Can a Ketogenic Diet Cause Hypoglycemia or Low Blood Sugar?

Short Answer: It can but usually only in the first few weeks of keto and usually in only the most insulin resistant.

Your Old Diet

Before we get into how hypoglycemia is possible with a ketogenic diet, let’s review what happens with your blood sugar levels when you start a ketogenic diet.  While you were eating your traditional high-carb Standard American Diet, you were training your body to produce a large amount of insulin with every meal.  This insulin was important because the high levels of blood glucose your diet was producing was toxic to your body so your body had to get that sugar out of the blood stream and into cells where it could be used as fuel or stored as glycogen or triglycerides.

Your New Diet

Now let’s look at what happens when you start a ketogenic diet.  Your body continues to produce the same amount of insulin when you eat which should cause your blood sugar levels to drop so instead, your body begins to pull sugar out of all the nooks and crannies in your body where it stored it.  The first reservoir to be tapped is the glycogen stored in your muscles.  This stock of sugar is large enough that you can potentially go several weeks with normal blood sugars on keto but eventually those stores run out and that’s when things can get a crazy.

Now for most people, by the time the stores of sugar are depleted, your body has already begun making a few of the necessary changes to your metabolism to run on fat and the feeling of being “run down” or what is sometimes called the “Keto Flu” only last a few days.  The body makes the transition over to running on stored fat and ketones and you are off to the races but for a few people, especially the really insulin resistant ones, you can start to feel the symptoms of hypoglycemia.

Symptoms of Hypoglycemia

Your body begins to produce adrenalin and cortisol, both are stress hormones that tell the liver to produce more blood glucose in the liver.  This causes feelings of hypoglycemia as the body struggles to maintain proper blood sugar levels while simultaneously trying to make the switch over to begin burning fat for fuel.  Symptoms include:

  • heart palpitations or fibrillation
  • dizziness
  • light-headedness
  • sweating
  • headaches
  • nervousness
  • irritability
  • shaking and tremors
  • flushing
  • craving for sweets
  • intense hunger
  • nausea, vomiting
  • panic attack
  • numbness/coldness in the extremities
  • fatigue and shakiness for hours afterwards

Remedies for Hypoglycemia

If you get like this, it is ok to eat something with some sugar in it to get some relief while the body continues to make the transfer.  Something like a piece of fruit of even glucose tablets.  The important thing to remember here is that this goes away eventually.  Soon your body will be humming along just fine on ketones and this will all be a distant memory.  Remember to drink plenty of water and up your salt intake during this time.

If you have any other questions, leave them in the comments below and I’ll answer them as best I can.  Thanks!

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Can a Ketogenic Diet Cause Hypoglycemia or Low Blood Sugar?


124 thoughts on “Can a Ketogenic Diet Cause Hypoglycemia or Low Blood Sugar?

  • I have been on keto for about 5 months. I am female, 63 , weigh 48kg. Had been sugar free and grain free and low carb for a year before keto. I went on keto to help chronic migraine, and had no idea that I was hypoglycaemic, but it was the first time I’d had a meter. Actually I think I’ve had for a while, but undiagnosed or maybe misdiagnosed. I have tried intermittent zero carb regime all to get rid of this hypoglycaemia. My medics say no diabetes. I get hypos even when eating zero carbs! What’s going on and how can I fix it?

    • It’s hard to know for sure with just what you’ve told me but there is one thing you should at least look at. It is possible to have an “over-active” pancreas that dumps a large amount of insulin at every meal. This would keep your A1c low enough that it would look like you don’t have diabetes but still cause these hypoglycemic episodes. The easiest way to test this is to get an insulin test that will directly test the amount of insulin your body produces fasting and 2 hours after a meal instead of the normal blood sugar test. It’s not a common test so that’s why your Dr hasn’t mentioned it before now. The other thing you could do is more weight-bearing exercise. Something that will cause your muscles to grow will help your body use sugar more efficiently and help your body produce ketones faster. At 63, you don’t want to overdo this but simple dumbbell arm exercises and a few squats will get you where you want to be. Remember that the one variable that most correlates with long life is leg strength. (Admittedly, the benefit of leg strength is larger for males than females but it is still there for women.) So don’t skip leg day!

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  • I’m sure I was hypoglycemic this afternoon. I started my Keto diet a month ago. My appetite early morning is nonexistent after coffe and I’m not eating until noon. Today, I became shaky, nauseous, headache and anxious. I started eating eggs but wasn’t feeling relief. I ate 3 slices of peaches and began feeling relief in 15-20 min. I completed my breakfast but still felt fatigue. Should I force myself to eat earlier?

  • I have been doing the Keto diet since August. I took a break from it for Christmas, and started back on the 27th. I have been doing great and feeling wonderful. This weekend we went out of town and I had a “cheat” meal of pasta and dessert Friday and then some ice cream yesterday. I dropped out of ketosis. This morning I decided to fast until this afternoon, because that is what I normally do when I drop out of ketosis accidentally or on purpose. About 1:30 I got dizzy and passed out. Would this be diet related? Do I need to rush to the doctor?

    • I am not a doctor so there’s no way I’m qualified to tell you whether or not to go to the doctor. It sounds a bit like a hypoglycemic episode though. Do you have a way to check your blood sugar? I would definitely get checked out if it persists.

  • I have been in ketosis for weeks now and have been having very low blood sugar (averaging about 60). I have stopped the insulin and medication but it’s still quite low. I’m frustrated as I end up having to eat carbs at night so it doesn’t get too low overnight. From what I understand, I should give this a few weeks and it will normalize?

    • It should but you will still need to watch it closely. If your sugar is low, the good news is that means you have enough pancreas function that you will be able to reverse your T2D relatively quickly. On top of the numbers on your meter, pay attention to how you feel as well. Are you feeling shaky at night? What happens when you wake up. It’s not unheard of to have low numbers on a meter but still feel ok with high enough ketones. Just remember that you’ve spent a lifetime training your body to run on sugar, it’s going to take time for it to get used to this new way of metabolizing energy.

  • I’m breastfeeding and going through the keto flu. I was feeling shaky and nauseous so my mom checked my blood sugar and the meter read 49! I drank a little juice to bring it back up but it’s been about 2 days and my blood sugar still remains low. Should I expect it to normalize eventually? Should I eat more carbs at night so I don’t pass out in the morning?

    • Breast feeding is tricky because you are essentially eating for 2. The main thing you should do is increase your water and salt intake immediately. If you feel better with more carbs, make them whole foods so carrots, a little sweet potato, onions, etc. That will be better than drinking juice. But water and salt, I cannot stress that enough. Again, I am not a Dr, nothing in this site should be taken as medical advice, consult your Dr if problems persist.

  • I’m new to keto, I’ve been doing it for about 2 weeks(OMAD), and I’ve felt fine, but these last 2 days I’ve felt awful, I’m also insulin resistant, but My fasting blood glucose this morning was 48, my feet were cold and I had numbness in my lower legs, whats up?

    • You aren’t fat adapted yet so your body is restricting the amount of energy available for heat. I would add another meal for at least the next few weeks and make sure they are both very high in fat until your body is fully adapted. Then you can go back to OMAD if you want. If you are doing keto for weight loss you should also consider mixing in a feast day on or 2 days a week so your body’s metabolism doesn’t slow down to adjust to OMAD. I started having success when I ate about triple the amount of calories I normally did on one day a week. It punched me through a few plateaus. You can mix in a few hot drinks as well like coffee and/or tea to combat the coldness. I’m not totally sure what is causing the numbness in your leg but if it persists I would consult a Dr to be safe. Let me know how it goes!

