A patient request for some “deprescribing”

I am an elite outrigger canoe paddler and Type 1 of 19 years. I have been quite successful over the years with multiple World Titles and WR's. During my years training and racing there was always the worry of hypos and not only effecting performance but also endangering life. I had tiredness and hunger constantly.

I then met RD Dikeman one day in the gym in Hawaii, both doing our own spin workouts. Discussions of T1 and low carb eating followed with me taking some months to get my head around it and how it could work with my very active life.

Starting in October 2014 in between major comps I started my LCHF lifestyle and have had the best months of my diabetic life. No hunger, great energy, good recovery, level BGL, and performance is fantastic.
I just wonder what i could have achieved if I had this WOE in the early diabetic days.

I get sad and frustrated to still see high carb diets being recommended to diabetics, my treating team are using me as a learning tool for them to help others gain better control of their condition and I hope that my example filters out to more T1s and even T2s to help improve their quality of life and decrease complications and the stress on the health system.

I'm a 49 year old type 1...I cannot understand the current recommendations in my country by the ADA on giving 30-60 carbs per meal. It's a proven, scientific fact that carbs raise glucose....and high glucose causes an entire slew of complications such as blindness, loss of limbs to neuropathy and kidney failure...so why recommend eating so many carbs?? I eat 30 grams or less of carbohydrate per day and all those are from non starchy veggies. I am well nourished, never hungry and my last 5 A1C's have been in the 4's. ..with the last one 4.8..why is this way not prescribed to patients? I eat delicious foods made with almond flour instead of wheat flour...with no sugars and no unhealthy ingredients...they are easy to make, recipes are readily available online and in cookbooks.....so why the high carb recommendations? It's akin to telling a child with a peanut allergy to continue to eat peanuts and just keep the epi pen handy. with the high carb recommenations of the ADA, people have to inject massive amounts of insulin and still have no control over roller coaster blood sugars...is that healthy? I think not. Please...someone...review these current guidelines that are slowly killing people and start saving lives!!

I am 42 years old, wife and mother of two children, aged 13 and 10 years. We live in Scotland. I have been Type 1 diabetic (insulin dependent) for 25 years, with a history of diabetes running through my father’s side of the family. In my early years of diagnosis, I was determined the condition was not going to stop me doing the things my friends were doing and as a result I possibly didn’t test my blood glucose often enough and ran with very high blood glucose levels, which for years averaged 9.5. I was never discouraged from consuming foods that were high in sugar but was educated on how to cover them with insulin and was frequently reliant on them to correct a low blood glucose reading (hypoglycaemic), which usually came on the back of an over correction from a high blood glucose (hyperglycaemic). While running with this high level of HBA1c I had a couple of operations stemming from infections caused by high blood glucose levels. I was also aware of losing some of the feeling in my toes and feet and was constantly bother with restless legs.

Hypos were a daily issue, with friends and family at least weekly having to intervene, sometimes catching the symptoms early enough and just suggesting “you need to do a blood sugar test” which I would correct but at least monthly I’d have hypos where I was unable to test therefore relying on friends or family to test me and force me to have something sugary.

After meeting my husband and deciding to have children, our social life calmed down considerably and realising to try and avoid complication it was essential to reduce my HBA1c. During my first pregnancy I managed to get my HBA1c down to 7.0 and was advised by the diabetes clinic I was one of their best patients at this time I was also diagnosed with retinopathy and required laser surgery in both eyes, this has been followed up with further laser eye surgery. It was also around this time I became aware of insulin pumps, which I bought, this did helped with control. After lowering my HBA1c from an average of 9.5 to averaging 7.5 my hypos were more frequent and more severe, my husband once coming home from work and I was unconscious beside my baby daughter. Over a number of years my husband required ambulance assistance with me having unresponsive hypos a number of times. Despite this and inspired by my young family I have been determined to lower my HBA1c to help prevent the common complications associated with diabetes, which I have since discovered many of the risk factors for these complications multiply dramatically above HBA1c levels of 5.5.

Since becoming a mother and in pursuit of improving my health and lowering HBA1c levels I have tried different methods, dieting and extreme exercise regimes which caused more severe hypos, these worked to an extent and noticeably reduced insulin requirements, however over a long period of time proved incompatible with family life. I was resigned to waiting on a cure to improve my health and give me a “normal” life span.

