Corticosteroids and Ketosis

Hi again. I thought I would start a topic on this. If it already exists, please accept my apologies and point me to the thread

As I have posted elsewhere I am in treatment for a rather nasty Autoimmune disease called Wegener's Granulomatosis. Part of the treatment consists of taking a weekly dose of Methotrexate (immunosuppressive drug) and daily Prednisone (corticosteroid). Recently my illness began to flare so the Prednisolone was increased from 10mg a day to 20mg. The disease is rapidly progressive and if not clobbered by steroids it destroys organs very quickly. Symptoms for a flare are usually increased pain.

Ok ... that's the steroids. On the LCHF or Ketosis side:

I started the LCHF diet after reading Dr. Bernstein's book in early January. I have been very strict with carbs trying to keep them around 20g or less a day. I noticed late last year that my Fasting BG was on the high side which was new. Originally the Steroids caused my diabetes (or triggered it in any case) but until late last year I had no problems with fasting blood glucose.

Since early January I have lost 3.2 KG not gradually but initially I jumped down by 1kg then stayed put and then did another drop, stayed put and now lost another 1/2 kg.

Given the strict adherence to the LCHF way of life I was expecting a more rapid weight loss. However I can live with slow as long as it keeps going.

The other day I bought some Ketone Blood test strips which fit in my BG meter. And I find that I am often out of Ketosis.

Results over the last few days have been:

Today (Sunday 22/2)  9:30am Ketones: 0.3  BG: 5.6
Saturday (21/2) 8:00pm Ketones: 0.9 BG 5.6
Saturday (21/2) 3:00pm Ketones 0.7 BG 6.4
Saturday (21/2) 6:30am Ketones 0.6 BG 7.2
Friday (20/2) 7 AM Ketones 1.3 BG 6.7
Thursday(19/2) 6:00 pm Ketones 0.4

I take the steroids at 7am with breakfast, after taking 30 units of Insulin. Initially that causes a drop in BG but within 3 hours it rises rapidly due to the steroids. I read today that Steroids are anti-ketogenic so I guess it will be a struggle to remain in Ketosis.

So ... I wake up with BG too high, take Insulin to lower it and have a very LC breakfast then take Steroids all around 7am. by 10am the BG starts to rise again. 11am I take another dose of Insulin (30 Units each time) and then around 12 have my LC main meal. BG keeps hard to control until around 3pm when the Steroid impact starts wearing off.

Would like to hear from anyone else here who has tried the Ketogenic life style whilst on such potent meds and how they controlled ketosis. Of course the flare up in disease is a major flareup in inflammation and that too has am impact on BG.

Hi Inge!

I'm 'Bumping' your post up in the hope that someone can help but in the meanwhile,could your lack of apparent blood Ketones be down to the amount of fast acting insulin you currently take? I don't know if this is relevant at all but type 1's with high levels of ketones and high BG numbers are treated with insulin to bring the levels down/eliminate ketones...Perhaps that applies to dietary ketones too although I'm not sure.
Also,could it be that you are so keto adapted you are using/burning all of your ketone bodies as fuel,hence the lack of them showing in your blood or urine?

Best wishes

Paul

Hi Inge ...... oh I wish I could give you some great advice on these questions but unfortunately I can't.

I am pleased you keep in touch and ask questions because I think many who read here are learning all the time.

Like Paul said - I hope someone can come along and offer some help.

All the best Jan

Hi Inge, I can't answer your specific question unfortunately as your condition is something I don't know enough about to comment but I do know you are managing very good BG control under what appears to be a difficult situation. Ketosis is a fine balancing act but to be honest, if you're losing weight and you hold good BG levels, does it really matter that you slip in and out now and then ?

Thanks Jan, Paul and mo.

Paul I take 30 units of insulin before breakfast and 30 units before lunch. After 3pm the affect of that on my BG seems to wear off. So I am not sure if this insulin would be giving me high fasting bg. I read in one of the studies I was following that high fasting BG is a sign of increasing diabetes severity. This is no surprise. I found out when I started high dose steroids last year that as long as I can ditch them in a few weeks I may be able to reverse the diabetes. Well it's over a year and I am still stuck with them so no wonder it is having a nasty impact on my diabetes.
mo you are right ... i should be happy enough to be losing weight and it seems that I am getting longer stretches in ketosis. Another impact on all this is that I am currently having a flare of the disease which means body riddled with inflammation that too would not do my BG any good and maybe also impacts the ketones.
Paul ... if my ketones were being burnt up so rapidly then I would expect a bigger drop in weight?
Thanks everyone for your advice. I keep studying up and it's such a complicated topic

Hi Inge and thanks for your thanks to me, Paul and Mo.

There certainly is a lot to study and take in but I think you are doing well, you are losing weight, you are learning a lot along the way. Just wish it could be that easier for you but unfortunately it isn't. Do keep coming back you know you have our support.

I'm sure Paul will be along soon to answer your question about  ... 'if my ketones were being burnt up so rapidly then I would expect a bigger drop in weight?'

For the moment take care and I wish you .......

All the best Jan