microsoft Word Document 8062015 65954 AM.bmp

If your blood glucose levels are above 6.0mmol/L or so it is hardly worth trying to measure ketones as they are going to be negligible and not tell you anything, so I suggest that you save your money on the ketone strips until  you have your blood glucose levels under control.  Once you are able to lower your blood glucose you will start to see blood ketones greater than 0.2mmol/L.

Personally I’m simply after normal blood glucose and some ketones for health, weight management and optimal brain function, so I’m not too concerned with the sort of extremely low GKI values that someone battling cancer or managing epilepsy would be aiming for.  For me achieving really low GKI values would require much greater levels of discipline, extended fasting and greater limitation of foods.  It also might be hard to eat regularly with my family and have the sort of diet that would be required to achieve those levels.

However if you are looking to manage extreme insulin resistance, epilepsy or cancer then pushing for very low GKI values may be worth pursuing.

crowd-sourcing data

Through the Facebook groups I was able to obtain more blood glucose/ketone data to add to mine.  The updated chart with the additional data is shown below, with a lot more points sitting out to the bottom right with higher ketones and lower blood glucose.

tracking BGs.xlsx 22072015 42438 AM.bmp

This data consists of:

  • 60 data points from me through my journey from poor blood glucose control to improved blood glucose control and achieving my target weight,
  • 35 data points from my dad who is in a similar position to me, refining his diet and experimenting with intermittent fasting to achieve better blood glucose control, and
  • 60 data points from ten other people much more experienced in the ketogenic diet than me.

What’s interesting to note is that the relationship between blood glucose levels and ketones is not necessarily linear.  As blood glucose levels drop ketones take over as the preferred fuel source.  As ketone levels increase blood glucose levels are held fairly stable.

The people with these exceptional ketone values are not achieving them with high fat diet and lots of MCT oil.  They’re achieving them with multi day fasts.  Ketone will increase as the fast progresses.   Then next time they fast the ketone levels seem to increase more rapidly.

If multi day fasts are not your thing then shorter term intermittent fasting will produce a similar but less dramatic effect to improve insulin sensitivity and help to manage blood glucose levels.

Check out Ted Naiman’s short guide to intermittent fasting here or Jason Fung’s series on fasting here for more info.

I’d love to add some more data to this to better understand the relationship between blood glucose and ketones, so if you do experiment with this style of testing yourself then be sure to send your data through or add it in the comments below.

updated ketone reference values

The table below shows the updated ketone and GKI values that correspond to the various HbA1c risk levels as discussed in this article, with the extra ketone data the ketone levels for “low normal” and “optimal” increase substantially.

  HbA1c average blood glucose ketones GKI
 (%)  (mmol/L)  (mg/dL)  (mmol/L)
low normal 4.1 3.9 70 4.0 1.0
optimal 4.5 4.6 83 2.4 1.8
excellent < 5.0 < 5.4 < 97 > 0.3 18
good < 5.4 < 6 < 108 < 0.3
danger > 6.5 7.8 > 140 < 0.3

This updated analysis seems to align reasonably well with Phinney and Volek’s optimal ketone chart shown below.  From this it appears that:

  • low level nutritional ketosis aligns with your blood glucose being under excellent control,
  • higher levels of ketones occur once you are highly fat adapted, and
  • in someone who is highly fat adapted, the body may hold the blood sugar relatively stable at the lower end of the normal range (using glucagon) while increasing ketones for fuel.

image012

individual glucose : ketone relationships

The chart below shows the glucose values versus ketones plotted for each individual person.  I am not sure what to make of this other than the observation that people who are fat adapted have flatter lines with more points out to the right of the chart.

tracking BGs.xlsx 21072015 24448 AM.bmp

The table below shows the GKI for the range of individuals.  You can see that my dad (Merv) and I did not do anywhere as well compared with to the GKI values of the more experienced ketogenic dieters.

Name  GKI
Marty 10.7
Merv 5.2
Yvonne 3.2
Johanne 3.1
Lara 2.8
Nikki 2.7
Suhayb 2.4
Samie 1.7
Jeff 1.7
Raymund 1.3
Ashley 1.5
Sheryl 1.5
Andrew 0.6

Andrew, with the lowest GKI value of 0.6, is using ketosis to fight cancer.  Check out his amazing story here or his blog here.

Jeff Cyr has used the ketogenic dietary approach to recover from extreme type 2 diabetes and now has a fasting insulin level of 2.2 uIU/mL and an HbA1c of 4.4%.  Jeff says that he has also used the ketogenic diet to recover from an autoimmune liver disease called Primary Sclerosing Cholangitis which he was diagnosed with in 2011 and given eight to ten years to live before dying of total liver failure.  His most recent bloodwork indicates that his liver tests are now normal.  No more death sentence!  He has also trimmed down a bit as shown in his before and after photos below.

