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Pseudo-diabetes

Posted: Mon Aug 14, 2023 4:48 am
by pberry
Does anyone have information or experience with a phenomenon that might be called pseudo-diabetes or starvation diabetes, where one’s insulin resistance appears to increase dramatically on a ketogenic diet?

I have never had elevated fasting glucose or Hba1c and have never been overweight. I started KetoFlex 12/3 eight months ago at age 51. About 2-3 weeks after entering ketosis an oral glucose tolerance test (OGTT) showed that I was in the pre-diabetes range. After seven months another OGTT showed my blood glucose shot up to 228 at the 1- hour blood draw. This would normally indicate diabetes. However, I have had consistently low fasting insulin levels (<=2), fasting glucose (around 80) and Hba1c (5.0) while on keto. Also, no symptoms of diabetes. I exercise for 5-6 hours per week including resistance training and cardio. My BMI started at 18.2 before keto and is now down to 17.0 due to unintentional weight loss of about one pound per month, which I am now focusing on stopping.

In short, I feel like I’m generally healthy and do not have type 2 diabetes. Has anyone else experienced this kind of effect? If so, was it temporary or did it resolve over longer periods on keto? What happened after resuming a normal carb diet?

Re: Pseudo-diabetes

Posted: Mon Aug 14, 2023 5:49 am
by TheresaB
pberry wrote: Mon Aug 14, 2023 4:48 am Does anyone have information or experience with a phenomenon that might be called pseudo-diabetes or starvation diabetes, where one’s insulin resistance appears to increase dramatically on a ketogenic diet?
I am not familiar with those terms, but I have heard of Physiological Insulin Resistance aka Adaptive Glucose Sparing. Taken from our ApoE4.info wiki Blood Sugar under the heading Causes of high glucose measurements is this discussion on Physiological Insulin Resistance aka Adaptive Glucose Sparing
This is a benign condition when fasting glucose levels are high (> 90 mg/dL) despite strict adherence to a low carbohydrate or ketogenic diet. This phenomenon occurs after the muscles have gotten good at fatty acid oxidation as a result of metabolic adaptation so it’s not pulling glucose into the muscles so the muscle tissue becomes "insulin resistant" in order to preserve (spare) serum glucose availability for the brain. This condition is very different from the insulin resistance associated with Type 2 Diabetes, which is why many are now referring to this as Adaptive Glucose Sparing instead. Just as with dawn effect, try a little later in the morning for a more reflective glucose measure ...

Re: Pseudo-diabetes

Posted: Mon Aug 14, 2023 6:36 am
by pberry
TheresaB wrote: Mon Aug 14, 2023 5:49 am
I am not familiar with those terms, but I have heard of Physiological Insulin Resistance aka Adaptive Glucose Sparing. Taken from our ApoE4.info wiki Blood Sugar under the heading Causes of high glucose measurements is this discussion on Physiological Insulin Resistance aka Adaptive Glucose Sparing
This is a benign condition when fasting glucose levels are high (> 90 mg/dL) despite strict adherence to a low carbohydrate or ketogenic diet. This phenomenon occurs after the muscles have gotten good at fatty acid oxidation as a result of metabolic adaptation so it’s not pulling glucose into the muscles so the muscle tissue becomes "insulin resistant" in order to preserve (spare) serum glucose availability for the brain. This condition is very different from the insulin resistance associated with Type 2 Diabetes, which is why many are now referring to this as Adaptive Glucose Sparing instead. Just as with dawn effect, try a little later in the morning for a more reflective glucose measure ...
Thanks Teresa. This is a very good lead. Originally I thought it didn’t apply because my fasting glucose is not high, but now that I googled Physiological Insulin Resistance I see that it applies to OGTT tests. In fact the test guidelines recommend that the patient eat at least 150 g of carbs during the three days before the test so that the body adjusts to producing the required insulin. So basically, my OGTT tests were not valid for assessing diabetes.

I feel reassured!