Keto and type 1 help

Chris_Kornelsen · 2020-01-01 23:39:04 UTC

So does anyone here know much or have resources about type 1 and keto? My wife wants to start keto and she is type 1. There are no doctors that will endorse it and her diabetic team is heavy heavy carbs. So they will “help” by just needing to by law but they wont really give us resources or info.

Mostly we need to know exactly how to change her I sulin requirements. Like how much insulin to do as the background insulin (I believe is basal not totally sure) or how much insulin to measure with protein.
How to avoid lows especially at night so she doesbt need to drink juice or have sugar
If your numbers are low and you drink juice or have sugar enough yo just raise them to normal does that effect ketosis? Or does your body immediately push that sugar to your cells and it avoids the liver?
Is ketoacidosis a serious concern with type 1 and ketosis?

beccs · 2020-01-02 00:20:59 UTC

http://www.ijcasereportsandimages.com/archive/2014/010-2014-ijcri/CR-10435-10-2014-clemens/ijcri-1043510201435-toth-full-text.php

ncbi.nlm.nih.gov

Management of Type 1 Diabetes With a Very Low-Carbohydrate Diet.

BS Lennerz, A Barton, RK Bernstein, RD Dikeman, C Diulus, S Hallberg, ET Rhodes, CB Ebbeling, EC Westman, WS Yancy and DS Ludwig, Pediatrics, 2018 06

To evaluate glycemic control among children and adults with type 1 diabetes mellitus (T1DM) who consume a very low-carbohydrate diet (VLCD).We conducted an online survey of an international social media group for people with T1DM who follow a VLCD. Respondents included adults and parents of children with T1DM. We assessed current hemoglobin A1c (HbA1c) (primary measure), change in HbA1c after the self-reported beginning of the VLCD, total daily insulin dose, and adverse events. We obtained confirmatory data from diabetes care providers and medical records.Of 316 respondents, 131 (42%) were parents of children with T1DM, and 57% were of female sex. Suggestive evidence of T1DM (based on a 3-tier scoring system in which researchers took into consideration age and weight at diagnosis, pancreatic autoimmunity, insulin requirement, and clinical presentation) was obtained for 273 (86%) respondents. The mean age at diagnosis was 16 ± 14 years, the duration of diabetes was 11 ± 13 years, and the time following a VLCD was 2.2 ± 3.9 years. Participants had a mean daily carbohydrate intake of 36 ± 15 g. Reported mean HbA1c was 5.67% ± 0.66%. Only 7 (2%) respondents reported diabetes-related hospitalizations in the past year, including 4 (1%) for ketoacidosis and 2 (1%) for hypoglycemia.Exceptional glycemic control of T1DM with low rates of adverse events was reported by a community of children and adults who consume a VLCD. The generalizability of these findings requires further studies, including high-quality randomized controlled trials.

ncbi.nlm.nih.gov

Low-carbohydrate diets for type 1 diabetes mellitus: A systematic review.

JL Turton, R Raab and KB Rooney, PloS one, 2018

Type 1 diabetes is an autoimmune condition characterised by pancreatic beta cell destruction and absolute insulin deficiency. The strongest predictor of diabetes complications is glycaemic control and achieving HbA1c ≤ 7.0% is the primary management target. However, standard treatment appears to be lacking and adjunctive strategies require consideration. A systematic review was conducted to examine the effect of low-carbohydrate diets on type 1 diabetes management. Four databases were searched from inception until 28 March 2017: MEDLINE; CINAHL; Cochrane Library; and EMBASE. All primary studies containing a methods section (excluding cross-sectional) were included. Reports had to quantitatively measure the effect(s) of a dietary intervention or observed intake over at least two weeks where carbohydrate is below 45% total energy in adults and/or children with type 1 diabetes. The primary outcome was HbA1c and secondary outcomes were severe hypoglycaemia, total daily insulin, BMI, quality of life and mean daily glucose. Seventy-nine full-text articles were assessed for eligibility and nine were included (two randomised controlled trials, four pre-post interventions, two case-series, one case-report). Eight studies reported a mean change in HbA1c with a low-carbohydrate diet. Of these, four reported a non-significant change (P ≥ 0.05) and three reported statistically significant reductions (P < 0.05). Two studies reported severe hypoglycaemia, five reported total insulin, three reported BMI, and one reported blood glucose. Due to the significant heterogeneity of included studies, an overall effect could not be determined. This review presents all available evidence on low-carbohydrate diets for type 1 diabetes and suggests an urgent need for more primary studies.