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summary

Hopefully there will be more research in the future to correlate fasting insulin levels with the GKI values. Or perhaps this dataset can be expanded to enable people to get a better feel for what constitutes optimal ketone values.

If it turns out that fasting insulin is approximately equivalent to GKI then perhaps we should be aiming for a GKI of somewhere less than 6 for general health (based on Guyenet’s definition of optimal), with people battling more serious issues such as cancer or epilepsy targeting 2 or below?

It appears that the GKI is an interesting tool to empower people in the self-quantification and self-management of their health.

references

[1] http://onlinelibrary.wiley.com/doi/10.1111/dom.12412/abstract

[2] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC329588/pdf/jcinvest00481-0161.pdf

[3] http://emedicine.medscape.com/article/2089224-overview

[4] http://wholehealthsource.blogspot.com.au/2009/12/whats-ideal-fasting-insulin-level.html

[5] http://articles.mercola.com/sites/articles/archive/2001/07/14/insulin-part-one.aspx

71 thoughts on “blood ketone and glucose levels in ketosis”

  1. Any thoughts on physiological insulin resistance for those doing ketogenic diets over the long term?

    I have been doing a ketgenic diet (565 days+) with all days having a blood ketone fasting level over 0.5 or greater with the average around 1.8. Over time the levels are reducing while fasting glucose is rising. I still test my fasting blood ketone as over 0.5 but it tends to range in the 0.8 to 1.3 range. I am careful with my tracking so my macros are always 80%+ fat with low protein and carbs.

    Just curious to anyone’s thoughts on this……

    Thanks
    Stats: Female/36 yrs/5’8/117 lbs

    Like

    1. There are a number of possible issue here.

      This paper from Seyfried indicates that a ketogenic diet with excess calories can be an issue. If this was the issue then fasting or cutting back on total calories could be a consideration. It would be interesting to know if you were gaining weight as well as having rising blood sugars. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1819381/

      What about insulin levels? C-peptide? Is the pancreas burning out.

      I have also heard Peter Attia discuss this sort of thing but there isn’t much other detail about why a long term keto diet might not trigger insulin resistance.

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      1. “Excess calories”, but consider the source: KetoCal

        http://www.myketocal.com/ketocal4-1.aspx

        INGREDIENTS: Refined Vegetable Oils (Palm, Soy, Sunflower), Milk Protein (Casein, Whey), Soy Lecithin, Soy Fiber, Tricalcium Phosphate, Tripotassium Citrate, Arabic Gum, Inulin, Corn Syrup Solids, Sodium Chloride, Magnesium Acetate, Microcrystalline Cellulose, Calcium Chloride, Fructo-oligosaccharides, Corn Starch, Artificial Flavor, Calcium Lactate, L-Cystine, M. Alpina Oil*, C. Cohnii Oil**, Choline Bitartrate, L-Tryptophan, Sodium Caseinate (Milk), Silicon Dioxide, Potassium Chloride, Ferrous Sulfate, Sodium Ascorbate, LPhenylalanine, Natural Flavor, L-Valine, L-Tyrosine, L-Carnitine, Taurine, L-Ascorbic Acid, M-Inositol, Mono and Diglycerides, L-Histidine, Zinc Sulfate, Artificial Sweetener: Sucralose, DL-alpha Tocopheryl Acetate, Niacinamide, Calcium D-Pantothenate, Manganese Sulfate, Copper Sulfate, Thiamine Chloride Hydrochloride, Pyridoxine Hydrochloride, Riboflavin, Vitamin A Acetate, Folic Acid, Ascorbyl Palmitate, Mixed Tocopherols, Potassium Iodide, Chromium Chloride, Sodium Molybdate, Sodium Selenite, Phylloquinone, D-Biotin, Vitamin D3, Cyanocobalamin.

        Whilst they can be interesting, I really don’t like conclusions based on junk keto meal replacement stuff primarily based on processed ingredients and seed oils.

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      2. Noted Ash. Do you have any thoughts on why blood sugars might be drifting up while fat is at 80%. Personally I wonder if it might be better for long term health to run at higher levels of protein (with the proviso that your pancreas can keep up) to maximise nutrients.

