Starting low carb or keto with diabetes medications
So you have diabetes and you want to try a low-carb or keto diet? Congratulations! It may be the single best thing you could ever do for your health. It can start to reverse your type 2 diabetes, and dramatically increase your blood sugar control with type 1 diabetes.
However, you need to know what you are doing. Once you start eating low carb you may instantly have to lower any insulin doses, a lot.
Avoiding the carbohydrates that raise your blood sugar decreases your need for medication to lower it. Taking the same dose of insulin as you did prior to adopting a low-carb diet might result in hypoglycemia (low blood sugar).
You need to test your blood sugar frequently when starting this diet and adapt (lower) your medication. This should ideally be done with the assistance of a knowledgeable physician.
No drugs
If you have diabetes and you’re treated either by diet alone or just with Metformin there is no risk of low blood sugar on low carb. You can get started right away.
Insulin
As a general guide you may need to lower your doses by 30-50% or more when starting a strict low-carb diet.
Unfortunately there’s no way to know the doses required in advance. You’ll have to test your blood sugar frequently and adapt (lower) insulin doses. This should ideally be done with the assistance of a knowledgeable physician.
Note that as a general rule it’s easier to err on the low side, and take more insulin later if needed. That’s fine. If instead you overdose and get low sugar you’ll have to quickly eat or drink more carbohydrates, and that obviously reduces the effect of the low-carb diet.
Insulin in type 1 diabetes
The advice on insulin above generally applies to type 1 diabetes too. A low-carb, high-fat diet can be fantastic for empowering people with type 1 diabetes to get steady blood sugars. It results in much fewer and milder highs or hypos (when insulin doses are adapted).
If you get regular hypos you should consider lowering your insulin.
One word of warning though: A strict low carb diet results in ketosis, a normal physiological state. A very strict low-carb diet that also restricts protein to moderate amounts can result in quite high, but still physiological, ketone levels (>1.5 mmol/L).
This is fine for healthy people, but in type 1 diabetes this means you’re uncomfortably close to ketoacidosis (usually at least 10-15 mmol/L). All that’s needed then is forgetting an insulin shot or two, or an insulin pump malfunction, and you might end up very sick in the hospital.
Thus it’s probably best in type 1 diabetes to try a more moderate low-carb diet, with a minimum of around 50 grams of carbs a day, so that you stay out of deeper ketosis (>1.5 mmol/L).
Do not do a strict low-carb diet (below 20 grams a day) unless you’re certain of how to handle this risk. Adding for example a fruit or two a day to it is probably wise, if you have type 1 diabetes. Just to be safe.
With that said, a low-carb diet can have fantastic results for people with type 1 diabetes:
Insulin-releasing pills
Some pills for type 2 diabetes work by releasing more insulin in the pancreas. These can also result in low blood sugar on a low-carb diet, even if the risk is slightly smaller than with injected insulin.
These pills are called sulfonylureas and include Minidiab, Euglucon, Daonil, and Glibenclamide.
You may need to reduce the dose or stop these drugs on a low-carb diet, as you may rapidly become too healthy for them. Discuss it with your doctor in advance.
Metformin
Metformin tablets can be safely taken on a low-carb diet. There’s no risk of low blood sugar if you’re only on Metformin.
GLP-1 agonists (e.g. Victoza) and DPP-4 inhibitors (e.g. Januvia)
These drugs should rarely lead to low blood sugar on a low-carb diet by themselves. But be observant, check your blood sugar often and discuss it with your doctor as needed.
SGLT2 inhibitors (e.g. Farxiga, Jardiance, Invokana)
These drugs1 are a good way to treat type 2 diabetes, but as a known side effect they increase the risk of a dangerous condition called ketoacidosis. It’s likely that this side effect could become more common on a strict low-carb diet. Proceed with caution and discuss it with your doctor.
If you get symptoms of ketoacidosis: extreme thirst, nausea, vomiting, confusion etc. you should stop the medication, eat carbs and contact a doctor immediately.
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A keto (strict low-carb) diet for beginners
Low carb for doctors
Are you a doctor or do you know one? Here’s our low carb for doctors resource, with information on how to safely handle medications on a low-carb diet:
For more brand names and information check out the Wikipedia page about this class of drugs. ↩
http://www.diabetes-book.com/
and now that i've found this site, it will help me do even better... i've tried cauliflower rice (yum!) and zucchini noodles (they do the job)... but recipes for low-carb bread? i'm going to have to try them! thank you! :)
Basically when you startup with exercise (with or without a change in diet though I believe a change of diet at the same time has double impact and this is not just for diabetics, but mainly aimed at people who are unfit, like the vast majority of T2s) you can experience a rise blood glucose levels, it has something to do with your body/muscles not being used to it and releases stress hormones which in turn increases your BG, in addition you can also experience high morning as the liver to convert stored glycogen into glucose, and dumps it nicely into your bloodstream. I used to have horrible DP, would go to bed with a BG of say 8.1 and wake up to discover a BG of 13.8 it was regular, it almost doubles...I would moan at the doctor...how unfair it was...blah blah...
I have been a T2 for a number of years now and use insulin in addition to oral meds, and in that time I have learned a few things about T2s, most (and please note folks, most means just that, moat, I am not tarring every single T2 out there, just most) of those T2s I ve met/encountered share a few common traits. Such as, generally being rather unfit, overweight, greedy, often in denial about their condition, their eating habits and their lack of effort to help put it right and very often give up and throw a stroppy moments when they realize things arent that easy, and very often, creating more issues, such as refusing to take certain meds after 3 days cos their legs ache etc...despite the fact they could have a heart attack at any moment due to their obesity, high cholesterol, and general unhealthiness.
I even knew a girl, im sure we all have, who claimed she ate salad every day and didnt eat that much and it was all about hormones, well we know that for the vast majority, thats just pure BS, no one, absolutely no one ends up being 30St eating lettuce, but my point, she really and honestly believed she was eating OK, home made food, salad with everything, she would make out that somehow the diabetes nurse was a horrible b!tch, etc...and the truth, she was plain good ol fat, cos despite her eating 'salad' what she failed to highlight was it was usually covered in cheeseburgers, fried chicken, fries, pies etc...she was plain lazy, so never did anything and of course didnt want anyone or anything ruining her comfort zone.
My advice to you, as a long time T2 and someone who has been through all those things I have mentioned (I didnt refuse the meds though cos I couldnt by the time i accepted I had near on killed myself by being a lazy lump with a greedy appetite at 20+stones) is stick with it, dont give up, you ll hear a lot, and i mean a lot, of nonsense about diabetes, mostly from people who dont know what they are talking about, even some T2s are utterly clueless, and the best advice any one can give you, or anyone else for that fact, is educate yourself, find out all you can and learn to separate the nonsense from the truth as best you can.
Dont give up on your exercise plan/food plan, just go moderate and keep your changes small and keep an eye on your BG and it will absolutely start to go down once your body has adjusted itself and once you start accepting you are in a marathon not a sprint and every little thing you do and and achieve now will earn you credit further down the line.
I walk, plenty, drink lots of water, managed to get a grip on my food intake, accept it is my own responsibility and have managed to drop 4St+, my morning BG is usually less than 5 and my evening BG is usually less than 10 and often near 8...
Best wishes
Best wishes...
I am aged 42 and used to be on Metformin (>3yrs) and have stopped it for awhile and changed to Forxiga (Dapagliflozin). For the past 2 years my blood test reports has been encouraging with the latest one done in Sep-2016. The results are all normal (except high urine sugar due to Forxiga). All along I do not have any high / low blood pressure problem. My diet are not strictly LCHF but avoid all starchy foods as much as possible.
Even though the test results are normal, there is always a persistent discomfort on some area of my skin (joints area, rashes due to abrasions) for these years. It will not take along time to heal and not always recover. I am puzzled why even the blood sugar has been so well controlled, why is the skin condition not improved or healed? In fact recently some area has worsen. Is it due to daily hot, humid weather here or is it with controlled blood sugar does not equate to controlled insulin-resistance for T2 patient?
AM CONFUSED please advise...
Will (Strict) LCHF reverse T2 COMPLETELY and normalize insulin and even symptoms of T2 (such as my skin conditions or other upcoming chronic diseases).
Look forward to your reply.
Best regards,
Max
If you are a member you can direct questions to Andreas here:
https://www.dietdoctor.com/member/ask-diet-doctor-new
Thanks for the advise!
Best regards,
Max
I am a normal weight person and look quite lean. Would the lchf diet be ok for my type 2 diabetes. I am a t2 for last 8 years and mostly uncontrolled.
