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Health & Nutrition

Testing for Sugar and Ketones

Testing for blood sugar and ketones levels is a great tool when using a ketogenic/LCHF diet for therapeutic purposes. Here is a suggested method to optimize its use to understand your baselines and guide you towards achieving your dietary goals.


Establishing baselines stage

To understand where you are in regards to your blood sugar levels and your body’s ability to deal with consumed sugar and carbohydrates, do the following for a week or so:

  • Check your blood sugar 1st thing in the morning before eating anything or starting daily activities. Do this on a morning when you had a good night’s sleep, are at your normal stress levels, and preferably have not eaten for about 12 hours since the last night meal.
  • Continue to test 30 minutes, 1 hour, and 2 hours after each meal throughout the day. This will show that blood sugar rises after a meal and that your body can efficiently remove the blood sugar and sugar from carbohydrates.
  • Keep a record of what you have eaten for each result, use an app or take a picture to keep track and write these numbers down in a spreadsheet, etc. You can also test your blood sugar before and after eating or drinking other foods and snacks or exercising to collect more data for how your body deals with various foods, activities, and stress levels.
  • At this stage, you do not need to test for ketones

Action stage

The purpose now is to lower your carb intake to the desired levels. Try this step after you have been on a low carbohydrate diet of 20mg net carbs daily for at least a week. Net carbs are the total carbs minus the fiber.

  • Check both blood sugar and ketones in the morning and after meals as you did for the baseline but pay attention to what you eat and how the levels are affected by the foods you eat.
  • The idea is to tune your diet to achieve and sustain low levels of sugar and detectable ketones levels.
  • As you learn what triggers a spike in your sugar or kicks you out of ketosis, you will need to test less and become more comfortable with the low-carb lifestyle.
  • The benefit of checking for ketones is that it is the best indicator for insulin levels in the blood. Insulin is not easy to test for; detecting ketones is an indication that your insulin is adequately low.

Additional comments

  • Blood sugar is measured in millimole per liter (mmol/l) or milligrams per deciliter (mg/dl) and calculated below; use the latter.
  • Formula to calculate mmol/l from mg/dl: mmol/l = mg/dl / 18
  • Formula to calculate mg/dl from mmol/l: mg/dl = 18 × mmol/l
  • Understand that this process can be complicated for the first few weeks, and setbacks and disappointments are expected. Sugar and carbohydrate consumption has created physical and psychological addictions for our bodies, and kicking these addictions will take time and perseverance.
  • You may have to make adjustments like increasing salt intake if feeling low energy, etc. There are many informational videos on this subject.
  • A positive ketone level does not mean that you are “fat adapted” as the body usually continues to use sugar for muscles, etc. It means you have some ketone bodies in your blood that are found to be therapeutic in “nutritional ketosis,” and your insulin levels are adequately low. I have a great video on this from Dr. Stephen Phinney under “Inflammation“.
  • Ketogenic/LCHF diet is highly individualized, ” Self Experimentation on the Keto Diet” explains it the best. 
  • You can subscribe to “Low Carb Down Under” for more of his and another great video.
  • The usual source of low (20 grams) daily carbs are usually leafy, green vegetables, carrots, almonds, avocados, a few black/red berries, and blueberries. Grains (bread, rice), starchy vegetables (potatoes, corn), and sugary fruits usually prevent ketosis.

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