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Type 1 Diabetes Advanced Keto Course

Advanced Keto Course

A Minimum 20 hours of CPD

This is a comprehensive assessed course covering all of the modules in the Essential Course but with extra information on metabolic processes and the management of keto diets for those with complications. There are also modules covering driving, mental health and physical activity. The Advanced Keto Course has a minimum of 20 hours of CPD. In practice, some people can take longer depending on how many references they choose to read. There are over 200 references in the course for further reading and over 150 assessment questions in multiple choice and workbook style format. It is well suited to those clinicians who need to make clinical decisions on the management of Type 1 diabetes.

The course content has been peer-reviewed by healthcare professionals who are considered to be experts in their field and/or are people with Type 1 diabetes and who have expert knowledge of managing this condition with a ketogenic diet.

The learning objectives of this course are as follows

Understand the rationale for a ketogenic diet in Type 1 diabetes

Understand how to formulate a ketogenic diet

Revise metabolic pathways that are relevant to a ketogenic diet

Have the practical knowledge required to help a person with Type 1 diabetes to adopt a ketogenic diet.

Advise on ketogenic diets with respect to diabetes complications

Have a rational plan for monitoring Type 1 diabetes at all stages of the condition

Have a working knowledge of the principles of physical activity in Type1 diabetes and the importance of this as a management tool

Understand the impact of Type 1 diabetes on mental health

Be aware of the aetiology of Type 1 diabetes

By the end of this course, the clinician should feel confident in managing and giving advice on all aspects of Type 1 diabetes with a ketogenic diet. 

Advanced Course content

Section 1: Metabolism and Biochemistry.

These modules provide the background science to the practice. They are pitched at a professional level and cover the knowledge needed to feel confident in providing information on ketogenic diets in Type 1 diabetes. Each module, including the podcasts and assessments, takes around an hour to complete on average

  1. Macronutrient metabolism (approximate time to complete 1 hour)

2) Metabolism and Metabolic Pathways. Glycolysis, Oxidative phosphorylation (approximate time to complete 1 hour)

3) Type 1 Diabetes. Insulin and Glucagon metabolism and regulation (approximate time to complete 45 minutes)

4) Regulation of Type 1 Diabetes Peripheral and Portal Insulin. Neuroendocrine Pathways (approximate time to complete 1 hour)

5) Nutritional Ketosis and Diabetic Ketoacidosis. Why these are entirely different situations. (approximate time to complete 45 minutes)

6) Cholesterol (approximate time to complete 30 minutes )

7) Controversies in Type 1 diabetes with respect to a  Ketogenic Lifestyle. Glucose as a fuel. Cholesterol  (approximate time to complete 30 minutes)

Section 2: Practical Modules.

These modules contain testimonials and podcasts from people with Type 1 diabetes to add a patient perspective to managing Type 1. Practical examples in this series of modules challenge the student to make decisions as if they themselves had Type 1 diabetes.

  1. Ketogenic diets; what they can and cannot do. Terminology.

2) Synthetic Insulin. Types of synthetic insulin and their pharmacodynamics (approximate time to complete 45 minutes)

3) What to Eat. Covers recipes and links to well-established resources on keto diets. Includes practical examples of choosing food from a menu when eating out. (approximate time to complete 1 hour)

4) How to count carbohydrates and protein and then estimate the insulin dose. Practical (approximate time to complete 1 hour)

5) Transitioning to a Ketogenic Diet; the technique. An important practical module on how it’s done.(approximate time to complete 1 hour)

6) Advanced Complications. Transitioning to a Ketogenic Diet for someone with diabetes complications; hypertension, calculi, renal disease, retinopathy, neuropathy, and contraindications for ketogenic diets.(approximate time to complete 1 hour)

7) Intermittent Fasting. Autophagy. (approximate time to complete 30 minutes)

8) What to Measure in Type 1 diabetes. A guide to monitoring through different stages of the condition (approximate time to complete 1 hour)

9) Examples of Continuous Glucose Meters from daily life to give context to management. (approximate time to complete 1 hour)

Section 3: Holistic Care.

This series of modules covers social and other aspects of care that affect people with Type 1 diabetes.

  1. Causes of Type 1 diabetes. Genetics, antibodies, geography, environment, microbiome. (approximate time to complete 1 hour)
  2. Physical Activity. How to approach managing physical activity, with a workbook example comparing a high carbohydrate and low carbohydrate lifestyle (approximate time to complete 2 hours)
  3. Mental Health. Stress, depression, eating disorders, and food addiction.(approximate time to complete 1 hour)
  4. Driving and Type 1 diabetes. UK-based information on the rules and regulations plus how Type 1 affects driving performance.(approximate time to complete 1 hour)
  5. Navigating an annual review. A guide for people with Type 1 who adopt a keto lifestyle. This is a guide produced following a survey of patients and their experiences. (10 minutes)

There is a certificate available to download on completion of the courses.

