Hi
@Natalie007,
Good on your son for thinking about his condition and what might improve it. And to you for enquiring about it.
From reading about and trying and staying on a low carb diet myself, but not as medical or dietitian advice or opinion:
The best approach i found was by reading Dr Bernstein's Diabetes Solution, book or e book.
There is a section in there that talks about the various protein needs of people, including teenagers.
Of course as is also pointed out in that book there is also a need to ensure that vitamin and mineral intake is adequate.
The other source of help with very low carbohydrate diets is dietdoctor.com, although this is aimed more at people wishing to go the further step of going into what is called nutritional ketosis, or fat burning. The difference between the ketosis caused by insufficient insulin and high Bsls which can lead to the very dangerous condition of diabetic keto-acidosis and the benign condition of nutritional ketosis is touched upon there.
Some important points about low carb approach:
health professionals may not be au fait with low carb diets and worry about research findings about such diets or about the fact that low carb means more protein and fat intake ( despite newer research findings showing no link between fat and heart disease ( except to do with transfats)). To refute such concerns from them , subscribe to zoeharcombe.com, whose work and articles debunk the research regarding saturated fate etc as cause/ risk of heart disease, same for low carb diets.
Dietitians may still believe that a persons needs 150 g carb plus per day to supply enough glucose for the brain to function and the type of 'usual' diabetic diets tend mirror this ( at least for the 52 years i have been on insulin). But again via Dr Harcombe and through recommendations in Dr Bernstein's book the need for carbs is quoted as 30 g carbs per day or less.
Why? If you ask any dietitian how Eskimos have survived over the centuries, woman, men and children on zero carbs most of the time ( maybe some berries in the tundra in spring)??? they are unlikely to have an answer. The theory about 150 g carbs plus per day flys out the window.
As explained in the references above, the liver can turn soare protein in the diet into glucose and only about 1/5 th of the brain needs glucose exclusively. 1/5 x 150 g = about 30 g, which can be from carb food or protein.
On a low carb diet less insulin is needed and that means close collaboration between doctor/nurse about adjusting insulin doses to avoid hypos and the understanding that on a very low carb diet that protein intake needs to be considered in calculating the insulin dose.
This is discussed in the book.
I was diagnosed ay age 13. , 52 years ago well before glucometers, fancy insulins, pumos, pens or cgm. The most challenging years so far were from age 13 to about 20, when i would note periodic increases in appetite associated with sugar showing up in the urine and thus need to increase insulin doses sometimes x2 or more of my daily doses for some weeks before the hypos began and i knew to decrease .my insulin doses. These episodes were explained as growth spurts where the growth hormones would surge and make my insulin less effective.
And whilst low carb diets were not in fashion back then i do know i really increased my protein intake, and there were few dietitins back then to ask, but i had found that protein helped best to ease hungervwithout seeming to increase bsls ( sugar in the urine) as much.
One of the beauties of low carb diet i found and read about is that because less insulin is needed there is less risk of hypos in general. Dr Bernstein calls this the law of small numbers. I imagine like me your son has suffered the hypo/hyper see-saw where a hypo occurs, then this leads to a rebound to a high bsl ( due to release if glucose stores from the liver due to adrenaline and glucagon release plus taking food to combat the hypo), then more insulin to correct the hyper possibly leading to another hypo and so on. Less insulin needs = less swings up and down.
As long as there is enough insulin for growth, maintaining bsls in a good range that is the ideal talked about.
What about growth in the teenagers years? This has been a torpedo favourite against low carb diets for children launched by dietitian organisations around the world. To refute this the following study is helpful:
Pediatrics May, 2018. Management of Type One Diabetes by Very Low Carbohydrate Diet. Authors: Ludwig et al
This study looked at adults and children ( including teenagres) on diets with about 20 to 40 g carb per day and showed best HBAIcs, lowest bsl variation, slightly above normal growth parameters in the children/teenagers and lowest hypo rate of any study of TIDs.
Low carb diets can vary by definition from say 120 g carbs per day down to 20 g per day. So there is no absolute need for a person to go very low carb ( say, less than 50 g carbs per day). Just that seems to be where most focus for TIDs seems to be at present.
The fact that TIDs may find their insulin is less effective in the morning compared to later in the day, or that some suffer from the Dawn phenomenon ( DP) and others do not is still a reality for those on low carb diets as far as i have read on forums ( on this site's Home or Forum page, if you type in Dawn Phenomenon in Question Box upper right of page, a description of DP is given).
The following forums may be helpful regarding low carb diets in TIDs:
Type One True Grit, Dr Bernstein's Diabetes Advocates.
Best Wishes to you both and please keep asking questions as you go