Dr Ian Lake is a GP based in Stroud, Gloucestershire and is a founding member of the Public Health Collaboration. He has had type 1 diabetes for 22 years, spending most of that time with poor control. However, within a few weeks of starting a low carb, ketogenic diet, Dr Lake felt that his life had been completely transformed. He now advocates the use of low carb diets for the management of type 1 diabetes. This talk was given at the PHC conference 2017 in Manchester.

Dr Lake notes that although he has the luxury of choosing whether or not to adopt a ketogenic lifestyle, there are plenty of type 1 diabetics for which it is necessary. He feels that currently, the NHS is not doing enough to support newly diagnosed type 1 diabetics, as they do not offer ketogenic diets as an option. Sadly, this means that diabetics wishing to try a low carb approach have to do so without the full support of their healthcare professional.

The REPOSE study looked at the effect on HbA1c scores, of flexible intensive insulin training (in the form of DAFNE dose adjustment), combined with either an insulin pump or multiple daily injections. Despite receiving highly intensive training, only 3 per cent of participants in both groups were able to achieve an HbA1c score below the NICE target of 6.5% (48 mmol/mol). This is disturbing, as HbA1c scores above this are strongly associated with increased risk of cardiovascular disease. On the other hand, the TYPEONEGRIT low carb approach has seen the vast majority of its cohort achieving an HbA1c below 6.5%.

Low carb diets are currently absent from the NICE guidelines for type 1 diabetes. Dr Lake explains that, when setting out to determine the effect of carbohydrate counting/restriction on diabetes control, NICE specifically excluded low carb diets from their evidence search. Thus, studies that show the efficacy of low carb diets in controlling type 1 diabetes (e.g. Nielsen et al. 2012) were omitted.

One major issue that Dr Lake raises, is that the development of rapid-acting insulins has led many diabetics to believe that they can eat anything they want. Indeed, they can even be told this by reputable authorities such as Diabetes UK. Ironically, overuse of insulin therapy leads to hyperinsulinaemia and the development of insulin resistance (i.e. type 2 diabetes) in type 1 diabetics.

Dr Lake summarises some key pointers on how to follow a low carb, ketogenic lifestyle for effective type 1 diabetes control. These are to eat real food, perfect basal insulin dosage, reduce carb intake, eat only when hungry, exercise regularly, sleep well, reduce inflammation and stress, challenge misinformation and keep an open mind. He also recommends that every newly diagnosed type 1 diabetic read Richard Bernstein’s Diabetes Solution book for more specific guidance.

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