Why your fasting blood sugar might still be high on low carb

September 9 2017 by in Blood sugar, Diabetes, Low carb & high fat

It’s not too uncommon to have slightly high fasting blood sugar on low carb and keto diets. Is this a problem?

It depends on your insulin levels, as outlined by Dr. Ted Naiman below. If you’re insulin sensitive, and have slightly higher fasting blood glucose, it’s likely just fine.

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Insulin

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Dr. Fung looks at the evidence on what high levels of insulin can do to one’s health and what can be done to lower insulin naturally.
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Do you really need to worry about protein on a ketogenic diet? Dr. Ben Bikman shares a new way of thinking about this.
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Diet Doctor Podcast #28 – Amy Berger
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Amy Berger has a no nonsense, practical approach that helps people see how they can get the benefits from keto without all the struggles.
Diet Doctor Podcast #29 – Dr. Spencer Nadolsky
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Dr. Spencer Nadolsky is a bit of an anomaly as he openly wants to explore low carb nutrition, low fat nutrition, multiple forms of exercise, and use it all to help his individual patients.
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Advanced low-carb topics

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A low-carb diet for T2D reversal – Dr. Sarah Hallberg
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What is the best approach to type 2 diabetes reversal? In this presentation, Sarah takes us on a deep-dive into the matter and she puts studies and evidence under the microscope.
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In the seventh episode of Diet Doctor Podcast, Megan Ramos, co-director at IDM program, talks about intermittent fasting, diabetes and her work together with Dr. Jason Fung at the IDM clinic.
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Can ketones create a possible metabolic advantage?
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Should you measure ketones on a keto diet? Dr. Westman guides you through situations when measuring is beneficial – and when it's not.
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The cause of obesity and diabetes
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Why do we get fat – and what can we do about it? Iconic science-writer Gary Taubes answers these questions.

Diabetes

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Dr. Naiman

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Is obesity mainly caused by the fat storing hormone insulin? Dr. Ted Naiman answers this question.
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39 comments

1
rpf
September 9 2017
Interesting but hard to know for oneself since there's no easy way to get your daily fasting insulin that I know of, is there?
2
Tanya
September 9 2017
I just got a glucose monitor and was a bit worried when I saw my fasting blood sugar-6.9 mmol, almost diabetic. So no need for concern? Will it normalise?
3
Cathis
September 9 2017
How can i messure the insulinlevel my self?

Reply: #5
4
Eddie
September 10 2017
Who created this infograph?

Are the conclusions (high FBG "not a problem" if insulin profile appropriate) supported by studies?

What is best course of action for a LCing (keto at time), exercising, daily IFing, man who is concerned about "pre-diabetic" FBG and A1c?
5
Reply to comment #3 by Cathis
Peter Biörck Team Diet Doctor
September 10 2017
Hi Cathis!

There are no easy way (like for sugar and ketones) yet to do home testing for insulin levels.

How can i messure the insulinlevel my self?
6
Jennifer bowerman
September 10 2017
Am I wrong here? Most doctors don't measure insulin levels. They determine diabetes status based on blood glucose levels and then prescribe insulin or its equivalent to balance off and bring the glucose down. So high insulin is treated with high insulin. Isn't this a message Dr. Fung makes many times in his lectures?
7
It
September 10 2017
Low carb is why i became hpothyroid. Good luck.
8
Peter
June 26 2018
I've been reading a lot about this. It could just be an insulin resistant liver that takes time to get rid of it's insulin resistance.

Insulin resistance can exist at different levels in different organs.

When the liver is insulin resistant, it thinks insulin levels are lower than they actually are. This can increase glucose production in the liver. Over time because of the insulin resistance, the glucose production set point changes, going higher.

You won't notice this unless you're fasting.

Then you go on the keto diet, causing your insulin levels to be lower than what it used to be and adding intermittent fasting causing longer periods of low insulin. Now your liver thinks it has to produce more glucose. It's glucose production set point is too high.

I think the only way to change insulin resistance in the liver is through eating a lot of vegetables and exercize.

It takes 3 to 6 or more months to rid your liver from insulin resistance, depending on how bad it is. The rest of your body can have mild insulin resistance while your liver has high resistance. And without lots of vegetables it may not go away at all. (I know that a lot of people on keto don't do the healthy amounts of vegetables required, and just stuff them selves with meat, fat, eggs and dairy products.)

