Keto with T1 diabetes

Mac Dabrowski

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Hi all. Looking to hear from people who are T1 and tried keto/low-carb diet. I'm T1 for over 2 years, managing reasonably well, but feeling like reducing carbs further so most likely I will end up producing ketones. I'm not really sure what to expect....but I'm assuming that if my glucose level is in a good range I shouldn't have any risk of DKA while producing ketons due to low intake of carbs?
 
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Melgar

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What is your reasoning behind wanting to go on a keto / low carb diet? It's a very successful diet for bringing down blood sugars and weight loss in type 2 diabetics, but wondering what benefits there are for Type 1. If indeed you are even thinking about diabetic benefits. I'm just curious. :)
 

Miss Marble

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Hi all. Looking to hear from people who are T1 and tried keto/low-carb diet. I'm T1 for over 2 years, managing reasonably well, but feeling like reducing carbs further so most likely I will end up producing ketones. I'm not really sure what to expect....but I'm assuming that if my glucose level is in a good range I shouldn't have any risk of DKA while producing ketons due to low intake of carbs?
Hi I have been T1 for 23 years now and tried the Keto diet recently. After about a week or so on the diet I did manage to achieve two weeks straight of 100% time in target and reduced my insulin by about half, however after these two weeks my glucose levels did become erratic I was having high readings even if I had a meal with no carbs or if I hadn't eaten at all. This may have been because I wasn't following the diet properly because I didn't really take in the bit about macronutrients. but I did read that as the body is not getting energy from carbs it will use fat for energy instead which causes the liver to produce more glucose. I also remember being told something about the 'honeymoon period' but I can't quite remember what that is. Anyway I am now back up to my original dose of insulin. If you haven't already the book Obesity Code by Jason Fung is a good place to start ( I'm 5.4 and 70kg so I am not overweight but was recommended this book and found it very interesting from a diabetic perspective). I'm planning on trying out the 8 week blood sugar diet next by Clare Bailey next as it has a clear timetable for breakfast lunch and dinner for 8 weeks which would be more helpful for me.
 

JAT1

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Type 1
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I am Type 1 and do low carb because it keeps me relatively stable and in range. If I eat more carbs and use more short-term insulin, quickly I end up on the glucose roller coaster, but that's what works for me - others will have different experience.
 

Antje77

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I mostly eat low carb but usually not keto levels (I like my beers).
I've never worried about or tested for ketones, ketosis is not the same at all as ketoacidosis.
What is your reasoning behind wanting to go on a keto / low carb diet? It's a very successful diet for bringing down blood sugars and weight loss in type 2 diabetics, but wondering what benefits there are for Type 1. If indeed you are even thinking about diabetic benefits. I'm just curious. :)
For me, it makes dosing much easier, both in timing as in amount of insulin.
I need to prebolus because most foods hit me faster than my insulin, but by how long?
If I have a meal needing 5 units, and I'm 20% off in my dose, I'll only need to eat enough to cover 1 unit to correct, or add 1 unit to correct.
If I have a meal needing 50 units and I'm 20% off in my dose, I'll need a significant extra dessert when I'm already full with my meal, or I'll shoot way up in the teens after which it will take ages for a correction dose to start working.

The amount of insulin I need for the same amount of carbs varies throughout the day, depends on activity, on food already eaten that day, on active insulin on board, and on the colour of my socks. So chances on choosing the perfect dose are rather slim.

That said, some people are very good at calculating their doses for higher carb meals, it's all personal preference and experience.
 

Melgar

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For me, it makes dosing much easier, both in timing as in amount of insulin.
I need to prebolus because most foods hit me faster than my insulin, but by how long?
If I have a meal needing 5 units, and I'm 20% off in my dose, I'll only need to eat enough to cover 1 unit to correct, or add 1 unit to correct.
If I have a meal needing 50 units and I'm 20% off in my dose, I'll need a significant extra dessert when I'm already full with my meal, or I'll shoot way up in the teens after which it will take ages for a correction dose to start working.

The amount of insulin I need for the same amount of carbs varies throughout the day, depends on activity, on food already eaten that day, on active insulin on board, and on the colour of my socks. So chances on choosing the perfect dose are rather slim.

