By now, you have probably heard of the keto diet, but maybe you’re unsure if it’s safe for type 2 diabetes or if it’s right for you. Keep reading to learn more about what the keto diet is, how it works for people with type 2 diabetes, and its potential benefits and risks. This article also offers a list of alternative diabetic-friendly diets to consider.

What is the Keto Diet?

The ketogenic diet or keto diet is a low-carbohydrate diet that is high in fat. Originally developed to help children with epilepsy manage seizures, the keto diet’s popularity has exploded, and it is now commonly used for weight loss. The keto diet has several variations, but they all typically limit carb intake to less than 50 grams per day or less than 15% of total daily calories.¹ This is the amount of carbs found in two medium-sized bananas! Limiting carbs helps accomplish the main goal of the keto diet: to enter a state of ketosis.

Normally, when your body needs energy for the brain, muscles, and other body tissues, it uses a mix of carbs, fat, and protein. When your body doesn’t have enough glucose (obtained from digested carbs), it needs an additional fuel source. In ketosis, the body breaks down fat into an energy source called ketones.

Because ketosis can only be achieved when the body isn’t getting enough carbs, the keto diet limits foods high in carbs, like grains, starchy vegetables (like potatoes), fruits, and processed sugars. Foods like protein, cheese, and non-starchy vegetables (like spinach) are the backbone of the diet. It can take as few as 2-4 days to enter ketosis.

Keto Diet and Type 2 Diabetes Management

Lifestyle factors, like diet and exercise, play an important role in the management of type 2 diabetes. Special diets for diabetes often focus on losing weight and lowering carbohydrate intake to manage blood sugar.

Because the keto diet restricts carbs, it may be beneficial for people with prediabetes or diabetes. However, note that a high-fat diet is not a blank check to eat bacon fried in butter every day! Focus on healthy fats like avocado, nuts and seeds, fatty fish (like salmon), and olive oil. These foods are generally heart-healthy. Also, be sure to include plenty of veggies to meet your body’s needs for fiber, vitamins, and minerals.

The keto diet is not recommended for everyone. If you are pregnant, have an eating disorder, or have a chronic health condition, such as heart disease, talk with your doctor about different options. If you do start the keto diet, be sure to monitor blood sugar and cholesterol levels.

Benefits of the Keto Diet for Diabetics

There are many potential short-term benefits of the keto diet for diabetics. Longer-term benefits are less clear due to a lack of research and the difficulty many people have in adhering to the diet. Some possible benefits of the keto diet include:

Weight Loss

The keto diet may help you lose weight. Following a diet may help you pay more attention to what you eat. Fat and protein, which comprise most of the keto diet, also help keep you full, so you may not want to eat as much. This may translate into weight loss. One research review found that the keto diet helped diabetics lose weight and reduce their waist circumference (a measure linked to diabetes and heart disease).² 

Most of the studies included in this review were short-term (about 6 months or less), and many people who lose weight regain the weight lost over time.³ A different review of 8 studies of people with type 2 diabetes found that while the keto diet may support weight loss for up to 6 months, there was no benefit at 12 months over other recommended diets for diabetics.⁴ The key to weight loss is a calorie deficit, so if keto helps you to stay in a deficit, you will lose weight. But if you cannot stick to the diet long-term, there may be better options for you.

Lower A1C

Too many carbohydrates can increase your blood sugar and HbA1c. It makes sense that a diet that limits carbs should help to lower your blood sugar. In the short term, research shows exactly this.² However, while research shows the benefits of the keto diet at 6 months, they do not last for a full year.⁴ This may be explained by poor adherence to the diet. But there may be more to the story. 

Some research in mice suggests that following a low-carb diet for a long time may make your body less responsive to insulin, causing insulin resistance.⁵ More research on the long-term effects of the keto diet is needed to better understand why this happens in humans.

Lower Fasting Insulin Levels

With fewer carbs entering the bloodstream, your body may not need as much insulin to clear it out of the blood. A study of 84 people with obesity and type 2 diabetes randomized to either a keto diet or a low-glycemic, low-calorie diet for 6 months found that the keto diet lowered fasting insulin.⁶ Again, more research is needed on the long-term effects of the keto diet.

Improved Blood Lipids 

Diabetes is a risk factor for heart disease, and high cholesterol contributes to this risk. If you have diabetes, it’s important to get regular bloodwork done to assess your risk. A research review found that people with type 2 diabetes who followed a keto diet had higher HDL (“good” cholesterol) and lower triglyceride levels than people who followed other diets.¹ However, sample sizes were low, and many studies also included exercise, which may have impacted the results.

May Reduce the Need for Medication

If you can lose weight, lower your blood glucose and insulin, and improve your cholesterol, you may be able to lower your dose of certain diabetes medications or come off of them entirely. In a trial of 102 overweight and obese diabetics, those who followed the keto diet were able to reduce the dose of their diabetes medications by half, and some were able to stop taking them altogether.⁷ You should never stop or change medications without talking to your healthcare provider. 