The lowest HBA1c I achieved was around 6.2, that is until 18 months ago when I was sent a web link of a presentation by Dr. Troy Stapleton speaking at a convention in Melbourne, he had recently been diagnosed T1 diabetic. Through his frustration of the blood glucose roller coaster and extensive research he discovered that disregarding the global diabetes advice that is: ensuring carbohydrates form a significant part of every meal, he changed his bodies main energy source to fat through a process called ketosis, this is achieved by restricting the consumption of carbohydrates to less than 30 grams per day and by doing this he was able to prevent blood glucose spikes and reduce insulin requirements, resulting in lowering his HBA1c to around 5.0. This way of eating he discusses is called Low Carb High Fat (LCHF). In his presentation he listed many books and sources of information, both current and historic, many of which I was able to check out online that day.

The following day I along with my husband’s support followed the dietary guidance, within two weeks we were both in ketosis and felt great for it, my insulin requirements dropped by around 50% and my HBA1c dropped within three months from 7.6 to 5.7 and has gradually continued to reduce to the most recent reading of 4.9. Hypos are virtually a thing of the past, which I believe is due to the fat metabolism, as my brain is no longer solely reliant on glucose for energy therefore I am always aware and able to respond and function at low blood glucose levels. As well as having higher energy levels I now have the feeling back in my toes and feet and I no longer suffer from restless legs.

I am immensely grateful for the education I received via online presentations and online medical publications as well as the support I have had from medical professionals via email and through social media groups, without whom I would still be high risk for all the associated “diabetes complications” and inevitably have be prone to a number of them as well as having dangerous hypos weekly/monthly.

It is my belief all diabetics should be given the same dietary information and health education to help them make the logical decision to prevent the complications that I once believed to be inevitable. Unfortunately I am left frustrated by my own diabetes clinic, the NHS and Diabetes UK’s reluctance to embrace and promote the life changing / healthy outcome that is possible through such a simple dietary change. Billions are being wasted on treatment while waiting for a cure and diabetics are losing limbs, sight and dying from complications, this is no longer acceptable, the low carb high fat dietary advise needs to become mainstream education for anyone diabetic or at risk of becoming diabetic.

I am a 39yr old Type 1 diabetic diagnosed in May 2014. When diagnosed, I had a fasting BSL of 14.1 and my HbA1c was 10.4%.

Prior to meeting my diabetic educator, I decided to investigate how I could 'manage' the condition. I came across a podcast on the ABC by Troy Stapleton (http://www.abc.net.au/radionational/programs/healthreport/low-carbohydra...). This gave me hope that I could manage this and lead a normal life.

I continued to research online all about Low Carb diets and diabetes. The more I read, the more I realised that diabetes was in some ways similar to an allergy (carbs and sugar play havoc with your system, insulin shot used to limit the damage) although all this was against the conventional 'wisdom' and guidelines.

I watched youtube videos from Low Carb conferences and a movie called 'Cereal Killers' (http://www.cerealkillersmovie.com/) which documented how switching your body to a Low Carb High Fat diet actually improved your health and reduced inflammation. I decided this was the diet for me and immediately started by cutting out all carbs and sugars. I gave up bread, pasta, rice, all starchy veg (potatoes, carrots, pumpkin etc.), fruit (except for berries), milk, cakes, biscuits and began eating more green veg, avocados, eggs, meats, fish, cheeses, creams, nuts, coconut oil. I followed the food tips from Low Carb Diabetic (http://www.lowcarbdiabetic.co.uk/) and monitored my sugar levels 4 times a day. Within a few weeks, I felt great, had more energy, lost my belly fat and kept my sugar levels below 8 at all times. My next HbA1c test (which was 2 months after starting the diet) came back at 7% which was very encouraging. 3 months later it was down to 5.9%. My last test (March 2015) was 5.6% .

Since I began this lifestyle (as I will be doing it for the rest of my life), I have read Dr. Richard Bernstein's book Diabetes Solution where he explains how your body processes carbs, sugar, protein and fats, how to manage your condition and live a long and healthy life without the complications of diabetes.

My lifestyle is not restrictive and my friends are often jealous of what I eat. My blood sugars are normal and are easy to keep between 3 and 8. I rarely have hypos (once every 3 months) and a hypo for me is when it drops below 2 as my body is in ketosis all the time and my brain runs on ketones not glucose.

This is definitely an easier way to live with this condition rather than the roller coaster of eating carbs and sugar and chasing it with insulin shots. I take 7 units of Lantus (long acting insulin) twice daily and take between 2-6 units of Novorapid at mealtimes if needed. I don't have any issues or worries about exercising, only that when I do strenuous exercise, my sugar levels actually go up (due to my liver releasing glucagon).

This LCHF lifestyle is not recommended by the diabetic associations and is only followed by a small percentage of diabetics, but the results are proof themselves that a Type 1 diabetic can lead a normal healthy life without any of the complications of high blood sugars.