Endocrine and metabolic consequences due to restrictive carbohydrate diets in children with type 1 diabetes: An illustrative case series

Abstract

Low carbohydrate diets for the management of type 1 diabetes have been popularised by social media. The promotion of a low carbohydrate diet in lay media is in contrast to published pediatric diabetes guidelines that endorse a balanced diet from a variety of foods for optimal growth and development in children with type 1 diabetes. This can be a source of conflict in clinical practice. We describe a series of 6 cases where adoption of a low carbohydrate diet in children impacted growth and cardiovascular risk factors with potential long-term sequelae.These cases support current clinical guidelines for children with diabetes that promote a diet where total energy intake is derived from balanced macronutrient sources.

ISPAD Clinical Practice Consensus Guidelines 2018: Nutritional management in children and adolescents with diabetes

“…Dietary patterns that restrict intake from one macronutrient may compromise growth and lead to nutritional deficiencies. 26 National guidelines for adults and children with diabetes in Australia and Canada recommend a carbohydrate intake of at least 45% energy. 2,6 Clinical consensus is that carbohydrate intakes in older, overweight or obese adolescents may be lower (40% energy) with higher protein intakes (25% energy).…”

“…There is international agreement that carbohydrate should not be excessively restricted in children and adolescents with type 1 diabetes as it may result in deleterious effects on growth, a higher cardiovascular risk metabolic profile and increase the risk of disordered eating behaviors. 26 There is evidence from ketogenic diets that low-carbohydrate diets can be nutritionally inadequate and result in growth failure. 32 Restricted carbohydrate diets may increase the risk of hypoglycemia or potentially impair the effect of glucagon in hypoglycemia treatment.…”

“…This may vary depending on meal patterns, cultural influences and metabolic priorities. Dietary patterns that restrict intake from one macronutrient may compromise growth and lead to nutritional deficiencies …”

“…The meaning of a low‐carbohydrate diet may differ between individuals and it is important to understand what it means to the individual family. If an individual child or family chooses to routinely consume a diet <40% energy from carbohydrate it is recommended that they discuss this with a dietitian to ensure the diet is nutritionally complete, particularly in regard to calcium, B vitamins, iron and fiber intakes . Dietary intake studies in children and adolescents using intensive insulin therapy have previously reported an association between lower total carbohydrate intakes and poorer glycemic outcomes, although more evidence is needed.…”

The ups and downs of low‐carbohydrate diets in the management of Type 1 diabetes: a review of clinical outcomes

“…People with Type 1 diabetes on low-carbohydrate diets have low total insulin requirements and unintentional caloric restriction may occur with the adoption of low-carbohydrate diets [24]. A case series described six children with Type 1 diabetes on restrictive carbohydrate diets where growth velocity was decreased [14]. In a recent study, change in height SDS on a low-carbohydrate diet was reported in a subset of 34 children for whom data were available [15].…”