September 9, 2025 • 19 mins
Before the discovery of insulin in 1921, strict carbohydrate restriction was the only way people with Type 1 diabetes could survive. A century later, some patients are revisiting ketogenic diets—not as replacements for insulin, but as experimental tools to improve blood sugar control.
In this episode of The Health Pulse, we explore the science, promise, and pitfalls of ketogenic diets in Type 1 diabetes. We unpack the crucial distinction between nutritional ketosis (a controlled, safe metabolic state with adequate insulin present) and diabetic ketoacidosis (DKA), a life-threatening emergency caused by insulin deficiency.
We highlight the potential benefits patients report: reduced blood sugar variability, lower HbA1c, decreased insulin requirements, and more time in optimal range. But we also confront the real risks, including increased vulnerability to DKA, hypoglycemia from insulin miscalculations, nutrient deficiencies, and unresolved questions about long-term safety.
The key takeaway? Ketogenic diets are not a cure for Type 1 diabetes, but they may hold promise as a highly personalized strategy—when paired with close medical supervision, continuous monitoring, and professional guidance.
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Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Nicolette (00:01):
Welcome to the Health Pulse, your go-to source for
quick, actionable insights onhealth, wellness and diagnostics
.
Whether you're looking tooptimize your well-being or stay
informed about the latest inmedical testing, we've got you
covered.
Join us as we break down keyhealth topics in just minutes.
Let's dive in.
Rachel (00:23):
Welcome to the Deep Dive where we cut through the noise
and deliver those essentialnuggets of knowledge.
Today we're diving into afascinating corner of modern
health, starting with a well, areally striking historical fact.
Before insulin was discovered,back in 1921, rigorous
carbohydrate restriction waspretty much the only way people
with type 1 diabetes could evensurvive.
Mark (00:45):
It's amazing, isn't it, how an old approach is sort of
circling back now, but withentirely new considerations.
Rachel (00:51):
Exactly that history really sets the stage for this
deep dive.
We're exploring a compellingand yeah, sometimes
controversial conversationhappening right now in diabetes
management.
Can the ketogenic diet actuallyplay a meaningful role for
people living with type 1diabetes?
Mark (01:06):
That's the core question.
Rachel (01:07):
Our mission today is to give you a shortcut to being
truly well-informed, unpackingthe nuances, the science and the
very real human experiencesbehind this complex topic.
Mark (01:17):
And we've gathered sources that really dig into what the
ketogenic diet is, what thepotential benefits might be for
T1D and, maybe most importantly,the significant risks, because
this isn't just about food, it'sa profound metabolic
conversation, especially wheninsulin is part of the equation.
Rachel (01:39):
Absolutely.
We'll look at what the researchtells us, what's still being
figured out and why.
This isn't just a simple yes orno.
So let's start with the basicsDefine our terms.
This isn't just a simple yes orno, so let's start with the
basics Define our terms.
Keto it's such a buzzword, butwhat exactly is the ketogenic
diet?
Let's get a clear definitionfor our deep dive, because it's
definitely more than justcutting out bread Right At its
core.
Mark (01:56):
The ketogenic diet is a nutritional strategy.
It involves dramaticallycutting down carbohydrate intake
.
We're typically talking lessthan 50 grams a day, sometimes
even lower.
Rachel (02:06):
Okay, less than 50 grams .
Mark (02:07):
Yeah, and this big shift forces the body's metabolism
away from using glucose sugar asits main fuel.
Instead, the liver startsbreaking down fat and producing
these molecules called ketones.
Rachel (02:19):
Ketones.
Mark (02:20):
And these ketones then become an alternative energy
source for the brain, muscles,other organs.
This metabolic state, when it'scontrolled, is what we call
nutritional ketosis.
Rachel (02:30):
Okay, nutritional ketosis, but here's where it
gets really interesting and,honestly, a bit tricky.
For someone with type 1diabetes, the idea of
deliberately producing ketonessounds complicated, because we
always hear about this dangerousthing called diabetic
ketoacidosis or DKA.
Mark (02:49):
Yes.
Rachel (02:49):
So what is the crucial difference here?
How does that delicate balancework or sometimes not work?
Mark (02:55):
This is maybe the most critical point to understand the
difference between nutritionalketosis and diabetic
ketoacidosis.
Dka isn't just semantics.
It is, like you said, thefundamental line between a
managed metabolic state and agenuine life-threatening crisis.
In nutritional ketosis from thediet, ketone levels rise
moderately, usually 0.5 to maybe3 millimole L and, crucially,
(03:16):
blood sugar stays under controlbecause there's enough insulin
around, either from the body orfrom injections, to manage it
Got it.
Rachel (03:21):
Insulin is present and working.
Mark (03:25):
Exactly, but diabetic ketoacidosis, dka, that's a
medical emergency.
That's where ketones skyrocket,often way above 10 millimole,
because there's a severe lack ofeffective insulin.
This usually happens alongsidevery high blood sugar,
dehydration, electrolyteimbalances.
The body basically becomesdangerously acidic.
Rachel (03:44):
So the key differentiator is having enough
insulin to keep everything incheck.
Mark (03:48):
Precisely Enough.
Insulin prevents thatuncontrolled danger spiral into
DKA.
Without it, nutritional ketosiscan potentially tip over.
Rachel (03:56):
Right, with that critical difference clear, let's
just quickly recap type 1diabetes itself.
