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Type 1 Diabetes: Can a low carb diet cure it? Does immunisation cause it?

Our online health professionals discussion group includes clinicians who use dietary interventions to change the course of type 2 diabetes. One of them described two patients newly diagnosed with type 1 diabetes and his approach to their treatment, raising a couple of interesting questions:

– Can a low-carb diet help with type 1 diabetes?

– Could immunisation be a trigger?

Image: Mykenzie Johnson on Unsplash, and DALL-E

The cases

Patient A (age 25) started a meat-based (carnivore) diet a week after his diagnosis of type 1 diabetes. His blood sugar stabilised, and he stopped needing insulin injections. His fasting blood insulin levels returned to normal, while his IA-2 (autoantibody) levels stayed high. The doctor noted he had a flu vaccination before his diabetes diagnosis.

Patient B (age 15) was hospitalised with diabetic ketoacidosis as her first major symptom. After discharge, she was prescribed a ketogenic (low-carb), then carnivore diet. Despite challenges with adherence, her insulin needs dropped to only 5 units per day, and her HbA1c improved from 11.4% to 8%, but IA-2 and GAD65 autoantibody levels remained high. She too had a flu shot, a couple of months before her diagnosis.

Understanding diabetes: Type 1 vs. Type 2

Type 2 Diabetes (T2D) is the common type of diabetes, occurring typically in older, overweight individuals. It happens when the body becomes resistant to insulin and is linked to high carbohydrate intake, especially from sugary foods. Reducing carbs can help manage T2D and even lead to remission (i.e., not needing glucose lowering medication for 3 months or longer) in many cases, especially with weight loss.

Type 1 Diabetes (T1D) is a lifelong condition that usually starts in young people. It happens when the immune system makes antibodies that attack the insulin-producing cells in the pancreas. Certain viral infections may be a trigger and there is a genetic component. Patients usually need to take insulin from the start.

Diet and T1D

Some case reports (see Readings below) suggest low-carb diets can improve blood sugar control in T1D more effectively than traditional carbohydrate-focused diets. They also reduce insulin needs and promote weight loss. A few reports describe patients early in the disease not needing insulin for a long time.

It’s important to note the common, naturally occurring “honeymoon phase” of T1D, where blood sugar levels and insulin needs temporarily decrease. This lasts weeks or months, sometimes even years. Improvements during this phase can easily be mistakenly attributed to dietary changes. It’s not a permanent cure however.

Image: DALL-E

Promising results from case reports in which low carb diets are used early in T1D therefore need to be confirmed by controlled trials, with a comparison group getting standard treatment and a good period of follow-up.

Safety must be checked also as there are concerns about possible increased risk for ketoacidosis, difficulties with dietary adherence, potential growth issues in young patients, and higher cholesterol levels which might increase the later chance of cardiovascular disease.

Bottom line, current recommendations

Q: Can a low-carb diet help with Type 1 Diabetes?

A: Maybe, but it’s not a cure, and not currently recommended in guidelines

Professional bodies currently do not recommend carbohydrate restriction for T1D.

There’s no convincing published evidence that permanent remission or cure of T1D is possible by means of diet, or any other medical intervention.

Food as medicine

The lack of funding for trials is a challenge. Pharmaceutical companies do not benefit.

A problem is that diets are named but often variable. The exact amounts, combinations and quality of different dietary components are important but not always well defined, affecting our ability to understand their effects on health and disease.

The American Heart Association agrees that “food is medicine” and has a new initiative funding 20 trials. Hopefully results arrive soon.

The microbiome in T1D

Because the gut microbiome might be involved in T1D, some people think probiotics help, with interesting reports of possible benefits, but the level of clinical evidence is low without which these approaches are not generally recommended.

Vaccination misinterpretation and bias

Multiple countries monitor vaccine-related side effects and diabetes incidence. There is no accepted evidence linking immunisation to the onset of T1D, only to viral infection.

The proximity in time of immunisation (a common event in childhood) to diabetes diagnosis can lead to “temporal bias,” where the timing is misinterpreted as causation. Recall bias (parents might more readily recall recent vaccinations) and surveillance bias (increased healthcare visits during vaccination periods) can also falsely suggest a link.

Q: Does immunisation cause type 1 diabetes?

A: No evidence for this!


New ideas about type 1 diabetes and diet-based treatments, including those that come from clinical experience and other observations, should be welcomed but studied carefully. High-quality trials should be funded. They will help to overcome biases, avoid mistaken conclusions and limit unintended harm from untested therapies.

Vaccines, including flu shots, are extraordinarily safe and beneficial, with no evidence that they cause diabetes.



Medical management of children with type 1 diabetes on low-carbohydrate or ketogenic diets (2021) – the medical management and potential benefits and challenges of using low-carbohydrate or ketogenic diets in children with type 1 diabetes.

Ketogenic diets in the management of type 1 diabetes: Safe or safety concern? (2021) – the safety and efficacy of ketogenic diets for managing type 1 diabetes, highlighting both potential benefits and risks.

Managing type 1 diabetes mellitus with a ketogenic diet (2023) – case studies demonstrating the effectiveness of a ketogenic diet in managing type 1 diabetes, though it also underscores the need for careful monitoring.

A low-carbohydrate high-fat diet initiated promptly after diagnosis provides clinical remission in three patients with type 1 diabetes (2020). A low-carbohydrate high-fat diet initiated soon after diagnosis led to clinical remission in three patients with type 1 diabetes.

Partial clinical remission of type 1 diabetes mellitus in children: Clinical applications and challenges with its definitions explores the concept of partial clinical remission in children with type 1 diabetes, discussing the clinical applications and challenges in defining and achieving remission.

Low-Carb and Ketogenic Diets in the Treatment of Type 1 Diabetes (2019) – review examining the use of low-carbohydrate and ketogenic diets in treating type 1 diabetes, indicating potential benefits such as improved blood sugar control and reduced insulin requirements.

NHS vaccinations and when to have them  – like the title says Can a ketogenic diet be safely used to improve glycaemic control in a child with type 1 diabetes? A ketogenic diet can improve glycaemic control in children with type 1 diabetes mellitus treated with insulin, but potential risks ou

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