Ketogenic Diet and Type 1 Diabetes

Ketogenic Diet and Type 1 Diabetes

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 affects all age groups. Although it usually appears during childhood or adolescence, it can develop in adults as well.

In the US, the rate of Type 1 diabetes in children has increased by almost 60% in 11 years (1) and approximately 1 in 300 children in the US will be affected by type 1 diabetes by 18 years of age (2). 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. (1) Data suggests the incidence of T1D has been increasing by 2–5% worldwide. (4)

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 (5).

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):

• Keto Mexican Kale Frittata
• Keto Mexican Breakfast Casserole
• Keto Chorizo Egg Muffins
• Easy Eggs with Kale and Sausage Crumb
• Keto Morning Hot Pockets
• Quick & Easy Keto Eggs Benedict
• Fat-Burning Vanilla Smoothie
• Keto Savory Zucchini Muffins
• Chocolate Keto Smoothie

Lunch & Dinner (12 grams of carbs each):

• Low-Carb Greek Chicken Bowls
• Low-Carb Vegetarian Mexican Cauli-Rice
• Beef, Spinach & Mozzarella One-Pot Bake
• Mediterranean Cauli-Rice with Fried Halloumi
• Keto Chicken Fajitas
• Low-Carb Chicken Fricassee
• Low-Carb Philly Cheese Steak Salad
• Easy Keto Thai Skillet Chicken
• Keto Bacon Cheeseburger Pizza

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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