Type 1 diabetes and LCHF – a great combination

Hanna Boëthius, type 1 diabetic

Hanna Boëthius has type 1 diabetes

Is an LCHF diet really a great option for type 1 diabetes? What do people with a lot of experience say?

We were just on the most spectacular trip of the year, the low-carb cruise in the Caribbean. We invited our participating moderators to write guest posts here on the blog. Here’s travel report number three, with important information on type 1 diabetes from our moderator Fredrik Söderlund:

Guest post by Fredrik Söderlund

Type 1 diabetes and LCHF – a great combination

On the cruise I was inspired by both presenters and guests to write a few paragraphs about LCHF and type 1 diabetes. There’s still a fairly common misconception that type 1 diabetics won’t benefit from LCHF or that it may even be dangerous.

One of the presenters was nephrologist Dr. Keith Runyan who himself has lived with type 1 diabetes for 17 years and switched to LCHF three years ago. Today he eats a ketogenic LCHF diet, or LCHFKD.

Among the conference participants were several type 1 diabetics who advocate LCHF; one of them was Hanna Boëthius. She has had the disease for 30 years, since she was 2 years old, and switched to LCHF four years ago. Hanna was convinced of the benefits of the diet when she studied to become a nutrition counselor and now has her own business to help other diabetics worldwide (www.hannaboethius.com.)

Hanna eats a ketogenic LCHF diet with 20–30 g carbohydrates daily and, like Dr. Runyan, she points out the many benefits of the diet that are beneficial for type 1 diabetics. I’m compiling some of the benefits that they both put forward on the cruise, but first some background knowledge.

Type 1 diabetes

Type 1 diabetes is an autoimmune disease that we don’t know how to prevent. The pancreas produces no, or very little, insulin. Insulin is needed to transport glucose from the liver’s production of glucose and from carbohydrates from food into the cells. Thus, insulin must be supplied daily.

The challenge for a type 1 diabetic is to calculate continuously how much insulin needs to be added, usually a basal dose for the entire day and then additional doses associated with each meal. The calculation is sensitive, as very small amounts of carbohydrates, 4 g, may be enough to raise blood sugar by 18 mg/dl (1 mmol/l), while a unit of injected insulin may lower blood sugar by about 36 mg/dl (2 mmol/l) (numbers may vary greatly between individuals.)

High blood sugar and insulin levels will cause damage in the long run to both small and large blood vessels, and a low blood sugar may result in hypoglycemia. This is a serious condition that quickly can lead to unconsciousness. It is estimated that hypoglycemia represents a direct cause of death for 6–10 % of insulin-dependent diabetics which in a scary way underscores the difficulty in calculating how much insulin is needed.

Using LCHF as a treatment

How can an LCHF diet facilitate the treatment of type 1 diabetes (and also insulin-dependent type 2 diabetics)?

First, fat from the food is not converted into glucose, as carbohydrates and even protein are to some extent. LCHF means reducing the amount of carbohydrates in the diet and replacing these with good fats. This significantly reduces the blood-sugar spike from food and thereby the need for added insulin. By working with small amounts of carbohydrates in the diet, the risk of major blood-sugar swings and hypoglycemia caused by incorrectly estimated insulin doses is potentially reduced.

Another factor is that a healthy pancreas secretes an exact amount of insulin that is distributed via the liver into the blood continuously throughout the body. When you inject insulin locally the distribution is significantly more uneven as it’s absorbed and spread differently in the body depending on where, how deep and when in relation to the meal it’s injected. The uptake of injected insulin may vary by about 30 % and constitutes a factor of uncertainty that makes it difficult to make an accurate assessment of insulin requirements. However, if you start with a small amount of carbohydrates the consequences of this uncertainty are reduced. Small amounts of carbohydrates will produce small errors. Large amounts of carbohydrates and insulin can produce large and potentially dangerous errors.

Hanna describes LCHF as an effective tool to facilitate the treatment of diabetes. Blood sugar immediately stabilizes and doesn’t plummet or shoot through the roof as it could do earlier when she estimated incorrectly, as when guessing the amount of carbohydrate in a sauce when eating out. She has chosen to eat a strict LCHF diet, which means that she’s in ketosis most of the time.

The body then uses ketone bodies as its main fuel and doesn’t need to rely entirely on glucose for energy supply to cells. This means that blood sugar won’t fall as quickly as before, which makes it less alarming when you note low blood-sugar levels.

Ketosis sounds scary to many as it sounds like ketoacidosis, a state of intoxication that occurs if you don’t take your insulin, but Hanna is not concerned. She explains that this can only happen if you’ve been completely without insulin for hours. If you monitor your blood sugar regularly you don’t have to worry. Thus, ketoacidosis is caused by not taking insulin, not by reducing carbohydrates.

Hanna doesn’t advocate that a ketogenic LCHF diet is best for everyone, it works well with a moderate LCHF and you must find your own level. However, it takes time to adjust to a new diet and for her this meant a lot of additional measurements of blood glucose, adjusting insulin doses and paying attention to trends before she found her sweet spot. She thinks it was well worth the effort and the health benefits are significant with both a lower blood pressure, lower HbA1c and an improved lipid profile. Today, she uses only 20 % of her former insulin dose and feels that her insulin sensitivity has increased gradually on LCHF.

