Ketogenic Diet for Diabetes – Is Keto Good for Diabetics?

How Does Ketosis and Keto Diet Work? 

Ketosis and keto diets are interesting topics in the media when it comes to dieting and losing weight. Understanding how Ketosis or Keto diet works will help to consider this analogy that will show you how your body loses weight and burns more fat. Take, for instance, a car that is your body, in this case, will require fuel to function properly or for energy.

In the case of your body, your glucose is broken down to produce the energy your body needs to do all its work. When there is no energy in your car, it won’t move. The same applies to your body. But our body is built more special. Instead of running out of energy, it relies on Ketones, which can be considered backup energy producers for your body.

Ketones are created in your liver from fats. During its production, your body undergoes a state known as ketosis. When keto diet people embark on a keto diet, their protein and carb intake are greatly reduced, and their fat intake increases. And since their body doesn’t get enough carbohydrates or proteins as a source of energy, it relies on ketosis for its source of energy.

Literally, it means that your body is burning fat quickly to meet your energy need.    Switching from using glucose or proteins as a source of energy to using Ketones is not achieved immediately. It takes your body quite some time to achieve that. Even after you successfully achieve ketosis, maintaining it is always a problem.

Why? Even the smallest amount of carbohydrates can opt your body out of ketosis. Aside from a small amount of carbohydrates, excessive consumption of proteins can lead to the same effect. If you want to maintain your ketosis and let it last for a long time, then you have to read the following and follow the instructions. 

Maintain a steady fat consumption

To achieve ketosis, you need to consume mostly fats in your diet. That is also the best way to make ketosis last longer for you. When I say eat mostly fat, I mean that most of your meals, about 80% to 90%, must consist of fat. Whether snacks or main meals, dietary fats should be your go-to food choice. 

Watch your protein consumption

While you are eating enough dietary fats, you need to also watch out for food that is rich in proteins. Most times, when your body can’t find carbohydrates to convert to glucose, it uses proteins. And if you have available proteins that your body can use, you can kiss your ketosis goodbye. If you want to avoid this, then stay away from proteins.

Avoid carbohydrates completely or only eat low-carb food

If you want ketosis to last a very long time for you, then you need to be mindful of the level of carbs you consume and the ones in your blood. For best results, you will have to limit your carbohydrate intake to about 30g or 50g of carbohydrates a day. Anything higher might affect your diet. To understand this, a medium-sized apple will contain about 25g of carbohydrates.

So taking just two in a day is enough carbohydrates for you in a day. I always advise my patients to go for fresh carbohydrates for their carbohydrates and avoid packaged carbs source. There might be issues with the advertising of such products. They might claim to have very low carb content; on the contrary, their carb content is way over the roof. 

Check if your body is in ketosis

This step is not really necessary, and you must not do it. However, it helps if you know whether your body is still in ketosis. To check if your body is still in ketosis, you will need a breath test or blood or urine test. The test might be quite expensive and not covered by an insurance policy.   

What do Ketones do to Diabetic People? 

Before we look at what ketones do to your body, let us first go over what they are and how they are formed. Ketones are produced in your liver, and they are water-soluble. They are created from fats when your body lacks energy and has insufficient insulin or carbohydrates to make more blood glucose or when you have low blood sugar. You can see them as your body’s alternative energy source when you run out of carbs.

The whole process of ketones formation is ketosis, and the energy from ketones can be used to support your body’s normal body functions and metabolism. Ketones are very important in your body and are produced when your body does not have the required amount of insulin needed for blood glucose production.

Some of these times are when you are fasting, consuming only foods that are high in fat or have low carb content, or when you are sleeping. If you have unmanaged Type 1 diabetes, your body will produce ketones when the beta cells in your pancreas fail to produce insulin. Or there are not enough beta cells to produce the needed insulin. It can also occur if your body can not get an external source of insulin.   

But what do Ketones do to you aside from helping with energy production? 

