Low-carb diet in type 1 diabetes provides safer and more stable blood sugar levels

[DCUK NewsBot]

A new randomised trial, comparing high-carbohydrate and low-carbohydrate diets, has found that the latter lead to safer and more stable control in type 1 diabetes. In this small study, ten participants with type 1 diabetes followed both diets for one week each. The high-carb diet contained 250g or more of carbohydrates daily, while the low-carb diet was capped at 50g or less per day. The participants were middle-aged, insulin-pump users with an average HbA1c averaged of 53 mmol/mol (7%) before starting the study. At the end of each week, the researchers gathered fasting blood sugar measurements as well as information from the participants' pumps and sensors after eating one diet or the other. After reviewing the data, researchers reported that while average blood sugar levels were similar between the two diets, the variation in participants' blood glucose curves were significantly different. The low-carb diet resulted in reduced time with both high and low blood glucose levels and more time within the normal range, compared to the high-carb diet. The fact that participants on low-carb spent less time with low blood sugar levels indicates that it is a safer way of eating, limiting the incidence of hypoglycemic events. As they also spent less time with high blood sugar levels, this is likely to mean a lower risk of developing long-term complications if a low-carb lifestyle is maintained. Longer studies than this one have reached the same conclusion, that restricting carbohydrate intake improves blood sugar management and a host of other factors for people with diabetes. Whilst the study was small, it represents one of the first randomised studies into low-carb eating for people with type 1 diabetes. The research could pave the way for larger randomised trials testing the benefits of low-carb over a standard low-fat diet.

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[Kristin251]

Exactly how I feel and react. Less highs and less lows. Steady wins the race.

 

[tim2000s]

I'm not entirely sure about this piece of research. Whilst I agree with the conclusions, a week on HC then a week on LC is hardly going to demonstrate a long term benefit or any side effects.

 

[azure]

Sounds too short term and too vague to me. I've eaten around that number of carbs and my control was no worse than on minimal,carbs (raw food diet). We all have our own max carb limit per meal, but in my opinion most of the highs are caused by incorrect insulin use, as evidenced by some of those daft charts online comparing diets.

 

[Pipp]

I think the most promising thing from the report is that it was a pilot study, of necessity with a small number of participants, and that the results suggest more studies are needed to see if the effects can be replicated on a larger scale. Too early to draw conclusions from such a small sample size yet.
It does remind me of the early Newcastle diet research. That started with a small number of participants, but the results and the interest in those results drew in funding for a much bigger research project, which is still ongoing, some 7 or 8 years after the first pilot study. These things, rightly, take time, but it is reassuring that there are more ways being discovered and tested to assist in diabetes management.

 

[Hoping4Cure]

Sounds too short term and too vague to me. I've eaten around that number of carbs and my control was no worse than on minimal,carbs (raw food diet). We all have our own max carb limit per meal, but in my opinion most of the highs are caused by incorrect insulin use, as evidenced by some of those daft charts online comparing diets.

Right, but the absolute correct insulin dose to cover meals precisely is very hard to achieve, at least by humans, and can take years of practice before getting it right (if ever).

This is like saying, we don't need safer cars because most accidents are caused by poor driving skills. That may be true, but short of taking out the human factor, errors will remain commonplace. I'll take the safer car (i.e. a diet with less glucose requires less insulin, making correction errors less severe), thank you very much.

Would you rather crash your car at 20 or 100 mph? This is really a quite similar analogy a low carb and a high carb diet for type 1 diabetics. I'm sure you know this already, but the law of small numbers (from Bernstein's book) is a smart thing. The insight came from his prior career as an engineer before becoming an MD.

In other words, LCHF / ketogenic diets are old news by now. This isn't the first study I've seen on the matter and I'm sure it won't be the last. Just file it in the "duh" pile.

 

[azure]

No, what you're saying is that there's only one safer car - in fact, there are many.

You can't just make up analogies. Your 20mph or 100mph is just a made up premise that has no relevance to the discussion - a false choice.

And, of course, you're ignoring all the cons of a LCHF diet.

