How many Carbs?

I am not following Bernstein's plan, but the idea of it. Just began reading his book. Carb reduction.

My son newly diagnosed in February is in honeymoon. How many carbs can I reduce without getting into DKA? That is what the endo has told me.

How many carbs is too low? What can happen if insulin intake is low and there is carb reduction?

I want to guide him to this idea as he moves out of honeymoon. And as Bernstein says the ideal is to keep them in a prolonged honeymoon.


Diabetic Ketoacidosis is not something you're going to have to worry about on a low carb diet. DKA is caused by a massive amount of ketones being produced from the breakdown of fats and proteins. For a diabetic, the only way that can happen is if you go off insulin completely.

Any amount of protein or fat being used by cells will produce some amount of ketones. While it's true that a very low carb diet doe can produce enough ketones to put you into ketosis, it's is simply not going to be enough ketone production to concern yourself about DKA.

My son is currently on 1 unit of Lantus only. If I reduce his carbs can he go into DKA? The Endo's office seems to be reactionary about low carb. I am confused of how low to go. Knowing that Type 1 is all about blood sugar stability, then you would think that this is what they would be teaching. But then I have to remember that this is mainstream and mainstream says take the pill! or in this case use the insulin!

Well, mainstream or not, if your son isn't producing insulin, he'll need to inject insulin.

The question is, how much insulin will your son require? Low carb should result in less insulin usage but it won't eliminate the need to inject insulin if your son is type 1.

To answer that question, you'll need to keep your eye on your son's blood sugar readings by testing regularly. Low carb means more dependence on protein and fat, which means more ketone production. For a diabetic, dangerous levels of ketones are associated with dangerously high blood sugar readings.

The whole point of low carbing is to get better control of your sons blood sugar. As long as that goal is being achieved, you shouldn't have to worry about excess ketone production, dangerously high blood sugar, or DKA.

Just realize, with type 1 diabetics, low carb or not, DKA is a very real danger and your best defense is to keep track of Bgs.

DKA can come with little insulin and restricted carbs. That is why I am trying to find out how low I can go. DKA does not only come with high blood sugar.

DKA is not the same as ketosis on a low carb diet. DKA is dangerous. Ketosis on a low carb diet is a good thing. It is a normal by-product of the body shifting to being predominantly a fat-burner vs a carb-burner. Adults shift their metabolism to this fat-burning mode at some point below 60g of carbs daily. Not sure what the cut-off might be for a growing child but the principle is the same. As your son's body shifts from preferring carbs to fat, he won't need as much insulin (and he won't stress his remaining beta cells as much and thus the honeymoon may last longer).

Why are endo's so carb conscious and say don't restrict carbs?

I have wondered the same thing. After looking into diet in general, I have concluded that high carb foods are not necessary. They may taste good but they don't add nutrients we can't get elsewhere.

Well, we do need energy, so carbs do fulfill that but so can fat.

And this is where I come back full circle. How do I handle my son's diabetes? Stability works better when riding on fat and protein not carbs. How low can I go? I will
read Bernstein's book and see if they explain.

I don't know about children, but as an adult, there really isn't a floor. Most days, the only carbs I ingest are the trace amounts in eggs. When I do eat carbs, they are in spinach or other dark green leaves. My carb intake is extremely low, even lower than Dr. Bernstein's plan.

The only time I have had DKA was when I was very sick with no one to look after me. I was not eating and not taking insulin.

So long as I am eating, I do not go into DKA, even on a diet of virtually no carbs.

But, as I said, I am an adult. And I am not a doctor. So I can't say for certain if my experience extrapolates to a child.

Like Don says, we need to be clear about what KetoAcidosis is versus Ketosis.

KetoAcidosis is a dangerously low pH condition of the blood (Acidotic), produced specifically by massive amounts of Ketone production. Diabetic KetoAcidosis, DKA, specifically, is KetoAcidosis in diabetics caused by insufficient insulin production, therefore leading to an inability to use glucose followed by a complete dependence on proteins, first, then fat, which then produce said massive amounts of ketones

While KetoAcidosis can certainly be caused by many other things besides diabetes, DKA specifically will always be accompanied by high blood sugars, by definition.

