Type 1 diabetes

Letter to the editor: Low carb diet trades glycaemic control for other risk

Thursday, 24 May 2018


Lead author Z.Z.X. Leow, a PhD Candidate and Exercise Physiologist responds to our story last week on ‘Low carb trades glycaemic control for other risk’. 

Dear editor,

Our findings on hypoglycaemia should be interpreted with caution. Yes, our study reports a high rate of hypoglycaemia defined in our article as a blood glucose level below 3 mmol/L.

However, what should also be highlighted is the very low rate of self-reported hypoglycaemia experienced by our participants on ketogenic diets, with “a mean of only 0.4±0.7 episodes of self-reported hypoglycaemia per week”.

Of note, this rate does not exceed the self-reported hypoglycaemia rate of the general population of people with type 1 diabetes. In our article, we mentioned that these apparent conflicting findings between self-reported and measured hypoglycaemia rates may result from either increased hypoglycaemia unawareness and/or an increased tolerance to low blood glucose levels that results in a lower blood glucose threshold for impairment in cognitive function and thus hypoglycaemia symptoms.

As we explained, this latter thought provoking possibility is based on the work of Amiel and colleagues who showed “that ketone infusion reduces cognitive impairment during induced hypoglycaemia”.

It still remains to be determined, however, whether the combined use of ketone bodies and glucose by the brain of people on ketogenic diets makes them and their cognitive function more tolerant to the deleterious effects of low blood glucose levels.

Corresponding author Z.Z.X. Leow, PhD Candidate, Exercise Physiologist.

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