‘I’m a GP with type 1 diabetes. This diet changed my life’

Around a decade ago, I woke up in the back of an ambulance. I had been shopping in Stroud and realised I was approaching hypoglycaemia, when blood sugar drops dangerously low in type 1 diabetes. I saw spots in front of my eyes and felt light headed. Knowing how urgent it was to raise my blood sugar, I rushed into a shop to buy sweets and gobbled them down.

However, my body didn’t absorb the sugar quickly enough, and I passed out. I spent an hour being treated by paramedics and count myself lucky to have escaped with only a gash on my head.

I knew it was time to make a change. I had been living with type 1 for two decades, having diagnosed myself in 1995, aged 36. I was fit and well at the time, and a GP. I was tired, but had put this down to work pressure, until I developed a raging thirst that I have never experienced before or since – a telltale symptom of diabetes.

An endless cycle of calculation and stress

Having diabetes means that you don’t produce insulin, a vital hormone that regulates your blood sugar levels. As a result, you have to inject yourself with it. Failing to bring down your blood sugar levels can lead to complications such as heart attacks, strokes, kidney problems, nerve damage and sight issues.

I don’t know why I developed type 1. It’s an autoimmune condition, where the immune system attacks the pancreatic cells that release insulin, but there’s no single known cause. Most cases are diagnosed in early spring, so scientists believe viruses or low vitamin D levels are implicated. Studies have also found associations with milk protein and gluten. Mine may have been triggered by a nasty bout of flu, but I’ll never know for sure.

A diabetes consultant confirmed my diagnosis and gave me the standard NHS advice about the Dafne (dose adjustment for normal eating) approach, which is essentially eat what you like and inject enough insulin to manage your blood sugar spikes. So I tried to carry on as normal, tucking into porridge for breakfast, a sandwich for lunch and a meal such as spaghetti bolognese for dinner. A typical British, high-carb, omnivorous diet in which half of my calories came from carbohydrates.

I diligently counted the carbs in each meal. Roughly, for every 10g, an adult needs one unit of insulin. It’s quite difficult to get right. I liken it to driving a car and having to turn the steering wheel 30 minutes before you go around a corner. When you are living with type 1, there’s a constant background noise of worry that you’ve not taken the right dose. It’s an endless cycle of calculation and stress.

I pressed on for 20 years, believing I was doing everything the right way, but my results were getting worse. My average blood sugar levels (HbA1c) were 80 mmol/mol, much higher than the 48 mmol/mol target. I had constant muscle aches, low energy and brain fog. I perpetually felt like I’d just eaten Christmas dinner.

I was also having more hypos (hypoglycemic episodes) and the amount of insulin required to bring my blood sugar back to baseline was increasing.

The change that halved my insulin requirements

What changed my life was reading a book shortly after the hypo that landed me in an ambulance, Dr Bernstein’s Diabetes Solution by American doctor Richard Bernstein, who had been living with type 1 since the age of 12.

I read the whole thing over a weekend. He turned the advice I had received on its head, advocating a low-carbohydrate, high-fat and high-protein diet to naturally reduce blood sugar spikes and enable patients to lower their insulin dose.

It made sense, so I overhauled my diet completely to high fat, high protein and very low carb, essentially a keto diet. Instead of my body breaking down carbohydrates into glucose for energy, it breaks down the fat in my diet into ketones to use for fuel instead.

I don’t crave carby, sweet food, so I didn’t find it hard. My breakfast became yogurt and berries, lunch a cheese-and-mushroom omelette, and dinner salmon with salad.

From my first low-carbohydrate meal, I had a very flat blood sugar reading, meaning my insulin requirements halved. Within about three weeks, my joint pains were gone, my brain fog had lifted, and I was focused and energised. There was no doubt that I was doing the right thing.

It was a sheer relief to feel more in control after two decades at the mercy of my diabetes.

I had to overcome my fear of fat

The biggest challenge was overcoming my fear of fat. My medical training had hardwired me to believe fat is bad and low-fat diets are optimal for health. Certainly, some processed fats aren’t healthy, but I now know dietary fat isn’t inherently bad.

