Ketogenic Diet and Type 1 Diabetes

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What is Type 1 Diabetes?

Type 1 diabetes is an autoimmune disease. The immune system is a defence that guards the body against bacteria, fungi or parasites.

A combination of genetics and an environmental (viral infection, vaccines, low levels of vitamin D, cow’s milk or increased insulin demand) trigger engages the immune system to attack and destroy the beta cells in 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. With type 2 diabetes, the pancreas produces insulin.

Who Gets Type 1 Diabetes?

Type 1 diabetes can affect all age groups. Although the thought has been that type 1 diabetes 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 too many children who are effected 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?

Beta cells in the pancreas are destroyed by your own immune system resulting in too little or no insulin (a hormone released by the pancreas) produced.

Without insulin, energy (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 (as opposed to nutritional ketosis in DKA severe high blood sugar shifts the blood from having a more neutral ph to more acidic).

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 avoid blood sugar fluctuations and optimize 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, math and analytical skills helps to keep blood sugar within target range. Less than one-third of people with T1D in the U.S. are achieving target blood glucose control. (6)

Type 1 diabetes can be a life-long burden; but truthfully consistency and commitment makes living with diabetes much easier. What you eat has a significant impact on blood sugar and insulin injection.

Why is Type 1 Diabetes Difficult to Manage?

According to Keith Runyan (expert interview), 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 and slow available glucose, 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 high, low or just not ideal blood sugar levels.

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 extremely difficult.

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 insulin the variability is less and there is a much better chance you will hit 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 a concern, it seems those who use a ketogenic diet find the low blood sugar is much more manageable (vs. the low resulting from an over 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 relatively new, using a ketogenic diet to treat type 1 diabetes is becoming more popular. 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 dose.

Dr. Richard Bernstein uses a very low carb ketogenic diet of 30 grams of carbohydrates to manage his and his patients' blood sugar. He found that his blood sugar would stay in the normal range when he minimized his insulin injections consuming 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 use more like 50 grams of carbohydrates. You'll need to consult your doctor and work with an expert to find a carbohydrate target that works for you.

Take Home Message

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 dose.

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 consult any dietary changes with a health professional, especially if you have a health condition such as diabetes or heart disease. You may need an adjustment to the medication you are taking.

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By Valerie Goldstein, MS,RD,CDE
Author and Health & Blood Sugar Expert

Valerie is a Dr. Atkins trained registered dietitian and certified diabetes educator. She is acknowledged in his books, "Dr. Atkins New Diet Revolution" and "Atkins for Life".

Valerie always says, "The ketogenic diet provides the most nutrient bang for the calorie buck" and so she uses this nutritional approach and personalizes it for all her medical, weight loss and athletic clients throughout the country.

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Comments (10)

I am a type 1 diabetic. I know how hard it is to live with. When I was first diagnosed I was advised by doctors to eat 40% carbs as long as I took my insulin. I put on 15kg's in a month, felt ill and was completely depressed. Ive tried all sorts of eating plans. Then I read dr bernstiens books and found the keto diet.  The keto diet/ lchf is by far the best way to control my blood sugar in conjunction with daily strenuous exercise which includes weightlifting. Now 11 years since my diagnosis my doc recommends low carb high fat to his other patience. 😉

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Thank you for sharing Tatiana! Good for you and all the patients that benefit from your doctor's ketogenic diet recommendations. I wish you continued success with your diet and health.
Valerie Goldstein, MS RD, CDE

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No mention of the very high risk of ketoacidosis? You're putting people in danger by recommending a diet that could very well kill them. (Ketosis combined with the high blood sugar you can get when you have T1D = ketoacidosis which is very much lethal). Low carb may help some people with T1D (idk, taking your word for it I guess), but I feel your article does not emphasize enough the risks and the ABSOLUTE NECESSITY to do this with the help of a medical professional and a very precise tracking of blood sugar/ketones level.
I'd like to see sources for your claims that keto/LCHF/low carb helps for T1D because this contradicts everything I've read on the subject.

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I disagree. Diabetic ketoacidosis is indeed a serious condition in diabetics, however, you are confusing it with nutritional ketosis (0.5 to 3 millimolar). In ketoacidosis, ketone levels are much higher (15 + millimolar) and combined with extremely high blood sugar levels. Also, this article does emphasise the necessity to work with a health professional - you may have not read the whole post. To see what these claims are based on, simply go through the scientific references, including  Dr. Bernstein's book.

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Hello OB,
I understand your concern.
Might I suggest you join the Typeonegrit facebook group; its members are type 1 diabetics who use a ketogenic diet to live healthier lives.
Good luck with your diet choice whichever you choose.

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I have heard that the risk of ketoacidosis is higher for Type I diabetics.  How would one avoid this?

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Hello Muriel,
I agree with Martina.
Just to reiterate, diabetic ketoacidosis (DKA) is the result of dangerously high levels of blood sugar and ketones; the combination makes your blood acidic and is very dangerous. Being in ketosis helps control and normalize blood sugar and does not mean ketone levels are so high that it causes blood to become acidic and reach DKA levels.
I'd also like to add that if you monitor blood sugar and work with a professional who can help you adjust medications, your risk of going into ketoacidosis on a ketogenic diet is lower because eating less carbs (helps to manage blood sugar not raise it) and managing insulin dose (with a medical expert) accordingly will minimize blood sugar fluctuations.

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It is incorrect to state that Type 1 diabetes "usually appears during childhood or adolescence".  Onset of type 1 diabetes is just as likely to occur in people older than 30 years of age as in those younger, new research shows.  See this article discussing the research presented at the EASD 2016 meeting: "Half of All Type 1 Diabetes Develops After 30 Years of Age" https://www.medscape.com/viewarticle/869028

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Thank you for sending me this link, Susan! Valerie sent me an updated version and I'll upload it soon.

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Hello Susan,
Thank you for providing the EASD findings. The information will be changed ASAP.
In good health,
Valerie

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