Blood glucose levels are a critical indicator of metabolic health, extending beyond just diabetes risk. While elevated blood sugar increases the risk of diabetes, maintaining blood glucose within a normal range is essential for overall well-being. This article delves into the complexities of blood glucose, its measurement, and how tools like Keto-Mojo can aid in monitoring and managing these levels, especially within the context of a ketogenic lifestyle.
The Significance of Blood Glucose
Blood glucose, or blood sugar, is a primary source of energy for the body. Glucose is derived from carbohydrates consumed in the diet. While essential for survival, particularly for red blood cells, chronically elevated blood glucose levels can lead to insulin resistance and associated health issues.
When you eat a meal, your blood sugar rises, and your pancreas secretes the hormone insulin, which helps move that blood sugar out of your blood and safely into cells. But when sugar consistently enters the body (think daily Big Gulps), the boss gets overworked. This is called insulin resistance - the inability of insulin to effectively store blood sugar in muscle and liver cells. In a state of insulin resistance, blood sugar stays too high for too long.
Measuring Blood Glucose
To assess metabolic health, measuring blood glucose levels is essential. Fasting blood sugar and postprandial blood glucose can be easily measured at home using a glucose meter. This involves pricking your finger, inserting a test strip into the meter, and recording the result.
Taking a blood sugar test is an ideal way to learn the effects of different foods on your body. Simply take a baseline reading (at least 3 hours after your last meal), eat a particular food, then test one or two hours after eating. You might be surprised which foods spike (or don’t spike) your blood sugar.
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Target Blood Sugar Levels
Determining target blood sugar levels is a subject of debate. However, a fasting blood glucose level below 85 mg/dl (4.7 mmol/L) is generally considered optimal. Postprandial blood glucose should ideally spike minimally, with increases of less than 30 mg/dl over baseline one hour after a meal. Blood sugar levels should return to baseline approximately three hours after eating.
Limitations of Blood Glucose Measurements
Fasting blood sugar and postprandial blood glucose measurements aren’t the most reliable measures of metabolic health. Stress, for instance, can cause the liver to secrete glucose into the bloodstream. If you’re nervous before the test, it could throw off the results. A poor night of sleep could have a similar effect. And then there’s the “dawn effect“, a natural release of cortisol in the early hours of the morning - which elevates glucose - to help your body get ready for rising. Therefore, additional markers like HbA1c and insulin levels should also be measured. Measuring the insulin response following an oral glucose tolerance test (OGTT) can give insight into your metabolic flexibility.
Managing Blood Sugar Levels
To keep your blood sugar under control, be sure to exercise, sleep, and to keep carb intake low. Lifestyle modifications play a crucial role in managing blood sugar. Regular exercise, adequate sleep, and a low-carbohydrate diet are effective strategies. For more intensive management, adopting a ketogenic lifestyle, with or without intermittent fasting, can be beneficial.
Ketone Levels and Ketosis
When starting a keto diet, pretty much everyone gets focused on their ketone levels. It makes sense. They are concrete measurements of progress and most of us are goal-oriented. But we can’t tell you how many people we’ve spoken to who wanted to give up because they weren’t where they thought they “should be” early on. So, let’s not get ahead of ourselves. Instead, let’s explore ketone levels for ketosis with an eye on learning what they are and what they mean, so you can understand what optimal levels are based on your goals.
Understanding Ketone Levels
On a ketogenic diet, the body shifts from using glucose to using ketones as its primary fuel source. Ketones are produced from fat and can be measured to determine the level of ketosis. According to keto experts, nutritional ketosis begins at molecular concentration levels of 0.5 mmol/L. That means that the minute you cross that 0.5 threshold, you’re “in ketosis.” From there, nutritional ketosis is considered “light” through 1.0 mmol/L (light is still good!), then becomes “optimal” in the 1.0 mmol/L through 3.0 mmol/L range.
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Optimal Ketone Levels
The optimal ketone level will be different if your goal is to lose weight than it is if you want to prevent illness, improve mental clarity, or become more physically fit. That’s why it’s helpful to reference a ketone levels chart.
- Weight Loss: Aim for light nutritional ketosis (0.5 mmol/L-1.0 mmol/L) as a starting point, then progress to optimal ketosis (1.0 mmol/L-3.0 mmol/L).
- Therapeutic Benefits: For medical conditions like epilepsy or cancer, higher ketone levels (3.0 mmol/L -5.0 mmol/L or higher) may be desired.
Exercise and Ketone Levels
Exercise affects ketone levels, though the impact varies. Anaerobic exercise tends to decrease circulating ketones and slightly increase blood glucose, while aerobic exercise generally increases circulating ketones.
Using Keto-Mojo for Monitoring
Keto-Mojo is a tool designed to track and monitor ketone and glucose levels. It simplifies the process of understanding how your body responds to the ketogenic diet.
How to Use Keto-Mojo
- Preparation: Twist off the top of the lancing device. Then take a new lancet and insert the lancet into the device.
- Adjust Depth: Adjust the depth selector. There are five settings for the depth of the lancet’s pierce, ranging from the lightest to deepest, to accommodate everything from soft or thin skin to thick or calloused skin. Choose the depth that you think is best for you; with experience, you’ll find the optimal depth for your skin.
