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Starting Low Carb or Keto with Diabetes Medications – Diet Doctor

Oct 30th, 2022

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For instance, we want you to know that its very important to adjust diabetes medications when starting a low-carb diet. In particular, insulin doses may need to be lowered to avoid low blood sugar, and SGLT-2 inhibitors may need to be discontinued (see below).

We want you to discuss any changes in medication and lifestyle with your doctor before making any such changes. Full disclaimer

So you have diabetes and want to try eating low carb or keto? Good for you! Making these dietary changes has the potential to reverse type 2 diabetes. Or, if you have type 1 diabetes, doing so could dramatically improve your blood sugar control.

However, you need to know what you are doing, and you need to communicate frequently with your healthcare team. Once you start eating low carb you will likely have to lower your insulin doses as well as the doses of other diabetes medications, frequently by quite a lot.

Avoiding the carbohydrates that raise your blood sugar decreases your need for medicationto lower it. Taking the same dose of insulin or insulin-stimulating oral medication as you did prior to adopting a low-carb diet might result in low blood sugar, something that can be dangerous.

You need to test your blood sugar frequently when starting this diet and adjust your medication accordingly. This should always be done with the assistance of a physician or other health professional with expertise in diabetes (find a low-carb doctor).

If you have diabetes and youre treated by diet alone, there is an extremely low risk of low blood sugar on low carb. You can get started right away.

As a general rule, you will need to lower your doses when starting a strict low-carb diet.

Work with your doctor to find the right initial reduction. Many find they need to reduce long acting insulin between 30 and 50%. If you take intermediate- or long-acting insulin once or twice daily, consider reducing both doses by the same proportion. If you are on a basal-bolus regimen (taking fast-acting insulin before meals, and long-acting insulin once or twice a day), you may want to reduce your mealtime doses more than your basal. This careful experimentation should be done in conjunction with your healthcare provider.

If you remain low carb, it is possible you will be able to stop mealtime insulin altogether. If your blood sugar levels continue to drop off the mealtime insulin, you can then begin to more aggressively reduce your long-acting insulin. As blood sugars stabilize in the normal range, you may be able to continue weaning the insulin, as long as glucose levels continue to be normal. Many people on a low carb diet are able to come off insulin completely.

Note that many physicians feel it is safer to decrease insulin doses by too much rather than not enough. This is because taking too much insulin can result in a low blood sugar level, which has the potential to be acutely dangerous. On the other hand, having slightly high blood sugars for short periods of time is usually not going to have major health consequences.

In addition, frequent low blood sugars lead to eating or drinking glucose or another form of rapid-acting carbohydrate in order to raise your glucose to a safe level. These extra calories may very well thwart your efforts at weight loss.

Much of the above advice about insulin also applies to people with type 1 diabetes, with the critical difference that people with type 1 will not be able to discontinue insulin entirely. Nonetheless, a low-carb, high-fat diet can be fantastic for empowering people with type 1 diabetes to smooth out their wide swings in blood sugar.

However, eating low carb with type 1 diabetes requires even greater attention to blood sugar levels and insulin adjustment, and an even closer working relationship with your healthcare team.

Many people with type 1 diabetes use an insulin to carbohydrate ratio (ICR) to calculate their mealtime insulin doses. If using an ICR while eating a low-carb diet, you may continue to give the same ratio of insulin to the carbohydrates you eat. But, as you eat fewer carbs, you will be injecting less insulin overall.

In some cases, the amount of insulin required for meals will not decrease as much as would be expected for the lower carb intake; this is presumably due to the potential of higher protein intakes to increase gluconeogenesis (the production of new sugar by the liver). In other cases, insulin doses will drop more than expected, as some people will lose weight on a low-carb diet, becoming more insulin sensitive in the process.

People who use relatively fixed mealtime doses of insulin, or those on premixed insulin twice daily, should use a similar approach to those with type 2 diabetes. Again, the critical difference is that people with type 1 diabetes will always need some insulin, even on a very low-carbohydrate diet.

It is important to be aware that a diet with less than 50 grams of carbs each day can lead to ketosis, a normal physiological state that results from the body burning fat for energy. This should not be confused with ketoacidosis, a dangerous complication of type 1 diabetes that can occur when there is insufficient insulin.

Because people with type 1 diabetes are at risk of progressing from physiologic ketosis to dangerous ketoacidosis, we recommend that they start with a more liberal low-carb diet, containing at least 50 grams of carbs per day. If you wish, you can eventually begin to reduce your carb intake to 30-40 grams of carbs per day, while working closely with your healthcare team and carefully monitoring your ketone levels.

We do not recommend starting a ketogenic low-carb diet (below 20 grams a day) unless youre certain of how to manage this risk and are working closely with a very experienced healthcare practitioner. You have to be able to test your ketones often, using extra care if you feel even slightly ill, practice intermittent fasting, or have been exercising.

Type 1 diabetes how to control your blood sugar with fewer carbs

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Starting Low Carb or Keto with Diabetes Medications - Diet Doctor

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