T1 New Low Carb Study

[xyzzy]

Not often I get to post in the T1 threads but thought you would find this research of interest . A new 4 year study showing the benefits of low carbing for T1's. Done by my mates the Swedes by the looks of things.

http://www.dmsjournal.com/content/pdf/1758-5996-4-23.pdf

For those who don't want to read the whole thing

Conclusion

An educational program involving a low-carbohydrate diet and correspondingly reduced
insulin doses for informed individuals with type 1 diabetes gives acceptable adherence after
4 years. One in two people attending the education achieves a long-term significant HbA1c
reduction.

 

[Paul1976]

Sounds interesting and the 50% improvement on overall control is very encouraging.

 

[Scardoc]

Very interesting. What perplexes me however is whether or not the improvements seen are down to low carbing or education. Here's where I am coming from. I carb count and know, eg, that in the morning I will take 1 unit of insulin for every 12g of carbs. The morning is a good example as I normally stick to toast (mon-fri) so there is no deviation or other factors that come into play. Now, if I reduced my carb intake by 50% - then I'd adjust my insulin accordingly.

Where things become a bit more complex is when you start having meals which are a combination of food groups as this can effect absorption rates etc. Carb counting does not work as clearly for me at these times and experience plays a huge part of knowing whether to adjust the ratio up or down. Again, as I base it on carb counting then I would simply adjust my insulin by the same percentage as the reduction of carbs.

I certainly don't discount the study and I see where they are coming from with the idea that it reduces the chances of error. Hopefully, they will continue the research and find more adherant people!!

I do think that education on carb counting would also have a significant impact.

 

[phoenix]

Yes, compliance was very poor and these were people who had been asked and agreed to take part, they weren't randomised.
As I said eleswhere they don't give you any info on the reasons for non compliance which could include hating the diet but also that the diet wasn't so effective in some. They also don't define partial compliance which could range from a couple of low carb meals to a couple of 'cheat' days.

 

[jopar]

I see that you took a link at the I gave in another thread!

The actually full ''Conclusion' is

Conclusion
Attending an educational course on dietary carbohydrate reduction and corresponding insulin
reduction in type 1 diabetes gave lasting improvement. About half of the individuals adhered to the program after 4 years. The method may be useful in informed and motivated persons
with type 1 diabetes. The number needed to treat to have lasting effect in 1 was 2

Looking at the trial in more depth, and precipitants..

48 T1's from one clinic of 300 T1's who decided to take part in the trial after reading the details!

38 injections
14 pumpers

7 of them had gatro-paresis

All started with a HbA1c >7.1%

75g > (lower by choice) low carb diet, reduction of starchy carbs, but Hard Bread! and vegetables allowed...

Main comparison points 3 months and 4 years...

At the end of 2 years, 25 precipitants had stopped adhering to the diet a 52% drop out..

So how much difference did it make.. to weight, BMI and chol/lipids!

Surprisingly very little difference

All are mean's results and not individual results..

Weight started at 77.6, 3 months had dropped to 74.9 but at 4 years gone back up to 76.7kg!

Total, chol, started 5.4, 3 months gone up to 5.6 and stayed there
A slight shift in Chol/HDL start 3.9 to 3.6
similar for the TAG/HDL
Trig stayed the same at 0.9

HbA1c's (means)

The did have to separate this into groups, so reflected, those that stop adhering completely, partial adhesion and total adhesion..

Well all groups improved all precipitants started out at 8.6/7.6 after 4 years 7.9/6.9 Readings given in Mono-s and DCCT

End means for each group..

total NO ad, >-0.1 = 0.1
Par ad >-0.7=0.4
tot ad >-1.8=0.9

There's some interesting information in the discussion concerning benefits and the conclusion for the discussion

An educational program involving a low-carbohydrate diet and correspondingly reduced
insulin doses for informed individuals with type 1 diabetes gives acceptable adherence after
4 years. One in two people attending the education achieves a long-term significant HbA1c
reduction.

Again in the discussion part of the study, after crunching the numbers etc

"The model described here may be an option for 10-20% of the patients with type 1 diabetes."

So yes the theory works with control, but the stumbling block is both in possible uptake and adhering to the diet is very low...

So my personally conclusion is... Based on the out comes of all, that even those who didn't adhere didn't adhere to the dietary regime still made a improvement in control that Education rather than a specific regime is what improves control!

 

[smidge]

Hey all!

Thanks for the the link, Xyzzy! It's very interesting to know that studies into carb reduction for Type 1s are actually happening. The adherence to the LC diet in the study is disappointing. I think one of the problems is that Type 1s think they can get away with a normal high carb diet and cover with insulin. Personally, I think that approach is a ticking time bomb. Undoubtedly, education is critically important to managing Type 1 diabetes, but to really be effective, it needs to be accompanied by good information and advice concerning the reduction of carbs. 'Cut the carbs' is never going to be an appetising message, but 'eat normally' will contribute to long-term complications. This is the issue I have with DAFNE. I know it's heresy, but while I accept DAFNE and similar are excellent programs of education for carb-counting and matching insulin to food, the net result is that many Type 1s are fooled into thinking it is OK to go back to eating normally - and I believe that is damaging for their long-term health. It would be interesting if the study was able to catch up with the groups every couple of years over a long period of time to see just how well each of them fair. A kind of 7-up for diabetics!

