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[IP] Carbohydrate Intake in Patients With Type 1 Diabetes

For well-controlled type 1 diabetics, what percentage of daily caloric
intake should come from carbohydrates? Are there any advantages to
restricting total carbohydrate intake in order to reduce insulin
from Ann M. Coulston, MS, RD, 07/05/01
This question has been debated among practitioners, but to my knowledge, no
answer has been forthcoming. Adequate insulin is essential not only for
blood glucose control, but also for aspects of protein and fatty acid
metabolism. Thus, unlike patients with type 2 diabetes who frequently have
an excess of insulin, patients with type 1 disease can be lacking sufficient
insulin for effective metabolism if carbohydrate intake is extremely low.
Most of the information regarding the "pros and cons" of insulin
requirements comes from the Diabetes Control and Complications Trial (DCCT).
When patients are carefully controlled to the most near-normal glucose level
possible, patients gain body weight and, as a result of the low blood
glucose concentrations, are more prone to hypoglycemic episodes.
Because we know that patients with type 2 diabetes and insulin resistance
are at increased risk for cardiovascular disease, many practitioners suspect
that the larger amounts of insulin used in patients with type 1 diabetes who
have a higher intake of carbohydrates might result in increased
cardiovascular risk. To my knowledge, however, there are no data to support
this hypothesis.
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