For those with type 1 diabetes, you should be aware of the advantages and drawbacks of low-carbohydrate and ketogenic diets.
The Keto Diet is possibly the biggest trend in eating habits for those with diabetes and can be useful for weight loss. But because a low-carb or no-carb diet causes ketosis in everyone, it is not without dispute.
Understanding the distinction between nutritional ketosis and ketoacidosis is crucial for someone with T1D because the latter is a potentially fatal condition brought on by insufficient insulin.
On a low-carb diet, your demand for insulin may decrease, but you should be cautious when cutting down on your dosages. When the body requires more insulin, such as during illness, stressful times, corticosteroid usage, heart attacks, and drug misuse, DKA may be more likely to happen. It can also happen if insulin dosages are forgotten or if an insulin pump malfunctions. Medications you may be taking in addition to insulin, particularly SGLT2 inhibitors, can increase your chance of developing DKA.
Advantages of a low-carb diet
According to studies, eating a low-carbohydrate diet will help to some extent with glucose control, including A1C and glucose variability. A diet modification of any kind necessitates insulin changes. The majority of research demonstrate that people who follow a low-carbohydrate diet have much lower insulin needs. This makes sense because consuming fewer carbohydrates reduces the amount of insulin required to manage the blood sugar spike caused by eating.
However, if utilising an insulin-to-carb ratio, it’s crucial to keep an eye on blood sugar levels after meals since you might discover that meals with high protein and no carbohydrates DO need some insulin to control post-prandial numbers. This is a tactic that needs to be tailored to your unique situation based on your observations and experience.
Negative aspects of a low-carb diet
Low-carbohydrate diets can be challenging to follow for a number of reasons.
In children, a very low carbohydrate diet may result in decreased weight and growth, which is probably connected to the diet’s lower palatability.
- Psychiatric diagnoses, including as eating problems, are twice as common in children with T1D.
- Low-carb diets can sometimes make you feel tired, especially in the beginning while your body adjusts to using ketones as fuel. As a result, adopting restricted eating practises may pave the way for disordered eating and increase social isolation.
- According to the available evidence, it is NOT recommended to suggest a low-carbohydrate diet or a ketogenic diet for blood glucose control in kids with T1D.
When recommending a low-carb diet, medical professionals are quite concerned about the potential for adverse consequences on cholesterol levels.
- A low-carb diet has been linked to a considerable rise in dangerous (LDL) cholesterol in both populations with and without T1D, according to numerous research.
- This is probably connected to the substantial intake of saturated fat that characterises these diets.
- Increased LDL, a significant risk factor for atherosclerosis and cardiovascular disease (CVD), is brought on by saturated fat.
Mono- or polyunsaturated fat reduces LDL and triglycerides and is linked to lower incidence of CVD and mortality. Saturated fat should be replaced with this type of fat.
As a result, fat quality is extremely important. When following a ketogenic or low carbohydrate diet, vitamin and electrolyte shortages (sodium, potassium, magnesium, calcium) are also a problem.
Additional issues to consider
With low carbohydrate or ketogenic diets, three additional aspects need to be taken into account.
- A low-carb diet may reduce the effectiveness of glucagon injections. This is because glycogen levels are low due to the reduced carbohydrate intake. As a result, the glucagon does not need to break down as much glycogen to produce glucose. Shorter-term low-carb diets have been found to cause a decreased glucose response to glucagon rescue, according to study. I am not aware of any research on the glucagon recovery response in type 1 diabetics who have been long-term Keto-adapted (50g of carbs per day) dieters. This might result in adaptations to glycogen, which might result in a different response—possibly a more successful one—when glucagon is administered as an emergency therapy.
- If they follow a low carbohydrate diet, people on SGLT2 inhibitor medications are probably more likely to develop ketoacidosis. As a result, it is not suggested to adhere to such a diet when taking an SGLT2 inhibitor drug. See this IN article for more information.
- On a low carbohydrate diet, really high-intensity exercise might not be possible. The body relies on carbs as a fuel source when exercising at a very high level. As a result, you can experience a drop in performance when engaging in this particular physical activity.
Takeaways
- To match your needs for exercise, you might need to modify your carbohydrate consumption.
- Low-carbohydrate diets increase your chance of developing DKA and shouldn’t be used in conjunction with SGLT2 inhibitor medications without extremely cautious medical supervision.
- It is crucial to know how to modify your insulin when eating a low-carbohydrate diet in order to avoid hypoglycemia.
- When designing a low-carb diet, the kind of dietary fat is crucial. It is advised that you speak with your doctor about your new diet and routinely check your cholesterol levels to make sure it is not having a detrimental impact.
