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A recent article on the consequences of restricted carbohydrate diets for T1D children

I think studies are always so open to manipulation and I always feel sorry for the participants in some way! I think it's good to try different approaches especially when the current one isn't working. I don't agree or disaree with low carb diets it's what works for the individual. All the info should be available and we make our own informed choice.
 
ickihun said:
Why is the huge emphasis on type1s going low carb? Has management no longer believed to be effective anymore or are parents looking for an easier way to manage their child's diabetes to fit in with modern fast lifestyles?

There must be other ways this can be achieved without nutients which are needed are interferred with, surely?
I never thought type1 was a dietary problem. Maybe some type2s but not all.

Maybe the benefits of carbs need injecting too to counter-act the problem?
Timing can be everything in digestion and metabolism!
Just a thought.
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Let's be clear here, there isn't a "huge emphasis" on T1s going low carb. There has been a greater awareness of it in the online community as an alternative way of making T1 easier to live with. The majority of t1s follow national governmental guidance rather than low carbing.

A lot of this stems from the Bernstein "Law of Small Numbers" approach, which says that if you don't eat a lot of carbs, you don't need as much insulin, so any over- or under-shooting in dosing results in far less variation and less likelihood of severe hypoglycaemia.

In terms of parents low carbing T1 kids, it comes back to the basic point that they are trying to look out for their kids future life health. Typically, but not always, by reducing amounts of carbs, and the associated post-prandial highs, it is expected that Hba1C, the gold standard of measuring glucose level management, will be lower, and the DCCT evidence all points to a lower complication level if the Hba1C is lower. Bernstein also says that aiming for a normal glucose level adds to this.

In essence, it's really parents attempting to protect their kids from future complications.
 
I guess same principle for everyone. Everything in moderation, even low carbing?
I personally wouldnt advise very low carb diet for a child, even an obese one. Diet can help with health problems but not only resolution or should be relied on as the sole solution.
Just my opinion.
I understand why parents are desperate to help their children through a difficult education and how important it is to get it right.
In my experience anything extreme is very dangerous!

That is why I will only do a longterm low calorie diet (bariatric surgery) under strict supervision and not on my own. So any problem can be picked up quickly and effectively. GPs haven't the time to monitor my personal choice to try and put my diabetes in remission. Specialists have set themselves up to do just that.
Could specialist not supervise a lower carb diet for type1 kids? Parents should receive adequate help to get the best for their kids.
Is there enough?
 
ickihun said:
Could specialist not supervise a lower carb diet for type1 kids? Parents should receive adequate help to get the best for their kids.
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They won't because there is no official evidence to support low carbing in either T1D or CWT1D. So that's a non-starter.
 
Would be interested to follow these kids through life. The reason why I'm so care-free, why I sometimes binge, etc... has a lot to do with how strict & anxiety-controlled my family was for all of those things.
 
Its tough keeping your kids right without them having to be injected numerous times daily too.
I admire any parent having to keep their kids safe in adversity. They must be exceptional parents.
I think only open-minded parents would appreciate what they all go through.
Parenting can be tough at the best of times!
 
I think low carbs makes more sense for poorly controlled Type 2's than for us. They tend to be insulin resistant we don't. So if we take the right amount for our carbs the BS comes down to normal. Insulin for Type 2's isn't as effective so if they do a carb bolus the BS tends to stay up there, and taking an extra metformin or glipizide won't work.
 
Thanks for highlighting this interesting study, Tim.

I've read a lot about keto/LCHF for children and this isn't the only study suggesting it's not all good. I think some sites on the Internet (not this one) are closed echo chambers where only LCHF views are heard. I've also seen a huge amount of scaremongering, which is unhelpful to parents. There are potential psychological effects as well as possible physical ones.

As you say, parents choose this diet to try to,do the absolute best for their children. However, that's also the motivation of the many more parents of Type 1 children that don't eat LCHF.

Every parent wants to do the best for their child. I have 3 children - fortunately none have diabetes (fingers crossed) but if they did get Type 1, I wouldn't choose LCHF for them.
 
TheBigNewt said:
I think low carbs makes more sense for poorly controlled Type 2's than for us. They tend to be insulin resistant we don't. So if we take the right amount for our carbs the BS comes down to normal. Insulin for Type 2's isn't as effective so if they do a carb bolus the BS tends to stay up there, and taking an extra metformin or glipizide won't work.
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That may be true for adults, however what you will see is that there are parents that prefer to low carb with their kids because it makes managing childhood Type 1 that much easier.

