Those switching to low carb diet need to adapt medical therapy accordingly

Summary: For long, medical therapy using oral drugs or insulin was considered the only effective way to manage diabetes. However, new studies show that a low-carb diet and weight loss may cause diabetes remission in many. Remission of diabetes means that many who were earlier on drug therapy or insulin may stop taking these medications altogether. However, nutritional therapy works when practiced for several months. It means that there is a gradual decline in the need for drug therapy. But, despite the acceptance of nutritional therapy as a viable option by the American Diabetes Association, there are no guidelines regarding adapting medical treatment. Not adjusting the therapy increases the risk of hypoglycemia. One may especially need to adapt insulin therapy, treatment with drugs like sulfonylureas and SGLT2 inhibitors. Additionally, one may need to adjust the dosage of diuretics and some other medications.

 Despite the well-known fact that diabetes is a lifestyle disorder, doctors often did not focus enough on lifestyle interventions. It has been a century since the invention of insulin. Since then, diabetes experts have proposed that the only way to manage diabetes effectively is to intensify medical drug therapy over lifestyle intervention. Fortunately, recent findings have proven these notions wrong.

It appears that dietary measures alone can have excellent results in any kind of diabetes. However, nutritional interventions are especially effective in the most common type of diabetes, which is type 2 diabetes1.

Finally, the American Diabetes Association has included a low-carb diet as an intervention in its recommendations. 

Low carb diet - Photo by Tima Miroshnichenko from Pexels

Many large clinical trials show that severely restricting carbs intake along with weight loss may help lower blood glucose levels. Not only that, in a large number of cases living with type 2 diabetes, such measures may result in prolonged remission of diabetes. 

These measures may even help patients get rid of using medications to manage their condition. Already, dietary measures have helped many to start living without any medical drug. However, it means that those taking medical drugs and switching to a low-carb diet may gradually need to adapt the dosage of their medications.

Further, the benefits of the nutritional approach are not limited to diabetes. Such a dietary approach may also help reduce the severity of other comorbidities. For example, it may help lower blood pressure, improve lipid profile. In addition, it means correcting the dosage of antihypertensive drugs, statins, and other medications.

Clinical trials in the US and Europe show that about half of all those living with type 2 diabetes may expect complete remission of diabetes after about two years of low carb diet. Further studies show that a low-carb diet may help bring blood glucose levels within the normal range in more than 90% of cases of prediabetes. But that is not all; studies also show that the most significant benefit can be expected in grossly overweight individuals2. 

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There are other reasons to support the broader use of nutritional therapies. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) demonstrated that aggressive medical therapy is not always the best option. In many cases, aggressive drug therapy may rather increase the risk of all-cause mortality. In addition, various clinical trials show that even gaining glycemic targets with the help of medications does not necessarily prolong life2.

All these findings only highlight the importance of using nutritional therapy as a first-line treatment in all cases of type 2 diabetes. However, at present, there are no guidelines regarding the gradual reduction of drug therapy in such individuals. It exposes them to the severe risk of hypoglycemia.

Some of the medications are more likely to cause life-threatening hypoglycemia than others, like insulin. Further, one would need adjustments to sulfonylureas, SGLT2 inhibitors2. 

But not only that, there would often be a need to correct the dosage of antihypertensive therapy, like reducing the dosage of diuretics. Else, there is a greater risk of severe hypotension in some.

Additionally, knowing about the need for adapting medical therapy is also essential for patients. It is because practicing a restrictive diet does not essentially require a medical prescription. Thus, many may decide to switch to a low-carb diet like the keto diet without consulting a doctor. Hence, patients equally need to be aware of specific risks and need to adapt the drug therapy.

References

1.Shaughnessy AF. Low-Carb Diets May Produce Short-Term Diabetes Remission. AFP. 2021;104(1):95-95.

2.Cucuzzella M, Riley K, Isaacs D. Adapting Medication for Type 2 Diabetes to a Low Carbohydrate Diet. Frontiers in Nutrition. 2021;8:486. doi:10.3389/fnut.2021.688540