About Type 1 Keto
‘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 change. The graphic shows the current state of Type 1 diabetes care. It is from a recent National Diabetes Audit report for England and Wales.
These figures have been interpreted in the reference below and are sobering.
For every year a patient has an HbA1c above 58mmol/mol they lose 100 days of life. (reference)
This is equivalent to 7 out of 10 people in England and Wales starting to live their year on 10 April.
The static nature of these percentages over successive audits suggests that current management strategies are not producing good enough outcomes.
Offering the choice of a low-carbohydrate lifestyle for diabetes management should be an option for all Type 1 Diabetics. It is up to them if they decide to choose it.
We need to rethink Type 1 diabetes
Following a low-carb lifestyle means less insulin is needed and there is a reduced risk of large blood glucose swings. Evidence shows that Type 1 Diabetics who follow a low-carb approach, more than 90% of people reach their blood glucose target, experience fewer hypos, fewer hospital admissions with diabetic ketoacidosis and a reduction in insulin doses. https://pubmed.ncbi.nlm.nih.gov/16454166/
HbA1c from studies of very low carbohydrate diets. HbA1c 48mmol/mol is equivalent to 6.5%. For comparison with the national Diabetes Audit Table above. From https://pubmed.ncbi.nlm.nih.gov/29735574/
Insulin is important!
In Type 1 Diabetes, 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. All 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 is difficult
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 blood glucose, which makes life miserable, with an increased risk of low sugars (called hypos).
High blood glucose makes people feel generally sluggish. With higher carbohydrate diets, higher doses of insulin are required which increases the chances of error. Sometimes insulin is not absorbed from the skin reliably, and sometimes the estimation of carbohydrates is inaccurate. And there are other factors which make things worse. Protein and fat can affect glucose control as can stress, poor sleep, and physical activity. So, adding in carbohydrates to an already complex situation adds an unnecessary opportunity for error.
There’s no such thing as an Essential Carb
Dietary carbohydrates are non-essential nutrients, meaning our body does not need them to function. It is important to understand that the body can switch to burning fat stores and that this is an entirely natural process. Burning fat as an alternative fuel to carbohydrates does not mean that the body is in ‘starvation mode’.
Reducing carbs does not affect the nutrient value of the diet, but it does lead to an improvement in diabetes control with improved health and well-being in the short and long term. More dietary carbs mean more insulin; fewer dietary carbs mean 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.