Here is the actual study [1]. This is n=3, so we are talking about highly anecdotal data. Nonetheless, I think this statement is misplaced:

> Low carb diets can help type 1 diabetics, but it's not a cure

Likely, as in most cases, the real picture is much more complex. It could be the case that LCHF diets can cure some percentage of individuals, can help some percentage and can be detrimental perhaps even fatal to some percentage. All of these could easily be simultaneously true.

Indeed, in case 1 it seems to have possibly "cured" the patient, though he could have also easily been a false positive or there could have been any number of other confounding factors. I quote from the study:

"He was able to stop insulin completely 15 days later (after diagnosis), and has not used insulin since March 2015." and "In the 4 years since his diagnosis, he has had no diabetes-related complications".

Here is patient #2's summary:

"He stopped insulin therapy at the beginning of the diet and has not used insulin since, except for one infectious episode." and " At 1 year after the diagnosis, he had no diabetes-related complications".

Also of note, both of these patients had started exercising 1-2 h a week, and 2 and 2-3 times a week respectively, before the diagnosis.

1. https://www.sciencedirect.com/science/article/abs/pii/S12623...

It's well understood that insulin production in type 1 diabetics can continue at low levels for ~5 years post-diagnosis; the process of beta cell destruction is a gradual one and diagnosis typically occurs after 80-90% of beta cells function has been lost.

You need a small amount of insulin even during ketocis, otherwise you will go into ketoacidosis. Type 1 diabetics suffer from destruction of b islet cells and thus have reduced to zero insulin production. There are some reasons why you might have a small insulin production( e.g. acute pancreatitis destroying some but not all b islet cells) but those are pretty rare. For most people the destruction happens as a result of an auto-immune disorder and eventually they all get destroyed. So maybe there's a period between the diagnosis( usually around ~90% destroyed cells) and when all cells get destroyed that you can manage it with keto. But it won't last forever and thus is not a cure.

Same feelings as you on this one - not that it isn’t par for the course with most science journalism, but it’s especially frustrating for T1 news.

Perpetually thankful that we’re only five years from a cure.

Yeah, it's always the same. Either we're five years away from the cure, a magical cure was just discovered, or somebody just "discovered" that keto can cure T1D.

Hugely reducing insulin dosing is still probably valuable, especially for Americans since it's so expensive.

It's expensive but not as bad as you'd think. I didn't have insurance for half a year, and I just called the manufacturer and got a huge discount ($200/bottle -> $35/bottle). One bottle lasts a month or so.

This was only due to not having insurance and wasn't need-based - I had earned FAANG income earlier that year and the year before.

Just curious, which manufacturer did you call, Eli Lilly or Novo Nordisk? I think the details of how you were able to get a discount would be beneficial to others. I am a type 1 and I recently heard of another type 1 who recently died at age 40 because he lost his job+insurance and was rationing insulin.

I called Lilly, but both manufacturers have programs to help. These two are need-based. I didn't qualify but still got a sharp discount.

https://www.lillycares.com/aboutlillycares.aspx https://www.novocare.com/diabetes-overview/let-us-help/pap.h...

Both those prices seem excessive.

These prices are not high. I went through a period when I had no health insurance, and I had to rely on generic insulin, the kind you can buy at Walmart for $25 a vial. I have insurance now and the insulin I take now costs me a co-pay of $100 a vial. Paying $35 a vial without insurance is not bad at all.

It's a hell of a lot higher than most developed nations. Here in Ireland, as far as I'm aware, it's free thanks to the long term illness scheme. (We have both public and private healthcare available)

Just because you never see the cost, doesn’t mean it costs “nothing”.

Sure, but to someone who's on unemployment benefits. It's free. To someone who's earning a little bit more than that, it's free. To someone who is earning enough to pay tax, they're paying a tiny amount. To someone who's earning more than 30K€, they're paying a few grand in taxes (which covers other public services also). To someone who's earning 60k€ they're paying even more.

But the important thing is that the person who's earning fuck-all can still afford it, because it costs nothing to them.

I am aware that insulin costs a lot less in other countries. I have read the stories of Americans going to Canada to buy insulin. I have also read the stories of diabetics in the United States who died because they tried to make their insulin last longer by rationing their dose.

If I didn't have insurance my insulin would cost me either $245 (fast-acting) or $700 (basal) a vial.

I was just pointing out that getting insulin for $35 a vial in the United States is a very good deal.

> I was just pointing out that getting insulin for $35 a vial in the United States is a very good deal.