But I think you're missing the point. The mantra goes, the more carbs you eat, the more insulin you need to take and the greater the margin of error involved, e.g. On a meal containing roughly 80g of carbs, you may take 8u of insulin, however on 10g, only 1u. If both of those carb amounts are low by 10% in one case you've taken 0.1u too many and in the other 0.8u. The latter is more likely cause a Hypo, so in reducing the carbs, parents expect to see fewer large swings, less risk of hypos and overall lower and less varied numbers and therefore logically, if the numbers would contribute to a better Hba1C result, fewer future complications.
 
Yeah I don't advocate a LOT of carbs, and I advocate low glycemic index carbs. Strawberries and quinoa are way different than white rice and dates for example. Sure you gotta take a bit more insulin with more carbs, but you still have to take some with each meal. Most Type 2's don't take any insulin.
 
Exactly @TheBigNewt Its not a choice of hardly any carbs or a large amont of carbs. As with most things, moderation is probably the answer.

I'd also add that a pump allows the tiny adjustments that a young child needs, which helps get doses more accurate.

While the law of small numbers makes theoretical sense, I don't find it that useful in practice. I try not to make mistakes firstly, and secondly I know that above a certain amount of carbs my BS is more likely to be harder to control - but that's not because I made a mistake. It's to do with the digestion and insulin action involved in processing a mega carb meal.
 
Here is an example, taken from a non-low carb Facebook group that explains why parents do this:

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If there were calorific differences between the diets then it isn't a strict comparison of low-carb and normal.
 
jrussell88 said:
If there were calorific differences between the diets then it isn't a strict comparison of low-carb and normal.
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It isn't anyway. The way the discussion is played out, it's a call for one thing then drawing different conclusions based on data that wasn't really presented. Although it has been peer reviewed, it's like it was peer reviewed by those who also wanted that conclusion drawn.
 
TheBigNewt said:
Yeah I don't advocate a LOT of carbs, and I advocate low glycemic index carbs. Strawberries and quinoa are way different than white rice and dates for example. Sure you gotta take a bit more insulin with more carbs, but you still have to take some with each meal. Most Type 2's don't take any insulin.
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That's true but I have to feel if I'd received insulin therapy sooner I wouldnt be so obese. Many type2s are struggling with their weight - should they be?
Evidence is coming through lack of weight loss is coming before type2 diabetes.
I wish I'd been helped sooner. :(
At 6yrs old I had thrush and starting with obesity. I ate and played the same as my 2 sisters. They aren't diabetic.
 
ickihun said:
That's true but I have to feel if I'd received insulin therapy sooner I wouldnt be so obese.
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Given that physiologically, it's insulin that causes the body to store fat, and that Insulin Resistance in type 2 is ultimately what causes Hyperinsulinemia, then the likelihood is that even if you had started insulin therapy earlier than you did, yo'd be likely to see a similar effect, as you'd still have the insulin resistance, which would mean you'd still require more insulin than someone who isn't insulin resistant.

That's the tricky thing about Type 2 and Insulin. Whilst it can easily be paralleled with Type 1, the insulin dosing algorithms are rather different due to this additional insulin resistance factor.
 
Children have very different needs to adults whether they have T1 or not they are growing all the time so they need all the vitamins and minerals that they can get for energy and growth and those come from foods including the starchy carbs and they will not get this if some foods are removed or limited in their diet.You can't impose a diet very low in carbs that an adult might follow for their diabetes on a growing child. I think the danger of low carb could very well result in malnutrition and stunted growth. We all know that low carb causes weight loss and whether the person doing it needs to loose weight or not they still do so it must be the same for children most of whom will not need to loose weight so that can't be good.
 
@Pinkorchid children also need normal blood sugars in order to grow well, which some parents (definitely me) find impossible to achieve when feeding a t1 child starchy carbs. My 6 year old has been LC for 18 months (as have the whole family, her twin sister and 4 year old brother too), and she has normal blood sugars, is following her growth and weight line and is certainly not malnourished or stunted. We've run into cholesterol issues, which was immediately put down to diet. However results this week suggest thats almost certainly genetic not lifestyle induced and is Familial Hypercholestrolaemia. We should know for sure on Friday when my cholesterol results come in.

@tim2000s thanks for the link to your analysis of the study. It certainly appears to be more of an opinion piece with only 6 subjects. I look forward to the results of the t1grit Harvard study, it should be interesting.
 
CathP said:
It certainly appears to be more of an opinion piece with only 6 subjects. I look forward to the results of the t1grit Harvard study, it should be interesting.
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Yes, I'm looking forward to that one too.
 
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