The ketogenic diet (“keto”) has been around for a long time. It’s popular. That’s debatable. Some people love me too. Some people don’t like it. Some even say it can help your blood sugar levels stay in better control.
After a thorough review of the scientific literature and trying out the ketogenic diet for over six months, I’m ready to explore everything you’re hearing and decide for myself what you’re thinking about diets that have caught the world and the diabetic community in the storm.
This guide is relevant for people with all types of diabetes. When discussing how the keto diet affects blood sugar levels, I mainly talk about insulin, but some studies have also shown the possibility of a reduction in certain type 2 drugs.
Disclaimer: Always consult with your healthcare team, adjust your medication, or change your diabetes management routine before starting a new diet.
What is the Ketogenic Diet?
In the 1920s, keto was the original “diabetic diet” prescribed by people with type 1 diabetes before insulin was discovered. This will extend their lives as diets are less likely to raise blood sugar levels due to low carbohydrate content. (Carbohydrates are the main nutrients that raise blood sugar levels.)
A ketogenic diet is a low-carb diet, which only gives you about 5-10% of your daily calorie intake from carbohydrates. By limiting your carbohydrate intake very strictly, you force your body to get most of that energy from fat. This byproduct of fat burning is the name of the diet, as it is the production of natural ketones in the body.
Fat burning ketones provide the body with alternative forms of energy, rather than rapid, accessible energy from carbohydrates (glucose), and define a ketogenic diet. Here are two main reasons why people with diabetes follow the keto diet:
- To reduce insulin needs and avoid fluctuations in blood sugar levels
- Supporting weight management (weight loss)
The rest of this guide will review the pros and cons of the keto diet and try to answer the most important questions. “Is the keto diet good for people with diabetes?”
What foods are recommended for the keto diet?
Some recommended sample foods for this diet include:
- meat (For example, beef, pork, lamb, chicken, game meat.
- Fat fish (Example: salmon, mackerel, sardines, trout, and other fish rich in omega-3 fatty acids)
- egg (preferably free-range or omega-3 concentrated eggs)
- High Fat Dairy Products (Example, butter, cream, specific cheese)
- Nuts and seeds (Examples: almonds, walnuts, flaxseeds, pumpkin seeds, chia seeds)
- Healthy oils (Mainly extra virgin olive oil, coconut oil, avocado oil)
- avocado (whole avocado or freshly made guacamole)
- Low carb vegetables (Examples: green vegetables, tomatoes, onions, chili peppers)
- seasoning (Examples: vinegar, mustard, hot sauce, garlic, herbs, spices)
- drink (For example, water, unsweetened coffee and tea)
A nutritionist will help you figure out the best combination of foods you eat, taking into account your lifestyle and overall health goals.
How much fat, protein and carbohydrates are eaten on the keto diet
To follow the keto diet, you are looking at this division of daily calorie intake:
- 75-85% fat
- 10-20% protein
- 5-10% carbohydrates, or about 20-50 grams per day
As an example, if you convert this to grams for a person on a 2,000-calorie diet, this is:
- 167-189 grams of fat
- 50-100 grams of protein
- 25-50 grams of carbohydrates
Note: I’m not saying you should eat a 2,000-calorie meal. This is just an example! Please read This post learn how to calculate your daily calorie needs.
If you follow a ketogenic diet, it is important to keep your protein intake down. When there are no carbohydrates, the body can use proteins to create glucose through a process called gluconeogenesis.
This can drive you out of ketosis. Therefore, in order to maintain ketosis, it is recommended to limit your protein intake to less than 1 gram per pound of body weight (unless you are engaged in weight lifting regularly).
I spend the rest of the article talking from a perspective of 20-50 grams of carbohydrates and medium protein (about 20%).
How does the keto diet affect blood sugar?
The premise of a ketogenic diet and diabetes is simple. There should be fewer carbohydrates and fewer blood sugar spikes. Less glucose spikes increase the range time and improve A1C levels (a measure of glucose control over the past 2-3 months).
Additionally, several studies have shown that keto diets improve insulin sensitivity, further reduce the need for insulin, and facilitate blood glucose control.
(And if it’s large), keto can be a very effective way to manage blood sugar levels. Blood sugar levels really start to dissipate, and the trendline in CGM can flatten and A1c drops considerably. I had the best A1c of my life while I was doing keto.
Conversely, “hypoglycemia” (hypoglycemia) can become a problem, especially after adopting the keto diet. Treat your hypo too aggressively and you can knock you out of ketosis.
During my first three weeks in keto, CGM trendlines hugged around 80 blood sugar levels. It was glory, but trial and error reduced the insulin considerably and felt it was low every 5 seconds.
When I treat low, I sometimes push carbohydrate amounts to the keto threshold and get out of ketosis. It’s not the worst thing in the world, but the goal is to stay as close to ketosis as possible.
The Keto diet is a carbohydrate diet that is less popular among diabetics, and many people pledge to its effectiveness in blood glucose control.
