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Can Fasting Cause Ketoacidosis?

Ketoacidosis In A Non-diabetic Woman Who Was Fasting During Lactation

Ketoacidosis In A Non-diabetic Woman Who Was Fasting During Lactation

Abstract Ketoacidosis is a potential complication of type 1 diabetes. Severe ketoacidosis with a blood pH below 7.0 is only rarely seen in other diseases. Three weeks after delivery, a young woman was admitted because of tachypnoe and tachycardia. Blood gas analysis showed a severe metabolic acidosis with a high anion gap. Further workup revealed the presence of ketone bodies in the urine with normal blood glucose and no history of diabetes. The patient reported that she had not eaten for days because of abdominal pain. After initial treatment in the ICU and immediate re-feeding, the patient’s condition rapidly improved. While under normal circumstances fasting causes at most only mild acidosis, it can be dangerous during lactation. Prolonged fasting in combination with different forms of stress puts breast feeding women at risk for starvation ketoacidosis and should therefore be avoided. Background Severe acidosis is a potentially life-threatening condition. In case of metabolic acidosis, determination of the serum anion gap helps to narrow down the differential diagnosis. An increased anion gap indicates the presence of an unusual amount of an acid that is most commonly found in ketoacidosis, lactic acidosis, renal insufficiency, and intoxications while other causes are rare. Ketoacidosis is a potential complication of type 1 diabetes while severe ketoacidosis with a blood pH below 7.0 is only rarely seen in other diseases. In diabetic ketoacidosis, glucose is not properly taken up into tissue due to an absolute insulin deficiency that is mainly found in type 1 diabetes. In parallel, glucagon release is not suppressed leading to hyperglucagonemia. Subsequently the body activates stress hormones, which worsen hyperglycemia by promoting gluconeogenesis (and also ketog Continue reading >>

In Defense Of Fasting: Common Misconceptions

In Defense Of Fasting: Common Misconceptions

Clearing misconceptions For those of you wondering, the tone of this article has been highly edited from my anger-rant earlier. I used my blog as catharsis, but now it’s back to business. I get a message across better being polite anyway. Fasting is a fairly unique diet technique. It’s at a crossroads (more like highway junction) of efficacy, health, social perception, eating disorders, and overall safety. It’s not bad given you avoid a few pitfalls and don’t blatantly starve yourself, but some people are still caught up in the midst of all this confusion, not knowing whether not eating for a single day will hurt them or help them. This article is subject to editing in the future. I am using this to keep tabs on the current science of fasting, both good and bad. It might be nice to keep it bookmarked and come back to it from time to time. I also suspect some time in the future it might become Tl;Dr, but a valuable tool nonetheless. This can be used in drug testing also and because of this some people have found a way to access synthetic urine. One of the most popular sites is Since fasting is put on ‘trail’ a lot, I figured I might bring up the common arguments like a court case. Just for kicks. Exhibit A: Ketosis and Ketoacidosis First, definitions: Ketosis is the state of an organism characterized by elevated serum levels of ketones Ketoacidosis is a metabolic state characterized by uncontrolled production of ketone bodies and decreased serum pH Ketosis is the presence of ketones, ketoacidosis is the presence of ketones combined with a drop in pH. The drop in pH is due in part to overproduction of ketones (which are acidic in nature) and a failure of the body/diet to buffer said acidity. So from this, we can preliminarily conclude that ketoacidosis will ki Continue reading >>

Fasting Ketosis And Alcoholic Ketoacidosis

Fasting Ketosis And Alcoholic Ketoacidosis

INTRODUCTION Ketoacidosis is the term used for metabolic acidoses associated with an accumulation of ketone bodies. The most common cause of ketoacidosis is diabetic ketoacidosis. Two other causes are fasting ketosis and alcoholic ketoacidosis. Fasting ketosis and alcoholic ketoacidosis will be reviewed here. Issues related to diabetic ketoacidosis are discussed in detail elsewhere. (See "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Epidemiology and pathogenesis" and "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis" and "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Treatment".) PHYSIOLOGY OF KETONE BODIES There are three major ketone bodies, with the interrelationships shown in the figure (figure 1): Acetoacetic acid is the only true ketoacid. The more dominant acid in patients with ketoacidosis is beta-hydroxybutyric acid, which results from the reduction of acetoacetic acid by NADH. Beta-hydroxybutyric acid is a hydroxyacid, not a true ketoacid. Continue reading >>

What Is Ketosis?

