Answer 1 is incorrect. 10.61% chose this answer. “ST is motivated for change, encourage their desire to implement a very low-carbohydrate diet as it is safe for all individuals with diabetes.”  While very-low-carbohydrate diets has evidence for reducing A1c and need for additional medications, they may not be universally safe for all individuals. Keep reading to learn more.

Answer 2 is incorrect. 12.77% of you chose this answer. “ST should avoid a very low-carbohydrate diet.”  A very-low-carbohydrate diet is not inherently contraindicated for individuals with diabetes, but careful planning and potential discontinuation of the SGLT2 inhibitor is recommended to reduce the risk of euglycemic ketoacidosis. 

Answer 3 is correct. About 59.53% of respondents chose this. “A very low-carbohydrate diet may be appropriate if ST transitions off the SGLT2 inhibitor.”  Use SGLT2 inhibitors with caution when implementing a low carbohydrate diet and strong consideration should be made to cease this medication if implementing a very low carbohydrate diet, less than 50 grams of carbohydrate per day. Very low carbohydrate diets may increase the risk of euglycemic ketoacidosis by lowering insulin levels. After additional clinical review, a very-low-carbohydrate diet can be considered for ST if they transition off the SGLT2 inhibitor. Educating ST about the difference between physiological ketosis and pathological ketoacidosis may also be considered. 

Finally, Answer 4 is incorrect. 17.09% chose this answer. “ST should follow a fixed carbohydrate intake at each meal to align with their medication regimen.” While fixed carbohydrate intake can sometimes simplify diabetes management, it does not align with ST’s interest in very-low-carbohydrate eating patterns. The current medication regimen does not necessarily require a fixed carbohydrate plan. Simply educating on this approach without additional shared decision making may not provide an individualized dietary intervention. 

Reference: American Diabetes Association Professional Practice Committee; 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S77–S110. https://doi.org/10.2337/dc24-S005

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!