  • Hi there,

    I hope you can help me.
    Blood sugar no longer picking up. In 20s and 30s after meals and. I am eating at a deficit now only because I pack on weight super fast, and weight loss was the prob before.

    Meeting macros, maybe a little less fat.
    I have tried eating more fat and it didn’t help.

    I am pretty dang sick. Losing tons of muscle, no energy. Plantar fasciitis now in both feet. Lost leg and glute strength.

    What to do to stop and reverse this long term damage?

    This is what I am eating on daily basis.

    Keto on or switch to carbs?

    • Blood sugar in the 20s or 30s means you are pretty close to dead. I’m not sure how you are even functioning. This means your insulin resistance is CRAZY high and your pancreas is dumping ridiculously high levels of insulin driving your BS levels down. Are you taking extra insulin? Are you on medications that increase your insulin sensitivity like Metformin? Something is up there that I can’t see.

      If you are losing muscle, you aren’t eating enough protein but it is really hard to lose muscle on a low carb diet.

      If I had to guess, you are feeling the mother of all keto flus. My MIL went through something similar when she switched over and it passed after about 2 weeks. I would say to keto on but you need to do what is best for you.

      • Thanks Alan for your quick reply. I am trying to hang in there. With such resistance, I’m unsure to raise protein, or fat. I dont want to lose muscle but resistance will def do that. Does collagen protein count towards the macro? If so I am getting 50g. So raise fat or protein? I need to avoid diabetes.

      • Thanks Alan for your quick reply. I am trying to hang in there. With such resistance, I’m unsure to raise protein, or fat. I dont want to lose muscle but resistance will def do that. Does collagen protein count towards the macro? If so I am getting 50g. So raise fat or protein? I need to avoid diabetes.

  • Just reading through this thread was a comfort. I’ve been fat adapted for 3 months, I do 30 minutes daily on my elliptical and practice a modified IF (I have a morning and afternoon keto coffee) and am down to a 4-5 hour eating window in the evenings. I eat one meal and a snack. I’m a 61 year old female and started my diabetic husband, and I on this ketogenic journey to improve his diabetes, and attempt to improve my weekly migraine headaches, plus we both needed to lose weight. My bs has been between 62-99 for the last month but I’m noticing that for a few days before I had today’s migraine, that upon rising it was 99, and I’ve been dizzy the last couple of days. Each of these days my bs was in the 60’s before eating in the evening. So I’m wondering if maybe blood sugar that low is triggering my migraines. Perhaps I should eat a little sooner?

  • Just reading through this thread was a comfort. I’ve been fat adapted for 3 months, I do 30 minutes daily on my elliptical and practice a modified IF (I have a morning and afternoon keto coffee) and am down to a 4-5 hour eating window in the evenings. I eat one meal and a snack. I’m a 61 year old female and started my diabetic husband, and I on this ketogenic journey to improve his diabetes, and attempt to improve my weekly migraine headaches, plus we both needed to lose weight. My bs has been between 62-99 for the last month but I’m noticing that for a few days before I had today’s migraine, that upon rising it was 99, and I’ve been dizzy the last couple of days. Each of these days my bs was in the 60’s before eating in the evening. So I’m wondering if maybe blood sugar that low is triggering my migraines. Perhaps I should eat a little sooner?
    Oh, and this is my first migraine in 2 weeks.

  • We are doing keto as a family AMD my daughter of 4 tested 3,5 in her glucose levels. We are 3 weeks into keto. Is this too low. I dont know her ketones as the doctor only tested for glucose

    • I am not a Dr but I would look for signs of lethargy before I started to worry. Kids fat adapt MUCH more easily than adults so as long as there is no underlying medical condition you didn’t mention, she should be ok. However having said that, I just want to reiterate that I am not a Dr and nothing I say should be taken as medical advice.

  • I’ve been doing well and in Ketosis for almost 3 months now. Today I had a bout of why my hubby called Hypoglycemia, I was in the shower, felt panicky, weak, short of breath, was sweating, my hands and legs were tingling. I almost passed out and ended up on the bathroom floor. My hubby gave me an orange and I felt better almost immediately. Everything is fine now.
    Can you have hypoglycemia 3 months after starting the Keto diet, or only during the first month?
    Thank you for your great column.

    • Maybe. The main trigger for an episode like this after 3 months into ketosis is usually stress. I think you did the right thing by eating an orange and then getting back into a ketogenic diet. Different bodies react differently and you may have something that makes you more susceptible to a hypoglycemic episode than other people. If it happens again, pay attention to what happened directly before, especially your sleep and stress levels. Sometimes high stress and not enough sleep can make things more difficult for a body that is already struggling with the transition over to a ketogenic diet.

  • Hello, I am looking to start the Keto diet but I have one concern.\

    I have been a type 1 diabetic for 15 years and have pretty good control. I will have to reduce the insulin I take daily to make up for the lack of carbs I will be eating. While I am testing how much insulin i need to take I may have a low blood sugar. I have to eat sugar or carbs to correct lows. I am under the impression that the Keto diet allows for some carb ingestion. If I only eat glucose tablets for lows will this affect my Ketosis? Will I have to start all over again?

    • A few questions:
      1.) What king of insulin(s) do you use?
      2) Bolus using the carb count method. (example- 1 unit per 10g carbs). Adjust as necessary.
      3.) Basal amount? Typically, .5 to .9 units/hour x 24 hrs if you use Levimir or Lantus.
      4.) When you feel low, confirm the BG reading with your glucose meter.
      5.) Always pack something to counter hypoglycemia, which can be dangerous. I use Peanut M&Ms, which contains about 30-35g carbs. Glucose Tabs are also ok, but quite expensive.
      6.) Be patient with your insulin adjustments. Mine sometimes take an hour or two to register a blood sugar drop.
      7.) When you feel very low, screw the Keto diet and eat something with quick-acting sugar. You can always return to Keto later.

  • Hi, I’m so glad I found this thread! I’m in week 2 of Keto and the last 2 days my blood glucose has dropped to 3.7 during the afternoon and I’ve been feeling a bit light headed. I usually dink coffee or two with cream in the morning/afternoon and then pretty much just have supper in the evenings. I usually run but I took a short break knowing the keto transition might be hard. Is this blood sugar drop just my body transitioning to fat burning? Should I just hang in and continue what I’m doing, or should I rather have lunch? Going for a run this eve, and I’m worried it’ll drive my blood sugar even lower. Drinking some water with salt in, as I see electrolytes have been mentioned. Or what is the best way to achieve electrolyte balance?

    • The first few weeks of keto can be tricky as your body adapts to its new source of energy. The key is to consume plenty of salt, water, and fat during this time. Once your body is able to efficiently pull fat out of fat cells, blood sugar will normalize and your energy levels will stabilize. IN another week you won’t have any of these issues anymore.

  • This thread is helpful!! I will be starting Keto in 2 days. I have had hypoglycemic episodes often in the past requiring me to always have a granola bar in my bag in case I start to feel lightheaded I have something to eat. I’m also breastfeeding. I’m wondering if this will be a safe choice for me?

