A lot of diabetes specialist worry about us type 1's having hypo's, many would prefer the patient to be a little higher and in the safe zone. I think that could be the reason for the higher carb intake. Carbs have a longer lasting effect on the body.
This is of course erroneous thinking, though. I'm sure you know this but just for the benefit of the person asking.
I've fasted and eaten barely anything for a week about a dozen times last year (see the FMD thread), 500 calories a day and was in ketosis most of the time (meaning in a caloric deficit, catabolic state, and burning my own fat stores for ketones), and one of the things I worried about the most was life-threatening hypos. But this isn't what happened. The fact that I ate less calories meant I also took much less insulin, actually only a couple handfuls of units per day, and my hypo frequency
dropped. Significantly. I also felt great. Full disclosure: When it came time to refeeding though, my insulin sensitivity dropped but that's another issue.
I'm 100% positive that low-carbing is a safer way for type 1s to live for the hypo issue alone, regardless of the myriad of other benefits such as improved A1C and lower weight.
Hypos are primarily caused by insulin overdose, i.e. over-corrections for ingested carbs. So higher carbs = more insulin = more insulin overdose. So, if you want to lower your hypo frequency, switch to a low-carb diet and thereby cut your insulin dose significantly, and thus your risk of insulin overdose as well. It's a fact. See: Dr Bernstein.
Also, the last sentence isn't true: fats last longer in the body, not carbs. Fat takes much longer to digest.
I can eat a couple slices of bacon and I'm satiated for the entire day until supper. I only eat two meals a day this way. If I ate a stack of pancakes and took a massive insulin dose I'd have to eat again in a few hours, or likely collapse. This is the law of small numbers at play.
To the OP: I would also say, ignore the high-carb mantra, they are wrong. My endo also doesn't believe in low-carbing and my A1C is much better than his. Sometimes the "experts" get it wrong. Just go shopping for a good nutritionist who understands ketosis and insulin-to-carb ratios and has read Dr Bernstein's book (and agrees with it). The bottom line is that your son's diet is your choice, not the doctor's, and sometimes doctors make mistakes and you have a right to get a second, third, fourth opinion. Or just reject their advice completely. He's wrong. People are now even thinking about switching to low-carb immediately during weaning. You don't need carbs to live (we do need a small amount of sugar, but you can get that from gluconeogenesis from protein). And it's not like you can 100% avoid them anyway.
An 11 year old type 1 can certainly experiment with ketosis. It's how humanity has lived since the beginning, periods of feast and famine resulting in us being able to not only survive, but thrive on ketones (from fat) as our primary fuel source. The brain actually prefers ketones and it makes your mind sharper. Eating excessive carbs and calories results in mental lethargy (think: after a big, heavy lunch at the office = no brain power for hours after, vs a small salad = go go go).
The goal of ideal type 1 control is a combination of three things:
a) a good A1C,
b) good sugar variance (A1C doesn't tell the whole story),
and
c) low insulin dose
You can only achieve all three at the same time by minimizing carbs. A low insulin dose has the side benefit of much lower hypo risk compared to a high-carb diet. To my mind it's literally dangerous to tell people to take more insulin. An insulin OD can kill you. This is just a fact. I crashed my car and woke up up-side down, bleeding, due to having too much insulin on board while driving. It came on too suddenly to do anything about it, as my vision blacked out suddenly (prior to the accident). My car and two others were totalled and the cops thought I must've been on drugs or booze. Nope, just insulin. They made me walk the line and touch my nose and breathe into a breathalyzer machine. "Ahh, you're a type 1, ok, it's not your fault but we're revoking your license until your doctor attests that you're under control". I tested myself right before turning the ignition. 4.7. This is the problem with insulin, it's both your friend and your enemy. So take it sparingly. And to do that, the best way is to avoid needing to take more of it. By eating less carbs and sugar. It is really that simple.
My last point is this:
It's not your endocrinologist's responsibility to manage your son's diabetes, it's
his.
Not even yours. You can help (especially with food selection* and prep), sure, but he needs to learn the hard way to do everything himself and know how his body works. Get him the Bernstein Diabetes Solution book and tell him to make it his Bible. The sooner you take responsibility for being pro-active and learning about how to manage the disease, the better.
*There are plenty of delicious recipes for low-carb foods that won't spike his sugars much (or at all). You can eat most of the yummiest foods on the planet with some alterations to reduce or remove carbs. Make spaghetti squash instead of spaghetti. Zucchini fettuccine (buy a slicer) is great too. Even butternut squash poutine is a wonderful, low-insulin required delight (though takes time to prepare enough of it).