I am sorry, but we simply don’t yet have the resources to respond to questions in the comments or via email.
We do respond to questions about the membership, but for other questions, it would be great if readers could help each other in the comment section.
I'm type 2 overweight and like carbs.
BUT after reading your post I'm going to make a big effort and do the low carb programme.
I so want to get of humulog insulin.
Many thanks and best wishes to you Maddy.
Try Stevia to sweeten your yogurt.
My boyfriend is a Type 2 taking Metformin, and currently not managing his disease well. He believes that exercise will offset his poor eating habits. I can see from reading about how our bodies handle glucose that his best hope is the keto diet initially, until his disease is under control. Then he might be able to add a few complex carbs.
The thing that gives me the most hope for both of us is that I now realize that the current advice of calories eaten minus calories expended means NOTHING! Most doctors and nutritionists in the US preach that garbage like it is something carved in stone. The food pyramid, as taught in the US, is upside down. No wonder I weigh nearly 300 pounds. No wonder obesity is skyrocketing in this country, even among children and adolescents.
Thank you! I'm moving in with my boyfriend next weekend, and I'm going equipped with a 2 week ketogenic plan and a shopping list. I will be leaving all my "bad food" behind.
Lee Avery, I hear you. As a former mostly-vego eater, who has just stopped eating wheat and starches (again) this week, I feel sick of meat having eaten it 5 times in a row. Previously, I've also overdone the greek yoghurt on LCHF. There's a tasty No Grain-ola in the I Quit Sugar book that I often eat for breakfast with 4 strawberries and either greek yoghurt OR whipped/ double cream, and that makes breakfast more interesting. (Choose lower carb nuts, and reduce the coconut.) Re eating eggs, I had eggs benedict at a restaurant today, and asked them to put my two eggs on two thick slices of fried tomato instead of a muffin or toast: I love this as a substitute and it's a no-fuss solution I do at home often. On a bed of spinach with a bit of avocado on the side, it makes a very satisfying meal. As for bread, it's not cheap, but an Aust. company, The Protein Bread Co, is making very low carb bread. I've only just bought my first packet. It's highly reviewed, and on their website they show some great low carb options you could put on top. I will try a few online recipes for low carb bread, too, and I found a few by typing in 10 best wheat free bread recipes. However, I wanted to make a loaf using the mix, slice it and freeze it so that when I really feel like a piece of toast, I have a good option handy (esp if I have some failures with other recipes). I'm sure other countries have smart companies beginning to make good options also. It may take a bit of searching, though. I found the bread mix when I went looking for a place to buy a ready-made paleo loaf I saw in a local, mostly-vegan cafe earlier this year. I've been on and off LCHF for almost three years.Twice I've been quite strict on it, and then holidays came and I got casual about a potato here, a piece of toast there... However I feel better on LCHF and "cheat days" can really derail my efforts. I read today that some people have "three cheat meals" a week, but for me that would be too many. I'm diabetic, so falling off the wagon causes long-term damage to my health, so I need to not risk it this time. One two-course meal a week is the most I am going to allow myself to "cheat on" this time. I'm also going to put my kids on a wheat free diet by Christmas, too, so that there's less things in the house to tempt me... Finally I'm reading Grain Brain atm, and there's some very compelling reasons in there to change our diet, I just got up to the recipe section, and there's some lovely meal ideas there. Anyway, best of luck. I hope you find some great foods to satisfy you on LCHF.
If you are planning to eat carbohydrates you shouldn't do this. High Fat +carbs equals weight gain and out of control blood sugars. Also its very hard on your body You asked about sweeteners, I use Pure Loa Han Guo also known as monkfruit, I buy it online at ZNaturals.com I get the 1 oz package. If you can tolerate erythritol you can get Lakanto monkfruit. I am allergic to erythritol. If you really want to try again I invite you to join me and thousands of other peple from all over the world chattin on Ketogenicsuccess.com. I wish you all the best!
thanks
Something to look into as both drugs are basically the same thing.
I have insulin-resistance. May I use keto diet?
You should !
Insulin resistance is diabetes t2
You don't want to have more insulin, so....no eat carbs...no insulin needed!