    • The main thing you will need to be careful with is to keep your water and salt levels up while breastfeeding. It will be very easy for your electrolyte levels to get too low. As for the granola bar, you might consider a lower carb option like a Quest bar or maybe an Ample K shake.

  • Hey I know that my reply might be similar to others but you seem really competent and I would love to hear your answer. I really loved your post, it made me feel a bit more reassured but unfortunately I’m still a bit on edge. I’ve started keto a week ago, and my adaptation is really horrible. I’m female, 26 and I suffer from anxiety and depression due to my borderline disorder. Before starting keto I was pretty stable, meaning I was feeling well most of the time. After starting keto I immediately started regressing, I feel constant anxiety for couple of hours a day or sometimes even a whole day, that usually end up in full blown panic attacks that also last a bit. I also feel pretty weak, dizzy, like I’m about to pass out, I can’t really concentrate and focus on anything and I’m hungry all the time. My symptoms do seem like a low blooded sugar but I do drink tons of water, I suplement on magnesium, I add salt to my water as well. I don’t really want to eat anything with carbs because I’m afraid that it will extend my adaptation, and I’m really desperate to start feeling well soon. I would like to ask you how do you measure your blood sugar to know if it’s really low and it’s the reason and do you have any advice for me to make it a bit easier and maybe faster to adapt? I don’t want to give up on keto since it usually helps people with mind problems once you adapt, but It’s getting really hard to fight on. Thank you a lot in advance for reading this and replying.

    • Thanks for reaching out. Before I give you my opinion, I want to say from the start that I am not a doctor and nothing I say should be taken as medical advice. I’m just a guy that became obsessive about this way of living and saw incredible results. What you are describing doesn’t sound as much like electrolyte issues as much as just plain ole withdrawal. You’ve taken a brain that was a bit on edge to start with and then cut out its usual fuel source. Your transitional time might be a little more intense than a person with no disorders and might require a bit of white knuckling to get through.

      It sounds like you have the basics of the diet down so let’s focus on other things.
      #1 Get people who know you involved. If you start acting manic or depressed, you might not realize it and need someone on the outside who can tell you there is an issue.
      #2 Pay attention to how you feel. You may need to start a journal that will log how you feel after you eat and after any medications you take. As you adapt, you might find that certain foods cause a reaction or medications don’t affect you the same way anymore. These are things you really need to understand moving forward.
      #3 Remember that this was the normal way of eating for hundreds of thousands of years. This isn’t some novel diet that will fade away, this is the way your ancestors ate and thrived. Don’t succumb to the temptation to give up, your brain needs the nourishment that comes from a high fat diet and doesn’t need the inflammation that comes from sugar, grains and PUFAs. You aren’t just feeding your body, you are feeding your brain and giving it a chance to heal.
      #4 This takes time. Remember that if you have eaten a diet high in PUFAs and low in saturated fat for years, then that is the raw materials your body had access to to repair and rebuild any issues in your brain. Your brain may just simply not be made up of the right mix of fats to function properly. Replacing all those bad fats from healthier animal fats will eventually fix a lot of issues but it is going to take time. How much time? No clue and you might not be 100% but will get better. Do you want to be healthier in a year? What you do now determines who you will be in a year or 5 years.

      I sincerely hope this help and please keep in touch.

  • Great article! I’m also very happy to see you typically respond. I have a question that I hope you may know from experience. I have started Keto for weight loss and really other than a high weight and terrible eating habits, I’m pretty healthy and a 40 year old female. Since the day after I started Keto, I have a headache throughout the day and moderate to severe dizziness. No shakes or anything else. I’m not sure what to do. The last couple of Dayan I’ve taken magnesium and drank large bottles of zero sugar Gatorade. Any thoughts of what it might be, what I can do to make it better or a guess on when it might end? Thanks!

  • Hi Aarn,
    I did the Whole 30 a couple of years ago for two weeks and while driving to pick up my child I nearly passed out and crashed. I was hungry at the time but didn’t think it would lead to this. I ended up in the ER and my blood sugar was severely low. This incident gave me panic attacks when driving home from work and I stopped the Whole 30. Now, I really want to try Keto but I am afraid this will happen again, which causes me increased anxiety. Based on what I’m reading here, this is possible, but it’s OK to take a glucose tablet or eat some fruit and this will eventually go away. I just want to know that I will not be passing out from low sugar for the rest of my life if I go Keto. Thank you!

    • You certainly won’t unless you have some kind of underlying medical condition I don’t know about. I don’t know what that would be but I’m not a Dr. The important thing is to get into a fat adapted state as quickly as possible, then your body can make its own blood sugar on demand and you won’t have to supplement with anything. Let me know how it goes!

  • Like others here, I’m experiencing 3.6 – 3.9 and I feel aweful… I did just cheat 3 days ago and ate a bunch of nuts, milk, jerky (with sugar in ingredients)… basically a binge. So lots of fats and keto coffee and white knuckling it. but when I feel faint and bg is low – I get scared. I don’t want to have an orange / fruit because that is basically a cheat, right? Then I have to start ALL OVER again? (Gawwwd noooo!) Can I white knuckle through it? Will it stop? I know you can’t answer 100% but how do I find the answers for me?

    • You won’t start all over but it will lengthen the time until you adapt. Something else that some people do is drink something sweet but sugar free like a La Croix. If you want a fruit, stick with lower glycemic fruit like berries. It will pass, I swear!

  • I am asking this question on behalf of my boyfriend, who had been in ketosis for 2 months before his episode.

    He works a very high stress job, very long hours, one day off per week. He had been doing great on keto… lost 25 pounds very quickly, but has been stuck for a few weeks, not really losing much weight. He isn’t very involved in his meal planning or what he should or shouldn’t be doing (I do all his meal prep). He was a heavy drinker prior to keto, and stopped completely for the diet. He lost the 25 pounds in the first month, then began having a couple of shots of whiskey after work (I didn’t know this at the time). He was still in ketosis, so he assumed that everything was okay, and didn’t say anything about it to me. He had stopped losing weight while he was having the alcohol shots (someone at work told him he could have whiskey on keto). When he mentioned that he wasn’t losing weight, he admitted that he had been having shots, and he quit the drinking, again. A few days ago, he was lucky to have an extra day off from work, and he decided to buy a pint of whiskey and have a “relaxing day”. He drank it all that day, but time got away from him, and he didn’t eat or drink anything else that day. The next day, back at work, he passed out, went pale, profuse sweating, and high BP. He visited the doctor the next morning. His blood sugar was 60. The doctor thought it was a “perfect storm” of the day of drinking, stress, dehydration, and carb reduction. I gave him quinoa that night, and he reported that he felt “normal”, again, after having that. He told me today that he had a similar episode last night at work, but not as serious. He ate some BBQ and and had pain and nausea in his upper abdomen almost immediately, but the hypo symptoms went away. I think the drinking day was the catalyst, as he had been fine all along before that. Can you please give me your take, since you seem to have a good grasp on this subject? TIA….