- Prepare Finger: Grip the finger you are going to test with your index finger and thumb of your other hand and squeeze for about 12 seconds before using the lancet.
- Insert Strip: Make sure the strip is pushed all the way down in the port. Your meter will automatically turn on when a strip is placed in the meter. Make sure the strip is facing up. Wait for the meter to display a flashing droplet icon on the right-hand side of the meter screen. After the strip is placed into the meter, meter will display the droplet icon above an image of the strip.
- Lancing: Test on the side of your finger where the skin tends to be softer and the prick is less painful. For men or people with calloused hands, use your ring or pinky finger.
- Blood Collection: Wipe away the first blood droplet with a clean paper towel or tissue to ensure a more accurate result. Sometimes you’ll get more interstitial fluid (the substance just below the skin) with the first droplet than capillary blood. Do not place blood on the top of the strip (vs the tip of the strip).
- Apply Blood: Make sure you get a good fill. If the blood sample is too small, you may get an inaccurate reading or you will get an error message. Keep the strip to the blood droplet until you see the channel is completely full with blood and the meter starts to countdown.
- Sequential Testing: If you are testing both glucose and ketones, you can conduct the tests back to back; after your first reading displays, remove the strip and place the other strip (ketone strip, if you started with glucose) in the meter. If you have a large enough blood droplet from your first lancet pierce, you can apply that to the tip of the ketone strip.
Accuracy and Reliability of Keto-Mojo
A study evaluated the agreement between a previously validated ketone and glucose meter (Meter 1 - Precision Xtra) and a more affordable meter that has not been validated (Meter 2 - Keto-Mojo), and also to assess the diagnostic performance of Meter 2 for identifying nutritional ketosis.
The study found that reliability between the meters was excellent for measuring ketones (ICC = .968; .942-.981) and good for measuring glucose (ICC = .809; .642-.893), though the Bland-Altman plot revealed substantial differences in agreement for measuring glucose. Area under the ROC curve (Area = 0.913; 0.828-0.998) was excellent for diagnosing nutritional ketosis. Both Meter 1 and Meter 2 displayed excellent agreement between each other for ketone measurement.
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Ketogenic Diet and Athletic Performance
The ketogenic diet (KD) is a nutritional approach in which daily carbohydrate intake is restricted, commonly to < 50 g/day or 5% of energy intake. Chronic daily restriction of carbohydrates limits the use of glucose as a substrate and necessitates the use of free fatty acids (FFAs) for energy. FFAs cannot be directly used as substrate in the absence of oxaloacetate (a byproduct of glycolysis), and must instead be converted to ketone bodies in the liver through a process called ketogenesis. FFAs are converted to acetyl-CoA and then to ketone bodies (KB), most notably in the form of β-hydroxybutyrate (BHB), which can then be used by tissues of the body as an alternative fuel source to glucose . Prolonged adherence to the KD forces the body to adapt to these changes in substrate availability and shift to a state of ketosis in which most energy is derived from ketones (via FFAs) rather than from glycogen.
Benefits of Ketogenic Diet for Athletes
The metabolic changes that characterize the KD reduce the dependence of athlete performance on limited carbohydrate stores and promote glycogen sparing during prolonged activity, a possible ergogenic benefit. This benefit is most relevant to KD adapted athletes competing for substantial periods of time (> 2 h) such as ultra-endurance runners in whom fat oxidation contributes a greater percentage of energy, but who retain the ability to use muscle glycogen as fuel when needed. Reduced tissue inflammation has been observed as well, which complements recovery from practice for subsequent athletic competition.
In addition to observed metabolic and recovery adaptations, adherence to the KD causes changes in body mass and composition which may be favorable to competition in many weight-class sports. Among these are an initial rapid reduction in body weight (due to decreased glycogen and water storage throughout the body and appetite reduction from hormone actions) and increased fat oxidation.
Applications in Sports
The characteristic metabolic and body composition changes following KD adherence are practical and effective for a variety of athletes. Those who compete in specific weight categories (wrestling/martial arts, Olympic weightlifting, etc.) benefit from being able to shed weight quickly to meet these category requirements without inducing common weight-cutting side effects, such as dehydration or loss of skeletal muscle protein content. Strength and power athletes may also benefit by dropping unnecessary weight and maintaining muscular strength and power, thereby increasing strength-to-mass ratio, provided that protein consumption is sufficient. Even endurance athletes may benefit from adhering to a ketogenic diet, through improvements in peak power, VO2max, lactate threshold, and markers of muscle damage.
Monitoring BHB Levels
Accurately monitoring BHB levels is important for maintaining diet adherence and making effective modifications to the diet. Desired metabolic adaptations to a ketogenic diet are made when the athlete is in a state of nutritional ketosis (NK) and BHB is increased above resting levels to at least 0.5 mM in the blood. Objective measurement of BHB levels is needed to confirm a state of NK, or to make necessary changes to the diet and activity level to achieve NK and resulting adaptations throughout the training cycle. Knowledge of blood glucose levels is also of interest when tracking metabolic adaptations, as glucose levels remain at normal physiological levels following ketogenic adaptation and are still used as substrate during exercise.