Prevention and early detection of vascular complications of diabetesBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38922.650521.80 (Published 31 August 2006) Cite this as: BMJ 2006;333:475
All rapid responses
People suffering from diabetes are commonly instructed to consume a
diet high in carbohydrates, particularly starches, and to reduce fat
All carbohydrates are converted to blood glucose although some at a
slower rate than others.
It follows that, for insulin users a high carbohydrate diet will
necessitate a higher insulin dose.
Absorption of subcutaneous insulin shows considerable intra -
Larger insulin doses may therefore result in more unstable control in
terms of hypo and hyperglycaemia.
Reducing dietary carbohydrate may therefore be a feasible means of
improving control without the disadvantage of more frequent or severe
hypoglycaemia. Blood glucose levels may become more predictable with less
Fears that lipid profile may deteriorate as additional fat is
substituted to maintain caloric intake, may be unfounded as the relatively
minor contribution of fats to blood lipids may be offset by the benefits
of improved glycaemic control on the lipid profile. If lipids are a
concern then the intake of saturated fat could be kept low and mono-
unsaturated fat consumed in its place.
A small study of a low carbohydrate diet( 70 to 90 g per day) in type
1 patients, demonstrated a reduction in HbA1c of 1.1 percent, reduction in
frequency of hypos, no increase in total cholesterol or deleterious effect
on HDLc, and a reduction in triglycerides.2
An American Physician with type 1 diabetes himself, of longstanding
duration, treats himself and his patients with a very low carbohydrate
diet, and attains normoglycaemia around the clock together with a healthy
lipid profile and absence of severe hypoglycaemia.3
His approach takes self denial to new extremes and flouts all the
conventional wisdom about diet, but it works for him and his patients.
A mor realistic approach for those who enjoy fruit and a few grains
would be perhaps to reduce carbs to around 30 to 40 percent of caloric
intake as opposed to 45 to 60 percent.
I have reduced my HbA1c from 7.6 percent to 6.5 percent by such an
approach.Total cholesterol has reduced from 4.1 to 3.6 mmol/L with a total
cholesterol: HDLc of 2.5 and triglycerides < 1mmol/L
When will we begin to tailor dietary advice to the individual in
order to truly optimize health rather than try to enforce a rather rigid
set of guidelines which in some cases may not benefit the patient and may
in fact worsen their health and quality of life. The reasons given for not
following a lower carbohydrate diet are usually side effects of poor
glycaemic control ( lack of energy, keto acidosis, kidney disease and poor
lipids) or high insulin doses ( severe hypoglycaemia) rather than results
of following such a diet.
1.Heineman.L. Diabetes Technol.Ther. 2002 4(5) 673-82
2. Nielssen JV. Jonsson E. Ivansson A. Low Carbohydrate Diet in Type
1 Diabetes. Clinical Experiment. A Brief Report. Ups.J.Med Sci. 2005 110
3.Richard K Bernstein, M.D. Dr Bernstein's Diabetes Solution. The
Complete Guide to Achieving Normal Blood Sugars. 2003
Person with type 1 diabetes
Competing interests: No competing interests