Why is managing it such aconstant, day in, day out
challenge, and why might someoneeven consider a really strict
diet like keto?
Mark (04:09):
Well stepping back.
Type 1 diabetes.
It's an autoimmune condition.
The body's immune systemmistakenly attacks and destroys
the insulin-producing beta cellsin the pancreas.
It's not caused by lifestyle.
You don't grow out of it, andpeople with T1D need lifelong
insulin therapy just to stayalive.
Rachel (04:22):
It's non-negotiable.
Mark (04:23):
Absolutely.
And managing it means thisconstant, complex balancing act.
You're juggling insulin doseswhich you eat, especially carbs,
physical activity, stress,illness.
Even tiny miscalculations cansend blood sugar dangerously low
.
That's hypoglycemia or way toohigh of hyperglycemia.
It really is like walking atightrope every single day.
Rachel (04:45):
That sounds exhausting and our sources really highlight
some major hurdles that makelong-term management tough.
There's glycemic variability.
You mentioned the highs andlows, that metabolic
rollercoaster.
It's not just unpleasant, itdrives long-term complications
Definitely.
And then there's somethingparticularly scary hypoglycemia,
unawareness, losing the abilityto feel those warning signs of
(05:05):
a low.
That's like losing your safetynet.
Mark (05:07):
It's incredibly dangerous.
Rachel (05:13):
Plus just the basic difficulty of figuring out
insulin for meals heavy incarbohydrates.
Mark (05:15):
It adds another layer of complexity, exactly right.
And those challenges, thevariability, the fear of hypos,
the carb counting burden.
That's precisely why somepatients get interested in
low-carb or ketogenic diets.
Again, the goal isn't to ditchinsulin.
That's impossible for T1D.
Rachel (05:29):
Right, it's not a cure.
Mark (05:30):
No, but the hope is to potentially simplify blood sugar
management, maybe smooth outsome of those wild swings, sort
of creating a more stablebaseline, making that complex
insulin dosing puzzle maybe alittle less overwhelming.
Rachel (05:46):
OK, so despite the risk, we've touched on risks.
We'll get into more deeply.
Why are people exploring this?
What are the potential upsidesthat make keto seem compelling
for some with type 1?
Mark (05:56):
Well, it's important to state up front this isn't in the
standard medical guidelines yet, but the central idea is pretty
logical.
If carbs are the main thing,spiking blood sugar.
Rachel (06:05):
Then drastically reducing them should help.
Mark (06:08):
That's the hypothesis.
Reducing carbs could lead tomore stable glucose control and
our sources point to severalpotential benefits.
People report or that smallstudies suggest.
A big one is lower glycemicvariability, Fewer big swings
after eating.
That can make insulin dosingmore predictable, less reactive.
Rachel (06:24):
That alone sounds like a huge quality of life
improvement.
Mark (06:28):
It can be.
We also see reports and somedata suggesting reduced HbA1c
levels.
Hba1c that's the marker forlong-term blood sugar control
and complication risk.
Remember that 2018 survey inpediatrics, Participants on very
low-carb diets reported anaverage HbA1c of 5.67%.
Well, that's near non-diabeticlevels.
(06:49):
Then there's often decreasedinsulin requirements.
Less glucose coming in fromfood means many people find they
need smaller insulin doses,which can sometimes reduce the
risk of calculation errors orsevere lows.
Rachel (07:01):
Makes sense Less fuel and less need for the hormone
that processes it.
Mark (07:05):
Right and related to variability.
Continuous glucose monitoring,or CGM studies sometimes show
increased time and range TIR.
That means more hours per dayspent within the target blood
sugar zone, typically 70 to 180mGl.
Rachel (07:18):
Which is the goal, really staying in that safe zone
.
Mark (07:20):
Exactly and finally, maybe the most impactful for some,
are the patient-reportedimprovements in quality of life.
People talk about fewer hypos,more stable energy levels and
feeling less of that constantmental burden, that cognitive
load of managing diabetes minuteby minute.
Rachel (07:34):
So for some people it seems like it can genuinely
improve their day-to-day reality, their relationship with the
condition.
But and this is a big but wehave to keep stressing these are
potential benefits.
They vary hugely and they comewith significant trade-offs and
risks.
Mark (07:50):
Absolutely crucial caveat.
Rachel (07:51):
Okay, let's pivot now to that flick side, because this
is where the conversation getsreally serious.
What are the significantpotentially dangerous risks
associated with the ketogenicdiet, specifically for someone
with type 1 diabetes?
Mark (08:04):
The risks are very real and they absolutely must be
front and center in anydiscussion.
This isn't like type 2 diabetes, where keto might be generally
safer because there's oftenstill some internal insulin
production.
With type one, you're entirelydependent on external insulin.
Yeah, and that changes the game.
The biggest, most seriousconcern we already mentioned is
the risk of diabeticketoacidosis DKA ketoacidosis.
Rachel (08:27):
DKA Right, and just to connect the dots again.
That's because if somethinginterrupts insulin delivery,
like a pump malfunction, ormaybe you forget an injection or
even just get sick and yourinsulin needs to shoot up, those
moderate ketone levels producedby the diet don't have enough
insulin to keep them in checkand they can escalate
dangerously fast.
Mark (08:44):
That's exactly the mechanism.
The body needs sufficientinsulin to use ketones properly
for fuel and, crucially, to putthe brakes on uncontrolled
ketone production.
