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Glucose & Keto: What You Need to Know & Monitor

June 3, 2021
Written by
Team NutriSense
Reviewed by

Whether you are new to the ketogenic world or an avid low carb dieter, you have likely heard the term "keto" before. Ketogenic or "keto" diets have actually been around for years. Recently, the keto diet has become very popular thanks to an ever growing amount of weight loss success stories from keto enthusiasts. Our collective obsession with fat is back again, but this time it's okay to eat fat—and a lot of it!

As you can imagine, there is more to a keto diet than just eating a lot of fat, just like there are more benefits to a keto diet than weight loss. A well crafted ketogenic diet can be a great tool for enhancing metabolic flexibility, reducing insulin levels, managing glucose levels, preventing neurological diseases, and treating migraines. Research has found that a well crafted keto diet may even be more effective than low fat diets for treatment of obesity and diabetes.

When following a keto diet, most people obsess over their ketone levels. While it is easy to focus on just measuring ketones, doing so would be a disadvantage. The truth is that ketones and glucose go hand in hand -- and monitoring your glucose through a continuous glucose monitor may be more beneficial than just monitoring your ketones alone.

How a ketogenic diet impacts blood glucose

Before we jump into keto diets, let's take it back to the basics.­ Our bodies break carbohydrates down into glucose to use as fuel, making it the main source of energy for our bodies. There are a couple reasons for this. 

One, our bodies are very efficient at using glucose for energy. Two, we have some organs that require glucose for energy. Keto diets limit carbohydrate intake, which deprives the body of exogenous glucose, meaning glucose sources from outside the body. This forces it to make certain adaptations. 

First, limiting the body’s glucose sources causes the body to switch from primarily exogenous glucose for energy to glycogen—or glucose storages—causing specific metabolic changes.

Because certain organs require glucose for energy, our bodies can produce their own glucose, specifically from the liver. This process is known as gluconeogenesis, and it ensures our organs get the correct amount of glucose to function properly. 

When glucose availability drops so low that the body doesn’t have enough to use for energy, it enters a state called ketogenesis. In this state, Ketone bodies are created from fatty acids and replace glucose as the body’s primary source of energy. We can measure one ketone body in the bloodstream, beta hydroxybutyrate (BHB), and when BHB is within a 0.5 mmol/L - 1.0 mmol/L range would be considered a “light nutritional ketosis.” BHB levels within 1.0 mmol/L- 3.0 mmol/L would be considered a more optimal ketosis. 

As you can see, the relationship between ketones and glucose is inverse. You can't really get a full picture of what is happening in your body unless you are monitoring your glucose as well. 

Here are a few common glucose trends that we have seen with a keto diet.

Lower glucose trends

There is no doubt that carbohydrates have the most influence on glucose levels. So, it makes sense that if you are following a zero to very low carbohydrate diet, your glucose levels will remain more steady. 

Individual glucose baselines will differ from person to person depending on health history, length of time following a keto diet, and activity level. However, average glucose levels for keto dieters usually hover anywhere between 70-­90 mg/dL.

Another metric that we use to evaluate glucose trends is glycemic variability, also known as glucose swings. While a certain degree of variation is normal (and good), we want to prevent large glucose swings. A common trend that we have observed amongst keto diets is low glycemic variability or very stable glucose levels.

Elevated fasting glucose levels

Elevated fasting glucose levels are a very common trend that we see with individuals who have been following a keto diet for a prolonged amount of time. This trend, also known as "glucose sparing," appears to be a natural adaptation. 

Elevated fasting glucose levels usually start to occur with those who have been following a strict keto diet for over a year. This is the body's way of assuring that glucose is present for organs that require it. According to current research, this isn’t necessarily a bad thing. However, we recommend monitoring other health metrics such as glycemic variability, fasting insulin, HDL, triglycerides, and liver enzymes to ensure that everything else remains in a good range.

High glucose spikes to small amounts of carbs

Keto diets help to lower insulin levels. But, another common trend that we see is slightly higher glucose responses to a small amount of carbs. Individuals who follow a very low carb diet may have lower insulin sensitivity compared to someone who consumes more carbs. Keto diets can lead to a temporary physiological insulin resistance, in which the body overreacts when carbs are introduced.

