Q: Is Fasting Safe For Someone With Type 1 Diabetes?
Fasting has recently become a popular dietary trend. However, if you have type 1 diabetes, there are important things to consider to know if fasting is safe for you.
Going without eating alters the balance of glucose, insulin, and ketones in your blood. This presents a unique challenge for someone with type 1 diabetes. Before you start skipping meals, you should first talk to your diabetes care team about what fasting would mean for you.
How Fasting Affects Blood Glucose
When you fast, your body takes steps to maintain the amount of glucose it needs to function well. Your brain cannot go with glucose, and every part of your body requires a source of energy.
For a fast shorter than 18 hours, your body will tap into glucose stores in the liver and convert some fat into ketones for energy. The body will also secrete less insulin and adjust other hormone levels to conserve energy and be more efficient.
When someone is in a fasting state, glucose levels in the blood will naturally be lower.
A prolonged period of fasting will cause a shift to more production of ketones for energy. In someone without diabetes, the body will eventually enter ketosis, where the level of ketones in the blood is high and are the predominant source of energy.
Ketosis is different than diabetic ketoacidosis. In a person with a healthy pancreas, the level of ketones stays within a safe range.
Fasting and Type 1 Diabetes
For someone with type 1 diabetes, the normal progression of fasting looks different.
Because the pancreas does not produce insulin, when your body begins to burn fat for energy, the level of ketones can become toxic. This means you would still require insulin, but the amount would be different than what you’re used to.
Lower glucose levels, shifts in how your body uses energy, and changes in hormone levels in the fasting state can all impact blood sugar control.
Here are three things to take into account before you skip a meal.
Talk to Your Care Team
First and most important, talk to your doctor to see if fasting is right for you. Everyone with type 1 diabetes is different, and depending on your history, blood glucose control, and insulin regimen, fasting may be more or less safe.
Certain people, including pregnant women and those on specific medications, should avoid fasting.
Some studies have shown it may be possible for an otherwise healthy person with type 1 diabetes to fast safely. But, your doctor is your best resource to determine your individual risk.
Monitor Your Blood Glucose Closely
If your doctor gives you the green light to fast, they will likely ask you to closely monitor your blood glucose levels. Remember, your body will be responding to the fasting state differently than usual.
Hypoglycemia and hyperglycemia are both possibilities when you go without food. Be prepared for either situation and have glucose tabs and insulin with you at all times.
Adjust Your Insulin
Your doctor will work with you to plan how your insulin regimen should change to accommodate fasting. Most likely, you will take less of your basal insulin dose and omit the fast-acting dose you would typically take with food.
Follow the instructions from your doctor and keep your care team in the loop to make adjustments to your insulin as needed.
The Bottom Line
Fasting may not be appropriate for everyone with type 1 diabetes. Before you try a fast, connect with your diabetes care team and work together to decide the best path for you.
