Managing Type-1 Diabetes with Nutrition

Sep 13, 2018

“Type-1 Diabetes doesn’t just mean one devastating diagnosis it means: 4-8X the risk for cardiovascular disease, 4X the risk for cancer, 3.5X the risk for kidney disease, 80% chance of vision impairment, increased risk for cognitive decline and a life cut short by over a decade.”

APK_Photo.jpgAndrew Koutnik, a graduate student at the University of South Florida, College of Medicine, and Type-1 diabetic himself, is educating and empowering those with Type-1 Diabetes to look at their disease through the lens of nutrition. In his recent TEDx talk he shares his personal experience and scientific perspective on how nutrition plays a significant role in the management of this disease. His ultimate goal is simple: he wants to provide valid scientific information on the topic of nutrition and Type-1 diabetes, and the answers to the many questions Type-1 diabetics may be asking; the information he undoubtedly wished he had access to when diagnosed at the age of 16. He truly comes from a place of passion, and as an academic his knowledge and in depth understanding of the problem at hand, glycemic control, is invaluable. He is opening up the eyes of many to the relationship between the food on your plate and the management of this disease.

We at KetoNutrition want to help spread his message because we are truly inspired by what Andrew is doing for the Type-1 diabetic community, and we believe that what he has to share can impact the lives of many.

Andrew’s TEDx talk is highly recommended as an entry into the world of how a Very Low-Carbohydrate Diet can be used to manage Type-1 Diabetes:

Andrew has thoughtfully, and very generously, put together a three-part series to accompany his TEDx talk, and we think (know) EVERYONE can benefit from reading it, not just those with diabetes.

Part 1: What is Type-1 Diabetes?

Part 2: The Risks and Complications of T1D and Current Management Tools

Part 3: Can You Achieve Optimal Blood Glucose Control as a Type-1 Diabetic?

This quote is taken from his work and really encompasses the theme of the series:

“Unfortunately, many Type-1 Diabetics are only given “enough” information to manage their disease to avoid acute health complications. I argue that “enough” is not adequate to optimize glycemic control.”

In Part 1 Andrew discusses:

The History of Diabetes:

  • The experiments underlying the discovery of the disease; ultimately leading to how we distinguish between Type-1 and Type-2 Diabetes
  • Defining Type-1 and Type-2 Diabetes

The Biology of Type-1 Diabetes Initiation

  • What causes Type-1 Diabetes
  • Type-1 Diabetes as an autoimmune disorder
  • The role of insulin and insulin producing pancreatic beta-cells
    • How insulin manages our blood glucose
  • The difference between a Type-1 Diabetic and a healthy individual

The Pros and Cons of Type-1 Diabetes as a Patient and a Researcher

  • Inevitably, a diabetes diagnoses creates the learning ground for understanding metabolism and how your body works on a whole new level
    • As a researcher who studies metabolism, to Andrew, learning which lifestyle factors play a role in glycemic control is incredibly insightful
    • This is not the case for most Type-1 diabetics

And finally, Why Managing Type-1 Diabetes is So Difficult

  • He answers this question by eluting to the many factors that influence glycemic control: sleep, growth hormones, dawn phenomenon, exercise, nutrition (arguably the most important), insulin management, diurnal variation, and others
  • The dangers of unmanaged blood glucose fluctuations

In Part 2 Andrew discusses:

Historical and Practical Diagnostic Biomarker for Assessing Diabetic Glycemic Control: Hemoglobin A1c

  • What is HbA1c and why it is the most important and predictive/diagnostic biomarker for diabetic health

Data on Type-1 Diabetic Glycemic Control

  • The associations between higher HbA1c’s and blood glucose variability/instability

Risks and Complications of Type-1 Diabetes

  • Type-1 Diabetics are at an increased risk for all 10 of the current leading causes of death and on average are predicted to live a decade shorter than non-diabetics therefore a Type-1 Diabetes diagnosis is not simply one diagnosis but rather at an increased risk for various other diseases

Current Treatment Strategies and Outcomes

  • Andrew explains the current diabetic treatment strategies or technologies and whether they offer glycemic control in patients
  • He includes: carbohydrate counting, intensive treated therapy, insulin pumps, continuous glucose monitor (CGM), closed loop (automated CGM + insulin pump), islet-cell and pancreatic transplantation, BCG vaccine, and stem cell therapy

In Part 3 Andrew discusses:

Why the Standard High Carbohydrate Diet is Prescribed for Type-1 Diabetics

  • Type-1 diabetics are recommended to follow a high carbohydrate, moderate protein, low fat diet (aka Standard Dietary Approach), yet there has been no clinical trial to validate that this dietary protocol is optimal for Type-1 Diabetic glycemic management

How Dietary Macronutrient Compositions Influence Non-Diabetic and Type-1 Diabetic Blood Glucose Metabolism

  • Each macronutrient (protein, carbohydrate, and fat) effects blood glucose differently and therefore all three have different insulin requirements

Endogenous vs Exogenous Insulin Influence on Dietary Choices

  • In Type-1 Diabetics, exogenous insulin is required to attenuate blood glucose elevations for both carbohydrates, protein, and the residual production of glucose even during fasting periods (e.g. sleeping or long periods between meals)

Very-Low Carbohydrate Diet’s Influence on Glucose Metabolism and Insulin Requirements

  • Andrew goes into depth on both acute and chronic factors that influence insulin sensitivity and blood glucose flux

Personal Anecdotes Utilizing Both Dietary Options

  • Andrew describes his personal experience with both the standard dietary approach and a very low carbohydrate approach and his personal data

Research on Very-Low Carbohydrate Diets in Type-1 Diabetics

  • Results from a 2018 study on 300 participants from the Type-1 Grit community who had been consuming a very low-carbohydrate diet for at least 3 months showed an average blood glucose of 104mg/dL representing an HbA1c that only 1.28% of Type-1 Diabetics achieve (based on data from T1D Exchange)

As stated previously, Andrew’s insight on this topic is invaluable. Parts 2 and 3 will be released in subsequent weeks following Part 1 and each post covers new topics that will substantially enhance your understanding of Type-1 Diabetes and the role of nutrition in such.


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Written by: Andrew Koutnik

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