Type 1 Keto

Checklist for Healthcare Professionals

 

 

Willingness to change

GRIN model , addiction management

Carb Counting Skills

Core skill might need revision

Insulin Carb Ratio

Revise. It might reduce in longer term T1 as sensitivity returns

Insulin protein Ratio

Inform patient of protein effects and delayed glycaemia.

Bolus for protein

Insulin assessment

Will the insulin choice suit a low carb lifestyle? Would a less rapid insulin be better in very low carb?

Basal adjustment

Usually accurate but testing it will refine the dose. Twice daily dose a good option

Testing proficiency

Can the patient use the glucometer and understands the need for frequent testing 4-6 times a day. Does the patient have adequate test strips?

CGM eligible?

20% of T1 are eligible. With frequent testing a case can be made. It is possibly the single biggest agent to educate the patient.

Shopping list?

 

 

Plenty of online recipes and a starter fortnight list here. Check the nutrition section

Ketone testing equipment?

Blood ketones are best. Enable patients to get an idea of their personal ketone levels in nutritional ketosis. Urine sticks a minimum and ok for DKA but not ketosis measurement as urine testing may go negative in the presence of  higher blood ketones on a keto diet .

Ideas for managing sleep. An important part of a keto lifestlye

Sleep hygiene, no food after 8pm, screen protectors against blue light, etc

Ideas for managing stress. Important in any dietary management of T1

 

Stress hormones affect blood glucose

Ideas for regular physical activity.  Important in T1 and often underestimated

Encourage regular physical activity. Strength, joint flexibility and aerobic training should be included in any recommendation. Increased muscle mass increases insulin sensitivity and glucose handling. There is a practical webinar on this important topic.