That said, some people are very good at calculating their doses for higher carb meals, it's all personal preference and experience.
Gawd @ANTJE you have to be a mathematician to work out your insulin dosing! As I'm a complete dud at math I don't know how I will cope when/if I go on insulin. Yeah I did wonder what the benefits are with low carbing, in particular child onset T1, but Type 1 (LADA) has some of the components of type 2, like metabolic syndrome and insulin resistance in varying degrees. I did read that the type 2 aspect of LADA varies considerably from individual to individual. Some have little or no insulin resistance or metabolic syndrome, while others more. I can't remember where I read that nugget of info, unfortunately.

You may or may not have read my failure to reduce my blood sugars on Keto instead it raised my LDL's. If anyone reading this is off put by my raised LDLs , don't be as apparently I am one of these lean hyper mass responder types so my fat metabolism works differently . My trigs are only 0.61 mmol/ls way below the 2.21 mmol/L range (Canada).

My C-reactive protiens (CRP) are well below the threshold for insulin resistance too, at 1.9 mg/L. I believe the typical range for Type 2 folks with insulin resistance is 4.49 and 16.48 mg/L. The level of insulin resistance is a key determinant in the development of T2DM. There is a relationship between Insulin resistance, systemic inflammation and the level of CRP your liver produces. I guess I'm saying if any of these indicators are high in anyone then a keto diet would help bring those values down in folks. Hopefully all that that made some sense!
 
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Antje77

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Gawd @ANTJE you have to be a mathematician to work out your insulin dosing! As I'm a complete dud at math I don't know how I will cope when/if I go on insulin.
Uhm, I'm one of those lazy diabetics mainly winging it, not calculating. Low carbing makes this much easier. The only time in 7 years I've properly calculated carbs (apart from reading on my pack of LC bread it has 3.8 grams per slice) was when I made some keto nuts and chocolate things to send to @JoKalsbeek to celebrate Sinterklaas and I wanted to include the correct carb count. :hilarious:
Type 1 (LADA) has some of the components of type 2, like metabolic syndrome and insulin resistance in varying degrees. I did read that the type 2 aspect of LADA varies considerably from individual to individual. Some have little or no insulin resistance or metabolic syndrome, while others more.
Correct.
Many LADA's don't have any of those T2 traits, they're simply slow onset T1's.
I do have considerable insulin resistance, medication for BP, and at diagnosis my lipids were out of whack. The lipids got all back to perfect numbers after getting decent BG and changing to LCHF, the BP still needs medication, and I'm still fat.
Keto instead it raised my LDL's. If anyone reading this is off put by my raised LDLs , don't be as apparently I am one of these lean hyper mass responder types so my fat metabolism works differently .
Someone posted a study a while back on how the effect of a low carb diet on lipids can be completely different for fat and thin people, but I can't find it anymore.
It's also outside the scope of this thread, I fear.
@EllieM was that you sharing this interesting study?
I'm T1 for over 2 years, managing reasonably well, but feeling like reducing carbs further
At only 3 years in, it's quite likely you're still producing some insulin yourself, the honeymoon period.
Is there a particular reason you're interested in reducing carbs?
Many T1's do very well on dosing for their carbs, it's all about individual approach and preferences.
 

EllieM

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I'm on low carb, but not keto, at less than 100g a day.

Some people like to follow DR Bernstein's approach, which is less than 30g a day

The Typeonegrit group on facebook is a group of T1s currently following this approach, but as I don't go that low I haven't joined the group and don't know anything more about it.

If you don't eat carbs at all then you have to start dosing for protein, which is too much work for me.

My dietician claims that if you go very low carb your ratio of insulin to carbs go up, and my breakfast ratios agree with that. My 2g of white coffee needs 1 unit of insulin, whereas if I eat a carby breakfast I use a ratio of 1 unit to 3g....

And I managed my pregnancies on traditional high carb meals (as recommended by the dieticians at the time) with hba1cs less than 48. Admittedly those hba1cs were accompanied by some major hypos, but those were pre cgm days.

As regards DKA, my ketones normally run at levels of about .2, as I'm not in dietary ketosis. It's not impossible to have a DKA at normal blood sugars (google euglycemic DKA) but I think that is normally associated with certain medications (eg flozins).

There is a really interesting article here studying a young German male who went on a ketogenc diet.
It worked very well for him, but obviously this is more of an anecdote than anything else, because N=1 studies don't tell you much other than whether a treatment did or didn't work for one individual.
 
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EllieM

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Someone posted a study a while back on how the effect of a low carb diet on lipids can be completely different for fat and thin people, but I can't find it anymore.
It's also outside the scope of this thread, I fear.
@EllieM was that you sharing this interesting study?
Not me I'm afraid.
 
