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Quick Summary tl;dr
There are people who live with type 1 diabetes and follow a ketogenic diet as a safe way to improve quality of life. Controlling carbohydrates may be a vehicle for avoiding large fluctuations in blood sugar and extreme low blood sugar reactions from incorrect guessing on insulin dosing.
A ketogenic diet seems to help maintain a more stable dynamic between at least two critical factors (food and insulin) in Type 1 diabetes care, underscoring its value for clinical use and quality of life in diabetes self-management.
You should always consult with a doctor or other health professional who has expertise in diabetes prior to adopting a new diet, as you may need an adjustment to the medication you are taking.
What is Type 1 Diabetes?
Type 1 diabetes is an autoimmune disease. The immune system is a defence that guards the body against viruses, bacteria, fungi, parasites and toxins.
A combination of genetics and an environmental trigger (potentially a viral infection, low levels of vitamin D, cow’s milk or increased insulin demand) engages the immune system to attack and destroy the insulin-producing beta cells of the pancreas. After these beta cells are destroyed, the body is unable to produce insulin.
Type 1 diabetes is the result of the inability of the pancreas to produce insulin. In type 2 diabetes, the pancreas produces insulin, although cells are often resistant to its effects
Who Gets Type 1 Diabetes?
Type 1 diabetes can affect all age groups. Although historically 1 diabetes was considered to be a disease that appears during childhood, current research has found that adults are just as likely to be diagnosed with type 1 diabetes; half of type 1 diabetics are diagnosed after age 30 (1).
Yet the rate of Type 1 diabetes in children in the US has increased by almost 60% in 11 years (2), and approximately 1 in 300 children in the US will be affected by type 1 diabetes by 18 years of age ( 3). There are thousands of children who are affected globally.
The highest rates are in northern Europe and in individuals of European decent. Men are more commonly affected in early adult life (2). Data suggests the incidence of T1D has been increasing by 2–5% worldwide (5).
What Happens When Your Body Does Not Make Enough Insulin?
In type 1 diabetes, beta cells in the pancreas are destroyed by the body's immune system. As a result, very little to no insulin is produced (a hormone released by the pancreas) produced.
Without insulin, glucose (sugar) from food cannot enter the cells. Instead of fueling the cells, this excess sugar circulates in the blood causing high blood sugar levels (also known as hyperglycemia).
If there is no insulin to shuttle blood sugar into the cells, excess blood sugar increases critically, and this is called diabetic ketoacidosis (DKA) as opposed to nutritional ketosis. In DKA, severe high blood sugar shifts the blood from having a pH of 7.3-7.45 to a more acidic pH of less than 7.3.
Constant high blood sugar increases risk of diabetes complications such as kidney, nerve and eye disease, heart disease and stroke. Maintaining blood sugar as close to normal is the goal to avoid these complications.
What Are the Symptoms of Type 1 Diabetes?
Until one is diagnosed and lying in a hospital bed, it is unlikely the signs and symptoms of type 1 diabetes will be recognized. This is why, especially for those with a family history, being aware of the symptoms is crucial. If you notice any of these symptoms, schedule a doctor's visit immediately.
- Extreme thirst
- Frequent urination
- Behavior changes (moody, less tolerant)
- Drowsiness, fatigue or lethargy
- Increased appetite coupled with weight loss
- Sudden weight loss
- Sudden vision changes
- Fruity odor on the breath
- Nausea and vomiting
Is There a Cure for Type 1 Diabetes?
There is no cure for type 1 diabetes. A ketogenic lifestyle can help people with type 1 diabetes avoid blood sugar fluctuations and optimize their quality of life.
Living With Type 1 Diabetes
Self care is of the utmost importance in the successful management of type 1 diabetes. Coordinating life skills (activity, nutrition, blood sugar monitoring, medication) — along with increased awareness of low blood sugar symptoms — analytical skills helps to keep blood sugar within target range. Sadly, less than one-third of people with type 1 diabetes in the U.S. are achieving target blood glucose control (6).
Type 1 diabetes can be a life-long burden, but consistency and commitment makes living with diabetes much easier. What you eat has a significant impact on blood sugar and the amount of insulin you need to inject.
Why is Type 1 Diabetes Difficult to Manage?
According to type 1 diabetic Dr. Keith Runyan in this presentation there are two main underlying factors as to why type 1 diabetes is difficult to manage:
1. High Variability of Absorption of Carbohydrates
Digestion and absorption of the different types of carbohydrates (rapid-digesting, slow-digesting, or processed) are almost impossible to time. ( 7)
There may be as much as a 50% variation in carbohydrate absorption from various types of carbohydrates. If you miss that peak blood sugar window of opportunity, the insulin will not be as effective, or work as expected, therefore resulting in blood sugar levels that are either too high or too low.
2. High Variability of Absorption of Insulin
Injected insulin can have as much as a 30% variability in absorption. How is one to determine this factor? Again, this is not easily determined, and in fact impossible to predict accurately.
Why Following a Low Carb Approach Works for Type 1 Diabetes
In essence, the high variability of absorption for both food and insulin makes it almost impossible to target treatment. If you lower carbohydrates and thus lower the amount of insulin required, the variability is less and there is a much better chance you will achieve target blood sugar.
Managing Type 1 Diabetes with the Ketogenic Diet
Health risks for people living with type 1 diabetes significantly decline with consistent and normal blood sugar levels. Life expectancy can also be similar to those without diabetes.
A ketogenic diet helps improve quality of life of patients living with type 1 diabetes. While low blood sugar is always a concern for type 1's, it seems those who use a ketogenic diet find it is much more manageable (compared to the low resulting from an excessive bolus of insulin) because the symptoms are not as overwhelming and mental acuity is not affected.
Consensus amongst type 1 keto dieters seems to be to treat a low blood sugar with one standard glucose tab that provides 4-5 grams of carbohydrates (the total amount will depend on your situation and how low the blood sugar number is) to provide a necessary steady reliable rise in blood.
How to Follow the Ketogenic Diet to Manage Type 1 Diabetes?
Although not actually new, using a ketogenic diet to treat type 1 diabetes is becoming more popular. Importantly, you should work with a knowledgeable healthcare professional when attempting to switch from a high to lower carbohydrate diet to help select the appropriate foods and manage insulin dosing.
Dr. Richard Bernstein uses a very low carb ketogenic diet of 30 grams of carbohydrates per day to manage his and his patients' blood sugars. He found that his blood sugar would stay in the normal range when he minimized his insulin injections consuming a carbohydrate regimen as follows:
- 6 grams for breakfast
- 12 grams for lunch
- 12 grams for dinner
Source: Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars
Ketogenic Menu Examples for Patients with Type 1 Diabetes
Breakfast (6 grams of carbs):
Lunch & Dinner (12 grams of carbs each):
Other Approaches
Troy Stapleton is another medical doctor using a ketogenic diet for better health (from Dr. Troy Stapleton's presentation: I Manage My Type 1 Diabetes By Eating LCHF). Others consume closer to 50 grams of carbohydrates per day. You'll need to consult your doctor and work with an expert to find a carbohydrate target that works for you.
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