References

Gerstein HC, Miller ME, Byington RP Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008; 358:(24)2545-2559 https://doi.org/10.1056/NEJMoa0802743

American Diabetes Association. Types of carbohydrates. 2014. https://tinyurl.com/qbne7x5 (accessed 23 July 2019)

5. Lifestyle management: standards of medical care in diabetes-2019. Diabetes Care. 2019a; 42:S46-S60 https://doi.org/10.2337/dc19-S005

13. Children and adolescents: standards of medical care in diabetes—2019. Diabetes Care. 2019b; 42:S148-S164 https://doi.org/10.2337/dc19-S013

Beck RW, Bergenstal RM, Cheng P The relationships between time in range, hyperglycemia metrics, and HbA1c. J Diabetes Sci Technol. 2019; 13:(4)614-626 https://doi.org/10.1177/1932296818822496

Bell KJ, Barclay AW, Petocz P, Colagiuri S, Brand-Miller JC. Efficacy of carbohydrate counting in type 1 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2014; 2:(2)133-140 https://doi.org/10.1016/S2213-8587(13)70144-X

Cato A, Hershey T. Cognition and type 1 diabetes in children and adolescents. Diabetes Spectr. 2016; 29:(4)197-202 https://doi.org/10.2337/ds16-0036

Cho NH, Shaw JE, Karuranga S IDF diabetes atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018; 138:271-281 https://doi.org/10.1016/j.diabres.2018.02.023

Davies MJ, D'Alessio DA, Fradkin J Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2018; 41:(12)2669-2701 https://doi.org/10.2337/dci18-0033

Mortality in type 1 diabetes in the DCCT/EDIC versus the general population. Diabetes Care. 2016; 39:(8)1378-1383 https://doi.org/10.2337/dc15-2399

Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. BMJ. 2002; 325:(7367) https://doi.org/10.1136/bmj.325.7367.746

Engoren M, Habib RH, Zacharias A The prevalence of elevated hemoglobin A1c in patients undergoing coronary artery bypass surgery. J Cardiothorac Surg. 2008; 3 https://doi.org/10.1186/1749-8090-3-63

Feinman RD, Pogozelski WK, Astrup A Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition. 2015; 31:(1)1-13 https://doi.org/10.1016/j.nut.2014.06.011

Foster NC, Miller K, DiMeglio L Marked increases in CGM use has not prevented increases in HbA1c levels in participants in the T1D exchange (T1DX) clinic network. Diabetes. 2018; 67 https://doi.org/10.2337/db18-1689-P

Foster NC, Beck RW, Miller KM State of type 1 diabetes management and outcomes from the T1D Exchange in 2016-2018. Diabetes Technol Ther. 2019; 21:(2)66-72 https://doi.org/10.1089/dia.2018.0384

Hirsch IB, Brownlee M. Should minimal blood glucose variability become the gold standard of glycemic control?. J Diabetes Complicat. 2005; 19:(3)178-181 https://doi.org/10.1016/j.jdiacomp.2004.10.001

Ikeda F, Doi Y, Ninomiya T Haemoglobin A1c even within non-diabetic level is a predictor of cardiovascular disease in a general Japanese population: the Hisayama Study. Cardiovasc Diabetol. 2013; 12 https://doi.org/10.1186/1475-2840-12-164

Kawamura T, Takamura C, Hirose M The factors affecting on estimation of carbohydrate content of meals in carbohydrate counting. Clin Pediatr Endocrinol. 2015; 24:(4)153-165 https://doi.org/10.1297/cpe.24.153

Lennerz BS, Barton A, Bernstein RK Management of type 1 diabetes with a very low-carbohydrate diet. Pediatrics. 2018; 141:(6) https://doi.org/10.1542/peds.2017-3349

Leow ZZX, Guelfi KJ, Davis EA, Jones TW, Fournier PA. The glycaemic benefits of a very-low-carbohydrate ketogenic diet in adults with type 1 diabetes mellitus may be opposed by increased hypoglycaemia risk and dyslipidaemia. Diabet Med. 2018; 35:(9)1258-1263 https://doi.org/10.1111/dme.13663