Without that brake, things canspiral out of control very
quickly.
But DKA isn't the only risk.
There's also hypoglycemia orlow blood sugar.
Rachel (09:04):
Oh right, because you're taking less carbs, so you need
less insulin.
But getting that adjustmentperfect is hard.
Mark (09:10):
Extremely hard.
If insulin doses aren'tmeticulously reduced and matched
to the lower carb intake,frequent and potentially severe
lows can happen, and severehypos are dangerous in their own
right.
Then you have potentialnutrient deficiencies.
These diets are restrictive bynature.
Rachel (09:26):
Yeah, you're cutting out entire food groups.
Mark (09:28):
Sometimes you are, and if it's not really carefully
planned you can miss out onimportant things like fiber,
certain B vitamins, magnesium,other micronutrients.
That needs careful management,maybe supplementation.
We also need to watch theimpact on lipid levels,
cholesterol.
Rachel (09:43):
Because it's a high-fat diet.
Mark (09:44):
Exactly.
While some people seeimprovements, others might
experience concerning rises inLDL cholesterol, the bad kind,
or another marker called ApoB,which is linked to
cardiovascular risk.
This is really individual andneeds monitoring.
Rachel (09:59):
And the big one underpinning all this.
Mark (10:01):
The big one is the limited long-term evidence.
This is key.
We have these case reports,patient surveys, small studies
they're suggestive, interestingeven but we just don't have
large scale long-term clinicaltrials that definitively prove
the safety and effectiveness ofketogenic diets for type 1
diabetes over years or decades.
Rachel (10:21):
And that lack of robust long-term data is why the major
medical organizations arehesitant.
Mark (10:26):
It's exactly why Organizations like the American
Diabetes Association, ADA,acknowledge the potential but
currently don't recommend ketoas a standard therapy for T1D,
because the evidence simplyisn't strong enough yet,
especially weighed against theknown risks.
Okay, so drilling down nowwhat's the absolute bottom line
(10:47):
here for you the listener?
Ifoglycemia, the unknowns.
Anyone with type 1 diabetesconsidering trying a ketogenic
diet should only ever do itunder very close medical
supervision.
We're talking working with anendocrinologist or a specialized
team, having regular access tolab testing, definitely using
continuous glucose monitoring.
It's still really in the realmof an experimental approach.
(11:08):
It demands serious caution andpartnership with your health
care providers.
Rachel (11:12):
That message of extreme caution and close supervision
seems paramount.
Ok, we've touched on theresearch landscape a bit, but
let's dive into that morespecifically.
What does the current body ofresearch and the guidelines from
major medical societiesactually say?
Where does the evidence standright now?
Mark (11:27):
Well, as I mentioned, the research is still somewhat
limited but it is growing.
It mainly falls into a fewcategories.
You've got case reports andpatient registries, like that
pediatric survey from 2018, wekeep mentioning.
It looked at a specific onlinecommunity following very
low-carb diets for T1D.
They self-reported good bloodsugar control, that low average
HbA1c and notably low rates ofsevere hypoglycemia average
HbA1c and notably low rates ofsevere hypoglycemia.
(11:50):
Individual case studies pop uptoo often, documenting
impressive drops in HbA1c andinsulin needs for specific
patients adults and kids.
Rachel (11:58):
So compelling anecdotes and self-reported data from
motivated groups.
Mark (12:07):
Exactly.
Then you have some smallclinical studies.
For example, a 2016 study indiabetes therapy looked at
adults with T1D on alow-carbohydrate diet maybe not
strictly keto but low-carb andfound improvements in glycemic
control and reduced insulinrequirements compared to a
control group.
Other small trials using CGMhave noted benefits like
increased time and range andreduced glycemic variability,
backing up some of the patientreports.
Rachel (12:27):
But these are still small studies, right?
Not the large randomizedcontrolled trials that really
form the bedrock of medicalguidelines.
Mark (12:34):
Correct.
They provide signals,hypotheses to test further, but
they aren't definitive proof ofwidespread long-term safety and
efficacy yet.
Rachel (12:44):
And that's reflected in the official stances from the
professional societies.
Mark (12:48):
It really is.
They look at the whole picture.
The American DiabetesAssociation, ADA, for instance,
acknowledges in their standardsof care that low-carbohydrate
eating patterns might help someindividuals, particularly with
glycemic variability.
But they immediately followthat by stressing the critical
need for more research onlong-term safety and the
potential risks, especially DKAand hypoglycemia in the T1D
(13:11):
population.
Rachel (13:11):
So acknowledging potential but emphasizing
caution.
Mark (13:15):
Precisely, and the Endocrine Society echoes that
they advise similar caution,really highlighting that without
extremely careful monitoringand patient education, the risks
of lows in DKA are significant.
Rachel (13:25):
Okay.
So putting it all together, theresearch offers some intriguing
hints of promise, some positivesignals from smaller studies
and patient groups, but thebroader medical community, the
guideline bodies, are stillsaying hold on.
We need more robust data beforewe can recommend this widely.
Proceed with extreme caution.
Mark (13:45):
That's a very fair summary of the current landscape.
It's definitely not a greenlight situation for routine
clinical practice.
Yet.
Rachel (13:52):
Given everything we've laid out the potential benefits,
the very serious risks, theexperimental nature it's crystal
clear that if someone doespursue this path with their
doctor, monitoring isn't justhelpful, it's absolutely
non-negotiable.
