January 24, 2003
Meal Planning, Food and Diet
Question from Laconia, New Hampshire, USA:
I have read different publications and the questions you have already answered regarding low carbohydrate diets, but I am still confused. I have type 1 diabetes, I follow a low carbohydrate diet on and off, and whenever I follow it, my whole life is better. I run perfect blood sugars (usually 70-130 mg/dl [3.9-7.2 mmol/L] or so), I have more energy, I eat less, and I just feel better in a million ways.
I have one basal rate on my pump for when I am eating very few carbohydrates (total of 10 units per 24 hours) plus a few small boluses that usually add up to between two to four units by the end of the day (these boluses are for eating salads, low carb veggies, and nuts). I take multi-vitamins and eat eggs, fish, and leaner meats like chicken, ham, and turkey. I check my ketones every day, and they are usually between small and moderate). Will these ketones cause me to suffer from other problems later in life? Is this kind of diet unhealthy because I am not eating fruits and drinking milk and because I’m missing other nutrients? If I am burning ketones but my blood sugar is in range, and I’m not sick or anything, is it still a problem?
There is just so much information that contradicts other information I feel like I’m running in circles. and I don’t know what to do. Whenever I follow my doctor’s suggestions I feel lousy physically, and my blood sugars are crazy off the wall. I would just appreciate any suggestions or information or resources you have to offer.
Answer:
I am glad that you feel well and that is probably an important consideration. But on a low-carb, but emphasis on protein diet, you have placed yourself on a ketogenic diet. In light of your feeling well, this is probably why you may have moderate ketones in the urine when you check.
The presence of ketones is probably not so terribly harmful, after all, you are trying to get rid of them. The dilemma comes when knowing what to do when you are sick. Folks with type 1 diabetes are prone to DKA [diabetic ketoacidosis], a potentially fatal complication associated with brain swelling and death. It is usually accompanied by nausea and vomiting. But many things can cause a person with (or without) diabetes to vomit such as the flu, food poisoning, etc. The screening to do at home in those situations is to test the blood or urine for ketones the presence of which is cause for worry of impending DKA. However, if you already have ketones in the system, how would you know that DKA is there, too? Another potential problem is that the protein load on the kidneys with your diet may be problematic for someone with type 1 diabetes.,P> So while I congratulate you on feeling well and am pleased that your sugars apparently are good, I think that you may be playing with fire and personally, I cannot condone this regimen. Your own doctor may have a different view.
DS
[Editor’s comment: Or maybe you need a different doctor?
WWQ]
