In Depth

Dr Ian Lake: The type 1 diabetes elephant in the room

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 Public Health Collaboration conference 2018 at the Royal College of General Practitioners in London.

Dr Lake begins by identifying a disconnect between the knowledge of healthcare professionals and their patients with type 1 diabetes, noting that many healthcare professionals know about low carb and accept its applications in diabetes management, while the patients are unfortunately not aware. Echoing the words of Richard Bernstei, Dr Lake says that people with type 1 are entitled to the same blood sugars as non-diabetics. However, it has been found that, on the best current guideline advice available, 97 per cent of people with type 1 diabetes are not meeting the NICE HbA1c target of 48 mmol/mol (6.5%). It’s worth noting that this target is still not within the normal range for non-diabetics.

Although there are some studies that have been done and are being done on carbohydrate restriction and type 1 diabetes, these do not often feature in guidelines’ literature searches. Indeed, studies looking at carbohydrate restriction were excluded from the literature search in the NICE [NG17] guidelines for type 1 diabetes. Although the Diabetes UK guidelines have shifted their stance slightly to allow consideration of low carb approaches in type 2 diabetes, Dr Lake presents their statement on carbohydrate restriction in type 1 diabetes, which states there is “no convincing evidence” that it improves glycaemic control. Dr Lake addresses each of the references given in this statement, opining that these are small, outdated studies that have not truly looked at low carb interventions. That said, there has been progress as the Diabetes UK guidelines also recognise that a small pilot study has highlighted the potential for low carb approaches to be used for type 1 diabetes.

After addressing some of the healthcare world’s worries around low carb approaches, Dr Lake asks the question: “What has low carb ever done for T1?” In this vei, he lists some of the benefits that low carb has to offer, as evidenced by scientific studies. These benefits include reduction in daily insulin doses, improved blood glucose control (allowing reductions in HbA1c and frequency of hypos and hospitalisations), weight loss and improvements in mental health.

Dr Lake shares some of the data from the Diabetes.co.uk Low Carb Program which, at last count, had over 37,000 members with type 1 diabetes, despite not being made specifically for use with it. The data shows that people with type 1 diabetes were able to modestly reduce their weight and HbA1c after following the program. The Type 1 Program, which was very much made specifically for supporting people with type 1 diabetes, is open for registering interest, and this will hopefully yield yet more favourable results in the future.

 

If you would like to view Dr Lake’s Public Health Collaboration talk from the previous year, click here.

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