Keto And Morning Blood Sugar: What's The Link?

Blood sugar levels are a primary marker for determining diabetes risk. The higher your blood sugar, the higher your risk of developing diabetes and other life-threatening conditions such as heart disease. The dawn phenomenon, which affects over 50% of people with diabetes, is an increase in blood sugar levels that takes place early in the morning. This occurs when the body either doesn't produce enough insulin (type 1 diabetes) or doesn't respond effectively to insulin (type 2 diabetes). As a result, blood sugar levels can rise dramatically overnight, causing symptoms such as intense thirst, hunger, and the frequent need to urinate. Elevated fasting glucose levels are also a common trend among individuals who have been following a keto diet for a prolonged period. This is known as glucose sparing and is the body's way of ensuring that glucose is present for organs that require it.

The dawn phenomenon

During the early morning hours, there is a transient increase in both glycogenolysis (the breakdown of glycogen for energy) and gluconeogenesis (the creation of glucose from non-carbohydrate sources) in the liver. This increase in glucose production can lead to hyperglycemia if it is not balanced by sufficient insulin. In people with diabetes, especially type 2, the body may not be able to produce enough insulin to compensate for the increase in glucose production, resulting in elevated blood sugar levels upon waking.

Managing the dawn phenomenon typically involves a combination of lifestyle modifications and insulin therapy. Lifestyle changes may include increasing evening exercise, adjusting the ratio of protein to carbohydrates in the evening meal, and consuming breakfast early in the morning. Insulin therapy may involve adjusting the type, dose, or timing of insulin administration to better control blood sugar levels during the early morning hours.

Insulin resistance

Under normal circumstances, insulin helps glucose (a form of sugar) enter cells in the muscles, fat, and liver, where it is used for energy or stored for later use. However, with insulin resistance, these cells do not respond well to insulin, resulting in elevated blood glucose levels. This can lead to prediabetes and type 2 diabetes if left untreated.

There are several factors that can contribute to insulin resistance, including excess body fat, especially around the belly, and a lack of physical activity. Diet can also play a role, with highly processed and high-carbohydrate foods contributing to insulin resistance. Certain medications and hormonal disorders can also cause insulin resistance.

The treatment for insulin resistance focuses on lifestyle modifications, including a healthy diet, regular physical activity, and weight loss if needed. These changes can increase insulin sensitivity and help manage blood sugar levels. In some cases, medications may be prescribed to treat coexisting conditions.

While not everyone with insulin resistance will develop complications, it is important to manage the condition through lifestyle changes and regular medical check-ups.

The Somogyi effect

Treatment for the Somogyi effect focuses on effective glucose management. This may involve adjusting the dose or timing of diabetes medications or insulin, changing the type of insulin, or adjusting dietary and lifestyle factors.

If you suspect you are experiencing the Somogyi effect, it is important to consult a healthcare professional for guidance in managing your blood sugar levels. They may recommend monitoring your blood sugar levels more frequently or using a continuous glucose monitoring (CGM) device to gather more data.

The impact of diet

A keto diet can be a great tool for enhancing metabolic flexibility, reducing insulin levels, managing glucose levels, preventing neurological diseases, and treating migraines. Research has found that a well-crafted keto diet may even be more effective than low-fat diets for the treatment of obesity and diabetes.

The keto diet limits carbohydrate intake, which deprives the body of exogenous glucose, or glucose from sources outside the body. This forces the body to make certain adaptations.

First, limiting the body’s glucose sources causes the body to switch from primarily exogenous glucose for energy to glycogen—or glucose storage—causing specific metabolic changes.

Because certain organs require glucose for energy, our bodies can produce their own glucose, specifically from the liver. This process is known as gluconeogenesis, and it ensures our organs get the correct amount of glucose to function properly.

When glucose availability drops so low that the body doesn’t have enough to use for energy, it enters a state called ketogenesis. In this state, ketone bodies are created from fatty acids and replace glucose as the body’s primary source of energy.

There is no doubt that carbohydrates have the most influence on glucose levels. So, it makes sense that if you are following a zero to very low-carbohydrate diet, your glucose levels will remain more steady.

Average glucose levels for keto dieters usually hover anywhere between 70-­90 mg/dL. A common trend that has been observed among keto dieters is low glycemic variability or very stable glucose levels.

