Managing Blood Sugar: Testing Tips For Keto Dieters

Testing blood sugar levels is an important part of a ketogenic diet. Ketogenic diets aim to keep carbohydrate intake as low as possible, forcing the body to get energy from fat instead of carbs. This process is known as ketosis, and it can be measured through blood, breath, and urine tests. Blood glucose meters are a common way to measure blood sugar and can be purchased at most pharmacies. The optimal ketone and blood sugar levels for ketosis vary from person to person, but generally, blood sugar levels should be kept low while in ketosis. For people with prediabetes or type 2 diabetes, reducing carbohydrate intake can help manage blood sugar levels.

Calibrate the ketone and glucose meters

Calibration is the process of testing your meter to ensure it is giving you accurate results. Control solutions are used to calibrate your meter and contain a known amount of β-Ketone or Glucose that can react with test strips.

When to Calibrate Your Ketone Meter

You should calibrate your ketone meter when:

• You first receive or purchase the meter.
• You are checking the meter and test strips (this should be done at at least once a week).
• You are using a new vial of test strips.
• You suspect the meter or test strips are not working properly.
• Your blood ketone test results are not consistent with your expectation, or you think the results are inaccurate.
• The meter has been dropped or damaged.

How to Calibrate Your Ketone Meter

• Insert a ketone test strip to turn on your meter.
• Wait for the meter to display the flashing blood droplet.
• Shake the control solution vial thoroughly.
• Squeeze out a drop of solution onto the tip of the vial cap and wipe it off.
• Then squeeze out another drop onto the tip of the vial cap.
• With the strip in the meter, gently move the tip of the test strip to the control solution droplet and hold it there until the strip fills completely and the meter begins to count down.

When to Calibrate Your Glucose Meter

You should calibrate your glucose meter when:

• You first receive or purchase the meter.
• You are checking the meter and test strips (this should be done at at least once a week).
• You are using a new vial of test strips.
• You suspect the meter or test strips are not working properly.
• Your blood glucose test results are not consistent with your expectation, or you think the results are inaccurate.
• The meter has been dropped or damaged.

How to Calibrate Your Glucose Meter

• Remove a test strip from its foil pouch.
• Insert a test strip into the meter.
• The meter will turn on after a beep. An image of a test strip with a flashing blood droplet will appear, letting you know the meter is ready to test.
• Shake the control solution bottle thoroughly.
• Squeeze the control solution bottle gently and discard the first drop.
• Squeeze out a second small drop onto a clean, non-absorbent surface.
• Immediately touch the tip of the test strip to the drop of control solution. The control solution will be drawn into the test strip.
• Hold it in the drop until the meter beeps, and you see the meter begin to count down on the screen. After this, your control test results will be displayed.

Take the readings

Taking the Readings

Now that both meters have been calibrated, you are ready to take a blood glucose and blood ketone reading. For the glucose test, your hands must be clean and dry. Using warm water to wash your hands will improve blood flow.

Get the strips ready first, being careful to not to touch the testing parts. This will also ensure that the meter doesn't shut off before you can get the strip out and insert it. Open one of the individual ketone strips and take the strip out. You can just place it on top of the meter until you are ready to insert it. Do the same thing with a glucose strip.

Once the strips are ready, wash your hands and dry them thoroughly. Using the lancet tool that comes with the Ketone meter, prick your finger and squeeze out a small drop of blood. Being careful to protect the blood drop, insert the glucose strip into the meter and wait for the screen to show a raindrop symbol, which indicates that it is ready to test. Then touch the end of the strip to the drop of blood on your finger. If you are using the same meter for both, wait for the blood glucose result, then remove the strip.

Now squeeze out a larger drop of blood for the Ketone meter, insert the ketone strip into the meter and wait for the raindrop symbol to show on the screen. Touch the end of the strip to your blood drop and wait for it to draw the blood all the way into the strip.

Ketone Test Results

Wait for the ketone test results. The test results will look similar to the pictures below. Those are my results after fasting for one day.

