Day 10 | Today’s FIRE Map
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Fix it: Phone your Doctor
In a Matchbox:
This guide is provided for general information and does not constitute medical advice. You should work closely with your healthcare team before making any changes, as every individual’s needs may differ. Please use this resource to facilitate discussions with your doctor and healthcare team.
If you’re starting the FIRE Diabetes In 40 Days journey and have Type 2 Diabetes, congratulations! This journey involves a low carb ketogenic diet, which has the potential to reverse type 2 diabetes. However, it’s crucial to know what you’re doing and communicate frequently with your healthcare team. When you begin eating low carb, you’ll likely need to lower your insulin doses and adjust other diabetes medications accordingly. Testing your blood sugar frequently and consulting with a physician or diabetes expert is essential for medication adjustment.
Read:
Information on Diabetes Medications
Discussing diabetic medication with your healthcare provider
Important: This guide is provided for general information and does not constitute medical advice. Every individual will have a slightly different need and should work closely with their healthcare team before making any changes. Please use this as a resource to help facilitate that discussion with your doctor and your healthcare team.
For instance, we want you to know that it’s very important to adapt diabetes medications when starting a low carb diet. In particular, insulin doses may need to be lowered to avoid low blood sugar, and SGLT2 inhibitors (e.g. Forxiga) may need to be deprescribed (see below).
However, we also want you to discuss any changes in medication and relevant lifestyle changes with your doctor before making any changes.
Starting Your FIRE Diabetes Journey with diabetes medications
So, you have Type 2 Diabetes and are starting on the FIRE Diabetes In 40 Days journey? Good for you! This journey includes a low carb ketogenic diet. Making these dietary changes has the potential to reverse type 2 diabetes
However, you need to know what you are doing, and you need to communicate frequently with your healthcare team. Once you start eating low carb you will likely have to lower your insulin doses as well as some other diabetes medications, frequently by quite a lot
Avoiding the carbohydrates that raise your blood sugar level decreases your need for medication to lower it. Taking the same dose of insulin or insulin-stimulating oral medication as you did prior to adopting a low-carb diet might result in low blood sugar, something that can potentially become dangerous.
You need to test your blood sugar frequently when starting this diet and adjust your medication accordingly. This should always be done with the assistance of a physician or other health professional with expertise in diabetes.
No drugs
If you have diabetes and you’re treated by diet alone, there is an extremely low risk of low blood sugar on the FIRE Diabetes journey. You can get started right away.
SGLT2 inhibitors (e.g. Farxiga, Forxiga, Jardiance, Invokana)
These drugs lower blood sugar in Type 2 Diabetes, and can be helpful in people on a more liberal low carb diet as they directly remove glucose (blood sugar) from the bloodstream. However, they can increase the risk of a dangerous condition called ketoacidosis.
The risk of this could be increased by a strict low-carb diet. It is therefore advised to stop SGLT2 inhibitors before starting the FIRE Diabetes in 40 Days journey. This should be discussed with your doctor.
It’s worth noting that when ketoacidosis occurs while taking SGLT2 inhibitors, the blood sugar level is not necessarily high, making it harder to detect.
If you neglected to stop your SGLT2 inhibitors before commencing on the FIRE Diabetes journey and you get symptoms of ketoacidosis – extreme thirst, nausea, vomiting, stomach pain, confusion, etc. – you should stop the medication and contact a doctor urgently.
Insulin-treated type 2 diabetes
As a general guide, you will need to lower your doses when starting a strict low-carb diet, like the FIRE diabetes programme.
Work with your doctor to find the right initial reduction. Many find that the reduction may need to be between 30 and 50%11. If you take insulin once or twice daily, consider reducing both doses by the same proportion. If you are on a basal bolus regimen (taking fast-acting insulin before meals, and long-acting insulin once or twice a day), your mealtime doses should be reduced first.
If you remain on the FIRE Diet, it is possible you will be able to stop mealtime insulin altogether within a few days. You can then begin to reduce your long-acting insulin, if your blood sugar levels remain stable. Many people on a low carb diet are able to come off insulin completely.
Unfortunately, there’s no way of knowing how much insulin is required in advance. You will have to test your blood sugar frequently and lower insulin doses based on your blood sugar readings. This should be done with the assistance of a knowledgeable physician or healthcare team.
Note, that as a general rule, many feel it is better to err on the low side of insulin doses. If your blood sugar goes a bit high you can take more insulin later to help bring it down. That’s OK. If, instead, you take too much insulin and end up having low sugar, that is potentially far more dangerous. You’ll also have to quickly eat or drink glucose or another form of rapid-acting carbohydrate in order to raise your sugar to a safe level, and that likely reduces the effect of the low-carb diet.
Insulin-releasing pills
Some pills for type 2 diabetes work by stimulating the pancreas to produce more insulin. These medications can also result in low blood sugar on a low-carb diet.
These pills are either in the group known as sulfonylureas (this includes gliclazide, glipizide, glibenclamide, glyburide, and tolbutamide) or meglitinides (repaglinide and nateglinide).
You will need to reduce the dose or stop these drugs when starting a low-carb diet in order to avoid low blood sugar levels3,10,12. We recommend you discuss this with your doctor in advance.
Metformin
Individuals with type 2 diabetes can safely take metformin on a low-carb diet. There is a very low risk of low blood sugar from taking metformin v13.
GLP-1 agonists (e.g. Victoza) and DPP-4 inhibitors (e.g. Galvus, Januvia)
These drugs should rarely lead to low blood sugar on a low-carb diet by themselves14–16. But be observant, check your blood sugar often, and discuss with your doctor as needed.
Acknowledgement
This document was adapted from a publication by:
Eenfeldt A, Scher B. Starting low carb or keto with diabetes medications [Internet]. Diet Docor. 2020. Available from: https://www.dietdoctor.com/low-carb/with-diabetes-medications