This website is intended to provide information to people with Type 1 diabetes to enable them to transition to a low carb lifestyle safely. From current evidence, this should give benefits of improved glycaemic control and reduced frequency of emergencies.
Published studies on low carbohydrate management of Type 1 Diabetes are encouraging. They show a reduction in hypoglycaemic episodes and an improvement in HbA1c. There is evidence of adherence in 50% of people for at least four years, with an average 1.3% fall in HbA1c. (1) There have been studies showing improvement in depression and also hope scores. It is because people feel in control of their condition.
The diet can, of course, be reversed if not suitable. Low carb does not suit everyone and can be stopped at any time with no untoward consequences.
A ketogenic lifestyle aims to move towards normal blood glucose levels safely. The intention is to reduce the HbA1c as close as possible to that of the non-diabetic population. Normal or near-normal HbA1c is a safer zone for the prevention of long term complications. Time spent in the normal range of blood glucose is an important marker for complications. We encourage the use of Continuous or Flash Glucose Monitoring where possible as it speeds up learning and reduces the risk of glucose excursions. We also recommend the provision of blood ketone testing devices and strips. This will help your patient to become familiar with their usual level of nutritional ketosis and be more adept at predicting and managing situations that might lead to DKA. Nutritional ketosis is healthy in a low carbohydrate diet and is not a risk factor for DKA.
The principle is easy to grasp, and there are just three management steps that are familiar to those involved in diabetes management.
1 Ensure optimal basal insulin dosing. Basal insulin might need to be injected twice a day in a 50:50 ratio. It should be possible to achieve a near flat trace in the normal glucose range if the patient fasts (with possible necessary adjustment using 1-2 units of rapid insulin to cover the dawn phenomenon). If the patient is using a pump, the same principle applies, i.e., basal dosing for a flat, fasting glucose.
2 Assess the patient knowledge of carb counting. This is, of course, fundamental to all Type 1 Diabetes care irrespective of their choice of diet. The patient needs to know their insulin to carbs ratio (ICR). They also need to be aware of how long their bolus insulin takes to work, and also know by how much 1 unit of insulin reduces blood glucose. We expect that all T1 will have been taught this at some point as part of routine care. It might need to be revised to help them to be confident in applying their knowledge.
- Teach the patient to balance their carbohydrate with injections ofbolusinsulin. The main difference with conventional management is that the carbohydrate intake is around 60% to 90% less than with a currently recommended diet. Corresponding bolus doses will be reduced to reflect this.