So what specific lab testsbecome that essential toolkit,
that metabolic GPS for someonewith T1D on keto?
Mark (14:12):
Yeah, if we connect this back to safety, robust
monitoring is the cornerstonebecause you're fundamentally
changing the body's fuel sourceand altering insulin needs so
drastically.
Tracking key biomarkers isnon-negotiable.
It helps both the patient andtheir medical team make informed
and critically safe adjustmentsalong the way.
Rachel (14:29):
Makes sense.
So what are the key tests?
Mark (14:31):
Okay, top of the list is probably HbA1c.
That gives you the big pictureview of average blood glucose
control over the past two, threemonths, a central baseline and
follow-up.
Then for the day-to-day fasting, glucose checks and ideally
continuous glucose monitoring,cgm are vital.
Cgm gives you that real-timedata on variability highs, lows
(14:53):
and, critically, time and range.
Rachel (14:55):
Seeing the patterns, not just snapshots.
Mark (14:57):
Exactly and absolutely crucial on keto with T1D is
ketone testing, specificallytesting for a ponhydroxybutyrate
, BHB, usually with a bloodketone meter.
This is how you differentiatesafe nutritional ketosis levels
from the dangerously high levelsseen in DKA.
Urine strips aren't reliableenough for this distinction.
Rachel (15:15):
Blood ketones, not urine .
Got it yes.
Mark (15:17):
Then because it's a high-fat diet.
A regular lipid panel isimportant, checking LDL, hdl,
triglycerides and, increasingly,apob to monitor cardiovascular
risk markers.
We also need to keep an eye onkidney function Tests like
creatinine, egfr and checkingfor protein in the urine, urine
albumin.
Both diabetes itself and majordietary shifts can impact the
kidneys.
Rachel (15:37):
Right Got to protect the kidneys.
Mark (15:38):
And finally, monitoring electrolytes like sodium,
potassium and liver enzymes isusually recommended just to
track overall metabolic balanceand ensure the liver is handling
the changes okay.
Rachel (15:48):
Wow, that's a comprehensive list.
So for you, the listener, thetakeaway is clear.
If you and your doctor decideto explore this, these tests
aren't optional extras.
They are your essential safetynet, the data you need to
navigate this complex metabolicterritory safely and effectively
.
They really empower thatcrucial partnership with your
doctor.
Mark (16:09):
Absolutely Informed decisions require good data.
Rachel (16:11):
Now, while the formal research continues, it's
impossible to ignore that realpeople are already living this,
navigating this path right now.
Our sources often highlightthese personal stories, these
real world perspectives.
Mark (16:23):
And these stories are so valuable, aren't they?
They provide this personaldimension that really
complements the clinical datadata.
They bring to life the daily,often relentless, challenges of
living with type 1 diabetes, theconstant vigilance, the carb
counting, the fear of hypos.
And they show how some patients, often working closely with
(16:48):
their doctors, are proactivelytaking control, experimenting
with nutrition to try andimprove their quality of life,
their sense of well-being.
Rachel (16:51):
Yeah, you hear things like someone mentioning finally
being able to sleep through thenight without that constant fear
of blood sugar crashing.
That's huge.
Mark (16:59):
It's profound, or someone feeling like they've regained
some predictability, somecontrol, freeing up immense
mental energy that waspreviously consumed by diabetes
management.
These personal accounts reallyunderscore that managing
diabetes isn't just abouthitting target numbers.
It's about living a fuller,less burdened life.
Rachel (17:17):
That tightrope walk analogy you used earlier really
resonates.
It makes you understand whypeople are willing to explore
demanding approaches like keto,even with the risks involved.
Mark (17:26):
It's a testament to the burden of the condition and the
desire for better solutions.
Rachel (17:30):
So let's try and bring this all together.
We've taken a really deep diveinto the ketogenic diet for type
1 diabetes.
We've seen its potential, thisintriguing possibility of
stabilizing blood sugar,reducing insulin needs.
But weighed against reallysignificant risks hypoglycemia,
nutrient issues and the mostcritical one, dka it's
definitely a complex picture.
Mark (17:52):
I think the ultimate takeaway here, the thing to
really hold on to, is this theketogenic diet is not a
replacement for insulin therapyin type 1 diabetes ever, nor is
it some magic bullet or aone-size-fits-all solution.
It's best understood, at leastcurrently, as an experimental
dietary approach, one thatabsolutely demands careful
ongoing medical supervision,highly individualized insulin
(18:14):
adjustments and thatcomprehensive lab monitoring we
discussed all to ensure safety.
It requires a very informedpatient and a very collaborative
relationship with theirhealthcare team.
Rachel (18:24):
So for you, the listener , whether you're simply curious
about the cutting edge ofdiabetes management, or perhaps
personally exploring advancedstrategies for type 1, the
consistent message from all oursources is crystal clear
Knowledge is power, but diligentmedical oversight is paramount.
Always, always, prioritizeprofessional medical guidance
and rigorous monitoring beforeconsidering or making such a
(18:46):
significant change to yourmanagement plan.
Mark (18:48):
Couldn't read more Safety first.
Rachel (18:50):
And that leaves us with the final thought to ponder.
As we watch patient-ledinnovation and scientific
research continue to push theboundaries in diabetes care,
what role do you think thesehighly personalized dietary
approaches, when supported bysophisticated monitoring
technology and close medicalpartnership, will ultimately
play in shaping the future ofhow we manage chronic conditions
like type 1 diabetes?
