‘As much insulin as needed but as little as possible’
It is possible to eat any food with Type 1 diabetes. But this practice means that only one in ten people manage to get the balance of insulin and carbs just right. It is such a particular skill that nine out of ten people are failing to meet the current guideline target. With such a low level of achievement, something must be wrong. We surely can’t go on accepting 10% success without offering low carb as an option for management when we know that it improves control?
We need to rethink Type 1 diabetes. Low carb means less insulin and therefore, less risk of large swings of blood glucose. In fact, low carb in Type 1 diabetes has been shown to smooth out the high and low blood sugars and enables people to achieve levels of control they could only have dreamed on when on a high carb diet. Evidence shows that with low carb in Type 1 diabetes that more than 90% of people reach the target, there are five times fewer hypos, fewer hospital admissions with diabetic ketoacidosis, a high level of adherence to the diet, and a reduction in insulin doses.
Insulin has to be injected into the body to replace its inability to produce insulin. In essence, Type 1 diabetes is a hormone replacement therapy requiring insulin. Insulin has many actions in the body, but perhaps the most crucial is to control blood glucose. Any dietary carbs will produce glucose. It doesn’t matter if they are from sugary sweets or healthy whole grains. They are absorbed into the body as glucose. And insulin is needed to control the glucose rise that happens when we eat carbs.
Calculating insulin doses to allow for the carbohydrate content of each meal is something that most people find difficult. Any over or underestimation will cause large swings of glucose which makes life miserable with an increased risk of low sugars called hypos. High glucose makes people feel generally sluggish.
One piece of good news for people with Type 1 is that dietary carbohydrates are non-essential nutrients. Reducing carbs does not affect the nutrient value of the diet, but it does lead to an improvement of diabetes control with improved health and well-being in both the short and long term. More dietary carbs mean more insulin; fewer dietary carbs means less insulin. But zero dietary carbs, which is very difficult, does not mean zero insulin. People with Type 1 have to inject insulin because the body needs it for other metabolic processes. The body also makes carbs ‘in-house’ as required, so insulin is necessary for that too. Low carb in Type 1 isn’t about stopping insulin; it is about minimising insulin to make Type 1 easier and safer to control. The phrase ‘as much insulin as needed but as little as possible’ sums this up nicely
Dr. Ian Lake.
I have been a GP for 26 years and work in Gloucestershire. I have a degree in Medical Cell Biology and Biochemistry from Liverpool University and qualified as a Doctor in 1985 from Southampton University.
I was diagnosed with LADA Type 1 Diabetes, aged 36. I managed it with a DAFNE style approach for the first 20 years and changed to a very low carb four years ago. I had such dramatic results that I decided to dedicate my time to get the information about low carbohydrate lifestyles to those with Type 1 themselves.
I am a founder member of The Public Health Collaboration www.phcuk.org.uk, which is a charity dedicated to promoting a real food lifestyle for health. I have spoken on low-carb management of Type 1 diabetes at various conferences.
I am a medical advisor for Type 1 diabetes to the European Keto Live Center
You can access my work through the following links.
YouTube. I am a founder member of The Public Health Collaboration. I am fortunate to be able to present my learning on low carb in Type 1 diabetes; these links go to my talks.
Diabetes Unpacked Book. I was privileged to contribute to a book in support of Prof. Tim Noakes’s legal fund. You might know Tim Noakes. He is a highly respected scientist internationally and also an ultramarathon runner. He wrote most of the science about carb-loading for sport. However, when he developed type 2 diabetes himself, he realised that he could not outrun his condition and that diet was essential. He changed his mind about his belief in carbs for energy as he became aware of the benefits of low carb lifestyles. He received a complaint from a dietitian in his home country of South Africa about his advice and underwent a 3-year trial with his professional organisation. He won the case and has since received an apology. The appeal was rejected too. So the profits from the book all went to the Tim Noakes’ Charitable Foundation. The book is an excellent read on all aspects of low carb for health. I wrote chapter 5 on Type 1 diabetes.
Take Control of Type 1 Diabetes. David Cavan. Dr. Cavan is an internationally respected Diabetologist and had a long career in the NHS. He included me in his section on low carb for Type 1 diabetes.
Diet Doctor Interview. I gave a short interview to Diet Doctor for their information on Type1 diabetes