Bakgrund: Diagnostiserade fall av personer med typ 1-diabetes ökar globalt och komplikationer kan uppstå i samband med sjukdomen. Lågkolhydratkost har visat sig vara en potentiell metod för att förbättra blodsockerreglering. Sjuksköterskor ansvarar för kostrådgivning och därav behövs mer kunskap om ämnet då det vetenskapliga underlaget är otillräckligt. Syfte: Uppsatsens syfte var att undersöka påverkan av lågkolhydratkost hos personer med typ 1-diabetes. Metod: En litteraturstudie av 10 vetenskapliga artiklar genomfördes med en induktiv ansats. Resultat: Följande huvudkategorier presenterades i studiens resultat: kroppsliga förändringar och upplevelser. Underkategorierna var: blodsocker, insulin, blodfetter, ketoner, vikt och BMI, vitalparametrar, positiva erfarenheter och utmaningar. Effekter av lågkolhydratkost varierade avseende blodsocker, insulin, blodfetter, vikt och blodtryck. BMI förbättrades, ketonnivåer höjdes och diabetes ketoacidos förekom i samband med lågkolhydratkost. Erfarenheter av lågkolhydratkost varierade. Konklusion: Sjuksköterskor och sjuksköterskestudenter behöver information om lågkolhydratkost och typ 1-diabetes. På så sätt kan adekvat information, evidensbaserad vård och personcentrerad vård erbjudas till personer med typ 1- diabetes. / Background: Diagnosed cases of people with type 1 diabetes are growing globally and complications can occur in correlation with the disease. Low carbohydrate diets have shown to be a potential method to improve blood sugar regulation. Nurses are responsible for dietary advice and therefore more knowledge is needed on the subject as the scientific basis is insufficient. Aim: The aim of this thesis was to examine the impact of a low carbohydrate diet for people with type 1 diabetes. Method: A literature study of 10 scientific articles was conducted with an inductive approach. Results: The following main categories was presented: bodily changes and experiences. The subcategories were: blood sugar, insulin, blood fats, ketones, weight and BMI, vital parameters, positive experiences and challenges. The effects of low carbohydrate diets varied regarding blood sugar, insulin, blood fats, weight and blood pressure. BMI improved, ketone levels were raised, diabetic ketoacidosis occurred and experiences with a low-carbohydrate diet varied. Conclusion: Nurses and nursing students need information about low carbohydrate diets and type 1 diabetes. In this way adequate information, evidence-based care and person-centered care can be offered to people with type 1 diabetes.

Low carbohydrate diets have been studied for many years as nutritional therapy for treating patients with type 2 diabetes mellitus (T2DM). Type 2 diabetes is an inflammatory disease that is defined by high blood glucose and HbA1c, lipid levels, BMI, central adiposity, and cholesterol levels, are some among the many indicators that can signal risk for diabetes or help to diagnose diabetes. These indicators are used in studies to evaluate the effectiveness of the nutritional therapy in producing positive health outcomes. Many medications are available for the treatment of T2DM; however, they have a host of side effects, and nutritional therapy has been shown to at least help reduce the dosage of these medications needed by the patients. There are other forms of nutritional therapy besides low carbohydrate diets, and some controversy remains about low carbohydrate diets that in the long term, replacing carbohydrates with fats and proteins could result in increased cholesterol and lipid levels, creating an increased risk for cardiovascular disease. Although some studies have found that low carbohydrate diets, especially very low carbohydrate ketogenic diets (VLCK), do result in increased cholesterol, it is generally an increase in HDL, which is considered good cholesterol and not harmful. Overall weight loss benefits from reduced central adiposity, BMI, and reduced HbA1c levels outweigh the increase in HDL as a side effect. A few different variations of low carbohydrate diets are compared in this review, such as very low carbohydrate ketogenic diets, moderate carbohydrate calorie restricted diets, and moderate carbohydrate low (MCD) Glycemic Index (GI) diets. Due to the ability to exchange carbohydrates with high GI for carbohydrates with low GI, the MCD with low GI sounds promising for good adherence and positive health outcomes in the long run. Although very low carbohydrate ketogenic diets produce many positive health outcomes, the nutritional therapy must be very well designed and followed up, and care must be taken that fiber and nutrients are maintained in the diet. Adherence is a key part of the success of nutritional therapy and a study design plays a major role in that. Providing behavioral development classes, nutritional information classes, and intermittent classes focused on physical activity and healthy habit formation leads to overall increased positive affect which is better for the patient and thus, for the study as well. The easier the nutritionist or dietician can make the therapy transition for the participant, the more likely they are also to stay and try to stick with it. For example, in the studies where the study coordinator provided some small food provisions at the beginning or throughout the study seemed to be successful because the patients were less likely to fall to making their own choices poorly and being inconsistent. Although there were many diets that resulted in many positive health outcomes, ultimately a well-designed, adherence focused, very low carbohydrate ketogenic diet seemed to be the most effective at decreasing HbA1c and producing other positive health outcomes as well. In the long term however, a VLCKD, may be unsustainable for the patient and the body, given the extreme reduction in important carbohydrates.