Hanna currently has more energy, zest for life and knows that the disease no longer controls her life, and I can attest that both she and Dr. Runyan beamed up with the sun in the Caribbean!

Fredrik Söderlund


Thank you for the third cruise report, Fredrik! More coming up.


With insulin-treated diabetes it’s important to monitor your blood sugar closely when starting an LCHF diet! A diet including few carbohydrates usually causes a greatly reduced need for insulin. It’s then important to adjust (lower) the doses sufficiently to prevent blood sugar from dropping too low. This should be done with the support of your physician or diabetes nurse, especially if you have limited experience of insulin adjustment yourself. 

You also need to be diligent about closely checking your blood sugar in the event of an acute illness, please see Type 1 Diabetes

Previous reports

Annika Rane’s Reflections on the Low-Carb Cruise

The Caribbean Low-Carb Cruise

The 2015 Low-Carb Cruise – Brief Video Report


LCHF for Type 1 Diabetes?


  1. Stacy
  2. Debbie
    This is a great article. I, too am a type 1 diabetes and I've eating low carb for 6 years, my A1C has not gone over 5.1 in 6 years and is currently 4.8 without lows. my graph on my CGM is flat lined....when you add in healthy fats like avocado and coconut oil to your low carb lifestyle....it's beneficial to stop any roller coastering that is experienced with the ADA recommended 45 carbs per meal. To me, it's common sense. sugars and carbs raise blood glucose levels...so why not eliminate those from your diet? it's a no brainer!!!!
  3. Kim
    A low carb diet has been such a blessing for my type 1 daughter. No more blood sugar roller coaster! One thing missing from this article is the fact that kids need sufficient protein to grow normally on this diet. Don't eliminate protein in favor of fat, or growth may stall. Type 1 diabetics need to learn how to take small amounts of insulin for the slow and steady effect protein has on blood sugar in the absence of carbs.
    Reply: #14
  4. Mary E
    I've been a Type 1 diabetic for 40 years. I changed to a LCHF diet 1.5 years ago. Through this way of eating, I finally have control of my blood sugars. As an added bonus, I lost 20 pounds.
    Dr. Richard Bernstein, also a Type 1 diabetic, promotes this way of eating in his book, "The Diabetes Solution." Followers of Dr. B's recommendations have a FaceBook group, TYPEONEGRIT. The group is an excellent source of information, support, and ideas.
  5. RD
    Thousands of people are doing this and achieving normal blood sugars. Its the only game in town. Results posted here. http://typeonegrit.blogspot.com

    Common Experience:
    1. Both hyperglycemia and hypoglycemia are reduced almost to zero.
    2. Normal, non-diabetic A1c achieved.
    3. Depression removed.
    4. Complications of hyperglycemia removed.
    5. Probability of DKA vanishes.
    6. Stunted growth and cognitive issues found in T1 kids both resolved via normal blood sugars.
    7. No deprivation - the food is fantastic.

  6. Nate
    Hey Fredrik thanks for the great article. And, thanks to all the commenters for their encouraging comments.

    I read Dr. Bernstein's book 11 years ago and never looked back. After reading the pages on gastroparesis, I started yelling and cursing. I knew I had it and was mad that my doctor never mentioned that possibility to me. I had had some very close calls while driving 11 years ago.

    I 'm now very thankful to Dr. Bernstein and all of the other people who have helped me with my LCHF diet. Without them, I believe that I would not be able to celebrate my 50th anniversary as a T1 in September.

  7. Pierre
    "Type 1 diabetes is an autoimmune disease that we don’t know how to prevent."

    Epigenetics in autoimmune diseases with focus on type 1 diabetes.


    With the obesity epidemic and type II diabetes, I guess you can expect a rise in children with type I diabetes born from obese parents.

    Replies: #8, #10, #16
  8. Paul TR
    "I guess you can expect a rise in children with type I diabetes born from obese parents."

    True. Unless children of the obese parents will not follow the habits of their parents, mainly dietary habits. That's epigenetics for you.

  9. Dr. Carrie Diulus
    I am a Type 1 diabetic and a physician. I manage my own condition with LCHF and low dose insulin and recommend it for patients. Thank you for articles like this to help people understand that this is a very valid option for managing this disease.
  10. Nate
    Yes, Pierre, I agree. In fact, I think I have read that the percentage of T1's in many populations has increased a little in the last few decades.

    Another hypothesis about why this increase is occurring is leaky gut. Leaky gut diagnoses is also increasing. The increase in leaky gut and thus maybe T1 is probably due to several things. Dr. William Davis explains the dangers of modern wheat in his book Wheat Belly. Dr. Natasha Campbell-McBride explains the dangers of antibiotics, pain killers with long continuous use, bottle feeding babies, stress, etc in her book, Gut and Psychology Syndrome.

    To help my gut and it's billions of buddies, I like to consume bone broth and fermented foods.