However, there are also people who experience reactions that respond when following the keto diet (including Christel Oerum, a diabetic owner). Instead of an increase insulin sensitivity, insulin resistance increases dramatically. As a result, even very small amounts of carbohydrates require large amounts of insulin.
This increase in insulin resistance to the keto diet is in contrast to most studies, but there are animal studies that support this phenomenon. More research is needed, but not everyone is responding to the keto diet the same thing, and there is ample anecdotal evidence to suggest that it is inappropriate for some people.
verdict: Keto diets are effective in managing blood sugar, but there are significant variations among individuals. It won’t work for everyone, but with OK from your healthcare team it may be worth trying to see how it works for you.
Is the keto diet effective for weight loss?
Given that the whole idea of a keto diet is to burn fat instead of carbohydrates for energy, it seems logical that a keto diet should be effective in weight loss.
This is often the case, but it is important to remember that individual outcomes may differ, and that there are factors that can affect weight loss, such as overall calorie intake, dietary quality, hormonal and physiological responses, metabolism, and exercise levels.
Therefore, it is important to improve weight loss outcomes according to a balanced keto diet that meets your individual needs and goals.
For more information on how to manage your weight with diabetes, read How to Lose Weight with Diabetes and follow the steps in the post. How to find your daily calories requires calculating the optimal daily calorie intake.
Theory behind using the keto diet for weight loss
Advocates who use the keto diet to lose weight claim that eating carbohydrates will help promote insulin production, increase hunger, keep the body fat and reduce calorie burns. Replacing carbohydrates with fat reduces the need for insulin, suppresses hunger, promotes calorie burns, and dissolves fat.
Many people also report that they are very satisfied with fat, making them feel full. The same can be said about proteins. When it’s full, it’s less calories and less cravings. When you are in a healthy calorie deficit, you are prepared to lose the pound you don’t want.
What science says…
Studies consistently show that there is no significant difference in weight loss between very low-carb or low-carb diets and comparison meals after 6-12 months.
However, long-term effects (more than 1 year) have not been studied due to budget constraints or other factors, so interpret the results as desired.
verdict: The keto diet is essentially less good in weight loss than other diets. However, it is very effective for weight loss (at least in the short term).
- Helps you manage your blood sugar levels better than other diets
- It’s easier to follow than other meals
- Work for your general lifestyle
Like most other diets, the main criterion for success is whether it is sustainable over the long term. If you like the keto lifestyle, your diet can work well. If you hate it, it probably won’t work for you.
A quick note about keto and moisture retention
People starting the keto diet said, “I’ve been keto for a week and have already lost 6 pounds! I love it!”
This can be a great motivation to stick to your diet, but most of that initial weight loss consists of water due to low glycogen storage (glycogen is a glucose storage form).
why? The old proverb says, “Where the glycogen goes, the water continues.”
Low carbohydrates make glycogen less storage. Low glycogen means less water is retained. Less water is held, and you guessed it: the scale goes down. That’s nothing wrong. Don’t misunderstand fat loss and water loss.
Keto diet and exercise
Starting with a ketogenic diet can affect your exercise performance in multiple ways. During the “adaptation period” (back later), it is likely that the decline in energy and motor skills will be completely reduced while the body is adapting to a new diet.
If your body adapts to a ketogenic diet, you will most likely experience aerobic exercise returning to previous levels of difficulty, but strength training may or may not be more difficult.
Don’t expect a major improvement in aerobic exercise
Despite the availability of stored fat as fuel, individuals may not experience improved aerobic performance by tracking ketonogenic diets.
In fact, for recreational athletes (regular exercise), ketogenic diets usually do not significantly affect heart performance after adaptation.
Many studies have found that low carbohydrates and ketogenic diets do not improve athletic performance in trained athletes, and in fact can reduce performance, especially among women.
Strength can be painful
New research suggests that ketonogenic diets may be effective in short-term fat loss, but their effects on muscle growth and strength are questionable, and may not be the ideal dietary approach for those seeking to increase muscle mass and exercise.
The long-term effects and safety of ketonogenic diets, particularly on body composition and strength outcomes, require further investigation.
Personally, in the first 4-6 weeks since switching to the keto diet, all of my lifts have been reduced by 40-50 pounds. The weight I was throwing easily became difficult to move until it was fully adapted.
It may not be impossible to improve the intensity during a keto diet, but it can make the process significantly more challenging.
How difficult is the keto diet?
This is the most important, but most subjective question about any diet. If you don’t feel good about diet physically or mentally, it won’t lead to long-term outcomes as you won’t follow it.
The keto diet is probably one of the most polarized meals when it comes to people’s opinions about how easy it is. Some people have almost loved it since day one, while others experience great cravings and even physical discomfort.
This is what my experience with the keto diet was like. Yours may be different:
Keto adaptation is rough
It takes time for the body to become something called “Keto-adapted,” a process that adapts to the ketogenic diet. It’s your body’s “Hey, I’ve got this, I’m mostly ready to burn fat!”
The length of the adaptation period depends on individual differences such as gender, age, and level of physical activity. Research shows that it can take weeks or months for your body organs to fully adapt to ketone utilization.
