Keto diet and diabetes: What to know

When following the keto diet, you reduce your intake of carbohydrates to a minimum while increasing how much fat you consume. This process leads the body into a state of ketosis. Ketosis happens when the body starts to use fat for energy instead of carbohydrates.

This diet may be particularly popular with people trying to manage their weight and people who have type 2 diabetes.

But currently, there is a lack of evidence around the long-term safety and effectiveness of the keto diet. Experts call for more studies and evidence before recommending this diet to people with type 2 diabetes.

About the keto diet and diabetes

Diabetes is a chronic condition that affects 537 million people worldwide and is predicted to affect 738 million people by 2045.

There are medical ways to manage blood sugar levels, such as oral or injectable medications. But the foundation of diabetes care is a healthy eating plan, so a low carbohydrate diet such as the keto diet may help to manage the condition.

When people eat foods containing carbohydrates, such as bread, rice, and pasta, the body’s digestive system breaks down the digestible carbs into simple sugars. The body then produces insulin to help the bloodstream absorb the sugars.

In people with type 2 diabetes, there may be difficulty producing insulin, or their bodies block the action of the insulin. This causes high blood sugar levels.

What the research says

Research from 2021 suggests that limiting carbohydrate intake may help you keep blood sugar within your target range. It also lowers the body’s demand for insulin and minimizes large blood sugar shifts.

But while keto diets may have short-term benefits, a 2022 review of randomized clinical trials found little evidence to support keto diets for the long-term management of type 2 diabetes.

The majority of the studies that the researchers looked at lasted only 6–12 months. Although the results showed that low carb diets could improve blood sugar management and aid in weight loss, more long-term studies are needed to assess the safety and effectiveness of this type of diet.

Sticking with a keto diet in the long term is often difficult. This is because it may be hard to maintain in certain social settings and can be costly. In some instances, it may also reflect underlying disordered eating, which is often prevalent in people with type 2 diabetes.

Experts do not recommend the keto diet if you are pregnant or breastfeeding or chestfeeding.

What are the benefits?

The keto diet may have other benefits, aside from helping manage blood sugar and weight. These include:

• lowering blood pressure
• improving insulin sensitivity
• improving high-density lipoprotein (HDL) cholesterol without increasing low-density lipoprotein (LDL) cholesterol
• improving triglycerides
• reducing inflammation

A 2022 study found that people with type 2 diabetes who followed the keto diet could reduce their diabetes medication for up to 12 months. Yet researchers concluded that participants found the level of carbohydrate restriction difficult to maintain in the long term, with medications eventually returning to their usual levels.

Risks

Although the keto diet may have many health benefits, it has short- and long-term drawbacks. Short-term common effects include:

• nausea
• vomiting
• headache
• fatigue
• dizziness
• insomnia
• constipation
• keto flu, which refers to a group of symptoms that resemble those of the flu

These symptoms typically last a few days to a few weeks.

Long-term effects include:

• a buildup of fat in the liver (hepatic steatosis)
• very low protein levels in the blood (hypoproteinemia)
• kidney stones
• vitamin and mineral deficiencies

Condition-specific risks

Additionally, the keto diet may not suit you if you are pregnant or nursing, or if you have any of the following conditions:

• pancreatitis
• liver failure
• fat metabolism disorders, such as Gaucher’s disease and Tay Sachs disease
• primary carnitine deficiency, which is a condition that prevents the body from using certain fats for energy
• conditions known as porphyrias that relate to the body’s production of chemicals called porphyrins, which form hemoglobin
• pyruvate kinase deficiency, which is a rare genetic condition characterized by the premature destruction of red blood cells

Risks and type 1 diabetes

Researchers concluded that a keto diet is unsuitable for people with type 1 diabetes. This is because it causes metabolic irregularities, which may lead to brain, kidney, and liver complications.

A small study reported that, although a keto diet improves blood glucose in people with type 1 diabetes, it also triggers more frequent and extreme hypoglycemic episodes.

In this study, episodes rose to 6.3 per week compared to 1–2 per week. The majority of participants also developed an imbalance of lipids such as cholesterol and triglycerides (dyslipidemia), which can lead to cardiovascular disease.

Diabetic ketoacidosis

Diabetic ketoacidosis occurs when the body’s main source of energy starts coming from fats instead of carbs, and the body creates too many ketones in the blood. This potentially fatal condition can affect people with type 1 and type 2 diabetes, especially if they are not taking insulin or have unmanaged blood sugar levels.

Other dietary changes for diabetes

There is evidence that the Mediterranean diet may successfully promote weight loss, improve blood sugar management, and reduce the need for glucose-lowering medication.

Research from 2018 found that people with a recent diabetes diagnosis who followed a low carbohydrate Mediterranean diet were 37% less likely to require glucose-lowering medication over a 4-year period than people who followed a low fat diet.

But the American Diabetes Association (ADA) does not recommend one diet over another, as everyone has different dietary needs. The ADA states that doctors and healthcare professionals are more likely to personalize diet plans to suit your eating habits, preferences, target weight, and blood sugar levels.

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Contacting a doctor

Always speak with a doctor or healthcare professional about dietary changes for managing a medical condition.

You should seek medical advice if you notice a combination of the following symptoms, which could indicate high ketone levels:

• breath that smells fruity
• high blood sugar levels
• frequent urination
• feeling very thirsty
• tiredness
• confusion
• fainting
• nausea
• vomiting

Summary

The keto diet may not only improve blood sugar levels in people with diabetes, but it may also aid in weight loss, improve insulin medication dependency, and lower blood pressure.

However, the keto diet has some drawbacks and may not be suitable for everyone. It can be difficult to follow in the long term, may be expensive, and could affect social situations.

It is important that you contact a doctor or healthcare professional before trying a diet intended to manage a medical condition.

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