FUDiabetes

New study on managing T1D in kids and adults with a very low-carb diet

I hope more research is done on this topic - including long-term outcomes (especially cardiovascular) of having mostly non-diabetic blood sugar levels throughout the day and the use of low insulin doses.

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Not that many of us needed more proof, but it is good to see them studying this. While we don’t ascribe to a diet that controls carbs quite this much, we can see the benefit of it nonetheless.

@Jen I think I posted a duplicate of your link… Wonder if we can merge? Or can I just delete my post.

I’m curious whether the risks that are least correlated with BGs will be improved with this diet. I guess we’ll have to wait 10-15 years (minimum) to see that effect of course.

This is a great idea for families with either 1 child, or who have lots of time to dedicate to making special meals for their diabetic children but the truth is, we just don’t have a) resources or b) the time to prepare special low-carb meals for Liam. I won’t worry about studies like this and; instead, focus on keeping a good A1C with a regular diet (under 7%) and let the cards fall where they may. I again think about all the old-timers who didn’t even know what their A1C was most of the time, who didn’t eat special foods and they’re OK today.

If it helps some families with T1 kids, great, though.

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Most of the families I see following a low-carb way of eating just do it for the whole family. No special meals or double food prep, everyone just eats the same way.

For me, I switched to a low-carb way of eating in part because I wanted to avoid complications. There are many old-timers on these sites with little to no complications, but like many aspects of these sites, I think they are the exception rather than the rule. In my 20s I got interested in reading autobiographies about people with diabetes and found that every single one of them was living with complications. I don’t know any T1D in person who’s past age 50 and hasn’t either passed away in their 50s or is living with severe diabetes complications. That really scared me as I lived with diabetes longer and is part of what pushed me to strive for the best control I could get.

But the main reason I eat this way is just because it makes the daily management of diabetes so much easier. I tried “sugar surfing” and eating a high carb diet, and I couldn’t do it because I felt like I would be in crisis if I didn’t attend to my diabetes every 15 minutes. With low-carb, I can often go hours without taking any diabetes action. I can sleep through mutliple nights in a row without highs or lows. If a high or low does happens, it’s a quick, one-time fix not a medical emergency. Overall, it’s nigh and day. And of course low-carb isn’t perfect, and I do still have some rollercoaster days or weeks, but often when that happens it also means I’m eating something I shouldn’t. :wink:

Diet is a very personal choice. Ten years ago I never thought I would be eating a low-carb diet. Now I think I’ll never not be eating this way. My way of thinking is that low-carb eating should be a legitimate option available to everyone, not criticized as “extreme” or frowned upon by medical professionals. Research like this helps position it as a legitimate optoin. If it’s an option available to everyone, then like pumps and CGMs and different types of insulins, maybe everyone should try it for a month or so to see how it works. Even if it’s not something one is willing to adopt full-time or long-term, it’s a useful strategy to have in our kit of diabetes strategies.

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Except for the quite a few on FUD? That seems strange to me that that would be the case.

I just know it wouldn’t ever work in my family so as my own personal preference, we won’t be doing this. We just don’t have the time that it takes to prepare the many “special meals” that low-carb buy-in requires…and doing this for 8 people would be super expensive. Any “special ingredient” is always more expensive. Also, I feel, personally, that doing this isn’t really being unlimited…I don’t want Liam to have any barriers. Instead of going low-carb, our goal is to FIGURE OUT how to properly dose for regular meals so that he can still have a reasonable A1C (aka - long term health).

Once you figure out things (with or without low-carb), the management is really quite easy. it’s just the figuring out part that’s the challenge, and one that we’ve taken upon ourselves to figure out for Liam’s sake.

Having said that, I don’t begrudge anyone that decides to do low-carb! As I’ve always said…Diabetes is very much a no 1 solution works for everyone…so whatever parents and those who live with diabetes decide is best for them, I’m all for it! Whatever works!

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There are advantages for some people. BG management can be easier, and it can help with weight loss.

