Keto Diet Plan For a Person With Diabetes

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

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Nowadays, the prevalence of diabetes is skyrocketing. In this chronic condition, a person’s sugar levels are not in a normal range. They tend to be higher than we usually handle.

This could be due to several reasons. The first reason could be that you don’t produce enough insulin for you to regulate sugar (type 1 diabetes). The second reason is that you could be producing insulin, but your body can’t respond to it anymore (type 2 diabetes).

Since carbs are the main culprit that cause sugar levels to spike, many people look to a ketogenic diet to handle their glucose levels. However, is it ok for a person with diabetes to follow a low-carb plan?

In this article, you will learn about keto and diabetes. What is keto for people with diabetes? What are the benefits and drawbacks of following this type of eating pattern? How can you start a ketogenic plan if you have diabetes? What foods should you eat and avoid? Once you learn all the basics, we have a shopping list and a one-day meal plan to guide you on this journey.


Keto diet and diabetes

A ketogenic plan for people with diabetes is a low-carb, moderate protein, and high-fat diet. Most of your energy comes from fat, especially unsaturated fats. The macronutrient distribution it uses is:

  • 5-10% of carbohydrates
  • 20% of protein
  • 70-80% of fat

There is a unique distinction to be made on who can follow this eating plan. There are several types of diabetes, but the most common ones are type 1 diabetes and type 2 diabetes. People with type 1 diabetes are insulin-dependent. This means that they need to get insulin shots to survive. On the other hand, people with type 2 diabetes could be getting insulin shots, but it can also be treated with oral medication and/ or diet and lifestyle changes.

Any person who is considering a change in diet should speak directly with a healthcare professional who knows their unique medical history. This is especially true of people with diabetes or other medical conditions. People with diabetes type 1 usually should not follow a keto plan since they are more likely to go into ketoacidosis (which is a very dangerous condition where blood sugar levels are too low). Be sure to speak with your doctor to determine if keto could be right for you.


Benefits of a keto diet for someone with diabetes

People have several reasons for starting a keto diet plan. It can help with a decrease in cravings, reduction in the incidence of heart disease, a better quality of sleep, more energy, and decreased joint pain. Those are some of the traditional benefits you may find by following a ketogenic diet. There are other additional benefits you can get that are extremely important, especially if you have diabetes.

  • Reduced glucose levels. For people with type 2 diabetes, it helps have a lower glucose level — more in the normal range.
  • Increased insulin sensitivity. When you are eating fewer carbs, there is less sugar and thus insulin spikes and the body becomes more sensitive to the insulin it makes. It also gives a break to the pancreas from having to secrete insulin.
  • Weight loss reduction. In most cases, most of the people that have pre-diabetes or type 2 diabetes are overweight. Once they drop at least 10% of their weight, they see improvements in their bloodwork.
  • Impact on medication. Since blood glucose levels seem to go down, some people are able to reduce their dependence on medication. Keep in mind that this has to be done by a healthcare professional. Never do it on your own.


Side effects of keto and diabetes

Following this type of eating if you have diabetes can be very beneficial. However, some downsides must be taken into account before making the switch.

The biggest drawback of following a keto plan if you have diabetes is the possibility of having hypoglycemia. It is a condition that happens when your sugar levels get extremely low. This can be very dangerous since it could lead to seizures or possible death. Whenever you are making a lifestyle change, make sure that you are always monitoring your glucose levels accordingly.

There are other possible negatives to following a ketogenic program, including:

  • Keto flu symptoms
  • Constipation
  • Gallstones
  • Kidney problems


How to start a keto diet plan with diabetes

Before you consider starting a ketogenic plan, it is vital for you to talk to your healthcare provider. Make sure your endocrinologist or any doctor that is handling your medication knows about this decision you are making.

Once your doctor approves of this change and determines whether you need a change in your medication, you can begin.

  1. Calculate your calorie intake. When you are starting an eating program, try not to go too low on your calories. First, make sure to have the calories that are required to maintain your body weight. Once you know how your glucose levels react, you can start removing calories if weight loss is your goal.
  2. Calculate your macros. Once you have the calories, you calculate the macronutrient intake.
    • Carbs: 5-10%
    • Protein: 20%
    • Fats: 70-80%
  3. Planning is key! Now that you know how much of each macro you need, make a weekly or monthly menu to make the transition as easy as possible.
  4. Take your glucose levels. Do this as frequently as possible when making the change. That way, you can modify the macronutrients in case your sugar levels are too high or too low.

It is always best to consult with a registered dietitian to accurately calculate the daily calories or macronutrients. If you don’t have access to one, ask your doctor or diabetes care team for advice if you get stuck.




Foods to eat and avoid

Now that we know how many calories and how much of each macronutrient we need, let’s get on what foods you can add.

You need to avoid certain foods because you are going to follow a keto meal plan and others that you need to avoid due to having diabetes. Find those that most appeal to you based on your condition and new eating pattern.

First, let’s start with the foods to avoid. Not only because they are high in carbs, which is not ketogenic, but also because they are high in simple carbs, and they can increase your sugar levels no matter the quantity. Here is a list of the foods for people with diabetes to avoid on keto:

  • Sugar, syrups, maple syrup, agave, and honey
  • White bread
  • Pastries, cookies, and cake
  • Candy
  • Ice cream

There are other carbs that you can include if your total daily carb intake allows it. They are high in nutrients, and most importantly, high in fiber, which means they offer a steadier sugar release, not producing a sugar spike. You can include the following foods in moderation:

  • Legumes (beans, lentils, chickpeas, edamame, and quinoa)
  • Sweet potato, butternut, and potato
  • Brown rice
  • Corn

Although vegetables have carbs, they are mostly fiber. Veggies are the perfect food to add to have stable glucose levels. Try to add them to every meal to get a lot of nutrients, fiber and avoid constipation. You can eat:

  • Zucchini
  • Carrots
  • Celery
  • Tomatoes
  • Leafy greens
  • Mushrooms
  • Eggplant
  • Cucumber

Now, let’s talk about our main energy source. Fats are going to be the main energy source in a ketogenic diet. They are the majority of the foods you are going to eat. Try to focus on unsaturated sources (mostly from plants) rather than saturated (from animal sources).

Unsaturated fats (have more):

  • Olive oil
  • Olives
  • Nuts and seeds
  • Nut butters
  • Avocado

Saturated fats (have less):

  • Coconut oil
  • Coconut milk
  • Ghee and butter
  • Sour cream
  • Cream cheese

Proteins are the other food group you need to pay attention to. They are going to help you keep your muscle mass nice and strong. Make sure to add a protein source to every meal.

  • Eggs
  • Plain Greek yogurt
  • Cheese
  • Red meat
  • Chicken
  • Fish (aim for 2 x servings of oily fish/ week)
  • Tofu and soy

Finally, if you are looking for something sweet, look for products that are made with sugar substitutes. This way you avoid increasing your sugar levels. Also, you can use unsweetened almond milk for your teas and coffees instead of dairy milk.


Keto-friendly grocery list

It is time to go shopping! Here is a list of foods to pick up the next time you go to the grocery store.

  • Vegetables
    • Carrots
    • Tomatoes
    • Zucchini
    • Mushrooms
    • Eggplant
    • Celery
    • Leafy greens
    • Cucumber
    • Broccoli
    • Cauliflower

When buying fruits, try to have those that have a low glycemic rating (low glycemic load/ GL). They will increase your blood sugars slightly, but are usually lower in calories or high in fiber, so the impact is not as great as if you are high GI fruits.

  • Fruits
    • Berries: blueberries, raspberries, strawberries, blackberries
    • Apples
    • Pears
    • Peaches
  • Protein
    • Fish and seafood
    • Tofu or minimally processed soy-based products (like tempeh or edamame beans)
    • Chicken
    • Beef
    • Pork
    • Cheese
    • Plain Greek yogurt
    • Eggs
  • Fats
    • Avocado
    • Olive oil
    • Seeds: flaxseeds, hemp, chia
    • Nuts: peanuts, almonds, walnuts
    • Coconut oil
    • Ghee or butter
    • Sour cream
  • Extras
    • Mustard
    • Low sodium soy sauce
    • Herbs and spices
    • Almond milk
    • Stevia or monk fruit (sweeteners)
    • Sugar-free soda or drinks (in moderation)


Sample keto meal plan for people with diabetes

Now that we know which foods to add and which to avoid, you might still have some questions about how a menu might look. Here is a one-day menu if you are following a keto meal plan and you have diabetes.

  • Breakfast: Keto waffles with strawberries
  • Morning snack: Peanut butter protein shake
  • Lunch: Steak with broccoli and cauliflower
  • Evening snack: Olives and Mozzarella cheese
  • Dinner: Zucchini lasagna

Calories: 1,733 | Macros: 36.6 g net carbs – 131 g protein – 114.3 g fats

BREAKFAST Ingredients Serving Size Calories Net Carbs(g) Protein(g) Fat(g)
Keto waffles with strawberries Eggs 3 units 215 1.1 18.9 14.2
  Almond flour 1/8 cup 69 1.5 2.5 6
  Cream cheese 1 oz 99 1.6 1.8 9.8
  Vanilla extract 1 teaspoon 12 0.5 0 0
  Strawberries 1/2 cup halves 24 4.4 0.5 0.2
Calories Net Carbs Protein Fat            
419 9.1 g 23.7 g 30.2 g            
MORNING SNACK Ingredients Serving Size Calories Net Carbs(g) Protein(g) Fat(g)
Peanut butter protein shake Almond milk 1 cup 39 2.9 1 2.5
  Peanut butter 1 tablespoon 94 2.4 3.8 8
  Vanilla protein powder 1/2 scoop 54 1 12.1 0.2
Calories Net Carbs Protein Fat            
187 6.3 g 16.9 g 10.7 g            
LUNCH Ingredients Serving Size Calories Net Carbs(g) Protein(g) Fat(g)
Steak with broccoli and cauliflower Steak 150 g 224 0 34.2 9.6
  Olive oil 1 tablespoon 119 0 0 13.5
  Broccoli 1 cup 28 2 2 0
  Cauliflower 1 cup 26 3.2 2 0.2
  Butter 1 tablespoon 102 0 0.1 11.5
   Garlic 1 clove 4 1 0.2 0
Calories Net Carbs Protein Fat            
503 6.2 g 38.5 g 34.8 g            
EVENING SNACK Ingredients Serving Size Calories Net Carbs(g) Protein(g) Fat(g)
Olives and cheese  Olives 10 units 45 0.3 0.3 4.1
  Mozarella cheese 2 units (60g) 168 1.2 13.4 11.6
Calories Net Carbs Protein Fat            
213 1.5 g 13.7 g 15.7 g            
DINNER Ingredients Serving Size Calories Net Carbs(g) Protein(g) Fat(g)
Zucchini lasagna Zucchini 1 medium 33 4.1 2.4 0.6
  Tomato sauce 1/2 cup 29 4.7 1.5 0.4
  Olive oil 1 tablespoon 119 0 0 13.5
  Ground beef 4 oz 137 0 24.9 3.4
  Mozzarella cheese 1 oz 78 0.9 7.7 4.8
  Mushrooms 50 g 15 3.8 1.7 0.2
Calories Net Carbs Protein Fat            
411 13.5 g 38.2 g 22.9 g            
DAILY TOTALS   1,733 cal 36.6 g net carbs 131 g protein 114.3 g fat




Frequently asked questions about keto and diabetes

Do you still have some questions regarding the ketogenic diet and diabetes? Here you’ll find answers to the most common questions asked about these topics.

Unfortunately, diabetes cannot be reversed. However, it can be controlled. This means that people with diabetes found an improvement in their glucose levels, reduced weight, and no longer depended on medication.

There are some fruits that you should be careful of if you have diabetes. Even if you control the portions and stick to the daily carb intake of a keto diet, they can still raise your sugar levels.

If you have diabetes, be careful when you have:

  • Watermelon
  • Pineapple
  • Overripe bananas
  • Grapes

These tend to be high in sugars and low in fiber, which makes them a dangerous combination for someone with diabetes.

If you have type 2 diabetes, this could be a good way of controlling your sugar levels, with your doctor’s supervision. Intermittent fasting has been shown to have positive results in increased insulin sensitivity.

If you have diabetes type 1, neither of these eating styles are usually recommended.

The glycemic index is how a food increases your sugar levels compared to white bread or sugar. A high glycemic index food tends to increase your sugar levels significantly. Glycemic load (GL) on the other hand also looks at how the food alteres your blood sugar levels, but takes the average amount eaten into consideration as well.

This is an attribution made to carb-based foods. Suppose you are following a modified keto plan or include some carb options that are within your daily budget. Make sure to pick those with a lower glycemic load — for example, berries.

Carbs are the main reason your insulin levels spike.

However, protein can also cause an increase in insulin. Keep in mind that keto is not a high-protein diet. It allows for only a moderate intake.

It might take 6-8 weeks to see an improvement in blood work. Make sure to have regular checkups to control your sugar levels, modify your medicines, and continue speaking with your doctor about making improvements in your lifestyle.


Other types of ketogenic diet plans