Background and Aims: Despite intensive insulin treatment of type 1 diabetes (T1DM), metabolic control remains suboptimal, especially in children. In an attempt to optimize postprandial glycaemia, some families decrease the amount of carbohydrates contained in a meal. While "low-carbohydrate diets" may improve metabolic control in some selected populations, controversies remain around the risk of hypoglycemia and ketoacidosis and the impact of such diets on growth and development of children.
Case Report: We report the case of a child whose whole family started a low-carbohydrate diet when it was seven years old, in an attempt to induce weight reduction for the parents. The child adhered to this diet and subsequently developed T1DM at the age of eight years. It continued the same diet after diagnosis.
Glycated hemoglobin (HbA1c) was 13.8% (127.3 mmol/mol) at the time of T1DM diagnosis and decreased to 7.3% (56.3mmol/mol) three months later. During subsequent follow-up, it ranged between 5.9% (41mmol/mol) and 6.4% (46.6mmol/mol). The diet of the child consisted of 10 30 g carbohydrates per day and numerous supplements such as omega-3 fatty acids, vitamins A, B1, B2, B6, C, D, E and K, as well as folic acid and niacin were taken on a daily basis. Almost every meal or snack the child ate was homemade by the mother of the family, including numerous "low-carbohydrate" desserts and bread, made of almonds, linseed and Chia seeds. Hypoglycemic events were rare and the insulin needs ranged from 0.11 to 0.24U/kg/day. Despite these very low insulin needs, ketone measurements were normal. After two years of carbohydrate restriction, weight gain and linear growth remained normal and no episode of ketoacidosis was observed. Lipid and cholesterol levels also remained within normal limits.
Conclusions: According to the International Society for Paediatric and Adolescent Diabetes (ISPAD), it is recommended that 50 55% of energy be derived from carbohydrates for children with T1DM. Potential adverse outcomes such as abnormal growth, increased risk of hypoglycemia, increased risk of ketoacidosis, dyslipidemia, vitamin deficiencies and psychological side effects may arise due to carbohydrate restriction. While there is currently no evidence to support this approach in children with T1DM, it is essential to accompany families who choose carbohydrate restriction in order to keep in touch with them on a long term and thus to be able to carefully monitor side effect of their dietary regimen.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology