Type 1 Diabetes Essential Keto Course

Essential Keto Course

Around 6 hours of CPD

The Essentials Course is for those who want an introduction to ketogenic dietary management of Type 1. It is a shorter course chosen from the modules of the Advanced Course and provides six hours of assessed learning and workbook style examples. The emphasis is on practical, real-world, dietary management support for people with Type 1 diabetes.

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

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

By the end of this course, the clinician should feel confident in managing Type 1 diabetes with a ketogenic diet. 

Essential Course content

1. Macronutrient metabolism (approximate time to complete 1 hour)
2. Ketogenic diets; what they can and cannot do. Terminology. (approximate time to complete 5 mins).
3. Synthetic Insulin. Types of synthetic insulin and their pharmacodynamics (approximate time to complete 45 mins).
4. 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 2 hours).
5. How to count carbohydrates and protein and then estimate the insulin dose. Practical exercise (approximate time to complete 1 hour).
6. Transitioning to a Ketogenic Diet; the technique. An important practical module on how it’s done. (approximate time to complete 1 hour).
7. Examples of Continuous Glucose Meters from daily life to give context to management. (approximate time to complete 1.5 hours).
8. 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).

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’. 

A  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 sports, 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.