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      3. Actually I have continued to lose weight my bmi is currently 17.6 so no weight gain and I eat at a caloric deficit, I weigh my food and track it carefully which is why I was curious about this specific phenomenon so that I look at any high correlations with changes in my glucose and ketone blood levels

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      4. Kathy, do you know if you get higher blood glucose levels with higher protein levels while keeping carbs low? There is heaps of useful nutrients in protein foods that would be good to maximise while keeping within the capacity of your pancreas to keep up. Have you don’t any matched ketone / glucose testing to know what your GKI number is? I would even be interested in adding your data points to this chart?

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      5. I stay on the super low end of the protein spectrum usually lower ranges for the therapeutic benefits of ketosis 30-45 g per day (under the 0.5 x lb/lean body mass).

        I have only increased my cals from fat when I went to under weight. Main sources of fat being mct oil, ghee, coconut oil, olive oil, avocado & avocado based products. I have started to consider keto supplements like ketocana but on the fence still.

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      6. Have you tried intermittent fasting to reset insulin sensitivity? Seems your insulin load is pretty low though so that’s unlikely to be a problem.

        I think it’s probably ideal for most to be at a higher protein intake to increase nutrients, though if you need the therapeutic benefits of keto that’s a whole different issue.

        I think the KeotoForce KetoCaNa is fascinating technology! I got the KetoCaNa in the mail the other day. I have tried it twice. Just a little seemed to kill my appetite for the day! My type 1 diabetic wife tried it and it gave her gut upsets (autoimmune – more sensitive). I’m looking forward to experimenting with it in the future.

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      7. Can’t seem to reply to your reply directly, dunno where this will end up in the stream…

        In the “keto science” communities we’ve come to a gentleman’s agreement to refer to it as adaptive glucose sparing as the term insulin resistance is too scary – much like many medicos and nutritionists are still freaked out by the term ketosis by conflating it with ketoacidosis.

        Eventually it’ll be more widely accepted the nature of insulin:glucagon ratios and such, and why protein can be insulinogenic and even raise blood sugar somewhat, but it’s not really an issue in sane amounts.

        I’m guessing you’ve been following the Unger stuff already.

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      8. Have seen a video by Unger on type 1. Interesting stuff.

        My main interest with protein being insulinogenic is for type 1 diabetics calculating their doses, but I think it’s relevant to some degree for type 2s who might benefit from moderate rather than high levels of protein to manage blood glucose levels.

        Is there any further keto science out there on blood glucose levels drifting up after a long period on strict keto? Jimmy Moore is another interesting case in point. I don’t think it’s a big deal if everything else is going along fine. It would seem to just be a way that your body decides to run at higher blood glucose levels?

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      9. Yeah I’ve been asking for more N=1’s from T1s with regard to protein intake for a while. From a purely observational standpoint it seems like mostly a non-issue. In T2s I don’t see how it could be an issue, if you’ve already got your carbs down to ketogenic levels the amount of protein you consume is never going to have any real effect on BG/insulin – relatively speaking. Some might benefit from an intervention period of a week or month of 4:1 keto, but for the most part cutting the carbs is going to do 90% of the work.

        There’s a fair bit of stuff out there regarding “physiological insulin resistance” and BG float. Again it’s something we’ve come to redefine as benign in the absence of exogenous carbohydrates at worst, and likely a beneficial trade-off in the long-term.

        As for Jimmy – I respect what the guy has done for the community overall, but I’m over the fascination and don’t really consider him an N=1 to follow. 3 years ago I wrote of my misgivings about him probably about to become “our” new ambassador: https://www.reddit.com/r/keto/comments/v2owk/after_8_years_as_a_lc_guru_jimmy_moore_finally/c50rxk1

        Liked by 1 person

      10. I suppose my interest in the GNG issue was sparked by seeing a lot of type 1 diabetics struggling to manage their blood sugar response to protein.

        See this draft article for more on that – https://www.dropbox.com/s/1cl533l2dzb1dzy/Advanced%20dosing%20for%20type%201s.docx?dl=0

        Agree that the nutritional value from protein is highly desirable, but in the absence of exogenous medicating it seems to be a balancing act between maximising nutrition and overloading the system.

        Type 2s certainly seem to struggle to deal with protein more than healthy people. See https://optimisingnutrition.wordpress.com/2015/06/15/the-blood-glucose-glucagon-and-insulin-response-to-protein/

        It’s interesting to note that Metformin works by limiting GNG! http://www.nature.com/nature/journal/v510/n7506/full/nature13270.html

        Like

      1. There’s not a lot written on PIR, however it usually refers to what happens when someone who is eating low carb then goes and has a significant amount of carbs and their blood glucose levels shoot up.

        This is not the case for Kathy as she is just continuing with her therapeutic keto diet.

        The issue could be pancreatic burn out which the c-peptide test would confirm.