Physiological insulin resistance is different from pathological insulin resistance. Pathological insulin resistance is a disease state, whereas physiological insulin resistance is a temporary adaptation. Similar to the elevated fasting glucose levels with a keto diet, this does not appear to be a bad thing. What is happening is that the muscles, which typically prefer glucose, start to prefer fatty acids for fuel instead. Muscles are a huge sinkhole for glucose. So, when the muscles start to prefer fatty acids over glucose, consuming carbs tend to cause larger glucose elevations.

One way to combat this is to understand your carb threshold and what type of carbs you tolerate best. Understanding your carb threshold will help maintain metabolic flexibility. This will allow your body to quickly shift from using ketones and glucose, without ever being dependent on just glucose.

What CGM (Continuous Glucose Monitoring) can do for keto

There are many factors that can impact ketosis. The four major components include diet, exercise, sleep and stress. It is no coincidence that the four main factors that impact ketone also impact glucose.

Ketones and glucose are interconnected. Checking your glucose or ketone readings with a meter provides a snapshot of what is happening in the body at that exact moment. Unfortunately, there is no device that measures ketones continuously at the moment. But, we do have the CGM, which monitors glucose continuously and will help cut through the noise and variables. The CGM gives real time feedback with your diet and daily habits. This provides precision and clarity into what is impacting your glucose levels, which as we know, may potentially be impacting your ketones. For example, for some, getting into ketosis and staying there can be difficult! This is where CGM data can be so useful.

Identify your trigger foods using a CGM

Everyone has a unique response to carbs. If we were to perform a test with two different people eating a banana, we could see drastically different glucose responses. The reason is that nutrition is very individualistic. This is why understanding your bio­-individuality and your responses to different carbohydrates is so important. Identifying how you tolerate specific carbs and identifying the foods that drastically increase your glucose will help optimize your keto diet. With a CGM, you don't have to guess if a certain food is kicking you out of ketosis. The CGM will provide you with the data you need to optimize your diet and give you some peace of mind. You may find that you tolerate more carb foods than you think!

Test out "keto­ friendly" foods

Don't believe those clever marketing labels! Not every "keto snack" is keto friendly. And if it is, not everyone responds well to them! Many keto-friendly foods are made with artificial sweeteners and highly processed starches that often raise glucose levels. If you have a go­ to "keto" food, definitely test it out! A CGM will help provide that insight to see how your body responds. Foods that cause elevated prolonged spikes (think higher than 140 and longer than 3 hrs), are foods we should reduce. For example, one customer at NutriSense found that Costco rotisserie chicken was causing huge glucose spikes. This seems odd, since chicken is a go-to food in the keto diet. After looking into this further, we found that the rotisserie chicken had a lot of additional ingredients that were injected during the cooking process. These additional ingredients caused their glucose levels to spike. Without the CGM, we would have never been able to figure out that this particular food was causing their glucose to spike and kicking them out of ketosis.

 Experiment with portion sizes

Getting into ketosis is one thing, but staying in ketosis is an entirely different challenge. The amount of carbs you can eat while staying in ketosis is unique from person to person. Individuals who are physically active and practicing intermittent fasting may be able to consume more carbs. This is why understanding your personal carb threshold is so important for diet sustainability and metabolic flexibility. The CGM can provide so many insights on your body's carb tolerance. Using a CGM will help you understand how much carbs your body tolerates in a day, at each meal, and when is the best time to eat those carbs.

Test your protein threshold

Too much protein, too little protein --­ this is often a big debate in the keto community. The amount of protein that one person can tolerate is highly personalized. To find out what works best for your body, it is best to test both ketones and glucose. You likely will have to continue adjusting your macros until you find what works best for you. Typically, the threshold for "excess" protein is very high. Any excess that is not utilized for repair and maintenance of tissue is converted into glucose for energy. Continuously monitoring your glucose will help catch those subtle glucose rises that often occur when too much protein is eaten.

Tips for monitoring glucose on a keto diet

Many popular keto websites will tell you that eating >30 g of carbs a day will kick you out of ketosis. For many users at NutriSense who are following a keto diet, we found this to simply be untrue.

 First step: test your carb threshold

One of the first experiments you can do using a CGM on a keto diet is testing your personal carb threshold. Once you are in a steady state of ketosis, you can start testing the 30 g carb boundaries a bit.