What Is Ketosis?

"Ketosis" is a word you'll probably see when you're looking for information on diabetes or weight loss. Is it a good thing or a bad thing? That depends. Ketosis is a normal metabolic process, something your body does to keep working. When it doesn't have enough carbohydrates from food for your cells to burn for energy, it burns fat instead. As part of this process, it makes ketones. If you're healthy and eating a balanced diet, your body controls how much fat it burns, and you don't normally make or use ketones. But when you cut way back on your calories or carbs, your body will switch to ketosis for energy. It can also happen after exercising for a long time and during pregnancy. For people with uncontrolled diabetes, ketosis is a sign of not using enough insulin. Ketosis can become dangerous when ketones build up. High levels lead to dehydration and change the chemical balance of your blood. Ketosis is a popular weight loss strategy. Low-carb eating plans include the first part of the Atkins diet and the Paleo diet, which stress proteins for fueling your body. In addition to helping you burn fat, ketosis can make you feel less hungry. It also helps you maintain muscle. For healthy people who don't have diabetes and aren't pregnant, ketosis usually kicks in after 3 or 4 days of eating less than 50 grams of carbohydrates per day. That's about 3 slices of bread, a cup of low-fat fruit yogurt, or two small bananas. You can start ketosis by fasting, too. Doctors may put children who have epilepsy on a ketogenic diet, a special high-fat, very low-carb and protein plan, because it might help prevent seizures. Adults with epilepsy sometimes eat modified Atkins diets. Some research suggests that ketogenic diets might help lower your risk of heart disease. Other studies show sp Continue reading >>

Ketosis Vs Ketoacidosis: Is Keto Healthy?

Ketosis Vs Ketoacidosis: Is Keto Healthy?

Because the two terms look and sound similar, many people often confuse ketoacidosis with ketosis. These conditions have very different meanings and effects on the body. One is a highly dangerous condition while the other has been shown to help you lose weight, prevent disease, and improve cognitive function. Here’s what you need to know about the difference between ketoacidosis and ketosis. What is Ketoacidosis? Ketoacidosis or diabetic ketoacidosis (DKA) is a life-threatening condition that results as a complication of type one diabetes. It occurs when there are dangerously high levels of ketones and blood sugar present at the same time. Ketones are compounds that are produced when the body uses fat instead of sugar as fuel. The combination of having too many ketones and too much glucose present in your blood makes it become highly acidic. This can result in damage to the normal functioning of your kidney and liver. Ketoacidosis can develop in the body within 24 hours and requires immediate care. The condition commonly affects people with type one diabetes who do not produce enough or any insulin. People with type two diabetes can also develop the condition. Ketoacidosis can be triggered by improper diet, infection or illness, and not taking proper doses of insulin (in diabetic patients). Symptoms of ketoacidosis include nausea, vomiting, and abdominal pain. Other symptoms may include a fruity odor on the person’s breath. A person’s breathing may also become rapid and shallow (1). Ketoacidosis is the leading cause of death in people with diabetes under the age of 24. Approximately 36 percent of the people who develop ketoacidosis are under the age of 30 while 27 percent are between 30 and 50, 23 percent are between 51 and 70, and 14 percent are over 70. Studies Continue reading >>

