Individuals suffering from type 1 diabetes sometimes utilize a ketogenic diet as a secure way to ameliorate their daily lives. Regulating the amount of carbohydrates consumed may be a way of preventing marked rises and falls of blood sugar, as well as avoiding overly low blood sugar episodes that come from misjudging the quantity of insulin to take.
It appears that a ketogenic diet is beneficial in aiding the management of Type 1 diabetes, through the stabilization of the relationship between food and insulin. This highlights the diet’s importance in patient care and the improvement of quality of life when managing diabetes.
It is essential to talk to your doctor or health expert experienced in diabetes before you make any dietary changes, as you may need a change in your medicine.
Type 1 Diabetes
Type 1 diabetes is an autoimmune disease. The immune system serves as a protective barrier, defending the body against infectious agents such as viruses, bacteria, fungi, parasites, and poisons.
A mixture of genetic traits and an outer influence (possibly a viral infection, below the normal amount of vitamin D, cow’s milk or a need for more insulin) can cause the immune system to strike and ruin the beta cells of the pancreas which produce insulin.
Once these beta cells are damaged, the body cannot make insulin any longer.
Type 1 diabetes is caused by the pancreas not making enough insulin. In type 2 diabetes, although cells may not respond to the insulin being produced by the pancreas, the organ still manufactures it.
Who Gets Type 1 Diabetes
Type 1 diabetes can affect all age groups. Despite the formerly held belief that type 1 diabetes was primarily a disease that affects children, recent studies demonstrate that adults are not exempt, having just as much risk of developing this condition. It is even noted that of those diagnosed with type 1 diabetes, half are 30 years of age or older.
In the US, the amount of children experiencing Type 1 diabetes has risen substantially by 60% in the past eleven years, and around 1 out of every 300 youth will have the disorder when they reach 18. There are thousands of children who are affected globally.
Northern Europe has the most significant levels, and those of European ancestry have the highest numbers. Men are more commonly affected in early adult life. Analysis indicates that T1D is occurring more often, rising between 2 to 5 percent around the world.
What Happens When Your Body Does Not Make Enough Insulin
In type 1 diabetes, the body’s immune system is responsible for eradicating the beta cells found in the pancreas. As a consequence, hardly any of the insulin (a hormone secreted by the pancreas) is made.
Without insulin, cells are unable to absorb sugar from food. Rather than powering cells, the excessive sugar travels inside the blood which leads to high blood sugar readings (also known as hyperglycemia).
Without insulin to move the glucose found in the blood into the cells, too much of it builds up, a condition known as diabetic ketoacidosis (DKA). This is different from nutritional ketosis. In DKA, the presence of extremely elevated blood glucose levels causes the pH of the blood to drop from a neutral range of 7.3 – 7.45 to a more acidic level of less than 7.3.
Constant elevated levels of glucose in the bloodstream can increase the possibility of suffering from diabetes-related issues such as kidney, nerve and eye disorders, as well as heart disease and stroke. The objective is to keep blood sugar at a regular level to prevent any of these issues.
Type 1 Diabetes Symptoms
It is unlikely you will recognize the signs and symptoms of type 1 diabetes unless you have been diagnosed and are in a hospital bed.
It is particularly important for those who have a history of the disorder in their family to be aware of the warning signs. If you detect any of these indications, set up an appointment with your doctor right away.
- 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
Low Carb Approach for Type 1 Diabetes
Essentially, it is almost impossible to accurately target treatment due to the wide range of absorption both with food and insulin.
If you reduce the carbohydrates you take in, this will reduce the amount of insulin you need and thus increase the likelihood of you achieving the desired blood sugar level.
Ketogenic Diet Parameters
Ketogenic diets usually are composed of a high amount of fat (60%-85%), a moderate quantity of protein (15%-30%), and a small quantity of carbohydrates (5%-10%). This results in the body relying primarily on fat as an energy source.
Misconceptions about the ketogenic diet are that only limited vegetables are allowable and it requires the excessive eating of meat. A healthfully planned diet can include all sorts of sources of protein, such as fish, cheese and Greek yogurt.
One could potentially consume four or five servings of veggies every day as part of their diet, with roughly 20 to 30 grams of carbs in sum. This would mean that the limited amount of carbs permitted could all be sourced from the veggies.
Calories from fat sources can be present in the traditional Mediterranean diet, like olives, oil, nuts, seeds, avocados, tuna, and salmon.
Biochemistry of Ketosis
Typically, glucose is broken down in glycolysis, generating adenosine triphosphate (ATP) which serves as the body’s major energy source.
In instances of starvation or reduced-carbohydrate diets, the body uses glycogen (glucose held in reserve) stored in the liver to provide the body with glucose.
After not having carbohydrates for a period of 48 to 72 hours or more, the glycogen stored in the liver is gone.
The liver produces ketone bodies from triglycerides in the absence of glucose to supply ATP to target tissues like the brain and muscles. Eventually, those ketones provide ATP for the cells to use. Ketogenesis is directed by the amount of insulin in the body; when carbs are consumed insignificantly, insulin levels plunge, thus causing ketosis to develop.
People with Type 1 diabetes should be aware of their ketone levels in order to detect and stop diabetic ketoacidosis (DKA) from occurring.
There are three ketone bodies that are produced when the liver processes fatty acids, and they can be measured in varied manners. Each one has its own pros and cons; these are acetone, acetoacetic acid, and beta-hydroxybutyrate.
It is essential for patients with diabetes who are on a ketogenic diet to be careful and keep an eye on their blood glucose levels more often. Although DKA can happen even with euglycemic levels when following a ketogenic diet, the blood sugar condition can reach an amount higher than 250 mg/dL, which is a warning sign of possible DKA.
Checking sugar levels can aid in avoiding hypoglycemia, which is a potential result of eating less carbohydrates. Research has shown that keeping track of blood sugar with a continuous glucose monitor (CGM) can be beneficial in preventing low blood sugar episodes.
Adjusting Diabetes Therapies
In medical care, it is regular to raise basal insulin instead of increasing or supplementing bolus doses, so the extended insulin can take on some or all of the patient’s demand for insulin after eating.
In those circumstances, too much of a base can heighten the danger of low blood sugar if a person reduces the carbohydrate consumption of their meals when they are beginning a ketogenic diet.
What’s more, many individuals with Type 1 diabetes have an augmented Body Mass Index, and insulin resistance is likely to improve and insulin needs should decrease when weight is dropped while on a ketogenic diet.
How to Adjust Insulin
The amount of insulin a person gets per gram of carbohydrate usually needs to be decreased when beginning a ketogenic diet, specifically for those with Type 1 diabetes. The following strategy can be used:
- If a patient’s HbA1c is near target, the daily dosage of basal insulin may need to be decreased by 10% to 20%.
- If the HbA1c is elevated, no adjustments may be required.
- It is often safest to adjust insulin with the aim of reducing the risk of hypoglycemia; the patient can be instructed to take additional correction doses of short-acting insulin to address hyperglycemia.
- Insulin dosages often need to be adjusted weekly in the initial stages as weight loss and adherence to the ketogenic diet will impact the necessary insulin adjustments, and these factors are highly individual.
Other Diabetes Medications
Many people with Type 1 diabetes often take medications that are approved by the Food and Drug Administration to treat Type 2 diabetes in order to reduce weight. These drugs include metformin, SGLT-2 inhibitors and GLP-1 receptor agonists.
There is a greater likelihood of experiencing euglycemic DKA when taking SGLT-2 inhibitors, particularly among those with Type 1 diabetes.
The factor that may be contributory to this situation can be various, like reduction of the restraint of fat break down and ketone substances production by insulin, the shrinkage of body volume, stimulation of the emission of glucagon, and limiting the filtering of ketone bodies by the kidneys.