 To do this, you would gradually increase your carbohydrate intake while monitoring your ketones and glucose values through your CGM at the same time each day. Next, choose one meal per day that you would include more carbs at and time this meal to be after a workout or some type of movement. Always pair your carbs with protein and fat for best glucose control. You could start by having 30 grams of carbs per day, then increasing your carbs by 10 g. You can keep bumping up your carbs until your morning ketones drop below 0.5. Once it dips below 0.5, you have found your carb threshold.

 Once you find your threshold, you can consume that many carbs every day or just do it a few days a week. You may be surprised with how many carbs you can consume a day while still maintaining ketosis! As a pro tip, typically the more fasting and exercise you do will give you more flexibility for carbohydrates. Ketones and glucose should have an inverse relationship. This means that if glucose is high, ketones are likely low.

 Second step: test your trigger foods

To test your trigger foods you need to first record your pre-prandial (before eating) ketone and glucose value. The best time to test this would be in a fasted state or at least three hours after a meal. Next, eat your experimental food choice. Two hours after your meal, record your postprandial (after eating) ketone and glucose values. This will allow you to see how quickly your values recovered from your experimental food.

Once you complete the experiment check your results. We want a glucose delta of <30. For ketones, we do not want ketones to drop >1.0 mmol/L and we want it to return back to baseline within 2 hrs. If glucose and ketones are out of the ideal ranges, try retesting with a smaller portion.

Third step: test out your protein threshold

The threshold for protein is typically high, though anything in excess will lead towards energy storage. To find out if you are consuming too much protein at one meal, test your ketones and glucose in a fasted state and make note of it. Eat a meal and make note of how much protein is in that meal. If the protein amount is too high, we typically see a very gradual rise in glucose data through the CGM. This rise can occur anywhere from 2­4 hours after a meal (depending on the other components of the meal).

Integrate CGM into your keto diet

Using the CGM while you are on a keto diet allows you to personalize your keto diet to your body and your lifestyle. You no longer have to guess if eating a "keto pizza" is kicking you out of ketosis. You no longer have to be afraid of adding in carbs in your diet. With a CGM you can experiment and find the right macro combinations, exercise regimen, and lifestyle habits that are specific to you. NutriSense utilizes this technology and pairs you with a dietitian to help find what works for you personally. You don't have to rely on blanket statements or general recommendations anymore. You can unlock your optimal keto diet and lifestyle using a CGM.


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Glucose & Keto: What You Need to Know & Monitor
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A Simple & Effective Tool To Help Balance Your Hormones Stat
A Simple & Effective Tool To Help Balance Your Hormones Stat

Catherine Staffieri discusses the impact of glucose on hormones, perimenopause and menopause, weight loss and the incredible benefits of using a CGM as a tool to help you feel your best.

Podcast
43
min
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The Benefits of Using CGMs in Your Health Coach Practice
The Benefits of Using CGMs in Your Health Coach Practice

To discuss how a health coach can incorporate this in their practice, Health Coach Academy invited Carlee Hayes to the show.

Story
12
min
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20 Mental Health and Wellness Podcasts Recommended by Dietitians
20 Mental Health and Wellness Podcasts Recommended by Dietitians

This week, we’ve compiled some of our favorite podcasts that go beyond nutrition. Here are 20 wellness-focused podcasts to add to your queue.

Story
12
min
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Are BCAAs Worth It? The Bottom Line on Branched-Chain Amino Acids
Are BCAAs Worth It? The Bottom Line on Branched-Chain Amino Acids

Are BCAAs worth it? This post digs into 30+ years of research to answer this question. The answer may surprise you.

Story
8
min
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Science Backed Tips for Menopause-Related Weight Gain
Science Backed Tips for Menopause-Related Weight Gain

Menopause can be a difficult journey, so we've compiled some of the most effective, science backed tips to help you with menopause-related weight gain.

Story
8
min
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Help Dad Stay Healthy this Father's Day
Help Dad Stay Healthy this Father's Day

Father’s Day is around the corner, and whether you’re celebrating your dad, a father figure, or another cherished loved one, helping them take care of their health can be the ultimate gift.

Story
10
min
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11 Great Low-Carb Snacks to Add to Your Diet [+ 5 Recipes our Dietitians Love]
11 Great Low-Carb Snacks to Add to Your Diet [+ 5 Recipes our Dietitians Love]

Here's a helpful list of some of our favorite low-carb snacks that can help you keep your diet varied and full of healthy nutrients.