(19:10):
Something to think about.
Thanks for joining us on theDeep Dive like type 1 diabetes.
Something to think about.
Nicolette (19:14):
Thanks for joining us on the Deep Dive.
Thanks for tuning into theHealth Pulse.
If you found this episodehelpful, don't forget to
subscribe and share it withsomeone who might benefit.
For more health insights anddiagnostics, visit us online at
wwwquicklabmobilecom.
Stay informed, stay healthy andwe'll catch you in the next
(19:38):
episode.
Welcome to the Health Pulse, your go-to source for
quick, actionable insights onhealth, wellness and diagnostics
.
Whether you're looking tooptimize your well-being or stay
informed about the latest inmedical testing, we've got you
covered.
Join us as we break down keyhealth topics in just minutes.
Let's dive in.
Rachel (00:23):
Welcome to the Deep Dive where we cut through the noise
and deliver those essentialnuggets of knowledge.
Today we're diving into afascinating corner of modern
health, starting with a well, areally striking historical fact.
Before insulin was discovered,back in 1921, rigorous
carbohydrate restriction waspretty much the only way people
with type 1 diabetes could evensurvive.
Mark (00:45):
It's amazing, isn't it, how an old approach is sort of
circling back now, but withentirely new considerations.
Rachel (00:51):
Exactly that history really sets the stage for this
deep dive.
We're exploring a compellingand yeah, sometimes
controversial conversationhappening right now in diabetes
management.
Can the ketogenic diet actuallyplay a meaningful role for
people living with type 1diabetes?
Mark (01:06):
That's the core question.
Rachel (01:07):
Our mission today is to give you a shortcut to being
truly well-informed, unpackingthe nuances, the science and the
very real human experiencesbehind this complex topic.
Mark (01:17):
And we've gathered sources that really dig into what the
ketogenic diet is, what thepotential benefits might be for
T1D and, maybe most importantly,the significant risks, because
this isn't just about food, it'sa profound metabolic
conversation, especially wheninsulin is part of the equation.
Rachel (01:39):
Absolutely.
We'll look at what the researchtells us, what's still being
figured out and why.
This isn't just a simple yes orno.
So let's start with the basicsDefine our terms.
This isn't just a simple yes orno, so let's start with the
basics Define our terms.
Keto it's such a buzzword, butwhat exactly is the ketogenic
diet?
Let's get a clear definitionfor our deep dive, because it's
definitely more than justcutting out bread Right At its
core.
Mark (01:56):
The ketogenic diet is a nutritional strategy.
It involves dramaticallycutting down carbohydrate intake
.
We're typically talking lessthan 50 grams a day, sometimes
even lower.
Rachel (02:06):
Okay, less than 50 grams .
Mark (02:07):
Yeah, and this big shift forces the body's metabolism
away from using glucose sugar asits main fuel.
Instead, the liver startsbreaking down fat and producing
these molecules called ketones.
Rachel (02:19):
Ketones.
Mark (02:20):
And these ketones then become an alternative energy
source for the brain, muscles,other organs.
This metabolic state, when it'scontrolled, is what we call
nutritional ketosis.
Rachel (02:30):
Okay, nutritional ketosis, but here's where it
gets really interesting and,honestly, a bit tricky.
For someone with type 1diabetes, the idea of
deliberately producing ketonessounds complicated, because we
always hear about this dangerousthing called diabetic
ketoacidosis or DKA.
Mark (02:49):
Yes.
Rachel (02:49):
So what is the crucial difference here?
How does that delicate balancework or sometimes not work?
Mark (02:55):
This is maybe the most critical point to understand the
difference between nutritionalketosis and diabetic
ketoacidosis.
Dka isn't just semantics.
It is, like you said, thefundamental line between a
managed metabolic state and agenuine life-threatening crisis.
In nutritional ketosis from thediet, ketone levels rise
moderately, usually 0.5 to maybe3 millimole L and, crucially,
(03:16):
blood sugar stays under controlbecause there's enough insulin
around, either from the body orfrom injections, to manage it
Got it.
Rachel (03:21):
Insulin is present and working.
Mark (03:25):
Exactly, but diabetic ketoacidosis, dka, that's a
medical emergency.
That's where ketones skyrocket,often way above 10 millimole,
because there's a severe lack ofeffective insulin.
This usually happens alongsidevery high blood sugar,
dehydration, electrolyteimbalances.
The body basically becomesdangerously acidic.
Rachel (03:44):
So the key differentiator is having enough
insulin to keep everything incheck.
Mark (03:48):
Precisely Enough.
Insulin prevents thatuncontrolled danger spiral into
DKA.
Without it, nutritional ketosiscan potentially tip over.
Rachel (03:56):
Right, with that critical difference clear, let's
just quickly recap type 1diabetes itself.
Why is managing it such aconstant, day in, day out
challenge, and why might someoneeven consider a really strict
diet like keto?
Mark (04:09):
Well stepping back.
Type 1 diabetes.
It's an autoimmune condition.
The body's immune systemmistakenly attacks and destroys
the insulin-producing beta cellsin the pancreas.
It's not caused by lifestyle.
You don't grow out of it, andpeople with T1D need lifelong
insulin therapy just to stayalive.
Rachel (04:22):
It's non-negotiable.
Mark (04:23):
Absolutely.
And managing it means thisconstant, complex balancing act.
