Check Your Blood Sugar And Ketone Levels
Check your blood sugar level if you have symptoms of DKA.
If your blood sugar level is 11mmol/L or above, and you have a blood or urine ketone testing kit, check your ketone level.
If you do a blood ketone test:
- lower than 0.6mmol/L is a normal reading
- 0.6 to 1.5mmol/L means you’re at a slightly increased risk of DKA and you should test again in 2 hours
- 1.6 to 2.9mmol/L means you’re at an increased risk of DKA and should contact your diabetes team or GP as soon as possible
- 3mmol/L or above means you have a very high risk of DKA and should get medical help immediately
If you do a urine ketone test, a result of more than 2+ means there’s a high chance you have DKA and you should get medical help immediately.
How Difficult Is A Keto Diet To Follow
This is the most important, but also most subjective, question about any diet. If you dont feel physically and mentally well on a diet, it wont lead to long-term results, because you wont adhere to it.
The keto diet is probably one of the post polarizing diets when it comes to peoples opinion on how easy it is to follow. Some people love it almost from day one while others experience major food cravings and even physical discomfort.
This is what my experience with a keto diet was like. Yours may be different:
How To Know If Your Treatment Plan Is Working
One way to see how well your plan is working is by tracking your A1C levels and aiming for specific blood sugar levels throughout the day.
Your target A1C goal may vary depending on your age and various other factors, but the American Diabetes Association generally recommends that A1C levels should be below 7 percent. A1C testing is one of the best indicators of how well your diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your insulin regimen, meal plan or both. This measurement should be taken at least every three months.
In addition to the A1C test, the doctor will also take blood and urine samples periodically to check your blood sugar levels, cholesterol levels, thyroid function, liver function and kidney function.
The goal is to keep your daytime blood sugar levels before meals between 80 and 130 mg/dL and your after-meal numbers no higher than 180 mg/dL two hours after eating.
As long as you are not plagued by unexpected stress, blood sugar and A1C levels will decline while you are on the ketogenic diet. However, even when both A1C and blood sugar levels are normal, it is still important to monitor blood sugar levels and administer the appropriate amount of insulin.
When insulin is not used in the proper amounts at the right times, an unhealthy amount of ketones can build up in the blood and cause diabetic ketoacidosis.
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Tip #3 Focus On Whole Foods And Avoid Processed Foods
When you think of a high-fat diet, the image of bacon, butter, and cheese drenched dishes may pop into your head. Although these are all keto-friendly foods, its important to also incorporate plant-based fats in your diet, in addition to a variety of low-carb, nutrient-rich foods. The healthiest keto diet for diabetics is built around whole, single-ingredient foods, including:
- Healthy proteins: wild-caught fish, grass-fed beef, poultry, eggs
- Nuts and seeds: almonds, pecans, walnuts, chia seeds, sunflower seeds
- Healthy oils: avocado, coconut, extra-virgin olive, flaxseed, walnut, sesame
- Minimally processed, high-fat dairy: whole-milk yogurt, cream, butter, ghee
- High-fat produce: avocados, coconut
- Non-starchy vegetables: green peppers, spinach, artichokes, broccoli, greens
- Low-carb fruits: berries, lemons, kiwis, plums
Having a variety of whole foods at your meals helps to provide your body with essential minerals, vitamins, fiber, antioxidants, and electrolytes needed to prevent nutrient deficiency and diet fatigue.
Whole foods can be defined as those that are as close to their natural form as possible. Although whole foods are preferred for a healthy diet, its important to note that not all processed foods are bad in fact, most food we get at the grocery store has been processed in some way through canning, cooking, freezing, dehydration, or milling.
The Theory Behind Using A Keto Diet For Weight Loss
Proponents of using a keto diet for weight loss argue that eating carbs drives up insulin production, which increases hunger and causes the body to hold on to fat and suppress calorie burn. When you replace carbs with fat, you decrease the need for insulin, subdue hunger, boost calorie burn, and melt away fat.
Many people also report fat as very satiating, making them full. The same goes for protein. When you feel full, you eat fewer calories and have fewer cravings. When you are at a healthy caloric deficit, you are primed to lose unwanted pounds.
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Dont Start Keto Unsupervised
If you have type 1 diabetes and are interested in the keto diet, its extremely important to start by seeking medical guidance from a registered dietitian and medical doctor .
An RD can assist you with the specific format and outline of the diet, whereas your doctor can help adjust your insulin regimen or oral medications accordingly.
Together, their supervision and guidance will greatly reduce your risk of serious complications and help you adhere to the diet safely and sustainably.
Risk Of Bias Assessments
Full assessments of the two RCTs reviewed with support for judgements are included in Tables. Risk of bias in one was rated low in four domains and unclear in four domains. The other controlled trial was rated low in seven domains and unclear in one domain. Of the pre-post intervention studies , two were rated as fair quality and two were rated as poor. The poor-quality studies did not attempt to control for the confounding influence of insulin therapy on HbA1c. One case-series had an overall risk of bias of high and the other case-series had a low risk of bias . Both reports had clear criteria for inclusion, valid methods for identification of type 1 diabetes, clear outcome results of cases and appropriate statistical analyses. The case-report had an overall appraisal of low risk of bias .