After months of a lowered carb diet (<100mg per day) my glucose levels stabilized after a bout with high ketone levels. I had to increase my carb intake to 150mg per day or else hypoglycemia would hit me. I did get the higher blood sugar readings after beginning a steady exercise program, but after a while it leveled off as well. Back to hypoglycemia again. I found myself having to eat sugar to stop it from falling too low. This led to eating more carbs than intended, and I also fell off the wagon with carbs during Christmas. My blood sugar levels shot back up to 218mg/dl an hour after eating. Just one week wrecked me. So, I'm back on the ultra-low carb diet again, hoping to bring the numbers down. I've tried the controlled fasting, but get stomach pain/extreme hunger pangs, and end up snacking to stop the pain. Even too many low carb veggies as snacks will cause weight gain. Increased the Lantus and now it's starting to lower everything again. I would like to eliminate the Lantus one day, and had it down to less than 12 units per day (was at 30 per day) and cut the Metformin dosage in half. The doctor wants me to take a different kind of insulin at mealtime in addition to the Lantus, but I'm trying to avoid having to do another bolus when I already have a hard time keeping my blood sugar from falling down too far. Up and down, constantly. How do I stop the rollercoaster?
This is my story about being diabetes 2 for 13 years and went into the hospital on 27of May 2017 with breathing problems and high glucose levels (32) as well as incidents of bowl and urine problems and high blood pressure, high cholesterol as well suffer from PTSD, and weigh 320 lbs, . In the past I tried all different plans of eating and did lose some weight but my glucose levels were still very high to make story worst I almost died and was on a ventilator and was unconscious for 5 days and hook to a salutation to lower glucose and woke up and couldn't speak and was extremely scared and thought that I was going to die. Well a made a prayer to God and ask him to take into spirit and safe my sole and I cried and didn't sleep all night. The next morning a made up my mind to get my life back with the help of God and with his help and once I left the hospital I started researching all kinds of natural foods that control glucose level and help in weight loss naturally. What I found did out that you must follow a low carb daily plan and 30 minutes of exercise a day. Also follow your doctor's advice along the way, they can aid you in your success. The most important thing is to find plants such as (chayo), bitter melon, Kala a, and put this into your diet. This aid in glucose levels and will drop the levels in half and bring it to non diabetic levels. The secret is to follow this daily routine for the rest of your life. Keto plan is the way to go. After 9 months my weight has come from 320lbs to 214lbs and my glucose levels are 5.2 on the average for three months and I reduce my insulin from 80ml. to 10ml.and hope to speak to my doctor to be completely off insulin and to reduce metformin from 2000ml.to 1000ml. and to be taken off blood pressure medication,and all other medications. My hair is coming back and becoming thick and curly and the color is coming back as well. I sleep allot better without any medication. My PTSD is still there but with with diet and exercise it is in check. The thing to remember that it can be done but it takes time and don't get discouraged it will start slow but it will increase and you will be a happy as I am. Thank you for your meal plan
it has been banned in most other countries and the EU due to the proven link between taking it and bowl cancer.
The makers of it have been fined billions of falsify research and covering up the known link Yet the FDA still allows it.
My doctor prescribed it for me and when I did my research on it I was shocked and refused it.
Dr Bernstein is a type 1.... The last half of the book are recipes, from appetizers to dessert...
https://pat.libreview.com/
I recommend this meter, I've been on mine for about 60 days. It can help point out issues as it is monitoring all the time.
https://www.ketoconnect.net/
some of the best keto recipes I've found!
Read, a lot! You'll need to determine what works best for you.
I'm not sponsored by any of the above, just a type 2, diagnosed Dec 2017.
I've had T2 for many years, probably due to meals that were mostly carbs in combination with no exercise. I turned that around with good workouts starting in 2010 (with a 2-year break to recover from Stage IV rectal cancer).
So I'm currently on 2000 mg of metformin a day (1000mg bid), and returned to a full ketogenic diet 7-20-18 (maybe 5-10 net grams of carb each day). My BGs are lowering already, but not quickly (morning BGs are around 170% of desired/normal). My BGs are high all day, but especially in the morning. I know I'll need time for the liver to clear out the glucagen and for my body fat to change type, and my insulin resistance to be repaired. I'll be patient.
My question is: what changes in my BG should I use to guide my reduction in metformin? I don't want to reduce either too quickly or too slowly. Of course, my doctor has no idea--he wants to put me on glipizide er, which may work at first but like metformin would eventually, keeping a high carbs diet, just make the diabetes worse.
Hoping for some very specific advice, if possible. Otherwise, I'll just use my intuition (guesswork).