Ketoacidosis Versus Ketosis

Ketoacidosis Versus Ketosis

Some medical professionals confuse ketoacidosis, an extremely abnormal form of ketosis, with the normal benign ketosis associated with ketogenic diets and fasting states in the body. They will then tell you that ketosis is dangerous. Testing Laboratory Microbiology - Air Quality - Mold Asbestos - Environmental - Lead emsl.com Ketosis is NOT Ketoacidosis The difference between the two conditions is a matter of volume and flow rate*: Benign nutritional ketosis is a controlled, insulin regulated process which results in a mild release of fatty acids and ketone body production in response to either a fast from food, or a reduction in carbohydrate intake. Ketoacidosis is driven by a lack of insulin in the body. Without insulin, blood sugar rises to high levels and stored fat streams from fat cells. This excess amount of fat metabolism results in the production of abnormal quantities of ketones. The combination of high blood sugar and high ketone levels can upset the normal acid/base balance in the blood and become dangerous. In order to reach a state of ketoacidosis, insulin levels must be so low that the regulation of blood sugar and fatty acid flow is impaired. *See this reference paper. Here's a table of the actual numbers to show the differences in magnitude: Body Condition Quantity of Ketones Being Produced After a meal: 0.1 mmol/L Overnight Fast: 0.3 mmol/L Ketogenic Diet (Nutritional ketosis): 1-8 mmol/L >20 Days Fasting: 10 mmol/L Uncontrolled Diabetes (Ketoacidosis): >20 mmol/L Here's a more detailed explanation: Fact 1: Every human body maintains the blood and cellular fluids within a very narrow range between being too acidic (low pH) and too basic (high pH). If the blood pH gets out of the normal range, either too low or too high, big problems happen. Fact 2: The Continue reading >>

Ketosis Vs. Ketoacidosis

Ketosis Vs. Ketoacidosis

It’s a sad fact that some experts who certainly should know better confuse ketosis with ketoacidosis, misleading people into thinking that they are one and the same. Worse, they suggest that a low carb diet can cause the bad one – which is ketoacidosis. Dr. Oz is one such expert. The good Dr. Oz wrote in an Time magazine article on September 12th 2011: Artisanal bakers wept (no carbs means no baguettes), and the uberfaithful (Note: here he is referring to low carbers) began to suffer the bad breath of ketoacidosis, which occurs when glycogen stores are too low. DOH! No it doesn’t – unless you are a type 1 diabetic that is. In other words, you can’t enter into the evil netherworld of ketoacidosis unless you are one of those rare people who produces little if any insulin because insulin regulates acidosis as you will learn soon. Now, was this just an innocent typo made by Dr. Oz’s editor? Maybe. But thus far, no retraction has been made – none that I am aware of at least. As I see it, Dr. Oz doesn’t understand the difference or doesn’t want to. But fear not – I’m here to help! I feel that it’s very important for people (especially doctors) to know the difference between the two so as not to fear diet-induced ketosis caused by a low carb diet or by intermittent fasting. Ketosis is a perfectly normal and healthy state to be in. Since I have a cursory understanding of the two being a layman, I decided to ask an expert, Dr. Richard Feinman, to spell it out for us. Here you go: Ketosis vs. Ketoacidosis So what is the distinct difference between the two? Both are a condition of high levels of ketone bodies in the blood but one is life threatening and one is not. So why would this be? 1. Ketone bodies in the blood is called ketosis. Ketone bodies in the u Continue reading >>

Ketoacidosis During A Low-carbohydrate Diet

Ketoacidosis During A Low-carbohydrate Diet

To the Editor: It is believed that low-carbohydrate diets work best in reducing weight when producing ketosis.1 We report on a 51-year-old white woman who does not have diabetes but had ketoacidosis while consuming a “no-carbohydrate” diet. There was no family history of diabetes, and she was not currently taking any medications. While adhering to a regimen of carbohydrate restriction, she reached a stable weight of 59.1 kg, a decrease from 72.7 kg. After several months of stable weight, she was admitted to the hospital four times with vomiting but without abdominal pain. On each occasion, she reported no alcohol use. Her body-mass index (the weight in kilograms divided by the square of the height in meters) was 26.7 before the weight loss and 21.7 afterward. Laboratory evaluation showed anion-gap acidosis, ketonuria, and elevated plasma glucose concentrations on three of the four occasions (Table 1). She had normal concentrations of plasma lactate and glycosylated hemoglobin. Screening for drugs, including ethyl alcohol and ethylene glycol, was negative. Abdominal ultrasonography showed hepatic steatosis. On each occasion, the patient recovered after administration of intravenous fluids and insulin, was prescribed insulin injections on discharge, and gradually reduced the use of insulin and then discontinued it while remaining euglycemic for six months or more between episodes. Testing for antibodies against glutamic acid decarboxylase and antinuclear antibodies was negative. Values on lipid studies were as follows: serum triglycerides, 102 mg per deciliter; high-density lipoprotein (HDL) cholesterol, 50 mg per deciliter; and calculated low-density lipoprotein (LDL) cholesterol, 189 mg per deciliter. The patient strictly adhered to a low-carbohydrate diet for four Continue reading >>

