Abstract
The pathological changes associated with type 2 diabetes (T2D) can be reversed through lifestyle measures, in some cases leading to remission.1 The low carbohydrate diet (LCD) is recognised as an effective option that is clinically inexpensive with few side effects.2 Many patients are achieving significant improvements in glycaemic control, with associated reduction in drug costs from cessation of hypoglycaemic agents.3 Digital-technology behaviour change solutions for T2D remission are being delivered at scale.4 Primary care clinicians need to be competent to adjust diabetes medications appropriately in individuals who follow an LCD. An LCD comprises <130 g of digestible carbohydrates per day.5 Digestible carbohydrate refers to sugars and complex carbohydrates such as starch, which is digested to glucose. Aligned with national guidance, carbohydrate choices in an LCD will typically be higher fibre and low glycaemic index (GI).6 Reduced total carbohydrate ingestion and low GI choices give the LCD a low glycaemic load (GL). In T2D the GI and GL of food consumed is a determinant of blood glucose level and thus the requirement for hypoglycaemic medication. Blood glucose levels typically fall substantially when an individual adopts an LCD. This article discusses key considerations regarding hypoglycaemic medications for an LCD and provides practical suggestions to prescribers. The recommendations are developed from the experience of the authors, discussion with …
Highlights
The pathological changes associated with type 2 diabetes (T2D) can be reversed through lifestyle measures, in some cases leading to remission.[1]
In T2D the glycaemic index (GI) and glycaemic load (GL) of food consumed is a determinant of blood glucose level and the requirement for hypoglycaemic medication
An initial dosage reduction of at least 50% is typically appropriate, with further reductions according to blood glucose response
Summary
Adapting diabetes medication for low carbohydrate management of type 2 diabetes:. C Murdoch, MRCGP, GP, Wincanton Health Centre, Wincanton; chief medical officer, Digital Diabetes Media, Coventry, UK. D Unwin, FRCGP, GP, Norwood Surgery, Southport, UK. D Cavan, MD, FRCP, consultant physician and endocrinologist, London Medical, London, UK. M Cucuzzella, MD, FAAFP, professor, West Virginia University School of Medicine, WVU Center for Diabetes and Metabolic Health, Morgantown, US. M Patel, PhD, FRPharmS, FHEA, senior academic and pharmacist, honorary senior lecturer, Medical School, University of Sheffield, Sheffield, UK
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