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Low Carb Diets in Children with Diabetes

December 8, 2021
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There have been many varieties of low carbohydrate diets and, most recently, there are many people who adhere to restrictive regimens, such as ketogenic diets. But how do you know what is right for your child with type 1 diabetes? We’ll explain the most recent data on carbohydrate recommendations for youths with diabetes.

In the pre-insulin days, everyone with diabetes was on a very restrictive diet, very low in carbohydrates and often very low in calories.1 This was extremely challenging, especially for children who did not fully understand why they could not eat, despite feeling so hungry. Luckily for us, insulin was discovered, and then children were able to eat more freely and live more healthy lives.

Some feel that perhaps we have gone too far from the restrictive methods, however, and that allowing children with diabetes to eat anything, including higher carbohydrate foods, is making it more challenging to meet glycemic goals .2 Others worry that significantly restricting carbohydrate could prevent proper growth and development and increase cardiac risk factors. Wherever you fall on the spectrum on the feelings of carbohydrates, we recommend discussing with your health care team what is best for your child and your family.

Three different research centers in the Czech Republic surveyed the families that attend their clinics to investigate how many of their patients were following low carb diets.2 The definition for low carb diet for this study was a total carbohydrate intake of <26% of the daily age-specific recommendation, which was 130 grams per day for children 11 years of age. They found that of the 624 families who completed the survey, 242 (38.7%) had experience with partial low carb diets, 31 (5%) had followed a low carb diet in the past, and 32 (5.8%) were currently adhering to a low carb diet. They compared the current low carb diet followers to matched non-low carb peers and found the following:

  • HbA1c levels were similar
  • Time in range was higher in low carb – 74% vs. 66.5%
  • Time in hyperglycemia was lower in low carb group – 17% vs. 20%
  • Slight increase in time hypoglycemic in the low carb group – 8% vs. 5%
  • Body height, BMI, and weight did not have a significant difference

These results are very encouraging for those who are interested in embarking on a low carbohydrate journey. Another study out of Italy looked specifically at carbohydrate intake and time in range (TIR).3 They found that among the 197 children in this study, those with time in range >70% consumed a significantly higher percentage of fiber and protein per day and had a diet consisting of 40 to 44% of carbohydrates. The normal recommendation is to consume 45 to 50% of total daily intake from carbohydrates, so this is a recommendation for a slight reduction in carbohydrate intake from this study. Children who consumed less than 40% and more than 45% of their diet as carbohydrates had lower time in range percentages, indicating that 40-45% is the optimum amount for these study participants.

These are only two studies in children with type 1 diabetes looking at carbohydrate intake compared to diabetes outcomes. There are some additional studies in adults with T1D on low and very low carbohydrate diets as well, but more research needs to be completed in the pediatric group to determine long-term outcomes and ensure that the results from these studies are applicable to the larger population of children with T1D. As with most things for diabetes management, everyone is unique and so is their diabetes experience. If you are considering a low carb diet for yourself or your child, we recommend talking to your health care team to make sure it’s right for you. It will also be helpful to have some support in changing insulin dosing with the change in diet.

You can check out dietitian Constance Brown-Riggs recorded presentation Carbohydrate Controversies from CWD’s virtual Fall FFL 2021 for more information.

  1. Before Banting: Treatments for Diabetes in the Pre-Insulin Era
  2. Low-Carbohydrate Diet among Children with Type 1 Diabetes: A Multi-Center Study
  3. Rethinking Carbohydrate Intake and Time in Range in Children and Adolescents with Type 1 Diabetes

Written and clinically reviewed by Marissa Town, RN, BSN, CDCES