Higher Fasting Glucose on Ketogenic Diets: Reason to Worry?

The huge majority of people who adopt a low carb or ketogenic diet experience stunning improvements in blood glucose control and insulin levels. Carbohydrate restriction is indeed effective for type 2 diabetes and metabolic syndrome, in fact, that researchers have said it should be “ the default treatment ” for these issues, and those who follow it are typically able to reduce or eliminate many medications, including insulin. however, individual unevenness being what it is, a small share of patients see a rise in fasting blood glucose after some duration of clock time on a very first gear carb diet. Considering that elevated fasting glucose is part of the diagnostic criterion for both type 2 diabetes ( T2D ) and metabolic syndrome, is this apparently paradoxical rise a reason for concern ?
As is true for so much of functional medicine, it’s all about context.  A fast blood glucose ( FBG ) that ’ s higher than one would typically expect in person adhering long-run to a very low carb diet doesn ’ triiodothyronine mechanically argue anything nefarious. There are many reasons why FBG might be elevated, and many ways to assess metabolic health and glucoregulation beyond fair this one measurement .
“Dawn Phenomenon”
The dawn phenomenon will be good known to any doctor who treats patients with diabetes or insulin resistance ( IR ). Blood glucose naturally rises in response to surges of hydrocortisone and other energy-mobilizing hormones in the early on hours of the dawn. This happens in everyone, not precisely those with diabetes or IR, but for healthy people with estimable insulin sensitivity, by the time they wake up, glucose has come back to a normal level. In those with diabetes or IR, on the other handwriting, the glucose remains elevated for a bite long, so when they test it first thing in the morning, it ’ randomness on the high side. This can happen flush when these individuals follow a low carb diet. Glucoregulation as a whole, however, will typically be vastly improved even if the first morning glucose understand is still higher than normal.

“Adaptive Glucose Sparing”
Another rationality for higher than expected fast glucose is something called physiological insulin resistance. This is a phenomenon that occurs in people who ’ ve followed a very low carb or ketogenic diet for a significant length of fourth dimension, and it ’ s slightly relate to the dawn phenomenon. In people who are keto-adapted or fat-adapted—that is, they ’ ve adhered to a very broken carbohydrate intake for a long time—most of the body ’ s cells run happily on fatso acids and ketones, with a much lower necessity for glucose than in people on a higher carb diet. Since these cells are fueled efficaciously and efficiently by fats and ketones, they need only minimal glucose .
The majority of glucose is spared for tissues with an absolute necessity for it, such as the brain. With muscle tissue “ refusing ” the glucose in ordering to keep it available for the brain, the lineage glucose rises, particularly first thing in the morning. This is sometimes called “physiological insulin resistance” in order to differentiate it from pathological insulin resistance, but a better name for it is adaptive glucose sparing—an adaptation some people’s bodies make as a healthy, normal, and to-be-expected response to a very low carbohydrate intake.  
Fasting Glucose – Limited and Misleading!
One measurement in isolation should rarely be used to diagnose something or to prescribe medication—especially when it ’ south something deoxyadenosine monophosphate variable as fasting glucose. A better tool to gauge glucoregulation is hemoglobin A1c. For most people, equally long as A1c is calm convention, a slenderly elevated FBG international relations and security network ’ t lawsuit for alarm clock. While the fasting degree may be on the high side, the A1c is a better indicator of glucose levels throughout the rest of the day, over the course of weeks and months. If a patient is particularly worried about a slenderly high FBG, they can use a home glucometer to test multiple times throughout the day for a few days or weeks in rate to get a more accurate painting of their glucose manipulate. People who experience click phenomenon or physiologic insulin resistance frequently find that their glucose levels throughout the day are well within the normal/low-normal range they expect on a ketogenic diet, and this can put baseless fears to rest .
however, A1c is fraught with liabilities and is not always a reliable indicator of blood glucose levels. There may be an even better way to assess metabolic health and insulin sensitivity. The real hit for the vaulting horse with esteem to insulin sensitivity and healthy glucose control is HOMA-IR .
HOMA-IR
The name says it all : homeostatic model assessment of insulin resistance. Where HOMA-IR shines over fasting glucose and A1c is that it takes insulin into account—that is, how hard the body needs to work in order to maintain homeostasis: how much insulin is required to keep blood glucose in a normal range?
Fasting glucose and A1c are both measurements entirely of lineage glucose. however, in a staggering number of people, FBG and A1c are normal because dangerously high insulin levels are keeping them in check. ( The research worker who uncovered the astounding oscilloscope of this was Joseph Kraft, MD, who chronicled these findings in his book, Diabetes Epidemic & You. )
By testing only FBG and A1c, potentially millions of people with impaired insulin sensitivity are lulled into a false sense of security with regard to their metabolic health.  HOMA-IR is what really tells the tale, and it can help identify patients at risk for myriad conditions stemming from chronically elevated insulin, even when blood glucose is normal. There are numerous such conditions, but the shortstop list includes PCOS, high blood pressure, gout, fleshiness, BPH, erectile dysfunction, and Alzheimer ’ second disease .
here ’ s how HOMA-IR is calculated :

Glucose in mass units (mg/dL)
clip image001 HOMA – IR =
( Glucose x Insulin ) / 405

Glucose in molar units (mmol/L)
HOMA – IR clip image002 =
( Glucose x Insulin ) / 22.5
  • Let’s see HOMA-IR in action:
    Excellent insulin sensitivity:  ≤ 1
  • Average insulin sensitivity:  1.75
  • Insulin resistant:  ≥ 2.75
Patient A
Fasting glucose : 92 mg/dL
Fasting insulin : 4 μIU/mL
 HOMA-IR: (92 x 4) / 405 = 0.90
Patient B
Fasting glucose : 82 mg/dL
Fasting insulin : 14 μIU/mL
 HOMA-IR: (82 x 14) / 405 = 2.83

Patient A’s fasting glucose is higher than Patient B’s, but Patient A’s insulin is much lower.  By taking both glucose and insulin into account, the HOMA-IR scores shows that even with a lower fasting glucose, Patient B is at greater risk for metabolic complications down the road.  Their body has to work harder and they require much more insulin in order to maintain a healthy glucose level.  

Bottom Line
A slightly elevated fasting glucose in long-time moo carbers or keto dieters is typically not cause for concern. As constantly, the full mental picture should be considered then that each measurement—be it glucose, A1c, insulin, triglycerides, LDL, or something else—can be interpreted as part of a dynamic system and within the proper context .
By Amy Berger, MS, CNS

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