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The Ultimate Guide To Low Carb Diets For Diabetics

There’s a lot online about the benefits of low carb diets for weight loss. However as diabetics we need to be extra careful with our diets. Low carb diets can be incredibly effective for normalising your blood sugars and reducing you requirements of diabetic medications. In this article we will take a look at what low carb diets mean for diabetics and whether it could be a good option for you.

Why follow a low carb diet?

As diabetics the biggest battle we face is keeping our blood sugars in a normal range. There’s a frustratingly long list of factors that can affect blood sugar, but there’s no question that the number one cause of blood sugar rises is eating carbs. Carbohydrate is the macronutrient which is most readily converted into glucose and so gives the largest and fastest spike in blood sugar when eaten.

Stopping these rises in blood glucose from eating carbs is the most challenging part of maintaining normal glucose levels and it is the main benefit of a Low Carb diet for diabetics. Reducing the size and time of blood sugar rises, as well as the medicine required to treat them has many knock on benefits which lead to a positive cycle of easier control and better glucose levels for diabetics.

Meat and Veggies
Meat and Veggies

What exactly is a low carb diet?

Low carb diets are fairly simple. The main goal is to choose the lowest amount of carbohydrate in your diet that gives you the best balance of control and sustainability. Generally low carb diets consist of under 100g of carbs per day and can go as low as under 30g per day. The goal is to get your daily carbs as low as possible, but you may find they can still achieve great results with a looser restriction. The real test for whether you are eating the right amount of carbs is whether you are able to consistently achieve blood sugars in a normal range most of the time.

How To Start a Low Carb Diet

From Visually.

Alternative source of calories

Removing most of the carbs from your diet will result in your diet relying much more heavily on fat and protein. Since you may not want to lose any weight (as is often the case with Type 1 Diabetics) following a low carb diet often means you increase the amount of fat and protein you eat on a daily basis to make up for your lost calories. Your body primarily uses carbohydrates for energy, but it is just as capable of getting this energy from fat and protein if there is not an excess of carbohydrate in your diet.

Don’t we need carbohydrates in our diet?

Carbohydrates, protein and fat all provide energy for our bodies. The body converts these nutrients into energy in different ways. Carbohydrates are quickly and easily broken down by the body into glucose which is transported around the body in our blood. 

Note

Our bodies normally prioritise carbohydrate as a source of energy as it is easily digested and energy rich. However this does not mean that we should prioritise carbohydrates over other nutrients in our diet. 

Carbohydrates are not as important as you think

In fact, unlike essential amino acids (proteins) and essential fatty acids (fats) there are no known carbohydrates that are essential for health.

The speed and quantity of glucose that enters the bloodstream from eating large amounts of carbs is a real problem for diabetics to manage. Diabetics are simply not capable of producing or using enough insulin to counterbalance the surge of glucose in the blood and are usually forced to take large doses of injected insulin as a result.

Note

Minimising the carbs in our diet means we can reduce the negative effects of these blood sugar rises without losing any essential components of a healthy diet.

A Healthy Balanced Meal
A Healthy Balanced Meal

Is a Low Carb diet safe for people with diabetes?

Low carb diets are safe for diabetics but it is extremely important that you talk with your doctor and look at adjusting your dosage of medicines to match your new diet. One of the most common side effects for diabetics switching to a low carb diet is that they get episodes of low blood sugar (hypoglycemia). 

In fact this is not a symptom of the low carb diet but rather a result of the larger dosage of medication they have been required to take to counterbalance their previous higher carb diet. If the dosage of medicine is not updated to match the new lower carb diet then it may overshoot your blood glucose levels and push your blood glucose down into hypoglycemia.

Here is a video explaining the difference of Type 1 and Type 2 Diabetes.

How does a low carb diet affect insulin dose and medications?

It is actually much easier to estimate doses for insulin and swallowed medication on a low carb diet. This is because the margin of error for carb counting and absorption rate is also reduced. This is commonly referred to as the law of small numbers.

You will also need to look at how the new diet may affect your weight. Most type 2 diabetics would benefit from weight loss and the new lower carb diet will usually start helping you shed some pounds over a few months.

Tip

You will need to keep rechecking your medicine dose as you lose weight as this usually helps reduce insulin resistance and the need for medicine in type 2 diabetics

Low carb diet for Type 1 Diabetics

If you are a type 1 diabetic like myself, then you are probably trying to avoid losing weight and may even be actively trying to gain weight. In this case the key to the low carb diet is making sure you are still reaching your target daily calories. This may mean adding extra protein and fats to your diet to make up the lost calories from cutting out the carbs. There is usually no problem with this increase in protein for a healthy individual but it may put too much strain on your kidneys if they are heavily damaged from diabetic complications.