Musa-Veloso K, Poon T, Harkness LS, O'Shea M, Chu Y. The effects of whole-grain compared with refined wheat, rice, and rye on the postprandial blood glucose response: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2018; 108:(4)759-774 https://doi.org/10.1093/ajcn/nqy112

National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes, heart disease, and stroke. 2019. https://tinyurl.com/ya7jy7ml (accessed 23 July 2019)

Tansey M, Beck R, Ruedy K Persistently high glucose levels in young children with type 1 diabetes. Pediatr Diabetes. 2016; 17:(2)93-100 https://doi.org/10.1111/pedi.12248

Thomas D, Elliott EJ. Low glycaemic index, or low glycaemic load, diets for diabetes mellitus. Cochrane Database Syst Rev. 2009; (1) https://doi.org/10.1002/14651858.CD006296.pub2

Tóth C, Clemens Z. Type 1 diabetes mellitus successfully managed with the paleolithic ketogenic diet. International Journal of Case Reports and Images. 2014; 5:(10)699-703

Tóth C, Clemens Z. A child with type 1 diabetes mellitus (T1DM) successfully treated with the paleolithic ketogenic diet: a 19-month insulin freedom. International Journal of Case Reports and Images. 2015; 6:(12)753-758

US Department of Health and Human Services, US Department of Agriculture. Dietary guidelines for Americans 2015-2020. 2015. https://tinyurl.com/gtr44nw (accessed 23 July 2019)

World Health Organization. Global report on diabetes. 2016. https://tinyurl.com/y4uq7dqf (accessed 23 July 2019)

Wolever TM, Bolognesi C. Source and amount of carbohydrate affect postprandial glucose and insulin in normal subjects. J Nutr. 1996; 126:(11)2798-2806 https://doi.org/10.1093/jn/126.11.2798

Yancy WS, Foy M, Chalecki AM, Vernon MC, Westman EC. A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab (Lond). 2005; 2 https://doi.org/10.1186/1743-7075-2-34

Introducing a very low carbohydrate diet for a child with type 1 diabetes

08 August 2019
Volume 28 · Issue 15

Abstract

Type 1 diabetes mellitus is a serious autoimmune disease for which no cure is available. The treatment includes insulin therapy, carbohydrate counting, eating healthy foods, exercising regularly, and maintaining a healthy weight. The goal is to keep blood glucose levels close to normal most of the time to delay or prevent complications. Despite the increase in the use of insulin pumps and continuous glucose monitors in recent years, the management of type 1 diabetes remains suboptimal in terms of glycaemic control and normal glycated haemoglobin (HbA1c) level. This article discusses the case of a child with type 1 diabetes who was successfully treated with a very low-carbohydrate diet, resulting in normal levels of HbA1c and normal blood glucose 95% of the time in a range of 70–180 mg/dL (4.0 mmol/L−10 mmol/L). Therefore, further studies are needed to verify how a very low carbohydrate diet impacts child development.

Diabetes is a dangerous condition that causes millions of deaths every year due to complications (Diabetes Control and Complications Trial (DCCT) and Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group, 2016). In 2017, there were 425 million adults aged 20 to 79 years with type 1 diabetes worldwide, while over 1 million children and adolescents had type 1 diabetes. The expectation is that the number of adults will increase to 629 million by 2045, according to the International Diabetes Federation (Cho et al, 2018).

The World Health Organization (WHO) (2016) has described diabetes as a serious chronic disease that occurs when the pancreas neither produces enough insulin nor uses it well. Without insulin, the body cannot store glucose as fat or convert it into energy. Hence, the glucose accumulates in the blood, causing hyperglycaemia. At high levels, blood glucose is toxic and damages cells and organs, causing serious short- and long-term health complications, including heart attack, stroke, hypertension, blindness and other eye problems, kidney disease, nervous system complications, foot problems sometimes leading to amputations, dental disease, pregnancy complications, mental health problems, such as depression and dementia, and skin issues.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content