Ketogenic diet and diabetes

Table of Contents

Ketogenic diet and diabetes are two health issues that are directly related to each other. Let us explain in detail.

A ketogenic diet or a low-carbohydrate diet is a good option for people with diabetes.

This article will learn why reducing carbohydrates will improve your quality of life if you have diabetes. You will also know the risks of the ketogenic diet for diabetes and how to avoid them.

Finally, we will tell you how to start the ketogenic diet if you have diabetes.

What is diabetes?

Diabetes mellitus is a disease in metabolism

Diabetes mellitus is a disease in metabolism that is causing high blood glucose levels (hyperglycemia).

How curious the reason for calling this disease “Mellitus” is because the urine of diabetics has a peculiar honey taste.

The leading cause of this disease is a dysregulation of insulin, a hormone made by the pancreas that allows cells to use glucose from the blood as a source of energy.

Today, the immune system, other hormones such as glucagon are also positively associated with diabetes. Still, in this article, we will focus only on the dysregulation of insulin, which is the primary hormone affected in this pathology from a classical point of view.

There are two leading causes of this deregulation:

  • In type 1 diabetes, the problem is a failure of the pancreas that stops producing enough insulin.
  • In type 2 diabetes, the problem is that the body generates “insulin resistance,”. It ceases to affect even if it is produced in sufficient quantities.

A person with diabetes must externally supply the insulin he needs, typically by injection.

Your biggest challenge is figuring out how much insulin to inject.

Each day you will generally inject a basal dose and then additional amounts depending on what you eat.

Calculating it is tricky since tiny amounts of carbohydrates (up to 4 g) are enough to raise blood sugar to require an extra injection.

Besides, the doses are not standard. Each person reacts differently. Physical activity or stress can also alter the need for one dose or another of insulin, generating even more complications.

In the long term, hyperglycemia can cause disturbances in the function of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels.

What is a low carb or ketogenic diet?

A ketogenic or low-carb diet is one in which carbohydrate intake is drastically limited and replaced by increased fat intake.

This diet generates a metabolic change in our body. Instead of using glucose as its primary energy source, the body turns to the fat that it previously transforms into ketone bodies (hence the diet).

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You can learn in more detail what this diet is in this article or this video:

Benefits of the ketogenic diet for diabetes

low carb diet or ketogenic diet

A low-carbohydrate diet makes diabetes easier to treat.

By consuming more fat, our body stops depending on glucose as an energy source. Fat is not converted to glucose, as carbohydrates and even proteins do to some extent, but rather it is converted into another energy substrate: ketone bodies.

The ketogenic diet, or low carb diet, significantly reduces the spike in blood sugar that we usually have when we eat and, therefore, need additional insulin.

Thus, the risk of large blood glucose swings from hyperglycemia and hypoglycemia caused by incorrectly calculated extra insulin doses is reduced.

Think that the injected insulin is not as efficient as that generated by the pancreas itself. It is estimated that its absorption may vary by approximately 30%. This constitutes a factor of uncertainty that makes it difficult to assess the need for insulin accurately.

If you eat a few carbohydrates, you need less insulin. So the risk of making a big mistake is reduced. Small amounts of carbohydrates will produce small health issues. Larger amounts of carbohydrates and insulin will produce large and possibly dangerous health problems.

Another benefit of the ketogenic diet for diabetes is how it uses ketone bodies as its primary fuel and is not solely dependent on glucose. This means that there will not be such an alarming drop in blood glucose if you consume more energy (for example, doing sports).


Ketone bodies are neuroprotective. For example, in metabolism, only adapted to carbohydrate consumption; if I force a sudden drop in blood glucose, my brain will complain and even cause a hypoglycemic coma. If the environment is rich in ketones, none of these symptoms appear.

Significant Health Benefits

The effort to adapt to this new diet is worth it as the health benefits are significant:

  • A reduction in insulin consumption (up to 20% on a high carbohydrate diet)
  • An improvement in insulin sensitivity
  • Lower blood pressure
  • Lower HbA1c
  • An improved lipid profile
  • More energy and vitality
  • Cancer risk reduction
  • Reduced risk of cardiovascular diseases
  • Risk reduction of neurodegenerative diseases

Ketogenic diet risks for diabetes

Ketogenic diet risks for diabetes

Apart from the few risks that this diet has in people without diabetes (you can see them here), for people with diabetes, the biggest fear is the association of ketosis with ketoacidosis. This is a state of intoxication that occurs if you do not take insulin.