    • So here’s a couple things to think about.
      #1 Now that he is 25 lbs lighter, alcohol will have a greater affect. I know that even a shot or 2 now gets me buzzed where I could put away quite a bit at 400 lbs.
      #2 Keto can dehydrate you and alcohol definitely dehydrates you. Put them together and you get a double whammy. Add to that the fact that you are drinking something so you really aren’t getting thirsty so you aren’t getting those water signals and you get a real potential for doing real harm.
      #3 The first block of weight is the easiest to lose. There are no more easy pounds for him, now is the hard work of losing actual body fat. He is going to have to be invested in his health.
      #4 If I had to guess, I would say that on top of not drinking enough water he is probably not eating enough salt because some of what you describe sounds like an electrolyte imbalance. Here’s more info on that. or
      #5 Stress is a killer. He needs to find a way to destress that doesn’t involve alcohol or anything else that would add stress to his body or life. Maybe a walk or exercise of some kind? Just something that reduces Cortisol.

      • Thank You!!! I stumbled on this site and these conversations by “accident”. I’ve been predominantly carb free since Jan. 18 and started following the keto diet when my friend was between jobs and decided to research this diet and meal prepped for us. I’ve lost 15 lbs and have recently stalled out. More importantly I had an episode a little over 2 weeks ago that has left me insanely concerned about my health and if I have done real damage to myself by being on this diet. After eating poorly on Fri, having a couple alcoholic beverages (literally 2 not very strong drinks) then again a poor choice in breakfast along with 1 mimosa followed by laying out in the sun I felt “wasted” as if I had been drinking non stop, I passed out or had a seizure after making the conscious choice to “eat normal” for the weekend for 2 reasons. #1 I thought that would “reset” my body and I could hopefully start losing weight again #2 We were having a weekend long birthday party for my bf and I just wanted to enjoy myself without thinking about what I was eating or drinking. Well apparently I had a reactive hypoglycemic seizure. I saw my dr the Tuesday after this happened and obviously now I’ve had blood work done, a CT scan and am going to see a cardiologist as well as a neurologist to make sure It isn’t something much more serious like epilepsy. Fortunately one of the gals at the party is a nurse and she monitored me through the whole episode, my bp was in the tank 60/40 when she took it with the electronic wrist thingy, then she did it manually and it was 107/70, much closer to my normal which is lower than most peoples. It was obvious that I was dehydrated and I could tell my blood sugar was low after I regained my composure (several hours later). I have always had bouts with hypoglycemia and eating protein was how I dealt with it, when It would get a little more severe I would eat something sugary, but typically I choose protein to raise my blood sugar. Since the episode I have been very strict about my diet, still no weight loss but now I’m even more stressed than I was before the episode because I’m so afraid it’s going to happen again. Anyway, reading these posts has helped me realize that #1 I’m not alone, #2 I want to stay on the keto diet but maybe I should adjust the proportion currently I’m trying to stay within the parameters of 5%, 75% & 25%, when I first started it was more like 15%, 60%, & 25%, I really don’t know what the best target is, & #3 maybe I should get a glucose monitor. In addition I haven’t really been in a good solid state of ketosis for weeks, I stay in the low range. Any suggestions?

        • First of all, I wouldn’t feel comfortable giving you advice because you had a seizure possibly. That is generally a sign that something is really wrong so I’m only going to give the most general of advice and tell you to stay under a Dr’s care. However, here is what I can tell you in a general sense. It sounds like you are trying to cut calories along with carbs, this is a big mistake. Eat until you are full with lots of meat. Don’t think in terms of protein first, thing in terms of fat. You should be eating fatty meats and veggies with lots of butter as the base of your diet. You also sound like you aren’t drinking enough water and eating enough salt. That would explain the fainting and low blood pressure. I would focus mainly on eating real foods, a lot of fat, a lot of salt, and a lot of water.

  • Hi, I started keto diet 2 weeks ago, and my readings are 80(fasting) and 83 (2 hrs after meal). Few people scared me that this was getting to low a reading for after meal. Is it normal? What should ideal for keto diet?

  • Hi!
    Thank you so much for the awesome post!
    I’m 5th week into keto diet together with calories restriction and 16:8 intermittent fasting. I’ve dropped 7.85 KG so far.
    Yesterday I bought a Blood glucose and ketones meters home to test out my results. However, I’m unable to find much information that addresses the reading levels with keto diet.
    Would appreciate if you can give me some insight.

    My Results are as followed:

    1hr after dinner :
    Blood glucose : 3.7 mmol/L
    Ketones: 5.6 mmol/L

    Tested this morning when I woke up (Empty stomach)
    Blood glucose: 3.3 mmol/L
    Ketones: 3.9 mmol/L

    I would like to know if this reading is a concern?
    Thank you!

    • The blood sugar levels are a little low but it looks like you’ve got enough ketones to offset it. You might just be someone who can have lower blood sugar than normal and be fine. The big question is how do you feel. If you feel good and have enough energy to go through your day, I wouldn’t worry about it all.

      • Hi Aarn,

        Thank you so so so much for your reply!
        I’m feeling much at ease now. As I’m really afraid I’m doing the keto diet the wrong way.
        I’ll monitor my blood glucose and ketones level as well as my energy level.
        Have a great day ahead 🙂

  • Hi there,

    I’m hoping you might have done some research that can help answer a problem I’ve been having. I’ve googled the heck out of it, seen my doctor (and had labs drawn), and can’t seem to find an answer.

    I’be been eating keto for about 5 weeks now. I’ve lost 10 pounds and reached my goal weight (I’m eating keto more for mental clarity than weight loss). For the last two weeks, my heart rate has begun to increase – my resting heart rate has gone up to about 70bpm (it’s always been around 58bpm), and every time I do any sort of light activity (even just walking around the house), my heart rate jumps up to around 110bpm. Just standing, my heart rate is staying around 90-95bpm.

    I had labs drawn last week. My electrolytes look good, I’m not anemic, kidney and liver function are fine, and my thyroid function is fine. I have a slightly elevated red blood cell count, but my doctor says that’s normal for people who live at a higher elevation. I drink sole water, and take a magnesium supplement (Natural Calm). I try to eat an avocado every day for potassium.

    Today, I feel like I’m having an extended hypoglycemic episode. Dizzy when standing, shaking hands, and my heart rate is even faster than normal. I ate some strawberries, and the symptoms have lessened a bit, but they’re still there. I *did* have a some non-compliant food on Sunday (some sugary-sweetened whipped cream that I made for some cupcakes for a birthday party), as well as a drink with a shot of tequila.

    I suppose my question is two-fold. First, have you found anything in your research that would explain a constantly elevated heart rate on keto (and should I consider eating differently because of it?). And two, can a cheat day 5 weeks into a ketogenic diet cause a hypoglycemic episode?

    • I hate cheat days, especially in the first month or 2 of keto because it seems to cause so many issues with people. I know you said your electrolytes look good but everything you are describing sounds like dehydration and lack of salt. I would try drinking more water and switching over to something like Redmond’s Real Salt ( and HEAVILY salting your food for a week or so ans see what happens. And when I say heavily salt, I mean don’t be shy in the least with the salt. It is almost impossible to overdo salt on keto. Beyond that, I would get in touch with a Dr that might understand a ketogenic diet and see what they say. And of course, nothing on this blog should be taken as medical advice and always consult your Dr.

      • you mention salt, is potassium citrate necesary or magnesium?

        So adaquate ketone production offsets low blood sugar? So slow ketone production is what wakes you up at 2 am?? I have no other symptoms and would think if my ketone production was not high enough to prevent low blood sugar at night, I would actually have hunger. I have no problem hunger wise with 2 meals in 6 hour window.

        What do you do at 2 am when you wake up. i seem to feel better blending kale and romaine lettuce with some sea salt and potassium citrate and even ashwagandha but it tastes like blah

  • Hi there!

