Hi all! I was wondering if any of you had found any research done on the benefits/risks of a ketogenic diet for Type 2 diabetics with pancreatic burnout...basically insulin dependent. In all the reading I've been doing, the docs all say that ketones can never get too high in anyone--including T2 diabetics--because the pancreas will always regulate it with insulin production/release if levels get too high.

However, there are a lot of warnings for Type 1s who don't produce insulin, although I have read a lot of anecdotal evidence from many T1s who are using nutritional ketosis as a diet plan.

I just can't find anything specifically about T2s who produce little to no insulin, like me. I am not, right now, taking my insulin, as I know it will counteract the benefits I am getting from NK, although I know I will have to start it again soon. I've been strictly following a ketogenic diet plan along the lines of Jimmy Moore's and Phinney/Volek. My BGs are staying pretty steady (I'm not eating much!) in the mid to upper 200s, which sounds horrendous but is better than I do eating SAD and taking insulin. I am HUGELY insulin resistant, and for the first time have started to drop a little weight on this, and am loathe to either change the eating plan or go back to injecting insulin...but don't want to have issues with DKA, either, of course, or long term effects of such a high BG.

I did get one of the free ketone meters from Abbott, and will be ordering strips soon so I can keep an eye on blood ketones, at which time I will start adding in very small boluses of insulin and still try to keep enough balance that I can stay in ketosis.

Do any of you either have experience with this, or know of any articles? I've searched high and low but haven't really found much specific to my situation.

Have you read Dr Richard Bernstein's books? http://www.amazon.com/Dr-Bernsteins...chard+bernstein

This is an updated version of a book he wrote in 1997 (which I read). While I don't think he uses the term Nutritional Ketosis in the 1997 book, he advocates keeping carbs at 30 grams per day, 6 grams at breakfast, 12 each at lunch and dinner, to keep blood glucose at optimal levels with minimal insulin. That is in the range that Phinney and Volek recommend to maintain NK.

Bernstein himself is a type 1 diabetic and has followed this way of eating for 30+ years. He has a website, and still maintains a medical practice. When I first read his book, it said to call his office to get his current recommendation on which blood sugar meter was best/most accurate (apparently they change a lot). I called and he answered the phone. I can't think of anyone who would be better prepared to answer your questions than him.

Thanks, Liz...I have read his book and followed that regimen. The problem is I think my metabolism is so messed up I can't really fix anything with that many carbs daily. I'm trying to keep it around 10. And I know he would tell me to start my insulin again :-)

I think I will probably be able to answer my own question as soon as I get my meter strips and can see what's really going on Thanks so much for your reply!

Do you know if he has made any significant changes to his earliest books? He is such an inspiration!

Sorry, I've not read the updated book.

I wonder what he thinks about NK for people with a wildly deranged metabolism. If I eat a normal diet, I can take over 200 units of insulin a day and still have terribly high bgs. If I eat a standard lc regimen like his, I still have to take large doses to get decent bgs and then play the "let's not crash" game, and watch my weight go up.

*sigh* Even with unacceptably high numbers now, this is the closest I've come to feelIng normal, and with a little weight loss...as long as I still produce enough endogenous insulin to keep ketones in a healthy range. I guess that remains to be seen.

Have you looked into Jenny Ruhl's blog? She has formulated her ideas by reading Bernstein and everything else she can get her hands on. diabetesupdate.blogspot.com

From what I remember, Bernstein says to start with 30 g carbs and whatever protein is needed to control hunger. If that is not enough to normalize blood glucose, then you should start cutting back on protein.

OK, either with SAD or low fat or whatever your alternative is, you require insulin to get your blood glucose in line. Do you require more or less insulin if adhering to LC? My understanding is that the longer you eat LC the more normal your insulin response becomes (assuming you still make insulin) and if all goes well, the less exogenous insulin you should need. Have you not found that to be the case? How long have you stuck with it rigorously?

I have adhered rigorously, but not for more than a few months at a time since it has become so uncontrolled. I have seen some improvement, certainly, with regular lc, but as long as I need to keep taking so much insulin (my last test, which was several years ago, showed I was producing little to no insulin) I just cant seem to break the cycle of IR, weight gain, etc...and find it really difficult to titrate my dosages correctly. I did switch to regular insulin on lc, which works better for the slower glucose release from eating more protein/fat. That helped. Maybe I will try some small boluses of regular and see what happens.

I have heard of Jenny Ruhl but haven't looked at her blog...I will check it out! Thank you!

I've just started rereading Bernstein and I'm amazed at some of the little...but important things he said (which means I'm revamping my own diet).

I originally read "4-5 oz of protein at a meal"...but what he clarified was 1-1.5gm per kilo of *ideal* weight. Crud. I've been doing 4-5 and just eating whatever protein I wanted and my protein numbers were coming in at 100-115. In another thread, I think I said they were lower, but I misread the column. Instead I should be eating 60-68gm per day. Oops.

He also does low fat, but I just don't think that's as important on low carb and many experts agree. As far as carbs, the only ones I get at breakfast are what's in the 2 eggs and then I eat 10 at lunch and 10 at dinner (and that includes any hidden carbs). If i go above 25gm, I can see the fluctuation in my BG.

So I'd look at your grams of protein *and* consider lowering your carbs a bit more. Just my .02.

Thanks, Elfie...nice to know his current recommendation. I am doing nutritional ketosis, which is considered high fat, moderate protein...I had to adjust to the lower protein, too. Seems to be working though! Is it for you?

Not diagnosed at diabetic, but I have done some experimenting with NK myself. I find that protein has a large effect on my blood glucose. I eat around 90-110g and my fasting BG is 100+. I lower it to 60-70g and I see FBG's around 70-80. An incredible difference.

Also, I bought a blood ketone meter and find the lower protein amounts raises my blood ketones quite a lot, but it is still well within dietary ketosis measurements.

I'll let you know. I just started on the lower protein today...but I lost my weight and lowered by BG's from uncontrolled even on insulin (over 240) and am off all meds with an A1c of 4.9...all following Dr. Bernstein's diet, so I'm going to trust that it will make a difference in the long run.

Wow...now you are my inspiration :-) How long did it take you? Did you just gradually reduce your insulin as you lost weight and got better bg control?

I'm ordering my ketone meter strips today :-) Thanks for your input here, Nancy...I haven't measured how much protein I'm actually eating, but it can't be much, because I'm not really eating much overall... I'll have to crunch some numbers to see what I'm really doing :-)

I'm sure an experienced diabetic will weigh in here, but from what I understand you do need insulin to cover what protein and carbs you are eating if you can't produce it yourself. You already know that, I'm sure.

Dr. Peter Attia has a 4 part series on ketosis that might be helpful: http://eatingacademy.com/nutrition/...od-state-part-i

I've only read the 4th part. It is technically dense, but I gleaned some interesting things.

I'd never heard that insulin regulates ketosis. I'd have thought if that were true then Type 1's would be pretty concerned about that and, AFAIK, they don't seem to be here.

what meds are you taking like aspirin can give false reading. It might be dangerous to have less carbs. He has a web near next week and you can ask questions. 4 servings of vegetable's or three with cheese and cream in coffee. first do the diet correctly talk to dr. about the things you think are screwed up.
insulin has stuff in it that may cause a reaction allergic. I did Atkins twice but because i am not diabetic doing Bernstein, Help us to help you. I always find going back to basic is best. when i did Atkins had to stayed induction long then most he ordered it. I am slowly loosing and for me its a long time coming. start by getting someone to read your sugars diet to help you. wvets