But for kids, restricting carb levels to less than 50 grams per day - which was quoted in the study - does not sound healthy.

Additionally, look at what happens when you replace carbs with more fat and protein:

From the article:
Those following the diet had increased LDL cholesterol, likely from consuming more saturated fat, which some experts said was potentially concerning and deserved further study.

From the study:
pediatrics.aappublications.org/content/early/2018/05/03/peds.2017-3349
Conventional chronic disease risk factors revealed a mixed profile, with low triglycerides (TG) and elevated high-density lipoprotein cholesterol (HDLc) but high total and low-density lipoprotein cholesterol (LDLc).

Look at those LDL and total cholesterol numbers. Not something to shoot for.

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Nice to meet you Jen. My name is Eric.

Please allow me to introduce myself
I’m a man of wealth and taste
I’ve been around for a long, long year
And I’ve put this disease to waste

It was 'round when I was 5
Had my moments of doubt and pain
I made damn sure that I would
Break free from the T1 chain

Pleased to meet you
Hope you guess my name
But what’s puzzling you
Is the nature of my game

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And I’m curious why, how, or what makes those in FUD who have managed all these years without severe complications, any different from those who aren’t on FUD? Maybe they just care more about their health which is what brings them to Forums in the first place?

@Jen — if the diet in 10 to 20 years shows dramatically lower levels of complications and lower overall mortality, etc. – then I don’t think it should be positioned as an “option” – it should be encouraged as the standard-of-care/first-line option.
Personally I think the results won’t be all that stark – the people in the study are essentially self-selecting for a very non-normative diet, which typically takes a lot of legwork – and they probably wouldn’t stick with it if they weren’t getting the results they wanted. (Which is why I feel comfortable with my carbaholic-child continuing to eat according to his preferences), I suspect if you then extended these results to a general population, some people won’t do well with low carb. But I do think it’s important to actually follow this cohort of folks out for a long time. I feel like it could also really shed light on some longstanding debates in diabetes care – what’s to blame for complications? Blood sugar rates? Insulin? Other factors? Some mixture?

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LOL. Notice I specified “in person.” To my knowledge, I haven’t met anyone on this site in person yet. :slight_smile:

I agree, but that’s in 10-20 years. I was talking about today.

Most of the families I see following a low-carb way of eating just do it for the whole family. No special meals or double food prep, everyone just eats the same way.

Oh man these families must have much less picky kids (and adults) than me. I think if our older kid had T1D we could easily do low carb – yesterday he chose for lunch a piece of sashimi, fried eggs for breakfast and at his birthday party he didn’t eat either the pizza or the cake. Meanwhile Samson said yesterday “the only foods I like are pizza and pasta.”

I try to prepare just one meal but what basically happens is that one kid picks out all of one item, the other kid picks out the totally opposite item, and they are essentially eating completely different meals. The Venn diagram of what they both like consists of maybe roasted cauliflower and mochi ice cream.

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Sounds like our T1 sons are exactly alike. lol. Pizza, Pasta and any dessert.

That said, if on a low carb diet Samson was never, ever low, I think we could gradually wean him of his pickiness. Part of the problem with his pickiness is that our usual strategy (if he’s hungry enough, he’ll eat) just doesn’t work because if he doesn’t eat anything he’ll eventually have a low, which needs to be treated with sugar.
So he never really gets hungry enough that he’s willing to eat foods that aren’t to his liking.

@TiaG, has your son figured out yet that he can game the system? By that I mean he knows that if he goes low he’s going to get candy? OR, if he doesn’t eat the food you’ve bolused him for, you’ll eventually end up giving him something he actually wants (the not-so-healthy option?)

Liam is at that stage now…he talks about being SOOOO hungry…then when we fix him X and bolus him for it, he eats only 25% and says, I’m full…so we end up giving him whatever he’ll eat we must to fill the void. To prevent this, we’ve tried not bolusing until he actually eats, but this inevitably causes severe spikes for us so we would prefer to give him something else and bolus him correctly, than to bolus him incorrectly and see the massive (HIGH ^^) spike.