You're juggling insulin doseswhich you eat, especially carbs,
physical activity, stress,illness.
Even tiny miscalculations cansend blood sugar dangerously low
.
That's hypoglycemia or way toohigh of hyperglycemia.
It really is like walking atightrope every single day.
Rachel (04:45):
That sounds exhausting and our sources really highlight
some major hurdles that makelong-term management tough.
There's glycemic variability.
You mentioned the highs andlows, that metabolic
rollercoaster.
It's not just unpleasant, itdrives long-term complications
Definitely.
And then there's somethingparticularly scary hypoglycemia,
unawareness, losing the abilityto feel those warning signs of
(05:05):
a low.
That's like losing your safetynet.
Mark (05:07):
It's incredibly dangerous.
Rachel (05:13):
Plus just the basic difficulty of figuring out
insulin for meals heavy incarbohydrates.
Mark (05:15):
It adds another layer of complexity, exactly right.
And those challenges, thevariability, the fear of hypos,
the carb counting burden.
That's precisely why somepatients get interested in
low-carb or ketogenic diets.
Again, the goal isn't to ditchinsulin.
That's impossible for T1D.
Rachel (05:29):
Right, it's not a cure.
Mark (05:30):
No, but the hope is to potentially simplify blood sugar
management, maybe smooth outsome of those wild swings, sort
of creating a more stablebaseline, making that complex
insulin dosing puzzle maybe alittle less overwhelming.
Rachel (05:46):
OK, so despite the risk, we've touched on risks.
We'll get into more deeply.
Why are people exploring this?
What are the potential upsidesthat make keto seem compelling
for some with type 1?
Mark (05:56):
Well, it's important to state up front this isn't in the
standard medical guidelines yet, but the central idea is pretty
logical.
If carbs are the main thing,spiking blood sugar.
Rachel (06:05):
Then drastically reducing them should help.
Mark (06:08):
That's the hypothesis.
Reducing carbs could lead tomore stable glucose control and
our sources point to severalpotential benefits.
People report or that smallstudies suggest.
A big one is lower glycemicvariability, Fewer big swings
after eating.
That can make insulin dosingmore predictable, less reactive.
Rachel (06:24):
That alone sounds like a huge quality of life
improvement.
Mark (06:28):
It can be.
We also see reports and somedata suggesting reduced HbA1c
levels.
Hba1c that's the marker forlong-term blood sugar control
and complication risk.
Remember that 2018 survey inpediatrics, Participants on very
low-carb diets reported anaverage HbA1c of 5.67%.
Well, that's near non-diabeticlevels.
(06:49):
Then there's often decreasedinsulin requirements.
Less glucose coming in fromfood means many people find they
need smaller insulin doses,which can sometimes reduce the
risk of calculation errors orsevere lows.
Rachel (07:01):
Makes sense Less fuel and less need for the hormone
that processes it.
Mark (07:05):
Right and related to variability.
Continuous glucose monitoring,or CGM studies sometimes show
increased time and range TIR.
That means more hours per dayspent within the target blood
sugar zone, typically 70 to 180mGl.
Rachel (07:18):
Which is the goal, really staying in that safe zone
.
Mark (07:20):
Exactly and finally, maybe the most impactful for some,
are the patient-reportedimprovements in quality of life.
People talk about fewer hypos,more stable energy levels and
feeling less of that constantmental burden, that cognitive
load of managing diabetes minuteby minute.
Rachel (07:34):
So for some people it seems like it can genuinely
improve their day-to-day reality, their relationship with the
condition.
But and this is a big but wehave to keep stressing these are
potential benefits.
They vary hugely and they comewith significant trade-offs and
risks.
Mark (07:50):
Absolutely crucial caveat.
Rachel (07:51):
Okay, let's pivot now to that flick side, because this
is where the conversation getsreally serious.
What are the significantpotentially dangerous risks
associated with the ketogenicdiet, specifically for someone
with type 1 diabetes?
Mark (08:04):
The risks are very real and they absolutely must be
front and center in anydiscussion.
This isn't like type 2 diabetes, where keto might be generally
safer because there's oftenstill some internal insulin
production.
With type one, you're entirelydependent on external insulin.
Yeah, and that changes the game.
The biggest, most seriousconcern we already mentioned is
the risk of diabeticketoacidosis DKA ketoacidosis.
Rachel (08:27):
DKA Right, and just to connect the dots again.
That's because if somethinginterrupts insulin delivery,
like a pump malfunction, ormaybe you forget an injection or
even just get sick and yourinsulin needs to shoot up, those
moderate ketone levels producedby the diet don't have enough
insulin to keep them in checkand they can escalate
dangerously fast.
Mark (08:44):
That's exactly the mechanism.
The body needs sufficientinsulin to use ketones properly
for fuel and, crucially, to putthe brakes on uncontrolled
ketone production.
Without that brake, things canspiral out of control very
quickly.
But DKA isn't the only risk.
There's also hypoglycemia orlow blood sugar.
Rachel (09:04):
Oh right, because you're taking less carbs, so you need
less insulin.
But getting that adjustmentperfect is hard.
Mark (09:10):
Extremely hard.
If insulin doses aren'tmeticulously reduced and matched
to the lower carb intake,frequent and potentially severe
lows can happen, and severehypos are dangerous in their own
right.
Then you have potentialnutrient deficiencies.
These diets are restrictive bynature.
