I have just gotten custody of a child with type 1 diabetes. I understand she is doing carb counting and how to do it (15grams of carb/1 unit of insulin). If the child has to take insulin for carbs, why are low carb diets such as the Atkins dangerous? How many carbs should a child with diabetes have in a day? We want to maintain level blood sugar and decrease the amount of insulin she has been taking.

You are to be commended for trying to learn to help the best you can with this new ward in your home. You didn’t mention the type of insulin regimen that she is receiving, but given the nature of your question, I presume she is on some type of variant of a basal/bolus insulin plan in which a long-acting insulin (such asLantus (insulin glargine) or Ultralente) functions as the baseline or basal insulin present “all day” although some will use an intermediate acting insulin (such as NPH or Lente) as the “basal.” Then a fast-acting insulin (Regular, Humalog, or Novolog) is taken with the meal to function as the meal or bolus insulin. And is 1 unit of fast-acting insulin per 15 grams of carbohydrate consumed at meals is a good starting point

The beauty of this type of approach is that carbs need not be too limited. You simply take enough insulin to cover the carbs. A Certified Diabetes Educator dietitian well versed in diabetes will be able to come up with a meal plan with you and the child.

The Atkins-type low-carb diet can be successful for people with diabetes, but it is generally thought more so for type 2 diabetes. It is riskier in type 1 diabetes because it is a ketogenic diet, meaning it causes the accumulation of ketones. In type 1 diabetes, this could lead to life-threatening DKA [diabetic ketoacidosis]. In obese folks and those with type 2 diabetes, the ketones are natural appetite suppressants; the low-carbs help lead to less insulin excursion and for obese folks, this can slow weight gain and cause weight loss. These types of diets can present a large protein load on the kidneys and that could be problematic for the person with underlying diabetes-related kidney disease.

DS

[Editor’s comment: I don’t understand why it is necessary to decrease the amount of insulin she is taking. She requires whatever amount of insulin it takes to keep her blood sugar levels in control. Since she is unable to produce her own, this must be given by injection.

As Dr Schwartz has suggested, you and this young lady need to set up an appointment with a dietitian in order to develop a meal plan. The dietitian with assure the meal plan is conducive to this young lady’s lifestyle, is effective in achievement of blood glucose goal, and helps with weight loss, if this is an issue. You should not try to establish an eating pattern on your own without professional help since it is integral to the overall treatment plan. Any changes in any part of this child’s regimen should only be made with the approval of her diabetes team.

SS]