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The glycaemic benefits of a very‐low‐carbohydrate ketogenic diet in adults with Type 1 diabetes mellitus may be opposed by increased hypoglycaemia risk and dyslipidaemia
Abstract
Aims: To investigate whether very‐low‐carbohydrate high‐fat diets, typical of ketogenic diets, can improve glycaemic control without causing any ill health effects in adults with Type 1 diabetes. Methods: In this observational study, 11 adults with Type 1 diabetes (seven men, four women, mean ± sd age 36.1± 6.8 years, mean ± sd duration of diabetes 12.8 ± 10.3 years), who followed a ketogenic diet (< 55 g carbohydrate per day) for a mean ± sd of 2.6 ± 3.3 years (β‐hydroxybutyrate 1.6 ± 1.3 mmol/l), underwent sampling and analysis of fasting blood, and were fitted with a blinded continuous glucose monitor for 7 days to measure glycaemic variability. Results: The mean ± sd HbA 1c levels were 35±4 mmol/mol (5.3±0.4%), and participants spent 74±20 and 3±8% of their time in the euglycaemic (4–8 mmol/l) and hyperglycaemic (>10 mmol/l) ranges, respectively, with little daily glycaemic variability (sd 1.5±0.7 mmol/l; coefficient of variation 26±8%). Blood glucose levels were <3.0 mmol/l for 3.6% of the time, and participants experienced a median (range) of 0.9 (0.0–2.0) daily episodes of hypoglycaemia. Total cholesterol, LDL cholesterol, total cholesterol/HDL cholesterol ratio, and triglycerides were above the recommended range in 82%, 82%, 64% and 27% of participants, respectively; however, HDL cholesterol levels were within the recommended range for all participants. Participants displayed no or little evidence of hepatic or renal dysfunction. Conclusion: This study provides the first evidence that, ketogenic diets in adults with Type 1 diabetes are associated with excellent HbA 1c levels and little glycaemic variability, but may also be associated with dyslipidaemia and a high number of hypoglycaemic episodes.
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“However, its effects on lipid parameters remain contentious. Some studies report positive improvements, while others observe increases in lipid profiles [8, 9].”
From Ketogenic diet-induced changes in adult lipid metabolism: a comprehensive systematic review and meta-regression of randomized controlled trials (2026) · cites this paper as [8]
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“Hypoglycaemia is possible if hypoglycaemic drugs are also taken [74].”
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Self-citationA Low Carbohydrate Diet in Type 1 Diabetes
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Evidence-based European recommendations for the dietary management of diabetes
The Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD), Aas, A.-M., Axelsen, M., Churuangsuk, C., Hermansen, K., Kendall, C. W. C., Kahleova, H., Khan, T., Lean, M. E. J., Mann, J. I., et al. (2023) · Diabetologia · doi:10.1007/s00125-023-05894-8 · Cited by 262
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Nutritional ketosis for weight management and reversal of metabolic syndrome
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Ketogenic diets and chronic disease: weighing the benefits against the risks
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Low-Carb and Ketogenic Diets in Type 1 and Type 2 Diabetes
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Metadata
- Authors
- Leow, Z. Z. X., Guelfi, K. J., Davis, E. A., Jones, T. W., & Fournier, P. A.
- Affiliations
- The University of Western Australia (AU)
- The Kids Research Institute Australia (AU)
- Corresponding author
- Leow, Z. Z. X.
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2018-05-23
- Volume
- 35
- Issue
- 9
- Pages
- 1258-1263
- ISSN
- 0742-3071 (ISSN-L)
- 1464-5491
- OpenAlex
- W2799506931
- Cited by
- 115
- References
- 14
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 18 · 2023: 13 · 2022: 15 · 2021: 13 · 2020: 17 · 2019: 14 · 2018: 4
- FWCI
- 8.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetic Medicine (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Funders
- University of Western Australia
- Topics
- Health Sciences › Medicine › Physiology (medical) › Diet and metabolism studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Physiology (medical) › Dietary Effects on Health
- Keywords
- ketogenic diet, very low carbohydrate diet, type 1 diabetes, glycemic control, glycemic variability, hypoglycemia, dyslipidemia, lipid profile, continuous glucose monitoring, beta-hydroxybutyrate, liver and kidney function
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