Keto Diet and Diabetes: How It Helps Manage Type 2 Diabetes

Living with Type 2 Diabetes requires careful consideration of dietary choices. One emerging approach gaining attention for its potential benefits for diabetes is the Keto diet. From weight loss to improved metabolic health, the keto diet has become a popular option for managing diabetes.

This comprehensive article will discuss everything you need to know about the keto diet and how it does wonders for managing type 2 diabetes.

Key Takeaways:

  • The keto diet is safe for people with type 2 diabetes under medical supervision.
  • Keto improves blood sugar control, insulin sensitivity, weight loss, and heart health while reducing dependency on medication.

Table of Contents:

Ketosis vs. Ketoacidosis

Ketosis and ketoacidosis are two entirely different things. Here’s why:

Ketosis

Ketosis is a natural metabolic state characterized by elevated levels of ketone bodies in the bloodstream. They are produced when the body breaks down fats for energy1 without sufficient carbohydrates.

This metabolic switch typically occurs when carbohydrate intake is restricted, such as fasting or following a low-carbohydrate diet like the Keto diet.

Although the byproduct is ketones, ketosis is a rare cause of acidosis, which means it does not cause life-threatening symptoms.

Ketoacidosis

Ketoacidosis,2 on the other hand, is a serious and potentially life-threatening medical condition that primarily affects individuals with Type 1 Diabetes. However, it can occur in specific situations for those with Type 2 Diabetes.

Ketoacidosis is characterized by dangerously high levels of ketones in the blood, leading to an acidic pH. Due to the acidity, diabetic ketoacidosis3 manifests with symptoms such as fruity-scented breath, confusion, and rapid breathing.

What is the Keto Diet?

The ketogenic diet, commonly known as the Keto diet,4 is a distinctive nutritional approach that prioritizes low carbohydrate intake, moderate protein consumption, and high-fat intake.

By sharply reducing the availability of carbohydrates, the body enters a metabolic state known as ketosis. In ketosis, the liver transforms fats into ketone bodies, an alternative energy source that replaces glucose.

This shift not only encourages effective fat utilization, aiding in weight loss, but also holds potential benefits for individuals with Type 2 Diabetes by stabilizing blood glucose levels.

The Keto diet is not a one-size-fits-all solution, but its variations allow for some flexibility to accommodate diverse nutritional needs and preferences.

  • Standard Ketogenic Diet (SKD)
  • Very-low-carb ketogenic diet (VLCKD)
  • Targeted Ketogenic Diet (TKD)
  • Calorie-restricted ketogenic diet
  • Cyclical Ketogenic Diet (CKD)

Keto Diet’s Effect on Blood Glucose

The impact of the keto diet on one’s blood glucose mainly relies on the low-carbohydrate intake.5

The Keto diet significantly changes how the body processes and utilizes glucose by drastically reducing carbohydrate intake. In the absence of carbohydrates, the body transitions to burning fats for energy, leading to lower levels of circulating glucose.

keto diet and diabetes

Here’s what happens to the body at the cellular level when doing the keto diet:

  1. Initiation of Ketosis: Low carbohydrate intake leads to reduced glucose availability, prompting a decrease in insulin secretion.
  2. Gluconeogenesis Activation: The liver initiates gluconeogenesis,6 synthesizing glucose from non-carbohydrate sources to maintain blood sugar levels.
  3. Glycogen Utilization: Depleted glucose levels prompt the utilization of stored glycogen as an immediate energy source.
  4. Transition to Ketogenesis: Once glycogen reserves are exhausted, the body shifts to ketogenesis in the liver, breaking down fatty acids into ketone bodies.
  5. Ketone Body Utilization: Ketones become the primary energy source, especially for the brain,1 sparing glucose for tissues with higher energy demands.
  6. Mitochondrial Impact: Ketosis influences cellular processes at the mitochondrial level,7 showcasing the body’s adaptability in transitioning between carbohydrate and fat metabolism.

Additionally, the effects of the Keto diet on blood glucose are intertwined with its broader metabolic impact. Elevating ketone bodies during ketosis is an alternative energy source and may contribute to the diet’s positive effects on insulin sensitivity.

However, since diabetes is a metabolic disorder, regular monitoring of the blood chemistries is recommended to ensure safety.

Keto Diet and Diabetes Research

The keto diet is an all-rounder that offers benefits even for people living with diabetes. Here are some of the science-backed effects of the keto diet for diabetes:

Improved Glycemic Control:

Scientific studies consistently report that the Keto diet is associated with improved glycemic control in individuals with Type 2 Diabetes. Reduced carbohydrate intake leads to stabilized blood glucose levels, potentially lowering the need for diabetes medications.

A good research example is this 2022 study among overweight subjects with Type 2 diabetes,8 stating that the keto diet improved glycemic control and recommended the keto diet as a therapeutic intervention.

Another study commends the keto diet9 for lowering fasting blood glucose by 1.29 mmol/L and glycated hemoglobin A1c by 1.07 among patients with Type 2 diabetes.