You will do this pretty often so checking blood sugar and ketone levels will become routine. Remember to keep a log of your results along with tracking your food intake so that you can troubleshoot if you don't reach the recommended targets.

As you begin tracking your readings, you'll notice that your blood sugars will be higher and ketones will be lower in the mornings. This is due to gluconeogenesis.

Understand gluconeogenesis

Gluconeogenesis is a metabolic pathway that results in the biosynthesis of glucose from non-carbohydrate carbon substrates. In vertebrates, gluconeogenesis occurs mainly in the liver and, to a lesser extent, in the cortex of the kidneys. It is one of two primary mechanisms – the other being degradation of glycogen (glycogenolysis) – used by humans and many other animals to maintain blood sugar levels, avoiding hypoglycemia.

The gluconeogenesis pathway is highly endergonic until it is coupled to the hydrolysis of ATP or GTP, effectively making the process exergonic. For example, the pathway leading from pyruvate to glucose-6-phosphate requires 4 molecules of ATP and 2 molecules of GTP to proceed spontaneously. These ATPs are supplied from fatty acid catabolism via beta oxidation.

In humans, the main gluconeogenic precursors are lactate, glycerol (which is a part of the triglyceride molecule), alanine and glutamine. Altogether, they account for over 90% of the overall gluconeogenesis. Other glucogenic amino acids and all citric acid cycle intermediates (through conversion to oxaloacetate) can also function as substrates for gluconeogenesis.

The gluconeogenesis process essentially reverses glycolysis. Four enzymes facilitate glucose synthesis by this pathway by reversing 3 highly exergonic glycolytic steps, namely, pyruvate carboxylase, phosphoenol pyruvate carboxykinase (PEPCK), fructose-1,6-bisphosphatase, and glucose-6-phosphatase. However, these enzymes are not present in all cell types. Therefore, gluconeogenesis can only occur in specific tissues.

The primary stimulus for gluconeogenesis is low blood glucose. Starting with pyruvate, the reactions involved in gluconeogenesis are as follows:

• In the mitochondrion, pyruvate carboxylase converts pyruvate to oxaloacetate. Pyruvate carboxylase requires ATP and the coenzyme biotin for activation.
• Oxaloacetate is converted to malate before it crosses the mitochondrial membrane.
• Malate is converted back to oxaloacetate once in the cytosol.
• In the cytosol, PEPCK decarboxylates oxaloacetate, which then rearranges to form phosphoenol pyruvate (PEP).
• Enolase hydrates PEP to form 2-phosphoglycerate.
• Phosphoglycerate mutase converts 2-phosphoglycerate to 3-phosphoglycerate.
• Phosphoglycerate kinase phosphorylates 3-phosphoglycerate to form 1,3-bisphosphoglycerate. This reaction requires ATP.
• Glyceraldehyde-3-phosphate dehydrogenase reduces 1,3-bisphosphoglycerate to glyceraldehyde 3-phosphate. Reduced nicotinamide adenine dinucleotide (NADH) is the electron donor.
• Triose phosphate isomerase isomerizes glyceraldehyde 3-phosphate to form dihydroxyacetone phosphate (DHAP).
• Aldolase combines glyceraldehyde 3-phosphate and DHAP to form fructose 1,6-bisphosphate.
• Fructose-1,6-bisphosphatase dephosphorylates fructose 1,6-bisphosphate to form fructose 6-phosphate.
• Phosphohexose isomerase converts fructose 6-phosphate to glucose 6-phosphate.
• Glucose-6-phosphatase dephosphorylates glucose 6-phosphate to form glucose, which can enter the bloodstream freely.

Glucagon is the most important promoter of gluconeogenesis. Secondary ones include the catecholamines, growth hormone, cortisol, and gluconeogenic substrates. Insulin is a potent inhibitor of gluconeogenesis. Falling insulin levels during fasting activate gluconeogenesis and the processes that increase the availability of gluconeogenic substrates.

