by Dr Ian Lake

Type 1 diabetes is well suited to a low carb lifestyle. It is a condition where the body doesn’t produce any insulin at all, so is the complete opposite of the metabolic diseases that cause type 2 diabetes. Insulin has to be injected into the body to replace its inability to produce insulin. In essence, Type 1 diabetes is a hormone replacement therapy requiring insulin.  Insulin has many actions in the body, but perhaps the most crucial is to control blood glucose. Any dietary carbs will produce glucose. It doesn’t matter if they are from sugary sweets or healthy whole grains. They are absorbed into the body as glucose. And insulin is needed to control the glucose rise that happens when we eat carbs. One piece of good news for people with Type 1 is that dietary carbohydrates are non-essential nutrients. Reducing carbs does not affect the nutrient value of the diet, but it does lead to an improvement of diabetes control with improved health and wellbeing in both the short and long term.  More dietary carbs mean more insulin; fewer dietary carbs means less insulin. But zero dietary carbs, which is very difficult, does not mean zero insulin. People with Type 1 have to inject insulin because the body needs it for other metabolic processes. The body also makes carbs ‘in-house’ as required, so insulin is necessary for that too.  Low carb in Type 1 isn’t about stopping insulin; it is about minimising insulin to make Type 1 easier and safer to control. The phrase ‘as much as needed but as little as possible’ sums this up nicely.

Calculating insulin doses to allow for the carbohydrate content of each meal is something that most people find difficult. Any over or underestimation will cause large swings of glucose which makes life miserable with an increased risk of low sugars called hypos. High glucose makes people feel generally sluggish.

It is possible to eat any food with Type 1 diabetes. But this practice means that only one in ten people manage to get the balance of insulin and carbs just right. It is such a particular skill that nine out of ten people are failing to meet the current guideline target. With such a low level of achievement, something must be wrong. We surely can’t go on accepting 10%  success without offering low carb as an option for management when we know that it improves control.

We need to rethink Type 1 diabetes. Low carb means less insulin and therefore, less risk of large swings of blood glucose. In fact, low carb in Type 1 diabetes has been shown to smooth out the high and low blood sugars and enables people to achieve levels of control they could only have dreamed on when on a high carb diet. Evidence shows that with low carb in Type 1 diabetes that more than 90% of people reach the target, there are five times fewer hypos, fewer hospital admissions with diabetic ketoacidosis, a high level of adherence to the diet, and a reduction in insulin doses. What’s not to like?

Dr Ian Lake. GP with Type 1 diabetes, managed on a very low carb diet. You can find out how to manage Type 1 diabetes with low-carb at www.type1keto.com