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A Comprehensive course for healthcare professionals

Course coming later this summer

The type1keto.com Clinicians Keto Course. Managing Type 1 Diabetes with a Ketogenic Diet. Theory and Practice

Thank you for visiting this page and showing an interest in ketogenic lifestyles in Type 1 diabetes. 

Who is this course intended for?

The Clinicians Keto Course is primarily for clinicians tasked with managing Type 1 Diabetes, including diabetologists, specialist nurses, primary care staff of all clinical grades and therapists who work with people who have Type 1 diabetes. 

It will also appeal to those with Type 1 diabetes who are experts and need detailed information on managing Type 1 diabetes with a ketogenic diet. 

All aspects of diabetes care are covered, but there is more emphasis on diet and insulin management than sleep and physical activity.  This course is a practical course on ketogenic diets and how to manage Type 1 diabetes using this method.

A UK NHS doctor has designed this course, Dr Ian Lake, who is a GP and himself has Type 1 diabetes. It was managed for 20 years on a standard guideline diet and for the past seven years on a ketogenic diet. You can find out more here( link to biog on website)

This course has been peer-reviewed by healthcare professionals who are experts in their field and/or are people with Type 1 diabetes who have expert knowledge of managing this condition with a ketogenic diet. It is pitched at a level suitable for use as part of a continuing medical education portfolio. 

This Type 1 keto Course consists of;

  • text-based content in three sections; practical management, metabolism and holistic aspects of care.
  •  an assessment for each module that builds your CPD hours. This includes examples that will give you confidence in the practical management of Type 1’s who transition to a keto diet. 
  • podcasts with people who have transitioned to a ketogenic lifestyle.
  • practical examples of diets used by Type 1 practitioners of a ketogenic lifestyle
  • testimonials of how Type 1 diabetes affects people
  • scenario-based practical learning to help clinicians understand the practical aspects of managing Type 1 diabetes daily. 
  • There are online revision sessions available on Zoom for those who prefer to supplement their knowledge using a video format.
  • This course is orientated towards healthcare professionals. There is a parallel course that can be accessed for free by people with Type 1 diabetes who seek less specialist information. You can find this on the website.

 There is more emphasis on the delivery of insulin with pens compared to pumps largely because pens are still used by the overwhelming percentage of people with Type 1. Pump calculations are also mentioned throughout. The same calculations will apply to both pumps and pens in the practical exercises. Five out of 6 people still use pens so the clinician will need to be knowledgeable on pen use. 

By the end of the course, the clinician should feel confident in managing all aspects of Type 1 diabetes that apply to a ketogenic diet. 

 This course is not intended to be a textbook on Type 1 diabetes, and the discussion of how to identify and manage complications has deliberately been excluded. There are excellent resources on this elsewhere including the NICE guideline NG17. Likewise, technical management of pumps is excluded as this will have been demonstrated to the patient when they choose a pump for management. 

 This course focuses on the challenges of initiating a keto diet in people with Type 1 diabetes. 

Questions and Answers 

 Here is a list of common concerns expressed by clinicians regarding a ketogenic diet in Type 1 diabetes.

Q. There is no mention of ketogenic lifestyles in the latest NICE guidelines. 

A The NICE guidelines allow clinicians to work with people who require a ketogenic diet as part of their lifestyle choice. It is unfortunate that the information has not been made available in the current guideline.

Q. I am concerned that patients do not fully understand what keto is and how important it is to adopt real food eating habits. 

A This is covered in the modules on what to eat and this is duplicated on the patient-orientated site. Those with eating disorders or food addiction might need more help. The methodology of transitioning to keto in this course is safe as it involves techniques already familiar to the patient. 

Q I am concerned about the patient’s ability to adjust insulin when ‘taking the plunge’. 

This is a common concern amongst all clinicians who are involved in managing Type 1. There are insulin management issues in sport, physical activity, eating out, and infection. Transitioning to keto is no different. Evidence has found that people on even a low carbohydrate diet have five times fewer hypoglycaemic episodes overall. The technique set out in this course is common practice amongst those who have adopted a keto lifestyle. Safety is paramount and the course will provide information on how to approach transition for those with insulin resistance and complications. The patient-orientated course also goes through the transition in detail. 