Although more research is needed, aerobic exercise may help speed up this process of adapting to keto.
Keto experts Ariel Warren, RDN, CD, and CDCES suggest that adapting to keto can also depend on the number of carbohydrates that are used to eating. For example, if you are transitioning from a high-carb diet, she says that adaptation can take longer.
During the first few weeks following the keto diet, your body is rebooting what is known throughout your life. Your brain is used to running on glucose, and suddenly, it doesn’t have it. Now it’s craving it. You are in glucose withdrawal.
Some people describe this phenomenon as “ketoflu.” Here we feel the opposition of essentially all the promised promised.
Oh, I probably should also mention that low carbs often mean low fiber. It is recommended to support the digestion and removal process to limit sodium and include high-fiber low-carb foods such as avocados, raspberries and spinach.
If you continue to experience constipation and other digestive issues with the keto diet, talk to your healthcare provider.
Is the keto diet safe for people with diabetes?
There has not been much research into the long-term safety and efficacy after the keto diet, especially for diabetic patients. This is an area of ongoing research. So far, it appears to be safe and effective for diabetics in the short term (up to 6-12 months).
One of the main risks when following the keto diet (or other diets that limit food choice and calorie intake) is that diet quality is deficiency, which means that there are much less plant-based foods such as fruits, vegetables, whole grains, and legumes, as they often contain moderate amounts of carbohydrates).
Another risk of a restrictive diet that is often overlooked is related to mental health. A restrictive diet can potentially lead to unhealthy relationships with food, and in some cases, it can contribute to eating patterns and disorders in eating disorders.
If you are constantly thinking about food, avoiding the social situation in which it is involved, or suffering from negative body images, seek the help of a mental health professional or registered dietitian specializing in this field
Note: It is important to emphasize that this risk is not particularly related to the keto diet, but generally not related to restrictive diets!
Additional potential risks of a keto diet can be included.
- Early side effects such as fatigue, headache, nausea, and constipation
- Increased risk of hypoglycemia (hypoglycemia) in people who use insulin or drugs that promote insulin or insulin release.
- Ketoacidosis, dehydration, and imbalances in various forms of electrolytes
- It can have a negative effect on bone health, such as a decrease in bone density
- Abnormal effects on cholesterol levels, particularly LDL (“bad”) cholesterol increase
- Increased risk of kidney stones, kidney disease, or worsening kidney disease
- Serious heart condition and potential development of ocular nerve damage
Keto Diet and Keto Acidosis
Diabetic ketosidosis can occur in diabetic patients if there are inappropriately high levels of ketones in the body.
This usually occurs due to a lack of insulin and is more common in people with type 1 diabetes. However, it can also occur in people with type 2 diabetes who require insulin, miss an insulin shot, clog the insulin pump, or use the wrong insulin dose.
Without insulin, cells cannot use sugar for energy, so the liver instead breaks down fat for fuel, thereby producing ketones. After that, ketones accumulate in the blood and turn blood acids, causing acidosis.
Other causes of diabetic ketosidosis may be the presence of disease, infection, or severe dehydration.
Ketogenic diets are more frequently associated with ketoacidosis, with or without diabetes.
To monitor keto acidosis, urine tests can measure ketone levels in the body. Ketone test kits can be purchased at the counter at most drug stores and pharmacies.
Urine ketone levels
You can also get a test kit that uses blood drops instead of urine. They use a different measurement scale, so always read the package carefully before taking the ketone test.
Keto diet and pregnancy
A ketogenic diet is not recommended for women with pregnancy, breastfeeding, or gestational diabetes. There has not been enough research to show that it is safe and can have harmful effects on your baby during pregnancy.
This diet is also advised to people with a variety of other health conditions, including pancreatitis and liver failure. For a more comprehensive list, visit the National Library of Medicine.
Final Thoughts: Is the keto diet good for people with diabetes?
The keto diet may be an effective short-term strategy for people with diabetes. Some of the potential benefits include:
- Better blood sugar management
- Initial weight loss
- Fullness (less craving)
However, individual differences can have a significant impact on the body’s response to the keto diet. Some people may experience weight gain or worsening blood sugar levels.
Furthermore, keto diets may be less safe for type 1 diabetes patients due to increased risk of ketosidosis.
If your doctor has approved it, try taking the keto diet for a while (as it’s always difficult for at least 2-3 weeks) and see how it works.
If you feel that the keto diet isn’t working for you after trying it, don’t feel like you’re forced to follow it just because some people with diabetes are recommending it.
There are many great options, such as a dietary approach to stopping hypertension (DASH), or a diet of the heart (a combination of MED and DASH).
I tried to follow the keto diet for a while, but eventually returned to the more traditional medium curved diet. It simply works well for me!
We hope this guide will give you a complete view of ketogenic diet and diabetes. At the end of the day, it’s up to you and your healthcare team to decide whether you want to try it or not, and see if it has a beneficial effect on your blood sugar, body composition, or your feelings. If you go for it, a good place to start is this ketogenic meal plan. Good luck!
