More people with diabetes are asking about the keto diet. This approach to eating focuses on high fat, low carbs, and moderate protein. The goal is to make your body use fat for energy instead of its usual source, carbohydrates. This switch is called ketosis. But is the keto diet a good or safe choice for diabetes? The answer is different for everyone and depends on your type of diabetes and your overall health. Also, working closely with a healthcare provider is important.
Some research shows benefits, especially for people with type 2 diabetes-mainly in managing blood sugar and weight. However, eating so few carbs can make some diabetes medicines work differently and increase the risk of low blood sugar (hypoglycemia). There are also concerns about nutrition and how easy this diet is to keep up long-term. Getting familiar with how keto works, its pros and cons, and how it fits with other diets is necessary before making any changes.
What is the Keto Diet for People with Diabetes?
The keto diet is all about eating very few carbohydrates, lots of healthy fats, and a moderate amount of protein. The aim is to get your body into ketosis, where it burns fat for energy instead of sugar from carbs. This can be important for those with diabetes because it may help keep blood sugar steadier.
For people with diabetes, the big draw to keto is that it cuts out the main source of blood sugar spikes-carbs. Eating less of them may help with sugar control and can even mean you need less diabetes medication. Still, doing keto safely with diabetes often needs to be done differently from how it’s done for general health or weight loss. Always speak with your doctor first.
How the Keto Diet Works
Normally, your body uses carbs for energy. If you lower your carbs a lot-usually down to 20-50 grams per day-you run out of stored glucose. Your liver then turns fat into ketones, which your body uses for fuel instead. This is nutritional ketosis.
Eating this way can lower insulin levels in the body. Some people feel less hungry and find it easier to lose weight this way. The usual ratio for keto is about 55-60% fat, 30-35% protein, and 5-10% carbs.
Foods to Eat and Avoid on Keto
| Eat More | Eat Less or Avoid |
|---|---|
|
– Avocados, olives, and their oils – Nuts and seeds – Eggs, fatty fish (like salmon), meats – Leafy greens, broccoli, cauliflower – Berries (small amounts) |
– Bread, pasta, rice, quinoa – Sweets and sugar – Most fruits (like bananas, grapes) – Potatoes, corn, peas – Beans and lentils – Heavily processed foods |
Sticking to the right foods can be tough, especially with limited options at social events or restaurants.
Difference Between Standard and Diabetic Keto Diets
Normally, keto eaters may not care about choosing healthy fats versus unhealthy ones. But heart health matters even more for diabetics, so focus on fats like olive oil, nuts, and avocados. The main difference, though, is medicine. People with diabetes may need to change their insulin or pills as soon as they start keto to avoid dangerously low blood sugar. Regular keto diets don’t need this level of care, but for diabetics it is essential to work with a healthcare team.
Who Might Benefit From Keto for Diabetes?
Keto can help some people with diabetes, especially if blood sugar control or weight loss has been hard. Still, it’s not right for everyone-and you should always work with your doctor or diabetes educator.
Short-term research is positive for type 2 diabetes. But the long-term effects-good or bad-are still being studied. Knowing who can try keto safely is important for good results.
Keto and Type 1 Diabetes
Type 1 diabetes (T1D) means your body makes little or no insulin. Some small studies show keto might help a little with blood markers in T1D, but major diabetes organizations don’t recommend it for this group. That’s because keto raises the risk of diabetic ketoacidosis (DKA), a serious and potentially fatal condition. Also, you would need to adjust your insulin very carefully if you have T1D. Official sources recommend not using keto diets for type 1 diabetes unless under constant, close medical care.
Keto and Type 2 Diabetes
Most of the studies and success stories about keto and diabetes are for type 2 diabetes (T2D). For many, keto can help lower blood sugar and support weight loss. Sometimes, people can cut down or even stop diabetes pills, including insulin, after some weight loss and better blood sugar results.
Type 2 diabetics who are overweight often benefit most. But keeping up with keto is challenging, and it’s important to watch cholesterol and heart health along the way.
