Low Carb

Starting Low Carb with Diabetes Medications

Testing blood sugar

So you have diabetes and you want to try a low-carb 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.

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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:

How to Avoid Complications of Type 1 Diabetes – Dr. David Dikeman4.9 out of 5 stars5 stars90%4 stars5%3 stars1%2 stars1%1 star0%55 ratings5537:28A Revolutionary Treatment of Type 1 Diabetes4.8 out of 5 stars5 stars83%4 stars16%3 stars0%2 stars0%1 star0%18 ratings1813:02


 

Insulin-releasing pills

Sulfonylureas

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.

Learn more

How to Cure Type 2 Diabetes


Videos:
Losing Weight and Reversing Diabetes – Maureen Brenner4.7 out of 5 stars5 stars80%4 stars7%3 stars11%2 stars0%1 star0%42 ratings4211:36How to Cure Type 2 Diabetes – Dr. Jay Wortman4.8 out of 5 stars5 stars90%4 stars4%3 stars2%2 stars2%1 star0%44 ratings4424:25Diet & Diabetes – How to Normalize Your Blood Sugar4.9 out of 5 stars5 stars88%4 stars11%3 stars0%2 stars0%1 star0%59 ratings5916:26

The Perfect Treatment for Weight Loss and Diabetes – Dr. Jason Fung4.6 out of 5 stars5 stars80%4 stars10%3 stars4%2 stars2%1 star2%179 ratings17945:20The 2 big lies of type 2 diabetes – Dr. Jason Fung4.8 out of 5 stars5 stars85%4 stars8%3 stars3%2 stars3%1 star0%120 ratings12042:54A Revolutionary Treatment of Type 1 Diabetes – Hanna Boëtius4.8 out of 5 stars5 stars83%4 stars16%3 stars0%2 stars0%1 star0%18 ratings1813:02


Return to the
Low-Carb Beginner’s Guide

Return to A Low-Carb Diet for Beginners
 

  1. For more brand names and information check out the Wikipedia page about this class of drugs.

16 Comments

  1. Rob
    Type 1 and 2 diabetics may want to refer to Dr. Richard K. Bernstein's book 'Diabetes Solution' for more detailed information about eating low carb and managing blood sugars (as well as alot of other sound principles about managing diabetes).

    http://www.diabetes-book.com/

  2. Bern
    Yes Dr Bernsteins book is incredible. What makes it extra special is that he himself is a type 1 diabetic.
  3. Sue
    I have started to eat lchf and had some success, my doctor has left me on 8-12 of Lantus and changed my humalog to Trajenta once a day. I am trying to get off insulin and lose more weight. I don't know why she did this and if this is the right thing to do
  4. Michelle
    I am on Lantus and I feel like I am gaining weight and I really need to cut out my sugars and have a low carb diet... sadly I love pasta and potatoes so this is a real struggle for me but I do not want to be worrying about my sugars anymore.
  5. Sandra
    I am on generic actos and janumet. Are they the same cautions as januvia? And
  6. larry johnson
    I take Trulicity once a week. Can I do the low carb diet?
  7. Tammy Font
    I've tried LCHF 2x in the last two years and I have an unusual happening compared to what all benefit claims state. Each time I went on the eating plan, I've kept to no more than 25 grams of carbs. No processed or preservatives foods and no fruit. I joined a gym and was faithful to it. Instead of blood sugars lowering, they went higher!!! I lost weight great but sugars went as high as 400!!! I was forced to make a choice of losing weight or having blood sugar under control. My primary Doctor and endocrinologist both were upset with me! So now I'm trapped!!! ?
    Reply: #9
  8. denice
    i just discovered this site, after being diagnosed as type 2 several months ago... since i was diagnosed, i started eating low-carb, to try to minimize the medication i need and to stay as genuinely healthy as long as i can... since then, i've lost over 30 pounds, i'm three sizes smaller and both my A1c and cholesterol levels are down... so, even for a novice like me, low-carb diets work.

    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! :)

  9. Lewis E. Hathaway
    Actually, I read something about this not so long ago while reading about excercising while on insulin (cant remember where/find it now sorry).

    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...

    Reply: #16
  10. Ramakrishnan
    I am ramakrishnan from India I want your for diabetes book can you please help me
  11. Max
    Dear Dr. Andreas,

    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

    Reply: #12
  12. Hi Max!

    If you are a member you can direct questions to Andreas here:
    https://www.dietdoctor.com/member/ask-diet-doctor-new

    Dear Dr. Andreas,
    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

    Reply: #13
  13. Max
    Hi Peter,

    Thanks for the advise!

    Best regards,
    Max

  14. Clive phillips
    So far, lost over 45lbs in weight and insulin down from 50 units twice daily to 6-8 units twice daily. Bags of energy! Downside; I have to buy lots of smaller sized clothes!😉😎. I have about another 45-50 lbs to lose and I'll do it. So delighted I found dietdoctor.com Sadly, in UK so called experts still spewing out calorie counting.
  15. Amit
    Hi
    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.
  16. nikki
    Lewis E. Hathaway..you're a bit of a arse aren't you......'most' diabetics do NOT carry on like you've described. You seem to think you're the expert on T2, get over yourself. You need a personality transplant mate, because the one you've got is shot to pieces......nasty piece of work.

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