    I was doing keto just fine for about a month, when I had a severe, stroke-like migraine a couple weeks ago. (Lost vision in one eye, slurred speech, numb left hand, then turned into a migraine)
    My family seemed to think it was a hypoglycemic attack, so I bought a monitor.
    Ever since then, I’ve still had dizziness, numbness in my hands if I don’t eat something sugary every few hours. I keep glucose tabs on hand and end up taking them every other day.
    I’m starting to be concerned that I can’t do keto. I went back to eating things like bananas and fruit because I’m afraid of having another migraine.
    I was already gluten free and a pretty sugar free lifestyle, (I used to be paleo and the last year or so it became very lazy paleo – eating rice & dairy) so it shouldn’t have been a huge change to start keto.
    I’ve been monitoring my blood sugar levels and whenever I start feeling really awful it’s usually in the low 70’s, which I read is still in the low but normal level. Then after I eat, it will go to the 90’s.
    In your opinion, could it have been an electrolyte problem instead as you’ve mentioned to others?
    I’ve recently made some bone broth and am trying to drink a cup a day and will see if that helps.
    Could it be that I’m still adjusting? Can eating more fat help stabilize my blood sugar?
    My family seems to think I shouldn’t do keto. However, with how amazing I felt on paleo, I really want to give it a real try.
    Thank you

    • There are cases of people that just don’t do well on keto. I heard Rhonda Patrick talk about this a little on the Joe Rogan podcast. It seems to be a genetic anomaly where you have issues processing ketones for fuel as efficiently as the rest of the population. Also some people with liver damage have issues processing fat for fuel. If you feel better with a few more carbs or eating Paleo, by all means do that.

  • Thanks for a great article. I’ve been on the keto diet for about 3 months, and I have very few cheat days, especially since I figured out my macros and how to track them. I’ve had numerous hypoglycemic episodes in the past and was probably pretty insulin resistant, but no diabetes as far as I know and recent blood work shows no pre-diabetes either. I decreased my carbs a little bit over the past 2 years which seemed to help but not resolve my issues. I went full keto 3 months ago to avoid the hypoglycemic episodes and to lose weight (I have about 30 pounds to lose). But, I find I am still having episodes occasionally. They are not as often, but I feel like I should be fat adapted by now. I had the keto flu pretty bad for about 2-3 weeks after starting the diet, but powered through.

    I have lost a little bloating but have not lost ANY weight since starting keto. I track my macros and test my ketones, so I am pretty sure I am in ketosis. I eat avocados and leafy greens regularly and think my electrolytes are ok – my energy is pretty good and brain fog is gone. I am learning to eat more intuitively (“eat to satisfaction”) and I work out pretty regularly at a moderate intensity (cardio and weights).

    Any ideas on how I can avoid the hypoglycemic episodes completely and start to lose some weight? My episodes almost always occur late morning, especially if I don’t eat much for breakfast (although I always have my keto coffee and feel like I should be fat-adapted by now so it shouldn’t be a big deal if I don’t have anything besides my keto coffee). My net carbs are usually between 30-50g per day. I eat a good amount of protein, but I don’t think I overdo it (maybe 2-3 eggs (if I eat breakfast) plus 3-4 oz. chicken or fish twice a day, plus a few sprouted nuts/seeds per day). I know calories aren’t a big deal on this diet, but I am generally around 2,000-2,300 per day, which I think is normal for a 37-year old 185-pound fairly active woman with good muscle tone? Any ideas would be appreciated! My doctor so far is no help.

    • I am not a doctor and nothing I say here should be taken as medical advice. If these problems persist, you need to see your doctor. Having said that, I have found that people with these problems are usually mineral deficient. I would do a couple things. #1) Whenever you feel an episode coming on, put some sea salt or Redmond’s Real Salt ( into a glass of water and drink it. #2) I would start taking a Magnesium supplement everyday. Almost everyone is Mg deficient and even if you aren’t, it won’t hurt. I get mine from Pure Vitamin Club ( #3) Start paying attention to what you ate an the 2 or 3 hours before an episode and start eliminating those things one at a time to see if it helps. I have heard of many people not feeling well after eating something with an artificial sweetener. The theory is the sweet taste triggers an insulin dump which lowers blood sugar levels. I hope this helps.

  • Hello.
    I’ve been on a keto diet for two weeks and the first three days I felt awful, then on the forth day I felt great and normal but today I think I had an hypoglycemic episode and it was horrible, I ate half of an apple and it went away but my question is the next: was this normal? Even after two weeks of strict keto diet? Thank you, take care. (I don’t know if this is necessary but I’m 5’8 and 225 pounds)

    • Not normal but it does happen. It can happens when someone eats something with an artificial sweetener. Your body dumps a load of insulin in response to the sweetener but because your body is used to doing that in response to sweet but you didn’t eat anything that raised your blood sugar. It will work itself out in a few weeks.

  • Hi, I’m on my 4th week of Keto and have experienced very severe Keto Flu. Currently I’m having weakness in my legs and feel fatigued/ lightheaded all the time. I consume about 75 percent fat 25 percent protein and about 5 percent carbs ( 7–10 grams a day) not sure what’s happening. Some people tell me it’s low blood sugar other say it’s electrolytes. Please let me know your thoughts.

    • It’s withdrawal. It’s not the funnest thing in the world but you do need to go through it. Just drink more water and eat more salt and it will pass in a few days.

  • Hi Aarn..congrats on your success story…hopefully you can shed some light on my episodes. I been on strict keto for nearly 3 months with NET carbs next to 0. I exercise for 5-6 hours a day (bike riding in the heat), and in the gym. My episodes were what I thought were heat exhaustion but were actually hypoglycemic related. I was very very dizzy, felt faint, like i was about to die, couldn’t speak, couldn’t move, muscle weakness, fatigue- scary stuff. Went to CITYMD today and checked my blood sugar levels. They were 48! I’m at risk of slipping into a COMA and/ or becoming hospitalized. She gave me yellow gatorade which with a gun to the head I wouldn’t drink but did. And BAM, my dizzy spells subsided…My inquiry to you is, it it better to abandon the KETO diet altogether or perhaps tweak it by incorporating fruit or carbs once a week? Or perhaps incorporate glucose tablets which may seem helpful…thanks kindly in advance for your reply.

    • So let me be absolutely clear here. I am not a Doctor and nothing I say should be taken as medical advice. The first issue you need to know is that it is not uncommon to have lower blood sugar levels and be fine, although 48 is definitely on the lower end of that spectrum with 65-90 usually being where you want to be. The Gatorade may have been beneficial because it replaced electrolytes more than BS levels. Working out that much in the sun can suck Sodium, Potassium, and Magnesium out of you faster than you would think. You might benefit from eating a few carbs (like a quarter sweet potato) before you work out. I know Zack Bitter is a fat adapted athlete but ups his carb intake on race days. I know of other athletes that will “sugar trickle” or suck on something like a Life Saver candy when pushing hard up a hill or something like that. Try some of these and see if it helps alleviate the issue.

      • Thanks for your reply; my symptoms are so bad I went to a nutritionist and spoke w/ my primary care physician whom all advised to put the diet to the wayside and eat 5-6 balanced meals per day and it will reverse low blood sugar symptoms. I’ve been doing that but still feel awful, less dizzy spells but anxiety, jittery, and some focussing issues. Also, I’m never hungry…what to do? Shall I revert back to Keto- or will that make symptoms worse because premise around Keto is designed to lower blood sugar? Thanks in adv.

