Diabetes mellitus, or simply diabetes, refers to several diseases where the body has trouble controlling blood glucose levels.
Around 1 in 11 adults today has some form of diabetes, and restricting carbohydrates to an extent is usually part of its management [1, 2].
Since keto is one way to restrict carbs, you’re probably wondering whether you should use it to prevent, manage, or even reverse diabetes. You may also be worried about possible risks.
Here’s some good news: Guidelines from several international bodies and professional groups support keto in the management of diabetes . Even the American Diabetes Association has recently joined this growing group.
This is only after many clinical trials showed keto works for diabetes management. Find out how and why below.
Keto and Diabetes Management
The ketogenic diet — or keto, for short — is a type of very-low-carb diet. It was originally designed as an epilepsy treatment over a century ago, but decades of research have found it shows many other potentials, like in diabetes management .
But even before clinics started using it for epilepsy, it was the first-line therapy for diabetes patients .
Using keto for diabetes can be effective because this condition is a disease of carb intolerance first and foremost. And keto lowers carbs to a minuscule 20-50g per day. This amount leads to low blood glucose production and — consequently — reduced reliance on insulin. It may even improve your metabolic functioning in the long run.
And besides, current guidelines recommend that diabetes patients reduce their intake of added sugars and refined carbs , which keto already does.
Here’s how keto benefits two of the most common types of diabetes.
Keto and Type 2 Diabetes
People with type 2 diabetes often have a genetic predisposition to it. However, most develop it due to obesity, being physically inactive, and/or aging . In other words, it seems to be triggered by an unhealthy lifestyle combined with aging.
Type 2 diabetes usually begins with insulin resistance when cells don’t respond well to insulin, a hormone that tells your cells to take up glucose. In later stages, those affected stop producing insulin altogether. That leads to glucose accumulating in the blood instead of being taken up by cells.
Studies show keto can help those with type 2 diabetes manage their blood glucose levels . This can happen to such an extent that many patients stopped relying on diabetes medication, i.e., they practically reversed their condition. Keto can also help by treating its underlying causes: excess weight and insulin resistance .
There are two reasons keto leads to weight loss. First, it has a strong appetite-suppressing effect. And second, low-carb intake reduces insulin reliance and production (insulin is a fat-storing hormone).
Keto and Type 1 Diabetes
There’s a strong genetic component to type 1 diabetes as well. However, this type is triggered by a faulty immune system more so than dietary habits and physical activity levels. In other words, it’s an autoimmune disorder, not a lifestyle one.
Like type 2 diabetes, the keto diet can also help manage blood sugar levels in people with type 1 diabetes . Eating the same amount of carbs every day with keto means you can stop worrying about taking the right dose of insulin or about blood sugar fluctuations. Your doctor can lower your insulin dose significantly as a result .
Furthermore, people with this type are prone to weight gain because they take exogenous insulin, which is known to cause weight gain. Keto can help them lose weight because they won’t need as much insulin, and they'll experience less hunger. Weight loss can further boost insulin sensitivity and glycemic control.
The keto diet puts the body in ketosis, which many seem to confuse with ketoacidosis. While ketoacidosis is a life-threatening complication of insulin deficiency in diabetes, ketosis is a normal response to low blood sugar.
People with diabetes often worry keto will cause ketoacidosis. And the reality is that this is a potential risk if you’re not careful. There have been case reports of diabetes patients developing ketoacidosis after going keto [7, 8]. This can happen if you forget to take insulin or are on SGLT-2 inhibitors. But if you carefully monitor your ketone levels and regularly take insulin as prescribed, your risk of ketoacidosis is pretty low.
Another possible risk is hypoglycemia. Researchers warn that people who follow keto while taking insulin may be at a higher risk of hypoglycemia . That’s because your insulin dose may be too high for the small amount of carbs you take in on keto, ending in dangerously low blood glucose levels. Adjusting your dose is essential in preventing this complication.
Does this mean keto is dangerous for people with diabetes? In short, no.
The keto diet simply isn’t without its risks — that are completely preventable with careful monitoring.
As already said, experts are now even recommending low-carb diets for diabetes management based on decades of research showing it works.
So, Should You Try Keto to Manage Diabetes?
The benefits of keto for diabetes management definitely far outweigh the risks. If this weren’t true, the American Diabetes Association and diabetes experts wouldn’t be suggesting it as an option.
The keto diet can help people with diabetes mainly by:
- Boosting weight loss
- Improving glycemic control
- Enhancing insulin sensitivity
If you carefully monitor your ketone levels and consult with your doctor before going on this diet, you’ll get the above benefits while keeping potential risks to a bare minimum. This is true no matter if you have type 2 diabetes or type 1.
And if you have prediabetes, aka borderline diabetes, a 2017 randomized trial found keto can help improve glycemic control in this group as well .
There are instances where you shouldn’t try the keto diet. For example, if you’re taking SGLT2 inhibitors. These are diabetes medications that lower blood glucose levels. Taking these in combination with keto can lead to life-threatening hypoglycemia.
All in all, keto can help you manage diabetes without medication while improving your overall metabolic health.
But before you go on this diet, make sure to consult with your healthcare provider to rule out contraindications and to help adjust your insulin dose if necessary.
Sapra A, Bhandari P. Diabetes Mellitus. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK551501/
Evert AB, Dennison M, Gardner CD, et al. Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care. 2019;42(5):731-754. https://care.diabetesjournals.org/content/42/5/731
Kelly T, Unwin D, Finucane F. Low-Carbohydrate Diets in the Management of Obesity and Type 2 Diabetes: A Review from Clinicians Using the Approach in Practice. Int J Environ Res Public Health. 2020;17(7):2557. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177487/
Ludwig DS. The Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed. J Nutr. 2020;150(6):1354-1359. https://academic.oup.com/jn/article/150/6/1354/5673196
Yancy WS Jr, Foy M, Chalecki AM, Vernon MC, Westman EC. A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab (Lond). 2005;2:34. Published 2005 Dec 1. doi:10.1186/1743-7075-2-34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1325029/
Turton JL, Raab R, Rooney KB. Low-carbohydrate diets for type 1 diabetes mellitus: A systematic review. PLoS One. 2018;13(3):e0194987. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875783/
Shaikh S, Mohamed MM, Mujeeb A, Shaikh F, Harris B. Euglycemic Diabetic Ketoacidosis Precipitated by a Keto Diet: Importance of Dietary History in Diagnosis. Cureus. 2020;12(9):e10199. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532873/
Mistry S, Eschler DC. Euglycemic Diabetic Ketoacidosis Caused by SGLT2 Inhibitors and a Ketogenic Diet: A Case Series and Review of Literature. AACE Clin Case Rep. 2020;7(1):17-19. https://pubmed.ncbi.nlm.nih.gov/33851013/
Leow ZZX, Guelfi KJ, Davis EA, Jones TW, Fournier PA. The glycaemic benefits of a very-low-carbohydrate ketogenic diet in adults with Type 1 diabetes mellitus may be opposed by increased hypoglycaemia risk and dyslipidaemia. Diabet Med. 2018;10.1111/dme.13663.
Saslow, L.R., Daubenmier, J.J., Moskowitz, J.T. et al. Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes. Nutr & Diabetes 7, 304 (2017). https://www.nature.com/articles/s41387-017-0006-9
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