  11. Nate
    Dr. Bernstein talks about the honeymoon period that a few newly diagnosed T1's experience. For the first few months, these T1's can stop taking their insulin and still maintain normal blood sugars. However, they must, as I remember, cut out sugar and maybe starchy foods. I actually met a young man in his twenties that said he was experiencing a honeymoon from his newly diagnosed T1.

    I'm wondering if those people could avoid becoming T1, if they immediately started a full court press to heal their gut. In other words, stop all things that can damage their gut lining and microbiology. Then at the same time, consume a lot of things that will heal their gut.

  12. Eric
    For people consuming hflc diet what ia the most likely vitamin
    Or mineral to be low or sub optimal
    And the best way or ways to avoid this problem?
    Take multi vitamin and mineral?
    How much broccoli
    Cabbage, or cauliflower can you eat in a week on 20 to 30 grams of carbs per day (assume 4 dairy and 4 in egg) leaves 12 other grams per day or about 8 ounces (227 grams) of vegetables per day.

    Would vitamin C maybe the only questionable low or not?
    Is the requirement for C less or very low on no grain and no sugar diets?
    Assume 36 eggs per week, 48 ounces beef, 12 ounces salmon, lots of butter and two cups home made chicken stock and coconut oil (besides c what might be low?)

    Reply: #13
  13. Zepp
    Its the same vitamine and mineral that others in your country get shortige of, by soil and preferable foods!

    C-vitamine is seldome any problems.. if you eats real and fresch food.

    In Scanindavia its often Selen, iodin if one dont live by the sea.. and very often D3, K2 and folic acid!

    You can always eat a lot of green leafs.. eat a pound of spinach for 10 grams of carbs!

    A pound of spinach is a mountain to eat!

  14. Marie
    Hi Kim,
    Could you please share more about amount of protein required for a growing child with T1? my daughter was diagnosed 6 months ago and after following the typical high carb diet recommended by doctors we recently switched to a low carb diet and increased proteins but her weight has remained unchanged in the last few months. We've also heard (Dr. Rosedale) that too much protein can have a negative impact on the body so what is a right amount of proteins? and what should her intake a fat look like? thanks in advance for any advice you may have.
  15. 1 comment removed
  16. Tonnia Williams
    Pierre, That is not how Type 1 diabetes "works". type 1 is an autoimmune disease. Type 2 diabetic parents will not "produce" type 1 children.
  17. Stephanie
    I just started keto eating and am insulin pump diabetic, also on CGM. I have noticed low basal rates and steady levels. However, at 3am my sugar spikes significantly and requires bolus to bring it down . Any way to prevent this other then raising my basal rate. My basal rate already differs greatly in middle of night (12am-2am 0.4 and then spikes to 1.4 at 2-4 and then drops back down. Will this spike in insulin preclude the benefit and weight loss that the keto diet offers?
  18. Stephanie
    Hi Stephanie (great name by the way) I too have type one, And CGMS. I think that the only way to avoid the 3 am spike IS indeed to increase your basal. I suggest that you look at when your BG begins to rise, and then increase your basal by the smallest increment your pump will allow, 2 hours before the rise starts. In other words if your BG starts to increase from say midnight, a small increase from 10 pm would be the way to go to start with. This gives the small increase time to actually stop the BG rising. Because once it starts to go up you will likely have an increased liver output which means you will probably need a bigger increase in basal rate. Hope this helps.
  19. Leonie Johnston
    I too have type 1, am on a pump and eat LCHF. I also play competitive racquetball. This morning, before I played, my BG was 6.8 mmol/L. After a 40 minute match, during which time I only consumed water, my BG was14.4 mmol/L. I corrected but it took 4 hours to get my level back to 5.9. How can I prevent this spike?
  20. Kristin Parker Team Diet Doctor
    Leonie, exercise can raise blood sugar for T1 diabetics and the more vigorous the exercise, the more it can affect that reading. You may wish to speak with your doctor about how best to adjust your medication to fit your specific situation.
  21. Leonie Johnston
    I’m now in ketosis & doing intermittent fasting (16:8), which has really streamlined my BG levels. Unfortunately I’m unable to find a doctor, diabetic educator or endo in Adelaide, South Australia, who knows more about LCHF / ketosis etc than I do, which is extremely frustrating. It’s also disheartening to talk to doctors who think ketosis & Ketoacidosis are both dangerous to type 1s.
    Diabetes SA considers 130g carbs/day is low carb so dealing with someone eating 30g-40g/day is totally foreign to them & considered too risky to ‘attempt’.
    Diet Doctor is a fantastic resource but I miss having someone to personally discuss medication changes & the like with. My ‘support team’ basically says that what I’m doing seems to be working so “carry on”. How disgraceful is that???
    Reply: #23
  22. Eleonora
    I 've started LCHF 10 days ago and already could see great results with T1 ( since 5years) , the levels are very stable, hypoglycemia is not anymore an issue,but I have the same problem- finding reliable dietitians in Italy ...my family doctor is not familiar with the plan
  23. Warwick HARTY
    Hi Leone
    I am a T1D also. You may not have any LCHF dieticians in SA but there are lots elsewhere in Australia, who you can zoom. Try metro dietetics in Melb or Jessica Turton in sydney

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