MarkGossage · 2020-01-02 09:14:52 UTC

I would suggest your wife joins the facebook group Type1grit who advocate a very low carb diet for T1’s and follow the Dr Bernstein principles.

KetoSnaps · 2020-01-02 11:19:48 UTC

I’m a keto T1D, diabetic since 1986, keto since 2015, and on an insulin pump since 2015 too.

There’s no magic formula - like reduce basal insulin by x and bolus insulin by y, because obviously everyone’s different, but I have made dramatic changes to my diet and diabetes management since starting eating keto.

I test, test, test ALL the time - mostly using a Freestyle Libre flash monitor, but also fingerpricks. That’s my non-negotiable - if I’m not testing, I wouldn’t have a clue. I need that data to work with!

I am on less insulin than I was before I went keto, but it’s been a gradual process as a result of lots of trial and error. It’s worth it, though.

If I’m taking small amounts of insulin (thanks to being keto) than the outcomes of any errors are by their very nature smaller. That makes me feel much safer than when I’d been used to taking a tonne of insulin when I’d go out for pizza, garlic bread and ice cream, go massively high afterwards and then hypo a couple of hours after that! An absolute rollercoaster!

I eat two scrambled eggs with butter for breakfast, and despite their negligible carbohydrate value, I nevertheless need 1.4u of rapid-acting insulin to keep my blood sugar from spiking.

Lunch is low-carb soup, or a chaffle (waffle made with cheese and egg) filled with ham or cheese or egg or creamy mushrooms or homemade pate or tuna mayo or whatever - I generally take one to two units with a lunch like these - and for my evening meal, my carb count varies quite a lot (homemade bolognese racks up quite a count thanks to the tomatoes and peppers, and fatty puddings tend to spike a bit too) and I’ll have anything between 2.5u (salmon and broccoli), 3.5u (when I’m having something like steak, cream cheese sauce and broccoli) and 4.5u (cauli bolognese), depending on what I’m having.

Protein and fat in the absence of carbs do still create a demand for insulin in my case. But the only way to find out to what extent is to keep testing.

As soon as I found I was no longer chasing excess carbs with insulin, and excess insulin with carbs, I discovered a much better relationship with food and I’m having far fewer hypos. And I’m very happy with my HbA1c of 37mmol/mol.

I found out about LCHF and subsequently this forum thanks to @MarkGossage when I was an active member of diabetes.co.uk/forum - take a look and see how other LCHF and keto T1s tackle it.

My diabetes specialist nurse knows that I avoid carbs, and she is very polite about it without going into it. The comment I tend to get is ‘we wouldn’t recommend it’.

But it’s my life, my health and my T1. And I’m absolutely thriving.

KetoSnaps · 2020-01-02 11:31:01 UTC

@Chris_Kornelsen in the case of treating hypos, treating the hypo is the priority, not the keto status. Yes, ketosis would be compromised (for the short term), but the hypo does need treating. My hypos are mild and in fact I very rarely need to take glucose if I’m hypo - I simply turn my pump down for a bit (that’s what I do - YMMV).

With less carbohydrate on a keto diet, and therefore less insulin, hypos would I hope become less frequent and less severe.

Ketosis and diabetic ketoacidosis are not the same, and in my opinion the former does not make the latter more likely. If your wife has persistent high blood glucose, keep testing both blood glucose and ketones, and if blood glucose AND ketones are excessively high at the same time, that is potentially a DKA scenario requiring urgent medical treatment.

The risk of DKA is because she’s T1 diabetic - simply, all of us T1s need to be vigilant of that - it’s nothing to do with being keto.