        • I would never advise someone to go against a Dr’s recommendation so I’m going to tell you to stick with your Dr’s advice but if it isn’t helping, it sounds like there is another issue. I couldn’t tell you what that issue is but I can tell you that most people with BS issues see them even out after a month or so. The key is that you can’t cheat while adapting to your new dietary reality and make sure you are eating enough calories. Don’t be afraid to over eat until everything settles down.

          • Sounds like a plan! You’re a star! Thanks for the advice & info…things have already been turning around…it’s sad, but I think Keto just isn’t for me. A modified approach will keep me out so it’s either SKD or nothing.

        • im not a doctor either so sue me. lol. you cannot start a keto diet AND workout hard for 5 hours a day anymore than you can workout hard for 5 hours a day while continuously fasting. My first crash day on keto, I had a moderately more physical day at work and felt aweful. Fat adaptation is stressful enough. the first few weeks of keto are for walking off stress and thats about it.

  • Hi, I feel fine but I’m a little concerned about glucose level tests. I’m only about 20 to 30 days into my KETO diet. I was finally classified as type 2 with an A1C of 6.9 and was put on Metformin. I feel fine eating between 25 and 70g carbs per day. I only had the starving sensation one week or less into my diet. One thing I have noticed is that my blood sugar after sleeping is higher than other periods during the day. I got a little concerned today because I tested with a glucose around 70 or 60. Also my blood sugar has been swinging up and down from Below 90 up to 128. Sometimes it spikes after ice cream or blueberries and then goes down below 90 a few hours later. I’m not having Hypoglycemia symptoms but the fluctuations in my glucose cause me to think that perhaps I am. From what I have read in the blog many of posts are indicating glucose swings may be normal for the first 6 weeks. I have recently increased my fat intake and getting that high spongy light headiness awareness feeling that feels kind of good. The other part to my concern is that I have two glucose monitors. One is always 10 lower than the other one. I tested the one that was 10 lower with a control solution and it was right on at a 100. Are glucose monitors really that reliable for micro monitoring glucose levels? Should I be more concern about how I feel?

    • Unfortunately most home monitors can be off so you are just going to have to expect that and use it as a ballpark number. As for the other things, I would remove anything that can raise blood sugar like the blueberries and ice cream you mentioned for a month and let your body get used to burning fat for fuel instead of glucose. The light headedness can be normal in the first few weeks on keto, just eat a little fat to deal with it. The temptation will be to have some fruit or something but stay away from that until you are fully keto-adapted. You should also join our support group at as we can answer your questions faster there.

  • I just started this way of eating (less than 2 weeks); however, I notice that my glucose is higher now than how I was eating previously. Both fasting and 2 hours after eating.

    Is this common? Should I add more protein/food to my diet?

    I would appreciate any comments.

  • I just started this way of eating (less than 2 weeks); however, I notice that my glucose is higher now than how I was previously eating. (fasting and 2 hours after eating)

    Is this common? Should I add more protein/food to my diet?

    I would appreciate any comments.

    • The higher glucose is your body burning through your sugar reserves to keep your BS levels high. Perfectly normal and you don’t need to adjust your food intake because of it. I would join our FaceBook support group so you can share your journey with all of us.

  • Hi Aarn, I am from the UK and just a couple of days into the Keto diet. I am T2D and have been for a number of years. UK readings are around 11.5 fasting. My friend who is South Asian had similar T2D and weight problems and after going on Keto his T2D is in remission and weight is dropping off. My question really is that after how long should I expect to start to see a drop in my blood sugar reading? Any additional tips for me as my goal on Keto is to reverse my T2D?

    • Welcome to Keto! My wife reversed her T2D and tons of people in our support group have done the same so you are on the right track. It usually takes 4-6 weeks to become fat adapted and start seeing changes in your blood sugar levels and about 90 days to start seeing your A1c drop. If you have any other questions, join us in the FaceBook support group!

  • I am hypoglycemic (not diabetic and on no meds). I have been attempting to transition to Keto, going from eating the 6 times a day, to 3 times a day, upping my fat and protein intake and lowering my carbs. I find that my blood sugar drops 2 hrs after every meal and I’m having to resort to the sugar to bring it back up. Any info or advice on what I am doing wrong? Did I drop carbs too quickly instead of doing it slowly, that it’s causing me to bottom out? I just need help in the transition period and it’s hard finding the help since my drs are against Keto. Can you help?

    • You are over producing insulin in response to blood sugar after meals. I would lower my carbs to almost nothing for a few weeks eating at most a few leafy greens but mostly fatty meats. You didn’t do anything wrong, your body just responds in an extreme way to carbs. It will fix itself eventually but for now you are going to have to cut out all carbs so your body doesn’t have anything to react to. Just be sure you are eating a lot of salt and drinking a lot of water and don’t eat anything sweetened even if it doesn’t have sugar because sweeteners can also trigger a hypo episode.

      • By removing all carbs, won’t my blood sugar drop at first? And if so, how do I get it to come back up without eating anything sugary? I guess I’m not understanding your reply because I have removed carbs down to almost nothing. I’ve mainly had avocado, and broccoli, celery. For example, I tested in the morning 84. For breakfast I ate 2 eggs, 2 bacon and 1/4 avocado. Two hours later when I tested, I dropped to 68. (Did I have to resort to juice to raise this or would I have been okay?) Well I did resort to juice. Lunch I had tuna salad, cottage cheese and avocado. Tested two hours later at 67. Again resorted to the juice. Supper had steak, broccoli and cheese, and dropped to 51 and had difficulty getting it up. Went to 56, then 64. Gave up trying. Went to bed frustrated.

  • When I tried this diet 8 years ago, my blood glucose was 60 or lower. I started getting too skinny so I started to eat even more meat. Probably 200 grams a day and just did an all meat diet to stop all carbs. My protein was getting converted to glucose so that explained why I was still gaining weight.

    I started the low carb diet again about 2 month ago. Per day, I average about 1-9 total carbs but never above 20. Doing about 37-100 grams of fat and 54g-60 grams of protein. I started at 200lbs and am down to 182lbs. My average calories are 600-1200 per day. When I test my fasting glucose in the morning, It’s still at 101-105. 3 to 4 times a week I go workout and lift heavy weights, it’s 115-120 right after. Nothing ingested but water.

    I doctor thought I might be pre-diabetic before I started my diet 2 months ago, because of my 115 score. The lowest I’ve seen my glucose go is 87, at about 6PM without eating anything that day. I’ve heard of gluconeogenesis where excess protein is converted to glucose. I’m pretty close to eating 0.8 grams of protein / KG of weight. So I’m not consuming excess protein. I have also doubled my muscle mass in my arms, legs and chest.

    My ketones show up consistently as the deepest purple on the ketostix. I’m steadily loosing weight.

    Here are my questions:

    Why is it that I still have tons of glucose in my blood stream?

    I don’t want to drop below 160lbs and I can’t do mct oil (its behaves like a laxative) to increase calories. I can’t eat carbs or protein because this will raise my glucose levels. Any advice?