Note

If your diabetes has caused any level of kidney damage then the increased protein intake of a low carb diet may cause issues. 

Effects of low carb diet on diabetics

A study from 2005 measured 22 Type 1 Diabetics for 12 months. They were split into two groups, one that ate 70-90g of carbs per day and the other on an extremely low carb diet of less than 20g of carbs per day. The results showed that episodes of hypoglycemia actually dropped in the low carb group. This is because the amount of insulin they were required to take also dropped meaning they were less likely to make a dosage mistake that pushed them into hypoglycemia. The low carb group also saw a reduction in their HBA1C from an average of 7.5% to 6.4%.

Will a low carb diet help me lose weight?

In a word… yes! Low carb diets have been shown again and again to help you lose weight.

Cutting out most of the carbs in your diet means that you don’t need to produce or inject as much insulin to balance it. Since insulin is the primary hormone used in storing glucose as fat then less insulin will help reduce fat storage.

In addition, if you don’t make an active effort to up your protein and fat intake, a lower carb diet will usually result in eating less calories per day.

Note

You will also benefit from the fact that unlike carbohydrates, protein and fat tend to make you feel full and satisfied for a long period of time after eating. 

Utilizing fats stored in our body

Together these factors mean that you will probably be eating less calories than you are used to and will start to use some of your existing fat stores for energy.

You can see some amazing progress pics from people who have recently switched to low carb diets in the r/keto subreddit. This is a great place to check out every now and again for some motivation if you are aiming to lose weight through a low carb diet.

It all comes down to the fact that you will be:

  • Eating less calories
  • Eating more healthy nutritious food.

Tip

Cutting out carbs will naturally mean you will have to cut out 90% of the processed junk food you eat every day. The great thing is you will get to eat some equally tasty protein and fat food sources instead so you won’t feel deprived.

A super easy demonstration of this is comparing how much steak you could eat instead of a bar of chocolate:

1 candy bar:

Chocolate Bar Split in Half
Chocolate Bar Split in Half

200g of beef steak:

Beef Steak Served on a Plate
Beef Steak Served on a Plate

If you are eating a carb rich diet the bulk of your calories will be coming from

  • Candy
  • Soda
  • Pasta
  • Rice
  • Bread
  • Dairy
  • Pastries

By cutting these out as part of your low carb diet you will also cut out a big chunk of your calories. You will most likely not match your current calorie intake by eating a satisfying amount of vegetables, protein and fats.

What if I don’t want to lose weight?

If your a type 1 diabetic like me, then you’re probably worried about the idea of losing more weight. Most Type 1 diabetics struggle with weight gain and the idea of switching to a diet that can be used for weight loss may be a bit of a turn off.

The reality is that a low carb diet is very flexible and can be shifted towards the goal of weight loss or weight gain to meet your needs. There are huge benefits for type 1 diabetics in adopting a low carb diet so it’s important to stack your diets so it can be sustainable for you no matter your goals.

Gaining Weight with Low Carb Diet

I have not noticed any weight loss from switching to a low carb diet as a type 1 diabetic and I have found it much easier to gain weight by upping my calories. At the end of the day if we want to gain weight we need to consume a surplus of calories. But we need to eat a surplus of calories that our bodies are able to use! The reason why so many type 1 diabetics struggle to gain weight is because they are constantly running with high blood sugar because their cells are not able to uptake the glucose in their blood.

Note

If your cells are not able to absorb the glucose from your food it doesn’t matter how much you eat, you’re going to lose weight. You’ll simply be eating large amounts of calories that end up in your urine, completely skipping any opportunity for your cells to store or use them.

Checking for Blood Glucose Levels Using A Glucometer
Checking for Blood Glucose Levels Using a Glucometer

Maintaining Glucose and Insulin Levels

On a low carb diet your glucose and insulin levels will be much more stable and manageable. You will much more easily and consistently be hitting normal blood glucose ranges for long periods of time. This means your cells are able to benefit from the calories you are eating and start to use them to build and grow.

…a low carb diet can actually be an optimal way for Type 1 Diabetics to gain weight

So a low carb diet can actually be an optimal way for Type 1 Diabetics to gain weight. The only difference is they need to focus on getting their required calorie intake from protein and fats. This is usually as simple as eating a larger portion of protein in your meals than you are used to.

What are the benefits of a low carb diet for diabetics?

To start with, let’s get rid of the common mistake. Ketosis is not Ketoacidosis! A very popular type of low carb diet is the Ketogenic diet. The aim of the diet is to put your body into a ketogenic state when it starts to use ketones for fuel. This is not the same as the dangerous state of Ketoacidosis that diabetics find themselves in after their blood sugars have soared off the charts. 

What is Ketoacidosis?

Ketoacidosis is an unnatural and life threatening condition for people with Type 1 diabetes that is brought about through extremely high blood sugars. It is not the same as the natural condition of nutritional ketosis. These two things sound the same but they are completely different. You may even find your doctor begins to worry at the first mention of ketones because of this misconception. If this is the case you should ask your doctor to read about ketogenic diets and their benefits for diabetics or find a new doctor.

So just to be completely clear, ketogenesis is not the same as ketoacidosis.

Here is a brief video explaining what Ketoacidosis is

Can a low carb diet prevent diabetes?

Improving diet, weight loss and exercise have been shown to prevent the progression of developing diabetes. The combination of these factors can even help Type 2 diabetics completely get off of medication and they may be able to control their diabetes from diet and exercise alone for the rest of their lives.

Benefits of Low Carb Diet

For Type 1 diabetics there is no way that any diet can reverse or stop the condition. No matter what miracle fads are being sold there is no trick or tactic for curing Type 1 diabetes. 

…good blood glucose levels help prevent diabetic complications

Trust me if there was one I would do it. There is however a big benefit for type 1 diabetics in having good control of their blood glucose levels. Not only will good blood glucose levels help prevent diabetic complications later on down the line but it will also help you manage your diabetes today.

Insulin Resistance

Keeping consistent controlled blood glucose levels have been shown to help reduce insulin resistance meaning your insulin doses will be easier to calculate and more effective. It has also been suggested that maintaining normal blood glucose levels can minimise the rate of beta cell burnout that type 1 diabetics experience. This is especially beneficial for recently diagnosed Type 1s because they may still have a large quantity of functioning beta cells. Minimising the rate that these cells are destroyed will have a huge affect on how easy it is to treat your diabetes in the years ahead.

Note

Adopting a low carb diet can give a virtuous circle of lower carbs intake leading to better glucose levels, which in turn lead to easier dosing and control, which leads to less insulin resistance and less beta cell burnout.

What should I eat on a low carb diet?

We are trying to minimise our carbs but that doesn’t necessarily mean we need to eliminate them completely from our diet. I have found it easiest to completely remove some things like bread, rice, pasta and potatoes from my everyday meals. I found eating small amounts of these foods wasn’t satisfying and you end up craving more of them. I found it was a better approach to try to create a new diet that consisted of low carb foods as staples that you can eat as much as you want.

Meat and Asparagus Dish
Meat and Asparagus Dish

What are examples of low carb foods?

Avocados, cheese, eggs, meat, fish, oils and nuts are all great staples. You can even make some low carb replacements for flour based products with almond flour. There’s an endless supply of low carb recipes thanks to the popularity of Ketogenic diets so just do a quick google search putting ‘keto’ before the name of the recipe you want. I’ve been loving this low carb pancake recipe I found by searching ‘keto pancakes’.

How to find low carb diet recipes?

Searching for information on Ketogenic Diets is a great way to find information and ideas for eating low carb. Just remember that as a diabetic your goals are different. You do not necessarily need to maintain a ketogenic state so don’t need to be as strict about things. Your goal is to keep controlled, normal blood sugars throughout the day. If you are achieving that then you do not need to worry whether you are in ketosis or not.

Reliable information resource

Another great resource is Dr Berstein’s Diabetes Solution. This is an absolutely fantastic book for diabetics. It really has become my go to resource for treating my diabetes. The recommendations for cutting out some foods may be too extreme for some, but the information and advice on maintaining a low carb diet as a diabetic is really amazing.

Recommendation

Dr Berstein also does a free weekly Q&A on Youtube that you can subscribe to for free. You can grab the book on amazon or listen to it on Audible. I’d highly recommend giving it a look if you haven’t already.

Avocado
Avocado

Isn’t eating a lot of fat bad for you?

If you are cutting out the bulk of the carbs from your diet you might need to fill in the lost calories with protein or fat.

You should try to focus on getting the fat in your diet from the following natural sources:

  • Meat
  • Fish
  • Dairy
  • Eggs
  • Nuts
  • Avocados
  • Olives
  • Olive Oil

These natural sources of fat have a good balance of monounsaturated, polyunsaturated and saturated fat.