Gestational Diabetes and Keto
Gestational diabetes is diabetes during pregnancy. There’s no proof that keto is safe or effective during pregnancy. In fact, experts are worried it could harm the baby’s development or lead to growth problems. Also, gaining enough weight and getting essential nutrients are important in pregnancy-something keto may make harder. Women with gestational diabetes should follow the advice of their health provider and eat a balanced diet.
How Does the Keto Diet Affect Blood Sugar and Insulin?
Keto works by limiting carbs, so your blood sugar doesn’t spike as much after meals. In diabetes, the body can’t use sugar properly. If you eat fewer carbs, your body doesn’t get as much sugar from food, which means steadier blood sugar levels and possibly using less insulin.
Keto Diet and Blood Sugar
Less carbs equals less sugar in the blood. Many people with type 2 diabetes see their HbA1c (long-term blood sugar average) drop within weeks. This is a big win for improving or even reversing diabetes for some. But these changes can mean your usual diabetes medicine may suddenly be too strong-so you need to test blood sugar often and work with your doctor.
Ketoacidosis vs. Ketosis
| Ketosis (Safe) | Ketoacidosis (Dangerous) |
|---|---|
|
– Normal result of a low-carb diet – Blood ketones rise, but not to dangerous levels (0.5-3 mmol/L) – Your body still makes some insulin – Not harmful if managed well |
– Life-threatening complication – Caused by not enough insulin (especially in T1D) – Very high blood sugar and ketones – Needs emergency treatment |
Keto and Insulin Sensitivity
People with type 2 diabetes often have insulin resistance (insulin doesn’t work well). Keto can improve insulin sensitivity-meaning your cells respond better and you may need less insulin. Losing weight is also good for this. Cutting out sugar and processed carbs helps too.
Benefits of the Keto Diet for Diabetics
- Weight Loss: The high-fat, moderate-protein keto diet makes many people feel less hungry, so they eat less without thinking about it. Losing weight helps control diabetes and even leads to remission for some.
- Lower Blood Sugar and HbA1c: Keto is very effective at lowering average blood sugar. Studies show reductions in HbA1c by up to 9% for some, compared to 7% for other diets like Mediterranean.
- Fewer Diabetes Medications: As sugar levels go down and weight comes off, doctors can often lower or stop some medications. But this must be done with a doctor to avoid low blood sugar.
- Better Heart Health Markers: Many see lower triglycerides and higher HDL (“good” cholesterol). Blood pressure may go down too, partly due to weight loss and less inflammation.
Risks and Side Effects of Keto for Diabetics
Keto isn’t for everyone, and there are side effects to watch for, especially in people with diabetes. Close medical follow-up is important.
- Hypoglycemia (Low Blood Sugar): The biggest risk is low blood sugar, especially if you keep taking the same doses of insulin or pills after starting keto. Symptoms are shaking, sweating, confusion, or even passing out-so you need to watch your blood sugar closely and adjust medications with your doctor.
- Nutrient Deficiencies: Cutting out lots of foods can mean missing out on vitamins, minerals, and especially fiber. This can cause constipation or problems over time. Keto is low in vitamin C, D, E, and some B vitamins. You may need supplements or careful meal planning.
- Cholesterol and Heart Health Issues: Some people’s LDL (“bad”) cholesterol goes up on keto-especially if they eat a lot of saturated fat (like bacon and butter). If you already have high cholesterol or heart disease, this is a concern. Focusing on healthy fats and regular blood tests can help spot problems early.
- Not for Everyone: Pregnant women, most people with type 1 diabetes, those with kidney, liver, or pancreas problems, and anyone with a history of eating disorders should avoid or be very cautious with keto. Always get advice from your doctor.
Is the Keto Diet Safe for People with Diabetes?
Keto can help some, but safety depends a lot on monitoring and working with your healthcare team. Making big changes without medical help can quickly lead to problems like low blood sugar, nutrient shortages, or other complications.
The Importance of Medical Supervision
Never start keto with diabetes unless your doctor or diabetes nurse agrees and monitors your progress. You might need to check your blood sugar (and sometimes ketones) more often, and also do regular blood tests for cholesterol, kidney, and liver health. Your medicine may need frequent changes, especially at the start.