Ketosis, on the other hand, is just higher than normal production of ketones and, in and of itself, presents no danger.

Many people on low carb diets will drop their carb intake low enough to put themselves into ketosis and become ketotic. It's a sign that you are burning predominantly, though not exclusively, fat and proteins.

What level does it take? That answer is not the same for everybody. It depends on many factors that include level of activity. Technically, all it requirss is a low enough carb intake level to chronically depress or deplete the glycogen reserves in your liver. Once that happens, you are completely dependent on gluconeogenesis on the one hand and protein and fat oxidation on the other.

Bottom line is this, since your son is diabetic, the first indicator that your son is in danger of going into DKA is high blood sugars over 250 mg/dl. If your son is not experiencing high blood sugars, that means he is receiving enough insulin to cover his needs and he is in no danger of going into DKA. His level of carbs or ketosis is completely irrelevent as far as DKA is concerned as long as his BGs are not high.

I was told that he could be DKA if insulin amount and carb amount was too low. Confused.

It is definitely confusing, no doubt.

Just remember, though, that your first indication of too low insulin will be high BG numbers. As T1s, our existence is all about balancing insulin dosage to carb intake and our natural amount of background glucose production.

Dr B himself is the guy who invented basal/bolus insulin dosage to cover our dietary intake of carbs (bolus) with our background production of glucose (basal).

We can completely eliminate our carb intake but we can never completely eliminate our background glucose production, which is why as T1s, we will always require some amount of injected insulin even if we completely starve ourselves. Thankfully, a low carb diet does not mean starvation.

Right now, your son is in his honeymoon period which means his pancreas can still produce insulin. That's why a basal dosage of insulin from Lantus is adequate to cover his daily requirement of injected insulin. You are supplementing his own daily production of insulin with an extremely low amount of injected long acting basal insulin.

Dr B believes this honeymoon period, meaning his own production of insulin, can be extended by greatly decreasing his carb intake. This decreases the burden on his pancreas to produce 5he excess amounts of insulin required to cover high amounts of dietary carbs. Presently, your son simply does not require short acting insulin injected through boluses with his meals to covert the carbs.

Eventually, however, as the islet cells in is pancreas are slowly destroyed by a relentless autoimmune attack, he will require some amount of short acting insulin in boluses to cover his meals.

According to Dr B, however, he can still continue to enjoy the long term benefits of normal BG numbers by continuing to adopt the low carb lifestyle. Since his dietary carb intake will be so low, he simply will not require large amounts of short acting insulin to cove his meals.

According to Dr B, there are countless benefits to a low carb. low bolus insulin dose, lifestyle.

Why are endo's so carb conscious and say don't restrict carbs?

I believe endos have caved in to the pressure from dieticians. Many states now have enforced laws which prevent anyone except a licensed practitioner (RDs) to give nutrition advice. So to avoid trouble most endos and doctors just defer to the lame advice from the AADE and the USDA on what people should eat. Unless an endo has a real personal and informed opinion on the matter, I simply discard everything they say on nutrition.

I think FHS has explained things very well. The conflict you have to resolve is when your medical team gives you advice that is in fact flawed. Over time, many of us have had to deal with this. This confusion of ketosis and DKA is one of the common problems encountered. You can either learn about the differences yourself and make a decision or continue to be confused as you listen to those giving you conflicting advice.

In my experience (fwiw), you should change that belief to DKA can happen when insulin is too low and blood sugar is too high. Carbs really have nothing to do with it. So long as your son is eating regularly and checking blood sugar regularly and adjusting insulin as needed, he should be fine.

