You read that correctly. I love ketones and I am actively pursuing ways to increase my bodies ability to produce them through the use of exogenous ketone supplements. Ketones are a dirty word in the world of diabetes because of the confusion surrounding their appearance as the harbinger of doom through DKA (diabetic ketoacidosis). Unfortunately many healthcare providers actively discourage their diabetic patients from attempting to achieve nutritional ketosis because they don’t fully understand the difference between nutritional ketosis and DKA. That difference is NOT the focus of this post, other than to establish the fact that there IS a difference.

It’s important to note that the means of detecting DKA is typically the presence of ketones in the blood. Adding them through exogenous supplementation or nutritional ketosis is useful (I would even argue beneficial), but not without some risk. In case of insulin deficiency (bad pump site, occlusion, skipped dose etc) while in ketosis one would be without the means to clearly identify DKA. You’d only be able to guess based on blood glucose level to infer how insulin deficient you are. The risk can be mitigated through vigilance and attention to insulin dosing but shouldn’t be taken lightly.

I’ve recently started using exogenous ketones to help put me into nutritional ketosis more readily and I wanted to report the initial findings since I’ve been asked about them so many times. Up till this point I didn’t feel compelled to spend the time and money on exogenous ketone supplements–which are not cheap! I took the plunge and got some delicious, chocolate-flavored betahydroxybutyrate or (BHB) for short. I am not going to attempt to get into the science behind the impacts of BHB on my blood sugar, energy and metabolism-just share what I have observed happening in my own blood sugar management and health since I’ve started using it.

Why ketone supplements?

I spent several years feeling pretty ambivalent about supplementing ketones. I got good results in balancing my blood sugar and maintaining energy from simply consuming the standard macronutrient balance (75% fat/25% protein) so I never felt the need to optimize the process. Boredom got me to experiment with the ketogenic diet in the first place and ironically it’s what inspired me to try to kick it up a notch. Also, due to recent life changes, I haven’t been climbing. Instead, I’ve returned to normal weight training (which is more affordable and accessible given my situation) and I found that my power in standard lifting techniques to be…lacking. I needed something to kickstart better performance.

Nutritional ketosis, when achieved strictly through endogenous ketone production is a little bit squirrelly. It doesn’t always occur at the times or to the extent that you want it to. You may be in deeper ketosis at night when you’re sleeping–but in the morning after you eat breakfast it falls off for several hours after eating, for example. One solution to this problem is intermittent fasting–delaying that breakfast for the sake of longer fat-burning ketosis (which I’ve been doing as well, but I don’t want to lump that discussion in here). The other solution is introducing external or exogenous ketones to kickstart nutritional ketosis even when the internal production mechanisms are moving a little behind your desired pace.

The introduction of ketone supplements has given me a greater control of when I am in ketosis (and how deep I go) and it’s also hinted at some other benefits of ketosis that I didn’t expect or understand–besides the energy increase. It seems as though exogenous ketones can have a blood glucose suppressant effect. I have noticed that the increase in blood glucose (after meals where I have taken exogenous ketones) is much less prevalent. Unfortunately my CGM broke and I have been without the continuous data to prove this, but I have been consistently surprised when testing one or two hours after a meal where I would normally have had to take a unit or two of insulin (having taken none) and finding my blood glucose to be in the mid-high 80s rather than 130-150 as I would have expected.

This could be part of the explanation of why ketones build up in the presence of extremely high blood glucose. Ketones are not simply the “bad guy”; they are dumped into the blood stream as part of an emergency response to enhance the role of insulin during high blood glucose events. Obviously ketones cannot replace insulin all together, which would explain the feedback loop of increasing blood glucose and dangerously high levels of ketones in the blood or DKA (which cannot occur strictly through nutritional ketosis with insulin on board). This is my hypothesis based on a couple weeks of personal observation–please note that I’m not suggesting that anyone stop taking insulin and replace it with betahydroxybutyrate.

Another thing I’ve noticed since being on the ketogenic diet is that my body responds differently to low blood glucose and insulin. It’s felt as though the insulin works harder and faster when my blood glucose is higher and then backs off as my sugar normalizes–almost like the ketones are educating my insulin to create a “smart insulin” performance. Since supplementing exogenous ketones and seeing the glucose suppressant effect that I noted earlier, I have had to deal with more low blood sugars-and I am in the process of tweaking my basal insulin dose to fix this. These undesirable hypoglycemic events actually have presented me with an opportunity to observe the way that ketones mitigate the symptoms of low blood sugar which is also exciting!

I want to be clear that I am not talking about hypoglycemia unawareness–which is dangerous and not something I know how to cultivate or would advocate for if I did. During lows I have been totally aware of the fact that my blood sugar is low and needs to be treated BUT notably absent are the sweating, shaking and panic-induced hunger that makes a low so scary and difficult to handle. It’s as though the increased ketones blunt the symptoms of a low to the extent that you still are aware of it–but do so while taking the bite out of the symptoms and allowing you to function fully normally. Imagine a hypoglycemic event without the panic-eating and corresponding blood glucose spike!

In terms of athletic benefits of the BHB supplement, the jury is still out. It will take more time for me to observe and report. The initial blood glucose indications are encouraging however not written in stone.

Where do exogenous ketones fit in the mix–specifically for people with diabetes? I’m not a doctor so I can only share my experimental philosophy–that’s what this stuff is at this point–an experiment. Go gradually. Starting from a “normal” diet, gradually reduce carbs by 20% per week. Get under 100g carbs and get comfortable there. Then get under 50. Then get the protein and fat right and dial in the ketogenic diet and learn how ketosis feels. Exogenous ketones aren’t something that you just try on for size over a week or two (at least that’s not how I have approached them) but they seem to be a really exciting way to enhance an already established low carb, high fat diet.

Stephen Richert is a photographer and filmmaker who happens to live with type 1 diabetes. You can see his professional portfolio here.

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