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For well-controlled type 1 diabetics, what percentage of daily caloric intake should come from carbohydrates? Are there any advantages to restricting total carbohydrate intake in order to reduce insulin requirements?
This question has been debated among practitioners, but to my knowledge, no answer has been forthcoming. Adequate insulin is essential not only for blood glucose control, but also for aspects of protein and fatty acid metabolism. Thus, unlike patients with type 2 diabetes who frequently have an excess of insulin, patients with type 1 disease can be lacking sufficient insulin for effective metabolism if carbohydrate intake is extremely low.
Most of the information regarding the "pros and cons" of insulin requirements comes from the Diabetes Control and Complications Trial (DCCT). When patients are carefully controlled to the most near-normal glucose level possible, patients gain body weight and, as a result of the low blood glucose concentrations, are more prone to hypoglycemic episodes.
Because we know that patients with type 2 diabetes and insulin resistance are at increased risk for cardiovascular disease, many practitioners suspect that the larger amounts of insulin used in patients with type 1 diabetes who have a higher intake of carbohydrates might result in increased cardiovascular risk. To my knowledge, however, there are no data to support this hypothesis.
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