Prolonged remission followed by low insulin requirements in a patient with type 1 diabetes on a very low-carbohydrate diet.

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM Endocrinology, Diabetes and Metabolism Case Reports Pub Date : 2024-02-19 Print Date: 2024-01-01 DOI:10.1530/EDM-23-0130
Hakan Ozoran, Phoenix Guwa, Pam Dyson, Garry D Tan, Fredrik Karpe
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Abstract

Summary: The use of a low-carbohydrate diet (LCD) reduces insulin requirements in insulinopenic states such as type 1 diabetes mellitus (T1DM). However, the use of potentially ketogenic diets in this clinical setting is contentious and the mechanisms underlying their impact on glycaemic control are poorly understood. We report a case of a patient with a late-onset classic presentation of T1DM who adopted a very low-carbohydrate diet and completely avoided insulin therapy for 18 months, followed by tight glycaemic control on minimal insulin doses. The observations suggest that adherence to an LCD in T1DM, implemented soon after diagnosis, can facilitate an improved and less variable glycaemic profile in conjunction with temporary remission in some individuals. Importantly, these changes occurred in a manner that did not lead to a significant increase in blood ketone (beta-hydroxybutyrate) concentrations. This case highlights the need for further research in the form of randomised controlled trials to assess the long-term safety and sustainability of carbohydrate-reduced diets in T1DM.

Learning points: This case highlights the potential of low-carbohydrate diets (LCDs) in type 1 diabetes mellitus (T1DM) to mediate improved diabetes control and possible remission soon after diagnosis. Could carbohydrate-reduced diets implemented early in the course of T1DM delay the decline in endogenous insulin production? Adherence to an LCD in T1DM can facilitate an improved and less variable glycaemic profile. This case suggests that LCDs in T1DM may not be associated with a concerning supraphysiological ketonaemia.

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一名 1 型糖尿病患者在长期缓解后,对胰岛素的需求量降低,并开始使用极低碳水化合物饮食。
摘要:在 1 型糖尿病(T1DM)等胰岛素分泌不足的状态下,使用低碳水化合物饮食(LCD)可减少对胰岛素的需求。然而,在这种临床情况下使用潜在生酮饮食还存在争议,而且人们对其影响血糖控制的机制也知之甚少。我们报告了一例晚发型典型 T1DM 患者的病例,该患者采用极低碳水化合物饮食,18 个月内完全避免胰岛素治疗,随后使用最小剂量的胰岛素严格控制血糖。这些观察结果表明,T1DM 患者在确诊后不久就坚持使用 LCD,可以改善血糖状况,减少血糖变化,并使一些患者的病情得到暂时缓解。重要的是,这些变化的发生不会导致血液中酮(β-羟丁酸)浓度的显著增加。本病例强调,有必要以随机对照试验的形式开展进一步研究,以评估在 T1DM 患者中减少碳水化合物饮食的长期安全性和可持续性:本病例强调了低碳水化合物饮食(LCD)在 1 型糖尿病(T1DM)患者中的潜在作用,即在确诊后不久改善糖尿病控制并可能缓解病情。在 T1DM 病程早期实施减少碳水化合物的饮食能否延缓内源性胰岛素分泌的下降?T1DM 患者坚持 LCD 可以改善血糖状况,减少血糖变化。本病例表明,T1DM 的 LCD 可能与令人担忧的超生理酮血症无关。
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来源期刊
CiteScore
1.50
自引率
0.00%
发文量
142
审稿时长
9 weeks
期刊介绍: Endocrinology, Diabetes & Metabolism Case Reports publishes case reports on common and rare conditions in all areas of clinical endocrinology, diabetes and metabolism. Articles should include clear learning points which readers can use to inform medical education or clinical practice. The types of cases of interest to Endocrinology, Diabetes & Metabolism Case Reports include: -Insight into disease pathogenesis or mechanism of therapy - Novel diagnostic procedure - Novel treatment - Unique/unexpected symptoms or presentations of a disease - New disease or syndrome: presentations/diagnosis/management - Unusual effects of medical treatment - Error in diagnosis/pitfalls and caveats
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