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The Takeaway What Is The Best Type 1 Diabetes Diet
If we put our findings we come up with a roadmap for an ideal type 1 diabetes diet that looks like this:
- Follow ketogenic diet
- Restrict the consumption of dairy and wheat products to see your insulin production improves
- Supplement with vitamin D3
Although these three dietary rules seem simple enough to follow, they will cause dramatic changes in your body. This is why it is important to work together with your doctor while you are on the ketogenic diet to see if it is effective for you.
The Evidence Points To The Ketogenic Diet For Type 1 Diabetes
The first line of evidence for an ideal type 1 diabetes diet is a pair of case studies: one with a young girl and another with an adolescent male.
The young girl in the first case study had epilepsy and type 1 diabetes, which is more prevalent in children with epilepsy. Researchers sought after an effective diet for this complicated case, so they put the girl on a classic ketogenic diet for 15 months.
The results were promising. Since the start of the ketogenic diet, no clinically overt seizures were reported. The girl was even being much more active and reaching significant developmental achievements that she wasnt reaching before the ketogenic diet.
The researchers also tracked the girls A1C levels and glycemic control, the two most important measures for type 1 diabetics. Both of them improved significantly without any adverse side effects. These results indicate that the ketogenic diet may help manage type 1 diabetes and epilepsy simultaneously.
The results of the other case study were even more incredible. In the study, a 19-year-old male with newly diagnosed type 1 diabetes was put on a special type of ketogenic diet for 6.5 months. During this period, he was able to discontinue insulin use and restore some of the insulin production in his pancreas.
The researchers went on to conclude that:
No, it was not a honeymoon period. But he decided to stop the diet and therefore had to go back to insulin. Another patient with a much longer follow-up: Case Study
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The Keto Diet And Type 2 Diabetes
As is the case for people with type 1 diabetes, the keto diet can encourage lowered blood sugar levels among people who have type 2 diabetes. This diets avoidance of carbohydrates may seem to make it a natural fit for people living with diabetes. However, you ought to be careful if you decide to follow the keto diet while living with type 2 diabetes.
For people with type 2 diabetes, the keto diet can cause dangerously low blood sugar levels. To avoid this, youll want to do blood sugar tests throughout the day and make adjustments in response to your results.
Diabetic ketoacidosis is relatively rare in people with type 2 diabetes, but high ketone levels are a risk factor. With that in mind, its important to know what to look out for if you are following a keto diet with type 2 diabetes. Specifically, if your blood sugar is above 240 mg/dL, you should use a urine strip to test for ketones.
Keto Diet Pills And Diabetes
Several supplements are available to people who are following the keto diet. Here are a few of these supplements and what you should know about each one:
- Ketone supplements/ketone esters work to boost the availability of energy to the body. These primarily consist of BHB salts, which combine the ketone body beta-hydroxybutyrate with sodium and potassium. These salts put ketones in the bloodstream, meaning the body doesnt need to burn body fat to access ketones. While valuable for athletes, these supplements are not ideal for people with diabetes interested in weight loss.
- Magnesium helps keep sodium and potassium levels in check, especially in the early days of a persons keto diet. Unless it impacts kidney function, excessive magnesium should not be a problem.
- MCTs, AKA medium chain triglycerides, are a dietary fat source touted by some researchers as being ideal for ketone development. This fat source can help people follow a keto diet while eating more carbs than they could otherwise. However, the jury is currently out on whether or not MCTs are better than other fats regarding weight loss.
- Cinnamon has been theorized to help boost insulin response and increase the speed of glucose metabolism. Because of this, some people on the keto diet have started eating cinnamon before meals. Still, we should note that research has not proven that cinnamon affects insulin sensitivity.
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Its Not Just About Weight Loss
I knew how to lose weight. But managing my blood sugars were another issue, says Lele. Even though I had lost weight, my blood sugars were very high. I was taking around 100 to 110 units of insulin every day to manage my type 2 diabetes.
Eventually, she came to realize that when it comes to diabetes management, how much you eat is important, but what youre eating is highly impactful as well.
Realizing that her eating plan and medication werent enough to get her health to where it needed to be, Lele turned to the internet. On a Reddit channel, she learned all about the potential benefits of transitioning to a keto diet.
Though hesitant, her doctors allowed her to try the keto diet out and Lele hasnt looked back since.
The keto diet is a low-carb, high-fat dietary regimen which has been linked to improvements in insulin sensitivity and higher rates of weight loss both positive factors in managing type 2 diabetes. Lowering carb intake induces a metabolic state known as ketosis, through which the body produces ketones which burn fat rather than carbohydrates for energy.
The transition to keto was difficult But I wanted to really give keto a shot, especially if it helped with my type 2, Lele recalls.
After a month or two, my blood sugars improved. I cut my units down to 75 and that was a big deal for me. After showing my results to my doctors, they agreed that I should stick with keto, she says.
