Medication Tips for Diabetic Patients on a Low Carb Diet

Some people with type 2 diabetes who have made significant progress in health since adopting a low carbohydrate diet should have their medications adjusted according to guidelines.

A hypoglycemic drug reduction protocol for patients whose glycemic control has improved since the Low Carb program was published in British Journal of General Practice .

"A low-carb approach is prevalent in clinical practice," said author Campbell Murdoch Medscape News UK. "One of the reasons is that it is very easy to implement. You do not need other resources. "

Dr. Murdoch, general practitioner and media officer at Diabetes Digital Media, in charge of the Low Carb program, added: "In terms of improving health, you can not improve type 2 diabetes. reducing carbs.All those who reduce their carbohydrate intake degree, improve their type 2 diabetes. "

More than 417,000 people have registered on the digital platform since 2015. The program is offered for a fee, but can also be accessed free of charge in some regions via the NHS.

One-year results of the program implemented in digital form involving 1,000 people, published in JMIR Diabetes in 2018, found that:

• The average weight loss was 7.45 kg

• The average reduction in HbA1c was 1.2% / 13 mmol / mol

• 40.4% of people on treatment have eliminated at least one of them

• 60% of insulin patients eliminated or reduced medications

Insulin, sulfonylureas and meglitinides

According to the paper, there are three key clinical considerations regarding the safety of taking specific medications for type 2 diabetes, alongside a low carbohydrate diet.

• Is there a risk that the drug causes hypoglycemia or other adverse events?

• What is the degree of carbohydrate restriction?

• Once the carbohydrates have been reduced, does the drug continue to have health benefits and, if so, are the potential benefits of the drugs greater or less than the potential risks and side effects?

According to the guidelines, practical experience suggested that a 50% reduction in daily insulin at the beginning of the program would be appropriate in most cases. However, people with high levels of HbA1c might be able to achieve only an initial reduction of 30%.

Some patients could expect to lose insulin completely over days or months as insulin resistance disappears, he added.

"And then sulfonylureas and meglitinides," said Dr. Murdoch. "They must be adjusted immediately – a reduction of about 50% at first, and then you continue to wean yourself off."

SGLT2 inhibitors and risk of ketoacidosis

The protocol also mentioned the SGLT2 inhibitors ("flozins") that might require adjustment because of an increased risk of diabetic ketoacidosis in people on a low carbohydrate diet. "So the general consensus is that we are fixing the problem, so do not take that risk," said Dr. Murdoch.

The guidelines also indicated treatments that did not pose an undue risk when badociated with a low carbohydrate diet. C & # 39; were:

• Metformin

• GLP-1 ("-enatides" and "-glutides") agonists

• Thiazolidinediones (& # 39; glitazones & # 39;)

• Inhibitors of DPP-4 ("gliptins")

• acarbose

• Blood glucose test strips

"Metformin has many potential benefits, so I certainly will not stop anyone," said Dr. Murdoch.