Story
7
min
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Low Glycemic Index Recipe Ideas Everyone Will Enjoy
Low Glycemic Index Recipe Ideas Everyone Will Enjoy

Whether you're looking for low GI summer snacks or healthy sweet treats, this post has got you covered. Here are tasty low glycemic index recipes everyone will enjoy!

Story
8
min
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Do Grapes Raise Blood Sugar Levels?
Do Grapes Raise Blood Sugar Levels?

Wondering if grapes are safe for people with diabetes to include in their diet? Read on to find out.

Story
7
min
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The Relationship Between Cholesterol and Blood Sugar
The Relationship Between Cholesterol and Blood Sugar

Cholesterol plays a very important role in the human body, contributing to the structure of the cells, helping with vitamin D synthesis, and also promoting the production of steroid and sex hormones, like cortisol, aldosterone, testosterone, and estrogen. But how exactly is cholesterol connected to blood glucose levels?

Story
11
min
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20 Questions to Ask Your CGM Provider (with Kara Collier)
20 Questions to Ask Your CGM Provider (with Kara Collier)

We sat down with Kara Collier, our co-founder and VP of Health here at NutriSense, to take a closer look at how CGMs work and what you need to know about these devices before using one.

Story
7
min
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Are Carbs and Sugar the Same? 
Are Carbs and Sugar the Same? 

Are carbs and sugar the same? In this post, we break down the key differences between the two and share the benefits of complex carbohydrates.

Story
9
min
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Best Recovery Breakfasts to Beat Post-Workout DOMS
Best Recovery Breakfasts to Beat Post-Workout DOMS

Read on to learn more about DOMS, how long it can last, and then pick from our list of the best breakfasts to help beat that post-workout soreness, support muscle building, and encourage fat loss.

Story
13
min
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7 Plant-Derived Supplements to Help Lower Blood Sugar
7 Plant-Derived Supplements to Help Lower Blood Sugar

When it comes to lowering blood sugar levels, not all supplements are created equal. From ginseng to aloe vera, here are some of the best supplements to help avoid high blood sugar and encourage blood sugar control.

Story
8
min
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Is Bloating After Surgery Normal?
Is Bloating After Surgery Normal?

Bloating that results from a surgery can sometimes be an unexpected part of the recovery process. Is there anything you can do to reduce bloating or prevent it from happening? And what causes this bloating anyway? Read on to find the answer to these questions and much more to help you combat your post-surgery swelling. 

Story
9
min
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Is Fiber a Carb? 
Is Fiber a Carb? 

Learn why fiber is classified as a carb and how to increase your intake of this health promoting nutrient.

Story
9
min
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Living with Autoimmune Conditions: Parkinson’s Disease 
Living with Autoimmune Conditions: Parkinson’s Disease 

Did you know Parkinson’s disease is the second most common neurodegenerative disease? Read on to learn what it's like living with PD plus discover treatment options.

Story
10
min
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An Expert Breaks Down 11 Viral Health Trends
An Expert Breaks Down 11 Viral Health Trends

From rosemary water to dry scooping, should you be trying every new trend that hits TikTok? How can you tell which ones may help and which ones to steer clear of?

Story
8
min
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Does Eating Too Much Sugar Affect Your Skin?
Does Eating Too Much Sugar Affect Your Skin?

As great as sugar tastes, including too much of it in your diet can lead to certain health problems. Read on to learn more about the role sugar plays in keeping your skin healthy.

Story
9
min
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14 Health and Nutrition Podcasts Recommended by Dietitians
14 Health and Nutrition Podcasts Recommended by Dietitians

Read on to see which podcasts our dietitians recommend if you’re interested in learning more about nutrition and health.

Story
7
min
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Does Nicotine Affect Blood Glucose?
Does Nicotine Affect Blood Glucose?

Nicotine is a chemical in tobacco that can affect your health in various ways. Read our article to learn how it impacts blood sugar levels and insulin sensitivity.

Story
9
min
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Why Everyone, Including Healthy People Should Use CGMs
Why Everyone, Including Healthy People Should Use CGMs

CGMs are now an excellent tool for anyone who wants to optimize their metabolic health. Read on to find out more about the benefits CGMs can have for healthy people!

