Rethinking Type 1 Diabetes Care

What New Research Says About Blood Sugar, insulin Resistance, and Carbohydrate Intake

Managing Type 1 diabetes (T1D) is about much more than taking insulin. Two recent scientific papers highlight a bigger story — one that may reshape how we think about long-term metabolic health, insulin resistance, and the role of dietary carbohydrates.

1. Why Insulin Resistance Happens Even in Type 1 Diabetes

A new scientific review shows that insulin resistance is surprisingly common in T1D, even though people with T1D produce little or no insulin.

But the reasons differ from Type 2 diabetes.

In T1D, insulin resistance is driven mainly by:

• chronic high blood sugar (glucose toxicity)

• inflammation and oxidative stress

• damage to the microcirculation

• glycemic variability and metabolic stress

• and sometimes, high injected insulin doses

Put simply:

High blood sugar stresses the body, and this stress makes cells less responsive to insulin — creating a difficult cycle to break.

2. What Happens When Carbohydrate Intake is Dramatically Reduced? A 10-Year Case Report Gives Us Clues

A new case report followed a man with Type 1 diabetes who adopted a ketogenic, very low-carbohydrate diet (<50 g/day) for more than 10 years. His results were striking:

✔ HbA1c held at 5.5% for a decade

✔ Daily insulin use fell by 43%

✔ Glycemic swings became rare

✔ No negative metabolic or hormonal effects

✔ Most remarkable: CT imaging showed zero coronary artery calcification

— at an age when 30–70% of men with T1D already show early signs of heart disease.

This suggests that stable blood sugar and lower insulin requirements may offer powerful cardiovascular protection, even when LDL cholesterol rises.

3. What These Two Studies Suggest Together

When both studies are viewed side by side, a clear picture emerges:

Lower carbohydrate intake — when done safely — helps reduce glucose toxicity, inflammation, and insulin requirements, breaking the vicious cycle of insulin resistance in T1D.

People often experience:

• fewer highs and lows

• lower total insulin doses

• less metabolic stress

• lower inflammation

• more stable energy

• potential cardiovascular protection

This aligns with emerging scientific consensus: glucose stability is one of the strongest predictors of long-term health in T1D.

4. Then Why Do Some Still Say Low-Carb Is “Not Recommended” in Type 1 Diabetes?

Despite encouraging evidence, some organizations and clinicians still express caution.

This is largely due to historical concerns, not modern data.

1. Fear of diabetic ketoacidosis (DKA)

Many clinicians worry that ketosis from a low-carb diet could be confused with early DKA. But nutritional ketosis and DKA are biologically different — and modern evidence shows that low-carb diets reduce, not increase, DKA risk when insulin is properly adjusted.

2. Hypoglycemia concerns (based on outdated assumptions)

Older insulin regimens made low carb risky. Today, with CGM and flexible dosing, studies show low-carb diets reduce hypoglycemia by reducing swings.

3. LDL cholesterol increases

Some patients see higher LDL on ketogenic diets. But the 10-year case study demonstrates that glycemic stability may matter more for heart disease risk than LDL alone, as this individual had zero coronary calcification after a decade.

4. Lack of large long-term trials

Guidelines often require big randomized studies before changing recommendations. Such trials in T1D and low-carb diets are still limited.

5. Old educational systems built around high-carb meal plans

Diabetes education historically centered on carb counting and matching insulin to meals. Changing this requires retraining — which takes time.

6. Concern about growth or nutrient deficiencies in children

These risks relate to poorly supervised diets, not evidence-based therapeutic carbohydrate reduction.

7. Guidelines lag behind real-world evidence by 10–15 years

Even when data improves, official recommendations move slowly.

In short, the caution is understandable — but increasingly outdated.

5. A New Direction for T1D Care?

The scientific landscape is changing. Sustained high blood sugar is now recognized as a major driver of insulin resistance, oxidative stress, and long-term complications in T1D.

Carbohydrate reduction — when properly supervised — offers a powerful way to lower this biological stress load.

Not a cure. Not a requirement.But a legitimate, evidence-based option.

And for some, like the individual in the 10-year case study, it can be life-changing.

Apostolopoulou, M., Zaugg, C. E., Bischof, M. G., & Othman, A. (2025). Insulin resistance in type 1 diabetes: Pathophysiological, clinical, and therapeutic relevance. Journal of Applied Physiology, 128(1), 1–15. https://doi.org/10.1152/japplphysiol.00541.2024

Koutnik, A. P., Lennerz, B. S., Deeb, L. C., & Watso, J. C. (2025). Coronary artery calcification in type 1 diabetes after a 10-year ketogenic diet. Journal of Applied Physiology, 128(2), 123–135. https://doi.org/10.1152/japplphysiol.00412.2024