Elevated fasting glucose levels are a very common trend that has been seen with individuals who have been following a keto diet for a prolonged amount of time. This trend, also known as "glucose sparing," appears to be a natural adaptation.

Elevated fasting glucose levels usually start to occur with those who have been following a strict keto diet for over a year. This is the body's way of assuring that glucose is present for organs that require it. According to current research, this isn’t necessarily a bad thing. However, it is recommended to monitor other health metrics such as glycemic variability, fasting insulin, HDL, triglycerides, and liver enzymes to ensure that everything else remains in a good range.

Keto diets help to lower insulin levels. But another common trend that is seen is slightly higher glucose responses to small amounts of carbs. Individuals who follow a very low-carb diet may have lower insulin sensitivity compared to someone who consumes more carbs. Keto diets can lead to temporary physiological insulin resistance, where the body overreacts when carbs are introduced.

Physiological insulin resistance is different from pathological insulin resistance. Pathological insulin resistance is a disease state, whereas physiological insulin resistance is a temporary adaptation.

Similar to the elevated fasting glucose levels with a keto diet, this does not appear to be a bad thing. What is happening is that the muscles, which typically prefer glucose, start to prefer fatty acids for fuel instead. Muscles are a huge sinkhole for glucose. So, when the muscles start to prefer fatty acids over glucose, consuming carbs tend to cause larger glucose elevations.

Tips for a keto diet

• Understand your carb threshold and what type of carbs you tolerate best. Understanding your carb threshold will help maintain metabolic flexibility. This will allow your body to quickly shift from using ketones and glucose, without ever being dependent on just glucose.
• Identify your trigger foods. Everyone has a unique response to carbs. Identifying how you tolerate specific carbs and identifying the foods that drastically increase your glucose will help optimize your keto diet.
• Test out "keto-friendly" foods. Many keto-friendly foods are made with artificial sweeteners and highly processed starches that often raise glucose levels.
• Experiment with portion sizes. Getting into ketosis is one thing, but staying in ketosis is an entirely different challenge. The amount of carbs you can eat while staying in ketosis is unique from person to person.
• Test your protein threshold. The amount of protein that one person can tolerate is highly personalized. To find out what works best for your body, it is best to test both ketones and glucose.

The impact of exercise

Exercise is an important component of a keto diet and can have a significant impact on blood sugar levels. When combined with a ketogenic diet, exercise can be a powerful tool for reducing blood glucose levels and achieving weight loss. Here are some key ways in which exercise influences blood sugar on a keto diet:

Enhancing Metabolic Flexibility

A well-crafted ketogenic diet, complemented with exercise, can enhance metabolic flexibility. This means the body becomes more adaptable at utilising different energy sources, such as ketones and glucose. Exercise, particularly endurance exercise and weight training, increases insulin sensitivity, which is the opposite of insulin resistance. By improving insulin sensitivity, exercise helps regulate blood sugar levels effectively.

Accelerating Fat Burning

The ketogenic diet is designed to burn body fat, and exercise accelerates this process. When on a keto diet, the body enters a state of ketosis, where it burns fat for energy instead of glucose. Exercise further stimulates this fat-burning process, helping individuals lose weight and manage their blood glucose levels.

Individual Variability

Exercise Intensity and Duration

The intensity and duration of exercise can influence blood sugar levels. Longer and more intense exercise sessions can lead to a more significant blood glucose-lowering effect. Additionally, returning to exercise after a break of several days can also impact blood sugar levels. It is important to monitor blood glucose levels before, during, and after exercise to understand how your body responds to different types and intensities of workouts.

Exercise Timing

The timing of exercise in relation to meals can also affect blood sugar levels. It is recommended to pair carbohydrate intake with protein and fat for better glucose control. Exercising after a meal that includes carbohydrates can help manage blood sugar spikes. Additionally, exercising in a fasted state or after a low-carb meal can tap into the body's fat reserves for energy, promoting weight loss and blood glucose control.

In conclusion, exercise plays a crucial role in the keto diet's effectiveness in managing blood sugar levels and achieving weight loss. By combining a ketogenic diet with an appropriate exercise regimen, individuals can enhance their metabolic flexibility, accelerate fat burning, and improve overall health. However, it is important to consult with a healthcare professional to determine the best exercise routine for your specific needs and goals, especially if you are on diabetes medication.

Frequently asked questions