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Endgames Case Review

A patient request for some “deprescribing”

BMJ 2015; 351 doi: (Published 03 August 2015) Cite this as: BMJ 2015;351:h4023

Rapid Response:

Re: A patient request for some “deprescribing”

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 ( 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' ( 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 ( 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.

Competing interests: No competing interests

01 September 2015
Shane Lavelle
IT Delivery Consultant
Melbourne, Australia