If he becomes ill, especially if he is vomiting and not eating, go on alert because dehydration can make DKA more likely and set up a cycle where the dehydration triggers DKA and the DKA increases dehydration. So definitely have sick day rules for insulin, food (you still don’t need carby foods for sick days, regardless of what professionals will tell you) hydration, and when to seek medical help (for example, if I’m throwing up so much I can’t keep down water, I go for help.)

But days when he is not sick, just feed him low carb, forget what anyone says about him “needing” carbs, and make sure to check his sugar regularly (or coach him to check regularly so it becomes habit. Not sure how old your son is, so no idea where you will be in the “doing for him” versus “making sure he is doing for himself” range of things)

DKA isn’t even an issue at all, while his blood sugars are around normal to 150. It’s when they start creeping up above 200, despite doing everything to keep them down that you need to start getting concerned. And if you’re paying attention to getting enough insulin and he’s not ill, it is hugely unlikely that DKA will even rear it’s ugly head.

Thank you for being such a caring mother and you made a good choice to come here to talk. I am regularly deeply grateful for the depth of knowledge and experience I found found in members here. This place (and Dr. B’s writing) have saved my life.

I have a PhD in Physiology from the University of Michigan and have a strong scientific background in metabolic disorders. I also have Type I DM. Since my diagnosis I have been shocked by the lack of scientific basis for the recommendations that my endocrinologist, nutritionist, and ADA have been giving, especially the high carb/low fat diet that is routinely prescribed for diabetics. I will just chime in and echo what all of the other people are saying on this forum that low carbohydrate diet will not lead to DKA; rather it is hyperglycemia that will lead to DKA. It might be useful to order a Physiology or Endocrinology textbook (I would recommend Widmaeir et al. for the Physiology text and the book "Basic Medical Endocrinology" by Goodman, you can get them used for as little as $5 at so that you have a reference book on the actual metabolic pathways that occur upon ingestion of nutrients (I would recommend this for anyone following the Bernstein diet, since in his book he does get down to the scientific details which can be confusing if you don't have your own references). Then, read Dr. Bernstein's book again, especially the section on the law of small numbers.

I admire you for questioning the ADA recommendations and for looking for the best options for your son. The more you know about the science behind metabolism, how our bodies utilize, produce, and store proteins, fats, and sugars, how hormones like insulin and glucagon act on cells, etc., the more you will begin to appreciate the scientific basis for the low carbohydrate approach to DM. His book is full of references to peer-reviewed, scientific studies as well as his own data from experiments on his own blood sugar and those of his patients. Finally, I'll just say that I am so grateful that I stumbled on his approach when I was first diagnosed; I had an HbA1C of 10.5%, very high triglycerides, and high cholesterol at time of diagnosis; after 6 months following the diet, my HbA1c was down to 5.0%, my triglycerides were off the chart low, and my HDL was increased and LDL was significantly reduced. It was my own validation of how a low carb diet alone not only improved my blood chemistry (and likely saved my life) but it did not ever cause anything remotely close to DKA.

To answer your orginal question:
Dr Bernstein rule is 6 gr carb for breakfast, 12 gr carb for lunch and 12 gr carb for dinner. His recipes was in the back of the book when I read it many, many years ago.

And just to echo the rest here;

Your son can´t go too low on carbs as long as he gets enough insulin to keep his blood sugar within normal range. If 30 gr carbs a day suits him or is too low for him as long as he´s still a kid is something you just have to find out based on how he feels.

Thank you for your response and support. I am sitting back to read his book today. The difficult part I have is getting everyone to chime in. Who want's to listen to mom, right?

I am going to have to find a doctor that can advise and direct my son in this fashion as well as be a significant force to my husband.

Thank you. You sound not only an intelligent woman, but wise as well.

Then the question is: If he is on very little insulin while in "honeymoon" how low can he go with carbs? And how many carbs does a growing 15 really need? Am I depleting him of nutrition and any kind of support and healing to his body if I take away carbs during this time? Kind of like taking away sleep. We know how harmful taking away sleep from the body is. But we also know we can do well on less.

Thank you for your response.