        I also wonder if someone at extremely low protein (i.e. very low glucose) is not getting the nutrition they need and this can lead to other issues.

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      2. I plan on increasing protein a bit and tweaking a few other items (IF I have experimented with but didn’t find an impact on trend line; tried the true fast and tried the modified version with bulletproof coffee).

        I feel great health wise no issues with energy, mental clarity, sleep etc. (with some data & tracking ocd still lurking lol)

        Another interesting correlation I will throw out there to see if anyone else is quirky. When I travel for work (flying only car rides do not do this) my ketone levels sky rocket even as I increase water greatly I assume it has something to do with dehydration.

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    2. I’ve just got a glucose meter. And I am still working my way through manual. Lol. But I think I should have got one that tests for ketones too. Although I read somewhere that you can get a good idea just from blood glucose. Oh and I’ve got pee strips. Which are showing deep purple. Do you think I can just track blood glucose or should I shell out for the ketone meter to get my ketone /glucose index
      Can’t wait till someone just makes an iPhone app to do this.

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      1. Ketones are interesting but I think is probably ideal to focus on get get your blood sugar down initially. The chart in this article will give you an idea of what your ketones might be.

        Like

  2. I think this a really useful development of your thoughts. I will certainly be using the GKI ratio myself, to see how I go. My recently started ketone tests seem to vary quite a bit: I don’t know if that is a common exoerience,

    I am a 62 yr old T2 DB in the UK, who is managing my diabetes with LCHF, fasting and HIIT exercise. I am a retired engineer (so I can make time available), and feel much more comfortable to work with some numbers that mean something to me. I have only recently started measuring ketones: the “ketone” label scared me off, until I educated myself. Last HbA1C was 5.1% (32) and my general wellbeing is transformed. As time goes on, I am looking much more at the wider health benefits of LCHF and a ketosis diet, and not just T2DB management.

    As a T2DB, I have often wondered what is the balance of my diabetes, between insulin resistance and low insulin production.

    One of the problems in the UK is that the tests available are fewer than in the USA. It is very difficult to get even one fasting insulin test, so something that is proximal is very useful.

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    1. Thanks Dave. Let us know how you go. I’m eager to add to this dataset as I think understanding the relationship between ketones and glucose is useful, even if just to save money on ketone testing.

      Like

  3. GREAT blog.
    What time of day are the ketone & glucose levels tested? Are these fasting (am) levels?
    I am in very similar situation as Kathy above.

    Liked by 1 person

    1. Correct, I take my levels completely fasted in the morning so that mct oil and other ingested fats are not contributing to the blood ketone levels.

      My fasted state is usually 12 hours + with my last meal around 6 or 7 at night.

      Like

    2. I was usually testing in the morning before food, but sometimes during the day too. I agree that it’s probably better to test in the morning for consistency without the food having an impact. Although I found typically my ketones increased through the day.

      Like

  4. Thank you for the time you spend in putting together this information. Unrelated but the mention of Rosedale reminded of a question re exercise. Rosedale says you should exercise after meals to burn the excess, Keifer says resistance exercise before exercise is optimum for T2. Before or after, what do you think?

    Like

    1. Rosedale and Kiefer are pitching at two very different audiences. Depends if you are sick/diabetic/obese or bodybuilder/figure competitor. A lot of Kiefer’s stuff is about getting an insulin surge to build muscle after periods of extremely low insulin. Most people just need to drop some weight and reduce their overall insulin load.

      Like

  5. I think the priority for type 2s would be to do some training. So whenever it works for you and feels good is probably the priority.

    Resistance training will burn through glycogen stores which are going to be full for most type 2s regardless of whether it’s before or after.

    For bodybuilders he’s saying to work out fasted and then eat afterwards to stop the ongoing breakdown of the muscles. Not as much of a priority if you’re not walking around most of the day with depleted glycogen.

    Like

    1. If fasting insulin levels are low (say 3uIU/mL), how can you be certain it may not be bcs your pancreas is unable to secrete enough insulin to keep glucose levels in check (like with Kathy’s gradually increasing FBG numbers)? Is the only way to know is with C-Peptide test and/or GAD65?
      Would they be definitive?

      Like

      1. Yeah. I’m not a doctor, but a c-peptide test seems logical to confirm that the pancreas is still functioning. If Kathy is using keto for therapeutic purposes (autoimmunity) it is possible that the same issue is also degrading her pancreas.

