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Sorry to hear what you are going through. A couple of comments from someone with an interest in the topic, but obviously not your practical experience on the front line as it were:

(1) You mentioned ISF (insulin sensitivity factor), but what you did not mention is that this is not a static factor. It is possible to significantly improve insulin sensitivity through diet and life style, and this is particularly useful for people with T1D. Part of this is to adapt to a significantly less carb-based diet. This is absolutely doable, carbs are not an essential nutrient.

(2) "If your BGL is high for a while (with high levels of ketones)" - this sounds wrong to me. Ketones are high when availability of glucose is low. In many ways this is the ideal to aim for. Ketones are a substitute for glucose, produced from fat. If the person is well adapted for producing and utilizing ketones, s/he can replace carb consumption with fat, which is insulin neutral, and avoid the wasting away of muscle mass which happens with T1D, because the body is energy starved and breaks down protein for glucose.

Just some well-meant input, hope to not sound glib in the context of your challenges.




"Ketones are high when availability of glucose is low" - it seems the body calculates this based on the amount of insulin available, which is why you can eat nothing (and have no basal) and have a BG spike.


Right -- because you have insufficient insulin available, cells cannot utilize the glucose. So your blood glucose rises. If BG is too high for too long, ketones build up, leading to diabetic ketoacidosis (bad), which is different than the ketosis (good) sought by a ketogenic dieter.

People with T1D are taught to check keytones if BG is very high (CDC says > 240 mg/dL; we were taught > 300) for an extended period of time, or also when sick.

https://www.cdc.gov/diabetes/basics/diabetic-ketoacidosis.ht...


AFAIK Ketones go high when glucose is low <b>in cells</b>, not in blood. DKA is literally so many ketones in the blood that it becomes acidic, this happens in conjunction with high BGL. Sams breath when he was in DKA was literally sweet smelling as his body was trying to get rid of the excess glucose. There is plenty of glucose, just none of it is available.




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