The Ketogenic Diet for Type 2 Diabetes: a Comprehensive Guide

You've likely heard of the ketogenic diet. The keto diet continues to grow in popularity within diabetic communities because of its no-carb approa...

You've likely heard of the ketogenic diet. The keto diet continues to grow in popularity within diabetic communities because of its no-carb approach.

But is the keto diet actually a safe choice for diabetics?

Many health studies have shown that adopting a ketogenic diet offers benefits for individuals with type 2 diabetes if they understand the risks and continue consulting with their doctors during the process. If you or a loved one has type 2 diabetes, the keto diet may be suitable.

A diet includes not only what one eats but also one’s relationship with nutrition in general. It’s a common talking point for those with diabetes, as everything you eat changes your blood sugar levels. The keto diet has received much attention in recent years for its potentially positive impact on diabetic individuals.

While many adults suffer from type 2 diabetes, the condition is manageable and even reversible in some instances. Making changes to your lifestyle can promote strong health, which is why the keto diet might be the perfect option for you. While diabetes is unlikely to be “cured,” in this manner, you can maintain the improvements in the long-term.

So, what’s the relationship between the keto diet and type 2 diabetes? What are the risks, and what steps can you take to adopt a new diet to help you live as a diabetic?

First Off, What’s the Main Appeal for Type 2 Diabetics?

The diabetes medications you take today all aim to reduce elevated blood sugar. There are many types, including:

  • Insulin
  • Sulfonylureas
  • SGLT-2 inhibitors
  • DPP-4 inhibitors
  • GLP-1 receptor agonists
  • Metformin

A keto diet claims to improve blood sugar control, rendering these medications unnecessary.

What Does a Ketogenic Diet Involve?

Developed in the 1920s, the keto diet focuses on eating foods high in fat but low in carbohydrates. It intends to change the way your body handles its processing of food by converting fat, rather than carbs or glucose, into energy.

Because diabetic individuals are often overweight, it may seem counterintuitive to use a diet high in fat. However, the low carbohydrate content of keto diets helps decrease blood glucose levels and, in turn, one’s reliance on insulin. Carbohydrates turn into sugar when your body processes them, so avoiding carbs minimizes blood sugar spikes.


On top of its potential benefits for diabetics, keto has evidence of fixing various other problems:

  • Obesity. Weight loss is common for those on a keto diet.
  • Low energy. Despite what the term “diet” might suggest, those adapted to a ketogenic reportedly feel satisfied and energetic.
  • High blood pressure. If you take blood pressure medication, keto might kill two birds with one stone for you. Expect lower blood pressure with the diet.
  • Cholesterol. Studies have shown keto practitioners see lower amounts of triglycerides and higher amounts of HDL, both signs of positive cardiovascular health.

  • There are even signs it improves mental performance. Other conditions like dementia and epilepsy are likely to be mitigated under a keto diet as well.

    What Is the Role of Nutritional Ketosis?

    A keto diet changes the main energy source of the body to fat instead of carbohydrates, which results in an increase in ketone bodies in the blood. This metabolic state is known as “dietary ketosis.”

    Ketones are a type of acid your body naturally produces when you don’t have enough insulin to convert glucose into energy. They are made from fat in the liver and provide energy to important organs like the brain and heart.

    Of importance to diabetics is the acid’s role in anti-inflammation, which is an underlying problem for type 2 diabetics. Current medical studies also link it to reduced blood sugar and better insulin sensitivity. All these factors together make ketones a suitable treatment for the condition.

    What Makes Up a Ketogenic Diet?

    We must first understand the components of the diet first, being carbs, protein, and fat.

    • Carbohydrates are chains of sugars that break down into glucose when digested. They are used as a major source of energy and increase blood sugar significantly.
    • Proteins are made up of amino acids. They result in a moderate increase in blood sugar when consumed, though they are not a significant source of energy for the human body.
    • Fat is made of long chains of fatty acids. Fat is a strong source of energy for the body, but its impact on your blood sugar level is fairly limited.

    The distinction here of interest to diabetics is how each of these breaks down during digestion. Fat does not break down into glucose efficiently, unlike the other two, so insulin is not necessary for the job. Protein gives us amino acids necessary for cell growth but does not provide much energy. In the sparing times the body converts proteins into glucose, insulin is involved in the process and thus can raise blood sugar.

    Because fat is an effective energy source that does not raise your blood sugar, a high-fat diet is an important part of a ketogenic lifestyle. A typical keto diet consists of the following groups:

    • 70% fat
    • 10% carbohydrates
    • 20% proteins

    Despite what rumor might tell you, carbohydrate restriction does not always result in poor health. Many of the molecules we receive from carbohydrates are already produced within the body, and fat is just as effective as glucose for energy. Keep in mind that patients taking diabetes medications are exempt in this case and likely will need carbohydrates in their diets.

    The exact amounts depend largely on individual factors, so talk with a doctor about your personal needs. You generally want to aim for less than 50 grams of carbs a day, which is approximately a cup of pasta.

    Some examples of foods in a ketogenic diet include high protein sources like eggs, fish, avocados, olives, and seeds. Vegetables like cauliflower, squash, and Brussel sprouts are included as well. Keto diets largely avoid high carbohydrate foods like grains, fruits, and sugars.

    Are There Studies That Suggest Keto Is Effective Against Diabetes Mellitus?

    Scientists are still studying the long-term health effects of the ketogenic diet, but current reports do tell us that weight loss and better control of your blood sugar levels are short-term benefits. Some specific studies to examine are the following.