Enhanced Insulin Sensitivity:

Research suggests that the Keto diet may reduce insulin resistance,10 a crucial factor in managing Type 2 Diabetes. Improved insulin sensitivity means the body can use insulin more effectively to regulate blood sugar, reducing the risk of insulin resistance.

The keto diet’s positive effects on improving insulin sensitivity are due to weight loss and low-carbohydrate intake.

According to a 2023 data review,11 people on the keto diet have improved insulin sensitivity after weight loss, and some studies also suggest the same even without weight loss. 

Weight Loss and Heart Health:

Numerous studies affirm the Keto diet’s effectiveness in promoting weight loss, a critical aspect of diabetes management.12 Weight loss contributes to improved metabolic health, reducing the burden on insulin-producing cells and aiding in overall glycemic control.

According to this 2020 meta-analysis,9 diabetic subjects under the keto diet have reduced waist circumference by 9.17 cm and BMI by 3.13. Another study also concluded with similar results of decreased weight and BMI.8

Moreover, studies suggesting the weight loss benefits of the keto diet also noted reduced levels of total cholesterol, triglycerides, and low-density lipoprotein while elevating high-density lipoprotein, which boosts heart health.

These results indicate the keto diet’s benefits not only for losing weight but also for preventing diabetes complications, as heart disease is one of the most common complications.

Reduced Medication Dependency:

Some individuals following the Keto diet under medical supervision have been able to reduce or eliminate their dependency on diabetes medications. Improved blood sugar profiles often accompany this reduction in medication usage.

For instance, in a study on patients with type 2 diabetes under the keto diet,13 7 patients discontinued their medication, 10 got reduced dosages, and only 4 stayed unchanged.

This only means that the keto diet can maintain one’s blood sugar levels even without medications.

Anti-Inflammatory Effects:

Chronic inflammation is a common feature of diabetes. The Keto diet’s emphasis on anti-inflammatory foods may contribute to reducing inflammation levels,14 potentially offering additional benefits in diabetes management.

Potential Neuroprotective Effects:

Emerging research explores the potential neuroprotective effects of ketones,15 the byproducts of fat metabolism during ketosis. This may have implications for preserving cognitive function, as diabetes is associated with an increased risk of cognitive decline.

It’s also important to note that the keto diet was invented as an epilepsy treatment.

How Fat Helps Prevent Diabetes

Here’s the deal: the benefits from fat intake rely on the source of fat. Healthy fats like monounsaturated fat16 found in foods like olive oil, avocados, and fatty fish, have demonstrated the ability to enhance insulin sensitivity.

This means that cells become more responsive to insulin, facilitating better regulation of blood sugar levels.

Additionally, omega-3 fatty acids, prevalent in fatty fish, exhibit anti-inflammatory properties17 that can potentially lower the risk of developing diabetes by mitigating chronic inflammation associated with insulin resistance.

Now, the trick for preventing diabetes is preventing or reversing insulin resistance18 through natural yet effective ways like the keto diet.

Is the Keto Diet Safe for People With Diabetes?

Yes, under medical supervision, the Keto diet is safe and has shown promise in enhancing blood sugar control, potentially reducing the reliance on diabetes medications.

However, the individualized nature of diabetes management necessitates close collaboration with healthcare professionals. Adjustments to diabetes medications, especially insulin dosages, may be required to prevent hypoglycemia.

Potential side effects, commonly known as the “keto flu,” including temporary fatigue and electrolyte imbalances, should be monitored.

Monitoring Diabetes on a Keto Diet

Regular visits to your healthcare provider are crucial when doing the keto diet to manage your diabetes. They may need to check your blood levels to ensure effectiveness and safety.

  • Blood Glucose Levels:19 Regular monitoring of blood glucose levels is paramount. This helps individuals and healthcare professionals assess the impact of the Keto diet on glycemic control and make necessary adjustments.
  • Ketone Levels:20 Monitoring ketone levels is essential to ensure the body is in a safe state of ketosis. Excessive ketone production, especially in the presence of high blood sugar, may lead to ketoacidosis, a potentially serious condition.
  • Regular Medical Check-Ups: Routine medical check-ups are crucial to assess overall health, including kidney function and cardiovascular health. The Keto diet can affect these aspects, and regular monitoring allows for timely interventions if needed.

Conclusion

From glycemic control and increased insulin sensitivity to prevention of diabetes complications, the keto diet is a safe and effective way to manage and prevent diabetes. While there are transitional side effects, they are temporary and manageable.

However, despite its effectiveness, medical supervision is crucial to secure safety. If you plan on doing the keto diet, talk to your healthcare provider for preventative measures and continuous monitoring.

If you are interested in another dietary approach that can help manage type 2 diabetes, look at intermittent fasting for diabetes.

Frequently Asked Questions (FAQ)

Is the keto diet OK for diabetics?

Yes, the keto diet is safe and effective for managing prediabetes and type 2 diabetes. It effectively reduces glucose levels and increases insulin sensitivity.

Can I reverse diabetes with keto?