Just my take on it. I had glucose levels of over 105 every day after 15 hours of fasting. They would be around 85, 4 hours after eating. Now, after 9 months on keto, and below 20% protein, my fasting glucose is below 95.

High protein intake can accelerate gluconeogenesis I think. Keeping protein below 20% will also help reduce high fasting glucose levels.

Replies: #18, #31
9
Cindi Long
July 24 2018
I'm badly type 2 diabetic, have been on an insulin pump needing 500 units per day when eating SAD, more like 200 units per day when eating better. I've done IF and LCHF a couple times when I was younger and I reversed it. I'm older now, and I tried plant based no oil last year in which I ate ONLY plants, and now trying to IF and eat LCHF is taking forever to work. My concern is that I've had only 20 g carbs daily for the last week and a half, eating only within 6 hours each day, and my blood sugar is still 250 to 300. I feel like that's too high and that I need to cautiously use insulin. Does anybody know of anybody else whose sugar stayed that high for this long? In the past I only needed 3 days to get normal blood sugar with no meds at all.

Reply: #10
10
Reply to comment #9 by Cindi Long
Michelle
August 1 2018
Cindi I’m experiencing this as well. I am eating 20g of carbs per day, taking metformin, basaglar, and Saxenda (for almost 2 weeks now) and my sugar was still 391 this morning and I hadn’t eaten for 8 hours.
11
Barbara
September 28 2018
I’m experiencing the same issue. I’ve been intaking >35 grams of carbs for the last 5 days and my fasting blood sugar is 168. I’ve been feeling to get out and walk or some type of exercise to burn off the excess sugars.
12
Barbara
September 28 2018
Oops. I used the wrong sign. I meant (less than) <35 gram of carbs per day.
13
Ronit
October 26 2018
U need to tighten your diet. I started with 43 units of insulin and 3 oral medications, diabetic for 25 years. I first went to LCHF, and slowly added IF, now I am LCHF and OMAD. It's been 6 months, and I watched my fasting sugars go from 350 to 119. I am now off the insulin, but still on the oral meds. It is taking a long time, but it's working. I also lost 25 pounds in the process. I expect to get off ALL my meds be next year
I also walk for one hour most days. Be patient, this is a Metabolic Syndrome we are repairing, this WORKS. Be patient dear, and keep at it.
Ronit

Reply: #16
14
Donna
February 26 2019
Hi I am Type 2 diabetic and am experiencing really high fasting blood sugars in the A.M. today it was high at 176.40 . I fast 23/1 and very little to no carbs. My sugars do go down and by 3pm can go as low as 88.20 . 2Hr PP after dinner - my bloods are 91.80 but just feel dismayed with the early morning high fasting levels.

Reply: #15
15
Reply to comment #14 by Donna
Kristin Parker Team Diet Doctor
February 26 2019

Hi I am Type 2 diabetic and am experiencing really high fasting blood sugars in the A.M. today it was high at 176.40 . I fast 23/1 and very little to no carbs. My sugars do go down and by 3pm can go as low as 88.20 . 2Hr PP after dinner - my bloods are 91.80 but just feel dismayed with the early morning high fasting levels.

You can read more about the Dawn Phenomenon here - https://www.dietdoctor.com/the-dawn-phenomenon

Some people find that a small amount of protein like cheese or nuts before bed will help bring that number down. If you are on diabetes medication, make sure and work with your doctor on dosage adjustments as needed.
16
Reply to comment #13 by Ronit
Kathleen
March 10 2019
We sure would like your type of results! We just had pulled pork that I made myself with no sugar or glucose and avocado with lettuce. My husband was 200 glucose afterwards. He’s trying to not use insulin. It’s maddening.
Kathleen
17
Troy
March 31 2019
Cindy Long - when the pancreas is insulin resistant it produces glucagon even in presence of food and during fasting. Liposomal GABA can be used to help improve sensitivity of pancreas. Take it when fasting - may require high doses so start small and titrate up accordingly!
18
Reply to comment #8 by Peter
Amy
June 12 2019
Hi Peter, do you have a source on the liver information presented here? Many Thanks