    • Yes, eat more calories. It sounds like your macros are pretty spot on so just increase your calories. Easiest way to do that is with butter or ghee on your veggies, fattier cuts of meat or maybe a dessert of whipped cream with a little stevia and cocoa powder in the blender for a minute. However if you are gaining muscle and losing weight, it would seem you have body fat to lose, why fight that? You will eventually run out of excess body fat to lose and stop losing weight.

  • Hi, I’ve been on the Keto diet for 4 months. Only lost 6kg. I have low blood sugar every day. The lowest was 3.4. But I don’t feel the effects. I have a monitor and I check it daily. Sugars are high fasting and then goes low after meals. I only consume 1 fruit a day to bring the sugar up a bit. I am not a diabetic. What can I do?

    • If you aren’t feeling the effects, don’t worry about it. It sounds like you are over-producing insulin after meals because that s what your body is used to doing. You can speed up the process by adding some weight training to your routine to add new insulin sensitive muscle tissue but eventually your body will figure it out.

  • It’s really hard to add fat. I tried doing coffee fat bombs but the mct didn’t agree with me. I have to find more recipes with lots of butter. MOst of the meat I eat is organic and has very little fat. I guess organic animals aren’t overweight. If you add butter/bacon grease and bbq the meat, most of the butter/bacon grease just drips out of it. (by weighing the meat before and after)

    Yesterday, I mixed a cup of heavy cream with half a scoop of organic protein powder and that gave me 80g of fat, 16g of protein and 16g of carbs. My total net carbs for the day was 20. 77g of protein. 93.4g of fat. Only ate 1194 calories. Unfortunately, I didn’t check glucose levels this morning. 🙁

    • Yeah, grass fed/finished animals are lower in fat overall. That’s why it is important to get the fattiest cuts like ribeyes. You can also add fat after cooking by putting a few pats of butter on top or slicing up an avocado and topping the meat or eating it on the side. Primal Kitchen makes some sauces with avocado oil you can try as well.

  • Thank you! Your article and responses here have been helpful and inspiring for me!

    I’ve been following a strict keto diet for a month or so, albeit with some slip ups by mistake as I’m still learning, and wondering why my glucose level would be low (3.9) while my ketone level poor at 0.9mmol… I just can’t wrap my head around the numbers this being my last reading. It varries too, so the time before this my glucose was 3.7 and ketones 2.2. Are you able to shed some light on why low glucose but also poor ketones ‘at times’ changing within a 12 hr period. Am I going in and out of ketosis so quickly…not sure.
    Thank you so much!

    • It sounds like you are not fully keto adapted yet. I wouldn’t worry about it. Stick with it and let your body adjust, you will be able to see things start to even out at about the 6 week mark.

  • I am considering starting the keto diet. I am a Type 1 diabetic on an insulin but. How will I treat a low blood sugar while in ketosis? Thank you

  • Hi just started Carnivore diet (just meat) just at end of day 4 as I write this. Tested blood glucose a few times and I’m between 80-85. I feel pretty weak (not dizzy but not great) ive had 1 glucose tablet on 2 different occasions when I was feeling extra fatigued in the evening. I’ve basically been just resting in bed these last few days. I am prediabetic when doctor tested me with HBa1c I was 6.1. Anyway I worry is my blood sugar too low? I wondered how low do I let it get before using my glucose tablets. I really want to get past this weakness as I’m on holidays with family and my young son is waiting to go for walks etc. Any thoughts greatly appreciated. Thank you love your site

    • Thanks for the kind words. You really jumped into the deep end of the pool going carnivore straight out the gate. If you are worried about it, try eating a few higher carb veggies for a few weeks like root veggies to give your body a chance to adjust to its new low carb reality. Then phase those out as your body begins to rely on its own endogenous glucose production. What is probably happening is you are over producing insulin which is driving your blood sugar levels too low, that will adjust over the next few weeks. Again, I would much rather you raise your blood sugar with real food than glucose tablets if you can do it. Hope that helps and keep me posted!

  • Hey there. Ive been on Keto (not full) for 6 months. I basically eat protein and vegetables or salad everyday and eggs and bacon in the mornings. I’ve lost 14kgs which I’m super happy about. My starting weight was 114. I’m now 100. The issue I have is with my blood sugar. It’s between 5.8 and 6 fasting. Then it drops low when eating or after meals. I’ve never been diagnosed with diabetes and I’m on no medication. I do take antagolin which is a pill to help with the sudden drops. I don’t feel the affects of lows, especially when it’s around 4.3. But I do feel the effects when it’s around 5.1. It’s weird. I test my sugar daily. Should I be worried about the lows and what can I do when I feel that terrible off feeling of a low when it’s actually normal?

    • This question is a bit more technical than I feel comfortable answering so you should definitely consult your Doctor. Just off the top of my head it sounds like your pancreas is a hyper-responder and dumps more insulin than normal in response to the carbs in your salads. One thing you might try is going zero carb for a month and just eat meat. If your BS levels stabilize, then that would give you a clue as to what is happening.

  • Can changing up eating habits from regular diet to the keto diet cause your body to become a diabetic while on it ( low blood sugar levels) or if you decide to begin eating sugars again? ( maybe the body not remembering how to breakdown the sugars and carbs in your body?)

    • Breaking down food into sugar is one of the most basic things your body does, there is no way your body could forget how to do that. You might have a low blood sugar episode while transitioning but that’s not you becoming diabetic, that’s your body working out the change from being primarily a sugar burner to primarily a fat burner. Even if you decide to eat sugar again, your body will always have the metabolic machinery in place to handle it.

  • Hello. I am on my 5th week of Ketogenic diet. I’m a female and I used to take carbs for primary source of nutrition like rice and flour. After reading your post, I got the hang of the reason why I’ve been suffering from those symptoms you listed.

    I don’t understand my strong insulin resistance, however, because this is my second time going for Ketogenic diet. I had lost about 15kg two years ago and gained 15kg back during the two years. I got a Keto-mojo device a few days ago and it shows my blood glucose levels under 80 mg/dL sometimes. Moreover, my ketone level is way too high between 4 to 5.7 mmol/L. I am very concerned about the results. My goal is loosing weight but recently I’ve noticed that there has been no reducing in my weight. I have even gained some but not sure because it fluctuates.

    Today, the symptoms were severe including heart palpitations or fibrillation, headaches, breast tenderness, numbness, shaking, flushing, heartburn, skin dryness and coldness in the extremities. I was about to consider quitting this extremely low carb diet because of the symptoms which caused me panic about my health condition until I read your post. Thank you so much.

    I am trying to drink a lot of water with some pink salt in it but I am reluctant to have sweets because I am worried that it might worse the symptoms and kick me out of ketosis. Do you think taking magnesium and potassium could be related to this issue too? I don’t understand my strong insulin resistance because this is my second time doing Ketogenic diet. I had lost about 15kg two years ago and gained 15kg back during the two years.

    • There are many things that could be going on. I think the main thing here is based on the numbers you gave me, you appear to still be transitioning out of being a sugar burner into a fat burner. A BGL of 80 isn’t that bad and with the ketone levels as high as yours, you are probably just a week or 2 away from everything normalizing. I would do a couple things.

      #1 Really increase the amount of salt you are taking in and make sure it is something like Redmond’s Real Salt that has more Mg and K than Morton’s. You can also supplement your Mg, I take Pure Vitamin Club Mg and am happy with it.