When to Stop or Change Keto
- If you notice warning signs like frequent lows, feeling weak, confused, or dizzy, get help right away.
- Signs of ketoacidosis (very thirsty, nausea, tummy pain, fruity-smelling breath) are emergencies-call for help.
- If you get ongoing issues like severe tiredness, constipation, or vitamin shortages, or your labs show problems, talk to your doctor-keto may not be the right choice.
- If you can’t stick with the diet or it’s making you unhappy, ask about less restrictive diets that may still help your diabetes.
How Does Keto Compare to Other Diabetes Diets?
Keto is very low in carbohydrates compared to most traditional diabetes diets, which include more balance with some healthy grains and starchy veggies.
| Diet Type | Main Features |
|---|---|
| Traditional Diabetes Diet | Focuses on balanced meals, controls portions, includes whole grains, lean proteins, fruits, veggies. |
| Keto Diet | Very low carbs (5-10% of daily calories), high fat, moderate protein, cuts out most grains and fruits. |
| Mediterranean Diet | Emphasizes vegetables, olive oil, fish, whole grains, and moderate carbs. Shown to help blood sugar and heart health, usually easier to stick with long-term than keto. |
| Atkins/Paleo/Low-Carb Alternatives | Low in carbs but usually not as low as keto. Paleo allows more fruits and is closer to natural foods; Atkins may start low-carb, then slowly allow more carbs back in. |
Tips for Starting and Keeping Up with Keto for Diabetics
Meal Planning
- Plan your meals around non-starchy vegetables, healthy fats, and lean proteins.
- Keep carb counts tight (20-50g/day).
- Prep meals ahead to avoid temptation.
- Work with a registered dietitian familiar with keto and diabetes if you can.
Healthy Snack Ideas
- Hard-boiled eggs
- Almonds, walnuts
- Olives
- Cheese sticks
- Vegetable sticks with guacamole or low-carb dips
- Check labels for sugars and carbs in packaged snacks.
Changing Medications
- Your doctor may need to lower, or sometimes stop, some medications. Never change them on your own.
- Check your blood sugar often, especially at first.
- Be aware of signs of low blood sugar and keep fast-acting sugar (like glucose tablets) nearby.
Eating Out and Traveling
- Pack snacks for trips.
- At restaurants, order meat or fish with extra veggies; skip breads and starchy sides.
- If comfortable, let the host know your needs or bring a dish to share.
- Remember: it’s progress, not perfection. Small slips don’t mean failure.
Common Questions About Keto for Diabetics
- Can Keto Cause DKA? No, not if you still make some insulin (as in most people with type 2 diabetes). DKA happens when there is too little insulin in the body-mainly in type 1 diabetes or during illness in type 2. Stay in contact with your doctor.
- Is Keto Good If I Have High Cholesterol? Sometimes keto improves good cholesterol and lowers triglycerides, but bad cholesterol may rise if you eat too much saturated fat. Stick to healthy fats and get your cholesterol checked.
- What’s the Difference Between Ketosis and DKA?
- Ketosis: Controlled, normal result from the keto diet (0.5-3 mmol/L blood ketones).
- DKA: Emergency situation, very high ketones (over 10 mmol/L) and blood sugar, mostly in type 1 diabetes.
Where to Get Help With Keto and Diabetes
Advice from Diabetes Organizations
Organizations like the American Diabetes Association support trying low-carb diets, including keto, for some people with diabetes-if done carefully. They stress that diets must be personalized, and you shouldn’t go it alone. Read their latest advice online or talk with your healthcare provider.
When to See Your Doctor
- If you’re thinking about starting keto and you have diabetes, ask your doctor first.
- If you need to adjust medications or have other health problems (heart, kidney, eating disorders), get a tailored plan.
- Keep seeing your provider to check progress, labs, and deal with any side effects.
Finding Recipes and Support
- Look for recipe books or websites focusing on keto for diabetes.
- Communities online or peer support groups can help, but check any advice with your doctor.
- Some national health systems offer digital programs for low-carb eating.
- A registered dietitian is a great partner for meal planning and answering nutrition questions.