That may very well be the case. But for someone paying 0% tax in Ireland, 0€ on insulin is an even better deal.

I agree, completely.

What's wrong with the cheap generic?

The cheap generic doesn't have the same effect profile. It's much harder to match an insulin bolus for the carbohydrates you're eating at a meal. The combination of fast acting and basal insulin can do a much better job of keeping your glucose readings in a good range.

That said, the same kinds of insulin cost a lot less in many foreign countries than they do in the United States.

The NHS (how much it pays not the patient) annual costs are about £400 so it doesn’t seem excessive

The best part of economic freedom is that one is free to start a manufacturer delivering a cheaper whatever one is complaining is too expensive!

"Not only are the big three insulin manufacturers financially opposed to biosimilars entering the market, they’ve actively taken legal steps to prevent it."

https://beyondtype1.org/how-much-does-it-cost-to-produce-ins...

It's possible the price is too high, but the reason it has that price $35/bottle is the minimum required to sustainably produce it. It's well accepted in economics that price of manufacture is not necessarily the societally optimal price [0]. If this is the case, what needs to be done is government subsidization, and no individual person can just start a company and do it themselves.

Also, the idea that everyone is free to start manufacturing insulin ignores the billions of dollars of capital that is required to create a FDA-compliant insulin production plant, which almost no one on earth has access to.

[0]: https://www.investopedia.com/terms/e/externality.asp

Not with the way the FDA has a pile of rules and regulations that combined have the unintended effect of blocking the market. Drugs of all kinds are not in a market state of economic freedom. There are pros and cons of the situation, but at least please stop pretending that it's a free market.

It’s not without tradeoffs. There’s a substantial overlap between T1 and CHD, and the impacts of keto on CHD in non-normal populations (hyper-responders, metabolic patients) are even more poorly understood than they are in the general population.

Lowering carbs is one thing; LCHF is an entirely different beast (and I say this both as a T1 and a T1 who tried LCHF for nearly a year).

It’s an option for some, but billing it as “remission” is going to make people think it’s a cure-all, when it’s far from that, and isn’t exactly “new” for the treatment of T1 - it’s both part of the general instruction set (“reduce carbs”) and even prior to insulin therapy, was the only treatment for T1, and it had a pretty poor success rate.

What does CHD stand for in this context?

Coronary heart disease. CVD (cardiovascular disease) may be more appropriate as it’s less specific but still covers the linkage between the two conditions.

http://journal.diabetes.org/diabetesspectrum/99v12n2/pg81.ht...

Thank you.

Yes, but any T1D is acutely aware of this fact. The whole treatment regimen is ratioing carbs to insulin.

great point to balance out the hype! This should be mentioned by article authors! I appreciate that comment.

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I’m also a T1D. I assure you, lots of diabetics have tried keto diets. It doesn’t put the disease “in remission”. That’s not how the disease works.

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You’d be off base in questioning any of that, at least as the central premise that “X person didn’t have Y effects because they ate too much Z macro.”

Keto, when strictly followed, provides a great reduction to bolus needs (in personal experience, 80-90% reduction, depending on protein intake), and a lesser, but still significant, reduction to basal needs (30% in my case); however, both types of insulin are absolutely still needed to prevent high blood sugars in an environment with no insulin, which is a significant risk of DKA (and death). Protein metabolizes into excess sugar in the blood stream as well, so unless you’re eating a pure fat diet, you will still need insulin. In addition to that, there are hormones (cortisol for sure), and other non-macro nutrients and alkaloids (a common report is caffeine, but this very much depends on individual biochemistry) that can cause rises in blood sugar, which require insulin to compensate for.

A type 1 diabetic without honeymoon insulin production will still die after a period of even the strictest of ketogenic diets. It was the treatment prior to the introduction of insulin, and was effective at extending the lives of diabetics; they would typically be able to live up to 3 or 4 years post-diagnosis before eventually dying.

For the record, my body enters keto at or around 45g/day, as measured by the presence and amounts of ketones; anyone who says “you need exactly N grams per day or it isn’t keto” is extrapolating from generalized experience at best.

The problem with keto isn’t that it isn’t effective for some things, it’s that people go a long way to oversimplify both the science behind it and the impacts it can have on other conditions by over applying that lens of simplification. It’s a good diet for some, but it isn’t a free lunch (pun not intended) - and it’s far from something that can eliminate the needs of insulin in type 1 populations, as this article alludes to.