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Managing T1D with a Low-Carbohydrate Approach

As the Family Centre dietitian and diabetes educator, it’s my job to support my patients to both achieve their diabetes management goals, and to help them eat in a way that meets their nutrient and energy needs. Recently, I’ve had a number of patients approach asking me to help them construct a diet that is lower in carbohydrate. Acknowledging that carbohydrate foods have the most extreme impact upon blood sugar, I fully support my patients to experiment with reduced-carbohydrate approaches in pursuit of better-managed blood glucose. Together, we’ve achieved some seriously good results. The benefits of reducing carbohydrate Fewer post-meal spikes After eating, the rate at which carbohydrate is absorbed varies greatly, depending on the food’s glycaemic index. Unfortunately, rapid-acting insulin doesn’t always sync up with the rate carbohydrates are absorbed, which can result in large post-meal glucose spikes. By decreasing the carbohydrate load of the meal, it is possible to decrease the time spent with high levels after meals. Reduces your error margins By lowering the amount of carbohydrate consumed, we can reduce the unavoidable error margins in doing diabetes maths. If you don’t have nutrition information panels at hand, the process of estimating carbs naturally comes with an error margin. Let’s say you eat a low-carb breakfast of a cheese and tomato omelette (5 grams of carbs) and your error margin counting the carbs is around 20% - you’d be 1 gram out, which won’t impact your insulin dose. However, if you’re eating a high-carb breakfast of toast, banana and cereal (let’s say 80 grams of carbs) the same error margin could have you out by a whopping 16 grams – which can quickly translate to over- or under-dosing your insulin! Tighter control Following a reduced-carbohydrate approach minimises the fallout from getting the carb count wrong, by also minimising errors in insulin dose calculations. It also means you’ll need to take less insulin at each meal and snack, helping you to get off the diabetes rollercoaster. Working with smaller numbers can help you achieve tighter blood glucose control. More stable overnight levels If you have your basal rates set right, reducing spikes and the need for corrections after dinner can set you up to cruise through the night with stable levels. And who doesn’t love a good night’s sleep? Got concerns? Let’s talk them through What about growth? There is no reason why a person can’t grow and thrive using a reduced-carbohydrate approach. I am yet to find a nutrient from a carbohydrate-containing food that cannot be supplied by a food low in carbohydrate, and the menu plans I create for my patients easily meet nutrient and energy targets. Indeed, given the mounting research that shows the impact of sustained highs and wild glucose fluctuations on growth and development, the argument for fixing these problems through food choices is compelling. Is there a greater risk of hypoglycaemia? If you reduce your carbs, you need to adjust your insulin downwards to avoid hypos. Treating a hypo is the same: use glucose tablets or other fast-acting carbs in controlled amounts. Is eating low-carb boring? No way! In fact, it’s the opposite. It’s a healthy, colourful diet full of non-starchy vegetables, meat, fish and poultry, eggs, dairy, nuts and berries. And meeting your energy needs with calorie-dense foods such as full-fat dairy, avocado, coconut products and nut butters is both delicious and satisfying. Baking and treats are out of the question either - ask the mums and dads in the Family Centre Parents' Community for their reduced-carb swaps, substitutions, tips and recipes! Can we still enjoy social events and eating out? Of course! Lots of cafes and restaurants are happy to accommodate. Parties and friends’ houses can be less predictable, but when you feel the profoundly positive impact of stable levels, you will be surprised how easy it is to pass on the potatoes. Being your own nutrition advocate is important – talk with your friends about how they can support with food that helps your health. Is it sustainable long-term? My answer is this is: if a way of eating offered variety, allowed you to eat when you liked, included delicious and satisfying foods and made you feel better, would you have any issues with adherence?  The take home message: Do what is right for you and your family. If you do choose to try reducing carbohydrate, don’t do it alone. Do your homework, be prepared, and find a health professional who is willing to be your sidekick!

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