    The 2005 Study

    A 2005 report concluded that low carbohydrate, ketogenic diets are effective for reducing the reliance on medication for patients with type 2 diabetes. In a 16-week study of 21 overweight, diabetic participants, everyone was given a diet of less than 20 grams of carbohydrates a day.

    The result was that glycemic control improved in most of them to the point where diabetes medication was no longer as necessary as before the study. The report does make a note that close medical supervision was required during the process.

    The 2008 Study

    Researchers in 2008 came to a similar conclusion. They found the ketogenic diet was shown to improve glycemic control and help reduce the need for medication in diabetic individuals.

    The study ran for 24 weeks and included 49 obese diabetics who completed the full process. The method of measuring glycemic control was the presence of hemoglobin A1C.

    Two groups were used: one with a low carbohydrate diet and another with a low-calorie diet. Diabetes medications could be reduced in 95.2% of the former group compared to only 62% in the latter group.

    The 2013 Review

    A review in 2013 also confirmed the effectiveness of the keto diet for controlling weight, blood sugar, and insulin needs compared to other diets. Strong evidence included weight loss, better cardiovascular health, and other improvements in metabolic parameters.

    A Counterexample

    Not all studies support the same conclusion, though. One clinical trial suggested that a low carbohydrate diet may actually contribute to a lower tolerance of glucose in patients. A diet high in fat specifically contributed to a reduction in carbohydrate metabolism and other changes in 24 individuals over a 14-day study.

    Because maintaining a low carbohydrate ketogenic diet for long periods is fairly rare, there are overall not many studies examining the keto diet in the context of diabetes. You should expect more related studies in the near future, however, as scientists are still conducting clinical trials.

    What Are the Potential Dangers of the Diet?

    What happens if you take ketosis too far in a ketogenic diet? A patient may suffer from Diabetic ketoacidosis (DKA), a potentially life-threatening condition where your blood becomes too acidic and damages your liver, kidneys, and other internal organs.

    Symptoms of ketoacidosis include:

    • High blood sugar
    • High ketone levels in urine
    • Nausea
    • Dry mouth
    • Dry skin
    • Frequent urination
    • Difficulty breathing
    • Inability to keep attention
    • Breathe that smells “fruity”

    Dietary ketosis has a chance of causing DKA, especially if you have low insulin levels or adopt the diet without proper supervision from your physician. For this reason, those eating ketogenic diets must check their blood sugar throughout the day and even check for ketone levels.

    The American Diabetes Association recommends testing ketone levels if your blood sugar is higher than 240 mg/dL. A urine strip test is sufficient for testing ketone.


    Also, conditions like long QT syndrome (indicated by fast, inconsistent heart rates) must be considered, though it’s fairly rare for patients undergoing ketosis. Many doctors link it to low amounts of magnesium in the body.

    Should You Try Keto?

    Individuals who suffer from any of the following conditions should not attempt a ketogenic diet:

  • Kidney disease. High amounts of protein may impact kidney functions.
  • Heart disease. Researchers are still studying the long-term impact of a low-carb diet on cardiovascular health, so individuals with a history of heart disease should look elsewhere.
  • Eating disorders. Do not restrict your diet if you have an eating disorder or have recently recovered from one.
  • Pregnancy. Diabetic pregnant women are susceptible to health problems stemming from low glucose levels and should avoid heavy diets entirely.
  • Fat intolerance. Any medical condition that affects how your body processes fat intake, like pancreatitis, should prevent you from trying keto.
  • Type 1 diabetes. Keto is only an option for type 2 diabetes. Type 1 patients usually have kidney impairments, and the ketone buildup catalyzed by keto can put too much pressure on the kidneys.

  • If you’re still considering the ketogenic diet, ask yourself whether you can stick with it in the long-term. Are you satisfied with the variety of food available? And does your physician recommend you start it?

    How Can You Adopt a Ketogenic Diet?

    You should not try to pick up the ketogenic diet casually as a diabetic. The process should instead begin at the hospital, where your doctor can monitor your blood glucose and ketone levels regularly. It can take several weeks for the benefits to start appearing.

    As your body adjusts to the new intake, your lifestyle must change alongside it. See your doctor a few times a month to test for changes in your metabolic parameters. Expect to change your insulin medication regularly.

    And do not be afraid if you suddenly feel ill at first. The transition from carbs to fat for energy is known to cause temporary side effects that often disappear in a few weeks.

    How Is Keto Different From the Atkins Diet?

    Another related diet you might have heard of during your research is the Atkins diet, created in the 70s by Dr. Robert Atkins. It’s a similar regime of low-carb and high protein that is often associated with ketogenic diets for its benefits toward type 2 diabetes patients, but it’s still important to know the differences.

    Unlike keto, the Atkins diet does not emphasize increased fat consumption. It cuts carbohydrate intake, which can contribute to weight loss. However, you risk low blood sugar (hypoglycemia), especially if you already take insulin medication and do not adjust your dosage based on the new diet.

    Much like keto, there are not enough studies out there to confirm the diet’s efficacy for diabetes treatment. Nonetheless, ask your doctor about Atkins, keto, and other related diets.

    What’s the Verdict? Should You Try Keto?

    If you or someone you know suffers from strong symptoms of type 2 diabetes, the ketogenic diet may be a viable option. Maintaining a diet of low carbohydrates may be difficult in the long term, and not everybody will be successful.

    A constantly changing diet is not healthy for a diabetic patient either, so know that you can commit to it before taking the plunge. Finally, always consult with your physician over major health decisions like this. Continue your testing to ensure you receive the right amount of medication throughout the process.

    Want to find out more about diabetes and the various diets like keto that can improve your life? Join CuraLife’s Winning Type 2 Diabetes Together group to connect with other diabetics who have tried the keto diet.