 

[Robinredbreast]

There is often some scepticism involving 'LCHF' I am using this term because that is what many type 2's use.
What is low carb, under 30 to some, under 150 to others ?
If I eat a mackerel dish with salad, or an omelette and a yogurt afterwards, I need a lot less Insulin, so less room for mistakes, but it's not written in stone for me anyhow.
I feel 'reduced carbs' is a much better term, could stop the arguments too (should do) lol
This is the forum's link on what is 'low carb' :-
http://www.diabetes.co.uk/diet/low-carb-diabetes-diet.html

 

[fletchweb]

I wonder if I will ever see the day that nutritionists get on board with the Low Carb diet (at least in my area) - I fell in to the LCHF years ago after discovering it was much easier to control my Blood Sugars (it also made me feel a lot better.) and yet I remember having a meeting with a nutritionist about 5 years ago who was "very concerned" about my eating habits ..... That's the way it goes I guess ....

 

[GrantGam]

Right, but the absolute correct insulin dose to cover meals precisely is very hard to achieve, at least by humans, and can take years of practice before getting it right (if ever).

This is like saying, we don't need safer cars because most accidents are caused by poor driving skills. That may be true, but short of taking out the human factor, errors will remain commonplace. I'll take the safer car (i.e. a diet with less glucose requires less insulin, making correction errors less severe), thank you very much.

Would you rather crash your car at 20 or 100 mph? This is really a quite similar analogy a low carb and a high carb diet for type 1 diabetics. I'm sure you know this already, but the law of small numbers (from Bernstein's book) is a smart thing. The insight came from his prior career as an engineer before becoming an MD.

In other words, LCHF / ketogenic diets are old news by now. This isn't the first study I've seen on the matter and I'm sure it won't be the last. Just file it in the "duh" pile.

I agree fully with @azure.

Your analogy - as fun as it is - doesn't make any sense. If you'd rather we stayed on the car analogy though, you could say that any 'car is safe' providing that the driver is competent. LCHF is not 20mph, and high carb is neither 250g daily or 100mph...

Driving at 100mph or 20mph is irrelevant; what is critical is how capable the driver is and the given external variables (or road) that the driver is travelling on.

If you do more driving lessons, you can eat 250g daily and have great control I have good control and my daily carb intake is a hell of a lot closer to 250g than it is "LCHF". I've tried the latter and it wasn't for me; my control neither improved nor did my BG become any easier to manage.

 

[Brunneria]

What a pity that there is no link to the studies mentioned in this sentence:

Longer studies than this one have reached the same conclusion, that restricting carbohydrate intake improves blood sugar management and a host of other factors for people with diabetes.

 

[azure]

Most Type 1s restrict their carb intake - ie don't eat as many carbs as they could. There's an optimum level of carbs for each Type 1 - neither too many, nor too few.

 

[azure]

You do like to make assumptions about people @Hoping4Cure Contrary to your belief, I've seen and read many Keto and LCHF sites. I'm always looking and hoping for anything that improves my results and my life. I'd quite literally eat dirt if it was safe and was a magic answer for Type 1. A magic bullet would be great but LCHF isn't it.

So,it's not that I'm so daft I haven't bothered to read studies. I have. I've spent a huge amount of time reading about LCHF and other diets too. The fact I choose not to eat LCHF is simply because I'm not convinced by what I've read. If you're happy eating that way and its reduced your hypos that's great, but it doesn't mean everyone else needs or wants to eat like that.

 

[Hoping4Cure]

No, what you're saying is that there's only one safer car - in fact, there are many.

You can't just make up analogies. Your 20mph or 100mph is just a made up premise that has no relevance to the discussion - a false choice.

And, of course, you're ignoring all the cons of a LCHF diet.

My 20 / 100 analogy is apt, since I've cut my daily carb intake to less than 1/5th of my previous level which I ate for 15 years and gave me many close calls (hospital visits, comas, car crashes).

Doing this has helped me cut my insulin to less than half of what it was before.