He’s tried that a few times but we’ll say that if he’s low because he doesn’t eat what he specifically requested, we’ll just treat him with glucose tabs. He doesn’t hate those but neither does he love them, so he’s not super motivated to get them.
I mean our usual policy if he doesn’t eat his dinner we say he can have a glass of milk or a slice of toast and a cheese stick. And if he doesn’t eat that and we bolused for part of his dinner he will go low, but not usually before he goes to sleep, so we just treat him at night with a syringe full of honey.
We don’t bolus upfront for most dinners – we will usually bolus for half or a third of the carbs, then follow up with the remainder of the bolus based on what he eats.

We don’t see huge spikes that way but we do still get at least a few daily lows/averted lows.
The thing is, even if we don’t bolus him he will eventually go low if he skips a meal. I think it may be that our food boluses are too strong upfront, but if he eats all his meals that doesn’t show up because he’s eating every 3 hours or so. At least some of our settings aren’t quite right but we just haven’t had the bandwidth to fix them. We’re also using openAPS again at nights, but not during the day… so there’s just this extra wrinkle of complexity to decode when tweaking his settings.

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Of course everyone has their own view of unlimited, but if food was included in what makes one unlimited or not, it would eliminate quite a number of people on this site… So I don’t include it in my view, personally.

This is one reason more research is needed. But it baffles me sometimes why eating low-carb attracts these types of comments. There has been no research done to show what type of diet is best, including a high-carb diet. So I don’t understand why low-carb gets so many people going “It doesn’t sound healthy…” despite the fact that there is no evidence that high-carb is healthy, either. In fact, any diet can probably be either healthy or unhealthy depending on the foods it’s composed of…

One thing i wonder about is what is the mean cholesterol level for people with diabetes on a high-carb diet. I’m wondering if these levels reported are all that much worse and “caused” by a low-carb diet, or whether they were poor to begin with and just not something that the diet improved. I know for me, eating low-carb (but not massive amounts of fat like some in the low-carb community do) has given me the best cholesterol profile I’ve had in 10 years.

The authors also note this in the discussion section:

However, total LDLc elevation on a VLCD (associated with low TG) may reflect large, buoyant lipoprotein particles, which is a relatively low-risk subtype.36 Furthermore, in the Diabetes Control and Complications Trial cohort of 1441 adolescents and young adults, HbA1c had the largest effects on cardiovascular risk, followed by TG and LDLc.37 Postprandial hyperglycemia has been proposed as an independent cardiovascular disease risk factor38 for which a VLCD would plausibly provide benefit. Another major cardiovascular risk factor, BMI, was significantly below population averages for study participants, possibly reflecting another benefit of a VLCD.39

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I was never an adventurous eater. I didn’t like veggies growing up and had food allergies so didn’t like trying new foods. Even as an adult, I’d grimace and force veggies down my throat just because I knew they were healthy, but I never enjoyed them. I’ve found eating low-carb has actually changed my tastes. When I was eating high-carb, most veggies tasted bitter and nasty to me. For the first time in my life (in my 30s), eating low-carb has me actually looking forward to eating Brussels sprouts or riced cauliflower for dinner. It’s honestly part of what motivates me to stick with it. I don’t want to go back to the days when veggies tasted disgusting, and I really think eating carbs would change my tastebuds back to their former selves.

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Eating high carb does not equate to high LDL. Eating a high carb and high fat diet would equate to a high LDL. Just because someone eats high carb does not mean they are eating high fat, so unless the people in the study were eating very unhealthy before beginning the study, there should be no reason their LDL would have been impacted during the study

My defenition of unlimited is being able to do anything that a non-diabetic would be able to do… Which includes eating whatever he/she wants to eat.

And I hope my comments did not come off as offensive because as I said, to each his or her own. If you choose low carb, then that is a perfect choice for you, and there is nothing wrong with that. But there is also nothing wrong with high carb, if you can learn to manage it