Rachel (09:26):
Yeah, you're cutting out entire food groups.
Mark (09:28):
Sometimes you are, and if it's not really carefully
planned you can miss out onimportant things like fiber,
certain B vitamins, magnesium,other micronutrients.
That needs careful management,maybe supplementation.
We also need to watch theimpact on lipid levels,
cholesterol.
Rachel (09:43):
Because it's a high-fat diet.
Mark (09:44):
Exactly.
While some people seeimprovements, others might
experience concerning rises inLDL cholesterol, the bad kind,
or another marker called ApoB,which is linked to
cardiovascular risk.
This is really individual andneeds monitoring.
Rachel (09:59):
And the big one underpinning all this.
Mark (10:01):
The big one is the limited long-term evidence.
This is key.
We have these case reports,patient surveys, small studies
they're suggestive, interestingeven but we just don't have
large scale long-term clinicaltrials that definitively prove
the safety and effectiveness ofketogenic diets for type 1
diabetes over years or decades.
Rachel (10:21):
And that lack of robust long-term data is why the major
medical organizations arehesitant.
Mark (10:26):
It's exactly why Organizations like the American
Diabetes Association, ADA,acknowledge the potential but
currently don't recommend ketoas a standard therapy for T1D,
because the evidence simplyisn't strong enough yet,
especially weighed against theknown risks.
Okay, so drilling down nowwhat's the absolute bottom line
(10:47):
here for you the listener?
Ifoglycemia, the unknowns.
Anyone with type 1 diabetesconsidering trying a ketogenic
diet should only ever do itunder very close medical
supervision.
We're talking working with anendocrinologist or a specialized
team, having regular access tolab testing, definitely using
continuous glucose monitoring.
It's still really in the realmof an experimental approach.
(11:08):
It demands serious caution andpartnership with your health
care providers.
Rachel (11:12):
That message of extreme caution and close supervision
seems paramount.
Ok, we've touched on theresearch landscape a bit, but
let's dive into that morespecifically.
What does the current body ofresearch and the guidelines from
major medical societiesactually say?
Where does the evidence standright now?
Mark (11:27):
Well, as I mentioned, the research is still somewhat
limited but it is growing.
It mainly falls into a fewcategories.
You've got case reports andpatient registries, like that
pediatric survey from 2018, wekeep mentioning.
It looked at a specific onlinecommunity following very
low-carb diets for T1D.
They self-reported good bloodsugar control, that low average
HbA1c and notably low rates ofsevere hypoglycemia average
HbA1c and notably low rates ofsevere hypoglycemia.
(11:50):
Individual case studies pop uptoo often, documenting
impressive drops in HbA1c andinsulin needs for specific
patients adults and kids.
Rachel (11:58):
So compelling anecdotes and self-reported data from
motivated groups.
Mark (12:07):
Exactly.
Then you have some smallclinical studies.
For example, a 2016 study indiabetes therapy looked at
adults with T1D on alow-carbohydrate diet maybe not
strictly keto but low-carb andfound improvements in glycemic
control and reduced insulinrequirements compared to a
control group.
Other small trials using CGMhave noted benefits like
increased time and range andreduced glycemic variability,
backing up some of the patientreports.
Rachel (12:27):
But these are still small studies, right?
Not the large randomizedcontrolled trials that really
form the bedrock of medicalguidelines.
Mark (12:34):
Correct.
They provide signals,hypotheses to test further, but
they aren't definitive proof ofwidespread long-term safety and
efficacy yet.
Rachel (12:44):
And that's reflected in the official stances from the
professional societies.
Mark (12:48):
It really is.
They look at the whole picture.
The American DiabetesAssociation, ADA, for instance,
acknowledges in their standardsof care that low-carbohydrate
eating patterns might help someindividuals, particularly with
glycemic variability.
But they immediately followthat by stressing the critical
need for more research onlong-term safety and the
potential risks, especially DKAand hypoglycemia in the T1D
(13:11):
population.
Rachel (13:11):
So acknowledging potential but emphasizing
caution.
Mark (13:15):
Precisely, and the Endocrine Society echoes that
they advise similar caution,really highlighting that without
extremely careful monitoringand patient education, the risks
of lows in DKA are significant.
Rachel (13:25):
Okay.
So putting it all together, theresearch offers some intriguing
hints of promise, some positivesignals from smaller studies
and patient groups, but thebroader medical community, the
guideline bodies, are stillsaying hold on.
We need more robust data beforewe can recommend this widely.
Proceed with extreme caution.
Mark (13:45):
That's a very fair summary of the current landscape.
It's definitely not a greenlight situation for routine
clinical practice.
Yet.
Rachel (13:52):
Given everything we've laid out the potential benefits,
the very serious risks, theexperimental nature it's crystal
clear that if someone doespursue this path with their
doctor, monitoring isn't justhelpful, it's absolutely
non-negotiable.
So what specific lab testsbecome that essential toolkit,
that metabolic GPS for someonewith T1D on keto?
Mark (14:12):
Yeah, if we connect this back to safety, robust
monitoring is the cornerstonebecause you're fundamentally
changing the body's fuel sourceand altering insulin needs so
drastically.
Tracking key biomarkers isnon-negotiable.
It helps both the patient andtheir medical team make informed
and critically safe adjustmentsalong the way.
Rachel (14:29):
Makes sense.
So what are the key tests?
Mark (14:31):
Okay, top of the list is probably HbA1c.
