Shaping the Future of Type 1 Diabetes Care: Insights from Dr. Andrew Koutnik on Low CarbMD

Type 1 diabetes (T1D) is not just a medical condition—it’s a daily challenge that profoundly affects the lives of those diagnosed and their families. This autoimmune condition destroys insulin-producing beta cells in the pancreas, requiring lifelong insulin management. For those navigating this path, stabilizing blood sugar levels is critical to avoiding life-altering complications like neuropathy, retinopathy, and nephropathy, along with reducing the daily burden of hypoglycemia and hyperglycemia.

In a recent episode of the Low CarbMD podcast, Dr. Andrew Koutnik, a leading researcher and advocate for T1D management, joined Dr. Tro Kalayjian to discuss the transformative potential of therapeutic carbohydrate reduction (TCR) in managing T1D. Drawing from his lived experience as a T1D patient and his extensive research background, Dr. Koutnik sheds light on the potential of nutrition, the role of patient advocacy, and the need for systemic change in how T1D is managed.

T1D: A Window into Metabolic Health

Dr. Koutnik opened the discussion by highlighting the unique insights T1D offers into metabolic health. The loss of insulin production forces individuals with T1D to become intimately aware of how their bodies respond to food, exercise, stress, and other factors.

"T1D makes you the sole regulator of your metabolism," said Dr. Koutnik. "You hold the reins to one of the body’s most powerful hormones, insulin, and every decision about what to eat or how to move impacts your blood sugar levels."

This hyperawareness provides a unique perspective on how carbohydrates drive glucose variability and underscores why dietary strategies like TCR can be so effective.

The State of T1D Guidelines: A Call for Change

One of the most pressing issues raised during the podcast was the lack of comprehensive dietary guidelines for T1D patients. While organizations like the American Diabetes Association (ADA) have acknowledged the role of carbohydrate reduction in managing Type 2 diabetes, they have largely failed to provide meaningful guidance for T1D.

“The ADA’s silence on nutrition for T1D is unacceptable,” Dr. Tro asserted. "Patients and healthcare professionals are left to navigate this complex disease without clear, evidence-based support for low-carb approaches."

Dr. Koutnik agreed, noting that the absence of guidelines has left many clinicians feeling unprepared to help patients implement TCR safely. This gap often forces families and patients to seek out solutions independently, relying on resources like the TypeOneGrit community or pioneering texts like Dr. Richard Bernstein’s Diabetes Solution.

The Impact of the IPTN Guidelines

The recent publication of the Therapeutic Carbohydrate Reduction in Type 1 Diabetes: A Guide for Dietitians and Nutritionists by the Institute for Personalized Therapeutic Nutrition (IPTN) marks a significant step forward in filling this void. Dr. Koutnik, a key contributor to the guide, emphasized its potential to empower both patients and healthcare providers.

“This guide is a blueprint,” he explained. “It combines lived experience, clinical expertise, and evidence-based recommendations to provide actionable strategies for managing T1D with a low-carb approach.”

Dr. Koutnik also highlighted the pivotal role of Beth McNally, a parent of a child with T1D and a fierce advocate for the community. “Beth’s passion and determination were the driving force behind this guide,” he said. “After years of challenges, she brought the team together and led the effort to completion. Her work is a testament to the power of community-driven advocacy.”

The guide has already been downloaded thousands of times, and its reception highlights the growing demand for practical, accessible resources in the T1D community. Dr. Koutnik expressed hope that it would serve as a starting point for healthcare providers and patients alike to explore the potential of therapeutic carbohydrate reduction in T1D care.

Why Low-Carb is Not Restrictive

One of the most common misconceptions about low-carb diets is that they are inherently restrictive. Dr. Koutnik challenged this notion, arguing that the trade-off is a net gain in freedom and quality of life.

“Living with T1D is inherently restrictive,” he said. “You’re constantly managing highs and lows, worrying about complications, and feeling the mental burden of the disease. A low-carb approach reduces variability and gives you stability—and that stability is liberating.”

Dr. Tro shared a poignant story about hosting a dinner for a T1D patient and his family. By preparing a fully low-carb meal—including snacks, sides, and desserts—the child experienced, for the first time, the freedom to eat without worrying about blood sugar spikes.

“This isn’t about deprivation,” Dr. Tro said. “It’s about giving people with T1D the tools to live their lives fully and without fear.”

The Lived Experience: Mental Health and T1D

Beyond physical complications, T1D significantly impacts mental health. Rates of depression, anxiety, and diabetes-related distress are disproportionately high in the T1D community. Dr. Koutnik pointed out that this burden often stems from the relentless demands of disease management.

“Variable blood sugar levels affect mood, cognition, and overall well-being,” he explained. “Stable blood sugar levels achieved through TCR can dramatically improve mental health outcomes.”

He also cited data showing that children with poorly controlled T1D experience neuroanatomical changes and cognitive deficits. “The stakes are incredibly high,” he said. “Every step toward stable blood sugar is a step toward better mental and physical health.”

The Role of Patients and Families in Driving Change

One of the most striking themes of the podcast was the role of patients and caregivers in advancing T1D care. While healthcare organizations have been slow to adapt, patients and parents have led the charge, experimenting with low-carb approaches and sharing their successes.

“Parents of children with T1D are some of the most resourceful advocates I’ve ever seen,” Dr. Koutnik said. “They’re not waiting for the medical community to catch up—they’re taking matters into their own hands.”

The TypeOneGrit community, for example, has demonstrated that TCR can help individuals with T1D achieve near-normal HbA1c levels—a feat once thought impossible. The 2019 Pediatrics study documenting these outcomes was a wake-up call for the medical community, showcasing the potential of patient-led innovation.

Overcoming Barriers to TCR Adoption

Despite its benefits, TCR faces resistance from some healthcare providers, who often cite concerns about its complexity and safety. Dr. Koutnik addressed these barriers head-on.

“The evidence doesn’t support the fears,” he said. “With proper insulin adjustment, TCR does not increase the risk of hypoglycemia or diabetic ketoacidosis. What it does is improve time in range, reduce insulin requirements, and enhance quality of life.”

He acknowledged, however, that implementing TCR requires education and support.

“Healthcare providers need guidelines, training, and resources,” he said. “Without those, it’s no wonder many feel unprepared.”

A Vision for the Future

Dr. Koutnik and Dr. Tro concluded the podcast with a hopeful vision for the future of T1D management. They emphasized the importance of continued research, patient advocacy, and collaboration to ensure that every person with T1D has access to life-changing tools like TCR.

“We’re not saying this is the only way,” Dr. Koutnik said. “But it’s a powerful option that should be on the table. Every T1D patient deserves the opportunity to explore what works best for them.”

Dr. Tro added, “The status quo isn’t good enough. We owe it to this community to do better—to listen, to innovate, and to support them in living their best lives.”

Conclusion

The insights shared by Dr. Andrew Koutnik on the Low CarbMD podcast illuminate the transformative potential of therapeutic carbohydrate reduction in T1D care. From stabilizing blood sugar levels to improving mental health and empowering patients, TCR offers a pathway to better outcomes and a brighter future.

As the T1D community continues to advocate for change, resources like the IPTN guide and communities like TypeOneGrit provide a foundation for progress. By embracing evidence-based approaches and centering the lived experiences of those with T1D, we can move closer to a world where every individual with T1D has the chance to thrive.

For more information and resources, visit the T1D Nutrition and IPTN Guidelines.