New Possibilities for Type 1 Diabetes: Insights from Dr. Laura Buchanan’s Presentation at Boca 2025

At the recent Symposium for Metabolic Health in Boca Raton, Dr. Laura Buchanan delivered a compelling presentation titled New Possibilities for Type 1 Diabetes (T1D). Her talk provided an in-depth analysis of the challenges faced by individuals with T1D and their families, emphasizing the critical gaps in conventional diabetes management while also presenting a path toward improved health outcomes through Therapeutic Carbohydrate Reduction (TCR).

Dr. Buchanan began by sharing her background and motivation for advocating metabolic health approaches, including her board certifications in family and obesity medicine, her role as a Metabolic Health Practitioner, and her work as a certified menopause specialist. She underscored the personal importance of family, acknowledging the presence of her husband, Dr. Matt Calkins, their son James, and her mother at the event. This personal connection set the stage for the real-world impact of TCR on T1D management.

Framing the Discussion: James’ Story

Dr. Buchanan’s presentation centered on a powerful case study—James, an 8-year-old boy diagnosed with T1D. Through James’ journey, she illustrated the harsh realities of conventional diabetes care, the limitations of current dietary guidelines, and the transformative potential of a well-formulated low-carbohydrate approach.

James’ story began with the early signs of Type 1 Diabetes, including excessive thirst, frequent urination, and unexplained weight loss. Initially dismissed as normal for an active child in hot weather, his symptoms escalated until he became lethargic, unable to get out of bed, and cognitively impaired. A rush to the emergency room confirmed the diagnosis: Type 1 Diabetes, with dangerously high blood glucose levels, and diabetic ketoacidosis (DKA)—a life-threatening condition requiring intensive care unit (ICU) admission.

This narrative highlighted the common yet devastating onset of T1D, emphasizing that 38% of children diagnosed with T1D present with DKA. Once stabilized, James was discharged home with standard dietary guidance, which emphasized high carbohydrate consumption and insulin dosing adjustments—an approach that would define his struggles with blood sugar control, mood instability, and increased risk of complications in the months ahead.

The Focus of the Blog

Dr. Buchanan’s talk revealed crucial insights about T1D management, which this blog will explore in detail:

• The current dietary recommendations for T1D
• The long-term health implications of conventional treatment
• How TCR offers better glycemic control, improved quality of life, and reduced complications
• The data-backed benefits of low-carb nutrition for children with T1D
• The need for greater provider education and clinical support in implementing TCR

Her presentation challenged the status quo, urging the medical community to rethink dietary guidelines for T1D and to empower families with effective, science-backed alternatives to conventional high-carb, insulin-dependent management strategies.

Understanding the Current Dietary Recommendations for Type 1 Diabetes

Type 1 Diabetes (T1D) is an autoimmune condition that results in little to no insulin production, requiring lifelong insulin therapy for survival. However, conventional dietary guidelines emphasize high carbohydrate intake, which can lead to significant challenges in blood sugar control.

Dr. Buchanan outlined the current recommendations from major medical organizations:

• International Society of Pediatric and Adolescent Diabetes (ISPAD): 40-50% of total daily calories from carbohydrates
• American Academy of Pediatrics (AAP): 45-65% of total daily calories from carbohydrates
• American Diabetes Association (ADA) & American Association of Clinical Endocrinology (AACE): No specific macronutrient recommendations, but emphasize carbohydrate counting and whole grains

For a child like James, following these guidelines would mean consuming approximately 265 grams of carbohydrates per day (based on a standard 2,000-calorie diet). This constant influx of carbohydrates requires high doses of insulin, making blood sugar control extremely difficult and contributing to unpredictable highs and lows.

How These Guidelines Play Out in Real Life: James' Case

After James was diagnosed with T1D and Diabetic Ketoacidosis (DKA), his family was educated on Type 1 diabetes management and provided with a standard meal plan based on high carbohydrate intake. James’ dietary recommendations included:

• 60g of carbohydrates per meal (breakfast, lunch, and dinner)
• Three 15g carbohydrate snacks per day
• Total daily carbohydrate intake: ~240g

These guidelines aligned with ISPAD and AAP recommendations, reinforcing the traditional belief that children with T1D should consume carbohydrates at similar levels to the general population while adjusting insulin doses accordingly.