Effects Of Fasting Ketosis | Allaboutfasting

Effects Of Fasting Ketosis | Allaboutfasting

Understanding ketosis and muscle loss during fasting. The process of ketosis is one of the physiological effects of fasting in which the brain (and some other bodily processes) uses ketones produced from fatty tissues as a fuel instead of the usual glucose. This is called "muscle sparing". When glucose isn't readily available via the diet (in the form of carbohydrates) and the glycogen stores in the liver become depleted, the body could break down muscle to get it. But ketosis is an adaptation that will spare muscle during times of shortage by instead breaking down fat stores and manufacturing ketones for brain fuel. It is said this state is attained at approximately 48 hours of a water fast for women and closer to 72 hours for men. The effects of fasting ketosis became a more popular and controversial subject about 10 years ago due to low-carb, high-protein dieters relying on it long-term to "burn the fat". Recent iterations of these "ketogenic diets" are fine-tuning fat to protein to carb ratios. Where ketosis was once considered a "crisis response" of the body and fine only for short durations, there are some diet doctors who now contend ketones are an acceptable alternative fuel, produced and used by the body any time glucose is scarce, which can happen even in non-fasting, non-dieting individuals, such as during intense exercise or during sleep. They are considering it a natural metabolic process where ketone production and use fluctuates constantly in response to the body's needs. What is so controversial about the dieters' use of ketosis is the long term, artificially produced, use of it. Over long periods of time, their high-protein diet produces excess protein by-products that become a strain on the kidneys to eliminate. Ketosis also creates a mild acidosis of Continue reading >>

Ketoacidosis In A Non-diabetic Woman Who Was Fasting During Lactation

Ketoacidosis In A Non-diabetic Woman Who Was Fasting During Lactation

Ketoacidosis in a non-diabetic woman who was fasting during lactation 1Department of Internal Medicine, Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Eberhard Karls University Tbingen, Otfried-Mller-Str. 10, 72076 Tbingen, Germany 1Department of Internal Medicine, Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Eberhard Karls University Tbingen, Otfried-Mller-Str. 10, 72076 Tbingen, Germany 1Department of Internal Medicine, Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Eberhard Karls University Tbingen, Otfried-Mller-Str. 10, 72076 Tbingen, Germany 3German Center for Diabetes Research (DZD e.V.), Otfried-Mller-Str. 10, 72076 Tbingen, Germany 1Department of Internal Medicine, Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Eberhard Karls University Tbingen, Otfried-Mller-Str. 10, 72076 Tbingen, Germany 2Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tbingen, Otfried-Mller-Str. 10, 72076 Tbingen, Germany 3German Center for Diabetes Research (DZD e.V.), Otfried-Mller-Str. 10, 72076 Tbingen, Germany 1Department of Internal Medicine, Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chemistry, Eberhard Karls University Tbingen, Otfried-Mller-Str. 10, 72076 Tbingen, Germany 2Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tbingen, Otfried-Mller-Str. 10, 72076 Tbingen, Germany 3German Center for Diabetes Research (DZD e.V.), Otfried-Mller-Str. 10, 72076 Tbingen, Germany 1Department of Internal Medicine, Division of Endocrinology, Diabetology, Angiology, Nephrology and Clinical Chem Continue reading >>

Starvation Ketoacidosis As A Cause Of Unexplained Metabolic Acidosis In The Perioperative Period

Starvation Ketoacidosis As A Cause Of Unexplained Metabolic Acidosis In The Perioperative Period