If you do not have diabetes, then there is no issue if your body produces ketones because keto and diabetes should be carefully watched when together. But if you have diabetes, you can end up having Diabetic Ketoacidosis, a severe medical condition associated with living diabetes you will soon learn more about.   

Do you Need Keto Diet to Control Diabetes?

First, what is the keto diet? The ketogenic or “keto” diet is a diet that is high in fat and low in carbs, which can be helpful for diabetics since it can potentially change the way your body stores and uses energy. The diet was originally created in 1924 as a treatment for epilepsy patients but has since been researched for other diseases and medical disorders, such as type 2 diabetes.  

How Does Keto Diet Induce Weight Loss?

Low carbohydrate or ketogenic diets are thought to lower insulin, a critical hormone that produces an anabolic state, inducing weight gain. Keto diets may questionably and indirectly improve heart and cardiometabolic function and induce weight loss.

Ketogenic diets restrict carbohydrate to cause nutritional ketosis and typically limits carbs to 20-50 grams daily. Restricting carbs induces glycogen depletion and ketone production from the mobilization of fat stored in fat tissue. Following a ketogenic diet may improve blood sugar levels while also reducing the need for insulin. However, as with most diets, the keto diet is no exception and carries its own risks.

Be sure to discuss it with your doctor or the SugarMDs team before making any drastic dietary changes. Especially for patients who are on insulin, who have to be extremely careful before commencing a keto diet. It would be great if you consult with an endocrinologist first. 

A precursor for type 2 diabetes is being overweight. With that being said, the vast majority of type 2 diabetic patients are overweight. So, a high-fat diet seems a little odd, right? As I have already pointed out, the ultimate goal is to reduce total daily calories. The purpose of the ketogenic diet is to make the body use fat for energy versus carbohydrates or glucose by creating ketosis. 

During the transition from glucose metabolism to fat metabolism in your blood, you will feel the hunger, but once you are in ketosis, the hunger will dissipate. This will help you consume fewer calories. 

On the other hand, carbohydrates, especially simple carbs with minimal fiber content, are rapidly absorbed and turned into fat unless the body uses that immediate source of energy.  Since the body does not want to go into a ketotic state, you will feel hungry and continue to eat carbs which will turn into a vicious cycle, causing a lot of weight gain.

Fats are absorbed much slower and allow your body to go into ketosis when energy is needed, as there have been no carbohydrates available to begin with. While on the keto diet, you will obtain most of your energy from fat, with little coming from carbohydrates.  

Keto and Low Carb Meals that are Good for Your Health

Any healthy or keto diet, including those with healthy vegetables, is surprisingly low-carb. So, for a healthy life and heart and to manage diabetes, you will need some of these meals.  

Zucchini in Zucchini zoodles

This low-carb meal is one of the most common for people on a keto diet. It has a very low carb content, tastes so good and sweet, and is very difficult for anyone to dislike.  Zucchini can be eaten raw, grilled, or roasted. But if you want, you can also make zucchini zoodles, slightly cooked noodles made with Zucchini, and some other ingredients like parmesan cheese, olive oil, and any other Low-carb seasoning.

Cauliflower

Your keto diet will not be complete if you don’t have any meals consisting of cauliflower. Although cauliflower has a very low carb content, it has a surplus of phytochemicals and vitamins that are great for people living with diabetes.  You can add cauliflower to salads, roast them, or make riced cauliflower.  

Spinach

Spinach has low carbs and can be easily incorporated into your meals. It is among the keto diet good for people living with diabetes. It can be used in salads, smoothies, or used with fried eggs. Other Low-carb keto diets that are vegetables include bell pepper, asparagus, broccoli, white mushrooms, celery, kale, cucumber, etc. Other foods that can be incorporated into the keto diet for people living with diabetes include: 

1. Seafood and fish, including salmon, flounder, lobster, tuna, crab, etc. 
2. Poultry and meat, including turkey, chicken, egg, beef, and sausages. 
3. Fruits like avocados and berries,
4. High-fat dairy product
5. Oil
6. nuts and seeds 

What Type of Fats is the Keto Diet Referring to?

