About Type 1 Keto
Dr Ian Lake
GP and person with Type 1 diabetes
I have been a GP for 31 years and work in Gloucestershire, UK. I have a degree in Medical Cell Biology and Biochemistry from Liverpool University awarded in 1981 and qualified as a Doctor of Medicine in 1985 from Southampton University.
I was diagnosed with LADA Type 1 Diabetes, at age 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 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 about the low-carbohydrate management of Type 1 diabetes at various conferences.
I am a medical advisor for Type 1 diabetes at the European Keto Live Center, Burghausen, Germany.www.keto-live.com
I am fortunate to be able to present my learning on ketogenic lifestyles for Type 1 diabetes. Please follow these links if you want to know more.
2016 Type 1 Diabetes from both sides of the consulting room
2017 Type 1 should claim their right to a normal blood glucose
2018 Type 1 diabetes. The elephant in the room
2019 Low Carb in the Keto Era: Respecting Insulin
2022 Fighting for the right for people with T1D to have information on a lifespan over a deathspan
2020 Diet Doctor Podcast on the zerofive100 project. This was an experiment in extreme ketogenic metabolism involving eight people, two of whom had type 1 diabetes
2022 Keto-Live, Bergun, Switzerland. Ketogenic Lifestyles for Type 1 Diabetes. Getting the Message Out
2022 Prolongevity Podcast on Type 1 ketogenic lifestyle.
The Zerofive100 project. This was a fasted (water only) 100-mile run with a group of eight people including one other person with Type 1 diabetes. It was conceived to explore some of the concerns about the ketogenic diet in Type 1 diabetes. It has made a significant contribution to both Type 1 diabetes in sports, but also Type 1 management in general. The published paper is here. Follow the link to the zerofive100 on the home page of this website.
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 organization. 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-carbohydrate diets 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 has had a long career in the NHS. He included me in his section on low carbs for Type 1 diabetes.
‘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. https://www.easd.org/virtualmeeting/home.html#!resources/estimating-life-years-lost-to-diabetes-outcomes-from-analysis-of-national-diabetes-audit-and-office-of-national-statistics-data-england-88c5df0d-653c-448b-8f4e-697f3e5be1df
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.
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.