Ketosis, insulin, glucose, carbs, ketones

Can this trendy, low-carb eating plan help keep your diabetes under control? Here’s what to consider before you try it.

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The Keto Diet for Diabetes

In this Article

In this Article
In this Article
  • What Is the Keto Diet?
  • Ketosis vs. Ketoacidosis
  • Does Keto Work if You Have Diabetes?
  • Is Keto Safe if You Have Diabetes?
  • Should You Try It?

The ketogenic, or keto, diet is popular as a way to help people lose weight. But is it a safe, effective method to keep diabetes under control? Scientists are still studying how the diet affects people with the condition, but here’s what we know.

What Is the Keto Diet?

It’s a low-carb, high-fat eating plan. Most of what you eat is fat, whether that’s unsaturated fats like nuts, seeds, and avocados, or saturated fats like butter and coconut oil. About 20%-30% of your diet is protein, either lean (like chicken breast) or fatty (like bacon). You’re supposed to strictly limit carbs, even those that are typically considered healthy, such as beans, whole grains, milk, and many types of fruits and vegetables. On the keto diet, you eat less than 50 grams of carbs a day. To put that in perspective, one medium apple has 25 grams of carbs.

How does it work? Normally, your body fuels itself from sugar, or glucose, that it gets from carbs. After a few days of the keto diet, your body runs out of glucose. So it starts burning body fat instead. This is called nutritional ketosis. It creates fatty acid substances called ketones, which your body can use for energy.

Ketosis vs. Ketoacidosis

If you have diabetes, it’s important to understand the difference between nutritional ketosis and ketoacidosis. Both involve ketones. But ketoacidosis is a dangerous condition that happens when your body doesn’t have enough insulin and ketones build up too much. Symptoms include excessive thirst, urinating often, confusion, and weakness or fatigue. It’s more common for people with type 1 than type 2.

Ketosis happens with much lower, safer levels of ketones than ketoacidosis. In fact, this process happens in the course of everyday life, depending on the amount of carbs and protein you eat. It’s the state that can lead to weight loss, especially belly fat, and lower A1c for many people with diabetes.

Does Keto Work if You Have Diabetes?

Research suggests that people with type 2 diabetes can slim down and lower their blood sugar levels with the keto diet. In one study, people with type 2 lost weight, needed less medication, and lowered their A1c when they followed the keto diet for a year.


If you’re insulin resistant — which means you have higher blood sugar levels because your body isn’t responding properly to the hormone insulin — you could benefit from nutritional ketosis, because your body will need and make less insulin.

There are fewer studies looking at the keto diet for people with type 1 diabetes. One small study found that it helped people with type 1 lower their A1c levels, but we need a lot more research to get the full picture of the diet’s effects.

Keep in mind that most studies have only looked at the short-term results of the keto diet. It’s unclear if it works as a long-term way to manage your diabetes.

If you decide to try the keto diet, be aware that it may be hard to stick to. The very low amount of carbs in the plan is a big change for many people. It also can make you feel tired for a few weeks until your body adapts. To make it a success, it’s a good idea to make a meal plan you can follow, including keto-friendly meals and snacks to keep on hand.

Is Keto Safe if You Have Diabetes?

That depends on the type of diabetes you have. In general, people with type 2 who are overweight seem to get good results safely. If you have type 1 and want to try the keto diet, it’s essential that you talk to your doctor first. You’ll need to carefully monitor your health and watch for signs of ketoacidosis. For either type, it’s a good idea to work closely with your doctor, since you may need to change your medications.

The keto diet has some side effects that are worth knowing about, too:

Hypoglycemia: Though the diet can lower A1c levels, that may mean you’re at a higher risk of blood sugar that dips too low, especially if you’re also taking medicine for your diabetes. Let your doctor or diabetes educator know if you try the keto diet. They can advise you about checking your blood sugar, taking your medicines, and what to do when your blood sugar drops too low.


Heart disease: The diet emphasizes eating a lot of fat. If you eat too much saturated fat (the kind in foods like bacon and butter), that could raise your cholesterol, especially LDL, which is linked to heart disease. This is a special concern for people with diabetes, since the condition itself makes you more likely to get heart disease. Make sure that healthier sources are providing your fats — the mono- and polyunsaturated kinds, such as those in foods like avocados, nuts, and olive and canola oils. If you do it right, your LDL cholesterol and triglyceride levels could go down. If you take medicine for heart problems, such as high blood pressure, check with your doctor to see if you need to make changes to your medications.

