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Introducing a very low carbohydrate diet for a child with type 1 diabetes.
By: de Souza Bosco Paiva, Caroline, Lima, Maria Helena Melo, British Journal of Nursing, 09660461, 8/8/2019, Vol. 28, Issue 15
"A very low carbohydrate diet (VLCD) (<30 g of carbohydrate/day) had a positive impact, without side effects, on the glycaemic control of a 5-year-old child recently diagnosed with type 1 diabetes
A VLCD normalised HbA1c, stabilised blood glucose levels, and kept blood glucose fluctuations in range most of the time
Basal and rapid-acting insulin daily average dosages could be reduced within days after the introduction of the VLCD
Future studies should follow children with type 1 diabetes of different ages, and verify how a VLCD impacts child development"
"Therefore, monitoring of carbohydrate intake, a major determinant of postprandial blood glucose, is a key strategy for achieving good blood glucose control and preventing complications ()."
"A person with diabetes should choose low-glycaemic-index and nutrient-dense foods because they will not cause blood glucose levels to increase much (). Despite whole grains being regarded as an important source of dietary fibre, and their consumption being encouraged, they also have high glycaemic index, and substitution of white-wheat for wholemeal wheat in bread and pasta does not lead to reduced postprandial blood glucose levels (). In contrast, a very low carbohydrate diet (VLCD) is an easy way to control glucose levels because it causes only a small increase in blood glucose levels at each meal ()."
"The patient was a 5-year-old boy who was diagnosed with type 1 diabetes at the age of 4 years and 9 months. Before being hospitalised, he showed symptoms of diabetic ketoacidosis (DKA), such as thirst, polyuria, vomiting, and fast weight loss. Symptoms appeared about 1 month before the diagnosis. At his diagnosis, on 27 August 2018, his blood glucose was above 600 mg/dL (33.3 mmol/L), and his C-peptide level was at 0.3 ng/ml. He was put on insulin-replacement therapy to cover 50 g of carbohydrate per meal plus 10-15 g of carbohydrate at each snack. The recommendation was to use 0.5 units of rapid-acting insulin to cover every 20 g of carbohydrate, combined with a daily 5.5-unit dose of basal insulin. He was discharged from the hospital on 30 August."
"On 4 September, at his first appointment with the nurse diabetes educator, his blood glucose was 176 mg/dL (9.7 mmol/L) and his HbA1c 10.9%. After 2 weeks unsuccessfully following the physician's recommendations, his mother was inspired by an article by , which showed excellent blood glucose control with a VLCD of 30 g of carbohydrate a day, and decided to reduce his carbohydrate intake accordingly."
"The VLCD described in Lennerz's article consists of 30 g of carbohydrate daily derived from fibrous vegetables and nuts with a low glycaemic index. In this case, high-protein foods with associated fat were substituted for carbohydrates and adjusted on the basis of outcomes, including glycaemic control and weight. To ensure adequate nutrient intake, the amount of protein was increased until the child felt satisfied after meals. The macronutrient distribution of the child's diet became: 70 g of protein, 30 g of carbohydrate and 55 g of fat per day."
"The carbohydrate content of every meal, as well insulin intake, were documented from August 2018 to February 2019 on an Excel spreadsheet. Blood glucose readings (mg/dL) were recorded using a Dexcom G6 (a CGM) and a Freestyle Lite glucometer. HbA1c values were obtained from routine clinical monitoring. The app FatSecret was used to collect information about carbohydrate counting. The case study was approved by the Ethics Committee of the University of Campinas (CAAE: 09131319.7.0000.5404). Both parents provided written informed consent for the study and publication of this article."
"Fortunately, there is evidence of alternative approaches that have resulted in consistently lower HbA1c levels. In the study by , the mean HbA1c achieved by study participants was 5.67 % (36 g of carbohydrate daily). In addition to improved HbA1c rates, other benefits were observed, such as fewer hospitalisations (only 2% over the previous 12 months), lower numbers of hypoglycaemic events, much lower rates of complications, much lower usage of insulin and other medications, and higher levels of satisfaction with health and diabetes control."
"Unrestricted consumption of carbohydrates, even covered by a corresponding insulin dosage, is proving to be a dangerous and ineffective way of lowering HbA1c"
"Although no specific diet for people with diabetes exists, avoiding refined sugar and processed foods, and lowering carbohydrate intake have been shown to be an excellent alternative to intensive insulin therapy."
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