A 5-year-old boy with known type 1 diabetes mellitus (T1DM), treated with insulin, presents to the paediatric diabetes outpatient department for his routine clinic review. The family have started the boy on a ketogenic diet (<50 g of carbohydrates daily with target blood ketones of 2–3 mmol/L) to improve his diabetes control and for additional perceived health benefits. On the ketogenic diet, the patient’s insulin needs decreased, his HbA1c is good (41mmol/L/5.2%) and his height and weight are increasing along the 75th centile for his age. He has normal screening bloods (including lipids) and a normal ECG.

The paediatric diabetes multidisciplinary team traditionally recommend a low-fat, high-carbohydrate diet for children with T1DM. The team have no experience of using a ketogenic or low-carbohydrate diet for the management of T1DM in children treated with insulin. You wonder if there is evidence to support the ketogenic diet in children with T1DM and if there are potential risks associated with the low-carbohydrate diet.. To read the full article, log in using your NHS OpenAthens details.