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Diabetes

Diabetic ketoacidosis

09/05/2008

Question:

I am a type 1 diabetic and would like to try a low carb diet.

How do the level of ketones typical for someone on a low carb diet compare to someone with diabetic ketoacidosis? At what level do ketones become dangerous for a type 1 diabetic?

What are the implications of a type 1 diabetic requiring little or no insulin?

Answer:

The comparisons I have read indicate that a variety of different diets work equally well depending on how effective they are in reducing calorie intake - that there is nothing "magic" about one type of diet, e.g. low carb, over another, except insofar as it helps to achieve the goal of reducing calorie intake.  The usual argument that is made about low carb diets in people without diabetes is that the reduction in carbohydrate intake reduces the demand for and secretion of insulin which in turn results in an increase in breakdown of body fat, manifested as a rise in urinary ketone production.  To extend the principle to someone with type 1 diabetes means a simultaneous and coordinated reduction in carbohydrate intake and reduction (NOT discontinuation, just a partial reduction) in insulin dose.  It is very tricky and potentially dangerous in a person with type 1 diabetes - it amounts to establishing a chronic state of increased ketone production and the challenge is to do that without going into ketoacidosis - that can be very dangerous and I really can't recommend that, at least not without the supervision of a doctor who is really experienced and comfortable carrying that out. 

In summary, it is potentially dangerous and I wouldn't undertake it without adequate understanding, precautions, and support.

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Response by:

Robert M Cohen, MD Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati