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Glucose & Keto: What You Need to Know & Monitor

June 3, 2021
Reviewed by
Kara Collier, RDN, LDN, CNSC

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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Discover Your Unique Blood Sugar Patterns to Optimize Health with Continual Glucose Monitoring
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Welcome to Low Carb Conversations with Leah Williamson, Holly Jean Barrett and Amber Horn, Functional Nutritional Therapy Practitioners.

Podcast
75
min
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Carlee Hayes, RDN: CGM Data & Metabolic Health
Carlee Hayes, RDN: CGM Data & Metabolic Health

Carlee Hayes, lead dietitian for Nutrisense, discusses how the data gained from wearing a CGM can lead to better metabolic health.

Podcast
31
min
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LLAMA LIVE! Carbs, wearable technology and a bagel
LLAMA LIVE! Carbs, wearable technology and a bagel

Wearable technology has evolved at a pace recently, making it possible to better understand how our bodies respond to food and exercise.

Podcast
43
min
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Carlee Hayes: Why continuously monitor our glucose?
Carlee Hayes: Why continuously monitor our glucose?

Real-time information about how our bodies respond to food and exercise is transforming preventative healthcare.

Podcast
62
min
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Blood Glucose Regulation: A Guide to Glycemic Index, Continuous Glucose Monitoring, & Intermittent Fasting · Kara Collier, RDN
Blood Glucose Regulation: A Guide to Glycemic Index, Continuous Glucose Monitoring, & Intermittent Fasting · Kara Collier, RDN

Kara Collier, the Director of Nutrition at Nutrisense, is a Registered Dietitian Nutritionist and Certified Nutrition Support Clinician who specializes in glucose control and...

Podcast
42
min
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My Blood Sugar Trends!
My Blood Sugar Trends!

Nutrisense hooked up Shanna Hussin, RDN with continuous glucose monitoring as a tool to see trends in food response, stress, sleep, and exercise.

Podcast
57
min
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Continuous Glucose Monitors: Why They’re Not Just for Diabetics Anymore with Kara Collier
Continuous Glucose Monitors: Why They’re Not Just for Diabetics Anymore with Kara Collier

In this episode, Kara talks about blood sugar levels and explains why CGMs (continuous glucose monitors) are useful for everyone and not just diabetics.

Podcast
70
min
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Blood sugar balance, weight loss, metabolic health and continuous glucose monitoring
Blood sugar balance, weight loss, metabolic health and continuous glucose monitoring

In this episode, Ellie interviews Kara Collier is a Registered Dietitian Nutritionist and Certified Nutrition Support Clinician with a background in clinical nutrition...

Podcast
53
min
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How Continuous Glucose Monitoring Can Lead to Health-Conscious Behavioral Change
How Continuous Glucose Monitoring Can Lead to Health-Conscious Behavioral Change

Curious how continuous glucose monitoring can lead to significant behavioral change? Kara Collier of NutriSense discusses how this happens with Heads Up founder Dave Korsunsky.

Podcast
58
min
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Continuous Glucose Monitors for Keto & Health Optimizations w/Kara Collier of NutriSense
Continuous Glucose Monitors for Keto & Health Optimizations w/Kara Collier of NutriSense

Learn how continuous glucose monitors can help you obtain metabolic flexibility and Ways to use CGM's to experiment.

Podcast
35
min
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Be your Healthiest Self
Be your Healthiest Self

Carlee Hayes is a Registered Dietitian Nutritionist (RDN) and Lead Nutritionist on a mission to help people become the healthiest version of themselves.

Podcast
45
min
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How Nutrisense Can Help You Personalize Your Diet
How Nutrisense Can Help You Personalize Your Diet

In this week’s episode, Nathalie talks to Carlee Hayes about how CGM’s and the Nutrisense app can support individuals to personalize their diet and reach their goals.

Podcast
42
min
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Improving Insulin Resistance, PCOS, and Overall Health with Continuous Glucose Monitors
Improving Insulin Resistance, PCOS, and Overall Health with Continuous Glucose Monitors

In today's episode, Amber talks with Molly, one of the dieticians at Nutrisense, a health technology company that specializes in Continuous Glucose Monitors.

Podcast
56
min
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How To Use A Continuous Glucose Monitor To Master Glucose Response and Avoid Disease: Carlee Hayes
How To Use A Continuous Glucose Monitor To Master Glucose Response and Avoid Disease: Carlee Hayes

We talk about tracking blood glucose and why it's important to see your individual glucose response to meals, stress, exercise, and even during sleep.

Podcast
74
min
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Understanding Blood Glucose Measuring For Fat Loss and More on Keto & Carnivore with Kara Collier
Understanding Blood Glucose Measuring For Fat Loss and More on Keto & Carnivore with Kara Collier

This episode is about how to understand blood glucose numbers for fat loss on Keto & Carnivore with Kara Collier, RDN, CNSC.

Podcast
73
min
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Hack Your Goals with Continuous Blood Glucose Monitoring (CGM)
Hack Your Goals with Continuous Blood Glucose Monitoring (CGM)

Achieve Your Goals with Continuous Blood Glucose Monitoring: Kara Collier, RDN, LDN, CNSC. Nutrisense Director of Nutrition.

Kara is a Registered Dietitian Nutritionist (RDN), Licensed Dietitian/Nutritionist (LDN), and Certified Nutrition Support Clinician (CNSC) who specializes in glucose control and metabolism. She graduated from Purdue University and previously worked at Memphis VA Medical Center, as a clinical dietitian at Providence Hospital, and in a management role at Nutritionix.

