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I recently had a question from someone who was a diabetic looking to understand their diabetes and low blood sugar.
They initially had high blood glucose. Then they did keto with intermittent fasting (IF) and wound up with low blood sugar or hypoglycemia. They were a bit concerned with this side effect of the diet, and they reached out for some advice on how to avoid this problem.
Here’s everything you need to know about what is happening in this situation and how you can do keto and IF without getting low blood sugar.
In this Article: -
- What Are We Talking About Here?
- The Problem: Both Medication and Keto Lower Blood Sugar
- What If You’re Not On Medication And You Have Hypoglycemia on Keto?
First Things First: What Are We Talking About Here?
First, let’s discuss the basics and explain diabetes, keto, and intermittent fasting.
Diabetes refers to a group of diseases that affect how your body uses blood sugar or glucose. The underlying cause of diabetes varies by type, but overall you can expect to have high blood sugar with this condition.
This is further exacerbated by the typical American diet, which is usually high-sugar and packed with things like fruit juice, refined carbs, and processed foods. Plus, the average person doesn't get as much physical activity as they should, and this can exacerbate chronic high blood sugar levels.
This chronic high blood sugar can lead to various health concerns and complications, including:
- Cardiovascular disease
- Nerve damage, or neuropathy
- Kidney damage, or nephropathy
- Eye damage, or retinopathy
- Foot damage
- Skin conditions
- Hearing impairment
- Alzheimer’s disease
This is why diabetes is such a serious disease.
There are two main types of chronic diabetes: type 1 diabetes and type 2. With type 1 diabetes, your immune system attacks and destroys your insulin-producing cells in the pancreas. This leaves you with little or no insulin, which causes sugar to build up in your bloodstream rather than being transported into your cells.
With type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells where it's needed for energy, sugar builds up in your bloodstream.
There is also gestational diabetes (diabetes during pregnancy) and prediabetes, but these are potentially reversible conditions.
- Increased thirst
- Frequent urination
- Extreme hunger
- Reactive hypoglycemia
- Unexplained weight loss
- Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough available insulin)
- Blurred vision
- Slow-healing sores
- Frequent infections, such as gums or skin infections and vaginal infections
The Ketogenic Diet
The ketogenic diet is a high-fat, medium protein, low carbohydrate diet. In our healthy keto program, we recommend a keto diet that consists of:
- 70% fat
- 20% protein
- 5% carbs
- 5% vegetables
There are a few reasons for this fat-centric diet:
- We have a lot more fat than stored sugar in our body, so it’s more regularly available for fuel. In fact, an average thin person has about 77,000 calories of stored fat! That’s a huge number, and it only gets higher
- Fat and ketones provide a better quality of fuel. With better fuel, you're much more likely to achieve your health goals. High levels of glucose in the body can lead to lots of serious health issues, including insulin resistance and diabetes. Ketosis - the state of burning fat for fuel - can improve mitochondrial function. Many people experience increased energy and less brain fog on ketosis (check out our full video on the benefits of ketosis).
Now, in our version of keto, we also call for a lot of greens. A straight keto diet does not recommend greens - instead, it'll call for 20-50 grams of carbohydrates. This could come from a banana, a piece of bread, etc., and it's a very low-carb approach. I'll never recommend that kind of diet.
Instead, I recommend that you add at least 7-10 cups of salad and non-starchy vegetables to your diet every day. These veggie carbs don't count in the 20-50 grams of carbs, and you can have as much as you want.
There are many reasons for this. First, there are lots of minerals in these greens that will help speed up the process and maintain your overall health. The potassium from the greens, in particular, will actually heal any insulin resistance and help stabilize the blood sugar at the cellular level.
Also, adding greens will avoid any negative keto side effects like fatty liver and brain fog.
Traditionally, intermittent fasting is a pattern of eating that changes when you eat and when you don’t eat. Now, switching to intermittent fasting is usually a gradual process. Normally, most people eat 5 times a day - breakfast, lunch, dinner, and two snacks. The goal is to pare this down - first to three meals a day in an eight-hour window (fasting the other 16 hours) then to two or even one meal in a 4-hour window (fasting the other 20 hours). You can find more about how to switch to intermittent fasting here.
This triggers two powerful hormones in your body - growth hormone and insulin - stimulates weight loss, lowers inflammation, and more.
We recommend that you combine keto with intermittent fasting because, if you’re just doing keto and you’re still consuming multiple meals, you’re going to spike too much insulin every time you eat. That means it’s going to take longer to go into keto-adaptation and get all the health benefits of keto.
With keto + intermittent fasting, you solve this problem. See, fat is the only food group that doesn’t bring too much insulin, so if you’re not eating as frequently and you’re consuming more fat together, then you’re going to drop insulin and achieve ketosis much faster.
