The glycaemic benefits of a very‐low‐carbohydrate ketogenic diet in adults with Type 1 diabetes mellitus may be opposed by increased hypoglycaemia risk and dyslipidaemia

Leow, Zac; Guelfi, Kym J.; Davis, Elizabeth A.; Jones, Timothy W.; Fournier, Paul A.

doi:10.1111/dme.13663

Cited by 86 publications

(81 citation statements)

References 13 publications

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“…Two recent observational studies , however, reported hyperlipidaemia in the majority of participants. One study with 11 participants found total cholesterol and LDL cholesterol levels were above the recommended range in most of the cohort . The other study observed dyslipidaemia in the majority of respondents .…”

Section: Clinical Considerations Associated With Low‐carbohydrate Dietsmentioning

confidence: 92%

“…These include a reported lower percentage of time spent below 3.9 mmol/L on continuous glucose monitoring on a low‐carbohydrate diet compared with a high‐carbohydrate diet and a lower incidence of patient‐reported hypoglycaemia after changing from standard treatment to a low‐carbohydrate diet . Conversely, a median of 0.9 daily episodes of hypoglycaemia on continuous glucose monitoring in those following a low‐carbohydrate diet has been reported . Another study described participant‐reported hypoglycaemic events, with 38% reporting one to five hypoglycaemic events per month, but 8% reporting >21 events per month.…”

Section: Clinical Considerations Associated With Low‐carbohydrate Dietsmentioning

confidence: 99%

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

et al. 2018

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Dietary management has been a mainstay of care in Type 1 diabetes since before the discovery of insulin when severe carbohydrate restriction was advocated. The use of insulin facilitated re‐introduction of carbohydrate into the diet. Current management guidelines focus on a healthy and varied diet with consideration of glycaemic load, protein and fat. As a result of frustration with glycaemic outcomes, low‐carbohydrate diets have seen a resurgence in popularity. To date, low‐carbohydrate diets have not been well studied in the management of Type 1 diabetes. Studies looking at glycaemic outcomes from low‐carbohydrate diets have largely been cross‐sectional, without validated dietary data and with a lack of control groups. The participants have been highly motivated self‐selected individuals who follow intensive insulin management practices, including frequent blood glucose monitoring and additional insulin corrections with tight glycaemic targets. These confounders limit the ability to determine the extent of the impact of dietary carbohydrate restriction on glycaemic outcomes. Carbohydrate‐containing foods including grains, fruit and milk are important sources of nutrients. Hence, low‐carbohydrate diets require attention to vitamin and energy intake to avoid micronutrient deficiencies and growth issues. Adherence to restricted diets is challenging and can have an impact on social normalcy. In individuals with Type 1 diabetes, adverse health risks such as diabetic ketoacidosis, hypoglycaemia, dyslipidaemia and glycogen depletion remain clinical concerns. In the present paper, we review studies published to date and provide clinical recommendations for ongoing monitoring and support for individuals who choose to adopt a low‐carbohydrate diet. Strategies to optimize postprandial glycaemia without carbohydrate restriction are presented.

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Section: Clinical Considerations Associated With Low‐carbohydrate Dietsmentioning

confidence: 92%

Section: Clinical Considerations Associated With Low‐carbohydrate Dietsmentioning

confidence: 99%

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

et al. 2018

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“…The overall duration of hyperglycaemia (blood glucose >10 mmol/l) was comparable to that observed in 11 individuals consuming <50 g of carbohydrate per day studied by Leow et al . (4.9% vs 3±8%, respectively). Whilst there are only limited data concerning the glycaemic profiles of exercising athletes with Type 1 diabetes, in the literature that is available hyperglycaemia is commonplace because of a tendency to adjust carbohydrate and insulin amounts in an effort to avoid hypoglycaemia .…”

Section: Discussionmentioning

confidence: 89%

“…NM's CGM data showed moderate to severe hypoglycaemia (<3.0 mmol/l) for 2.1% of the 20‐day ride. For comparison, a study of 11 adults with Type 1 diabetes on a very‐low‐carbohydrate diet found that participants’ blood glucose levels were <3 mmol/l more often than observed in NM (2.1% vs 3.6% of the day) . CGM data also showed that NM maintained blood glucose levels that would be conventionally considered as within the mild to moderate hypoglycaemic range (3.1–3.8 mmol/l) for 12.7% of the 20‐day period, during which time he was asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

