I’m doing OK with keto, but it can fall apart when D goes particularly brittle and I need to deal with lows.
I need to run my BG pretty high to avoid this.
I have found caffeine is a useful way to kick up my blood sugar. Any other no-carb suggestions? (I can’t afford glucagon micro-doses.)
If I’m heading downwards towards 80mg/dl I stop my basal delivery for half an hour. That isn’t always enough; it’s equivalent to a negative 0.25IU bolus for me, but it does help. That doesn’t work with MDI of course.
Hot showers raise my blood sugars, but for others they can drop theirs.
Thanks for the suggestions. Hot showers lower my BG typically and cutting off my basal takes maybe 90 minutes to really have much effect. (I’m on MDI currently anyway.) I need something that will make a significant impact within 30 minutes…
Well at least caffeine works.
I know there have been other threads on caffeine or coffee, but what’s the deal? I’m not a coffee drinker anyway, but I like a good black cup of tea. Never noticed increased BG. How much does it increase? And is it caffeine or coffee?
Stress releases counter-regulatory hormones. I’ve read that running 6 maximal-exertion wind sprints will cause a bg rise.
Yes, coffee raises my BG, too, as well as cheese and cherry tomatoes, both effect me like a glucose tab! 
It’s the caffeine I believe. It varies by person on if and how much it raises one’s BG. I definitely have a rise from caffeine; a more caffeinated drink will raise me more (like a Starbucks black coffee vs a cup from my keurigg.) I think most coffees have more caffeine than the average cup of tea
Cheese also raises me! Same for meats and poultry. But their rise from protein takes longer than a rise from carbs
@mentat are fruits, dried fruits or dark chocolate ok for you or you’re trying to cut all carbs?
Wow, that would ruin things for me … I love all 3 and typically have minimal BG rise from each (assuming I have no other carbs with each of those things)!!
What sort?
No, trying to cut all carbs. I have super-dark chocolate but it doesn’t raise my BG.
Great suggestions everyone… has anyone noticed an effect with things like antihistamines or nicotine gum or…?
All cheese. I love cheese but alas the type doesn’t seem to matter. 
Why would anti-histamines raise blood sugars? If anything, I’d think they would limit rises in blood sugars from immune hyperactivity.
Also, nicotine is potent and highly addictive. I can’t wrap my mind around a way in which using nicotine to treat lows could ever be more healthy than using the minimal necessary amount of carbs (often less than the 15g recommended, in my experience), even in the context of keto. Why is being so strict re: keto important to you—if it’s making you run your blood sugars higher out of avoidance of lows, is your motivation more about weight loss than glucose control?
Crippling neurological and psychiatric problems…
It’s a very complex situation but suffice to say I need tools to increase BG with minimal carbs.
It isn’t. They’re still better than on my normal diet. It’s a higher target but there are fewer major excursions.
Sure. I certainly wouldn’t take anything without weighing up the risks and benefits. But I want to identify as many options as possible, preferably cheap and OTC…
How about spices? Cough medicine? Anything that’s quickly caused you an unexpected high?
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+1
@Eric, you tend to know the most about glycogen around these parts I think, but one other thing I’m thinking re: this thread is that all of the things being talked about as non-carb ways to increase blood sugar work via glycogen release in some way (usually liver via stimulants or immune reactivity or such). Isn’t part of the point of keto to deplete liver glycogen (so that the body shifts to burning fat) and thus help flat-line, and if so, wouldn’t those same mechanisms likely be less responsive? Which also makes me wonder, is glucagon still effective for people doing keto?
I know as a non-keto person who seems to have some alpha cell function left, if I let a coasting low blood sugar ride and let my body take care of it, I find that over the next 12-24 hours, I’m at much higher risk of a subsequent low, because suddenly my basal needs plummet, presumably because of liver glycogen depletion. I’ve always assumed glucagon would not be as effective during that time frame, similar to following alcohol consumption.
Yes, a very good point you have brought up.
A keto diet would make the hormonal responses less effective for hypoglycemia.
Most of the counter-regulatory responses - glucagon, epinephrine (adrenaline), cortisol, and growth hormone - signal the liver to release glycogen. (Some also work by impairing insulin, so that part would still be effective.)
The body can use keytones, but they are not as effective as glucose.
So the net result of a keto diet would be that the counter-regulatory hormones - including a glucagon injection - would not be as effective.
Here is a good picture I have from a textbook.
One of the recommendations they give when taking a glucagon injection is to eat afterwards. Same idea. After you have burnt your glycogen stores with a glucagon shot, you are supposed to replenish the glycogen stores.
In the scenario you are describing, it’s the same thing at work. Diminished liver glycogen availability.
Ketones are usually only used as an energy source for the brain during starvation. Therefore we typically think of the brain as having a definitive requirement for glucose.
Right, so basically, it’s likely unrealistic to expect to be able to be super low carb and then not use carbs to treat lows.
My guess is that on keto, most lows are likely to be mild enough (you probably aren’t dosing enough short acting insulin to have plummeting lows) and carb sensitivity high enough that a few carbs will go a long way.
I vote for any form of dextrose (smarties for me). Like cardamom, I think lows should be less likely on that diet, so you shouldn’t need much over the course of a day.