I've been reading a lot about this. It could just be an insulin resistant liver that takes time to get rid of it's insulin resistance.
Insulin resistance can exist at different levels in different organs.
When the liver is insulin resistant, it thinks insulin levels are lower than they actually are. This can increase glucose production in the liver. Over time because of the insulin resistance, the glucose production set point changes, going higher.
You won't notice this unless you're fasting.
Then you go on the keto diet, causing your insulin levels to be lower than what it used to be and adding intermittent fasting causing longer periods of low insulin. Now your liver thinks it has to produce more glucose. It's glucose production set point is too high.
I think the only way to change insulin resistance in the liver is through eating a lot of vegetables and exercize.
It takes 3 to 6 or more months to rid your liver from insulin resistance, depending on how bad it is. The rest of your body can have mild insulin resistance while your liver has high resistance. And without lots of vegetables it may not go away at all. (I know that a lot of people on keto don't do the healthy amounts of vegetables required, and just stuff them selves with meat, fat, eggs and dairy products.)
Just my take on it. I had glucose levels of over 105 every day after 15 hours of fasting. They would be around 85, 4 hours after eating. Now, after 9 months on keto, and below 20% protein, my fasting glucose is below 95.
High protein intake can accelerate gluconeogenesis I think. Keeping protein below 20% will also help reduce high fasting glucose levels.
19
Amie
September 13 2019
Hi just wanted to tell anyone who is reading to not give up and I pray you all get better! God bless you all!
20
Barbara
October 31 2019
Thank all of you for this great info. It really helps to know I am not alone. Strict keto 8 weeks and fasting sugars are over 200. Much worse than with normal healthy foods and meds.
I know it will get better, but none of the medical professionals or health coaches have offered any explanation.
God bless all of you!

Replies: #33, #39
21
Andre
April 1 2020
I’ve been keto for almost 4 months and my fasting blood sugars range from 105-125 and my blood sugar throughout the day is 105-135. My A1C was 6.1 at the 3 month mark. I don’t know why my blood sugars can’t get below 100.

Reply: #22
22
Reply to comment #21 by Andre
Kristin Parker Team Diet Doctor
April 2 2020

I’ve been keto for almost 4 months and my fasting blood sugars range from 105-125 and my blood sugar throughout the day is 105-135. My A1C was 6.1 at the 3 month mark. I don’t know why my blood sugars can’t get below 100.

You may want to monitor your blood sugar before and after meals to see if what you're eating is inadvertently keeping your numbers higher than you would like. You may also find this helpful.
https://www.dietdoctor.com/blood-sugar
23
Peggy
April 14 2020
I've been LCHF for 7 years (dx with prediabetes at that time) and monitoring ketones for last 1 1/2 years. In the past week my fasting blood sugar, normally in the low 100's suddenly jumped to 140's even as ketone levels hold between 0.5 and 1.5. I eat around noon and early evening, usually protein and a vegetable or Greek yogurt with few berries. This week blood glucose tends to start dropping early afternoon to around 115 but then creeps back up through the evening. My last A1c was 5.1, from two months ago. I feel well otherwise and no other health issues but I am baffled by this new development. I have a very low tolerance for abnormal glucose levels! Part of me says cool it and just watch for now. The other part wants to fix it NOW. Any ideas as to what might be going on?

Reply: #24
24
Reply to comment #23 by Peggy
Kristin Parker Team Diet Doctor
April 14 2020

I've been LCHF for 7 years (dx with prediabetes at that time) and monitoring ketones for last 1 1/2 years. In the past week my fasting blood sugar, normally in the low 100's suddenly jumped to 140's even as ketone levels hold between 0.5 and 1.5. I eat around noon and early evening, usually protein and a vegetable or Greek yogurt with few berries. This week blood glucose tends to start dropping early afternoon to around 115 but then creeps back up through the evening. My last A1c was 5.1, from two months ago. I feel well otherwise and no other health issues but I am baffled by this new development. I have a very low tolerance for abnormal glucose levels! Part of me says cool it and just watch for now. The other part wants to fix it NOW. Any ideas as to what might be going on?