This diet doesn’t mean you should eat your way through all those saturated fats. The best fats are heart-healthy, which is key to maintaining a healthy life. Some healthy fats that are commonly included in the ketogenic diet are:

1. Eggs
2. Fish such as salmon
3. Cottage cheese
4. Avocado
5. Olives and olive oil
6. Nuts and nut butter
7. Seeds

Ketogenic Diets and Blood Sugar Control

The Keto diet impact on diabetics varies. It has the potential to decrease blood glucose levels. To manage carbohydrate intake, it is often recommended for people with type 2 diabetes because carbohydrates turn to sugar and, in large quantities, can cause blood sugar spikes. 

However, carb counts should be determined on an individual basis with the help of your doctor or our dedicated SugarMDs team. Eating too many carbs can be dangerous if you already have high blood glucose. Some people can experience reduced blood sugar by switching focus to fat.

Does keto work for managing type 2 diabetes?

Keto diets can benefit some people with diabetes since it helps to control their blood sugar levels.  Because the keto diet is low in carbs content, it reduces rapid fluctuations of your blood sugar level and helps with balancing it.  Although there have been studies into the keto diet’s efficiency for managing type 2 diabetes, experts still believe other strategies for managing diabetes are better for long-term diabetes management.

Who can use the Keto diet? 

Also, not everyone can benefit from the keto diet. Examples of such people are 

1. Pregnant or lactating people 
2. People with a history of eating disorder
3. Patients with kidney diseases 
4. People using some drugs 

The Keto Diet Sounds Great! So, What is the Catch?

Changing your body’s primary energy source from carbohydrates to fat causes an increase in ketones in the blood, which can lead to dietary ketosis. This “dietary ketosis” differs from ketoacidosis, an extremely dangerous condition that diabetes can face. When you have too many ketones in your blood, you may be at risk for developing diabetic ketoacidosis (DKA).

DKA is most prevalent in type 1 diabetes when blood glucose is too high and can arise from a lack of insulin. Although rare, DKA is possible in type 2 diabetes if ketones are too high in your blood. Being ill while on a low-carb diet may also increase your risk for DKA. If you’re on the ketogenic diet, test blood sugar levels throughout the day to ensure they are within their target range.

Also, consider testing ketone levels to make sure you’re not at risk for DKA. The American Diabetes Association recommends testing for ketones if your blood sugar is higher than 240 mg/dL. You can test at home with over-the-counter urine strips. DKA is a medical emergency. If you’re experiencing the symptoms of DKA, see your doctor immediately. Complications can cause a diabetic coma. The warning signs of DKA include:

1. Consistently high blood sugar
2. Dry mouth
3. Frequent urination
4. Nausea
5. Breath that has a fruit-like odor
6. Breathing difficulties

What not to eat on the ketogenic diet?

To eat a healthy diet, there are some things you should avoid (fats) or limit (alcohol). They include:

Fats

There are different types of fats. Some types of fats are better for your body than others.

Trans Fats

Trans fats are a type of fat that is especially unhealthy. They are found in margarine, many fast foods, and some store-bought baked goods. Trans fats can raise your blood cholesterol level and your chance of getting heart disease. Try to avoid eating foods with these types of fats. 

Even when the advertising says it does not contain trans fat, check the nutrient section to confirm. You may never know. It wouldn't hurt to check the written advertising policy of the company as well to know if you can hold them accountable or if their services are worth it. 

Polyunsaturated Fats

Polyunsaturated fats that are found in fish seem to be healthy and can reduce your chance of getting heart disease. But too much of it might not be good for you and can worsen your diabetes by spiking your blood sugar levels. When you cook, it’s best to use oils with healthier fats, such as olive oil and canola oil.

The ketogenic diet seems like any other diet. Eat specific types of food and avoid certain foods… simple enough. Right? Unlike a typical low-calorie diet, a high-fat diet requires careful monitoring, as mentioned above. Your doctor or SugarMDs team needs to monitor blood glucose and ketone levels to ensure that the diet isn’t causing any harmful effects.

