June 11, 2008
Meal Planning, Food and Diet
Question from United States:
There has been a lot of enthusiasm about low carbohydrate diets. Do you feel these are appropriate for children with type 1 diabetes? Why or why not?
It depends upon what your idea of a low carbohydrate diet consists of. For children (and adults for that matter) with diabetes, it is not recommended that a person follow a low carbohydrate diet of less than 130 grams of carbohydrate/day. A diet lower in carbohydrates (especially “ultra low carbohydrate diets”) can be void of essential vitamins and minerals the body requires for optimal health. Another consequence of a low carbohydrate diet is that by reducing carbohydrates, you sometimes are substituting with more fats and/or protein sources which may not be appropriate for persons with diabetes. Since meal planning for diabetes works best when it is individualized, talk with your health care team if you have questions about an appropriate amount of carbohydrates, protein and fats in your meal plan.
Additional comments from Dr. David Schwartz:
I have long promoted to my patients and students and residents (and insulin pharmaceutical sales representatives), that one should modify the diet to match the insulin. The best example I can think of is that for decades, patients with diabetes were prescribed a “three meal and three snack” meal plan. But, this was to match the peaks and valleys of the combination of NPH and Regular insulin so as to avoid hypoglycemia. As we use less of this particular combination, the meal plans should be adjusted accordingly, but too often, somehow, patients continue to get this three meal/three snack diet prescribed.
With the use of basal-bolus insulin plans, we can even better match insulin to food intake. With this as a background, then “low carbohydrate” diets COULD work well in patients with type 1 diabetes. But, I do not advocate this typically for my type 1 patients. Why? Because a low carbohydrate diet is ketogenic and ketones make us feel ill. The person with type 1 diabetes, when insulin deficient (virtually the definition of type 1 diabetes) is ketotic prone anyway and cannot clear ketones well. This is a recipe for rapid DKA, in my opinion. Now, low carbohydrate diets in type 2s can be used more safely. There may be places for this diet in type 1s as well, but to be used with caution, in my view.