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New research may pave the way for determining whether a ketogenic diet may be beneficial in managing blood glucose and complications associated with low blood sugar in diabetes.

Scientists at the Heart Research Institute are exploring if ketones can protect the brain from adverse effects of severe low blood sugar.

Cardiovascular Neuroscience Unit Leader Dr Melissa Farnham and Dr Polina Nedoboy, together with Dr Myfanwy Cohen have discovered that a ketogenic diet delays, but does not impair, the brain’s ability to respond to hypoglycaemia.

A ketogenic diet is 60 per cent fat, 30–35 per cent protein and 5–10 per cent carbohydrate.

“Our research is focused on whether a ketogenic diet, high in fat and low in carbohydrates, can ultimately help prevent the development of 'hypo unawareness' from repeated hypos in type 1 diabetics,” said Dr Nedoboy.

“The use of insulin to lower blood glucose levels is imperfect as too much insulin can lead to dangerously low blood glucose levels,” she said.

“When the body senses hypoglycaemia, a brain reflex is activated that stimulates rapid production of sugar from the liver, to elevate blood sugar levels and protect the brain from being starved of its major energy source, glucose.

“People who experience repeated hypos could eventually develop a condition called hypoglycemia associated autonomic failure (HAAF), or hypo unawareness, where an important reflex in the brain isn’t triggered. Without it, the person does not suffer the physical symptoms of a hypo – which are important because it alerts them about the need to increase their glucose levels by eating.

The lack of detection and response could be life threatening, because they might not realise they are having a severe low. If they were driving a car at that time, they would crash,” Dr Nedoboy said.

“The results of this research will provide critical evidence supporting the potential therapeutic effects of this dietary approach, which will inform future guidelines for type 1 diabetes management,” she said.

The researchers say an advantage of a ketogenic diet is people don’t have to use as much insulin, which for type 1 diabetics can become a problem with insulin resistance and associated cardiovascular diseases such as atherosclerosis and peripheral artery disease.

“As people with diabetes are twice as likely as those without to develop cardiovascular disease, it is imperative that we develop better ways to manage and treat diabetes,” Dr Melissa Farnham said.

Diabetes Australia helped fund the research.

Two years ago the peak body released a position statement amid increasing use of the ketogenic diet by people with diabetes.

In part, it said, “There is not yet enough evidence to recommend low carb eating for everyone. Low carb eating is not recommended for children or for people with specialised nutritional requirements. Type 1 diabetes may choose to follow a low carb eating approach and they should be supported in this”.

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