Yes, you can reverse type 2 diabetes with the keto diet, as it effectively regulates blood sugar levels. However, note that this does not mean you will be cured.

What happens when a diabetic goes into keto?

Getting into the keto diet means taking very low carbohydrates and reducing blood glucose levels. While there are transitional symptoms, they are temporary and easily managed, especially with medical supervision.

Does being in ketosis raise blood sugar?

No, it’s the opposite. Ketosis encourages the body to use fat as an energy source, and the low levels of carbohydrates prevent the glucose levels from rising.

References

1Dhillon KK, Gupta S. Biochemistry, Ketogenesis. [Updated 2023 Feb 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493179/

2Ghimire P, Dhamoon AS. Ketoacidosis. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534848/

3Gosmanov AR, Kitabchi AE. Diabetic Ketoacidosis. [Updated 2018 Apr 28]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279146/

4Masood W, Annamaraju P, Khan Suheb MZ, et al. Ketogenic Diet. [Updated 2023 Jun 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499830/

5Boden, G., Sargrad, K., Homko, C., Mozzoli, M., & Stein, T. P. (2005). Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Annals of internal medicine, 142(6), 403–411. https://doi.org/10.7326/0003-4819-142-6-200503150-00006

6Chourpiliadis C, Mohiuddin SS. Biochemistry, Gluconeogenesis. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544346/

7Miller, V. J., Villamena, F. A., & Volek, J. S. (2018). Nutritional Ketosis and Mitohormesis: Potential Implications for Mitochondrial Function and Human Health. Journal of Nutrition and Metabolism, 2018. https://doi.org/10.1155/2018/5157645

8Zhou, C., Wang, M., Liang, J., He, G., & Chen, N. (2022). Ketogenic Diet Benefits to Weight Loss, Glycemic Control, and Lipid Profiles in Overweight Patients with Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trails. International journal of environmental research and public health, 19(16), 10429. https://doi.org/10.3390/ijerph191610429

9Yuan X, Wang J, Yang S, Gao M, Cao L, Li X, Hong D, Tian S, Sun C. Effect of the ketogenic diet on glycemic control, insulin resistance, and lipid metabolism in patients with T2DM: a systematic review and meta-analysis. Nutr Diabetes. 2020 Nov 30;10(1):38. doi: 10.1038/s41387-020-00142-z. PMID: 33257645; PMCID: PMC7705738.

10Freeman AM, Acevedo LA, Pennings N. Insulin Resistance. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507839/

11Paoli, A., Bianco, A., Moro, T., Mota, J. F., & Coelho-Ravagnani, C. F. (2023). The Effects of Ketogenic Diet on Insulin Sensitivity and Weight Loss, Which Came First: The Chicken or the Egg? Nutrients, 15(14). https://doi.org/10.3390/nu15143120

12Yashi K, Daley SF. Obesity and Type 2 Diabetes. [Updated 2023 Jun 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK592412/

13Yancy, W. S., Jr, Foy, M., Chalecki, A. M., Vernon, M. C., & Westman, E. C. (2005). A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutrition & metabolism, 2, 34. https://doi.org/10.1186/1743-7075-2-34

14Masino, S. A., & Ruskin, D. N. (2013). Ketogenic Diets and Pain. Journal of Child Neurology, 28(8), 993. https://doi.org/10.1177/0883073813487595

15Włodarek, D. (2019). Role of Ketogenic Diets in Neurodegenerative Diseases (Alzheimer’s Disease and Parkinson’s Disease). Nutrients, 11(1). https://doi.org/10.3390/nu11010169

16DiNicolantonio, J. J. (2022). Monounsaturated Fat vs Saturated Fat: Effects on Cardio-Metabolic Health and Obesity. Missouri Medicine, 119(1), 69-73. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9312452/

17Zivkovic, A. M., Telis, N., German, J. B., & Hammock, B. D. (2011). Dietary omega-3 fatty acids aid in the modulation of inflammation and metabolic health. California Agriculture, 65(3), 106. https://doi.org/10.3733/ca.v065n03p106

18Scibilia, R. (2019). The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally. Clinical Diabetes : A Publication of the American Diabetes Association, 37(3), 302-303. https://doi.org/10.2337/cd19-0025

19Mathew TK, Zubair M, Tadi P. Blood Glucose Monitoring. [Updated 2023 Apr 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555976/

20Dhatariya, K. (2016). Blood Ketones: Measurement, Interpretation, Limitations, and Utility in the Management of Diabetic Ketoacidosis. The Review of Diabetic Studies : RDS, 13(4), 217-225. https://doi.org/10.1900/RDS.2016.13.217

Mag. Stephan Lederer, MSc. is an author and blogger from Austria who writes in-depth content about health and nutrition. His book series on Interval Fasting landed #1 on the bestseller list in the German Amazon marketplace in 15 categories.

Stephan is a true man of science, having earned multiple diplomas and master's degrees in various fields. He has made it his mission to bridge the gap between conventional wisdom and scientific knowledge. He precisely reviews the content and sources of this blog for currency and accuracy.

Click on the links above to visit his author and about me pages.

Leave a Reply