{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T05:21:14Z","timestamp":1773724874294,"version":"3.50.1"},"reference-count":64,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T00:00:00Z","timestamp":1730246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:p>Differentiating between an irrational versus a rational fear of hypoglycemia has treatment implications and presents significant challenge for clinicians facing patients with type 1 diabetes, illustrated in this case. A 39-year-old woman with autoimmune-positive insulin-dependent diabetes sought help to alleviate severe diabetes distress, and symptoms of depression and anxiety, associated with unpredictable drastic blood glucose drops. After exhausting conventional methods, she adopted a ketogenic diet (KD). Her glucose values decreased from around 20\u2009mmol\/L to 12\u2009mmol\/L (360\u2009mg\/dL to 216\u2009mg\/dL) in the first days. Then, by combining a KD with an insulin pump, her time in optimal glucose range increased from 8 to 51% after 2\u2009months, reducing her HbA1c with 25\u2009mmol\/mol (2.2%). This reduced biological and psychological stress, immediately improving her mental health and renewing her hope for the future. The main concerns regarding KD in patients with comorbid type 1 diabetes is the assumed increased risk of ketoacidosis, theoretical depletion of glycogen stores, and a potential adverse effect of saturated fat on cardiovascular risk factors. These concerns are evaluated against existing empirical evidence, suggesting instead that a KD may protect against acidosis, hypoglycemia, and cardiovascular risk. The present case, together with available data, indicate that patients with type 1 diabetes experiencing high levels of biological and psychological stress should be informed of the expected benefits and possible risks associated with a KD, to ensure their right to take informed decisions regarding their diabetes management.<\/jats:p>","DOI":"10.3389\/fnut.2024.1404842","type":"journal-article","created":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T05:43:08Z","timestamp":1730266988000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Case report: Ketogenic diet alleviated anxiety and depression associated with insulin-dependent diabetes 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