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I'm a type 1 diabetic and find these articles and studies frustrating. Or at least the way people interpret them. > Two weeks after adopting the low carb appro

I'm a type 1 diabetic and find these articles and studies frustrating. Or at least the way people interpret them. > Two weeks after adopting the low carb approach insulin was no longer needed. After 18 months insulin therapy was once again required at low doses of around 16 units per day. HbA1c remained very well controlled on the LCHF diet with insulin. So during the honeymoon period, he was able to live without insulin. This is pretty normal -- there's about a year after T1D diagnosis where the pancreas continues to produce insulin. It's common for people to be able to make it through that period with reduced insulin therapy. And then after 18 months he had to start on low doses of insulin again, even with the diet. Low carb diets can help type 1 diabetics, but it's not a cure. Please don't go around suggesting to your T1D friends that they just need to start on keto, and can stop taking insulin.

surfallday 6y ago
great point to balance out the hype! This should be mentioned by article authors! I appreciate that comment.
entitydc 6y ago
Same feelings as you on this one - not that it isn’t par for the course with most science journalism, but it’s especially frustrating for T1 news. Perpetually thankful that we’re only five years from a cure.
- Trasmatta 6y ago
  Yeah, it's always the same. Either we're five years away from the cure, a magical cure was just discovered, or somebody just "discovered" that keto can cure T1D.
rhinoceraptor 6y ago
Hugely reducing insulin dosing is still probably valuable, especially for Americans since it's so expensive.
- ng12 6y ago
  Yes, but any T1D is acutely aware of this fact. The whole treatment regimen is ratioing carbs to insulin.
- nick0garvey 6y ago
  It's expensive but not as bad as you'd think. I didn't have insurance for half a year, and I just called the manufacturer and got a huge discount ($200/bottle -> $35/bottle). One bottle lasts a month or so. This was only due to not having insurance and wasn't need-based - I had earned FAANG income earlier that year and the year before.
  - Kye 6y ago
    Both those prices seem excessive.
    - ovi256 6y ago
      The best part of economic freedom is that one is free to start a manufacturer delivering a cheaper whatever one is complaining is too expensive!
      - anchpop 6y ago
        It's possible the price is too high, but the reason it has that price $35/bottle is the minimum required to sustainably produce it. It's well accepted in economics that price of manufacture is not necessarily the societally optimal price [0]. If this is the case, what needs to be done is government subsidization, and no individual person can just start a company and do it themselves. Also, the idea that everyone is free to start manufacturing insulin ignores the billions of dollars of capital that is required to create a FDA-compliant insulin production plant, which almost no one on earth has access to. [0]: https://www.investopedia.com/terms/e/externality.asp https://www.investopedia.com/terms/e/externality.asp
      - arexxbifs 6y ago
        "Not only are the big three insulin manufacturers financially opposed to biosimilars entering the market, they’ve actively taken legal steps to prevent it." https://beyondtype1.org/how-much-does-it-cost-to-produce-insulin/ https://beyondtype1.org/how-much-does-it-cost-to-produce-ins...
DataDaoDe 6y ago
Here is the actual study [1]. This is n=3, so we are talking about highly anecdotal data. Nonetheless, I think this statement is misplaced: > Low carb diets can help type 1 diabetics, but it's not a cure Likely, as in most cases, the real picture is much more complex. It could be the case that LCHF diets can cure some percentage of individuals, can help some percentage and can be detrimental perhaps even fatal to some percentage. All of these could easily be simultaneously true. Indeed, in case 1 it seems to have possibly "cured" the patient, though he could have also easily been a false positive or there could have been any number of other confounding factors. I quote from the study: "He was able to stop insulin completely 15 days later (after diagnosis), and has not used insulin since March 2015." and "In the 4 years since his diagnosis, he has had no diabetes-related complications". Here is patient #2's summary: "He stopped insulin therapy at the beginning of the diet and has not used insulin since, except for one infectious episode." and " At 1 year after the diagnosis, he had no diabetes-related complications". Also of note, both of these patients had started exercising 1-2 h a week, and 2 and 2-3 times a week respectively, before the diagnosis. 1. https://www.sciencedirect.com/science/article/abs/pii/S1262363619300953 https://www.sciencedirect.com/science/article/abs/pii/S12623...
- cperciva 6y ago
  It's well understood that insulin production in type 1 diabetics can continue at low levels for ~5 years post-diagnosis; the process of beta cell destruction is a gradual one and diagnosis typically occurs after 80-90% of beta cells function has been lost.
- HeadsUpHigh 6y ago
  You need a small amount of insulin even during ketocis, otherwise you will go into ketoacidosis. Type 1 diabetics suffer from destruction of b islet cells and thus have reduced to zero insulin production. There are some reasons why you might have a small insulin production( e.g. acute pancreatitis destroying some but not all b islet cells) but those are pretty rare. For most people the destruction happens as a result of an auto-immune disorder and eventually they all get destroyed. So maybe there's a period between the diagnosis( usually around ~90% destroyed cells) and when all cells get destroyed that you can manage it with keto. But it won't last forever and thus is not a cure.
headShrinker 6y ago
...
- venantius 6y ago
  I’m also a T1D. I assure you, lots of diabetics have tried keto diets. It doesn’t put the disease “in remission”. That’s not how the disease works.
  - headShrinker 6y ago
    ...
    - entitydc 6y ago
      You’d be off base in questioning any of that, at least as the central premise that “X person didn’t have Y effects because they ate too much Z macro.” Keto, when strictly followed, provides a great reduction to bolus needs (in personal experience, 80-90% reduction, depending on protein intake), and a lesser, but still significant, reduction to basal needs (30% in my case); however, both types of insulin are absolutely still needed to prevent high blood sugars in an environment with no insulin, which is a significant risk of DKA (and death). Protein metabolizes into excess sugar in the blood stream as well, so unless you’re eating a pure fat diet, you will still need insulin. In addition to that, there are hormones (cortisol for sure), and other non-macro nutrients and alkaloids (a common report is caffeine, but this very much depends on individual biochemistry) that can cause rises in blood sugar, which require insulin to compensate for. A type 1 diabetic without honeymoon insulin production will still die after a period of even the strictest of ketogenic diets. It was the treatment prior to the introduction of insulin, and was effective at extending the lives of diabetics; they would typically be able to live up to 3 or 4 years post-diagnosis before eventually dying. For the record, my body enters keto at or around 45g/day, as measured by the presence and amounts of ketones; anyone who says “you need exactly N grams per day or it isn’t keto” is extrapolating from generalized experience at best. The problem with keto isn’t that it isn’t effective for some things, it’s that people go a long way to oversimplify both the science behind it and the impacts it can have on other conditions by over applying that lens of simplification. It’s a good diet for some, but it isn’t a free lunch (pun not intended) - and it’s far from something that can eliminate the needs of insulin in type 1 populations, as this article alludes to.