        Like

  6. Hi I’ve just recently been on the ketogenic diet for about 6 months working with Dr. Fung because I have type 2 diabetes and not sure if I’m Keto adapted or not yet. This morning I tested my ketones and they were a 2.7 mmol and my blood glucose was a 6.0 mmol. Any thoughts as to why this is since I thought if ketones went up blood glucose should go down? Could it be that my body is still not Keto adapted?

    Thanks,

    Eric

    Like

    1. Lots of people benefit from keto initially. Eventually you will want to see if you can build up your protein levels slowly to a point that you can heal your body and improve your insulin resistance with good food as well as fasting.

      Like

  7. Well look and you shall find. My fg was 90 ies with less than .5 ketone. A1c 5.7, so today i did glucose and ketone 2.5 hr after my lg meal. Glucose 84 (4.6) and ketone .7. With a GKI of about 6.6. Does this sound right, maybe im missing something, but I’m pretty sure im keto adapted. I need positive feedback, my A1c has got me bummed. Also, fg seens to be higher than evening glucose.

    Like

  8. Hi Marty.

    Keep up the good work I find your stuff very useful.
    My 2 cents on Glucose/Ketones.

    I have been restricting carbs for about 2 years now but have found it difficult to get ketones much above .5 mmol/l, even with glucose around 5 mmol/l. This was eating 1 or two meals a day and snacks.

    This changed dramatically when I went to 1 meal/day and fasting for 2 days/week. Ketones went to and stayed between 2-5 and glucose dropped further to about 4.6.

    Seems like a harsh regime but it actually isn’t. I never feel hungry weight is stable, I look forward to the fasting days as energy goes up and my mood elevates.

    We will see.
    Thanks for all your info.

    Tim.

    Like

  9. Very interesting piece. I was directed here after increasong ketone levels. I eat a Low Carb High Fat diet, and do not fast as such. Some days I may naturally do intermittent fasting, just due to lack of hunger. My blood glucose levels have consistently been in the 3s, and my ketones are usually in the mid 2s at their lowest, but over the last few days have been in the 4s and even as high as 5.2.

    Liked by 1 person

  10. I am a bit concerned as my fasting is 76 and would not rise above 78 even after I eating and would remain between 76 and 78 all day unless I dont eat or if I eat a low fat meal. I have tried researching but I have not come accross a definitive answer as to why fasting/not eating would raise my blood sugar. I have been on the ketogenic diet for 2 months now and would like some advice.

    Thanks,
    Regards
    Vivian Peters

    Like

  11. Hello Marty,
    I’ve been doing Keto since Sept. In the past month I have started IF – usually 24/1 eat lunch only with a tea for breakfast with a tb of coconut oil or MTC. I have no medical issues other than overweight. My BG is always around 3.4- 3.6 and ketones get as high as 7.1
    Is this ok?? I’ve asked this question on so many fb pages and no one seems to be able to answer me – I am hoping you will.
    Thank you so very much!!
    Sheila

    Like

    1. Do you feel and look OK? That level of ketones would be of more of a concern if your BGs were high too. Seems your insulin levels are very low. If your insulin levels are too low then you may be losing muscle mass and too much weight. If this was as problem you could see how you feel with a bit more protein and green vegies.

      Like

  12. I’ve been doing low carb for about 4 months now and I have lost over 70lbs. I’m pretty sure that I am/was insulin resistant. I have done two fast so far, one lasting 7 days and the other 4 days. I usually IF daily if I’m not doing a water fast. My question is, I saw a video by Dr. Jockers that stated that you’re not in NK with a bg of 80 and above. My fbg is usually 79-84 again unless I’m on the water fast. My bg is usually 65. Is a bg of 83-87 optimal for nk? What would the ketone be? I dont have a ketone meter.

    Like

    1. The table above shows the relationship between Ketones and glucose. Sounds like you’re in a pretty great place. If you try to chase higher ketones with more dietary fat you may stall your fat loss. Glucose may come down a little but more with more fasting and weight loss.

      Like

  13. Are you still wanting GKI numbers? I’ve been tracking the past 3 weeks and will continue for a while yet. Average seems about 5 which seems great but I’m T2D with NAFLD so must be IR?? Expected a higher number.

    Like

  14. Hi

    Please can people comment on the best time to test. I understand the best time in the morning fasted but not sure I understand why. Wouldn’t it be better to test after eating? And if so at what point?
    Thanks charlene

    Like

  15. Marty I am a type 1 diabetic (25+years) and recently started measuring my ppm acetone every morning (ketostix). How do I use this information and what is it tell me about my LCHF diet?

    Like

    1. Keeping minimal ketones in the urine mean you have adequate insulin on board so as not to be going into ketoacidosis. It’s more your blood sugars that will help guide your food choices.

      Like

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