I’ve made some further diet tweaks since then, as I’ve experimented to find out what works best for me. I now eat my meals within an eight-hour window. Each day, I have around 150g of protein (from meat, dairy and eggs), 30g of carbs (mostly from green vegetables and berries – I haven’t had bread for 12 years) and the rest of my diet is healthy fats (olive oil, tree nuts and fish), to make up my 2,000 calories.

Some alcohol is fine. I’ll have small amounts of red wine or prosecco on some weekends, as these options contain very few carbs. Sadly, beer is too carb-laden. Spirits and diet mixers are also allowed on a low-carb diet.

I’m now on around 20 units of insulin a day, when I used to need 40, and my average blood sugar level has halved from 80 to 40 mmol/mol. I feel like I’m now in control of the condition and my diabetes isn’t in control of me anymore. It’s not completely plain sailing. I do sometimes experience a blood sugar spike, usually when I’m stressed, ill, lacking in sleep, or if I snack or eat too late. Sometimes I can’t work out why the spike happened. It’s the unpredictable nature of type 1.

The frequency of my hypos has decreased, and they’re easy to recognise and manage. Evidence shows there are six times fewer hypos among type 1 patients on a low-carb diet than among those on a high-carb diet. It makes sense, as low blood sugar levels require only a low dose of insulin, meaning there is a lower risk of dosing errors.

Too much insulin is deleterious to health

Current type 1 diabetes advice prioritises eating whole-grain carbohydrates, a legacy from the 1980s, when it was felt that low-fat diets protected against heart disease, which people with type 1 are at higher risk of developing. But when the fat went down, the carbs went up.

The reality is that, while following this advice, only one in 10 people with type 1 can bring their HbA1c blood sugar levels down to the 48mmol/mol that the NHS recommends to reduce the risk of long-term complications, such as eye and kidney disease.

Another problem is that the focus is purely on blood sugar and not the dose of insulin required. But insulin is much more than a blood sugar regulator. It blocks fat burning, promotes inflammation and is a growth factor, so has been implicated in promoting heart disease and cancer. So, too much insulin is deleterious to health. Lower amounts enable the body to approach a non-diabetic healthy state.

I will never come off insulin, it is undoubtedly a life saver for everyone with diabetes, but I feel so much better for reducing how much I need.

Some doctors are concerned by my approach

Some medical colleagues can be quite uncomfortable with the concept of people with type 1 following a low-carb diet. The NHS and charities such as Diabetes UK argue that there is not enough evidence of its benefits.

A significant concern is that, by raising ketones in the body – which happens when you burn fat instead of sugar for fuel – you raise the risk of diabetic ketoacidosis, when ketone levels rise too high. It’s a medical emergency and can be life-threatening. But ketosis from dietary choice is not a risk factor for ketoacidosis.

Some also worry that a low-carb diet will be too high in unhealthy fats, harming heart health in the long run, and that by nudging your body to run on fat, rather than providing a steady stream of calories from carbohydrate,you’re starving yourself. But healthy fats seem safe based on emerging evidence, and the keto diet is not a starvation diet as it contains sufficient calories.

I’m a part-time GP in Gloucester, and I do offer a low-carbohydrate diet as one option to type 1 patients. They are then able to make an informed choice based on the options available. One woman who had been struggling for five years achieved blood sugar in the normal range within five days of going low-carb.

Low-carb is the way forward

Following a low-carb diet has allowed me to take on physical challenges I never thought I would manage. In 2018, I ran 730 miles over five weeks and, in 2024, I completed a 1,000-mile cycle from south-west England to St Moritz in Switzerland. This autumn, I will be running three half marathons.

I’ve done all of these on a low-carb diet. The muscles, brain and heart are all happy to run on the ketones and fatty acids from my diet. If I were on a high-carb diet, I would have been gorging on multiple glucose gels to cover that distance.

Through these challenges, I’ve shown that low-carb can be a healthy approach for some people with type 1 diabetes. For many, it could be a way out of their daily diabetes-related misery and stress, all the while improving their health for the long term.

[Source: Daily Telegraph]