You should also think about the types of oils you use for cooking as sources of fats. Here is a breakdown of the fat types in the most common household cooking oils.

Avoiding Junk Foods

You should avoid getting a lot of fat from junk food and takeaways. These are highly processed foods and will have negative effects on your health if you eat them in large amounts over time.

…many organisations have made an effort to label all fat as unhealthy

Fat really has got a bad deal in recent history. Many organisations have made an effort to label all fat as unhealthy. Part of this is due to the incentive of making anything that is considered ‘low-fat’ to be healthy. In reality many low-fat alternatives to foods are loaded with preservatives, chemicals and sugars to mask the reduced fat. Unfortunately what a lot of these products end up doing is lowering the fat content and raising the carb content of your diet.

Grilled Meat Served on a Plate
Grilled Meat Served on a Plate

Isn’t eating a lot of protein bad for you?

Protein is an essential part of our diet, it’s required in very human cell and is needed for many biochemical functions of the body. Dietary protein is our only source of the 9 essential amino acids which our bodies cannot manufacture. Without adequate protein you cannot have good health. If we don’t eat enough protein we will lose muscle and strength as well as heal slower.

How does excess protein affect our bodies?

One of the common concerns when following a low carb diet is that the resulting increase in protein in your diet is dangerous. The base level recommended daily allowance of protein is around 0.36 grams per pound of bodyweight (0.8 grams per kilogram).

This is the recommended amount under which the body of an average adult will not have enough protein for its normal functions. There have been several studies that indicate that this has been significantly underestimated. People who are more active, lift weights have been or are elderly have been shown to benefit from a much higher intake of protein in their diet.

How does it affect our bones?

There are two common myths around higher protein diets that people often worry about.

First, many people believe that high protein diets can cause a weakening of the bones (Osteoporosis). The reason for this belief is from the idea that more protein causes a higher acid load on your body. This is then said to cause the body to remove calcium from the bones to neutralize the acidity.

There are short term studies that show this effect of increased calcium excretion to neutralise acidity this does not last long. 

Better on the long run

Longer-term studies have shown that the calcium excretion showed no significant change and that there were actually improvements in the levels of some hormones that promote bone health like IGF-1. These studies indicated that the negative short term effects on calcium excretion are offset by the positive effects of a high protein diet to the point where there is an overall positive effect on bone strength.

higher protein diets have been shown to improve bone density and strength…

Higher protein diets have been shown to improve bone density and strength, reducing the likelihood of fractures. It has also been shown to improve levels of the hormone IGF-1 as well as improve lean mass, both of which are factors that are heavily linked with bone health. 

Isn’t excess protein bad for our kidneys?

The second common myth is that high protein diets can damage your kidneys. 

The kidneys act as waste removal systems in the body. They remove excess nutrients and liquid from the blood and pass it out of the body as urine. The common theory is that increasing the amount of protein in your diet puts an added load on your kidneys to remove the protein.

…the effect of increases in dietary protein on the kidneys is fairly minimal

In reality the effect of increases in dietary protein on the kidneys is fairly minimal. Healthy kidneys are able to clear over 180 litres of blood in a day. They have not been shown to have any problem with managing protein levels in high protein diets. 

Pre-existing damage

There is one exception to this however. If a person already has damage to their kidneys an increased protein load may be unhealthy

So if you are already living with some form of kidney damage then a high protein diet may be dangerous. Many diabetics have some level of kidney damage so it is important to get your kidney function tested before starting on a high protein diet.

Note

If your kidneys are shown to be healthy then high protein diets have not been shown to damage them. In fact there are many studies that show a higher protein diet will help you lose weight.

No reason to worry

So in summary there is no evidence that high protein diets are unhealthy for bone or kidney function. In fact, most evidence points to the fact that high protein diets have positive health benefits. For most people with healthy kidneys there is no need to worry about the higher levels of protein in your diet. But if you have some form of kidney damage then you should seek medical advice and possibly limit the amount of protein in your diet.

Dairy Products
Dairy Products

Can I eat dairy on a low carb diet?

There’s nothing wrong with eating dairy on a low carb diet. The only issue is that some dairy products contain a lot of sugar. Milk contains lactose which is a type of sugar and many diabetics report that it wreaks havoc with their blood glucose levels.

low-fat milks tend to have more sugar per glass than full-fat milk…

Low-fat milks tend to have more sugar per glass than full-fat milk so this tends to make the effect worse. In addition many yoghurts contain sugar which is quickly digested and raises blood sugar. A great alternative to regular milk is to drink unsweetened almond milk which is low carb. 