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Low-carbohydrate, high-protein (LCHP) diets have been shown to induce weight loss and beneficial changes in blood lipids that suggest cardiovascular disease risk reduction; however, LCHP diets have not been adequately investigated for health effects on the skeleton. A randomized trial to determine the effects of a LCHP diet on bone mineral status, biomarkers of bone turnover, indicators of acid-base balance, calcium homeostasis and fasting lipids in healthy pre-menopausal women was conducted. Women, aged 32 - 45 y, with a body mass index between 25-41 kg/m2 were randomized into one of two diet groups: LCHP (n = 13) or high-carbohydrate, low-fat (HCLF) (n = 12). Anthropometric (body weight, lean mass, fat mass) and bone mineral density (BMD) and content (BMC) measures and markers of lipid metabolism were taken at weeks 0, 6, and 12. Measures of acid-base balance, protein metabolism, and calcium homeostasis were conducted at weeks 0, 1-4, 6, and 12. Serum osteocalcin was analyzed at weeks 0, 1, 2, 6, and 12, while urinary NTx was analyzed at weeks 0, 1 and 2. Weight loss was significant at the end of 12 weeks in both diet groups (P < 0.05) but there was no Diet x Time interaction. Total proximal femur BMD was lower in the LCHP group (P < 0.05) compared to the HCLF group by week 12. Femoral neck BMC decreased in the LCHP diet group (P < 0.05), whereas total forearm BMC increased (P < 0.05) in the HCLF diet group by week 12 of the study. Serum osteocalcin showed significant main effects of diet (P < 0.05) and time (P < 0.0001), but a Diet x Time interaction was not observed. Urinary NTx exhibited no main diet effect, time effect or Diet x Time interaction at weeks 1 or 2. Urinary pH was lower in the LCHP group compared to the HCLF group throughout the study (P < 0.0001). Urinary calcium excretion was higher in the LCHP group and lower in the HCLF group (P < 0.0001) compared to baseline values at all intervals of the study. Urinary phosphorus excretion exhibited a significant diet effect (P < 0.001) and time effect (P < 0.002), while no Diet x Time interaction was observed. Total cholesterol, high-density and low-density lipoprotein cholesterol, and triacylglycerol concentrations did not differ between diets during the study. In conclusion, a LCHP diet appears to stimulate bone loss, while a HCLF diet appears to attenuate bone loss in healthy pre-menopausal women undergoing 12 weeks of weight loss. / Ph. D.

The purpose of this study was to determine attitudes toward low carbohydrate diets among consumers and the attributes that influence their purchase decision. A growing number of diet trends are spreading across the nation in an effort to improve health and lose weight such as the Atkins diet and the South Beach diet.

Bakgrund: Diabetes typ 2 (DT2) är ett ökande hälsoproblem och sjukdomen innebär att kroppen producerar mindre insulin än kroppens aktuella behov. Övervikt, fysisk inaktivitet, ohälsosamma kostvanor, ärftlighet och stigande ålder är riskfaktorer för att utveckla sjukdomen. För att undvika komplikationer ska ett stabilt blodsocker eftersträvas. Sjuksköterskan ska vara ett stöd och ge kunskap om egenvården, som enligt Orem innebär upprätthållande av hälsa och livskvalitet. Fettsnål kost har under många år rekommenderat. Populariteten kring lågkolhydratskost har under de senaste åren ökat och det förekommer studier som visar att kosten kan vara fördelaktigt för personer med DT2. Syfte: Att beskriva effekter av lågkolhydratkost hos personer med DT2. Metod: Litteraturöversikten har kvantitativ design och innehåller 13 vetenskapliga artiklar. Fribergs analysmodell användes för att analysera artiklarna. Resultat: Lågkolhydratskosten visade en signifikant förbättring i glukos, kroppsmassa och blodfetter. Kosten visade inga stora skillnader mellan variablerna på lång sikt jämfört med andra koster. Det stöd som förekom till deltagarna i studierna visade sig vara betydelsefullt för att uppnå ovanstående effekter och framförallt då det gällde att bevara effekterna över tid. Slutsats: Lågkolhydratskosten medförde positiva effekter på kort sikt och effekterna samvarierade med omfattningen av stöd som ingick i studierna. Trots rädslan för att kosten medför ökad risk för hjärt- och kärlsjukdom påvisade studien inga risker med kosten på kort sikt. Nyckelord: diabetes typ 2, lågkolhydratskost, egenvård, Dorothea Orem, diet. / Background: Diabetes type 2 (DT2) is an increasing health problem. The disease means that the body produces less insulin than the body need. Obesity, physical inactivity, unhealthy diet, heredity and rising age are risk factors for the disease. To avoid complications, a stable blood sugar pursued. The nurse will provide support and give knowledge for self-care, that according Orem means to provide health and quality of life. Low fat diets have for many years recommended. The popularity around low carbohydrate diet has increased in recent years. Studies shows that low carbohydrate can be beneficial for persons with DT2. Aim: To describe the effects of low carbohydrate diets in people with DT2. Method: The literature review with a quantitative design, contains 13 scientific articles. Friberg analysis model was used to analyze the articles. Results: A significant improvement was observed in glucose, body mass and lipids. The diet showed no significant differences between the variables in the long term compared to other diets. The support that occurred to the participants in the studies were found to be significant in order to achieve the above effects and especially when it came to preserve the effects over time. Conclusion: The low carbohydrate diet resulted in short- term positive effects and these effects varied whit the extent of support the studies conducted. Despite fears that the diet increases the risk of cardiovascular disease, studies showed no short-term risks. Keywors: diabetes type 2, low carbohydrate diet, self care, Dorothea Orem, diet