Go to: Abstract Patient: Female, 24 Final Diagnosis: Starvation ketoacidosis Symptoms: None Medication: — Clinical Procedure: Lumbar laminectomy Specialty: Orthopedics and Traumatology Besides providing anesthesia for surgery, the anesthesiologist’s role is to optimize the patient for surgery and for post-surgical recovery. This involves timely identification and treatment of medical comorbidities and abnormal laboratory values that could complicate the patient’s perioperative course. There are several potential causes of anion and non-anion gap metabolic acidosis in surgical patients, most of which could profoundly affect a patient’s surgical outcome. Thus, the presence of an acute acid-base disturbance requires a thorough workup, the results of which will influence the patient’s anesthetic management. An otherwise-healthy 24-year-old female presented for elective spine surgery and was found to have metabolic acidosis, hypotension, and polyuria intraoperatively. Common causes of acute metabolic acidosis were investigated and systematically ruled out, including lactic acidosis, diabetic ketoacidosis, drug-induced ketoacidosis, ingestion of toxic alcohols (e.g., methanol, ethylene glycol), uremia, and acute renal failure. Laboratory workup was remarkable only for elevated serum and urinary ketone levels, believed to be secondary to starvation ketoacidosis. Due to the patient’s unexplained acid-base disturbance, she was kept intubated postoperatively to allow for further workup and management. Starvation ketoacidosis is not widely recognized as a perioperative entity, and it is not well described in the medical literature. Lack of anesthesiologist awareness about this disorder may complicate the differential diagnosis for acute intraoperative metabolic acidosi Continue reading >>

Ketosis Vs. Ketoacidosis: What You Should Know

Ketosis Vs. Ketoacidosis: What You Should Know

Despite the similarity in name, ketosis and ketoacidosis are two different things. Ketoacidosis refers to diabetic ketoacidosis (DKA) and is a complication of type 1 diabetes mellitus. It’s a life-threatening condition resulting from dangerously high levels of ketones and blood sugar. This combination makes your blood too acidic, which can change the normal functioning of internal organs like your liver and kidneys. It’s critical that you get prompt treatment. DKA can occur very quickly. It may develop in less than 24 hours. It mostly occurs in people with type 1 diabetes whose bodies do not produce any insulin. Several things can lead to DKA, including illness, improper diet, or not taking an adequate dose of insulin. DKA can also occur in individuals with type 2 diabetes who have little or no insulin production. Ketosis is the presence of ketones. It’s not harmful. You can be in ketosis if you’re on a low-carbohydrate diet or fasting, or if you’ve consumed too much alcohol. If you have ketosis, you have a higher than usual level of ketones in your blood or urine, but not high enough to cause acidosis. Ketones are a chemical your body produces when it burns stored fat. Some people choose a low-carb diet to help with weight loss. While there is some controversy over their safety, low-carb diets are generally fine. Talk to your doctor before beginning any extreme diet plan. DKA is the leading cause of death in people under 24 years old who have diabetes. The overall death rate for ketoacidosis is 2 to 5 percent. People under the age of 30 make up 36 percent of DKA cases. Twenty-seven percent of people with DKA are between the ages of 30 and 50, 23 percent are between the ages of 51 and 70, and 14 percent are over the age of 70. Ketosis may cause bad breath. Ket Continue reading >>

Fasting Induces Ketoacidosis And Hypothermia In Pdhk2/pdhk4-double-knockout Mice

Fasting Induces Ketoacidosis And Hypothermia In Pdhk2/pdhk4-double-knockout Mice

Go to: Introduction The PDH complex (pyruvate dehydrogenase complex) plays a pivotal role in controlling the concentrations of glucose in the fed and fasted state [1]. In the well-fed state, the PDH complex is highly active, promoting glucose oxidation by generating acetyl-CoA, which can be oxidized by the citric acid cycle or used for fatty acid and cholesterol synthesis. In the fasted state, the PDH complex is inactivated by phosphorylation by PDHKs (pyruvate dehydrogenase kinases) to conserve three carbon compounds for the production of glucose [2]. The four PDHK isoenzymes responsible for phosphorylating the PDH complex are expressed in a tissue-specific manner [3–5]. Among the four, PDHK2 and PDHK4 are most abundantly expressed in the heart [5–7], skeletal muscle [5,8–10] and liver [5,11–14] of fasted mice. Of these two, PDHK2 is of interest because of its greater sensitivity to activation by acetyl-CoA and NADH and inhibition by pyruvate [15]. However, PDHK4 has received greater attention because its expression is increased in many tissues by fasting and diabetes [12] and transcription of its gene is regulated by insulin, glucocorticoids, thyroid hormone and fatty acids [16,17]. Inactivation of the PDH complex by phosphorylation helps to maintain euglycaemia during fasting, but contributes to hyperglycaemia in Type 2 diabetics. The increase in PDHK activity in diabetes raises the question of whether the PDHKs should be considered therapeutic targets for the treatment of diabetes [18]. Support for this possibility has been provided by the finding that mice lacking PDHK4 are euglycaemic in the fasted state and are more glucose tolerant than wild-type mice fed on a high-fat diet [19–21]. In the present study, PDHK2-KO (knockout) mice were produced to determ Continue reading >>

