Recommendations
1. Individuals with diabetes should be supported to choose healthy eating patterns that are consistent with the individual’s values, goals and preferences.
2. Healthy* low or very-low-CHO diets can be considered as one healthy eating pattern for individuals living with type 1 and type 2 diabetes for weight loss, improved glycemic control and/or to reduce the need for antihyperglycemic therapies. Individuals should consult with their health-care provider to define goals and reduce the likelihood of adverse effects.
3. Health-care providers can support people with diabetes who wish to follow a low-CHO diet by recommending enhanced blood glucose monitoring, adjusting medications that may cause hypoglycemia (sulfonylureas and insulin), or increase risk for DKA (SGLT2 inhibitors, underdosing insulin in those with insulin deficiency), and to ensure adequate intake of fibre and nutrients.
4. Individuals and their health-care providers should be educated about the risk of euglycemic DKA while using SGLT2 inhibitors and low-CHO diet, and further educated about the strategies to mitigate this risk (33).2
5. People with diabetes who begin a low-CHO diet should seek support from a dietitian who can help create a culturally appropriate, enjoyable and sustainable plan. A dietitian can propose ways to modify CHO intake that best aligns with an individual’s values, preferences, needs and treatment goals as people transition to or from a low-CHO eating pattern.