Risks and Possible Complications

Despite the promising research on its potential to improve health, the keto diet does not come without risks. It’s important to understand these risks and discuss them with your healthcare provider before starting a keto diet. Possible risks of the keto diet include:

Hypoglycemia

Hypoglycemia happens when your blood sugar drops to a dangerous level. Symptoms include shakiness, sweating, dizziness, and rapid heartbeat. Hypoglycemia is more likely if your diabetes medication is out of balance or if you take too much insulin. It can also happen if you skip meals or don’t eat enough carbs - as you would by following the keto diet. You may need to adjust your dosage of medications or insulin when starting a keto diet to avoid hypoglycemia.

Diabetic Ketoacidosis (DKA)

While ketosis may be desirable, DKA is a serious complication of diabetes. Like ketosis, DKA occurs when your body cannot make enough energy from carbs and breaks down fat to produce ketones for energy. Some ketones in the blood are usually safe, but too many cause your blood to turn acidic, causing DKA. DKA is more common in people with type 1 diabetes whose bodies don’t produce insulin but has been reported in people without diabetes who followed a keto diet.⁸ 

Common symptoms of DKA include nausea, vomiting, confusion, extreme thirst, fruity breath, shortness of breath, and more. If you notice these symptoms, go to the emergency room immediately.

Dyslipidemia

Abnormal cholesterol levels increase your risk for heart disease. Although some research shows that the keto diet may improve cholesterol levels, other studies show the opposite: that the keto diet may increase levels of LDL (“bad”) cholesterol.⁹ This underscores the importance of choosing healthy fats, like avocado or nuts, rather than saturated fats, like butter and red meats, to support a healthy heart.

Nonalcoholic Fatty Liver Disease (NAFLD)

NAFLD is a condition in which fat builds up inside the liver. Alcoholics are at risk, but NAFLD is associated with other factors, such as obesity, insulin resistance, and metabolic syndrome. Diets high in processed carbs, saturated fats, and meat protein can contribute to NAFLD.¹⁰ While the keto diet restricts carbs, it can be high in animal protein and saturated fat. Emphasizing unsaturated healthy fats from plants and lean proteins may reduce your risk of NAFLD.

Other Diabetic-Friendly Diets

While the keto diet may show some promise for managing diabetes, it isn’t for everyone. If the keto diet seems too restrictive, don’t worry; plenty of other diets might be a better fit. Here are some other diabetes-friendly diets to explore:

Atkins Diet

The Atkins diet is similar to the keto diet in restricting carbohydrate intake. Because of this, it should come as no surprise that it comes with similar risks and benefits. Atkins may help to reduce body weight, improve cholesterol, and more.¹¹ Unlike the keto diet, Atkins consists of 4 phases that gradually allow for a higher carb intake. Because you can progress through the different phases, each time adding in more carbohydrates, the Atkins diet may be easier to follow in the long term compared with the keto diet.

Intermittent Fasting

Rather than setting rules about what you can eat, Intermittent fasting (IF) sets rules around when you can eat. There are several types of intermittent fasting. The most common is time-restricted eating, which limits eating to a certain window of time during the day. For example, the popular 16:8 method limits eating to an 8-hour window each day (e.g., from 10 am-6 pm). The goal of IF is simple: if you simply can’t eat all day, you may eat less. The reality is that while IF may work for some, it is no more effective than other diets that cause a calorie restriction.¹²

Mediterranean Diet

The Mediterranean Diet is based on the dietary patterns of countries bordering the Mediterranean Sea. It emphasizes fruits, vegetables, whole grains, legumes (like beans and lentils), nuts and seeds, fish, and lean protein. A study of over 100,000 people found that people who followed the Mediterranean Diet more closely had almost a 20% lower risk of developing type 2 diabetes.¹³ In people with diabetes, the Mediterranean Diet may improve A1c and fasting glucose levels and reduce the risk of heart disease.¹⁴

Intuitive Eating

While not technically a diet, Intuitive Eating is a way of eating that aims to shift the focus on eating from external cues, like time of day or beliefs about “good” or “bad” foods, to internal cues, like hunger, fullness, and satisfaction. One study found that Intuitive Eaters eat more fruits and vegetables, while another found improved cholesterol levels.^15,16 In a study of almost 200 people with diabetes, Intuitive Eating was associated with improved glycemic control, regardless of body mass index (BMI).¹⁷ Although Intuitive Eating is not a weight loss diet, a study of over 250 people with type 2 diabetes found that Intuitive Eaters had lower BMI, waist circumference, and triglycerides.¹⁸

The Bottom Line

There is no one-size-fits-all diet for managing diabetes. If you think the keto diet is right for you, talk with your doctor in case they have any concerns or you need to make changes to your medication. Ready to take the leap? Check out this 14-day keto meal plan to help you get started.

Learn More About How to Improve Blood Sugar Health With Signos’ Expert Advice

Blood sugar health seriously affects how you feel and how well your body functions. That’s why it’s important to understand how different diets, like the keto diet, affect your blood sugar levels. 

Signos CGM empowers you to improve your health by keeping track of your diet, exercise, sleep habits, and blood sugar. Knowledge is power, and a CGM can give you specific information about how your habits affect your health. 

Signos has a team of health experts who compile evidence-based nutrition information to help you improve your health and wellness. Check out the resources here.

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