Management of Type 1 Diabetes With a Very Low–Carbohydrate Diet

Summary: Very Low–Carb Diet in Type 1 Diabetes

This study surveyed 316 people with type 1 diabetes (including children) who follow a very low–carbohydrate diet (VLCD). Participants reported exceptionally tight blood sugar control, low rates of acute complications, and high satisfaction with their health, while using relatively modest insulin doses. The findings are promising but come from a self-selected online community, so broader proof will require clinical trials.

Key Findings

• Glycemic control: Average HbA1c was 5.67% ± 0.66%, and 97% met American Diabetes Association targets. Continuous glucose monitor averages were about 104 mg/dL with comparatively low variability.
• Insulin use: Mean daily insulin dose was 0.40 U/kg, with about 64% as basal insulin.
• Adverse events: Over the prior year, diabetes-related hospitalizations were rare (2% of participants), with 1% for diabetic ketoacidosis and 1% for hypoglycemia. Severe hypoglycemia (seizure/coma) occurred in 2%, and glucagon use in 4%.
• Diet details: Most set a carb goal and aimed for roughly 36 g/day, achieving it about 6–7 days/week.
• Lipids: On fasting labs, triglycerides were low and HDL was high, while total cholesterol and LDL were often elevated. The study does not make claims about cardiovascular outcomes; it simply reports these values.
• Children: Kids on the VLCD had similar blood sugar results to adults. Height scores were near average, with no evidence here that the diet impairs growth, though more research is needed.
• Care relationships: Many participants felt their professional diabetes care was not supportive of VLCDs; providers who responded tended to rate patients’ diabetes control very highly, and perceived themselves as more supportive than patients reported.

What the Study Says (and Doesn’t)

• The VLCD group reported near-normal blood sugars and low acute complication rates. The authors call this “exceptional” control.
• The study is observational, based on self-reports from a Facebook community, with partial medical record and provider confirmation. It cannot prove cause and effect or generalize to all people with type 1 diabetes.
• The paper does not claim long-term cardiovascular safety or outcomes. It notes mixed lipid profiles and states further trials are required.
• The authors explicitly caution that these findings alone shouldn’t drive clinical practice changes without more research.

Practical Takeaways for People with Type 1 Diabetes

• A structured very low–carb approach (roughly 20–50 g/day; this cohort averaged ~36 g) was associated with lower average glucose, tighter HbA1c, and fewer acute events in this group.
• Insulin doses were lower on average, which may reduce variability, but safe dosing requires careful adjustment of basal and bolus insulin and monitoring.
• Success relied on consistency: participants reported hitting their carb targets most days of the week.
• If considering a VLCD, be aware that many clinicians may be unfamiliar or skeptical; the study highlights communication gaps. The authors emphasize the need for randomized trials to confirm safety and effectiveness.

Relevance

For people living with type 1 diabetes who struggle with post-meal spikes and variability, these findings suggest that a very low–carb strategy can be associated with tighter control and fewer hospitalizations in a motivated community setting. It’s not definitive proof, but it’s a notable signal that deserves rigorous testing.