Type 1 Diabetes and the Very-Low-Carbohydrate Diet (VLCD): What You Need to Know

Dietary recommendations for carbohydrate intake in Type 1 diabetes have varied over time. Recently, dietary patterns that lower carbohydrate recommendations have become increasingly popular within the diabetes community. Traditionally, a low-fat diet with at least 50 percent of calories from carbohydrate was widely accepted as the standard of care for individuals with Type 1 diabetes. Currently, the American Diabetes Association recommends a dietary pattern that is individualized based on a person’s diabetes health needs instead of a specific distribution of macronutrients.

The article “Management of Type 1 Diabetes with a Very Low-Carbohydrate Diet,” published this month in Pediatrics, suggests that a very low-carbohydrate diet (VLCD) may benefit glycemic control in children and adults with Type 1 diabetes. The study evaluated an online community of children and adults with Type 1 diabetes who followed a VLCD of no more than 30 grams of total carbohydrate daily. Participants had an average A1C of 5.67 percent compared to 7.15 percent when following a more traditional diabetes meal plan — without increasing the risk of severe adverse events, such as hypoglycemia and hyperglycemia.

According to first study author Belinda Lennerz, MD, PhD, of Boston Children’s Hospital, “This group of people with Type 1 diabetes achieved normal blood glucose levels with no apparent side effects by using a very-low-carbohydrate diet. This is unprecedented in diabetes care and traditionally not thought to be achievable. Our findings point toward the importance of more research into this approach, and should open the conversation on carbohydrate restriction for type one diabetes management.”

The bottom line, the VLCD:

• approach to diabetes management IS NOT considered a standard of care;

• is difficult to maintain and may not be realistic;

• requires more research BEFORE being considered a safe and effective approach

As dietary needs are individual, patients should consult closely with their health-care team before even considering a VLCD as part of their plan.

Access additional resources and practical information to enhance the care and treatment of your diabetes patients.

About our experts: Sheri Setser-Legg is a registered dietitian nutritionist and master licensed diabetes educator. She is a Diabetes Education Service Coordinator. Laura Hieronymus is a doctor of nursing practice and master licensed diabetes educator. She is the associate director of education and quality services. They are at the UK HealthCare Barnstable Brown Diabetes Center at University of Kentucky in Lexington, Kentucky.

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