As this is a new development, it may be worth checking in with your physician.
25
Peggy
April 15 2020
Thank you for your response. I think I've resolved it! It appears to be a bad lot of strips. I had already replaced my monitor thinking that was the problem. My husband suggested switching to a different lot of strips and voila! Numbers returned to expected levels and finger sticks taken at the same time with the "bad" strips are consistently 20 - 40 points higher. I'll continue to monitor but I feel pretty confident that is the issue. Note to self: look for simple solutions first!
26
Peggy Nestor
April 17 2020
My conversation with the strip manufacturer was quite enlightening so I wanted to share. I had purchased my meter and strips from Amazon. The customer rep says they have been having issues with strips purchased from Amazon giving faulty readings. Even the "new" meter I purchased a few days ago is actually an expired product that was manufactured in 2011! The company is making it right and sending me a replacement meter, strips, and control solution. She is also sending me a list of reliable distributors. I have to admit I have skipped the control solution for the last few years and presumably that would have picked up my problem strips right away. So lesson learned!
27
Kenn frye
June 7 2020
Hi, I am 54 type 2 have had two strokes in 2018, I have been one meal a day for three weeks, when I do eat my meal is 6 oz sirloin steak, and only water and black coffee to drink, my blood glucose level is around 174 after fasting in the morning, and ranges for 125 - 220 throughout the day, what am I doing wrong? I walk in the a.m 2.5 miles and again 1.5 at night, my doctor is no help!!!

Reply: #28
28
Reply to comment #27 by Kenn frye
Crystal Pullen Team Diet Doctor
June 8 2020

Hi, I am 54 type 2 have had two strokes in 2018, I have been one meal a day for three weeks, when I do eat my meal is 6 oz sirloin steak, and only water and black coffee to drink, my blood glucose level is around 174 after fasting in the morning, and ranges for 125 - 220 throughout the day, what am I doing wrong? I walk in the a.m 2.5 miles and again 1.5 at night, my doctor is no help!!!

I have two articles to share with you that may help shed some light. First is our guide to protein, please review it to see where your protein needs are https://www.dietdoctor.com/food-policy/protein The impact protein has on an individual will vary greatly. It may be that you need to consume other foods along with the protein depending on how lean the steak is.

Here is our link to our one meal a day guide. https://www.dietdoctor.com/intermittent-fasting/omad It does not sound like you're eating very much food. You may be stressing your body.
29
Shari
August 10 2020
My mom started keto diet. Her sugars were in the 119-145. Dr.suggested her to try it due to get AC1 being a 7.1. Now her sugars are only 59. She has no energy clammy and sleepy but can't sleep at night.
She has lost 5 pds in 3 days. I'm sure it's water. But I'm concerned on sugar level of 59. After eating lunch they went to 49. I made her drink a bit of orange juice. What is happening?
Doctors staff said no appt for a week😢

Reply: #30
30
Reply to comment #29 by Shari
Crystal Pullen Team Diet Doctor
August 10 2020

My mom started keto diet. Her sugars were in the 119-145. Dr.suggested her to try it due to get AC1 being a 7.1. Now her sugars are only 59. She has no energy clammy and sleepy but can't sleep at night.
She has lost 5 pds in 3 days. I'm sure it's water. But I'm concerned on sugar level of 59. After eating lunch they went to 49. I made her drink a bit of orange juice. What is happening?
Doctors staff said no appt for a week😢

If your mother is on any medication for her diabetes, she will need to work with her medical professional as keto can work quickly to reduce blood sugar. https://www.dietdoctor.com/low-carb/with-diabetes-medications
31
Reply to comment #8 by Peter
Pablo Cohen
September 2 2020
After days of searching your symptoms are exactly like mine. Any chance you could give me the reference of where you read about the liver been insulin resistant? I have been running for 6 months 7-14 miles per day and Went from 175 to 152 lb. but my A1C was 7 months ago 6.4 and now it’s barely 6. And my glucose average daily is about a 116-20 at fasting and after half marathons. Sometimes it will hit 90. I just can’t make sense of this contradiction.

Reply: #32
32
Reply to comment #31 by Pablo Cohen
Crystal Pullen Team Diet Doctor
September 2 2020

After days of searching your symptoms are exactly like mine. Any chance you could give me the reference of where you read about the liver been insulin resistant? I have been running for 6 months 7-14 miles per day and Went from 175 to 152 lb. but my A1C was 7 months ago 6.4 and now it’s barely 6. And my glucose average daily is about a 116-20 at fasting and after half marathons. Sometimes it will hit 90. I just can’t make sense of this contradiction.