This relationship does not exist. The two phenomena are entirely independent.

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Ketoacidosis is caused by not taking insulin. Not cutting back on carbohydrates. It can only happen if you’ve been complete without insulin for a couple of hours.

When you are in ketosis, your ketone levels reach 1.5 – 3 mmol within the physiological threshold and far from the ketoacidosis values ​​(10 -15 mmol),

It is better to monitor your blood glucose regularly. This way, you don’t have to worry.

This normalization of ketones in the blood does not immunize you from ketoacidosis. If you miss a couple of insulin injections, you can get ketoacidosis with all the risks that this entails.

One way to avoid this is to keep carbohydrate levels low (30 – 50 g daily) but not eliminate them from your diet.

Ketogenic diet drastically reduces the amount of insulin

Ketogenic diet risks for diabetes

Do not go on a deep ketogenic diet (less than 30 grams a day) unless you know how your body reacts and you are sure that you will not forget the insulin shots.

To provide that “extra” carbohydrates, you can follow a strict ketogenic diet menu and add a fruit piece a day.

One of the most significant risks of the ketogenic diet concerning diabetes is the long adaptation to eating habits changes.

This meant many additional blood glucose measurements, adjusting insulin doses, and paying attention to trends before finding the sweet spot.

The ketogenic diet will drastically reduce the amount of insulin you need. That is why it is essential to reduce your doses enough to prevent your blood glucose from dropping too low.

We recommend that before starting this process, you talk to your doctor or diabetes nurse.

How to get started on the ketogenic diet for diabetes

To start the ketogenic diet, we recommend that you start this free course.

If you follow the ketogenic diet correctly, you can correct type 2 diabetes.

If you have type 1 diabetes, you already know that you cannot correct it, but you can dramatically increase your glycemic control.

Your primary job will be to start reducing the insulin doses you take.

In the next few weeks, you will need to monitor your blood glucose level and frequently reduce your medication. Ideally, it should be done with the help of a familiar doctor.

Remember that using the same insulin dose as before starting a low-carb diet can cause hypoglycemia.

Insulin Treatment

Insulin Treatment

In general, diabetes patients treated with insulin injections can reduce insulin amounts by 30% to 50% by starting a ketogenic diet or a low-carbohydrate diet.

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You will have to regularly measure your blood glucose and adapt the amount of insulin. We suggest that you always start with a low dose and increase it if necessary. If you use too large a quantity, instead, you will be forced to devour carbohydrates, and that counteracts the ketogenic or low carb diet.

The advice above is valid for both type 1 and type 2 diabetes.

If you suffer from hypoglycemia regularly, consider lowering insulin and not increasing carbohydrates.

Insulin-releasing pills

If you are treating diabetes with sulfonylureas (Euglucon, Minidiab, Daonil, Glibenclamide), the risk of hypoglycemia is lower.

You will probably also need to reduce the dose or stop taking these medications. We recommend that you speak with your doctor before making any decisions.


Metformin is fast becoming a longevity drug. You can take it with or without diabetes without problems.

Although certainly, its benefits are the same that you will get if you follow healthy nutrition and play sports.

We suggest that you change the Metformin treatment for these actions in the long run. They will bring you more happiness and are much cheaper.

GLP-1 agonists and DPP-4 inhibitors

Incretin Mimetics (GLP-1 Agonists) will rarely cause low blood sugar levels on a ketogenic diet or a low carb diet.

Use common sense and regularly check your blood sugar levels and talk to your doctor when necessary.

SGLT2 inhibitors

SGLT2 inhibitors are more delicate to combine with the low carbohydrate diet.

One of the side effects they have is increasing the risk of ketoacidosis.

If you have ketoacidosis symptoms: extreme thirst, nausea, vomiting, confusion, etc., you should stop taking the medication, consume carbohydrates, and contact a doctor immediately.


The ketogenic or low carb diet is a perfect way to control diabetes.

By consuming a few sugars, you will need to inject less insulin with all the benefits.

In some cases, this diet can reverse type 2 diabetes!

If you have the reasonable control of your blood sugar levels, the ketogenic diet carries no risk.

Learn more about the ketogenic diet with our free course.