Consequently my hypo frequency has drastically fallen, reducing the chance of another coma or blackout to insignificant levels. I used to be an enthusiastic athlete on HC / LF / HP diet for years and it was a constant struggle.

The only other "safe" car IMO is using an insulin pump. But not everyone can afford one or is willing to plug themselves into a machine.

This is my opinion, and I'm entitled to it. It also happens to coincide with the results of this scientific study (and many others), so there's that.

 

[azure]

Yes, insulin pumps can reduce hypos due to the ability to micro dose and adjust basals. Are you considering getting one?

Edited to add that it sound like you've had a lot of trouble with your hospital visits, car crash, etc. If you have brittle diabetes then that would be a factor in your diet choice, I would imagine. Sorry you've had such a hard time of it.

 

[Hoping4Cure]

No. I already get only 2-3 hypos per month on my current regime, which is safe enough.

I'm against pumps philosophically, it seems extreme to me, inconvenient, expensive, the idea of being attached to a machine to do a job largely handled by my diet already. And GLP-1 helps too.

I am trying to refine / improve my control further though, it's a work-in-progress.

The only other contender for a diet choice would be vegan, but I tried it in my 20s and didn't like it. I enjoy meat / chicken / fish / cheese and cream too much. And LCHF / keto allows me to eat all those things. So compliance is a non-issue. (except for rare cheat days).

Even if I went vegan, I would still avoid bread and rice and pasta, even whole wheat varieties which are only marginally less detrimental to blood sugar stability.

Why spend extra time and effort to compensate for eating a type of food which my body inherently cannot process properly? That does not compute. It can't handle carbs, but it can process fat. Doing anything else seems irrational to me. Which is why I consider eating any simple carbs to be a cheat, and not a choice guided by concern for my health but rather for pleasure. I don't believe in lying to myself about why I might eat carbs: because sugar is yummy. Not because it's good for me or healthy.

 

[tim2000s]

@Hoping4Cure You mention that GLP-1 helps, but it has a corollary effect of increasing hypo risk, so you must be walking a very tight line most of the time to manage your levels?

 

[GrantGam]

@Hoping4Cure You mention that GLP-1 helps, but it has a corollary effect of increasing hypo risk, so you must be walking a very tight line most of the time to manage your levels?

Every piece on information I've read on incretin mimetics states that they're not to be used in patients with T1D...

 

[tim2000s]

Every piece on information I've read on incretin mimetics states that they're not to be used in patients with T1D...

Sent you a PM...

 

[Hoping4Cure]

@Hoping4Cure You mention that GLP-1 helps, but it has a corollary effect of increasing hypo risk, so you must be walking a very tight line most of the time to manage your levels?

I've been taking Victoza and now Trulicity for a total of six years now, and yes, initially one can have higher hypo risk until you learn to avoid taking as much short-acting. This is because digestion is slowed, and glucagon suppressed, so you end up needing less short-acting. It also suppresses apetite so weight loss occurs (the effect is diminished slightly over time). For an experiment, I went off it for a few months just to try and my sugars became far more erratic again. Also GLP-1 is a known beta cell regeneration agent, in many papers (shared on my blog, I have a list of all meds + rationales for their use in type 1s).

My initial reason for taking liraglutide was a study on type 1s showing it drastically helped their sugars + lose weight. The only thing a bit scary at first is when / if you do have a severe reaction, taking carb pills to fix it can take longer to pull you back up. So it's a double-edged sword. However appetite suppression and carb spike suppression are both winners in my book. Not to mention, combined with a LCHF diet it means my sugars don't rise as much. There are a few other type 1s on GLP-1, and it's the best supplemental drug I've ever taken. Main thing is learning how to avoid spiking insulin in one shot, so if you do eat a lot of carbs, split your insulin into several smaller doses. Not sure how pump users would achieve that but it's likely easier than manual injections. I remember when I first got on my GLP-1 I could eat a 6 inch subway sub and my sugars remained normal for 3 hours before needing any short-acting to cover it. I do recommend titrating up the dose of Victoza very slowly past 1.2 ml / day. (to a max of 1.8). Not sure about the 1/week versions like Trulicity.