Ketogenic diet?!

aileenmoore00 said:

Hiya I'm type 1 and have been reading about the ketogenic diet (low carb -high fat) has anyone else tried it?? Is it okay for type 1 or is it mainly aimed at type 2. I've spoken to my dietician about the Paleo diet before and she said I couldn't do that. Any info on this would be appreciated!

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I'm type 1 on a paleo ultra low carb diet and I do great. It's not for everyone but I have much better control this way. I needed to lower my insulin doses a LOT. I'm on MDI. What meds are you on?

aileenmoore00 said:

I'm on nova rapid, and Tresiba at night. I find if I don't have around 30 carbs in the morning my bloods drop around 11. So I would probably need to drop my insulin a lot as well

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Do you bolus for the morning carbs? Sounds as if too much insulin is on board to me. Are you comfortable adjusting your own? Please error on the side of caution until you figure it out.

As a side, I do bolus for half my protein but I don't eat 30 c in a day let alone one meal so I'm not sure if you would need to bolus for protein. Generally it's in the absense of carbs that bolusing for protein is needed.

aileenmoore00 said:

I'm on nova rapid, and Tresiba at night. I find if I don't have around 30 carbs in the morning my bloods drop around 11. So I would probably need to drop my insulin a lot as well

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That does suggest you arent using your insulin correctly. The point of a basal/bolus regiem is to allow you to manage your blood sugar and either eat no carbs, or all the carbs, or any amount in between.

The basal should be keeping blood sugars relatively flat when not eating or bolusing - so that should mean that you don't have to eat to feed your basal insulin. Have you done a basal test to check you aren't taking too much basal insulin?

Then the bolus dose is adjusted to match the carbs that are eaten. Are you carb counting? Are you confident your carb counts at less than 30g carb for breakfast days are correct? Are you confident you are using an insulin to carb ratio that actually works for you in the morning?

There's no reason a type 1 diabetic on a basal/bolus regiem who understands how to adjust their insulin can't eat paleo or keto. If you are considering keto there are a few things to be aware of in deciding whether to do it: 1) physiological insulin resistance - if you low carb you might find you need a stronger insulin to carb ratio to deal with carbs as your body gets out of practice in dealing with carbs; 2) the impact of protein on blood sugar - if you aren't eating carbs, your body wants to get glucose from somewhere, it will do this by turning the protein you eat into glucose in a process called gluconogenesis, so many type 1s on a low carb diet will bolus for the protein they eat - this might require a bolus after eating as the gluconogenesis process takes a while.

And yes, a keto diet is mainly aimed at type 2 diabetics aiming to manage their diabetes through diet alone - they will not have the complications of insulin adjustment to deal with when eating keto.

aileenmoore00 said:

Thank you for all the info really helpful! How would I do a basal check?! X

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This page has a good guide on how to do a basal check - https://mysugr.com/basal-rate-testing/ - the numbers are in mg/dL so divide by 18 to get the mmol/l equivalents

I don't have PIR but I certainly need to bolus for half my protein and if I eat more than 3 ounces at a time I would need a small bolus later.
I like to eat but my stomach doesn't like food haha. Especially carbs.
This is why I eat small snack meals more often and take small doses. At the three hour point the next dose COULD be picking up the protein tail end but I don't think so as it's only 2 oz and should be digested by then. In either case, the small multi boluses every three hours works for me as I usually like a snack by then. Some people wouldn't be bothered by all this. I don't like larger doses of insulin either. I get weird reactions so this is also what led me to ' my system' not to mention the hypos I wouldn't have even with 1-1.5 units.

I have eaten keto for 25+ years, LONG before I was diabetic ( 3 years as type 1)

I'm not familiar at all with treshiba so no advice there. If I take enough lantus to take me through the morning I'd be dead at midnight with a massive hypo. This is ok as then I'm not working out two I sulins and their actions during the day. Just humalog. Im on autopilot now but it took loads of testing for both foods and bolus timing.

aileenmoore00 said:

Hiya I'm type 1 and have been reading about the ketogenic diet (low carb -high fat) has anyone else tried it?? Is it okay for type 1 or is it mainly aimed at type 2. I've spoken to my dietician about the Paleo diet before and she said I couldn't do that. Any info on this would be appreciated!

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I'm not sure why you couldn't do a Paleo diet. Perhaps you could ask why? The amount of carbs on Paleo can vary.

Yes, there's a lot about LCHF and there's no reason why Type 1s can't eat that way, but it's not a magic bullet and still has its problems eg an increase in insulin resistance, often having to do more boluses, etc

I suggest you read both pros and cons, and check with your DSN for advice first

Hi everyone. I've just read your blogs.
I looked in as I want to do Keto diet.
I'm type two. I'm very over weight and in constant pain with arthritis.
Also have ulcerative colitis and that is good at the moment.
I don't know what bolus is or basal.
Any advice would be welcome.
Thanks Maddy.

