By Dale Cooke
Accredited Practising Dietitian
Is low carbohydrate eating an option for your
Low carb eating has been featured in the media for quite some
Diabetes Queensland health practitioners regularly receive
queries about whether this method of eating is healthy and safe, so
Diabetes Australia gathered a group to write a position statement on low carbohydrate eating for
people with diabetes to provide a guide on current
Written by an expert panel of Credentialled Diabetes Educators,
Accredited Practising Dietitians and an Endocrinologist, research
was gathered, the reliable evidence was reviewed and the statement
written. As further reliable research becomes available, the
statement will be updated.
What can you tell your patients?
1. For people with type 2 diabetes, there is evidence that low
carb eating can be useful in lowering blood glucose levels (BGLs),
as measured by HbA1c, for six months and for faster weight loss for
the first 12 months, than other interventions. It also results in
improved risk factors for heart disease for two years. The best
results seem to be for lower carb diets - less than 26 percent
total energy from carbs. Why only the first six or 12 months
or two years? There are a few reasons: the studies only went
that long so we don't know what happens in the long-term. In
addition, compared to normal dietary advice to lose weight and
manage BGLs, people can attain the same results but it takes a bit
longer. Lastly, after a while people stopped the low carb
diet. The lower the carb content the harder some people found
it was to follow long-term.
2. For people with type 1 diabetes, there isn't enough good
quality research to prove a benefit at present. There is anecdotal
evidence and even more recent observational evidence but DA can't
base its recommendations on anecdotal or observational evidence
3. It's important if your clients decide to follow a low carb
diet, whatever type of diabetes they have, that you refer them to
an Accredited Practising Dietitian to make sure they get all their
nutrition. The lower the carb diet followed, the harder it is to
meet nutrition requirements.
4. It's also important your patients talk to their GP or
Endocrinologist for advice on whether to change their medication
dosage and type. When they decrease their carb intake they will
likely need to reduce medications that cause hypoglycaemia, in
particular, insulins and sulfonylureas. The family of oral
medications called SGLT2 inhibitors increases the chance of
developing diabetic ketoacidosis (DKA) with low carb eating so this
may require swapping to a different family of medications.
5. Make sure your patients monitor their BGLs. Besides wanting
to see if the diet is improving BGLs it will also allow them to
prevent unexpected hypos.
6. If your patients do follow a low carb eating plan they might
have some side effects initially, such as tiredness and headaches.
They also won't store as much glycogen in their liver, so the
glucagon injection for hypo treatment won't work as well.
7. Research and international guidelines don't support the use
of low carb diets in pregnancy or for babies and children as there
are concerns about the fetus or child receiving adequate
nourishment for normal growth and development.
8. If your patients have any health issues such as malnutrition,
eating disorders, kidney or liver failure, or any rare metabolic
disorders, get them to talk to their GP or specialist before
considering following a low carb diet.
Keep in mind that everyone's diabetes is different so everyone's
management will be a little bit different to your patient's friend,
relative or neighbour who may also be living with diabetes. What
works for one may not necessarily work for your patient.
One of the inconsistencies with carbohydrate modified diets is
there is not an absolute definition of what low carb actually
Page 7 of the position statement gives a summary of what some
researchers are using to define low carb eating, so if someone
talks low carb to you, check what level of low carb they are
talking about using this table.
The position statement reminds us what carbohydrates are made of
and how the body uses them for energy.
It also reminds us that following healthy eating guidelines and
limiting carbs which contain very little nutrition (such as cakes,
biscuits, slices, juice, soft drink, chocolate and sweet treats) is
recommended as the usual way of eating for everyone, whether you
live with diabetes or not.
Check out Diabetes Australia's Low carbohydrate eating for people with diabetes
If you have any queries about the National Diabetes Services
Scheme or this article please call us on 1300 136 588.