Is The Keto Diet Safe for People With Diabetes?

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Written by Brenda Peralta, Registered Dietitian and medically reviewed by Abby Courtenay

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Managing your sugar levels when you have diabetes can be somewhat challenging. Certain health professionals may recommend following a ketogenic diet to help control your sugar levels from rising.

However, is keto good for diabetes? Is following a low-carb and high-fat diet appropriate for people with diabetes?

There can be advantages to following this type of eating plan if diagnosed with this condition. Nonetheless, there are certain considerations you need to keep in mind, like the type you have and medications that you are currently taking.

This article teaches you everything related to the ketogenic diet and this condition.

 

What is diabetes?

Diabetes is a chronic condition where you have trouble keeping your sugar levels stable1. When you eat carb-based foods (like rice, pasta, or bread), your body digests and breaks them down into sugar molecules (glucose).

The pancreas then releases insulin to allow the sugar that has been released to enter your cells to be used as an energy source or stored as fat. In other words, it acts like a key to open up your cells to let the sugar enter.

When you have trouble creating insulin or the insulin is not working correctly, your body cannot process the sugars in your bloodstream. When you have chronically high levels of sugars in your bloodstream, you may be diagnosed with diabetes.

There are several types of diabetes2:

  • Type 1. Your body doesn’t produce any insulin. This is typically an autoimmune disease that attacks the pancreas and destroys the cells in charge of making insulin. People with type 1 are often diagnosed in the early stages of their lives. However, it can happen later in life. Since people don’t produce any insulin, they need a daily insulin dose to keep sugar levels steady.
  • Type 2. Your body doesn’t produce good quality insulin, and it can stop making it altogether later on. This type is often related to lifestyle choices like bad eating habits, a sedentary lifestyle, and smoking. People usually require oral medication, but they might need insulin if your diabetes is uncontrolled or if damage to the pancreas becomes too great.
  • Gestational diabetes. This only occurs during pregnancy. It usually goes away once the baby is delivered, but if it is not treated, it can increase the chance of developing type 2.

There are other types, but these three are the most common.

 

Keto and diabetes

A ketogenic diet is often recommended for people with this condition to manage your sugar levels. Keto is a low-carb, moderate protein, and high-fat eating plan.

So, what is a low-carb diet for someone with diabetes? A ketogenic one typically has the following macronutrient distribution: 5-10% carbs, 20% protein, and 70-80% fats.

Since you have a very low carb intake, your body stops using glucose as its primary energy source, and it starts using ketones as a replacement. As a result, you increase ketones in your body, producing a ketosis state.

It is essential to know the difference between nutritional ketosis and ketoacidosis3.

Although both involve increased ketone production, nutritional ketosis is a normal physiological response to a low carb intake. The ketone levels are lower than ketoacidosis and the body’s acid-bases balance remains intact.

On the other hand, ketoacidosis is a hazardous medical condition that often occurs in people with type 1 (but can also occur in those with type 2). DKA happens when there is too much sugar in your blood and not enough insulin to break them down. As a result, the body compensates by breaking down fat very quickly. This causes ketone levels to rise too quickly and the body to go into metabolic acidosis which can be very dangerous. This can happen for a number of reasons, but most commonly happens when a type 1 diabetic is ill or when they miss an insulin dose. This is considered a medical emergency since it can lead to a diabetic coma4.

 

Can keto reverse diabetes?

A lot of people talk about reversing diabetes. First, before we talk about reversing diabetes with keto, it is important to determine what we mean by reversing.

The pancreas is an organ that cannot be regenerated. This means that once the damage has been done to the cells in the pancreas, they cannot function again. Hence, for people with type 1, where the cells in the pancreas are destroyed due to an autoimmune condition, the disease cannot be reversed.

On the other hand, for people with type 2, where there is not much damage in the pancreas, you can “reverse” diabetes. However, the term reverse means getting back to the original case, which you cannot do with this condition. Thus, a more accurate term would be remission5.

With the appropriate lifestyle changes, you can go from having high blood sugars and taking regular medicine to having normal sugar levels and not depending on any medication. However, if you go back to your previous unhealthy habits, the condition can reappear again.

So, now comes the golden question: can a ketogenic diet reverse diabetes? There are promising studies when it comes to keto and reversing diabetes. Thanks to its potential for rapid weight loss and control of sugar levels, studies have found that you can go into remission when following a ketogenic approach6. However, individual results may vary, and there is no guarantee that this will happen for any one person.

 

How does keto work for people with diabetes?

How does the keto diet help a person with diabetes? Here are some of the possible benefits that you can obtain when following a low-carb diet:

  • Reducing A1c levels
  • Having stable sugar levels
  • Weight loss
  • Improve insulin sensitivity
  • Increased energy levels
  • Decrease incidence of heart disease

 

Dangers of doing keto when having diabetes

Although there are several potential benefits of doing keto if you have diabetes, there are certain risks that you need to consider if you start this new lifestyle. Here is a list of the most common ones that you might have.

  • Hypoglycemia. Reducing your carb intake can severely impact your sugar levels, especially if you are on insulin. Thus, you need to thoroughly monitor your glucose levels to prevent them from being too low.
  • Constipation. Since carbs are the primary source of fiber, you might experience an increase in constipation. To avoid this from happening, make sure to eat several cups of vegetables every day.
  • Nutrient deficiency. Due to a reduction of many foods, you might have a decrease in your nutrient intake. To avoid nutritional deficiency, have at least three different color veggies each day.

 

Keto foods for a person with diabetes

The foods that you include in your diet have a severe impact on your sugar levels. So, which foods should a person with diabetes eat and avoid?

Let’s first talk about those foods high in fats that we want to include regularly. Focus on healthy fats like nuts, seeds, avocados, olive oil, and nut butter. Saturated fats (those that usually come from animal proteins and processed foods) can have an impact on insulin sensitivity and may increase your risk for heart disease. Thus, avoid having butter, sour cream, mayonnaise, and fatty meats too often.

Now, when it comes to carbs, you want to limit sugars, pastries, cookies, cakes, pasta, and white rice if you are following a ketogenic diet. You can still include carbs from certain fruits (like berries), whole grains, legumes, and non-starchy veggies.

 

Should people with diabetes do the keto diet?

Before you consider doing the ketogenic diet, you must talk to your healthcare provider to ensure that you can do it.

For people that have type 2 and need to lose weight, following a ketogenic plan may help you do that. Weight loss can then have beneficial effects on your insulin sensitivity and thus blood sugar levels.

However, if you are insulin-dependent (type 1 or some type 2’s), you might want a more balanced approach. Although studies have shown that people who are insulin dependent can still benefit from keto, they need to be very careful to avoid hypoglycemia7.

In any case, the main thing that you need to focus on is making lifestyle changes that you can maintain for a long time.

 

Is a ketogenic diet safe for people with diabetes?

Although keto can be safe for people with type 1 and type 2, you need to consult with your doctor to determine whether or not you can do this eating plan.

People who are insulin-dependent need to be extra careful as severely reducing your carbs could lead to hypoglycemia. For people who are not insulin dependent the body is usually still able to regulate blood sugar levels, keeping them stable. By reducing your carbs you reduce your calorie intake and may lose weight. In addition to this, reducing carbs can also help stabilize blood sugar levels and together with weight loss this may lead to remission. However, this should still only be considered with a doctor’s supervision.

 

References

  1. Centers for Disease Control and Prevention (CDC): “What is diabetes?
  2. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the most common types of diabetes are type 1, type 2, and gestational diabetes. Find more information at their official website.
  3. Medical News Today: “Differences between ketosis and ketoacidosis
  4. Mayo Clinic: “Diabetic ketoacidosis
  5. Diabetes UK: https://www.diabetes.org.uk/diabetes-the-basics/type-2-reverse
  6. Pubmed. Cox N, Gibas S, Salisbury M, Gomer J, Gibas K. Ketogenic diets potentially reverse Type II diabetes and ameliorate clinical depression: A case study. Diabetes Metab Syndr. 2019 Mar-Apr;13(2):1475-1479. doi: 10.1016/j.dsx.2019.01.055. Epub 2019 Feb 6. PMID: 31336509.
  7. Pubmed. Lennerz BS, Barton A, Bernstein RK, Dikeman RD, Diulus C, Hallberg S, Rhodes ET, Ebbeling CB, Westman EC, Yancy WS Jr, Ludwig DS. Management of Type 1 Diabetes With a Very Low-Carbohydrate Diet. Pediatrics. 2018 Jun;141(6):e20173349. doi: 10.1542/peds.2017-3349. Epub 2018 May 7. PMID: 29735574; PMCID: PMC6034614.