Hi @Happy hippy you would probably be best starting your own thread as this one is specific to type 1 diabetics eating (or wanting to eat) a ketogenic diet and for them this also involves learning and understanding how to manage their insulin doses on such a very low carb diet. Basal and bolus are terms related to insulin management techniques (see: http://www.diabetes.co.uk/insulin/basal-bolus.html) so may not necessarily be relevant to you as a type 2. But you may also need to reduce certain other diabetic medications when drastically reducing your carbohdrate intake too, and you'll need to provided information about these so that you'll be given suitable advice.

Robbity

I've been a Type 1 for 35 years and have been following the keto way of eating for 6 months. There is absolutely no reason why you can't follow the keto diet but you would have to be very careful with adjusting your insulin doses once you start. I used to only bolus for carbs, but now that I'm keto adapted I find I have to bolus for protein too, pretty much the same ratio that I used to for carbs. So my insulin levels haven't reduced much but I wasn't on high doses in the first place. My blood sugars are now so much steadier than they were when I was eating carbs, I can't tell you the benefit this diet has had to my diabetes in that respect. I have also been taken off my blood pressure meds as my blood pressure dropped dramatically, and I'd been on those pills for 25 years!

Justbe mentioned Dr Bernstein's book above, but I can also recommend The Ketogenic Diet for Type 1 Diabetes by Ellen Davis & Keith Runyan. Worth a read!

Hi Aileen

Just chipping in to share my experience with you.

I have T1D and currently following a keto diet (having tried moderate and low carbs before). Had the same questions as yours. It's not yet that a well-known diet so many dieticians and doctors are uncomfortable advising on it (because it is not in line with the official guidelines of many countries of recommending a low fat diet).

I echo the comments of many others on this thread in that the keto diet is bringing me significant improvements to date on the various metrics to watch out for with T1D (BG, weight, cholesterol etc.). To answer your question, yes it is mainly aimed at T2D people, but is good for people with T1D too as far as I have read, been told and tried (provided we make sure BG does not spike to avoid DKA).

The trick in the keto diet is to get the balance of daily macronutrients right every day (if too much carbs, ketosis doesn't kick in, if too much proteins, those proteins get turned into glucose and ketosis doesn't kick in). I find that to be the trickiest thing to do, because keto diet isn't really more expensive to do and it also means high fat (esp. good one), and thus generally very tasty food. There are a lot of resources on the internet on how much you should aim for of each macronutrients. Also, watch out for the hidden carbs in various foods (for example many fruits are high in carbs, yogurt etc.) and for hidden proteins (dairy/cheese would contain more than you'd expect).

Re insulin, I continue to take the basal one daily and it generally does the trick (need for no or very small amounts of bolus for now, except occasionally for proteins as also mentioned by others above). As T1D you won't get off insulin injections completely, but as far as I have tried it significantly reduces the need for it, which has a bunch of advantages as you probably know!

The real debate is whether keto is better than standard low carb diet (i.e. less than 130g carbs a day-ish). In my experience, both are very good at managing diabetes because they lower BG/make it more constant (thus reducing risks of hypo), reduce need for insulin (and thus increase insulin sensitivity) and reduce weight. Both have their pros and cons, and I think at the end of the day it comes down to what works for you in terms of flexibility, taste, time-commitment, priorities etc.

I hope this helps.

Alex

Same as others have mentioned most or all of the doctors will try and say being powered from Ketones is a bad thing with type 1 diabetes. I for one can tell you this is totally untrue. I've been diabetic 11 years now and the past 3 months on Keto is the best thing that has happened for my management.

The problem is, the diet the health care providers sets out for us requires extensive diabetes treatment therefor putting us all in this vicious circle of needing to pump more and more insulin.

If we don't eat all these extra carbs we don't need all this extra insulin. Exercise on lots of insulin is a no go in my opinion - go low take more sugar to come back up, go high take more insulin and this vicious circle continues and the pharma companies get richer. It's very odd and I have had arguments with many doctors about this, their treatment for diabetes is to cause diabetes mmmm.

Get your background insulin on point and you'll see blood sugars results as if you don't have the condition. You may need very small doses of novorapid from time to time because of proteins and such.

Don't dive in right away do extensive research. I always say to other type 1 diabetics you're either in full hilt or don't do it at all. I say this because if you're in a ketosis state and for some reason you say screw that I'm eating pasta and you don't take the correct amount of insulin, your blood sugar will go up and with the elevated levels of ketones you might have a chance of developing DKA, but again this will not happen if your blood sugars are perfect and they will be if you are in ketosis. So you're either in fully or not at all.

I hope it all goes well for you, and if you need and help just ask, lots of nice people here will be more than happy to help. If unsure about insulin doses make sure and consult your doctor never second guess.