It is important to discontinue using SGLT-2 inhibitors prior to beginning a ketogenic diet since there is a potential danger of developing DKA, despite not necessarily resulting in hyperglycemia, making it noticeably challenging to identify.
Using GLP-1 receptor agonists to treat Type 1 diabetes may lead to an increased likelihood of developing hypoglycemia and diabetic ketoacidosis. It is possible to keep an eye on patients on a ketogenic diet with careful attention, although some health care specialists would rather end them.
Metformin is generally considered safe to continue.
Blood Glucose Control: A Balancing Act
Maintaining suitable glucose levels in people living with Type 1 diabetes can be very difficult, but it is critical to avoid serious, timely difficulties including ketoacidosis.
It is essential to maintain good glucose levels over a long period in order to decrease the danger of microvascular irregularities such as neuropathy, retinopathy and nephropathy, as well as reduce the probability of macrovascular issues like stroke, coronary artery illness and peripheral vascular illness.
Nonetheless, attempting to counteract high blood sugar levels carries the risk of recurrent or severe low blood sugar levels, which can reduce one’s quality of life, require hospital stays, cause fainting or, in rare cases, death.
Maintaining normal blood sugar levels in diabetes patients is hard because it is difficult to correctly match carbohydrate intake to insulin dosage. This is due to inaccuracies in assessing the carbohydrates in food, different absorption rates of insulin, when injections are taken and gastroparesis.
It appears conceivable that a diet low in carbohydrates and the smaller doses of insulin necessary for digestion could lead to a better management of blood sugar, fewer fluctuations in blood glucose levels, and an enhanced sense of well-being.
Efficacy and Safety
Prior to using insulin as the primary method of treating Type 1 diabetes, diet was among the few treatments that could be employed. During the start of the 1900s, a restricted calorie, carbohydrate-free dietary plan was applied experimentally as a means of treating it.
Few studies have been done on the ketogenic diet’s efficacy in managing Type 1 diabetes, and the results have been inconsistent. A considerable number of the writings are examples of medical cases, and the bulk is from children with an inability to be cured with regular medicines for seizure ailments.
There is only a small amount of research that has been done on this topic, and each study was observational and had a different balance of macronutrients, making it challenging to draw broad conclusions from the observations. Data on long-term cardiometabolic effects are also limited.
More exploration is essential to assess the strength and protection of the ketogenic diet in people with Type 1 diabetes. A comprehensive conversation between the patient and their medical team must occur in order to determine if this diet is the right option for the individual and the possible repercussions associated with it.
It is highly recommended that conversations about diabetes should include a certified nutritionist as well as experts in diabetes related care and education, endocrinology and pharmacy. Close observation of patients on this diet should be emphasized, and the best way to do this is through Continuous Glucose Monitoring (CGM).
Managing Type 1 Diabetes with the Ketogenic Diet
People with type 1 diabetes can lower their health hazards if their blood sugar levels stay within the normal range. The life span of people with diabetes can be comparable to those without diabetes.
A ketogenic diet can bolster the well-being of individuals dealing with type 1 diabetes.
Those who maintain a ketogenic diet find that managing their low blood sugar is simpler than if a high amount of insulin was in their system, as the symptoms may not be so intense and their mental awareness is likely not affected.
Agreement between those who follow the type 1 keto diet appears to be to manage a low sugar level in the blood with one sugar tab which gives 4-5 grams of carbohydrates (the amount will rely on the circumstance and how low the glucose count is) to create a consistent and dependable increase in the blood sugar.
Follow the Ketogenic Diet to Manage Type 1 Diabetes
A ketogenic diet for the treatment of type 1 diabetes isn’t a novel idea, but its utilization is gaining momentum.
It is essential to collaborate with a well-informed healthcare practitioner when making the transition from a high carbohydrate to a lower carbohydrate diet in order to pick the suitable foods and regulate insulin dosage.
Dr. Richard Bernstein implemented a diet of barely any carbohydrates, containing no more than 30g per day, to regulate his and his patients’ glucose levels.
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
Ketogenic Menu Samples 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