Incorporation of the Ketogenic Diet in a Youth With Type 1 Diabetes

Background

Before the discovery of insulin in 1922, treatment of diabetes was limited to palliative methods along with carbohydrate restriction. Bouchardat observed resolution of glycosuria with calorie-controlled diets as well as intermittent fasts (1). From 1914 to 1919, Dr. Frederick Allen placed patients on severely restricted caloric diets (≤500 kcal/day), and that approach was adopted to some extent by Dr. Elliott Joslin until the advent of insulin therapy (1). The biggest issue then was patient compliance, which continues to be important in diabetes management today (1).

Around the time insulin was discovered, the ketogenic diet was promoted to treat epilepsy in children (2). The ketogenic diet can be defined as an eating pattern that includes <50 g carbohydrate per day or in which carbohydrates comprise <10% of calories consumed. In contrast, a low-carbohydrate diet includes 51–130 g carbohydrate per day or ≤25% of calories consumed (3). This case report describes the incorporation of the ketogenic diet in a youth with type 1 diabetes.

Case Presentation

A 14-year-old girl presented to our hospital in February 2018 for follow-up of type 1 diabetes after disagreement with her diabetes care provider regarding her choice of the ketogenic diet. She was diagnosed with type 1 diabetes in February 2014, presenting with polyuria, polydipsia, and weight loss. She was admitted to a teaching hospital with an A1C of 13.3% and sent home on basal-bolus multiple daily injection insulin therapy. Her medical history was unremarkable, and there was no history of other autoimmune-associated disorders. …