Yogurt
Yogurt

Natural unsweetened yogurt is also a great source of friendly bacteria and is relatively low in sugar in normal portions.

Cheese and cream have pretty minimal sugar contents so you can usually eat as much of these as you want. A lot of people use cream instead of milk in their coffee and I’m a big fan of adding cheese to my meals.

What is the difference between Keto and a Low Carb Diet?

Keto (Ketogenic Diet) is a type of low carb diet that is intended to trigger the state of ketosis in the body. It usually takes the form of a high fat and low carb diet. Ketosis is a metabolic state where the body uses ketones as a source of energy rather than the normal source of glucose. The liver uses fats to produce ketones when there is not much glucose present in the blood.

Note

Keto diets focus a lot on minimising the glucose levels in the blood to trigger a Ketosis state. This diet also have high fat as in ketosis fats will form the primary fuel source.

Focus on your goal

Diabetics may find ketogenic diets useful as a proxy for a low carb diet but it is important to keep your goals in mind. The goal of a low carb diet for diabetics is to keep your glucose levels at normal levels and relatively flat. Keto diets also try to keep low levels of glucose in the blood but they are especially strict on minimising carbs to trigger ketosis. For diabetics the process of ketosis is not a goal. I find it very useful to get recipes, tips and motivation from the Keto community but I don’t worry about trying to keep myself in ketosis.

What is the difference between Paleo and a Low Carb Diet?

Paloe (Paleolithic) diets are also a low carb diet but it is intended to mimic the supposed diet of our paleolithic ancestors. The idea is that our bodies evolved to eat a diet that we would have eaten in paleolithic times. Since then we have outpaced evolution with our abilities to farm and manufacture foods. This has left us eating a diet that our bodies are poorly adapted for and so we end up with medical issues and poor health as a result.

The paleolithic diet is low carb only as a byproduct of the fact that most carb sources were not readily available to our hunter gatherer ancestors. Potatoes, rice, grain and fruits are largely a part of our diet due to farming. 

Paleo Diet Food
Paleo Diet Food

Focus of the Paleo Diet

The paleo diet focuses on gaining your calories from organic animal and plant food sources such as meat, fish, eggs, green vegetables, nuts and other foods that would have been readily available in the paleolithic era. The diet allows you to have as much food as you wish from these sources but is very strict on cutting out any modern manufactured foods like bread, pasta, candy, and processed meats.

Tip

The paleo diet community can be a great source for getting fresh and organic meat based meal ideas. 

Difference in terms of goals

It’s great for learning different ways to cook and prepare fresh food and gives a different style of cooking that the typical keto recipe.

The paleo diet is all about matching what our ancestors would have eaten…

It’s also important to remember our goals as diabetics here too. The paleo diet is all about matching what our ancestors would have eaten. This generally crosses over with our goals of eating low carbs but there are some things that Paleo would see as a no go that wouldn’t matter for us. For example Paleo diets usually cut out dairy, however in our case cheese and creams are fine to eat since they contain relatively low carb content.

Should I follow Keto or Paleo as a diabetic?

The main difference I find between the Keto and Paleo diet communities is the style of meals they prefer. The Keto community is very practical and they try to come up with lots of clever ways to create our favourite foods without carbs. For example, if you want to make low carb birthday cake, low carb pancakes, low carb pizzas and anything else, then you’ll find a recipe by searching for ‘keto recipes’.

What makes Paleo community different?

On the other hand, the Paleo community is heavily focused on food quality. They don’t care so much about trying to recreate the foods they have had to cut out. They really value rich, raw organic food recipes. If you want a great recipe for preparing a cut of meat or some rich vegetable based sides then look up some Paleo recipes in google.

Tip

Both paleo and low-carb diet communities can be a great resource for diabetics looking to go low carb. 

Find the right balance

They can provide excellent sources of motivation, community and ideas. Just remember to keep your real goals top of mind and notice where they are different from the goals of these other diets. It’s fine to pick and mix what works for you, you are the one who’s in control.

To wrap up, we’ve seen that low carb diets have been shown to be a safe and effective way of losing weight and normalizing blood sugars for most people. It not only helps regulate blood sugar levels but the knock on effects of this also help diabetics reduce their insulin requirements. This can help reduce episodes of hypoglycemia and hyperglycemia as a result of day to day miscalculations.

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