Once your body adjusts to the diet, you still need to see your doctor for testing and any potential medication adjustments. Even if your symptoms improve, it’s still important to keep up with regular blood glucose monitoring. For type 2 diabetes, the testing frequency varies. Be sure to check with your doctor or SugarMDs team to determine the best testing schedule for you.  

Any Evidence to Back up this Keto Benefit?

“In 2008, researchers conducted a 24-week study to determine the effects of a low-carbohydrate diet on people with type 2 diabetes and obesity. At the end of the study, participants who followed the ketogenic diet saw greater glycemic control and medication reduction improvements than those who followed a low-glycemic diet.”

“A 2013 review reported that a ketogenic diet can lead to more significant improvements in blood sugar control, A1c, weight loss, and discontinued insulin requirements than other diets.”

“A 2017 study also found the ketogenic diet outperformed a conventional, low-fat diabetes diet over 32 weeks regarding weight loss and A1c.”  

The Verdict…

Reducing CHO intake with a ketogenic diet is effective in reducing body weight and, in patients with type 2 diabetes, improving glycemic control, with a stronger effect with a very low-carb diet. On the other hand, a keto diet may not be appropriate for all individuals, especially in patients with type 2 diabetes.

It is necessary to balance the potential increase in cardiovascular risk because of the unfavorable lipid profile observed with unhealthy fats with the benefits deriving from weight loss and improvement of glycemic control. Moreover, long-term compliance with low-carb diets is still an issue. In type 1 diabetes, there is no present evidence that a keto diet delays or prevents the onset of the disease.

These diets have the potential to improve metabolic control, but caution is needed because of the risk of DKA or worsening the lipid profile. Even in reviewed studies in the general population where a higher CHO intake was associated with worse outcomes, healthier macronutrient consumption was associated with decreased cardiovascular and non-cardiovascular mortality.

When a healthy low-fat diet was compared to a healthy low-carb diet, good results in terms of weight loss were observed with both diets. Therefore, macronutrients source, i.e., quality of carbs and fat, are not negligible factors, and preferring fibers and nutrient-rich foods is a good option for everyone.  For this reason, when designing future studies on nutrition, it will be important to evaluate not only the amount of CHO but also the type.

Conclusion

To summarize, the ketogenic diet may offer some help to people with type 2 diabetes who have difficulty controlling their symptoms or losing weight. Not only do many people feel better with fewer diabetic symptoms, but they may also be less dependent on medications. Still, not everyone has success with this diet.

Some may find the restrictions too difficult to follow over the long term. American Diabetes Association does not recommend any particular diet due to a lack of evidence. We are in support of this view as individual needs may vary. Please also keep in mind that “fat” dieting can be dangerous for your diabetes, so you should only start the ketogenic diet if you’re sure you can commit to it.

Your dietician, doctor, or SugarMDs team can help you determine the best diet choice for managing your diabetes.   You may want to begin the Keto diet as soon as possible but be sure to discuss the diet with your doctor or SugarMDs team first. The diet may throw off your blood sugar levels, causing further issues, especially if you’re on medications for diabetes.  

About Dr. Ergin

Who is Dr. Ergin? Dr. Ahmet Ergin is an endocrinologist interested in and passionate about diabetes care. Dr. Ergin earned his medical degree with honors at Marmara University School of Medicine in Istanbul, Turkey, and completed his internal medicine residency and endocrinology fellowship at Cleveland Clinic in Cleveland, Ohio. 

He is a board-certified Internal Medicine, Endocrinology, Diabetes, and Metabolism Physician; a certified diabetes education specialist, the author of The Ultimate Diabetes Book; and the Founder of the SugarMD youtube channel. He practices in Port Saint Lucie, FL as an endocrinologist physician. 

Disclaimer: Any information on diseases and treatments on this website is for general guidance only and must never be a substitute for the advice your doctor or other qualified healthcare professional provides. Always seek the advice of your physician, health provider, or other qualified healthcare professional’s advice with questions regarding your health.  

RESOURCES

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