Smidge

 

[Geri]

Here, here, Smidge,
I have been counting carbs but give top up insulin to compensate the extra treat or two. After feeling so fed up today and finding the info online, I'm going back to an LC diet after yo-yoing with hypos for ages now. I was always worried about cholesterol, but am having second thoughts after reading the report and other threads on here.
Many thanks to everyone with LC diet advice.
Geri x

 

[Mileana]

What would be very interesting was a study where people who are very familiar with carb counting was put on a LCHF diet - that way most of the educational benefit could be kept out of the study.

Take x amount of people familiar with their carb/insulin ratio and ask them to reduce carbs to 25 percent over a month, then follow them for 4 years.

Then we would be talking real results.

I am very happy that studies are being made, though, as that means eventually, we will end up in a place where there is less ****** advice being given to all types of diabetics.

 

[jopar]

What would be very interesting was a study where people who are very familiar with carb counting was put on a LCHF diet - that way most of the educational benefit could be kept out of the study.

Take x amount of people familiar with their carb/insulin ratio and ask them to reduce carbs to 25 percent over a month, then follow them for 4 years.

Then we would be talking real results.

I am very happy that studies are being made, though, as that means eventually, we will end up in a place where there is less ****** advice being given to all types of diabetics.

I'm very familiar with carb counting, been doing it for over 20 years now...

Would I volunteer for your suggestion!

Answer is no I would not! I have no intention to of following a VLC diet!

Why on earth would I want to do that! As I have HbA1c in the 5%, low cholesterol, no complications and the only medication I take is insulin, I take no other medication or supplement! I don't even have any weight issues to address never have done!

Can't say information I've been given is **** at all it works for me!

Oh, before you ask or suggest a VLC diet wouldn't neglect my need for a insulin pump, what every my choice I would still need to the pumps ability to fine tune deliver of my insulin!

 

[xyzzy]

Just found an earlier T1 study done by the same Swedish group. Seems to say much the same but explicitly states that it was good for cholesterol.

"Due to failure to achieve control twenty-two patients with type 1 diabetes with symptomatic fluctuating blood glucose started on a diet limited to 70-90 g carbohydrates per day and were taught to match the insulin doses accordingly. The caloric requirements were covered by an increased intake of protein and fat. The purpose was to reduce the blood glucose fluctuations, the rate of hypoglycaemia and to improve HbA1c. After three and 12 months the rate of hypoglycaemia was significantly lowered from 2.9 + 2.0 to 0.2 + 0.3 and 0.5 + 0.5 episodes per week respectively. The HbA1c level was significantly lowered from 7.5 + 0.9 % to 6.4 + 0.7 % after three months and was till after 12 months 6.4 + 0.8 %. The meal insulin requirements were reduced from 21.1 + 6.7 I.U./day to 12.7 + 3.5 I.U./day and 12.4 + 2.6 I.U./day after three and 12 months respectively.

Furthermore the triglyceride level was significantly lowered whereas the levels for total cholesterol and HDL-cholesterol were unchanged. Conclusion: the present report shows that a 70-90 g carbohydrate diet is a feasible long-term alternative in the treatment of type 1 diabetes and leads to improved glycaemic control."

The full study can be downloaded here.

http://www.dsolve.com/component/option,com_docman/task,doc_download/gid,24/

 

[Mileana]

Hey jopar.

No, I wasn't saying that particularly you had been given bad advice or that you should volunteer, heh.

What I am refering to is the experience of some people, particularly type 2s who are adviced to keep eating plenty of carbs they cannot process, or people like myself who are type 1.5 and aren't entitled to the same information that type 1s on insulin get, and I have seen a few examples of type 1s not getting information enough about the link between insulin and carb and insulin/carb and weight where appropriate.

I think the debate about low carb or not has to remain a personal choice. I am carb-conscious myself and trying to entirely work out my pattern of sensivity and exercise which still needs fine tuning as I'm only 1 month into basal/bolus. I think what I am saying is that I would like that choice to be an informed one that people make because they have the information at hand which is relevant to them. Some people honestly don't get this advice.

My endo would have put me on enourmous amounts of insulin, along with the standard amount of carbohydrates. I was entirely ignorant of the link as I wasn't told anything, ended up in a bad hypo even after reducing the dose that seemed 'crazy' to me, thinking I could take the other half later. As I am trying to lose weight, and doing that well with a pretty well controlled diabetes considering it's all new, I am eating less carbs and my insulin need is less than half of their estimate.

I still have work to do, but I would not be able to avoid after meal spikes the way I do now on MDI without having to do split bolus and correction doses a lot of the time, so for me, it matters.

 

[smidge]

Hey Geri!

Here, here, Smidge,
I have been counting carbs but give top up insulin to compensate the extra treat or two. After feeling so fed up today and finding the info online, I'm going back to an LC diet after yo-yoing with hypos for ages now. I was always worried about cholesterol, but am having second thoughts after reading the report and other threads on here.
Many thanks to everyone with LC diet advice.
Geri x

I haven't found any detrimental effect on my cholestorol from the low-carbing. Both cholestorol and blood pressure are excellent. My HbA1c has been between 5.7 and 6.1 for the whole time. I don't get the mad swinging from high BG to low that you seem to get with higher carb diets and I don't get the severe hypos that others report. When my BG falls below 4, it stays in the high 3s for a long time without dropping lower. My weight is also very stable - but you do have to increase your fat intake, otherwise your weight will fall when you reduce the carb. I honestly believe the low-carbing is the way to lower, more stable BGs. I keep my carb intake to up to 50g per day (usually between 30 and 40), so not as low as some of the guys.

Take a look in the low-carb diet section for some excellent recipes - and some really good low-carb treats.

Good luck

Smidge