Background Type 2 diabetes is a common disease and the prevalence has increased in large parts of the world. In treatment of diabetes the type of diet is of great importance considering metabolic factors such as glucose level and blood lipids. Which diet that is most beneficial to avoid diabetic complications has been heavily debated in recent decades. This thesis is based on two clinical studies designed to compare the effects of different macronutrients. Methods A clinical trial was designed to compare a low-carbohydrate diet (LCD) to a low-fat diet (LFD) in treatment of patients with type 2 diabetes. Sixty-one patients at two health care centres were included and randomized to get advice to eat a LCD or a LFD. The LCD had an energy content where 50 energy percent (E%) where from fat, 20 E% from carbohydrates and 30 E% from protein. For the LFD the nutrient composition was similar to what is traditionally recommended for treatment of type 2 diabetes in Sweden. Metabolic factors, anthropometrics and questionnaires were analysed. To study postprandial effects a trial was designed to compare three different diets. Twentyone patients with type 2 diabetes were included to in randomized order test the three types of diets on separate test days. On each test day the patients were served breakfast and lunch and blood samples were taken at six times these days. Glucose, lipids and hormones were analysed. Results There were equal weight reduction in the two groups in the first trial during the two-year study period. At six month when compliance was good according to diet-records, the glucose level (HbA1c) was lowered and the HDL-cholesterol was increased in the LCD group. The inflammatory markers IL-6 and IL-1Ra were significantly lower in the LCD group than in the LFD group. At 12 months the physical function, bodily pain and general health  scores improved within the LCD group only. In the second trial the postprandial glucose and insulin levels were lower on the LCD compared to the LFD. However, the LCD resulted in a tendency to higher postprandial triglyceride levels. The Mediterranean type of diet with all energy intake at lunch resulted in a more pronounced insulin response and a glucose level at lunch similar to that of the low-fat diet. The increase-ratio of insulin correlated to the elevation of the incretin glucose-dependent insulinotropic peptide (GIP). Conclusions In the two-year study we found benefits for the LCD group regarding glucose control and insulin doses. Furthermore, only the LCD was found to improve the subclinical inflammatory state and there were some aspects of improved well-being in this group. Aiming for 20% of energy intake from carbohydrates is safe with respect to cardiovascular risk factors  compared with the traditional LFD and this approach could constitute a treatment alternative. In the postprandial state, the LCD induced lower insulin and glucose excursions than the LFD but at the same time a tendency of higher triglycerides. The long-term significance needs to be further examined. The accumulation of caloric intake from breakfast to lunch to a single large Mediterranean-style lunch-meal in type 2 diabetes might be advantageous from a metabolic perspective.

Syftet med denna studie var att undersöka familjers upplevelser av att minimera intaget av socker/snabba kolhydrater. Detta genomfördes med kvalitativa ostrukturerade intervjuer där föräldrarna i familjen fritt fick berätta utifrån olika teman. Dessa teman täckte områden som anledning, tillvägagångssätt, reaktioner, svårigheter, beteenden och eventuella hälsovinster relaterade till kostomläggningen. Utöver dessa familjer valdes tre bloggar ut inom området lågkolhydratkost. Dessa följdes och analyserades som komplement till intervjuerna. Resultaten tolkades utifrån socialkonstruktivistiskt synsätt och teorin om symbolisk interaktionism. De mest framträdande resultaten var att samtliga som ingått i studien har upplevt förbättringar i sin hälsa, i de flesta fall förbättrades även barnens kognitiva förmåga. Vidare upplevde de att traditionen med sötsaker som både belöning och tröst, är djupt rotad vilket innebar att kostomläggningen inte var så enkel att genomföra utan att få höra epitet som "fanatisk" och "extrem". Ingen av intervjupersonerna uppger att de kan tänka sig att återgå till kolhydratrik kost. / The aim of this study was to examine families' experiences of minimizing the intake of sugar/highcarbs. This has been studied with a qualitative unstructured method with the parents in three families from different free to tell based themes. These themes covered areas like reason, procedures, reactions, problems, behaviors and potential health benefits related to their dietary change. In addition to these families, three blogs were selected in the field of low carbohydrate diets. These were followed and analyzed as a supplement to the interviews. The results were interpreted on the basis of social constructivist approach and the theory of symbolic interactionism. The most prominent findings was that all who entered the study have experienced improvements in their health, in most cases also improved children's cognitive ability . Furthermore , they felt that the tradition of sweets as both reward and comfort, made their dietary change implement difficult without hearing the epithet as " fanatical " and " extreme" . None of the interviewees stated that they would be willing to return to the high-carbohydrate diet.