Please see Dr. Fung's response to the first question in this Q & A. https://www.dietdoctor.com/why-is-blood-glucose-elevated-when-fasting
33
Reply to comment #20 by Barbara
LaWanda
September 9 2020
I am T2 and have been doing keto for about 6 weeks with little or no carbs and IF and my blood sugar is 200 every morning. But later, it goes down to about 160. It's scary and I know my doctor will try to add another pill. What can I do?

Reply: #34
34
Reply to comment #33 by LaWanda
Kristin Parker Team Diet Doctor
September 9 2020

I am T2 and have been doing keto for about 6 weeks with little or no carbs and IF and my blood sugar is 200 every morning. But later, it goes down to about 160. It's scary and I know my doctor will try to add another pill. What can I do?

Please make sure to work with your doctor regarding your medicine dosage.
35
In check at 52
November 21 2020
I wonder what’s wrong with me...
I was diagnosed with stage 4 liver fibrosis/cirrhosis after a biopsy in late September. I was said to also have a 4mm hematoma. The results shocked me! Needless to say, I had to do something and I went on Adkins. Since September I only consume about 20-25 carbs a day from vegetables. My glucose levels are still in the 130-140s -and I’m on 2000mgs of metformin a day with no hypoglycemia!
On November 13th, I saw a Hepatologist who ran a series of labs.
Today, those labs show I’m at an F1 liver fibrosis and by the way, I’ve lost 22 pounds from 217 lbs since October on Adkins!
I am on a liver study drug Obethiholic Acid as well.
My concern is my shot liver! Will my glucose levels ever come down? I don’t want other health issues related to diabetes.
I know I can’t get your medical advice , but What do you think?, I’ll be talking right my hematologist about it at my next appointment in January.

Reply: #36
36
Reply to comment #35 by In check at 52
Kerry Merritt Team Diet Doctor
November 21 2020

I wonder what’s wrong with me...
I was diagnosed with stage 4 liver fibrosis/cirrhosis after a biopsy in late September. I was said to also have a 4mm hematoma. The results shocked me! Needless to say, I had to do something and I went on Adkins. Since September I only consume about 20-25 carbs a day from vegetables. My glucose levels are still in the 130-140s -and I’m on 2000mgs of metformin a day with no hypoglycemia!
On November 13th, I saw a Hepatologist who ran a series of labs.
Today, those labs show I’m at an F1 liver fibrosis and by the way, I’ve lost 22 pounds from 217 lbs since October on Adkins!
I am on a liver study drug Obethiholic Acid as well.
My concern is my shot liver! Will my glucose levels ever come down? I don’t want other health issues related to diabetes.
I know I can’t get your medical advice , but What do you think?, I’ll be talking right my hematologist about it at my next appointment in January.

So happy to hear about your success so far! That's wonderful! Hopefully your doctor will be able to give you more information. However, this article may be helpful for you! https://www.dietdoctor.com/low-carb/fasting-blood-glucose-higher
37
Carol
December 9 2020
Caffeine could be spiking your blood sugar.. I was waking up to a 120 sugar level an just had coffee it would spike it up into the 200s I cut caffeine out an my sugar hasn't spike that high since

Reply: #38
38
Reply to comment #37 by Carol
Crystal Pullen Team Diet Doctor
December 9 2020

Caffeine could be spiking your blood sugar.. I was waking up to a 120 sugar level an just had coffee it would spike it up into the 200s I cut caffeine out an my sugar hasn't spike that high since

Individual response to caffeine will vary and it is a good idea to test if you have a concern.
39
Reply to comment #20 by Barbara
Raveen Bhojwani
February 28 2021
Me too Barbara! I have been on strict Keto for a month. I then went 20 hours fasting each day and eating between 6 pm to 10 pm and wow, my sugars, which were always around 200 or more went down into normal ranges, but, after 2 weeks, went back up! I decided to stop my insulin as I felt it was just making things worse. I am committed to doing OMAD between 8pm and 10 pm and doing this for a year! After seeing my father struggle with type 2 diabetes and take insulin and all the other meds they give to diabetics and die at 64, I don't trust the medical establishment anymore with this. I believe if I cut carbs, lose weight, work out, do some Yoga and breathing, over time, I am going to get better. I have heard many many people tell me it seemed that their "numbers" were getting WORSE when they cut carbs and worked out, ate lots of veggies etc. but as time went on, the numbers got better and better and most were totally off their insulin and threw out their meds. They are slimmer, and healthier now. I am gonna hang in there and see this thing through till the end!!