Story
10
min
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Why Do People Need to Lose Weight Before Bariatric Surgery?
Why Do People Need to Lose Weight Before Bariatric Surgery?

Although bariatric surgery can be an effective way to lose weight and improve health for people who are obese, it’s a major decision. Find out what lifestyle changes you need to make before going under the knife.

Story
8
min
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NutriSense Dietitians Recommend: Favorite Grilling Recipes
NutriSense Dietitians Recommend: Favorite Grilling Recipes

Excited to fire up the grill this summer? Read on to learn if grilling is healthy for you plus check out the NutriSense Nutrition Team's favorite grilling recipes for the season.

Story
9
min
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How a Healthy Gut Improves Blood Sugar
How a Healthy Gut Improves Blood Sugar

Did you know that your gut health can impact your blood glucose levels? Explore ways to improve your gut health for optimal glucose levels.

Story
8
min
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Living With Autoimmune Conditions: Rheumatoid Arthritis
Living With Autoimmune Conditions: Rheumatoid Arthritis

Rheumatoid arthritis is a chronic inflammatory autoimmune disease that can cause swelling and joint pain. Learn more about how it develops and how other health conditions affect its onset.

Story
10
min
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13 Best Weight Loss Apps to Consider
13 Best Weight Loss Apps to Consider

We’ve hand-picked the best weight loss apps available. Here are the thirteen best weight loss apps.

Story
8
min
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What is Red Light Therapy?
What is Red Light Therapy?

An emerging treatment, red light therapy promises to prevent and treat the signs of aging and other skin issues. Read on to find out more.

Story
9
min
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Diets People are Most Likely to Give Up On [+Tips to Stick with Them]
Diets People are Most Likely to Give Up On [+Tips to Stick with Them]

Struggling to stick with a health-promoting diet? Here’s how to make it enjoyable so you can reap the benefits.

Podcast
85
min
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Kara Collier on Optimal Health Through Blood Sugar Regulation
Kara Collier on Optimal Health Through Blood Sugar Regulation

VP of Health and co-founder of NutriSense Kara Collier discusses reaching optimal health through blood sugar regulation, what a continuous glucose monitor is, and who might benefit from using it.

Podcast
16
min
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How to Turn Your Idea into a 120 Person Team with Dan Zavorotny
How to Turn Your Idea into a 120 Person Team with Dan Zavorotny

In this episode of Zero to CEO, Jason Sherman talks to Dan Zavorotny about how to turn your idea into a 120 person team in 2.5 years.

Story
7
min
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A Breakdown of Body Mass Index (BMI)
A Breakdown of Body Mass Index (BMI)

Body mass index is a term you may have seen tossed around quite a bit in the health world. You may know that it’s a way to measure body fat, but with so many new tests for measuring overall fitness and health, is BMI still reliable?

Story
8
min
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Glucose-Friendly Recipes to Enjoy This Memorial Day
Glucose-Friendly Recipes to Enjoy This Memorial Day

If you're watching your glucose levels, traditional BBQ staples may not be the best choice. Here are some recipes that will help you enjoy a Memorial Day meal without a blood sugar spike.

Story
8
min
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Taking Mental Health Online: Tips & Tools for Self-Care
Taking Mental Health Online: Tips & Tools for Self-Care

Mental health has a significant impact on your overall health; here are tips, tools, and apps to improve your mental wellbeing.

Story
8
min
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Can You Check Your Blood Sugar at Home Without a Meter
Can You Check Your Blood Sugar at Home Without a Meter

Living with diabetes can be a challenge, especially when it comes to keeping your blood sugar levels regulated. Learn if you can check your blood sugar at home without a meter.

Story
10
min
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NutriSense Dietitians Recommend: Best Sunscreen for all Skin Types
NutriSense Dietitians Recommend: Best Sunscreen for all Skin Types

With summer right around the corner, it’s time to make sure you have the tools you need to protect yourself from sunburn and sun damage. But how do you choose the right one for adequate sun protection?

Story
8
min
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Japanese Water Therapy & Weight Loss: What’s the Deal? 
Japanese Water Therapy & Weight Loss: What’s the Deal? 

Learn how Japanese water therapy can help with weight loss, energy levels, and detoxification.