Zoom sessions can be arranged for those who need mentoring and more informal information. 

Course structure

  • 1) Text-based content in three sections; practical management, metabolism and holistic aspects of care.
  •  2) An assessment for each module builds your CPD hours.
  • 3) Podcasts with people who have transitioned to a ketogenic lifestyle.
  • 4) Practical examples of diets used by Type 1 practitioners of a ketogenic lifestyle
  • 5) Testimonials of how Type 1 diabetes affects people
  • 6) Scenario-based practical learning to help clinicians understand the practical aspects of managing Type 1 diabetes daily 
  • 7) Online revision sessions are available on Zoom for those who prefer to supplement their knowledge using a video format.

Both courses are orientated toward healthcare professionals. They will also appeal to patients who are looking to become experts themselves. A parallel course can be accessed for free by people with Type 1 diabetes who seek less specialist information. You can find this on this website under ‘Diabetes Management ‘.

 There is more emphasis on insulin delivery with pens compared to pumps, largely because pens are still used by the overwhelming percentage of people with Type 1. Pump calculations are also mentioned throughout. The same calculations will apply to both pumps and pens in the practical exercises. Five out of 6 people currently use pens, so the clinician must be knowledgeable about pen use. 

By the end of the courses, the clinician should feel confident in understanding Type 1 diabetes management with a ketogenic diet.    

Audit

There will be an opportunity to provide data for audit and development purposes. It will contribute to the evidence base on ketogenic diets in Type1 diabetes and facilitate the adoption of this type of diabetes management in mainstream clinical practice.

When you sign on to the course, you will have a personalised learning platform to enable you to work through the material at your own pace.  There is no time limit.  After completion of the module assessments, a certificate is issued. You can retake the assessment if you would like to increase your score. But it is more important to feel confident that you can manage someone with Type 1 diabetes who has chosen a keto lifestyle than worry about the assessment score. 

I hope that you enjoy the course. Please feel free to contact me if you have any questions or concerns. 

Dr Ian Lake 

Course Lead

Questions and Answers  

Q. There is no mention of ketogenic lifestyles in the latest NICE guidelines. 

A The NICE guidelines allow clinicians to work with people who enquire about a ketogenic diet as part of their lifestyle choice.

It is unfortunate that the information has not been made available in the current guideline.

Q. I am concerned that patients have not heard of ketogenic diets and how I will help them to adopt real food ketogenic eating habits.

A This is covered in the modules on what to eat, and this is duplicated on the patient-orientated site. Those with eating disorders or food addiction might need more help. The methodology of transitioning to keto in this course is safe as it involves techniques of carbohydrate counting and insulin estimation that are already familiar to the patient. 

Q I am concerned about the patient’s ability to adjust insulin when ‘taking the plunge’. 

This is a common concern amongst all clinicians who are involved in managing Type 1. There are insulin management issues for those with T1 undertaking sport, physical activity, eating out, and infection. Most people with Type 1 are skilled in adapting to situations as they face challenges daily. Transitioning to keto is no different. Evidence has found that people on even a low carbohydrate diet have six times fewer hypoglycaemic episodes overall. The technique set out in this course is common among those who have adopted a keto lifestyle. Safety is paramount, and the course will provide information on how to approach transition for those with insulin resistance and complications. The parallel patient-orientated course also goes through the transition with the same level of detail as the professional course. 

Q I am concerned that my patient will be at risk of diabetic ketoacidosis (DKA)

A This is still a commonly expressed belief. It is true that people who are on a keto diet are still at risk of DKA but this is not because of the diet. Nutritional ketosis that happens when anyone adopts a ketogenic metabolism is not a risk factor for DKA. This is explained in the course in detail. 

Q Patients who attend secondary care are discouraged from keto diets. 

A This is becoming less frequent. In a survey of 20 people with Type 1 on a keto lifestyle, 40% said that their healthcare professional was not against them using this diet. 

Of the remaining 60%, all had reasons for discouraging the keto diet. 75% of their reasons were based on bias or personal learning needs. 25% were based on concerns about long-term evidence, which is valid. However, these concerns were mostly based on the amount of fat in the diet and the risk of heart disease based on evidence from a high-carbohydrate diet. There is as yet little evidence of how lipid markers behave in a fat-burning, ketogenic metabolism compared to a fat-storing carbohydrate-based metabolism, as will be discussed in the course. However, almost all proxy markers of monitoring point to successful outcomes. The risk management of lipid markers and poor glycaemic control points overwhelmingly in favour of managing the latter. There is an information sheet for patients on a keto diet about how to approach an annual review to have a positive experience. This can be found in the parallel free area for people who live with Type 1. It is also included in the professional’s course for information.