A group of healthcare professionals have published a practical guide on type 2 diabetes medications in the context of a low carb diet.

It is hoped this guide will allow other healthcare professionals to make informed choices around their patients’ medications, should they choose to try out a low carbohydrate lifestyle.

The authors are Dr Campbell Murdoch, GP in Somerset and Chief Medical Officer at Diabetes Digital Media; Dr David Unwin, GP in Southport and RCGP clinical expert in diabetes; Dr David Cava, diabetes consultant in London and Bermuda; Dr Mark Cucuzzella, Professor at West Virginia University School of Medicine, USA; and Dr Mahendra Patel, pharmacist in Yorkshire.

Low carb lifestyles have been growing in popularity over the last few years. This is perhaps due to the increasing evidence of their power to help people lose weight, improve metabolic health and control type 2 diabetes, even placing it in remission in some cases.

However, despite the benefits a low carb way of eating can bring, the changes the body undergoes can raise certain challenges when it comes to type 2 diabetes medication.

One of the first things to happen when a person with type 2 diabetes begins eating low carb is blood glucose levels start to fall. This is, of course, seen as a good thing, as blood glucose levels are, by definition, too high in type 2 diabetes. However, there is a risk that restricting carbs, while on certain diabetes medications, could cause blood sugars to fall too low, causing hypoglycaemia, or a ‘hypo’.

The guide highlights insulins and sulphonylureas (such as gliclazide) as medications which pose a hypo risk with low carb, and so are likely to need to be reduced or stopped. Other medications that do not pose a hypo risk, such as metformin and GLP-1 agonists, could be considered on their individual merits.

While hypertension (high blood pressure) medications are not discussed at length in the guide, the authors do note that blood pressure often falls on a low carb diet and so these medications may also need discussing with one’s doctor.

Dr Campbell Murdoch, co-author of the guide and Chief Medical Officer at Diabetes Digital media has this to say about the publication: “More people with type 2 diabetes are choosing a low carbohydrate approach to manage the condition and potentially place it into remission. It is important that clinicians have the tools to support patients and adjust their medications appropriately. Clinical practice can be very busy.

“We knew a clinician-friendly resource was needed for prescribers including; doctors, nurses, pharmacists, and dietitians. This practical guide makes the healthcare professional’s role in adjusting diabetes medications easier, and patients feel supported with safe and effective care.

The article supports choice and best practice for type 2 diabetes care. We hope it helps to improve the lives of individuals and accelerates the reversal of the global type 2 diabetes epidemic.”

Our own Low Carb Program, which has over 400,000 users, is a resource designed to deliver structured education and support in following a low carb lifestyle. Our one-year outcomes have seen people with type 2 diabetes, on average, lose 7.4kg and reduce their HbA1c by 1.2%, with 1 in 4 achieving remission.

The guide was published in the British Journal of General Practice and is free to access.

Please note that the suggestions outlined in the guide are intended for consideration by healthcare professionals and do not constitute medical advice to patients. Any queries around changes to medication should be discussed with your doctor.

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