“…This is consistent the findings of Leow et al . , which suggest that very‐low‐carbohydrate diets may lower the threshold for symptomatic hypo‐ and hyperglycaemia. In the context of ketogenic diets, the increased availability and utilization of ketones by the brain may compensate for the reduced availability of glucose, thereby lowering the threshold for neuroglycopaenic symptoms, although there are only limited data supporting this hypothesis .…”

Section: Discussionmentioning

confidence: 99%

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Glycaemic stability of a cyclist with Type 1 diabetes: 4011 km in 20 days on a ketogenic diet

2019

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Background Maintaining glycaemic control during exercise presents a significant challenge for people living with Type 1 diabetes. Significant glycaemic variability has been observed in athletes with Type 1 diabetes in competitive contexts. While very‐low‐carbohydrate ketogenic diets have been shown to minimize glycaemic excursions, no published data have examined if this translates to exercise. Case report We report the case of a 37‐year‐old man with Type 1 diabetes who successfully undertook a 4011 km cycle across Australia over 20 consecutive days whilst consuming a very‐low‐carbohydrate ketogenic diet. Continuous glucose monitoring data capture was 98.4% for the ride duration and showed remarkable glycaemic stability, with a standard deviation of 2.1 mmol/l (average interstitial glucose 6.1 mmol/l) and 80.4% of time spent within a range of 3.9–10 mmol/l. Interstitial glucose was <3 mmol/l for 2.1% of this time, with only a single episode of symptomatic hypoglycaemia prompting brief interruption of exercise for carbohydrate administration. Conclusion This case demonstrates the viability of a very‐low‐carbohydrate ketogenic diet in an individual with Type 1 diabetes undertaking exercise. While the effect of a very‐low‐carbohydrate ketogenic diet is yet to be examined more broadly in athletes with Type 1 diabetes, the glycaemic stability observed suggests that fat adaptation may attenuate glycaemic swings and reduce reliance on carbohydrate consumption during exercise for maintaining euglycaemia.

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Very low carbohydrate ketogenic diets and diabetes

Dyson

2020

Practical Diabetes

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Very low carbohydrate ketogenic diets (VLCKD) have been widely promoted for the management of diabetes. There is confusion among people with diabetes and health professionals about the efficacy and safety of these diets and this review aimed to explore the role of VLCKD for people with diabetes.An electronic search of English language articles was performed using MEDLINE (1980 to January 2020), EMBASE (1980 to January 2020) and the Cochrane Central Register of Controlled Trials (1980 to January 2020). Randomised controlled trials (RCTs) >12 weeks duration comparing VLCKD, defined as <50g carbohydrate/day, with higher carbohydrate intakes in people at risk of or with diagnosed diabetes were included. Primary outcomes included HbA1c and weight and secondary outcomes were lipid concentrations.There were no RCTs examining the role of VLCKD for diabetes prevention. Two RCTs in diagnosed type 2 diabetes reported significant weight loss, but outcomes for glycaemic control and lipid concentrations were inconsistent. There were no RCTs in people with type 1 diabetes, although observational trials reported lower HbA1c, with a high prevalence of dyslipidaemia and hypoglycaemia.A lack of high‐quality evidence limits the use of VLCKD in people with diabetes. Copyright © 2020 John Wiley & Sons.

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The glycaemic benefits of a very‐low‐carbohydrate ketogenic diet in adults with Type 1 diabetes mellitus may be opposed by increased hypoglycaemia risk and dyslipidaemia

Abstract: This study provides the first evidence that, ketogenic diets in adults with Type 1 diabetes are associated with excellent HbA levels and little glycaemic variability, but may also be associated with dyslipidaemia and a high number of hypoglycaemic episodes.

Cited by 86 publications

References 13 publications

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

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

Glycaemic stability of a cyclist with Type 1 diabetes: 4011 km in 20 days on a ketogenic diet

Very low carbohydrate ketogenic diets and diabetes

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