Lack of nutrients: Since many foods are off-limits, including some fruits, vegetables, and dairy products, you could miss out on the important nutrients you’d get from them. Work with a nutritionist familiar with nutritional ketosis to make sure your body gets what it needs.

Liver and kidney problems: These organs help your body process fat and protein. Some experts worry that the keto diet could overwork them. Others say that if your organs are healthy, you’re probably fine.

Constipation: Since you’re not eating foods like whole grains and beans, you could miss key sources of fiber.

Gallstones: If you lose weight quickly, you could be more likely to get gallstones. Some foods, like those high in fiber and those with healthy fats, could help you prevent them. Talk to your doctor about other ways to avoid gallbladder trouble.

Should You Try It?

Talk to your doctor before you sign up for the keto diet. For some people with diabetes, especially those who need to lose weight, this way of eating can help improve symptoms and lessen the need for medication. But for others, the keto diet could make diabetes worse.

You’ll want to be careful when you transition off of it; adding carbs back in all at once can cause blood sugar spikes and weight gain. Your best bet is to start slowly with carbs that are high in protein and fiber.


Cleveland Clinic: “What Is the Keto Diet (and Should You Try It)?” “How to Smoothly Transition Off the Keto Diet.”

Harvard Health Letter: “Should You Try The Keto Diet?”

Diabetes Therapy: “Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study,” “Low Carbohydrate Diets and Type 2 Diabetes: What is the Latest Evidence?”

Nutrition & Metabolism: “A low-carbohydrate, ketogenic diet to treat type 2 diabetes.”

Nutrients: “Low-Carb and Ketogenic Diets in Type 1 and Type 2 Diabetes.”

CDC: “Diabetes: What’s Insulin Resistance Got To Do with It?”

Mayo Clinic: “Diabetic ketoacidosis.”

Diabetes Forecast: “What You Need to Know About the Ketogenic Diet.”

National Institutes of Health: “Dieting and Gallstones,” “Eating, Diet, and Nutrition for Gallstones.”

Is the Keto Diet Safe? The Real Risks and Rewards of Going Ultra-Low Carb

The rise of the keto diet is hard to overlook. From keto cruises to keto-friendly product lines from food manufacturers, it seems like everyone knows someone who has embraced the keto lifestyle.

With such a boom in popularity, many dieters are turning to the internet and social media for keto inspiration. However, there can be conflicting and confusing information about what this diet actually entails, which leaves some people asking, «what actually is the keto diet—and is it safe?»

What is the keto diet?

For starters, the keto diet is more than just eating unlimited amounts of bacon, eggs, and cheese—despite what some Instagram accounts would have you believe. Keto, also known as the ketogenic diet, is a way of eating that allows the dieter to enter a state of ketosis. When you are in ketosis, your body is breaking down stored fat into molecules called ketones that are released into your bloodstream and flushed out in your urine. Ketosis occurs when your body shifts from burning sugar and carbohydrates to stored fat.

In order to get into this metabolic state, the diet consists of high-fat and very low-carb foods. Cedrina Calder, MD, a preventative medicine doctor based in Nashville, explains that most people in ketosis aim to stay under 20 to 50 grams of net carbs total for the day, though the specific carb tolerance varies from person to person based on a number of factors, including activity level. When calculating net carbs, take the total carb count and subtract out the quantity of fiber and sugar alcohols, as those do not have the same impact on blood sugar as other carbs.

For reference, one medium apple has more than 20 net carbs, which would top out the daily limit for many keto-ers, making ketosis difficult to maintain.

«This diet is very hard to sustain on a long-term basis for the average person,» said Dr. Calder. «For the average patient, I advise them to choose a healthy pattern of eating that they can sustain rather than focus on a temporary diet.»

RELATED: No-sugar-added recipes you’ll actually look forward to eating.

Keto weight loss results can be striking and quick

With so many restrictions, it can seem surprising that keto has gained as much traction as it has. Like many recent phenomena, it all goes back to one cause: Social media.

The boom of Instagram, blogs, and other photo-sharing sites has led to more transformation pictures circulating than seemingly ever before. And the keto diet is a prime candidate for producing noticeable results quickly, making it a staple for the popular Instagram hashtag #TransformationTuesday.

«Recently, more and more people are inquiring about the keto diet—not necessarily for a long-term solution, but just to jumpstart their weight loss journey,» said Gabrielle Mancella, RD, who says that at least one-third of her daily patients inquire about going keto.

When you enter ketosis, the switch to burning stored fat creates a diuretic effect, making people lose water weight quickly compared to other methods of dieting. This can make progress look and feel quick at first.