      #2 You should really be combating your Insulin Resistance from the other direction as well by providing more places where your body can put the sugar you eat. You do that by building muscle with weight bearing exercise. Please consider adding more muscle building exercises into your exercise routine. I haven’t written too much about it yet but I am amazed at the difference my blood levels and body composition now that I lift heavy 3 times a week.

      And most importantly, I am not a Dr and nothing on this blog should be considered medical advice. If problems persist, please see your Dr.

  • Hi There,

    Is it possible that the “hypoglycemia” effects wont come until about two months down the road? The first month I lost about 10#, but have been on an impossible plateau for the last 4 weeks…even starting a moderate weight gain as of last week, but mostly just fluctuating between the same 137/140# every day. However, just recently my glucose readings have hit about 71 fasting, and I have started to feel light headed and mild headaches. It was brought to my attention that I may have been “starving” myself with around 1300 calories. (working out 6/7 day) but after reading your article it sounds like maybe my body is just now figuring out how to burn fat and I should just continue to push the same routine in this plateau? Any advice would me MUCH appreciated because I am feeling mentally defeated right now! Thanks 🙂

    • If the light-headedness persists for another week or so, then I would probably discontinue this and up your carbs a little. Still no sugar or processed grains but maybe more veggies or even a small baked sweet potato. As for the weight loss, give it a little more time and then try Intermittent Fasting but not cutting more calories. So skipping breakfast and then eating a larger lunch and a normal dinner and see what happens. The number of experiments I’ve had to run on myself to figure out what to do to lose weight has been the craziest thing about this weight loss journey.

    • I would brush the diet aside for now. I did and as hard it was initially, I feel much much better. Sure there were lots of pluses; lives the constant energy but everything backfired about 1.5 yrs in. Started getting intense carb/ sugar cravings during exercise..just seemed mentally taxing in the body and brain. In order for my blood sugars to stabilize I forced (was very anti carbs) but forced myself to eat whole grains again. But only in the early part of my day. Doing this helped be rebuild muscle, have energy all day, bs was stable and I could exercise. And now I’m even losing more weight than i did On keto. Doing Keto after the 6-7 month period, it’ll be virtually impossible to lose any more weight- which was my ultimate goal. Bottom line is that long term it caused more harm than good (esp bc of the hypo g issue) and would recommend to go back to a VLC diet- and only in the early part of the day have them, promise you, you’ll feel better overall. Certainly from a mental and social perspective.

  • I have been on this diet for a week and have T2 diabetes. I quit all my medication and have been averaging about 115 on the monitor. I know it’s early but I was wondering if I ever get low blood sugar later in this diet would I get out of ketosis if I had a glucose tablet to bring my level up? It hasn’t happened but what would be the best thing to do in this situation. I know you are not a Dr but would like some advise. Thanks

    • If you have T2D, you should be monitoring your BS religiously until you get a handle on how your body is responding to the diet. The glucose tablet is probably not a bad idea but you really shouldn’t need it if you have been eating keto for a week with no symptoms. In the interest of covering my own rear end, I should also mention that it is never a good idea to stop taking medications without a doctor’s approval.

  • Hello! I started keto about 4 or 5 days ago and I’ve experienced a bunch of the stuff on the hypoglycemia list. Things such as fatigue, shakiness, nausea. I’ve also just today felt like I’m about to faint and become really lightheaded whenever I stand up ( you know that feeling ) Is that normal as well or should I be concerned in some way? 🙂

    • You are probably just transitioning over to being a fat burning person. That transition is harder for some people than other. You might try adding in something like a quarter of a sweet potato at dinner for a week to ease the transition. Let me know if that helps!

  • I have been a diabetic for 30 years. I started Keto with my husband 4 weeks ago. All was going well for me, I lost 10 lbs the first couple weeks which I understand may have been water weight. Now in the last week I have gained back 1.5 lbs over the week. I have not changed the diet, except I have been trying to eat less meals, like a piece of meat for lunch some days but I always eat an evening meal. WHY AM I GAINING WEIGHT back? Do I need to do a total one or two day fast? My husband continues to loose weight, why can’t I.

    • I don’t know for sure because I’m not there but here’s a few things to remember. Losing weight is primarily a hormonal process and hormones for women are less straight forward than they are for men. You are still in the beginning stages of the diet so for now, just continue to eat real, high fat food and let your body adjust. It’s going to take some time. If you are going to add something to your routine, I would rather see you do some muscle building exercise than try to fast the weight off. There might be a time in the future you add in some fasting but for now, try exercise first. Remember to salt your food liberally and drink primarily water. If you would like to schedule a time to talk face to face with me, use to do that.

      • Thank you for replying. I am 71 and had a radical hyst. so I don’t know how many hormones I have left. Anyway, I and my husband will do more exercising.
        Is there any physical negative to fasting now since you say we are still in the beginning stages? I feel good fasting and do not gorge when I eat, just have normal portions.
        But one big question is why is salt always mentioned with a Keto diet? My husband and I have always tried to avoid salt because it is bad for blood pressure and we blow up like beach balls. Is it just to reduce the amount of liquid expelled? Appreciate your help.

        • Salt is very important on a ketogenic diet. Once you cut out the carbs you will lose a lot of water from your body so the risk is you will start having cramps and having other signs of low electrolytes. I doubt now that you are keto if you will see any kind of inflammation or swelling once you increase salt and you shouldn’t see any rise in BP either but I would monitor that. I have a post on here about salt but I would really recommend you read The Salt Fix because he really goes into detail about how most of the bad effects you associated with salt was probably the sugar instead. Thanks again for reaching out! I love talking to people.

  • I have been on keto for about a year in the supervised DELISH study. I have dropped 55 lbs. My glucose before dinner is in the 90s, and my ketones run anywhere from 0.5 to 1.1. On a lark today I measured my fasting glucose before eating. It was 43. I did not feel poorly. I sometimes lately wake up with anxiety, and sometimes get very minor shaking in my leg muscles. My last A1c was 6.0. My insulin resistance was very high to start, but it has come down, but it not yet normal. Should I worry about low glucose at night, and take some glucose pills in the middle of the night?

  • Hi Aarn,

    First of all great site!
    I just stumbled on it by finding the specific post you wrote about morning hypoglycemia. That post is all I’ve read so far, but I have to commend you on your writing and straight forward communication.

    I don’t know if this is covered somewhere but on top of everything you’ve said, I’m finding that the morning hypoglycemia seems to be exacerbated by use of, or too much use of MCT oil. I’ve been on Keto for just over a year, lost nearly 100lbs and improved my health and well being in countless ways. However, this morning hypoglycemia started about a month ago, maybe a bit longer, when I started incorporating more fasts into my regime, and started using MCT oil as well as organic virgin coconut oil, which I had been using since the beginning.

    I’m cutting out the MCT and coconut oil for a week and have gone way way up on sodium and electrolytes because I realized I was way underestimating the need of those being supplemented. I’m a coffee addict, and when I combine the caffeine with the effects of the HypoGl… it makes me into a jittery nutcase. LOL

    Congratulations on all your success, it truly is life changing, and thanks for sharing.

  • I’ve been off and on with the ketogenic diet. I started back on it January 1st 2022. By Monday I was already back into ketosis blood sugar in the 80s and keton levels around 1.0 both checked with blood test. Today I checked it and my blood glucose is 57 and ketosis are 3.8. I feel great no problems at all. Just I can not find any answers on if having that low of blood sugar is ok.

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