Determined to follow medical advice to the letter, James' family carefully counted carbohydrates and adjusted insulin doses. However, within days of being home, they encountered the rollercoaster of blood sugar fluctuations that would become an ongoing struggle:

• Severe post-meal spikes, where James’ blood sugar soared above 350 mg/dL, despite insulin administration
• Frequent hypoglycemic episodes, requiring rapid correction with juice, candy, or glucose tablets
• Mood swings and fatigue, making daily activities, including his passion for tennis, increasingly difficult

Despite strictly adhering to the prescribed meal plan, James’ glycemic control remained poor. His family faced daily uncertainty, managing blood sugars that swung dangerously between highs and lows. These fluctuations took a physical and emotional toll, with James experiencing:

• Increased irritability and depressive symptoms
• Significant diabetes-related stress on the family
• Constant fear of nighttime hypoglycemia, where James could lose consciousness due to low blood sugar

Even with meticulous carbohydrate counting, insulin adjustments, and close adherence to medical recommendations, James' HbA1c levels remained elevated, mirroring the struggles of most children with T1D under standard care.

📊 A1C Progression on Standard Dietary Guidelines:
• Diagnosis: 10.9% (well above target levels)
• Three months later: 9.1%
• Six months later: 8.7%

At this stage, the medical team encouraged more "heart-healthy" whole grains, fruits, and a low-fat diet, yet this resulted in only a minor A1C reduction to 8.4%.

A Different Approach in Type 1 Diabetes: Therapeutic Carbohydrate Reduction (TCR)

Dr. Buchanan contrasted these conventional guidelines with the Society of Metabolic Health Practitioners (SMHP) position statement, which supports Therapeutic Carbohydrate Reduction (TCR) as a viable option for T1D management:

• Low-carbohydrate diet: Less than 130g per day
• Very low-carbohydrate diet: Below 50g per day

This alternative approach challenges the longstanding paradigm of high-carb intake in diabetes care, offering a potential pathway to more stable blood sugar levels and improved health outcomes for children like James.

As James' family continued searching for solutions, they began to question the efficacy of standard guidelines, paving the way for their exploration into low-carbohydrate nutrition as a potential strategy to improve his health and quality of life.

The Reality of Type 1 Diabetes Outcomes

Through James’ story, Dr. Buchanan highlighted the typical experience of a child diagnosed with Type 1 Diabetes (T1D) and the frustrating limitations of conventional care.

James’ Diagnosis and Initial Treatment

James, an active and happy 8-year-old tennis player, begins to experience increased thirst, frequent urination, unexplained weight loss, and fatigue. At first, his parents assume he is simply dehydrated from playing tennis in the summer heat. However, as his symptoms persist and worsen, they seek medical advice.

Initially, his pediatrician's office is unable to offer an immediate appointment, and when his parents bring him to an urgent care clinic, they are told that he does not have a urinary tract infection (UTI) and to return if his condition worsens.

James' condition does worsen. He becomes increasingly lethargic, struggles to wake up in the morning, and his personality seems different—his usual enthusiasm has faded. One day, he becomes severely weak and unresponsive, prompting his parents to rush him to the emergency room.

At the hospital, doctors quickly recognize the severity of his condition. His blood sugar is measured at over 500 mg/dL, and he is diagnosed with Type 1 Diabetes. By the time of diagnosis, James is already in Diabetic Ketoacidosis (DKA), a life-threatening condition that requires immediate intensive care intervention.

🔴 This is a common scenario:
📌 38% of children diagnosed with T1D present in DKA at the time of diagnosis. (Jensen et al., 2021)

James is admitted to the Intensive Care Unit (ICU), where doctors work urgently to stabilize his condition. Over the next 24 hours, his vital signs and laboratory values improve, allowing him to be transferred to a regular hospital floor for further care.

Before discharge, James’ family receives comprehensive diabetes education covering insulin therapy, blood glucose monitoring, and dietary management. They are given standard hospital guidelines that emphasize carbohydrate counting and adjusting insulin doses accordingly.

James' prescribed daily carbohydrate intake is:

• 60 grams of carbohydrates per meal (breakfast, lunch, and dinner)
• Three 15-gram carbohydrate snacks per day
• Total: ~240 grams of carbohydrates daily
With this information in hand, James’ parents feel prepared—or so they think.

The First Few Months of Conventional Care

James and his family diligently follow the hospital’s recommendations. They carefully measure portions, count carbohydrates, and administer insulin exactly as instructed. However, within days, they begin experiencing the rollercoaster of blood sugar swings that defines conventional diabetes management.

Despite precisely dosing insulin, James' blood sugar is highly erratic:

• Severe post-meal hyperglycemia: After eating, his blood sugar spikes above 350 mg/dL, leaving him feeling fatigued, irritable, and unwell.

• Frequent hypoglycemia: Multiple times per week, James experiences dangerously low blood sugar episodes, requiring immediate intervention with juice, candy, or glucose tablets to prevent loss of consciousness or seizures.