How to get into ketosis

As you enter a state of ketosis, many people experience symptoms known as the «keto flu.» While not a real flu, the transition period can cause headaches, nausea, weakness, muscle cramps, difficulty concentrating, constipation, or diarrhea. These symptoms can be caused by dehydration, sugar withdrawals, or an imbalance of electrolytes—all common effects of switching to the ultra-low-carb diet.

For many people, the keto flu is enough to convince them to give up on this way of eating. But, if you stick it out, the flu symptoms typically subside in about a week. Dieters can avoid, or lessen the symptoms of, the keto flu by drinking enough water, seeking out electrolytes, and cutting back on their carb intake gradually.

Once in a sustained state of ketosis, many dieters report enhanced mental clarity and overall improved wellbeing, in addition to weight loss. However, there hasn’t been a great deal of research done yet to determine if these results are an inherent trait of the diet. Dr. Calder said more research is needed to understand the long-term effects of the keto diet.

To check if you are in ketosis, strips from the drug store can detect the presence of ketones in urine.

The downsides of going keto

While the weight loss can be quick, the keto diet also has some potentially serious drawbacks.

«Being in a state of ketosis can be dangerous for people with kidney disease or diabetes, especially type 1 diabetes,» Dr. Calder said. «I also would not recommend it for individuals with an unhealthy relationship with food. Restrictive diets can worsen this relationship.»

Because success on keto is dependent on cutting out foods that don’t fit into the ultra-low-carb diet, this is not a diet made for people who like frequent cheat days or little daily indulgences, Mancella explains. After eating enough carbs that your body exits ketosis, the whole process has to begin again to get back into the fat-burning state.

«This puts immense strain on the body, and, in turn, is contraindicative to weight loss goals,» Mancella says. «The brain’s main source of energy are carbohydrates, and when we limit this, we are in turn affecting all of our other body processes.»

Although she said that in healthy adults keto is generally safe because the body is able to self-regulate ketone levels by flushing the excess through urine, Mancella added that dieters should approach keto with caution.

«If not done right, this diet can cause havoc on our bodies,» she says. «As a society, we have turned to a culture of restriction and extremes in order to obtain unrealistic beauty and aesthetic standards without considering the long-term consequences.»

Knowing the restrictive nature, some people turn to the keto diet as a quick fix before an event that they want to drop a few pounds for quickly. Even that, however, can have some unintended consequences.

«Anyone starting a keto diet should be aware that once they stop the diet, they are likely to regain weight if they do not transition to a healthy diet,» Dr. Calder said.

What do you eat on a keto diet?

The keto diet itself doesn’t have any required meals. The only goal is to stay under your allotted net carbs each day, so there is a lot of variation in how people choose to go about following the diet.

Generally, commonly eaten keto diet foods include meat, eggs, full-fat dairy, and low-carb vegetables, which helps to up your fat intakes to help maintain satiety without overdoing it on the carbs. You should aim for 70 to 80 percent of your daily calories to come from fat, 20 to 25 percent to come from protein, and 5 to 10 percent from carbs in order to maintain ketosis.

«A diet high in unhealthy fats increases the risk of heart disease,» Dr. Calder says, explaining that if someone does choose to pursue the keto diet, they should opt to eat lean protein, low-fat dairy products, and healthy fats, including nuts, nut butters, seeds, avocado, and healthy oils.

Planning ahead can be the key for success on the keto diet to avoid falling into the trap of eating carbs out of convenience. While there are certainly plenty of options when eating out at restaurants, keeping it keto without a plan can be a recipe for disaster.

«I caution anyone who is new to concepts including portion control, meal prepping, grocery shopping, exercise, and, including, but not limited to, even cooking their own meals, as this diet will likely be detrimental to their long-term health,» Mancella said.

Is keto for you?

When it comes to weight loss, Dr. Calder explains that all diets have the same end goal: creating a calorie deficit.

«If your goal is weight loss, you do not need to be on a keto diet to achieve this,» said Dr. Calder. «You can create this deficit by making different changes to your diet and eating patterns, and with physical activity.» She suggests that the average person consider a balanced, heart-healthy diet consisting of lean protein, fruits, vegetables, healthy fats, and high-fiber, whole-grain carbohydrates.

There is no one-size-fits-all approach to dieting and healthy eating. Every body is different, and different people need to find the right dietary plan that fits their physical, emotional, and financial needs.

While the ultra-low-carb nature of keto might be able to help people shed some weight quickly, it is not a universal solution for everyone, and any new diet should be undertaken with guidance from a health care provider.

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