Presenter: Dr. Robert Cywes, MD, PhD
Dr. Robert Cywes presents a comprehensive overview of the clinical implementation of low carbohydrate diets in Type 1 diabetes mellitus (T1DM) for both adults and children. His presentation, divided into two parts, delves into the challenges and solutions surrounding insulin replacement therapy, dietary management, and blood sugar control in T1DM.
Dr. Cywes highlights the historical context of T1DM treatment, emphasizing the shift towards insulin replacement therapy as the cornerstone of management. However, he notes the challenges inherent in this approach, particularly the risk of hypoglycemia and the need for precise insulin dosing based on various factors such as diet, exercise, and stress.
Dr. Cywes critiques the current standard of care, which focuses on advanced carbohydrate counting but often fails to significantly improve A1C levels. He advocates for a paradigm shift, suggesting that instead of using insulin to control variables like diet and exercise, insulin dosing should be the variable while blood sugar, diet, exercise, and stress should be controlled constants.
Dr. Cywes expands on the practical implementation of this paradigm shift. He introduces the concept of fat adaptation, which involves transitioning the body's fuel source from carbohydrates to fats over a period of time. This approach, he explains, can help stabilize blood sugar levels and reduce the need for insulin. Dr. Cywes describes a step-by-step therapeutic phase that includes measuring insulin resistance, adopting a low-carbohydrate diet, intentionally inducing hyperinsulinemia to lower blood sugar, and using a combination of long-acting and short-acting insulin to manage blood sugar levels effectively.
Throughout both parts of the presentation, Dr. Cywes emphasizes the need for individualized treatment plans tailored to each patient's specific needs. He discusses the use of continuous glucose monitoring systems (CGMS) and insulin pumps to track and manage blood sugar levels more effectively. Additionally, he touches on the potential benefits of using GLP-1 agonists to reduce insulin use and improve blood sugar control in T1DM patients.
In conclusion, Dr. Cywes's presentation provides a detailed roadmap for implementing low carbohydrate diets in the management of T1DM. His approach, focusing on blood sugar control through diet and insulin dosing, offers a promising alternative to traditional insulin therapy, with the potential to improve outcomes and quality of life for individuals with T1DM.
CHAPTERS
0:00 Introduction to Type 1 Diabetes Treatment Goals
1:58 Carbohydrate Reduction Lifestyle
4:25 Type 1 Diabetes Management -- SMHP Position Statement
5:30 Type 1 Diabetes Management - JSAPA Protocol Dexcom Study Preliminary Results
18:09 History of Type 1 Diabetes
20:47 History of Insulin & Insulin Resistance
24:15 History of Glucose Monitoring
26:58 HbA1c Strongly Predicts Cardiovascular Risk
27:38 History of Type 1 Diabetes Management - Diet
30:33 History of Type 1 Diabetes Management - Insulin
31:26 History of Type 1 Diabetes Management - Current Standard of Care
34:00 History of Type 1 Diabetes Management - Dr. Richard K Bernstein
36:05 History of Type 1 Diabetes Management - Beyond Bernstein
40:15 Genetics and Epigenetics of Insulin Resistance in Type 1 Diabetes
43:14 Insulin Resistance Determines Type 1 Diabetes Co-Morbidity
43:50 Type 1 Diabetes Management - JSAPA Protocol
50:26 Type 1 Diabetes Management - JSAPA Protocol Dexcom Study Preliminary Results
52:06 Conclusion
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