The Problem: Both Medication and Keto Lower Blood Sugar
If you’re on a blood sugar medicine for your diabetes, remember that the purpose of the medication that you’re taking is to lower your blood sugar levels. This can be done through various mechanisms. There's glucagon, which is a hormone usually released by the pancreas that raises glucose and fatty acids in the bloodstream. You can get glucagon injections or a glucagon kit from your doctor.
Then, there are some medicines that boost insulin levels, others that block enzymes that digest starches to low the rise of blood sugar, glucose tablets, etc. - but the point is usually to lower or stabilize high blood sugar levels.
The keto diet will also lower your blood sugar.
How? Well, normally, your body and your brain run on glucose for energy, otherwise known as ATP. You get the majority of your fuel, then, from sources that you can break down into glucose - usually carbohydrates. Your body, then, is constantly craving that sugar for fuel, and you need to eat more frequently in order to give your body what it needs.
This kind of diet doesn’t usually lower blood sugar levels, because you’re relying on sugar to function.
On the keto diet, on the other hand, you’re primarily consuming fats.
And fat is the only macronutrient that doesn’t spike insulin and blood sugar. Both protein and carbohydrates do. Carbohydrates, in particular, are the biggest source of sugar fuel, even if they’re “good carbs” like fruits and whole grains. As a result, when your body starts to run on ketones, the switch will keep your insulin from spiking, which will allow your body to burn fat and maintain muscle.
Overall, it’s a healthier, more efficient source of fuel for the body and the brain.
Intermittent Fasting Will Lower Blood Sugar Levels More
Intermittent fasting decreases that spike even more. Why? Spikes in insulin also come from the quantity of food that you eat. Even if you’re consuming mostly fat, you will still get an insulin spike if it’s an especially large meal. That’s why I recommend a combination of keto and intermittent fasting. This will lower your blood sugar levels and improve your health overall.
That said, if you’re still taking the medication and you’re doing keto with intermittent fasting, you could end up with excessively low blood sugar.
That’s because you’re duplicating your treatment. If you’re on keto with intermittent fasting, it’s likely that you won’t even need the medication - or you’ll need a much lower dose to maintain your blood sugar levels. That’s because keto with intermittent fasting decreases the need for blood sugar medication like glucagon, insulin injections, or glucose tablets.
So if you’re on keto with IF, get with your health care provider and adjust your dosage. If your blood sugars are at 100mg/DL or less, you won’t need medication at all.
What If You’re Not On Medication And You Have Hypoglycemia on Keto?
Now, let’s say that you’re off the diabetes medicine and your blood glucose is still too low. Well, there are a couple of things to consider here.
If your blood sugar levels are low but you feel fine, it’s really not a problem. When you do keto and intermittent fasting, you will have new, lower blood sugar target ranges because you’re not running your body on sugar anymore. Your body will adapt and you can get by with a lot less blood sugar than what is usually considered “normal.”
If this is the case, your blood glucose can be as low as 60mg/dL and you could feel fine because your body is not running on sugar anymore.
The Problem Here Could Be Your Adrenals
That said, if you feel poorly (if you feel jittery or like your low blood sugars are a problem) it could indicate that your adrenal gland is trying to compensate and bring your low blood sugar up - but it is unable to.
This can happen if your adrenals are depleted and you’re suffering from adrenalue.
Here’s the deal here: the adrenals primarily function to regulate and adapt the body to all stress states. That means they counter stress by producing cortisol and adrenaline. They also have many other functions, from anti-inflammatory actions (ridding the body of pain and swelling) and immune system protection to balancing fluid and salt levels and controlling minerals (like potassium), rapid heart rate, and sleep and wake cycles.
If your adrenals aren’t functioning properly, you’ll notice the symptoms of a spike in cortisol or adrenaline.
If that’s the case, then you basically have to go about intermittent fasting more gradually so you can build your adrenals back up. So instead of doing one meal a day, do two meals. Or instead of doing two meals, do three meals with no snacks. Add a lot of greens, B vitamins, and potassium supplements so you can actually correct this situation and go longer without meals.
So, you’re either going to support the adrenal directly with nutrition or you’re going to add in the key nutrients to allow your body to adapt to running off of fat 100%. That would mainly be the potassium and the B vitamins.
Going from high blood sugar levels - a side effect of type 1 and type 2 diabetes - to low blood sugar is a good thing. You just need to understand what’s happening, address the real cause, and resolve it.
Disclaimer: Our educational content is not meant or intended for medical advice or treatment.
Editor’s Note: This post has been updated for quality and relevancy.