Type 1 diabetes ultimately leads to a complete loss of insulin production. Without treatment, blood glucose levels remain elevated, which over time may cause complications such as glaucoma and diabetic wounds. There is, therefore, a need to regulate glucose levels in type1 diabetics and control of glucose intake plats a major role in this process
The ketogenic diet is a low-carbohydrate diet in which only ~5% of your daily calories are gotten from carbohydrates. As a result of the restrictions on carbohydrate intake, the body is forced to get most of its energy from fats. By restricting your carbohydrate intake so severely, you force your body to get most of its energy from fat. Natural ketones are byproducts of fat burning, hence the name of the diet (Keto diet). Burning ketones supplies the body with an alternative form of energy rather than quickly accessible energy from carbohydrates (glucose). Hence, the effectiveness of ketogenic diets. Before the discovery of insulin therapy, most doctors placed their patients on low carbohydrate diets as a primary solution to the reduction of blood glucose. Though it was not sufficient in the management of type1 diabetes, it prevented glucose spikes. Keto diets are important to diabetes for two main reasons
- To reduce the need for insulin and avoid blood sugar fluctuations
- To help in weight loss
Recommended amounts of fat, proteins, and carbohydrates to eat on a keto diet
In a keto diet, the split in calorie intake should be as follows;
- 75-85% (167-182 grams) of fat
- 10-20% (50-100 grams) of protein
- 5% carbohydrate (less than 20-50g)
Endeavor not to overdo protein intake because, in the absence of carbs, proteins are converted to glucose by a process called gluconeogenesis. The presence of glucose will, therefore, kick you out of ketosis.
How a keto diet affects blood sugar.
Ketogenic diets contain relatively fewer carbohydrates hence it results in fewer blood sugar spikes. The patient will also require less insulin intake. Fewer blood sugar spikes should lead to better-glycated hemoglobin values.
If patients adhere to keto diets, it can be very effective in the management of blood sugar levels.
On the contrary, hypoglycemia can be a challenge if keto diets are treated aggressively. Thus ensure a balance between extremely low carbohydrate intake, and pushing the number of carbohydrates to exceed keto threshold.
Keto diets are the most popular low-carbohydrate diets for blood sugar management in diabetics.
However, not everyone reacts the same to keto diets. It may not be suitable for some people.
Is a keto diet effective for weight loss?
Keto diets are effective in weight loss because the body burns up fats instead of carbohydrates for energy. The basic strategy for weight loss still applies in this case;
Calories in (eating) < Calories out (burning) = weight loss.
Irrespective of the type of diet you take, if you consume more calories than you burn, you will still gain weight.
Eating carbohydrates stimulate insulin production, which increases hunger and causes the body to suppress fat calorie burn. When carbohydrates are replaced with fats in keto diets, there is a decrease in insulin secretion, hunger subdued and a boost in calorie burns, that melts fat away.
Many people also report fat as very satiating, making them full. Same as proteins. 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 weight.
Keto diets can be very effective for weight loss if it:
- Helps in the management of blood sugar better than other diets
- Is easier to follow than other diets
- Works for your general lifestyle
As with other diets, the main criteria for success is long term consistency
Keto diet and exercise.
A ketogenic diet can influence exercise performance both positively and negatively. During the first 1-2 weeks, there will most likely be a decrease in energy and performance in high energy tasks while the body adapts to a new diet. This should not be a cause for worry, because it is normal.
There is most likely a return to the previous level of difficulty in cardio when the body adapts to the ketogenic diet. When the body has adapted to the ketogenic diet, you will most likely experience that cardio returns to its previous level of difficulty.
Is keto diet safe for people with diabetes?
Keto diets are generally considered safe for most people with diabetes.
The main risks when following a keto diet are related to mental health. Restrictive diets(like most diets) can potentially lead to an unhealthy relationship with food, and, in some cases, eating disorders.
Keto diet and ketoacidosis
Diabetic ketoacidosis (DKA) occurs when blood sugar levels spike in blood glucose, leading to toxic glucose levels. The blood can become acidic, hence the name acidosis. Diabetic ketoacidosis is not associated with keto diets. Ketones derived from keto diets never reach toxic levels as long as insulin is rightly taken.
Ketone levels in the body can be measured with a urine test, using ketone test strips. The test can also be done with blood
Carbohydrate counting versus low carbohydrate diet for type 1 diabetes
Injectable insulin allows type 1 diabetes patients to eat carbohydrates without a drastic rise in their blood sugar. Irrespective of insulin use, controlling blood glucose levels remains a major challenge for them.
Most diabetes counsellors often tell their patients that they simply require insulin to match their carbohydrate intake at each meal.
However, this approach still has the following setbacks:
Mistakes with carb estimation: Doctors, parents, and dieticians can overestimate or underestimate the carbohydrate content of many foods. This risks too much or too little insulin being given.
No differentiation between types of carbohydrates. Slowly digested carbs (such as vegetables) can raise blood sugar less and more gradually than rapidly digested carbs (like white bread).
Does not take insulin absorption variability into account. Researchers have shown that the amount of insulin absorbed from an injection may vary by as much as 25% in the same person.
How people with type 1 diabetes can safely achieve great blood sugar control with low carbohydrate diets
Type 1 diabetes patients who want to start eating low carbohydrate diets should ideally work with a doctor, or dietitian who specializes in diabetes and understands carbohydrate restriction.
This is because, in addition to decreasing the amount of insulin you take to cover carbs, you may need to make other adjustments, such as reducing your basal insulin dosage. Everyone is unique, and the best and safest approach is one that includes frequent testing, keeping detailed records, and evaluating your results.
For this reason, regular monitoring of blood glucose levels is important.
Protein may also need to be accounted for when calculating insulin dosage at mealtimes. Carb-free meals that contain protein have been shown to raise blood glucose, although much more slowly than carb-containing meals do. Failing to account for protein may result in excellent blood glucose levels an hour or so after a meal but higher levels several hours later.
A keto diet can be very effective for people with diabetes. Some of the potential benefits include:
- Better blood sugar management
- Effective weight management
- A feeling of fullness (fewer cravings)
However, there are large personal differences in how people react to a keto diet, and some experience almost the opposite reaction.
Patients are recommended to work with a doctor or dietician when following a keto diet. They should follow the keto diet for a while and observe how it works before they pursue.
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