Keto Diet and Feeling Sick

I have been eating keto for 3 days. I’ve had the flattest lines ever, but evening of day 2 felt really sick. Today I felt even worse, so I tested my blood ketones, and they were 1.2 which is pretty high. I know I’m supposed be making ketones, but I know high ketones are an indication of DKA. But I understand nutritional ketosis is different than diabetic ketoacidosis. I’ve been getting my insulin, and have been hydrating (and occasionally added electrolytes as well). Should I just push through the nausea or should I stop the diet? I feel like I’m “prone” to DKA after getting it really bad one time. After that I got it a few more times which I was told was due to Invokanna and not eating enough. I don’t want to give up because my numbers are so good, but maybe it’s just not right for me?

How strict of a keto diet are you doing?

I saw a video on SGLT2 from TCOYD. I believe Dr. Pettus stated that Type 1s taking this class of drugs need to eat like 25 or 30 carbs and take the meal time insulin for them 3 times a day. Otherwise euglycemic DKA could occur.

Did your provider give you a minimum amount of meal time insulin or carbs eaten for the day? Did you tell them you were starting a keto diet?

You should probably call your provider and let them know that you’re feeling sick and have high ketones. Especially with your history.

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Very few. I’ve been having coffee with 1T heavy cream till lunch, lunch was salami, cheese and cream cheese roll ups, and dinner was salad, goat cheese, some berries on top and chicken and broccoli. I snacked on some mixed nuts. I drank tons of water and water with electrolytes.

I don’t take Invokanna anymore, but I do take Ozempic, a pretty low dose.

I didn’t advise my doctor I’m doing a keto diet. He’s never gone into nutrition with me.

Sorry I didn’t realize that you weren’t on Invokanna anymore. I have no idea if Ozempic has the same issue. Hopefully someone with some keto and type 1 knowledge will respond soon.

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I wasn’t clear. Thanks for your reply. I had a few starchy foods with dinner tonight and feel better (may be totally unrelated). I’m going to email my Endo tomorrow and see what he thinks.

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I’m glad you feel a bit better!

I eat an opposite of a low carb diet but the day of food you described sounded pretty tasty- Especially dinner. I like a diet that allows a nice cup of coffee in the morning.

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And to @jo_jo there are 3 SHLT2 inhibitors that can cause euglycemic keto acidosis- Jardiance, Farxiga and Ivokanna. I am familiar with the risk when undergoing general anaesthesia. It happened to my son.

Ozempic has a list of gastric side effects. So that may be the cause of your ill feelings and the slightly elevated ketones is dietary and not keto acidosis.

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I’ve never done keto, but just about everything I’ve read about it says it’s not uncommon to feel sick – “the keto flu” – shortly after you start the diet. Headache, nausea and fatigue are common. It usually resolves on its own once your body adapts. But do keep an eye on your blood ketones and take action if needed.


I didn’t think of that, because I’m mostly acclimated to the Ozempic now, but I do remember reading that fatty foods could cause nausea with Ozempic, and keto is high fat, so maybe. That said, a lot of folks on Ozempic seem to thrive eating keto.

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I totally forgot about the “keto flu”. I read about that a long time ago when I considered doing the diet, but that didn’t even occur to me. Could be!