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Keto for Type 1 Diabetes

iStock-1735114816“Research increasingly shows that strongly limiting dietary carbohydrate can have a profound effect on improving quality of life and reducing risk for long-term complications in people with type 1 diabetes.” (Source) 

A paper published recently in Endocrinology, Diabetes & Metabolism Case Reports highlights the remarkable improvements in glycemic control and quality of life a young male with type 1 diabetes experienced after adopting a ketogenic diet. The impressive findings echo what we reported on in the past regarding the beneficial effects of carbohydrate restriction for people with type 1 diabetes.

The individual profiled decreased his daily carbohydrate intake from approximately 140 grams to 25-30 grams over the course of several months. His new diet consisted mostly of fresh vegetables, meat, eggs, goat cheese, butter, and fish.

His HbA1c dropped from 7.2% at baseline to 5.1% at the end of the study. In post-study follow-ups, it has remained at a normal, non-diabetic level, reported at 5.2% and 5.4% and the subject reported no occurrences of severe hypoglycemia or ketoacidosis. Moreover, he was able to change the types of insulin he uses to make it easier to control his blood glucose, with an overall 67% decrease in the total amount of insulin required. So, he experienced better glycemic control using less insulin. This is a key point, because individuals who require supra-physiologic doses of exogenous insulin may be at risk for developing “double diabetes” – type 1 diabetes coupled with resistance to the injected insulin resembling type 2, with all the attendant adverse effects and co-morbidities associated with this.

The subject had been using a continuous glucose monitor (CGM) since before the study and continued wearing it for the duration of the study and beyond. According to the paper, “At the time of his latest HbA1c value of 5.4 mmol/L (2023) his average 90-day blood glucose level was 89 mg/dL with a standard deviation of 15 mg/dL.” These numbers would be impressive for anyone, but are especially so for someone with type 1 diabetes. This is in marked contrast to what he experienced prior to the very low-carb diet: “Although the patient strictly adhered to the doctor’s recommendations, including carbohydrate counting and dosing rapid-acting insulin with meals, he experienced large fluctuations in his blood glucose levels, difficulty in concentrating and thinking clearly at times, along with increased fatigue.”

The subject also measured blood ketone levels (beta-hydroxybutyrate), typically seeing an average of 1 to 1.5 mmol/L, with a range of 0.2 to 2 mmol/L. As noted in the paper, this is a safe and physiologically normal level, well below anything approaching ketoacidosis.

Research increasingly shows that strongly limiting dietary carbohydrate can have a profound effect on improving quality of life and reducing risk for long-term complications in people with type 1 diabetes. The most fundamental truth should be self-evident, but the paper states it nicely: “If insulin is in short supply and carbohydrates cannot be properly metabolized, a low-carb diet would lower the amount of insulin needed.”

And since much of the glycemic volatility in type 1 results from a mismatch between exogenous insulin and the body’s reaction to it (with diet, admittedly, being just one factor that affects insulin sensitivity), it stands to reason that using lower doses may help to reduce the dangerous and complication-inducing highs and lows.

The paper stated, “The findings of this study demonstrate that following a ketogenic diet can have a positive impact on patients with type 1 diabetes mellitus. This dietary modification seems to decrease blood glucose variability, decrease HbA1c levels, reduce the amount of insulin required with every meal and improve the quality of life.” Unlike type 2 diabetes, which can be reversed or put into “remission” via dietary carbohydrate restriction and other interventions, type 1 diabetes must be managed for life. This recent paper adds to the evidence suggesting that very-low-carbohydrate diets may make this management safer and easier.

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