HOW CAN YOU HELP AS AN HCP?
Type 1’s who are struggling with their control often ‘get it’ very quickly. After all, they have to live with their condition 24 hours a day and often have an awareness of what advice works by their observations. Once they are introduced to lowered carb as an option, it can be a light bulb moment. The NICE guideline NG17 emphasises patient preference, and there is strong evidence that balancing carbohydrate intake with insulin injections is an effective management practice in Type 1 Diabetes.
Consider providing glucose test strips on-demand to enable patients to test frequently. It helps them gain confidence and is very motivating for both clinicians and patients. Ideally, become an advocate for your patient and make a case for continuous glucose monitoring. It makes learning rapid and improves safety.
Provide blood ketone testing strips. All people with Type 1 Diabetes should have these to be able to manage potential DKA during those times of vulnerability (infection, etc.). Patients will feel more confident when they are aware of their blood ketone levels when on a low carbohydrate diet. Indeed, also on a conventional higher carb diet. As the body adapts to ketogenic metabolism, the blood ketone levels tend to reduce. There is no need to test ketones regularly as the strips are expensive, but they are a useful monitoring tool at certain times.
Arrange HbA1c testing three monthly. It is helpful as it is motivating; patients often look forward to HbA1c testing when following a lower carbohydrate lifestyle. For patients with CGM devices, the Coefficient of Variability and Time in Range are beginning to emerge as better markers of control.
If you know of other people with Type 1 Diabetes in your practice who are interested in lower carbohydrate management, it is a good idea to put them in touch with each other locally if they so choose.