• Blood sugar fluctuations: disrupt his daily life, making it harder for him to play tennis, focus in school, or feel like himself.

📊 James’ Emotional and Psychological Challenges

Beyond the physical struggles of blood sugar instability, James and his family experience significant emotional distress. The mental and emotional burden of T1D is well-documented, and James’ experience aligns with these statistics:

📌 30% of youth with T1D develop depressive symptoms (Buchberger et al., 2016)
📌 32% develop anxiety symptoms (Buchberger et al., 2016)
📌 60% of adolescents with T1D experience moderate-to-high diabetes distress (Polonsky et al., 2019)

James' mother, now constantly fearful of nighttime hypoglycemia, finds herself waking up throughout the night to check his blood sugar, worried that he could have a severe low while asleep.

Meanwhile, James’ mood swings and energy crashes—caused by his fluctuating blood sugars—make it increasingly difficult for him to participate in activities he once loved, like tennis.

James’ HbA1c (A1C) Progression on Standard Treatment

Despite the strict adherence to standard dietary guidelines, James’ long-term blood sugar control remains poor.

• At diagnosis: 10.9% (well above the target of <7%)
• Three months later: 9.1%
• Six months later: 8.7%

At his six-month follow-up, James’ family asks what more they can do. His doctor recommends focusing on "healthy" whole grains, fruits, and a low-fat diet, but this only results in a minor reduction in A1C to 8.4%.

📌 A meta-analysis found that carbohydrate counting alone only reduces A1C by an average of 0.35%. (Bell et al., 2013)

Even though James’ family is doing everything "right" according to conventional guidelines, his blood sugar control remains suboptimal, and his risk for complications remains high. The frustration is growing, and his family begins to search for alternative approaches to better manage his diabetes.

Looking into the Future: The Consequences of High A1C

Dr. Buchanan underscored the grave long-term consequences of prolonged hyperglycemia and how the standard approach to T1D management often fails to prevent these complications. After six months on the recommended dietary guidelines, James' HbA1c (A1C) remains above 8%, significantly higher than the recommended target of below 7%. His family is concerned about what this means for his long-term health, and when they begin researching, they are shocked by what they find.

The Long-Term Risks of Elevated A1C

🔴 James’ current trajectory places him at risk for serious complications:

📌 For every year that A1C remains above 7.5%, a person with T1D loses 100 days of life. (Rawshani et al., 2018)
📌 Children diagnosed before age 10 have a life expectancy reduced by 14-18 years. (Australian National Diabetes Audit, 2021)
📌 Only 17% of youth achieve the ADA's target A1C (<7.5%), and only 21% of adults achieve an A1C below 7%. (Foster et al., 2019)

James’ current A1C trajectory suggests that he is unlikely to meet these targets, meaning he is on track for a significantly shortened lifespan.

Type 1 Diabetes Increases Risk of “Double Diabetes” and Cardiovascular Disease

James’ parents also learn about "double diabetes", a term used to describe individuals with T1D who develop insulin resistance, similar to Type 2 Diabetes. This combination significantly increases the likelihood of serious health complications.

• Heart Disease: By age 40, 70% of men and 50% of women with T1D have coronary artery calcification, a key marker of cardiovascular disease. (Bjornstad et al., 2015)
• Neuropathy (nerve damage): By age 25, 59% of individuals with T1D show signs of nerve damage, which can lead to chronic pain, numbness, and loss of mobility. (Bjornstad et al., 2015)
• Retinopathy (eye damage): By age 25, 27% of individuals with T1D develop eye damage, increasing the risk of vision loss or blindness. (Bjornstad et al., 2015)
• Nephropathy (kidney disease): By age 25, 5% of individuals with T1D have kidney damage, which can eventually progress to kidney failure and the need for dialysis. (Bjornstad et al., 2015)

James’ Parents Search for Alternatives

Confronted with these stark statistics, James' family is deeply unsettled. They feel like they are doing everything "right", following the medical advice exactly as prescribed, and yet James is still on track for serious health complications.

Desperate to improve his future, they begin to question whether there is a better way to manage T1D—one that does more than just slow the progression of complications, but instead helps James achieve normal, stable blood sugar levels.

A New Possibility: The Transformative Power of TCR

Desperate for answers after struggling to stabilize James’ blood sugar despite following the recommended dietary guidelines, his parents begin researching alternative dietary approaches. They come across the concept of Therapeutic Carbohydrate Reduction (TCR) and read about Dr. Richard Bernstein, a physician with T1D for over 70 years who has successfully maintained normal blood sugar levels through a low-carbohydrate diet.