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Melgar

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Okay, I don't want to derail @Mac Dabrowski discussion, it's an interesting one. Very, very briefly LMHR's are apparently a rare phenotype. It was brought into popular consciousness by the medical researcher who went on a Keto diet and his LDLs went extremely high, then ate packets of Oreo cookies to bring his LDLs back down. That happened to me, minus the Oreos .

 
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Melgar

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As regards DKA, my ketones normally run at levels of about .2, as I'm not in dietary ketosis. It's not impossible to have a DKA at normal blood sugars (google euglycemic DKA) but I think that is normally associated with certain medications (eg flozins).
Check out Ketosis-prone diabetes. I came across it by chance. Here is a wiki link to it. It's quick and easy to read. You will glaze over if I try and explain it. https://en.wikipedia.org/wiki/Ketosis-prone_diabetes
 
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Mac Dabrowski

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What is your reasoning behind wanting to go on a keto / low carb diet? It's a very successful diet for bringing down blood sugars and weight loss in type 2 diabetics, but wondering what benefits there are for Type 1. If indeed you are even thinking about diabetic benefits. I'm just curious. :)
Well, I thought that on keto maybe I can reduce my insulin and hence minimise events of hypo/hyperglycaemia. After reading comments and thinking more about it, it sounds like it might be tricky because I will still need to compensate for the glucose released by my body from fat, which looks like might be tricky? From this perspective maybe going to low carb diet, but with sufficient carbs in order to avoid ketosis, would potentially be better in the cae of T1?
 
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Mac Dabrowski

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[/QUOTE]

At only 3 years in, it's quite likely you're still producing some insulin yourself, the honeymoon period.
Is there a particular reason you're interested in reducing carbs?
Many T1's do very well on dosing for their carbs, it's all about individual approach and preferences.[/QUOTE]

Yes, I still produce some insulin. Why bother with low carb and keto? Because I can see that when I eat carbs (mostly dinners), I struggle to compensate well and can't avoid spikes. In general often can feel sleepy or with slight hypo, depending how much in advance I inject before carbs. So I was hoping to flatten my glucose curve. Being 2 days for very low carbs now I can feel slightly better. Although I still needed insulin after eating just fat and proteins, it was much less than usual.
 

Antje77

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Well, I thought that on keto maybe I can reduce my insulin and hence minimise events of hypo/hyperglycaemia. After reading comments and thinking more about it, it sounds like it might be tricky because I will still need to compensate for the glucose released by my body from fat, which looks like might be tricky? From this perspective maybe going to low carb diet, but with sufficient carbs in order to avoid ketosis, would potentially be better in the cae of T1?
No matter how many carbs you choose to eat, the main thing is matching your insulin doses to your food.
 
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Antje77

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Because I can see that when I eat carbs (mostly dinners), I struggle to compensate well and can't avoid spikes.
Same here, depending on how many carbs I eat.
But there is lots of room between no carb and low carb meals.
I usually eat lots of veggies with my protein and fats, and have no trouble dosing for them.
I also eat low carb bread and worked out how to dose for it.

I only have high carb meals very occasionally, but for myself I don't feel the need to go keto levels low carb. As long as I can dose for a food and usually stay within range, it's fine to me.
 

rabdcd

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Hi all. Looking to hear from people who are T1 and tried keto/low-carb diet. I'm T1 for over 2 years, managing reasonably well, but feeling like reducing carbs further so most likely I will end up producing ketones. I'm not really sure what to expect....but I'm assuming that if my glucose level is in a good range I shouldn't have any risk of DKA while producing ketons due to low intake of carbs?
Hi as a T1 I can highly recommend a keto diet for the last 4 years and my control is absolutely amazing. Yes you’ll have ketones but don’t get confused between dietary ketones and ketoacidosis.
 

Elmas

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Hi all. Looking to hear from people who are T1 and tried keto/low-carb diet. I'm T1 for over 2 years, managing reasonably well, but feeling like reducing carbs further so most likely I will end up producing ketones. I'm not really sure what to expect....but I'm assuming that if my glucose level is in a good range I shouldn't have any risk of DKA while producing ketons due to low intake of carbs?
That’s one of the biggest misconceptions. Ketones that are used for energy when you become fat adapted and keto acidosis which is when you’re ketones go extremely high most likely caused by a lack of insulin.