Carb Counting Vs Low Carb For Type 1 Diabetes
Prior to the discovery of insulin in 1921, many doctors placed their patients with diabetes on very-low-carb diets because they recognized that carbs raise blood glucose much more than does protein or fat.11 While this wasnt sufficient to manage type 1 diabetes, it did help to prevent extreme carb-related spikes.
The advent of injectable insulin allowed those with type 1 diabetes to eat carbohydrate without dramatically raising their blood sugar. However, even with insulin, controlling blood glucose levels can be a major challenge for them.
Today, diabetes educators often tell people with type 1 diabetes that they simply need to take insulin to match the amount of carbs they eat at each meal. In fact, many people who use ICRs have repeatedly heard, You can eat whatever you like as long as you take the right dose of insulin.
However, there are several issues with this approach, including:
For many people with type 1 diabetes, eating high-carb foods and taking large doses of insulin can cause blood sugar levels to resemble a rollercoaster rather than remaining within a narrow range.
In his book, Dr. Bernsteins Diabetes Solution, Dr. Richard K. Bernstein explains that eating very small amounts of slowly-digested carbs and taking very small doses of insulin leads to more predictable results and essentially normal blood sugar levels. He calls this The Law of Small Numbers.
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Data Synthesis And Analysis
To summarise the effects of low-carbohydrate diets on type 1 diabetes outcomes in controlled trials, we extracted mean outcome values for the intervention and control groups at baseline and follow-up. For other studies with only an intervention group or for trials where only one participant group was relevant to our study, we extracted mean outcome values for the intervention or observed group at baseline and follow-up. Standard deviations and/or standard errors, sample sizes, follow-up time and published levels of significance were also taken. If no P-value was published and raw outcome data were available, the P-value was calculated using the R Statistical Language . Results were considered statistically significant if P < 0.05 and non-significant if P 0.05. Standard errors were converted to standard deviations by SD = SE x n.
Could Reducing Carbohydrate Intake Play A Role In The Pathogenesis Of Type 1 Diabetes
A normal gut homeostasis is the consequence of a fine-tuned balance between intestinal microbiota, gut permeability and mucosal immunity . In this complex interplay, the alteration of one or more of these factors may contribute to the development and progression of inflammation or autoimmunity, that may result in diseases such as T1D or multiple sclerosis . Gut microbiota plays a key role in gut homeostasis, and for this reason it is currently being so intensively investigated. Clostridia are mainly butyrate-producing and mucin-degrading bacteria, with immunomodulating properties, and are generally associated with a normal gut homeostasis . De Goffau et al. observed that -cell autoimmunity is associated with a reduction in lactate-producing and butyrate-producing species, with an increased abundance of the Bacteroides genus. This finding agrees with what reported by Endesfelder et al., who suggested a protective role of butyrate in the development of anti-islet autoimmunity and onset of T1D furthermore, a reduced number of Clostridia was also observed in long-standing T1D patients .
It is known that diet influences gut microbiome and that an acute change in diet alters microbial composition within just 24 h, with reversion to baseline within 48 h of diet discontinuation . So how could a reduction in dietary carbohydrates, with a relative increase in fat or protein intake, affect gut microbiota and type 1 diabetes risk?
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Data Sources And Searches
The following databases for health sciences were systematically searched from inception until 28 March 2017: MEDLINE CINAHL Cochrane Library and EMBASE. Our search terms combined the population with the intervention. The medical subject headings used were Diabetes Mellitus, Type 1, Insulin Dependent Diabetes Mellitus, Insulin Deficiency, Diet, Carbohydrate-Restricted, Ketogenic Diet, Low Carbohydrate Diet, Diet, Low Carbohydrate, and Diet, Ketogenic. The complete search strategy for Ovid MEDLINE is shown in . The search was restricted to human studies published in English. Citations and abstracts of all papers retrieved from these searches were downloaded into Endnote reference management software . Reference lists of included studies were also searched.
Is A Keto Diet Effective For Weight Loss
Given that the whole idea of the keto diet is to burn fat instead of carbs for energy, it seems logical that the keto diet should be effective for weight loss. While this is also often the case, its important to remember that the basic mantra of weight loss still applies:
Calories in < Calories out = weight loss.
If you eat more calories than you burn, you will gain weight no matter what type of diet you follow. To learn more about how many calories to eat, please see my post How to Lose Weight with Diabetes and follow the steps in the post How to Find Your Daily Calorie Need to calculate your optimal daily calorie intake.
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How To Keto Diet Meal Plan For Diabetics
The goal of the ketogenic diet is to put the body in a state of nutritional ketosis, which has been shown to be effective for weight loss and in managing type 2 diabetes in the short-term. The obvious concern that arises is the long-term sustainability of following a restrictive eating plan. Before diving into a keto diet, work with your healthcare practitioner to ensure its done safely and is the right approach for your health state.
Although carb-rich foods are excluded from the keto diet, its essential to incorporate plenty of healthy fats and nutrient-rich whole foods that contain antioxidants and fiber. With proper meal planning, youre more likely to include a variety of unprocessed, keto-friendly foods and stick to a keto lifestyle. To make it easier and less overwhelming, PlateJoy can help you create diabetic meal plans, including keto meals! Here are some tips to help you get started.