Podcast
76
min
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The Power of Monitoring Glucose Levels with Kara Collier
The Power of Monitoring Glucose Levels with Kara Collier

Kara Collier is a Registered Dietitian Nutritionist and Certified Nutrition Support Clinician with a background in clinical nutrition, nutrition technology, and entrepreneurship.

Podcast
73
min
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The Power of Monitoring Glucose Levels
The Power of Monitoring Glucose Levels

Kara Collier is a Registered Dietitian Nutritionist and Certified Nutrition Support Clinician with a background in clinical nutrition, nutrition technology, and entrepreneurship. After becoming frustrated with the traditional healthcare system, she helped start the company NutriSense where she is now the Director of Nutrition. Kara is the leading authority on the use of continuous glucose monitoring (CGM) technology, particularly in non-diabetics for the purposes of health optimization, disease prevention, and reversing metabolic dysfunction. Kara oversees the health team and product development and has personally interpreted thousands of complex glucose datasets.

Podcast
58
min
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Optimizing Health Through Continuous Glucose Monitoring
Optimizing Health Through Continuous Glucose Monitoring

Metabolic health involves staying within a controlled glucose level and avoiding repeated “swings” in your glucose levels.

Podcast
50
min
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Continuous Glucose Monitors for healthy individuals looking to improve their glucose stability
Continuous Glucose Monitors for healthy individuals looking to improve their glucose stability

Information from Kara Collier about glucose and sleep: how are those two things connected, and what can we glean from monitoring this area related to improving sleep?

Podcast
48
min
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Optimizing Your Health Using NutriSense Continuous Glucose Monitoring with Carlee Hayes
Optimizing Your Health Using NutriSense Continuous Glucose Monitoring with Carlee Hayes

In this episode, Dr. Renee is joined by Lead Registered Dietitian Nutritionist for Nutrisense Continuous Glucose Monitoring, Carlee Hayes, as they take a deep dive into monitoring

Podcast
45
min
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The Lowdown on the NutriSense Continuous Glucose Monitor
The Lowdown on the NutriSense Continuous Glucose Monitor

Listen in to hear the breakdown on who this CGM is good for, who it’s NOT good for, and how it can be a beneficial step to help some who are looking to take their established healt

Podcast
42
min
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What Glucose Data Says About Your Health
What Glucose Data Says About Your Health

In this episode, we sit down with Kara Collier from NutriSense to discuss continuous glucose monitors (CGM).

Podcast
41
min
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The Change Maker! Kara Collier on The Surprising Benefits of Healthy Blood Sugar Levels
The Change Maker! Kara Collier on The Surprising Benefits of Healthy Blood Sugar Levels

The latest in nutrition, exercise, and dietary supplements. Guests include world record holders, documentary film makers, best selling authors, and health experts from all...

Podcast
34
min
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NutriSense Discusses CGMs on Nourish Balance Thrive Podcast
NutriSense Discusses CGMs on Nourish Balance Thrive Podcast

Kara from NutriSense joins the Nourish Balance Thrive Podcast with Christopher Kelly to explain why everyone should wear a CGM at least once

Podcast
27
min
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NutriSense is the very best
NutriSense is the very best

Dan and Kara from Nutrisense talk to Kyle Kingsbury about all things health and CGM technology.

Podcast
23
min
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Tips to Balance Blood Sugar and Optimize Metabolic Health - Part 2
Tips to Balance Blood Sugar and Optimize Metabolic Health - Part 2

Welcome to the second part of our metabolic health episode! Here you’ll learn more strategies to support your insulin and blood sugar levels.

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20
min
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Rusty Humphries Weight Loss - lessons learned
Rusty Humphries Weight Loss - lessons learned

On this episode of The Nisha Jackson Podcast, Nisha talks with co-host Rusty Humphries about his successful weight loss journey of 30+ pounds and improving.

Podcast
22
min
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NutraCast: NutriSense on glucose monitoring
NutraCast: NutriSense on glucose monitoring

NutraCast's Danielle Masterson speaks with NutriSense Director of Nutrition, Kara Collier, on the benefits of Continuous Glucose Monitoring (CGM) technology and the NutriSense app.

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18
min
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NutriSense CEO Alex Skryl on Bootstrapping In America
NutriSense CEO Alex Skryl on Bootstrapping In America

Some of the most interesting stories around are from entrepreneurs willing to take an idea and turn it into a business...

Podcast
14
min
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STOP making losing weight so hard!
STOP making losing weight so hard!

We will dive into how to not make every attempt at weight loss so hard, it really shouldn't be… and you truly have the control over this.⠀

Podcast
24
min
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14 Weight loss tips
14 Weight loss tips

14 tips to help you get the weight loss momentum going and provide you with a guide to lose weight and keep it off.⠀

Podcast
54
min
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Can Continuous Glucose Monitoring Support Your Health Goals?
Can Continuous Glucose Monitoring Support Your Health Goals?

Blood glucose holds keys to many important health markers including metabolic health, insulin levels, and our risk for chronic disease.

Podcast
57
min
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Learn to Better Regulate Blood Sugar All Day Long
Learn to Better Regulate Blood Sugar All Day Long

We're back with a brand new interview on our Conversations with Cabral podcast that centers on the topic on of controlling blood sugar for maximum body transformation and wellness results!   I’ve invited Kara Collier, co-founder of NutriSense, to share what she has learned from thousands of customers’ data wearing continuous glucose monitors…   For all the details on learning how to better regulate blood sugar all day long tune into today’s #CabralConcept 2099 - Enjoy the show and let @KaraCollier1 and me know what you thought in the comments!