surfallday 6y ago

great point to balance out the hype! This should be mentioned by article authors! I appreciate that comment.

entitydc 6y ago

Same feelings as you on this one - not that it isn’t par for the course with most science journalism, but it’s especially frustrating for T1 news. Perpetually thankful that we’re only five years from a cure.

Trasmatta 6y ago
Yeah, it's always the same. Either we're five years away from the cure, a magical cure was just discovered, or somebody just "discovered" that keto can cure T1D.

rhinoceraptor 6y ago

Hugely reducing insulin dosing is still probably valuable, especially for Americans since it's so expensive.

ng12 6y ago
Yes, but any T1D is acutely aware of this fact. The whole treatment regimen is ratioing carbs to insulin.
nick0garvey 6y ago
It's expensive but not as bad as you'd think. I didn't have insurance for half a year, and I just called the manufacturer and got a huge discount ($200/bottle -> $35/bottle). One bottle lasts a month or so. This was only due to not having insurance and wasn't need-based - I had earned FAANG income earlier that year and the year before.
- Kye 6y ago
  Both those prices seem excessive.
  - ovi256 6y ago
    The best part of economic freedom is that one is free to start a manufacturer delivering a cheaper whatever one is complaining is too expensive!
    - anchpop 6y ago
      It's possible the price is too high, but the reason it has that price $35/bottle is the minimum required to sustainably produce it. It's well accepted in economics that price of manufacture is not necessarily the societally optimal price [0]. If this is the case, what needs to be done is government subsidization, and no individual person can just start a company and do it themselves. Also, the idea that everyone is free to start manufacturing insulin ignores the billions of dollars of capital that is required to create a FDA-compliant insulin production plant, which almost no one on earth has access to. [0]: https://www.investopedia.com/terms/e/externality.asp https://www.investopedia.com/terms/e/externality.asp
    - arexxbifs 6y ago
      "Not only are the big three insulin manufacturers financially opposed to biosimilars entering the market, they’ve actively taken legal steps to prevent it." https://beyondtype1.org/how-much-does-it-cost-to-produce-insulin/ https://beyondtype1.org/how-much-does-it-cost-to-produce-ins...