Manage your insulin load

Insulin resistance is a condition in which your body does not respond normally to insulin, a hormone produced by the pancreas that is essential for regulating blood sugar levels. Insulin resistance can be temporary or chronic, and it is treatable in some cases. It is often associated with Type 2 diabetes but can also affect those without diabetes. The two main factors contributing to insulin resistance are excess body fat, especially around the belly, and physical inactivity. A diet high in processed, high-carbohydrate foods and saturated fats has also been linked to insulin resistance.

• Follow a lower-carb eating plan : Of the three macronutrients (carbohydrates, protein, and fat), carbs raise blood sugar and insulin levels the most. Lower-carb diets can be effective for weight loss, managing diabetes, and increasing insulin sensitivity.
• Consider supplementing with apple cider vinegar : Apple cider vinegar may help prevent insulin and blood sugar spikes after eating, especially when consumed with high-carbohydrate foods. While results are mixed, some studies suggest that consuming 2-6 teaspoons of vinegar daily can improve glycemic response.
• Keep an eye on portion sizes : Eating large amounts of food can lead to hyperinsulinemia, especially if the food causes your body to produce extra insulin. Even if you are otherwise healthy, large portion sizes can still impact your blood sugar levels.
• Lower your intake of all forms of sugar : Diets high in added sugar are associated with insulin resistance and metabolic disease. Limiting your sugar intake can help lower insulin levels and improve insulin sensitivity.
• Prioritize physical activity : Regular physical activity can have powerful insulin-lowering effects. Both aerobic exercise and resistance training can increase insulin sensitivity and decrease insulin levels, especially in people with obesity or type 2 diabetes.
• Increase soluble fiber intake : Soluble fiber helps regulate blood sugar levels by slowing the movement of food through your digestive tract. It also feeds the friendly bacteria in your colon, which may improve gut health and reduce insulin resistance.
• Concentrate on weight loss, if advised : Visceral fat, or belly fat, is linked to inflammation and insulin resistance. Losing weight can help reduce visceral fat and improve insulin sensitivity. Talk to your doctor about safe and effective weight loss programs if this is advised for you.

Determine the optimal ketone and blood sugar levels for ketosis

Ketosis is a metabolic state in which your body burns fat instead of carbohydrates for energy. The optimal ketone range for nutritional ketosis is typically between 0.5 and 3.0 millimoles per litre (mmol/L). However, some sources state that a level of 0.5-1.0 mmol/L indicates a "light nutritional ketosis", whereas a level of 1.0-3.0 mmol/L is considered "optimal".

Ketone levels can be measured in the blood, breath, and urine. Blood ketone testing is the most accurate method and directly checks beta-hydroxybutyrate (BHB), the most abundant ketone. Breath testing measures acetone, the least abundant ketone, and is a new and non-invasive way to measure ketone levels. Urine testing is the least accurate method and involves using urine test strips to check for the presence of acetoacetate, one of the primary ketones.

It's worth noting that ketone levels may fluctuate throughout the day and can be influenced by factors such as food intake and exercise. Additionally, ketone levels tend to decrease over time as the body adapts to burning fat and ketones more efficiently.

While there is no magic number for optimal blood sugar levels, keeping them stable is crucial. Generally, a blood sugar level of 65-90 mg/dL is considered the ideal range for a keto-based diet. Levels above 180 mg/dL may indicate a condition called hyperglycaemia, and medical attention is advised.

To achieve optimal ketone and blood sugar levels for ketosis, it is essential to restrict carbohydrate intake. Most keto diets limit daily carbohydrate consumption to less than 50 grams of total carbs or 25 grams of net carbs (total carbs minus fibre). This reduction in carbs forces the body to burn fat for energy instead of glucose.

It's important to note that ketosis and ketoacidosis are two different states. Ketoacidosis, a severe complication of diabetes, is characterised by extremely high blood ketone and blood sugar levels. Nutritional ketosis, on the other hand, is generally safe and does not present with severe symptoms.

Frequently asked questions