Ketoacidosis Associated With Low-carbohydrate Diet In A Non-diabetic Lactating Woman: A Case Report

Ketoacidosis Associated With Low-carbohydrate Diet In A Non-diabetic Lactating Woman: A Case Report

Go to: Case presentation A 32-year-old white woman presented to our county hospital with a history of nausea, vomiting, heart palpitations, trembling and extremity spasms. She had started a strict LCHF diet, with an estimated carbohydrate intake of less than 20g per day, 10 days before admittance, lost 4 kilograms and had felt growing malaise. She was breastfeeding her son of 10 months of age. She continuously denied any alcohol or drug intake. She had a past medical history of hypothyreosis and had a family history of high blood pressure but not for diabetes. She took acetaminophen occasionally but no other medications. The initial examination in the emergency department revealed an unaffected woman with respiratory rate of 12 breaths per minute, oxygen saturation 96% on room air, body temperature 36.3°C, pulse 102 beats per minute and blood pressure of 110/80mmHg. Nothing abnormal was revealed on examination of her heart, lungs, abdomen and thyroid gland. An arterial blood gas was taken. It revealed pH 7.20, base excess (BE) −19, partial pressure of carbon dioxide (pCO2) 2.8 kPa, glucose 3.8mmol/l and lactate 1.0mmol/l. Her blood ketones were 7.1mmol/l (reference 0 to 0.5mmol/l). No genetic testing of any kind was performed. The primary diagnosis was thought to be ketoacidosis due to starvation induced by the LCHF diet but blood samples for s-paracetamol, s-salicylate, s-ethanol, s-methanol, s-ethylene glycol, kidney function, diabetic autoantibodies, plasma cortisol (p-cortisol) and tests for thyroid function were added. She was admitted to our medical ward, given an intramuscular vitamin B injection and started on a 10% glucose infusion. In total 3L of glucose were infused, with an infusion rate of 125mL/hour, during 48 hours. The following day, after glucose inf Continue reading >>

Ketones: Clearing Up The Confusion

Ketones: Clearing Up The Confusion

Ketones, ketosis, ketoacidosis, DKA…these are words that you’ve probably heard at one point or another, and you might be wondering what they mean and if you need to worry about them at all, especially if you have diabetes. This week, we’ll explore the mysterious world of ketones, including if and how they may affect you. Ketones — what are they? Ketones are a type of acid that the body can form if there’s not enough carbohydrate to be burned for energy (yes, you do need carbs for fuel). Without enough carb, the body turns to another energy source: fat. Ketones are made in the liver from fat breakdown. This is called ketogenesis. People who don’t have diabetes can form ketones. This might occur if a person does extreme exercise, has an eating disorder, is fasting (not eating), or is following a low-carbohydrate diet. This is called ketosis and it’s a normal response to starvation. In a person who has diabetes, ketones form for the same reason (not enough carb for energy), but this often occurs because there isn’t enough insulin available to help move carb (in the form of glucose) from the bloodstream to the cells to be used for energy. Again, the body scrambles to find an alternate fuel source in the form of fat. You might be thinking that it’s a good thing to burn fat for fuel. However, for someone who has diabetes, ketosis can quickly become dangerous if it occurs due to a continued lack of insulin (the presence of ketones along with “normal” blood sugar levels is not necessarily a cause for concern). In the absence of insulin (which can occur if someone doesn’t take their insulin or perhaps uses an insulin pump and the pump has a malfunction, for example), fat cells continue to release fat into the circulation; the liver then continues to churn Continue reading >>

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