DataDaoDe 6y ago

Here is the actual study [1]. This is n=3, so we are talking about highly anecdotal data. Nonetheless, I think this statement is misplaced: > Low carb diets can help type 1 diabetics, but it's not a cure Likely, as in most cases, the real picture is much more complex. It could be the case that LCHF diets can cure some percentage of individuals, can help some percentage and can be detrimental perhaps even fatal to some percentage. All of these could easily be simultaneously true. Indeed, in case 1 it seems to have possibly "cured" the patient, though he could have also easily been a false positive or there could have been any number of other confounding factors. I quote from the study: "He was able to stop insulin completely 15 days later (after diagnosis), and has not used insulin since March 2015." and "In the 4 years since his diagnosis, he has had no diabetes-related complications". Here is patient #2's summary: "He stopped insulin therapy at the beginning of the diet and has not used insulin since, except for one infectious episode." and " At 1 year after the diagnosis, he had no diabetes-related complications". Also of note, both of these patients had started exercising 1-2 h a week, and 2 and 2-3 times a week respectively, before the diagnosis. 1. https://www.sciencedirect.com/science/article/abs/pii/S1262363619300953 https://www.sciencedirect.com/science/article/abs/pii/S12623...

cperciva 6y ago
It's well understood that insulin production in type 1 diabetics can continue at low levels for ~5 years post-diagnosis; the process of beta cell destruction is a gradual one and diagnosis typically occurs after 80-90% of beta cells function has been lost.
HeadsUpHigh 6y ago
You need a small amount of insulin even during ketocis, otherwise you will go into ketoacidosis. Type 1 diabetics suffer from destruction of b islet cells and thus have reduced to zero insulin production. There are some reasons why you might have a small insulin production( e.g. acute pancreatitis destroying some but not all b islet cells) but those are pretty rare. For most people the destruction happens as a result of an auto-immune disorder and eventually they all get destroyed. So maybe there's a period between the diagnosis( usually around ~90% destroyed cells) and when all cells get destroyed that you can manage it with keto. But it won't last forever and thus is not a cure.

headShrinker 6y ago

...

venantius 6y ago
I’m also a T1D. I assure you, lots of diabetics have tried keto diets. It doesn’t put the disease “in remission”. That’s not how the disease works.
- headShrinker 6y ago
  ...
  - entitydc 6y ago
    You’d be off base in questioning any of that, at least as the central premise that “X person didn’t have Y effects because they ate too much Z macro.” Keto, when strictly followed, provides a great reduction to bolus needs (in personal experience, 80-90% reduction, depending on protein intake), and a lesser, but still significant, reduction to basal needs (30% in my case); however, both types of insulin are absolutely still needed to prevent high blood sugars in an environment with no insulin, which is a significant risk of DKA (and death). Protein metabolizes into excess sugar in the blood stream as well, so unless you’re eating a pure fat diet, you will still need insulin. In addition to that, there are hormones (cortisol for sure), and other non-macro nutrients and alkaloids (a common report is caffeine, but this very much depends on individual biochemistry) that can cause rises in blood sugar, which require insulin to compensate for. A type 1 diabetic without honeymoon insulin production will still die after a period of even the strictest of ketogenic diets. It was the treatment prior to the introduction of insulin, and was effective at extending the lives of diabetics; they would typically be able to live up to 3 or 4 years post-diagnosis before eventually dying. For the record, my body enters keto at or around 45g/day, as measured by the presence and amounts of ketones; anyone who says “you need exactly N grams per day or it isn’t keto” is extrapolating from generalized experience at best. The problem with keto isn’t that it isn’t effective for some things, it’s that people go a long way to oversimplify both the science behind it and the impacts it can have on other conditions by over applying that lens of simplification. It’s a good diet for some, but it isn’t a free lunch (pun not intended) - and it’s far from something that can eliminate the needs of insulin in type 1 populations, as this article alludes to.