Q I am concerned that my patient will be at risk of diabetic ketoacidosis (DKA)

A This is still a commonly expressed belief. It is true that people who are on a keto diet are still at risk of DKA but this is not because of the diet. Nutritional ketosis is not a risk factor for DKA which is explained in the course. 

Q Patients who attend secondary care are discouraged from keto diets. 

A This is becoming less frequent. In a survey of 20 people with Type 1 on a keto lifestyle, 40% said that HCP were not against them using this diet. 

Of the remaining 60%, all had reasons for discouraging the keto diet. 75% of their reasons were based on bias or personal learning needs. 25% were based on concerns about long-term evidence which is valid. However, these concerns were mostly based on the amount of fat in the diet and the risk of heart disease based on evidence from a high-carbohydrate diet. There is as yet little evidence of how lipid markers behave in a fat-burning, ketogenic metabolism compared to a fat-storing carbohydrate-based metabolism as will be discussed in the course. However almost all proxy markers of monitoring point to successful outcomes. There is an information sheet for patients who are on a keto diet about how to approach an annual review so that they have a positive experience. This can be found in the area for people who live with Type 1. ( link)

The course content is laid out below. It is recommended that the sections are worked through in the order presented, as this should enhance the learning experience. For those with knowledge of ketogenic diets in Type 1 management, individual modules, groups of bespoke modules or case studies might be more relevant and can be built up into a portfolio as needed by the clinician. 

Three main sections are covered. 

Section 1:Metabolism and Biochemistry.

These modules provide the background science to the practice. They are pitched at a professional level and cover the knowledge needed to feel confident in providing information on ketogenic diets in Type 1 diabetes. The modules take around an hour to complete including the podcasts and assessments. 

  1. Macronutrient metabolism
  2. Metabolism and Metabolic Pathways. Glycolysis, Oxidative phosphorylation
  3. Regulation of Type 1 Diabetes Peripheral and Portal Insulin. Neuroendocrine Pathways
  4. Type 1 Diabetes. Insulin and Glucagon metbolism and regulation
  5. Cholesterol

Section 2: Practical Modules. These modules contain testimonials and podcasts from people with Type 1 diabetes to add a patient perspective to managing Type 1. There are practical examples in this series of modules that challenge the student to make decisions as if they themselves had Type 1 diabetes. 

  1. Ketogenic diets; what they can and cannot do. Terminology. ( modules on terminology, what is a diabetic)
  2. Advanced Complications. Transitioning to a Ketogenic Diet for someone with diabetes complications; hypertension, calculi, renal disease, retinopathy, neuropathy, and contraindications for ketogenic diets.  
  1. Transitioning to a Ketogenic Diet; the technique. An important practical module on how it’s done. 
  2. What to Eat. Covers recipes and links to well-established resources on keto diets. Includes practical examples of how to choose food from a menu when eating out.( keto playtime)
  3. Intermittent Fasting. Autophagy. 
  4. Controversies in Type 1 diabetes with respect to a  Ketogenic Lifestyle.      Glucose as a fuel. Cholesterol 
  5. Examples of CGM from daily life to provide context to management. 

Section 3: Holistic Care. This series of modules covers social and other aspects of care that affect people with Type 1 diabetes in daily life. 

  1. Causes of Type 1 diabetes. Genetics, antibodies, geography, environment, microbiome. 
  2. Physical Activity. Contains a  practical example of a day in the hills for the student to work through as if Type 1. 
  3. Mental Health. Stress, depression, eating disorders, and food addiction. 
  4. Driving and Type 1 diabetes. UK-based information. 
  5. Navigating and annual review. A guide for people with Type 1 who adopt a keto lifestyle. This is a guide produced following a survey of patients and their experiences.
  6. One-hour zoom sessions will be provided where you can submit questions. 

There is a certificate for completion of the modules. 

When you sign on to the course, you will have a personalised learning platform to enable you to work through the material at your own pace.  There is no time limit.  After completion of the module assessments, a certificate is issued. You can retake the assessment if you would like to increase your score. But it is more important to feel confident that you can manage someone with Type 1 diabetes who has chosen a keto lifestyle than worry about the assessment score. 

I hope that you enjoy the course. Please feel free to contact me if you have any questions or concerns. 

Dr Ian Lake 

Course Lead