That gives you the big pictureview of average blood glucose
control over the past two, threemonths, a central baseline and
follow-up.
Then for the day-to-day fasting, glucose checks and ideally
continuous glucose monitoring,cgm are vital.
Cgm gives you that real-timedata on variability highs, lows
(14:53):
and, critically, time and range.
Rachel (14:55):
Seeing the patterns, not just snapshots.
Mark (14:57):
Exactly and absolutely crucial on keto with T1D is
ketone testing, specificallytesting for a ponhydroxybutyrate
, BHB, usually with a bloodketone meter.
This is how you differentiatesafe nutritional ketosis levels
from the dangerously high levelsseen in DKA.
Urine strips aren't reliableenough for this distinction.
Rachel (15:15):
Blood ketones, not urine .
Got it yes.
Mark (15:17):
Then because it's a high-fat diet.
A regular lipid panel isimportant, checking LDL, hdl,
triglycerides and, increasingly,apob to monitor cardiovascular
risk markers.
We also need to keep an eye onkidney function Tests like
creatinine, egfr and checkingfor protein in the urine, urine
albumin.
Both diabetes itself and majordietary shifts can impact the
kidneys.
Rachel (15:37):
Right Got to protect the kidneys.
Mark (15:38):
And finally, monitoring electrolytes like sodium,
potassium and liver enzymes isusually recommended just to
track overall metabolic balanceand ensure the liver is handling
the changes okay.
Rachel (15:48):
Wow, that's a comprehensive list.
So for you, the listener, thetakeaway is clear.
If you and your doctor decideto explore this, these tests
aren't optional extras.
They are your essential safetynet, the data you need to
navigate this complex metabolicterritory safely and effectively
.
They really empower thatcrucial partnership with your
doctor.
Mark (16:09):
Absolutely Informed decisions require good data.
Rachel (16:11):
Now, while the formal research continues, it's
impossible to ignore that realpeople are already living this,
navigating this path right now.
Our sources often highlightthese personal stories, these
real world perspectives.
Mark (16:23):
And these stories are so valuable, aren't they?
They provide this personaldimension that really
complements the clinical datadata.
They bring to life the daily,often relentless, challenges of
living with type 1 diabetes, theconstant vigilance, the carb
counting, the fear of hypos.
And they show how some patients, often working closely with
(16:48):
their doctors, are proactivelytaking control, experimenting
with nutrition to try andimprove their quality of life,
their sense of well-being.
Rachel (16:51):
Yeah, you hear things like someone mentioning finally
being able to sleep through thenight without that constant fear
of blood sugar crashing.
That's huge.
Mark (16:59):
It's profound, or someone feeling like they've regained
some predictability, somecontrol, freeing up immense
mental energy that waspreviously consumed by diabetes
management.
These personal accounts reallyunderscore that managing
diabetes isn't just abouthitting target numbers.
It's about living a fuller,less burdened life.
Rachel (17:17):
That tightrope walk analogy you used earlier really
resonates.
It makes you understand whypeople are willing to explore
demanding approaches like keto,even with the risks involved.
Mark (17:26):
It's a testament to the burden of the condition and the
desire for better solutions.
Rachel (17:30):
So let's try and bring this all together.
We've taken a really deep diveinto the ketogenic diet for type
1 diabetes.
We've seen its potential, thisintriguing possibility of
stabilizing blood sugar,reducing insulin needs.
But weighed against reallysignificant risks hypoglycemia,
nutrient issues and the mostcritical one, dka it's
definitely a complex picture.
Mark (17:52):
I think the ultimate takeaway here, the thing to
really hold on to, is this theketogenic diet is not a
replacement for insulin therapyin type 1 diabetes ever, nor is
it some magic bullet or aone-size-fits-all solution.
It's best understood, at leastcurrently, as an experimental
dietary approach, one thatabsolutely demands careful
ongoing medical supervision,highly individualized insulin
(18:14):
adjustments and thatcomprehensive lab monitoring we
discussed all to ensure safety.
It requires a very informedpatient and a very collaborative
relationship with theirhealthcare team.
Rachel (18:24):
So for you, the listener , whether you're simply curious
about the cutting edge ofdiabetes management, or perhaps
personally exploring advancedstrategies for type 1, the
consistent message from all oursources is crystal clear
Knowledge is power, but diligentmedical oversight is paramount.
Always, always, prioritizeprofessional medical guidance
and rigorous monitoring beforeconsidering or making such a
(18:46):
significant change to yourmanagement plan.
Mark (18:48):
Couldn't read more Safety first.
Rachel (18:50):
And that leaves us with the final thought to ponder.
As we watch patient-ledinnovation and scientific
research continue to push theboundaries in diabetes care,
what role do you think thesehighly personalized dietary
approaches, when supported bysophisticated monitoring
technology and close medicalpartnership, will ultimately
play in shaping the future ofhow we manage chronic conditions
like type 1 diabetes?
(19:10):
Something to think about.
Thanks for joining us on theDeep Dive like type 1 diabetes.
Something to think about.
Nicolette (19:14):
Thanks for joining us on the Deep Dive.
Thanks for tuning into theHealth Pulse.
If you found this episodehelpful, don't forget to
subscribe and share it withsomeone who might benefit.
For more health insights anddiagnostics, visit us online at
wwwquicklabmobilecom.
Stay informed, stay healthy andwe'll catch you in the next
(19:38):
episode.
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