Keto Hypoglycemia: How to Fix Hypoglycemia on Keto

Keto Hypoglycemia

Keto Hypoglycemia is low blood sugar when you are on a keto diet. It puts you in a complicated situation. On the one hand, you are trying to avoid carbs as you are on a keto diet. On the other hand, you need to take carbs because your blood sugar is low.

This situation is more often seen in diabetic people who are also taking blood sugar-lowering medications.

Keto hypoglycemia in diabetic people can be very serious and may lead to coma. It is recommended to keep track of your blood glucose levels and make slow changes in your diet.

What is Keto Diet?

The keto diet has become increasingly popular in recent decades. It was actually introduced to treat epilepsy, but it is now popular due to the significant weight loss it causes in a short period of time.

It is not only within the scientific community but also among the general public, with best-selling dedicated books and intense discussion on social media networks keeping them at the top of the diet trend list for years.

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A ketogenic diet is a low-carb, high-fat diet that limits carbohydrate intake to 20-50 g per day. Most stringent keto diets allow only 20g of carbs per day.

Diabetics typically follow this diet because it creates low insulin to glucagon ratio and increases glycogen depletion.

This diet shifts the body’s fuel source from carbohydrates to lipids. As a result, fat is removed from the body, and weight is lost.

Excess ketones can cause ketonemia and, in some cases, ketoacidosis.

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Is Keto Diet Safe?

The Keto diet is generally safe if used for a short duration, but that too with careful monitoring. However, long-term use of keto diets has undesirable effects.

Some of the adverse effects that ketogenic diets can cause are:

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What is Keto hypoglycemia:

Keto diets that are being increasingly practiced have been reported to cause hypoglycemia.

This is mainly because the primary tenet of a keto diet is that, the body enters a state of ketosis and starts to use fats as the main source.

And in order to enter ketosis, the glycogen stores are completely depleted which causes a low blood sugar level.

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One study suggests that hypoglycemia can occur with all types of restricted carbohydrate diets, but ketogenic diets have a greater carbohydrate restriction that’s why they lead to hypoglycemia more often. [Ref]

Another study that accessed the effect of a low carb high fat diet, reported that participants experienced a high frequency of recurrent episodes of hypoglycemia. [Ref]

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Another study that compared the effect of a usual carbohydrate diet to a low-carb diet concluded that participants who had less than 20 g/d carbs had achieved lower blood glucose levels. It suggested that low-carb diets imply better glycemic control. [Ref]

The Keto diet also causes hypoglycemia among individuals with drug-resistant epilepsy. A retro-prospective study among 158 children with intractable epilepsy reported that 80% of the children suffered from hypoglycemia.[Ref]

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How to prevent Keto Hypoglycemia?

The Keto diet is effective for some people who need to control their blood sugar levels, but they are not for everyone.

In some cases, these diets can be proved beneficial when followed in a proper way. Otherwise, mismanagement of such a diet can cause harmful effects.

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Here are some ways to help you manage your ketogenic diet properly to prevent hypoglycemia.

Customize Your Carbohydrate Intake:

There is no universally accepted definition of a low-carbohydrate diet. A ketogenic diet may limit carbs to 10% or less of your total daily calorie intake, but other low-carb plans may allow up to 20% of your calories to come from carbs.

It may take some trial and error to find the optimal number for you. It is best to fill up this percentage with complex carbs such as whole grains, cereals, and vegetables (include low-carb vegetables and limit intake of starchy vegetables such as potato and corn) and go for low GI fruits.

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Consume plenty of protein and healthy fats.

To get the most out of your ketogenic diet, you must always go for healthier alternatives. Keto doesn’t mean loading up on unhealthy trans and saturated fats.

Fill your meals with nutritious food choices such as lean meat, grilled meat, fish, nut, and essential fats.

Some dairy products, such as eggs and cheese, may also fit into your diet. Avocados have a lot of monounsaturated fat these can be the best everyday option on a keto diet.

Other health fat sources include olive oil and seeds. Although the keto diet is largely fat, it is vital to prioritize healthy fats over less nutritious options like bacon, sausage, red meat, and fried cheeses.

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Select High Fiber Foods

Look for carbohydrate items with more fiber because it does not affect blood glucose levels. Fiber also has the following advantages:

  • When you consume high-fiber foods, you will likely feel fuller for longer, and eating high-fiber foods can also help you lower your LDL cholesterol.
  • High-fiber foods are typically plant-based and closest to their natural state. An apple, for example, has fiber, although apple juice contains none.
  •  Whole nuts give protein, fat, and fiber, but nut butter and nut milk frequently have sugar and salt added during processing, which may increase your carb intake.

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Keto diet and reactive hypoglycemia:

Reactive hypoglycemia is low blood glucose after you eat a carbohydrate-rich diet. It is common in patients who consume refined carbohydrates.

Refined carbohydrates are easily absorbed. Thus, when you take lots of refined carbohydrates, your blood glucose levels temporarily go up. This stimulated insulin secretion.

Insulin enhances the entry of glucose into the cells. Sometimes the insulin response is exaggerated. This exaggerated response is due to the high load of refined carbohydrates.

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Once all the carbohydrates enter the cells, the excess insulin causes hypoglycemia. So in response to a carbohydrate-rich diet, your blood glucose temporarily goes up and then rapidly down to the level that you feel more hungry, anxious, dizzy, have tremors, and become shaky.

A Keto diet can reverse reactive hypoglycemia. Because you consume fewer carbohydrates when on a keto diet, and protein and fatty diet are not good stimuli for insulin secretion, the risk of hypoglycemia after a meal is minimal.

Reactive hypoglycemia is also common in patients with insulin resistance and those who may develop diabetes later in life. A keto diet and complex carbohydrates can prevent reactive hypoglycemia.

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The keto diet is a restrictive diet that must be followed with caution. Although it brings desired outcomes, long-term use of this diet can be harmful.

What do you think?

Written by Dr. Ahmed

I am Dr. Ahmed (MBBS; FCPS Medicine), an Internist and a practicing physician. I am in the medical field for over fifteen years working in one of the busiest hospitals and writing medical posts for over 5 years.

I love my family, my profession, my blog, nature, hiking, and simple life. Read more about me, my family, and my qualifications

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