A Shift in James' Diet

Determined to explore a different path, James’ parents begin gradually lowering his carbohydrate intake under the guidance of his healthcare provider.

🔹 James reduces his carbohydrate intake to 70-90g per day, a significant shift from the 240g per day recommended in standard guidelines.
🔹 His blood sugar stabilizes, reducing the extreme highs and lows he had been experiencing.
🔹 His mood improves, and he begins to feel like himself again.
🔹 His A1C drops significantly, from 7.5% to 5.7%, achieving levels that are considered normal rather than diabetic.

Clinical Data Supports This Approach

📊 The benefits of TCR are supported by existing research:

A 2018 study of 131 children with T1D who followed a very low-carb diet (30g/day) found:

📌 Average A1C of 5.71%, compared to 8.6% in the standard care group (Lennerz et al., 2018)
📌 Severe hypoglycemia reduced from 6.2% to 2%
📌 DKA incidence dropped from 9.9% to 1%
📌 Total insulin requirements were reduced by 50%

James' results reflect similar improvements, demonstrating that lowering carbohydrate intake can lead to significantly better glycemic control.

A Remarkable Transformation

🔹 After one year on TCR, James’ glycemic control is better than 99% of individuals with T1D.
🔹 His time-in-range (glucose stability) is 90%, meaning his blood sugar remains in a healthy range most of the time.
🔹 His risk of long-term complications is drastically reduced, offering him a healthier and more promising future.

James' Experience is Not Unique

📌 More studies continue to support TCR as a superior option for blood sugar control, improved insulin sensitivity, and long-term metabolic health.

James’ journey illustrates how Therapeutic Carbohydrate Reduction can be a life-changing tool for individuals with T1D, allowing them to achieve normal blood sugar levels, reduce complications, and improve overall quality of life.

Final Thoughts: The Future of Type 1 Diabetes Management

Dr. Buchanan concluded her presentation with a powerful message: education is empowerment. James' journey highlights both the challenges of conventional T1D management and the potential for transformation when families are given the option to utilize Therapeutic Carbohydrate Reduction (TCR).

The Need for Greater Provider Education and Support

Dr. Buchanan emphasized that TCR should not be an outlier approach but a valid option for all individuals with T1D. However, for this to become a reality, several key changes need to take place:

📌 Provider Education on TCR for T1D: Many healthcare professionals do not receive training on how a low-carbohydrate approach can benefit patients with T1D. As a result, families like James’ are often not informed about TCR as a potential management tool. Increased provider education would allow for more informed discussions and personalized diabetes care plans.

📌 More Clinical Support for Families Choosing This Approach: Families who choose TCR often face barriers, including lack of support from healthcare teams and concerns about criticism. According to Dr. Buchanan, 27% of families do not even discuss dietary changes with their doctors due to fear of being judged or pressured to stop. More structured support from the medical community could help these families navigate the transition safely and effectively.

📌 Randomized Controlled Trials Comparing TCR to Conventional Treatment: Dr. Buchanan called for more research to compare TCR to standard high-carbohydrate approaches in order to solidify its place as a mainstream treatment option. Although observational studies and case reports have demonstrated the benefits of TCR, randomized controlled trials (RCTs) would provide stronger clinical evidence to support its use.

James’ Story: A Case for Change

James’ journey demonstrates how TCR can offer a sustainable, effective solution for T1D management, allowing for:

✅ Better blood sugar control
✅ Reduced insulin requirements
✅ Lower risk of long-term complications
✅ Improved quality of life

His story is not unique. Other children and adults with T1D have reported similar benefits when given the tools to manage their condition through dietary interventions.

Resources for Families and Healthcare Providers

For those interested in learning more, Dr. Buchanan recommended the following evidence-based resources:

🔗T1D Nutrition Resources: https://www.t1dnutrition.com/resources

🔗 SMHP’s Position Statement on TCR – A peer-reviewed document outlining the scientific basis and clinical applications of Therapeutic Carbohydrate Reduction for T1D: https://journalofmetabolichealth.org/index.php/jmh/article/view/100

🔗 The Therapeutic Carbohydrate Reduction Guide – Published by the Institute for Personalized Therapeutic Nutrition (IPTN), this guide serves as a comprehensive resource for dietitians, nutritionists, and healthcare providers supporting individuals with T1D: https://www.therapeuticnutrition.org/tcr-type-1-diabetes-guide

A Changing Landscape for T1D Management

🚀 The future of Type 1 Diabetes is evolving. James’ story is a testament to the possibilities that exist when families and providers explore alternative approaches. The question now is:

Are we ready to embrace it?